PREP U Ch. 63
A nurse is performing an eye examination. Which question would not be included in the examination? A. "Are you able to raise both eyebrows?" B. "Do any family members have eye conditions?" C. "What medications are you taking?" D. "Have you experienced blurred, double, or distorted vision?"
A. "Are you able to raise both eyebrows?" Asking to raise both eyebrows is a test for cranial nerve VII, the facial nerve, and would not be included in an eye assessment.
The nurse is demonstrating how to perform punctal occlusion. Which activities does the nurse perform? A. Applies gentle pressure bilaterally on the bridge of the nose to the inner canthus of each eye B. Applies firm pressure to the upper and lower eyelids at the outer edges to keep eyelids in approximation C. Holds down lower lid of eye by evenly applying pressure on the eyeball and the cheekbone D. Applies gently pressure to the upper eyelid to keep the lid open while telling the client to gaze upward
A. Applies gentle pressure bilaterally on the bridge of the nose to the inner canthus of each eye Punctal occlusion is done by applying gentle pressure to the inner canthus of each eye for 1 to 2 minutes immediately after eye drops are instilled. The nurse does not apply pressure to the eyeball when administering medications. The lower eyelid is held down to expose the conjunctival sac. The other action described will not aid in the retention or absorption of medication.
What type of medication would the nurse use in combination with mydriatics to dilate the patient's pupil? A. Cycloplegics B. NSAIDs C. Corticosteroids D. Anti-infectives
A. 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.
Which action should the nurse recommend to a client with blepharitis? A. Keep lid margins clean B. Soak in warm water C. Sleep with the face parallel to the floor D. Incision and drainage
A. Keep lid margins clean nstructions 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 layer? A. Laser-assisted stromal in situ keratomileusis (LASIK) B. Photorefractive keratectomy (PRK) C. Keratoplasty D. Keratoconus
A. Laser-assisted stromal in situ keratomileusis (LASIK) LASIK involves flattening the anterior curvature of the cornea by removing a stromal lamella or layer. PRK is used to treat myopia and hyperopia with or without astigmatism. Keratoconus is a cone-shaped deformity of the cornea. Keratoplasty involves replacing abnormal host tissue with healthy donor (cadaver) corneal tissue.
A nurse conducted a history and physical for a newly admitted patient who states, "My arms are too short. I have to hold my book at a distance to read." The nurse knows that the patient is most likely experiencing: A. Loss of accommodative power in the lens B. Decreased eye muscle tone C. Shrinkage of the vitreous body D. Opacity in lens
A. Loss of accommodative power in the lens Presbyopia is a refractive change that occurs with age. The lens of the eye loses accommodative power. Opacity in the lens indicates a cataract.
A nurse is teaching a client about medications for glaucoma. What is the main marker of glaucoma control with medication? A. Lowering intraocular pressure to target pressure B. Increasing the visual field C. Reducing the appearance of optic nerve head D. Changing the opacity of the lens
A. Lowering intraocular pressure to target pressure The main marker of the efficacy of the medication in glaucoma control is lowering of the intraocular pressure to the target pressure. Opacity of the lenses relates to cataract formation. The appearance of the optic nerve head and the visual field are not goals with glaucoma medication.
Which is the most common cause of visual loss in people older than 60 years of age? A. Macular degeneration B. Glaucoma C. Retinal detachment D. Cataracts
A. Macular degeneration Macular degeneration is the most common cause of visual loss in people older than 60 years of age.
Assessment of visual acuity reveals that the client has blurred vision when looking at distant objects but no difficulty seeing near objects. The nurse documents this as which of the following? A. Myopia B. Astigmatism C. Hyperopia D. Emmetropia
A. Myopia Myopia, or nearsightedness, refers to the condition in which the client can see near objects but has blurred distant vision.
