Chapter 42: Caring for Clients with Eye Disorders

Which feature should a nurse observe during an ophthalmic assessment? a. Internal eye function b. Appearance of the external eye c. Visual acuity d. Intraocular pressure

b During an ophthalmic assessment, the nurse should examine the appearance of the external eye and the pupil responses in the client. A qualified examiner determines internal eye function, visual acuity, and intraocular pressure.

A nurse is teaching a client instructions on how to instill eye medications at home. Place the steps the client should follow in the correct sequence, from first to last.

1. Wash hands thoroughly. 2. Wipe the lids and lashes in a direction away from the nose with a moistened, soft gauze pad, paper tissue, or cotton ball. 3. Pull the tissue near the cheek downward, forming a sac in the lower lid. 4. Tilt the head slightly backward and toward the eye in which the medication is to be instilled. 5. Instill the prescribed number of drops into the conjunctival pocket, or apply a thin ribbon of ointment directly into the conjunctival pocket, beginning at the inner corner and moving outward. 6. Close the eye gently.

The nurse is admitting a 55-year-old client diagnosed with a left eye retinal detachment. While assessing this client, what characteristic symptom would the nurse expect to find? a. Flashing lights in the visual field b. Sudden eye pain c. Loss of color vision d. Colored halos around lights

a Flashing lights in the visual field is a common symptom of retinal detachment. Clients may also report spots or floaters or the sensation of a curtain being pulled across the eye. Retinal detachment is not associated with eye pain, loss of color vision, or colored halos around lights.

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. hyperopia b. emmetropia c. myopia d. astigmatism

a Hyperopia is farsightedness. People who are hyperopic see objects that are far away better than objects that are close.

Which type of glaucoma presents an ocular emergency? a. Acute angle-closure glaucoma b. Normal tension glaucoma c. Ocular hypertension d. Chronic open-angle glaucoma

a Acute angle-closure glaucoma results in rapid progressive visual impairment. Normal tension glaucoma is treated with topical medication. Ocular hypertension is treated with topical medication. Chronic open-angle glaucoma is treated initially with topical medications, with oral medications added at a later time.

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? a. open angle b. angle closure c. congenital d. secondary

a The client described open-angle glaucoma. This type of glaucoma develops painlessly, and visual changes occur slowly. As the IOP rises, it causes edema of the cornea, atrophy of nerve fibers in the peripheral areas of the retina, and degeneration of the optic nerve.

The nurse should recognize the greatest risk for the development of blindness in which of the following clients? a. A 58-year-old woman with macular degeneration b. A 28-year-old man with astigmatism c. A 58-year-old woman with hyperopia d. A 28-year-old man with myopia

a The most common causes of blindness and visual impairment among adults 40 years of age or older are diabetic retinopathy, macular degeneration, glaucoma, and cataracts. The 58-year-old woman with macular degeneration has the greatest risk for the development of blindness related to her age and the presence of macular degeneration. Individuals with hyperopia, astigmatism, and myopia are not in a risk category for blindness.

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. Ask the client where to store his or her self-care items. b. Keep personal care items where the nurse knows their location. c. Arrange the meal tray in a way that is easiest for the nurse to assist the client. d. Open all containers without prompting to be helpful.

a 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. At mealtime, describe where food is on the plate using the positions on the face of a clock. This measure assists the client to identify the location of food. Allow the client to open containers and offer help if needed. Having a choice facilitates independence.

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 of tube along lower lid while squeezing ointment on to lid. b. Avoid using a container of ophthalmic medication for anyone other than the client. c. Change gauze eye bandages using aseptic technique. d. Wash hands before examining the eyes or performing any procedure about the face.

a 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.

Which of the following medications decreases the production of aqueous humor? a. Beta blockers b. Miotics c. Sympathomimetics d. Mydriatics

a Beta blockers decrease the production of aqueous humor, with a resultant decrease in IOP. Miotics and sympathomimetics decrease the size of the pupil, facilitating the outflow of the aqueous humor, which decreases IOP. Mydriatics dilate the pupil.

