Assessment & Management: Visual Problems (Lewis Med-Surg CH. 20)

Which intervention would be the nurse's priority to implement for the patient with poor visual acuity from age-related macular degeneration (AMD)?

A) Assess impact of vision on normal functioning. - The most important nursing intervention is to assess the patient's ability to function with the visual impairment. The nurse will use this information to plan nursing care, including assessment of the patient's coping strategies and teaching about vision enhancement techniques and nutrition.

For which patient condition would the nurse withhold the prescribed timolol (Timoptic; Istalol), two drops to each eye every 12 hours, and contact the prescriber?

A) Asthma - Timolol is a nonselective β-adrenergic blocking agent that can cause bronchoconstriction and bronchospasm. For this reason, it should not be used in patients with severe chronic obstructive pulmonary disease (COPD) or asthma. Timolol will not increase urinary retention; that commonly is seen with use of anticholinergics. It will not cause or worsen headaches or constipation.

For treatment of wet age-related macular degeneration, which intervention would the nurse implement for the patient who had photodynamic therapy (PDT) with use of IV verteporfin (Visudyne) and a cold laser? 1) Instruct the patient to quit smoking during the immediate postsurgical period. 2) Suggest that the patient consider using supplements of vitamins and minerals. 3) Advise the patient to eat lots of dark green, leafy vegetables containing lutein. 4) Instruct the patient to avoid direct exposure to sunlight for five days after treatment.

A) Verteporfin, used for phototherapy, is a photosensitizing drug that becomes active in the presence of low-level laser light waves. The medication can be activated by exposure to sunlight or high-intensity light until it is fully excreted. If activated, it can cause thermal burns in the area. The patient should be instructed to avoid direct sunlight and other intense forms of light for five days after treatment. Taking vitamin and mineral supplements, eating green leafy vegetables high in lutein, and cessation of smoking are measures to decrease the risk of AMD.

When planning the discharge of a patient after eye surgery, which activities would the nurse instruct the patient to avoid? Select all that apply. !) Eating 2) Lifting 3) Coughing 4) Bending over 5) Breathing deeply

A) 2, 3, 4 - Activities such as coughing, bending over, and lifting increase the pressure within the eye (2,3,4). Eating and breathing deeply do not involve straining or lowering the head, so the pressure within the eye is not increased (1, 5).

When performing a patient's visual examination, the presence of which classic clinical manifestation would lead the nurse to suspect primary open-angle glaucoma (POAG)?

A) Decreased peripheral vision - POAG develops slowly and without symptoms. The gradual loss of peripheral vision is one of the diagnostic criteria for POAG, which manifests as tunnel vision in late stages. Vacillating pupils and constant tearing are not directly associated with any form of glaucoma. Colored halos around lights are seen in acute angle-closure glaucoma, which is less common than POAG. Acute angle-closure glaucoma is an ocular emergency requiring immediate intervention because intraocular pressure increases rapidly and may cause optic nerve damage and blindness.

When preparing a patient for a surgical procedure, which finding would the nurse expect in the history and physical examination report regarding the patient's history of primary open-angle glaucoma?

A) Denial of eye pain or pressure - Primary open-angle glaucoma is typically symptom-free, which explains why patients can have significant vision loss before diagnosis, unless regular eye examinations are performed. Glaucoma does not result in diplopia or frequent falls and does not affect extraocular eye movements.

Which action would the nurse implement when a patient with a history of asthma receives a prescription for timolol to treat chronic glaucoma?

A) Do not administer timolol, and notify the health care provider. - In an asthmatic patient, administration of timolol should be avoided because it causes bronchospasm. Decreasing the dose and suggesting that the patient only use the medicine for a short period of time do not reduce the risk of bronchospasm. Vomiting is not a side effect of timolol.

Which type of inflammation would the nurse associate with the patient's clinical manifestations of ocular pain; photophobia; decreased visual acuity; headaches; corneal edema; and reddened, swollen conjunctiva?