During a routine eye examination, a patient complains that she is unable to read road signs at a distance when driving her car. What should the patient be assessed for? A. Myopia B. Astigmatism C. Presbyopia D. Anisometropia
A. Myopia Some people have deeper eyeballs, in which case the distant visual image focuses in front of, or short of, the retina; those with myopia Impaired Vision are said to be nearsighted and have blurred distance vision.
A nurse practitioner is assessing a patient who is experiencing changes in her vision. The nurse performs the following steps. Place them in the order in which the nurse would complete them. Use all options. A. Obtain an ocular history B. Examine the external eye C. Test visual acuity D. Perform direct opthalmoscopy
A. Obtain ocular history B. Test visual acuity C. Examine the external eye D. Perform direct opthalmoscopy
A nurse notices that a client's left upper eyelid is drooping. The nurse has observed: A. Ptosis B. Ptolemy C. Proptosis D. Nystagmus
A. Ptosis Ptosis is drooping or falling of the upper or lower eyelid. Ptolemy is not a medical condition. Proptosis is the extended or protruded upper eyelid that delays closing or remains partially open. Nystagmus is uncontrolled oscillating movement of the eyeball.
A nurse is assessing a pediatric client in a public health clinic. The parent states that the client has been sneezing and rubbing the eyes. The nurses observes the client's eyes and documents objective symptoms of watery and red eyes. When reporting to the physician the assessment findings, which word is appropriate? A. Signs and sx of conjunctivitis B. Signs and sx of proptosis C. Signs and sx of ptosis D. Signs and sx of nystagmus
A. Signs and sx of conjunctivitis Conjunctivitis often stems from an allergy causing inflammation of the conjunctiva, which is a thin, transparent mucous membrane. Conjunctivitis can cause symptoms of itchiness, redness, and watery eyes.
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? A. The presence of halos around lights B. Pain associated with purulent discharge C. Diminished acuity D. A significant loss of central vision
A. The presence of halos around lights Colored halos around lights is a classic symptom of acute-closure glaucoma.
A young client is being seen by a pediatric ophthalmologist due to a recent skateboarding accident that resulted in trauma to the right cornea, and is now at risk of developing an infection. Which nursing intervention would be contraindicated for a client at risk for infection? A. To ensure correct application of antibiotic ointment, gently drag tip along lower lid while squeezing ointment on to lid B. Wash hands before examining the eyes or performing any procedure about the face C. Change gauze eye bandages using aseptic technique D. Avoid using a container of opthalmic medication for anyone other than the client
A. To ensure correct application of antibiotic ointment, gently drag tip along lower lid while squeezing ointment on to lid Avoid contaminating the medication dropper or tube by holding the tip above the eye and adjacent tissue. Using a separate container of ophthalmic medication for each client prevents cross-contamination. Maintaining asepsis prevents the introduction and transmission of infection. Handwashing prevents infection.
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? A. To prevent vision loss B. To eliminate the need for medical care C. To serve as a stopgap measure until help arrives D. To hasten formation of scar tissue
A. To prevent vision loss Prolonged eye irrigation after a chemical burn is the most effective way to prevent formation of permanent scar tissue and thus help prevent vision loss. After a potentially serious eye injury, the victim should always seek medical care. Eye irrigation isn't considered a stopgap measure.
Which of the following types of conjunctivitis is preceded by symptoms of an upper respiratory infection? A. Viral B. Toxic C. Allergic D. Vernal
A. Viral Viral conjunctivitis is usually preceded by symptoms of an upper respiratory infection. The other types of conjunctivitis are not usually preceded by symptoms of a respiratory infection.
The school nurse is testing the kindergarten class with the Snellen chart. What is the nurse testing the children for? A. Visual acuity B. Near vision C. Hearing D. Color vision
A. Visual acuity Th Snellen eye chart is a simple screening tool for determining visual acuity, the ability to see far images clearly.
It is determined that a patient is legally blind and will be unable to drive any longer. Legal blindness refers to a best-corrected visual acuity (BCVA) that does not exceed what reading in the better eye? A. 20/150 B. 20/200 C. 20/100 D. 20/50
B. 20/200 Legal blindness is a condition of impaired vision in which a person has best corrected visual acuity that does not exceed 20/200 in the better eye or whose widest visual field diameter is 20 degrees or less.