A client got a sliver of glass in his eye when a glass container at work fell and shattered. The glass had to be surgically removed and the client is about to be discharged home. The client asks the nurse for a topical anesthetic for the pain in his eye. What should the nurse respond? a. "Overuse of these drops could soften your cornea and damage your eye." b. "You could lose the peripheral vision in your eye if you used these drops too much." c. "I'm sorry, this medication is considered a controlled substance and patients cannot take it home." d. "I know these drops will make your eye feel better, but I can't let you take them home."

a Most clients are not allowed to take topical anesthetics home because of the risk of overuse, even though they are not classified as controlled substances. Clients with corneal abrasions and erosions experience severe pain and are often tempted to overuse topical anesthetic eye drops. Overuse of these drops results in softening of the cornea. Prolonged use of anesthetic drops can delay wound healing and can lead to permanent corneal opacification and scarring, resulting in visual loss. The nurse must explain the rationale for limiting the home use of these medications.

To avoid the side effects of corticosteroids, which medication classification is used as an alternative to treating inflammatory conditions of the eyes? a. Nonsteroidal anti-inflammatory drugs (NSAIDs) b. Miotics c. Mydriatics d. Cycloplegics

a NSAIDs are used as an alternative in controlling inflammatory eye conditions and postoperatively to reduce inflammation. Miotics are used to cause the pupil to constrict. Mydriatics cause the pupil to dilate. Cycloplegics cause paralysis of the iris sphincter.

People with hyperopia are considered which of the following? a. Farsighted b. Nearsighted c. Normal vision d. Astigmatism

a People with hyperopia are farsighted. Nearsighted people have myopia. Emmetropia is normal vision. Astigmatism is an irregularity in the curve of the cornea.

The nurse realizes that a client understands how to correctly instill ophthalmic medications when the client: a. pulls the tissue near the cheek downward to instill medication. b. wipes the lids and lashes prior to instillation in a direction toward the nose with moistened, soft gauze. c. allows the tip of the container to touch the eyelid while administering the medication. d. rubs the eye after administering medication.

a Pull the cheek downward to form a sack in the lower lid. Instill the drops into the conjunctival pocket. The lid and lashes would be wiped in a direction away from the nose to avoid contamination. The tip of the container will be contaminated if it touches eye or eyelid. Do not rub the eye because it may irritate the eye.

Which of the following is the overall aim of glaucoma treatment? a. Prevent optic nerve damage b. Optimize the patient's remaining vision c. Reverse optic nerve damage d. Reattach the retina

a 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.

A client is being treated for glaucoma. What is the rationale for the nurse's instruction to maintain regular bowel habits? a. Straining at stool increases intraocular pressure. b. The client's medications may lead to diarrhea. c. Problems with constipation may compound problems with lens clarity. d. The client's medications may cause constriction of all blood vessels, contributing to hemorrhoids.

a The client should maintain regular bowel habits because straining at stool can raise intraocular pressure (IOP). The other answers are distracters for this question.

A client presents to the ED reporting a chemical burn to both eyes. Which is the priority nursing intervention? a. Irrigate both eyes. b. Obtain the Material Safety Data Sheet (MSDS). c. Assess visual acuity. d. Assess the pH of the corneal surface.

a The eyes should immediately be irrigated to remove the chemical and preserve the eye. If the chemical is allowed to remain on the eye surface, it may cause ulcerations and permanent damage to the eye. It is appropriate to obtain the MSDS and assess the pH of the corneal surface after irrigation has begun. Irrigation should continue until the pH normalizes. Visual acuity can be assessed once the emergent phase is over.

A 6-year-old is brought to the pediatric clinic for the assessment of redness and discharge from the eye and is diagnosed with viral conjunctivitis. What is the most important information to discuss with the parents and child? a. Handwashing can prevent the spread of the disease to others. b. The importance of compliance with antibiotic therapy c. Signs and symptoms of complications, such as meningitis and septicemia d. The likely need for surgery to prevent scarring of the conjunctiva

a The nurse must inform the parents and child that viral conjunctivitis is highly contagious and instructions should emphasize the importance of handwashing and avoiding sharing towels, face cloths, and eye drops. Viral conjunctivitis is not responsive to any treatment, including antibiotic therapy. Clients with gonococcal conjunctivitis are at risk for meningitis and generalized septicemia; these conditions do not apply to viral conjunctivitis. Surgery to prevent scarring of the conjunctiva is not associated with viral conjunctivitis.