A) Endophthalmitis - Endophthalmitis is an extensive intraocular inflammation of the vitreous cavity. Ocular pain; photophobia; decreased visual acuity; headaches; reddened, swollen conjunctiva; and corneal edema are the symptoms of endophthalmitis. Blepharitis is a common chronic bilateral inflammation of the lid margins. Cytomegalovirus retinitis is an opportunistic infection that occurs in patients who are immunocompromised. Scotoma is the presence of blind spots in the visual field; it is not an infection.

For the patient diagnosed with epidemic keratoconjunctivitis (EKC), which intervention would the nurse suggest to help alleviate the patient's symptoms?

A) Suggest the use of ice packs and dark glasses. - Epidemic keratoconjunctivitis is an ocular adenoviral disease. It is spread by direct contact, including sexual activity. Treatment involves the use of ice packs to reduce irritation. Dark glasses are used to reduce photophobia. Treatment should not be avoided in this condition. In severe cases, therapy can include mild topical corticosteroids and topical antibiotic ointment.

Which explanation would the nurse associate with a white patient's sclera having a yellowish discoloration?

A) There is an accumulation of lipid deposits - The excessive deposition of lipids in the sclera may result in a yellowish discoloration of the sclera in the white patient; the African American patient normally has a yellowish cast to the sclera. A patient who has a thin sclera will have a bluish tinge in the sclera. The presence of a white sclera indicates that the patient has a normal finding. A patient who has a subconjunctival hemorrhage will have the appearance of a blood spot on the sclera.

For the patient who has consistently worked outside for years or experienced prolonged exposure to ultraviolet light, which potential visual abnormality would the nurse teach the need to wear sunglasses?

A) Cataract - Chronic exposure of the eye lens to ultraviolet light reduces the function of the retina and results in cataract. Presbyopia is the loss of near vision, which may increase with age. Blepharodermachalasis is the presence of excessive skin in the upper lid, which is associated with a prolapse of fat into the eyelid tissue. Yellow discoloration of the sclera is associated with lipid deposition on the sclera.

For which contraindication would the nurse assess the patient before administering a new prescription for timolol (Timoptic; Istalol) eyedrops as treatment of glaucoma?

A) Chronic obstructive pulmonary disease (COPD) - Timolol is a nonselective β-adrenergic blocker that could lead to bronchoconstriction and bronchospasm. For this reason, it should not be used in patients with COPD. Timolol may be used to treat migraine headaches and does not affect sinusitis or chronic urinary tract infections.

Which purpose would the nurse associate with the having the patient cover one eye and count the number of fingers the nurse moves into the patient's field of vision?

A) Determining the patient's full field of vision - A nurse is performing a confrontation visual field test when the nurse asks the patient to cover one eye and count the number of fingers present in the patient's field of vision. This test helps determine the patient's full field of vision. The nurse performs a pupil function test by shining light into the patient's pupil and examining the pupillary response. Intraocular pressure testing with a Tono-pen will help measure intraocular pressure. The nurse performs a visual acuity test using a Snellen chart to determine distance and near visual acuity.

For the patient diagnosed with bacterial conjunctivitis, which clinical manifestations would the nurse expect the patient to exhibit?

A) Discomfort, pruritus, redness, and a mucopurulent drainage in the eye - Bacterial conjunctivitis manifests as discomfort, pruritus, redness, and a mucopurulent drainage in the eye. It occurs due to unhygienic conditions. The infection is caused by Staphylococcus aureus. It can be treated with antibiotic drops. Itching, burning, irritation, and photophobia are signs of blepharitis. Tearing, redness, photophobia, and foreign body sensation are symptoms of epidemic keratoconjunctivitis. Red, swollen, circumscribed, and acutely tender areas in the lid margin are the symptoms of hordeolum.

For the patient recovering from a recent total hip replacement, on which intervention would the nurse focus when establishing a plan of care related to increased intraocular pressures from the 68-year-old patient's glaucoma?

A) Encourage medication compliance to reduce progression of vision loss. - Drug therapy is necessary to prevent the progression and eventual vision loss that accompanies glaucoma. For this reason, the nurse should encourage the patient to remain compliant with drug therapy. Physical therapy will not improve or treat visual deficits. Glaucoma does not cause pain, and, unless the vision is severely impaired, driving restrictions are not necessary.