A patient comes to the clinic with a suspected eye infection. The nurse recognizes that the patient most likely has conjunctivitis, as evidenced by what symptom? A. Elevated IOP B. A mucopurulent ocular discharge C. Severe pain D. Blurred vision
B. A mucopurulent ocular discharge Bacterial conjunctivitis manifests with an acute onset of redness, burning, and discharge. There is papillary formation, conjunctival irritation, and injection in the fornices. The exudates are variable but are usually present on waking in the morning. The eyes may be difficult to open because of adhesions caused by the exudate. Purulent discharge occurs in severe acute bacterial infections, whereas mucopurulent discharge appears in mild cases.
Following cataract removal, discharge instructions will be provided to the client. Which of the following instructions is most important? A. Only sleep on back B. Avoid any activity that can increase intraocular pressure C. Apply protective patch to both eyes at nighttime D. Avoid washing face and eyes for the first 24 hours
B. Avoid any activity that can increase intraocular pressure For approximately 1 week, the client should avoid any activity that can cause an increase in intraocular pressure. Clients may sleep on back or unaffected side. Clients may use a clean damp cloth to remove eye discharge and wash face. An eye shield is often ordered for the first 24 hours and during the night to prevent rubbing or trauma to the operative eye.
A patient has had cataract extractions and the nurse is providing discharge instructions. What should the nurse encourage the patient to do at home? A. Lift weights to increase muscle strength B. Avoid bending the head below the waist C. Maintain bed rest for 1 week D. Lie on the stomach while sleeping
B. Avoid bending the head below the waist The nurse should encourage the patient to avoid bending or stooping for an extended period. Keep activity light. Avoid lying on the side of the affected eye the night after surgery. Avoid lifting, pushing, or pulling objects heavier than 15 pounds.
An ophthalmologist diagnoses a patient with myopia. The nurse explains that this type of impaired vision is a refractive error characterized by: A. Farsightedness B. Blurred distance vision C. Eyes that are shallow D. A shorter depth to the eyeball
B. 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.
Which of the following is the main refracting surface of the eye? A. Conjunctiva B. Cornea C. Pupil D. Iris
B. Cornea The cornea is a transparent, avascular, domelike structure that covers the iris, pupil, and anterior chamber. It is the most anterior portion of the eyeball and is the main refracting surface of the eye.
Which of the following is the role of the nurse toward a patient who is to undergo eye examinations and tests? A. Conducting various tests to determine the function and the structure of the eyes B. Ensuring that the patient receives eye care to preserve his or her eye function and prevent further visual loss C. Determining if further action is warranted D. Advising the patient on the diet and exercise regimen to be followed
B. Ensuring that the patient receives eye care to preserve his or her eye function and prevent further visual loss Although nurses may not be directly involved in caring for patients who are undergoing eye examinations and tests, it is essential that they ensure that patients receive eye care to preserve their eye function and/or prevent further visual loss. The nurse is not involved in conducting the various tests to determine the status of the eyes and in determining if further action is warranted. Patients who are to undergo eye examinations and tests are not required to modify their diet and exercise regimen.
Which type of benign tumor of the eyelids is characterized by superficial, vascular capillary lesions that are strawberry-red in color? A. Xanthelasma B. Hemangioma C. Nevi D. Milia
B. Hemangioma Hemangiomas are vascular capillary tumors that may be bright, superficial, strawberry-red lesions or bluish and purplish deeper lesions.
