Nursing Management: Patients With Eye and Vision Disorders

A nurse is reviewing the medical records of several clients who have come to the clinic. Each of the clients wears corrective lenses. For the client with which corrected visual acuity would the nurse need to include additional devices and strategies to address low vision?

20/80

An 8th grade boy comes to the school nurse and tells the nurse that he had an eye exam the day before. He says the eye doctor told him he had astigmatism and that meant his eyeball wasn't shaped right. The boy is concerned because he says he went home and looked in the mirror and both eyes looked just alike. What is the school nurse's best response?

"Astigmatism means that the cornea of the eye is shaped differently than the cornea in most eyes."

A male patient in his 20s has presented to a free clinic with signs and symptoms that are highly suggestive of viral conjunctivitis. The nurse is aware of the relationship that can exist between sexually transmitted infections (STIs) and viral conjunctivitis. What assessment question is most likely to be clinically relevant?

"Have you ever been diagnosed with herpes simplex virus (HSV)?"

Which type of glaucoma presents an ocular emergency?

Acute angle-closure glaucoma

On ocular examination, the health care provider notes severely elevated IOP, corneal edema, and a pupil that is fixed in a semi-dilated position. The nurse knows that these clinical signs are diagnostic of the type of glaucoma known as:

Acute angle-closure.

When conducting an eye exam, the nurse practitioner is aware that a diagnostic clinical manifestation of glaucoma is:

The presence of halos around lights.

A client has undergone a cataract extraction with an intraocular lens implant. After providing discharge instructions, the nurse determines that the client needs additional teaching based on which statement?

"My vision will be back to normal immediately after surgery."

A client is diagnosed with a corneal abrasion and the nurse has administered proparacaine hydrochloride per orders to assess visual acuity. The client requests a prescription for this medication because it completely took away the pain. What is the best response by the nurse? "Usually we will send you home with this bottle and written instructions for administering the medication." "I will let the doctor know." "It is standard for the doctor to write a prescription for this medication." "Prescriptions of this medication are generally not given because it can cause corneal problems."

"Prescriptions of this medication are generally not given because it can cause corneal problems."

A client is diagnosed with a corneal abrasion and the nurse has administered proparacaine hydrochloride per orders to assess visual acuity. The client requests a prescription for this medication because it completely took away the pain. What is the best response by the nurse? "Prescriptions of this medication are generally not given because it can cause corneal problems." "It is standard for the doctor to write a prescription for this medication." "I will let the doctor know." "Usually we will send you home with this bottle and written instructions for administering the medication."

"Prescriptions of this medication are generally not given because it can cause corneal problems." Proparacaine hydrochloride can cause corneal softening and other complications if overused. Clients with corneal abrasions or other painful eye disorders have a tendency to overuse the medication, thus leading to the complications. It would not be appropriate to give the bottle with written instructions, and it is not a standard prescription for eye disorders because of the complications from overuse. Telling the client that you will let the doctor know does not provide the education needed about this medication.

A nurse is discussing vision loss with a group of participants at a community-based health fair. The nurse knows that many individuals are unaware of the deleterious effects of glaucoma and is briefly explaining the disease to the group. What should the nurse teach these participants about the signs and symptoms of glaucoma?

"Unfortunately, many people have no idea they have glaucoma until their vision is affected."

A 52-year-old comes to the clinic for a follow-up examination after being diagnosed with glaucoma. The client states, "I'm hoping that I don't have to use these drops for very long." Which response by the nurse would be most appropriate?

"You'll need to use the drops for the rest of your life to control the glaucoma."

When assessing the pressure of the anterior chamber of the eye, a nurse normally expects to find a pressure of:

10 to 20 mm Hg.

A major role for nursing in the management of glaucoma is health education. Which of the following is the most important teaching point that the nurse should advise the patient of?

Adhere to the medication regimen.

A patient has been diagnosed with hyphema. Which of the following medicationclassifications stabilizes clot formation at the site of hemorrhage? Corticosteroids Diuretics Antifibrinolytics Antiplatelets

Antifibrinolytics An antifibrinolytic agent, aminocaproic acid (Amicar), stabilizes clot formation at the site of hemorrhage. Corticosteroids, antiplatelets, and diuretics do not have this action. Aspirin is contraindicated.

Which term refers to the absence of the natural lens?

Aphakia

A client who is blind is awaiting elective surgery. What should the nurse do to promote this client's control over their hospital environment?

Ask the client where to store his or her self-care items.

Following cataract removal, discharge instructions will be provided to the client. Which of the following instructions is most important?