Which cells in the body may have compromised functioning in a patient with an allergy?

A) Eosinophils - A primary function of eosinophils is to engulf antigen-antibody complexes formed during an allergic response. Basophils show response in inflammation and allergic reactions. They respond by releasing substances within the granules. Thrombocytes initiate the clotting process by producing an initial platelet plug in the early phases of the process. The main function of granulocytes is phagocytosis.

Which action would the nurse implement when performing an assessment of the patient's cranial nerve VII?

A) Establish the patient's ability to close and open both eyelids. - Cranial nerve VII is a facial nerve that controls the actions of facial muscles and helps in blinking or in closing and opening of eyelids. Cranial nerve III is the oculomotor nerve that helps in the constriction of the pupils. Light entering the eye is controlled by dilation of the iris, which is associated with the function of the cranial nerve V. The lens present in the eye will help bend the light entering into the eye.

Which intervention would the nurse teach a patient about managing blepharitis?

A) Gently cleaning the lid margins with baby shampoo - Blepharitis is a common chronic bilateral inflammation of the eyelid margins. Emphasize thorough cleaning practices of the skin and scalp. Gentle cleansing of the lid margins with baby shampoo can effectively soften and remove crusting. Blepharitis is not contagious nor does it spread unless conjunctivitis is occurring simultaneously. In this case, antibiotic drops may be used, but not artificial tears. It is not necessary to teach the family good hygiene, unless they are touching the eyelids.

After undergoing a recent kidney transplantation surgery and taking immunosuppressant medications, which viral ophthalmic infection would the patient be susceptible to developing when exposed to a person with chickenpox?

A) Herpes zoster ophthalmicus - The patient is being treated with immunosuppressant drugs to prevent the rejection of a transplanted kidney. The immunosuppressive drugs tend to decrease the patient's immunity. If the patient comes in contact with a patient with chickenpox, there is the possibility of herpes zoster ophthalmicus infection. It may occur due to reactivation of an endogenous infection. The endogenous infection might have persisted in a latent form after an earlier attack of varicella or by contact with a patient with chickenpox or herpes zoster. It occurs most frequently in older adults and immunosuppressed patients. Blepharitis is a common chronic bilateral inflammation of the lid margins. Hordeolum is an infection of the sebaceous glands in the lid margin. Astigmatism is an eye disorder; it is not a viral infection.

A patient has a new prescription for pilocarpine 1% (Isopto Carpine), two drops in each eye twice a day. For which patient co-morbidity would the nurse hold the prescription and contact the health care provider?

A) Hypertensive retinopathy - Contraindications to the use of pilocarpine include preexisting retinal disease (retinal detachment reported in susceptible individuals and those with preexisting retinal disease). Acute iritis and acute inflammation of the anterior segment of the eye have a potential to increase the intraocular pressure. Pilocarpine is a cholinergic parasympathomimetic agent that increases secretion by the exocrine glands. When applied topically to the eye as a single dose, it causes miosis (persistent constriction of he pupil), spasm of accommodation, and may cause a transitory rise in intraocular pressure followed by a more persistent fall. Benign prostatic hypertrophy, macular degeneration, and COPD are not contraindications to using this medication.

Which condition would the nurse correlate with a patient's clinical manifestations of exophthalmos and ability to view the patient's sclera above the iris when eyes are opened?

A) Hyperthyroidism - A patient who has hyperthyroidism may have exophthalmos, which manifests with a protruding eyeball and sclera above the iris when the eyelids are open. Blepharitis is the condition that is associated with redness, swelling, and crusting along the lid margins. Hordeolum is an infection of the sebaceous gland of the eyelid; the patient may have a superficial nodule along the lid margin. The patient who has macular disease will have a loss of central vision.

Which description would the nurse use to explain the location of blood accumulating from a hemorrhage within the fundus of a patient's eye?