A client with an inflammatory ophthalmic disorder has been receiving repeated courses of a corticosteroid ointment, one-half inch in the lower conjunctival sac four times a day as directed. The client reports a headache and blurred vision. The nurse suspects that these symptoms represent: A. Expected drug effects that should diminish over time B. Increased IOP C. Incorrect ointment application D. Common adverse reactions to corticosteroid therapy
B. Increased IOP Headache and blurred vision are symptoms of increased IOP, such as from glaucoma. Ophthalmic corticosteroids may trigger an episode of acute glaucoma in susceptible clients. Although the effects of some drugs may diminish with continued use, this doesn't happen with ophthalmic corticosteroids. Incorrect ointment application doesn't cause headache or blurred vision.
A client comes to the eye clinic for a routine check-up. The client tells the nurse he thinks he is color blind. What screening test does the nurse know will be performed on this client to assess for color blindness? A. Jaegar B. Ishihara C. Rosenbaum D. Snellen
B. Ishihara Color vision is assessed with Ishihara polychromatic plates. The client receives a series of cards on which the pattern of a number is embedded in a circle of colored dots. The numbers are in colors that color-blind persons commonly cannot see. Clients with normal vision readily identify the numbers.
A nurse practitioner is performing direct ophthalmoscopy and observes the fundus. Which area of the fundus would the nurse examine last? A. Physiologic cup B. Macula C. Periphery of the retina D. Veins
B. Macula When performing direct ophthalmoscopy, the last area of the fundus to be examined is the macula, because this area is the most sensitive to light. When the fundus is examined, the vasculature (veins and arteries) comes into focus first. Next the physiologic cup is examined, followed by the periphery of the retina. Reference:
The nurse is performing an assessment of the visual fields for a patient with glaucoma. When assessing the visual fields in acute glaucoma, what would the nurse expect to find? A. Clear cornea B. Marked blurring of vision C. Constricted pupil D. Watery ocular discharge
B. Marked blurring of vision Glaucoma is often called the "silent thief of sight" because most patients are unaware that they have the disease until they have experienced visual changes and vision loss. The patient may not seek health care until he or she experiences blurred vision or "halos" around lights, difficulty focusing, difficulty adjusting eyes in low lighting, loss of peripheral vision, aching or discomfort around the eyes, and headache.
Which group of medications causes pupillary constriction? A. Mydriatics B. Miotics C. Beta Blockers D. Adrenergic agonists
B. Miotics Miotics cause pupillary constriction. Mydriatics cause pupillary dilation. Beta-blockers decrease aqueous humor production. Adrenergic agonists increase aqueous outflow but primarily decrease aqueous production with an action similar to that of beta-blockers and carbonic anhydrase inhibitors. Reference:
To avoid the side effects of corticosteroids, which medication classification is used as an alternative to treat inflammatory conditions of the eyes? A. Miotics B. NSAIDs C. Cycloplegics D. Mydriatics
B. NSAIDs NSAIDs are used as an alternative in controlling inflammatory eye conditions and postoperatively to reduce inflammation.
Which of the following would be an inaccurate clinical manifestation of a retinal detachment? A. Bright flashing lights B. Pain C. Sudden onset of a greater number of floaters D. Cobwebs
B. Pain Patient may report the sensation of a shade or curtain coming across the vision of one eye, cobwebs, bright flashing lights, or the sudden onset of a great number of floaters. Patients do no complain of pain.
The nurse is reviewing the medical record of a client with glaucoma. Which of the following would alert the nurse to suspect that the client was at increased risk for this disorder? A. Hyperopia since age 20 years old B. Prolonged use of corticosteroids C. History of respiratory disease D. Age younger than 40 years old
B. Prolonged use of corticosteroids Risk factors associated with glaucoma include prolonged use of topical or systemic corticosteroids, older age, myopia, and a history of cardiovascular disease.
A patient presents to an eye clinic with a number of symptoms related to his diminished vision. An initial history leads the nurse practitioner to suspect that the patient has acute angle-closure glaucoma. Which of the following symptoms would apply to this diagnosis? Select all that apply. A. Gradual loss of peripheral vision B. Severe eye pain C. Reddening of the eye D. Tunnel vision E. Nausea and vomiting F. Sudden onset of visual disturbance
B. Severe eye pain C. Reddening of the eye E. Nausea and vomiting F. Sudden onset of visual disturbance Gradual loss of peripheral vision, usually in both eyes, and tunnel vision in advanced stages are symptoms of primary open-angle glaucoma.