Avoid any activity that can increase intraocular pressure.

A nurse instructs a client to refrain from blinking after administering eye drops based on which rationale?

Blinking causes the eye drop to be expelled from the conjunctival sac.

An ophthalmologist diagnoses a patient with myopia. The nurse explains that this type of impaired vision is a refractive error characterized by:

Blurred distance vision.

An ophthalmologist diagnoses a patient with myopia. The nurse explains that this type of impaired vision is a refractive error characterized by: A shorter depth to the eyeball. Eyes that are shallow. Blurred distance vision. Farsightedness.

Blurred distance vision. People who have myopia are said to be nearsighted. They have deeper eyeballs; thus, the distant visual image focuses in front of, or short of, the retina. Myopic people experience blurred distance vision.

The nurse is administering an ophthalmic ointment to a patient with conjunctivitis. What disadvantage of the application of an ointment does the nurse explain to the patient?

Blurred vision results after application.

What type of medication would the nurse use in combination with mydriatics to dilate the patient's pupil? NSAIDs Cycloplegics Corticosteroids Anti-infectives

Cycloplegics Mydriasis, or pupil dilation, is the main objective of the administration of mydriatics and cycloplegics (Table 63-3). These two types of medications function differently and are used in combination to achieve the maximal dilation that is needed during surgery and fundus examinations to give the ophthalmologist a better view of the internal eye structures.

The nurse is caring for an older adult client who is frail in appearance. The client has been diagnosed with glaucoma and will be started on eye drops for the condition. Which medication would cause the nurse to call the health care provider before administering the first dose?

Brimonidine (Alphagan-P)

The nurse is preparing to discharge a patient home. During discharge teaching, the nurse realizes that the patient is not able to read the medication bottles and has not been taking her medications at home. How should the nurse intervene appropriately in this situation?

By asking the social worker to investigate community support agencies

The nurse on the medical-surgical floor is reviewing discharge instructions with a patient who has a history of glaucoma. Which classification of drugs on the patient's discharge instructions is used to treat the patient's glaucoma?

Cholinergics

Which medication classification increases aqueous fluid outflow in the client with glaucoma?

Cholinergics

A nurse is teaching a patient with glaucoma how to administer her eye drops to achieve maximum absorption. Where should the nurse teach the patient to instill the eye drop?

Conjunctival sac

Which of the following medications needs to be withheld for 5 to 7 days prior to cataract surgery?

Coumadin

The nurse is giving instructions to a client who has been diagnosed with viral conjunctivitis. The nurse will teach the client which aspects of self-care related to this disorder? Select all that apply. Place cool soaks on your eye each morning to remove purulent drainage. Stay at home for the first 24 hours. Wash hands before touching eyes and frequently during the day. Do not wear contact lenses until there is no more inflammation. Do not use the same towels or washcloths as other members of the family.

Do not wear contact lenses until there is no more inflammation. Wash hands before touching eyes and frequently during the day. Do not use the same towels or washcloths as other members of the family. Home care involves staying at home and away from others until the inflammation is no longer present. Warm soaks should be used each morning to remove any crusty type drainage. Contact lens should not be worn until the eye has healed. Hands should be washed before and after touching the eyes and frequently during the day and the client should use separate towels, washcloths and other linens until the infection has cleared.

Which of the following is the correct advice regarding food for a patient who underwent a cataract surgery?

Eat soft, easily chewed foods.

The nurse is providing care to a client who has been admitted to the hospital for treatment of an infection. The client is visually impaired. Which of the following would be most appropriate for the nurse to do when interacting with the client?

Face the client when speaking directly to him.

The nurse should monitor for which manifestation in a client who has had LASIK surgery?

Halos and glare

A client has undergone enucleation. What complication of enucleation should be addressed by the nurse?

Hemorrhage

A client who has come to the clinic for an evaluation is diagnosed with glaucoma. The client asks the nurse, "What is this disease?" Which information would the nurse most likely include in the response?

Increased pressure in the eye causes damage to the optic nerve.

A client presents to the ED reporting a chemical burn to both eyes. Which is the priority nursing intervention?

Irrigate both eyes.

Which action should the nurse recommend to a client with blepharitis? Soak the area in warm water Keep lid margins clean Incision and drainage Sleep with the face parallel to the floor

Keep lid margins clean Instructions on lid hygiene (to keep the lid margins clean and free of exudates) are given to the client. Treatment of a stye includes warm soaks of the area and incision and drainage. The client is not required to sleep with the face parallel to the floor.

Which surgical procedure involves flattening the anterior curvature of the cornea by removing a stromal lamella?