A) In the retinal background - The fundus is the retinal background. Normally, vascular hemorrhages or exudates are not present in the fundus. The fundus area is not the aqueous humor, between the cornea and the lens, or between the iris and the lens.

Which intervention would the nurse implement for a patient who has undergone retinal surgery and injection of an intravitreal bubble?

A) Instruct on positioning and activity as preferred by the surgeon. - Postoperatively, the patient may be on bed rest and may require special positioning to maintain proper position of an intravitreal bubble. The level of activity restriction after retinal surgery varies greatly, depending on the patient and surgeon. Monitoring BP and preventing fluid volume excess are not necessarily related to post-retinal surgery care. Maintaining a darkened environment is not necessary and may present a risk for falling.

When performing an assessment on a patient with glaucoma, which antiglaucoma medication would the nurse associate with the patient's brown iris pigmentation?

A) Latanoprost (Xalatan) - Latanoprost is an antiglaucoma drug that stimulates melanin production in melanocytes and increases the amount of brown pigment in the eye. Carteolol is an antiglaucoma drug that may cause blurred vision, photophobia, and bradycardia. Dipivefrin is an antiglaucoma drug that may cause ocular discomfort and redness in the eye. Carbachol is an antiglaucoma drug that may cause transient ocular discomfort, headache, and blurred vision.

When assisting the health care provider to perform a fluorescein angiography on a patient reporting left eye pain, which nursing intervention has the highest priority?

A) Monitor for extravasation - Fluorescein angiography is when the dye is injected IV into a peripheral vein, followed by serial photographs (over a 10-minute period) of the retina. The dye is toxic to tissue, so it is important to monitor the patient for extravasation at the IV site. Retinal detachment is not a complication of fluorescein. Transient nausea and vomiting may occur, and the patient may experience urine discoloration. However, these are not as high-priority concerns as avoiding contact between the fluorescein and surrounding tissue. Note: Fluorescein dye on an eye strip is used to stain the corneal surface for identification of foreign bodies or abrasions of the corneal surface. This test does not require an IV access.

When evaluating a patient's visual acuity, which assessment tool would the nurse use?

A) Snellen chart - The Snellen chart, which is used to evaluate the patient's ability to read letters or symbols at a distance of 20 feet, is a tool for measuring a patient's visual acuity. A slit-lamp is a special microscope used to examine the eye. An audiometer is a device used to assess hearing acuity. Retinal angiography is a radiographic procedure used to determine retinal damage.

While awaiting arrival of the emergency response team, which intervention would the occupational health nurse implement for the patient who sustained a penetrating eye injury from a foreign object?

A) Stabilize the foreign object within the injury site. - The nurse should stabilize the foreign object penetrating the eye to prevent further damage until the injury can be treated by an emergency medicine specialist and ophthalmologist. The head of the patient should be elevated 45 degrees to prevent excessive pressure within the eye. Bending over is avoided. Irrigation of the eye is indicated only if the injury is caused by chemical exposure.

Which condition would the nurse document when a child has an asymmetric eye position during the visual health assessment?

A) Strabismus - An asymmetric eye position indicates that the patient has strabismus. Blepharitis is associated with redness, swelling, and crusting along the lid margins. Hordeolum is an infection of the sebaceous gland of the eyelid where the patient may have a superficial nodule along the lid margin. Conjunctivitis is associated with redness or swelling of conjunctiva; it is a bacterial infection.

After presentation of age-related macular degeneration (AMD) content by the nurse, which patients' statements indicate understanding? Select all that apply. 1) "Family history is a major risk factor for AMD." 2) "Age-related macular degeneration is related to retinal aging." 3) "People with dark-colored eyes have a higher risk for AMD." 4) "Long-term exposure to ultraviolet light is a risk factor for AMD." 5) "Supplementing with vitamins C and E, beta-carotene, and zinc restores lost vision."