A client comes to the clinic for an ophthalmologic screening, which will include measurement of intraocular pressure (IOP) with a tonometer. Which statement about this procedure is true? A. The client will direct the gaze forward while the physician rests the tonometer on the scleral surface B. The tonometer will register the force required to indent or flatten the corneal apex C. A topical anesthetic will be administered after the examination D. The client should wear dark glasses for several hours after the procedure
B. The tonometer will register the force required to indent or flatten the corneal apex The tonometer will register the force required to indent (using Schiotz's tonometer) or flatten (using an applanation tonometer) the corneal apex. This force varies with firmness of the eye, which fluctuates with IOP. Although the client does direct the gaze forward during tonometry, the tonometer rests on the surface of the cornea, not the sclera. Topical anesthetic drops are administered before, not after, the examination. The client should wear dark glasses after pupil dilation, not tonometry, to protect the eyes from light.
A client is having a routine eye examination. The procedure being performed is done by using an instrument to indent or flatten the surface of the eye. This is known as ________ and it is routinely done to test for ________. A. tonometry; macular degeneration B. tonometry; intraocular pressure C. retinoscopy; cataracts D. retinoscopy; detached retina
B. tonometry; intraocular pressure The procedure being performed is known as tonometry and it measures intraocular pressure.
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? A. "These drops are just the first step to make sure your vision doesn't get worse." B. "Most clients need to use the drops for only about a few months." C. "You'll need to use the drops the rest of your life to control the glaucoma." D. "If the drops don't work, surgery may be needed to cure your condition."
C. "You'll need to use the drops the rest of your life to control the glaucoma." The client is demonstrating a lack of understanding about the condition and its treatment. The nurse needs to provide additional information to the client that the condition can be controlled but not cured. The statement about lifelong therapy would be most appropriate. Eye medications would most likely be needed for the long term, not just a few months. Surgery may be used in conjunction with medication therapy; however, neither method cures the condition. The goal of therapy is to reduce the intraocular pressure to prevent optic nerve damage.
When undergoing testing of visual acuity with a Snellen chart, the client can read the line labeled 20/50 but misses three letters on the line. The nurse documents this finding as which of the following? A. 20/20+30 B. 20/20/50 C. 20/50-3 D. 20/50
C. 20/50-3 The nurse would document the finding as 20/50-3, indicating that the client missed three of the letters on the line 20/50.
A patient is suspected of having glaucoma. What reading of IOP would demonstrate an increase resulting from optic nerve damage? A. 6-10 mm Hg B. 0-5 mm Hg C. 21 mm Hg or higher D. 11-20 mm Hg
C. 21 mm Hg or higher Intraocular pressure of greater than 21 mm Hg is a sign of primary open-angle glaucoma.
A client who is blind is awaiting elective surgery. What should the nurse do to promote this client's control over their hospital environment? A. Open all containers without prompting to be helpful B. Keep personal care items where the nurse knows their location C. Ask the client where to store his or her self care items D. Arrange the meal tray in a way that is easiest for the nurse to assist the client
C. Ask the client where to store his or her self care items Ask the client's preference for where to store hygiene articles and other objects needed for self-care. Involving the client promotes his or her control over the environment. Personal care items should be kept in the same location at all times to provide the client with the ability to locate toiletries easily.
A nurse instructs a client to refrain from blinking after administering eye drops based on which rationale? A. Blinking slows absorption of the instilled eye drops B. Blinking limits the size of the conjunctival sac for the needed amount of eye drop C. Blinking causes the eye drop to be expelled from the conjunctival sac D. Blinking keeps substances from entering the eye
C. Blinking causes the eye drop to be expelled from the conjunctival sac Blinking expels an instilled eye drop from the conjunctival sac, which interferes with the efficacy of the medication. Blood-ocular barriers keep foreign substances from entering the eye. The size of the conjunctival sac does change with blinking. It can hold only 50 uL.