Laser-assisted in situ keratomileusis (LASIK)

A nurse is teaching a client about medications for glaucoma. What is the main marker of glaucoma control with medication?

Lowering intraocular pressure to target pressure

Which is the most common cause of visual loss in people older than 60 years of age? Cataracts Retinal detachment Glaucoma Macular degeneration

Macular degeneration Macular degeneration is the most common cause of visual loss in people older than 60 years of age.

During an initial assessment, the nurse notes a symptom of a mild case of bacterial conjunctivitis and documents in the electronic medical record that the client is displaying which of the following ?

Mucopurulent ocular discharge

To avoid the side effects of corticosteroids, which medication classification is used as an alternative to treat inflammatory conditions of the eyes?

NSAIDs

There are four major types of ophthalmic procedures to complete a glaucoma examination. If the health care provider wants to inspect the optic nerve, the nurse would prepare the patient for:

Ophthalmoscopy.

Which term refers to swelling of the optic disc due to increased intracranial pressure?

Papilledema

Which of the following surgical procedures involves taking a piece of silicone plastic or sponge and sewing it onto the sclera at the site of a retinal tear?

Scleral buckle

Prior to an eye exam for possible macular degeneration, the nurse completes a history of symptoms. The nurse is aware that a diagnostic sign of age-related dry macular degeneration is:

The appearance of tiny, yellow spots in the field of vision.

Prior to an eye exam for possible macular degeneration, the nurse completes a history of symptoms. The nurse is aware that a diagnostic sign of age-related dry macular degeneration is: The abrupt onset of symptoms. The appearance of tiny, yellow spots in the field of vision. Reporting that a straight line appears crooked. Reporting that letters in words appear broken.

The appearance of tiny, yellow spots in the field of vision. Drusen are tiny yellow spots that patients who have dry AMD report.

A client is prescribed pilocarpine. When preparing the client's teaching plan about this drug, which of the following would the nurse integrate?

The client may experience difficulty seeing in the dark.

A patient with a diagnosis of open-angle glaucoma is being prepared for discharge, and the nurse is performing relevant health education. Which of the following teaching points should the nurse emphasize? The importance of not rubbing or pressing the eyes while washing the periorbital region The need to wear sunglasses or other forms of eye protection in all high-light situations The importance of adhering to life-long treatment because the disease cannot be cured The need to maintain vigilant hygiene of the eyes and perform saline flushes regularly

The importance of adhering to life-long treatment because the disease cannot be cured The medical and surgical management of glaucoma slows the progression of glaucoma but does not cure it. The life-long therapeutic regimen mandates patient education. It is not necessary to avoid all physical contact with the eyes or to perform regular eye flushing. Light protection is not specifically indicated.

A patient visits a clinic for an eye examination. He describes his visual changes and mentions a specific diagnostic clinical sign of glaucoma. What is that clinical sign?

The presence of halos around lights

A client accidentally splashes chemicals into one eye. The nurse knows that eye irrigation with plain tap water should begin immediately and continue for 15 to 20 minutes. What is the primary purpose of this first aid treatment?

To prevent vision loss

Which of the following types of conjunctivitis is preceded by symptoms of an upper respiratory infection?

Viral

A client is color blind. The nurse understands that this client has a problem with:

cones.

A client has noticed recently having clearer vision at a distance than up close. What is the term used to describe this client's visual condition?

hyperopia

When obtaining the health history from a client with retinal detachment, a nurse expects the client to report:

light flashes and floaters in front of the eye.

A nurse is obtaining a history from a new client with glaucoma. The client indicates having read about the diagnosis and understanding that this type of glaucoma is due to the degeneration and obstruction of the trabecular meshwork, whose original function is to absorb the aqueous humor. The loss of absorption will lead to an increased resistance, and thus a chronic, painless buildup of pressure in the eye. Which type of glaucoma has the client described?

open angle

The nurse realizes that a client understands how to correctly instill ophthalmic medications when the client:

pulls the tissue near the cheek downward to instill medication.

After a fall at home, a client hits their head on the corner of a table. Shortly after the accident, the client arrives at the ED, unable to see out of their left eye. The client tells the nurse that symptoms began with seeing spots or moving particles in the field of vision but that there was no pain in the eye. The client is very upset that the vision will not return. What is the most likely cause of this client's symptoms?

retinal detachment

When the client tells the nurse that his vision is 20/200 and then asks what that means, the nurse informs the client that a person with 20/200 vision

sees an object from 20 feet away that a person with normal vision sees from 200 feet away.