- Age-related macular degeneration is the most common cause of irreversible central vision loss in people above 60 years of age. Some patients with AMD may benefit from supplements of vitamins C and E, beta-carotene, and zinc, which delay progression; however, the supplements do not reverse the disease (5). People with light-colored eyes, not dark-colored eyes, are more at risk for AMD because light eyes have less pigment, which makes them sensitive to light and can cause AMD (3); the patient making this statement requires further teaching. AMD is related to retinal aging because changes in astrocytes in retinal aging cause retinal ischemia, which leads to AMD (2). Genetic factors play a major role in AMD; family history is a major risk factor for AMD because multiple genetic variants are involved in AMD (1). Long-term exposure to ultraviolet light is a risk factor for AMD because long-term exposure may cause retinal detachment (4).

Which intervention would the nurse teach a patient with glaucoma to perform when instilling their scheduled dose of pilocarpine (Isopto Carpine) drops?

A) "Do not perform any activities requiring visual acuity immediately after administration." - Pilocarpine causes blurred vision and difficulty in focusing, so it is important not to engage in any activities requiring visual acuity until the vision clears. Prolonged eye irritation is not an expected adverse effect of pilocarpine. Pilocarpine will stimulate iris sphincter contraction. "At least five years" is not an appropriate amount of time to estimate to the patient.

When interviewing a patient with a new diagnosis of glaucoma, which question is most relevant to the patient's condition? 1) "Have you ever had surgery?" 2) "When was the last test for visual acuity performed?" 3) "Do you have a history of cardiac or pulmonary disease?" 4) "Have there been any recent changes in your eyeglasses or contact lenses?"

A) "Do you have a history of cardiac or pulmonary disease?" - When collecting a health history for a patient diagnosed with glaucoma, the nurse should ask about cardiac or pulmonary disease. Glaucoma is often treated with beta-adrenergic blockers, which may decrease heart rate, decrease BP, and exacerbate asthma or chronic obstructive pulmonary disease (COPD). Information regarding a visual acuity test, previous surgeries, and a change in lens prescription is gathered as general data but is not specifically related to glaucoma.

Which question will the nurse ask a patient based on the following eye assessment findings? 1) "Do you have loss of central vision?" 2) "Do you have trouble seeing at night?" 3) "Do you notice floaters in your visual fields?" 4) "Do you notice a change in color perception?"

A) "Do you have trouble seeing at night?" - The opacity of the cornea may cause loss of night vision, so the nurse would ask about vision at night. Loss of central vision is associated with macular degeneration of the retina. Floaters are a normal part of aging changes in the aqueous humor. Loss of color perception is associated with a decreased number of cones in the retina from aging.

When assessing the eye health of a patient reporting an eye irritation, which question would the nurse ask about sleep hygiene?

A) "How many hours of sleep do you have in 24 hours?" - The health of the eyes depends on various lifestyle factors. One important parameter is sleep. An adequate duration of sleep is required for optimum eye health. Asking how many hours the patient sleeps gives information about the duration of sleep. Bedtime is not an important factor in determining eye health, but duration is important. Position of sleep doesn't affect eye health. Similarly, information about dreams may be used in psychologic and emotional assessment but is not related to eye health.

Which clinical manifestations would the patient report when experiencing an ophthalmic condition resulting in a decrease in tear production?

A) "I have a sandy, gritty, and irritating sensation in my eyes." - Tears act as a lubricant in the eyes. In the absence or deficiency of tears, the patient has a dry, gritty, sandy, and irritating sensation in the eyes. Double vision is caused by an abnormality in the extraocular muscles because they regulate the vision. Tear production does not affect vision. Vision and night vision are regulated by the retina. Night blindness is caused due to damage to structures known as rods, which are present in the retina. Stiffening of the ciliary muscles affects the acuity of a patient's near vision.

For glaucoma discharge instructions, which patient statement indicates understanding of the nurse's teachings? 1) "I'll limit my fluid intake each day." 2) "I'll change positions very slowly." 3) "I'll use my eyedrops until my vision clears." 4) "I'll check the labels on my nonprescription drugs."

A) "I'll check the labels on my nonprescription drugs." - Nonprescription drugs, even caffeine, may increase intraocular pressure, resulting in enough pressure to cause damage. Therefore it is important for the patient to check the contents of all drug labels. Limitation of fluid intake and slow position changes will not affect intraocular pressure. Eyedrop medications for glaucoma must be taken as prescribed. Stopping these medications could cause a rebound increase in intraocular pressure.