The nurse is caring for a client with increased fluid accumulation in the eye. When assessing the client, which structure within the eye is noted to drain fluid from the anterior chamber? A. Fovea centralis B. Choroid C. Canal of Schlemm D. Canthus
C. Canal of Schlemm The canal of Schlemm drains the anterior chamber of the eye. By draining the fluid, it decreases the fluid amount and pressure in the eye. The other options have no draining ability.
Which of the following medication classifications increases aqueous fluid outflow in the patient with glaucoma? A. Beta blockers B. Alpha-adrenergic agonists C. Cholinergics D. Carbonic anhydrase inhibitors
C. Cholinergics Cholinergics increase aqueous fluid outflow by contracting the ciliary muscle, causing miosis and opening the trabecular meshwork. Beta blockers decrease aqueous humor production.
Which of the following medications needs to be withheld for 5 to 7 days prior to cataract surgery? A. Glucophage B. Prednisone C. Coumadin D. Lasix
C. Coumadin It has been common practice to withhold any anticoagulant therapy such as Coumadin to reduce the risk for retrobulbar hemorrhage (after retrobulbar injection) for 5 to 7 days before surgery
The nurse asks a client to follow the movement of a pencil up, down, right, left, and both ways diagonally. The nurse is assessing which of the following? A. Eyeball oscillation movements B. Pupillary reaction C. Extraocular muscle function D. Eyelid drooping
C. Extraocular muscle function The nurse is testing the client's extraocular eye muscle function by having the client follow an object through the six cardinal directions of gaze (up, down, right, left, and both diagonals). Pupillary reaction is tested using a penlight. The nurse observes the position of the eyelids for drooping. The nurse asks a client to stare at an object and then each eye is covered and then uncovered quickly while the examiner looks for any shifts in the eye and oscillations in the eyeball.
A client suffered trauma to the sclera and is being treated for a subsequent infection. During client education, the nurse indicates where the sclera is attached. Which structure would not be included? A. Cornea B. Pupil C. Eyelids D. Iris
C. Eyelids The sclera does not attach to the eyelids. The sclera protects structures in the eye, and connects directly to the cornea, anterior chamber, iris, and pupil.
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? A. Avoid using the terms "see" or "look" B. Touch the client before identifying himself or herself C. Face the client when speaking directly to them D. Talk to the client in a loud tone of voice
C. Face the client when speaking directly to them When interacting with a client with a visual impairment, the nurse should face the client and speak directly to the client using a normal tone of voice. It is not necessary to raise the voice unless the client asks the nurse to do so and it is not necessary to avoid the terms, "see" or "look" when interacting with the client. The nurse should identify himself or herself when approaching the client and before making any physical contact.
What should the nurse recommend to a client with blepharitis? A. Incision and drainage B. Sleeping with the face parallel to the floor C. Frequent washing of the face and hair D. Warm soaks of the area
C. Frequent washing of the face and hair Frequent washing of the face and hair is recommended in a client with blepharitis because seborrhea or excessive oiliness of the skin of the face and scalp is associated with blepharitis. Warm soaks would be included for treatment of a sty. There is no benefit to sleeping with the face parallel to the floor.
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? A. Myopia B. Emmetropia C. Hyperopia D. Astigmatism
C. Hyperopia Hyperopia is farsightedness. People who are hyperopic see objects that are far away better than objects that are close.
A client with chronic open-angle glaucoma is now presenting with eye pain and intraocular pressure of 50 mm Hg. An immediate iridotomy is scheduled. Which of the following describes the desired effects of this procedure? A. To relieve pain B. Reverse optic nerve damage C. Improve outflow drainage D. Restore vision
C. Improve outflow drainage Laser iridotomy or standard iridotomy is a surgical procedure that provides additional outlet drainage of aqueous humor. This is done to lower the IOP as quickly as possible since permanent vision loss can occur in 1 to 2 days. Once optic nerve damage occurs, it cannot be reversed, and vision is not restored. Pain that occurs with rising IOP will be controlled once pressure is lowered through improved outflow drainage.