Which refractive error would the nurse associate with a patient's uneven cornea and complaints of visual distortion?

A) Astigmatism - Visual distortion that is associated with an uneven cornea indicates that the patient has astigmatism. Myopia is a refractive error in which the patient is not be able to view objects that are far away. Hyperopia is an impairment in vision in which the patient is not be able to see close objects clearly. Presbyopia is the inability to focus on objects that are near, and the condition increases with age. Myopia, hyperopia, and presbyopia are associated with an elongation or shortening of the eyeball, but not an uneven cornea.

Which patient statements indicate understanding of the information taught by the nurse on postsurgical cataract care? Select all that apply. 1) "I might feel some scratchiness in my left eye after surgery." 2) "I should notice an improvement in my vision within a few days." 3) "I will call my health care provider if I notice white drainage or redness of my left eye." 4) "I now have a new lens in my eye, so I will not need glasses or contacts after surgery." 5) "Prior to surgery, I need to remove potential obstacles to prevent falling after surgery."

A) 1, 3, 5 - The patient will notice an improvement in vision after surgery, not in a few days (2). Cataract surgery typically results in little to no pain, but the patient may have some scratchiness in the operative eye (1). Mild analgesics are usually sufficient to relieve any discomfort, but if the pain is sudden or intense, the patient should notify the health care provider because this may indicate hemorrhage, infection, or increased intraocular pressure (IOP). The patient should be instructed to call the health care provider if redness or drainage occurs in the affected eye; these symptoms can be signs of infection (3). Some patients may still need glasses or contact lenses to achieve their best visual acuity (4). Patients may have significant visual impairment after surgery or until the permanent lens is implanted. Patients should remove potential obstacles prior to surgery to maintain an adequate level of safe functioning, such as moving area rugs and furniture out of common pathways (5).

A group of adults received educational content from a nurse about eye health care. Which statements indicate understanding of the content? Select all that apply. 1) "Wash hands regularly to prevent the spread of diseases." 2) "Avoid removing contact lenses if there is redness and pain in the eye." 3) "Wearing sunglasses and having proper nutrition does not prevent cataract development." 4) "Wear eye protection during hazardous work activities to reduce the risk of eye injuries." 5) "Regular eye checkups help in early detection of disease and prevent further loss of vision."

A) 1, 4, 5 Proper care of the eye plays a vital role in maintaining eye health. Regular hand washing helps to prevent the spread of disease from one eye to the other (1). Wearing sunglasses and eating a proper diet help to prevent cataract development and age-related diseases (3). Wearing eye protection during hazardous work helps to reduce the risk of eye injuries (4). Regular eye checkups help in the early detection of diseases and prevent further loss of vision (5). Contact lenses should be removed if there is redness and pain in the eye (2).

When determining whether a patient has ocular problems, which questions would the nurse ask during the patient's assessment? Select all that apply. 1) "Does your eye problem hamper your daily activities?" 2) "How much do you appreciate the fact that you can see?" 3) "Do you wear contact lenses? How do you care for them?" 4) "How do your eye problems make you feel about yourself?" 5) "Have you participated in any activity that may be harmful to your eyes?"

A) 1, 5 - The nurse has to assess the patient's activity in order to assess the severity of the disorder. Assessing occupational hazards may help to understand the possible cause of the eye disorder. Asking the patient if daily activities are disturbed due to eye issues helps in assessing severity. The nurse should ask whether the patient has participated in any harmful activity that may have caused eye damage. Asking how the patient cares for contact lenses helps in understanding how the patient cares for the eyes. Asking how the eye problem makes the patient feel about self helps to explore the patient's psychologic sphere. Asking how much the patient appreciates being able to see only reveals the patient's attitude.

When documenting a patient's health assessment, the nurse utilized the abbreviation PERRLA. Which findings did the nurse document? Select all that apply. 1) Pupils are round. 2) The retina responds to light bilaterally. 3) Lacrimal apparatus is functioning in both eyes. 4) Intraocular pressure is even and within normal parameters. 5) Pupils constrict when the patient focuses on a nearer object.

A) 1, 5 The abbreviation for a normal pupillary response is PERRLA (pupils are equal [in size], round, react to light, and accommodation) (1). Accommodation occurs when the pupil constricts when focusing on a nearer object (5). The retina is examined with use of an ophthalmoscope (2). The lacrimal apparatus contains the structures involved with tear formation and distribution to maintain eye moisture (3). Intraocular (i.e., within the eye) pressure is measured with various instruments and normally is 10 to 21 mm Hg (4).

The nurse darkens the room, shines a penlight on the cornea, and asks the patient to follow finger movement 10 inches from the patient's nose. For which cranial nerves would the nurse evaluate weakness or paralysis? Select all that apply. 1) Facial nerve 2) Trochlear nerve 3) Abducens nerve 4) Trigeminal nerve 5) Oculomotor nerve

A) 2, 3, 5 - The examiner is assessing the extraocular muscle function by darkening the room and shining the penlight over the cornea. The trochlear, abducens, and oculomotor nerves are present near the eyeball, and an abnormality of these cranial nerves results in paralysis of the extraocular muscles (2, 3, 5). The facial nerve helps in the opening and closing movements of the eyelids (1). The trigeminal nerve helps in the dilation of the iris (4).

For which health conditions would the nurse question the patient with acute-angle glaucoma when teaching about their new eyedrop prescription?

A) A history of heart or lung disease - A particularly important assessment is to determine whether the patient has any history of cardiac or pulmonary disease because β-adrenergic blockers often are used to treat glaucoma. These medications can slow heart rate, decrease BP, and exacerbate asthma or chronic obstructive pulmonary disease (COPD). Dry eyes, use of corrective lenses, and sensitivity to sulfonamide antibiotics are incorrect.

When a patient describes central vision loss, for which test would the nurse provide instructions so macular function changes may be identified?

A) Amsler grid test - The Amsler grid test is self-administered, and regular testing is necessary to identify any changes in macular function. B-scan ultrasonography is used to diagnose ocular pathologic conditions (e.g., intraocular foreign bodies or tumors, vitreous opacities, retinal detachments). Fluorescein angiography is used to diagnose problems related to the flow of blood through pigment epithelial and retinal vessels. Intraocular pressure testing with a Tono-pen is done to test for glaucoma.

Which abnormal visual system finding would the nurse document when a patient exhibits deviation of eye position in one or more directions?

A) Strabismus - Strabismus results from overreaction or underreaction of one or more extraocular muscles. Abnormality of extraocular muscle action related to muscle or cranial nerve pathologic conditions results in diplopia (double vision). A cataract is an opacification of the lens due to aging, trauma, diabetes, or long-term systemic corticosteroid use. The patient with exophthalmos may have hyperthyroidism, or intraocular or periorbital tumors. This patient presents with protrusion of the globe beyond its normal position within the bony orbit.

Which intervention assists in preventing further vision loss from chronic open-angle glaucoma?

A) Strict adherence to prescribed eyedrop medication schedule. - Strict adherence to prescribed medication regimen to treat glaucoma will keep the intraoptic pressure at safe levels to avoid optic nerve damage. Tobacco cessation is healthy but will not treat glaucoma. Yearly eye examinations are important but will only measure any damage done if the patient does not follow treatment. A diet high in lutein, found in green leafy vegetables, is thought to improve eye health. Lysine is an amino acid that has some antiviral properties.

The nurse would teach the patient diagnosed with a hordeolum which intervention for self-management of the red, swollen, circumscribed, and acutely tender area in the lid margin?

A) Suggest applying warm, moist compresses at least four times a day until the condition improves. - Hordeolum is an infection caused by the bacteria Staphylococcus aureus. It manifests as a red, swollen, circumscribed, and acutely tender area in the lid margin. Treatment involves applying warm, moist compresses at least four times a day until the condition improves. If it recurs, lid scrubs should be performed daily to aid healing. In addition, appropriate antibiotic ointments or drops are prescribed if required. Wearing glasses may not help in treating hordeolum. The disorder is not a normal body protective mechanism; therefore treatment should not be deferred.