The nurse is preparing a presentation for a local community group comparing photorefractive keratectomy and LASIK refractive surgeries. Which of the following would the nurse include? A. PRK requires that a thin flap be made to allow access to the cornea. B. PRK is used primarily for people without astigmatism C. LASIK involves working with the cornea on a deeper level D. LASIK is appropriate for people with very thin corneas
C. LASIK involves working with the cornea on a deeper level LASIK involves the creation of a corneal flap to allow access to the corneal stroma at a deeper level. PRK is used to treat myopia and hyperopia with or without an astigmatism and is now reserved for clients unsuitable for LASIK, such as those with very thin corneas.
A client with multiple sclerosis is being seen by a neuro-ophthalmologist for a routine eye exam. The nurse explains to the client that during the examination, the client will be asked to maintain a fixed gaze on a stationary point while an object is moved from a point on the side, where it can't be seen, toward the center. The client will indicate when the object becomes visible The nurse further explains that the test being performed is called a: A. Color vision test B. Retinal angiography C. Perimetry test D. Slit-lamp examination
C. Perimetry test A visual field test or perimetry test measures peripheral vision and detects gaps in the visual field. Reference:
The nurse is caring for a client ordered for multiple eye screening. Following which procedure will the nurse instruct the client on a yellow coloring to the skin and urine as being normal? A. Ultrasonography B. Retinal imaging C. Retinal angiography D. Retinoscopy
C. Retinal angiography The nurse is most correct to instruct the client that his skin and urine may turn yellow following a retinal angiography. Sodium fluorescein is a water-soluble dye that is injected into a vein. The dye then travels to the retinal arteries and capillaries, where pictures are obtained of the vascular supply. The other options do not include a dye injection.
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? A. Chalazion B. Angle-closure glaucoma C. Retinal detachment D. Eye trauma
C. Retinal detachment A detached retina is associated with a hole or tear in the retina caused by stretching or degenerative changes. Retinal detachment may follow a sudden blow, penetrating injury, or eye surgery.
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? A. Pneumatic retinopexy B. Pars plana vitrectomy C. Scleral buckle D. Phacoemulsification
C. Scleral buckle The scleral buckle is a procedure in which a piece of silicone plastic or sponge is sewn onto the sclera at the site of the retinal tear. The buckle holds the retina against the sclera until scarring seals the tear. The other surgeries do not use this type of procedure.
When the patient tells the nurse that his vision is 20/200, and asks what that means, the nurse informs the patient that a person with 20/200 vision: A. Sees an object from 20 feet away that a normal person sees from 20 feet away B. Sees an object from 200 feet away that a normal person sees from 200 feet away C. Sees an object from 20 feet away that a normal person sees from 200 feet away D. Sees an object from 200 feet away that a normal person sees from 20 feet away
C. Sees an object from 20 feet away that a normal person sees from 200 feet away The fraction 20/20 is considered the standard of normal vision. Most people, positioned 20 feet from the eye chart, can see the letters designated as 20/20 from a distance of 20 feet.
Following an ophthalmologic exam, an anxious client asks the nurse, "How serious is a refraction error?" Which of the following is the best response from the nurse? A. "Simple surgery can fix the problem." B. "This is normal for anyone your age." C. "It is nothing serious." D. "It means corrective lenses are required."
D. "It means corrective lenses are required." Refractive errors can be corrected with glasses or contact lenses. Telling a client that "nothing is serious" does not provide the necessary information to help alleviate fears. The word surgery can increase fears. If the refractive error is associated with aging, this is a normal finding but does not provide information to the condition.
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? A. "Usually we will send you home with this bottle and written instructions for administering the medication." B. "It is standard for the doctor to write a prescription for this medication." C. "I will let the doctor know." D. "Prescriptions of this medication are generally not given because it can cause corneal problems."
D. "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.
The nurse is giving a visual field examination to a 55-year-old male client. The client asks what this test is for. What would be the nurse's best answer? A. "This test measures visual acuity." B. "This test measures how well your eyes move." C. "This test is to see how well your eyes are aging." D. "This test measures peripheral vision and detects gaps in the visual field."
D. "This test measures peripheral vision and detects gaps in the visual field." A visual field examination or perimetry test measures peripheral vision and detects gaps in the visual field.
A client's vision is assessed at 20/200. The client asks what that means. Which is the most appropriate response by the nurse? A. "You see an object from 200 feet away just like a person with normal vision." B. "You see an object from 200 feet away that a person with normal vision sees from 20 feet away." C. "You see an object from 20 feet away just like a person with normal vision." D. "You see an object from 20 feet away that a person with normal vision sees from 200 feet away."
D. "You see an object from 20 feet away that a person with normal vision sees from 200 feet away." The fraction 20/20 is considered the standard of normal vision. Most people, positioned 20 feet from an eye chart, can see the letters designated as 20/20 from a distance of 20 feet.
A patient is to have an angiography done using fluorescein as a contrast agent to determine if the patient has macular edema. What laboratory work should the nurse monitor prior to the angiography? A. AST and ALT B. Hemoglobin and hematocrit C. Platelet count D. BUN and creatinine
D. BUN and creatinine Angiography is done using fluorescein or indocyanine green as contrast agents. Fluorescein angiography is used to evaluate clinically significant macular edema, document macular capillary nonperfusion, and identify retinal and choroidal neovascularization (growth of abnormal new blood vessels) in age-related macular degeneration. It is an invasive procedure in which fluorescein dye is injected, usually into an antecubital vein. Prior to the angiography, the patient's blood urea nitrogen (BUN) and creatinine should be checked to ensure that the kidneys will excrete the contrast agent
A client is color blind. The nurse understands that this client has a problem with: A. Lens B. Rods C. Aqueous humor D. Cones
D. Cones Cones provide daylight color vision, and their stimulation is interpreted as color. If one or more types of cones are absent or defective, color blindness occurs. Rods are sensitive to low levels of illumination but can't discriminate color. The lens is responsible for focusing images. Aqueous humor is a clear watery fluid and isn't involved with color perception.
The nurse should monitor for which manifestation in a client who has had LASIK surgery? A. Stye formation B. Cataract formation C. Excessive tearing D. Halos and glare
D. Halos and glare After LASIK surgery, symptoms of central islands and decentered ablations can occur that include monocular diplopia or ghost images, halos, glare, and decreased visual acuity. These procedures do not cause excessive tearing or result in cataract or stye formation.
The upper eyelid normally covers the uppermost portion of the iris and is innervated by which cranial nerve? A. I B. IV C. II D. III
D. III The upper lid is innervated by the oculomotor nerve (CN III).
Which part of the retina is responsible for central vision? A. Optic disk B. Sclera C. Fundus D. Macula
D. Macula The macula is the area of the retina responsible for central vision.
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: A. Perimetry B. Tonometry C. Gonioscopy D. Opthalmoscopy
D. Opthalmoscopy Four major types of examinations are used in glaucoma evaluation, diagnosis, and management: tonometry to measure the IOP, ophthalmoscopy to inspect the optic nerve, gonioscopy to examine the filtration angle of the anterior chamber, and perimetry to assess the visual fields.
Which of the following is the overall aim of glaucoma treatment? A. Reattach the retina B. Reverse optic nerve damage C. Optimize the patient's remaining vision D. Prevent optic nerve damage
D. Prevent optic nerve damage The aim of all glaucoma treatment is prevention of optic nerve damage. Although treatment cannot reverse optic nerve damage, further damage can be controlled. Reattachment of the retina is not part of glaucoma treatment.