The sclera of an older African American adult patient's eyes has a slightly yellowish cast with small blood vessels visible along the edges of the conjunctiva. Which conclusion would the nurse document from the assessment findings?

A) The assessment findings are within the normal range. - A slight yellowish cast of the sclerae, a normal assessment finding, is caused by lipid deposits that occur with aging. A yellowish cast is normal in patients with dark skin. Small blood vessels are often visible in the conjunctiva near the periphery. Impaired coagulation or bleeding from trauma in the eye is visible as areas of dark red in the sclera. Effects of hypertension may be visible when observing blood vessels in the retina with an ophthalmoscope. A patient with jaundice displays yellowing of the entire scleral area, indicating the need for liver function tests.

Which interpretation would the nurse associate with the patient's Snellen chart reading of right eye 20/30, left eye 20/40?

A) The patient has a refractory error consistent with myopia. - Documentation of Snellen test results includes documenting the eye tested, the distance the vision is tested (20 feet), and the line that the patient is able to read correctly. Patients should wear corrective devices while being tested. Myopia is nearsightedness, the ability to see near objects clearly while distant objects are blurred. The findings of 20/30 and 20/40 are consistent with myopia. Presbyopia is a loss of ability to accommodate and focus on near objects that occurs normally with aging. The Ishihara color test assesses the patient's ability to distinguish color patterns and screens for color blindness. The vision acuity is stronger in the right eye (20/30) than in the left eye (20/40).

For the patient who precipitated a car accident, which visual abnormality would the nurse associate with the statement, "I hit the vehicle moving in front of me, but I thought it was far away and misjudged the distance"? 1) Hyperopia affected the patient's vision. 2) Presbyopia may have occurred while driving. 3) The patient has impaired stereopsis. 4) An abnormal response to light occurred while driving.

A) The patient has impaired stereopsis. Stereoscopic vision allows a patient to visualize in three dimensions. A patient who has impaired stereopsis will be unable to judge the distance between vehicles or between steps, which may result in accidents. Hyperopia is farsightedness or a loss of near vision. In this condition, a patient will be able to judge distances. Presbyopia is a loss of near vision that comes with age, but it does not result in the loss of three-dimensional vision. A patient who has an abnormal response to light will have impaired pupil response but not the inability to judge distances.

Which action would the nurse implement when performing an eye assessment of a patient's near visual acuity and a Jaeger eye chart is not available?

A) Use a newspaper or the label on a container. - If the nurse does not have access to a Jaeger eye chart, the nurse can ask the patient to read a newspaper or the label on a container. The findings should be documented as "reads newspaper headline at X inches." Snellen's chart is used for assessing distant vision. The test should not be skipped because an assessment of near vision is important to the patient's overall health. The patient does not need to return on a different day because a near visual acuity assessment can be completed with a newspaper test.

For the patient recently blinded from a motor vehicle accident, which patient goal has the highest priority?

A) Verbalize feelings related to visual impairment. - The nurse's priority is to help the patient express - feelings about vision loss, because the patient is not coping effectively with the situation. Until the patient expresses how he or she feels, the patient will be unable to progress in the rehabilitation process, including using suitable coping strategies to reduce stress, developing strengths and a support system, and transitioning successfully to the sudden vision loss. Topics

For which clinical manifestations would the nurse monitor the patient after a fluorescein angiography?

A) Yellowish discoloration of the skin and urine; Nausea and vomiting after the procedure - In fluorescein angiography, fluorescein is injected into the body. This dye is a noniodine and nonradioactive dye. This procedure has some common side effects. The dye can cause yellowish discoloration of skin and urine. This dye can also cause some nausea and vomiting. The presence of blood in urine is a serious sign and is not a common side effect of this procedure. Redness of the eyes can have many causative factors and is unlikely after this procedure.