A client has been prescribed eye drops for the treatment of glaucoma. At the yearly follow-up appointment, the client tells the nurse that she has stopped using the medication because her vision did not improve. Which action by the nurse is appropriate? a. Explain the therapeutic effect and expected outcome of the medication. b. Talk with the doctor about switching to a different glaucoma medication. c. Administer the medication immediately. d. Refer the patient to the emergency department.

a The nurse needs to explain the therapeutic effect and expected outcome of the medication. The medication is not a cure for glaucoma, but can slow the progression. The client will not see improvements in vision with the use of the medication but should experience little to no deterioration of vision. The doctor may choose to switch the medication, but not because the vision is not improving; it would be based on not obtaining the set intraocular pressure. Administering the medication immediately or referring the client to the emergency department is not appropriate because this is not an emergent situation.

What is the correct advice regarding food for a client who underwent a cataract surgery? a. Eat soft, easily chewed foods. b. Eat red meat two to four times per week. c. Increase intake of vitamins A and C. d. Eat spinach or collard greens two to four times per week.

a The nurse should advise clients recovering from cataract surgery to eat soft, easily chewed foods until healing is complete to avoid tearing from excessive facial movements.

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. Scleral buckle b. Pars plana vitrectomy c. Pneumatic retinopexy d. Phacoemulsification

a 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 obtaining the health history from a client with retinal detachment, a nurse expects the client to report: a. light flashes and floaters in front of the eye. b. a recent driving accident while changing lanes. c. headaches, nausea, and redness of the eyes. d. frequent episodes of double vision.

a The sudden appearance of light flashes and floaters in front of the affected eye is characteristic of retinal detachment. Difficulty seeing cars in another driving lane suggests gradual loss of peripheral vision, which may indicate glaucoma. Headache, nausea, and redness of the eyes are signs of acute (angle-closure) glaucoma. Double vision is common in clients with cataracts.

A client's ocular tumor has necessitated enucleation and the client will be fitted with a prosthesis. The nurse should address what nursing diagnosis when planning the client's discharge education? a. Disturbed body image b. Chronic pain c. Ineffective protection d. Unilateral neglect

a The use of an ocular prosthesis is likely to have a significant impact on a client's body image. Prostheses are not associated with chronic pain or ineffective protection. The client experiences a change in vision, but is usually able to accommodate such changes and prevent unilateral neglect.

Which of the following types of conjunctivitis is preceded by symptoms of an upper respiratory infection? a. Viral b. Allergic c. Toxic d. Vernal

a 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.

A nurse is caring for a client who is scheduled to have an enucleation performed. The nurse is discussing postsurgical management and care of the prosthesis with the client. Which instructions would be included? Select all that apply. a. The prosthesis should be removed before going to bed and returned the next morning. b. The client should hold his or her head over a soft surface when removing or inserting the prosthesis. c. Immediately after surgery, the client will lie face down in bed to avoid hemorrhage. d. When healing is complete, the client will remove and reinsert the metal or plastic ball for cleaning.

a, b Removal before bed will protect the prosthesis from accidentally getting scratched or damaged. Removing or inserting the prosthesis over a soft surface will help to avoid damage if the prosthetic eye falls. Hemorrhage is a complication of enucleation, and will be controlled with a pressure dressing. The client is not instructed to lie face down. A metal or plastic ball is buried in the capsule of connective tissue at the time of surgery. After the tissues are healed, a shell-shaped prosthesis is placed over the buried ball. The shell is painted to match the remaining eye. The shell portion is the only portion removed for cleaning.

The nurse is preparing a presentation for a group of older adults on the topic of open-angle glaucoma. Which symptoms would be included as indications of open-angle glaucoma? Select all that apply. a. Difficulty adjusting eyes in low lighting b. Halos around lights c. Blurred vision d. Decreasing peripheral vision e. Bright flashing lights f. Severe pain

a, b, c, d Decreased peripheral vision, difficulty adjusting eyes in low lighting, halos, and blurred vision are typical symptoms of open-angle glaucoma. Bright flashes of light may be an indication of retinal detachment. Severe pain is usually associated with angle-closure glaucoma or eye trauma.

A public health nurse is teaching a health promotion workshop that focuses on vision and eye health. What should this nurse cite as the most common causes of blindness and visual impairment among adults over the age of 40? Select all that apply. a. Diabetic retinopathy b. Trauma c. Macular degeneration d. Cytomegalovirus e. Glaucoma

a, c, e The most common causes of blindness and visual impairment among adults 40 years of age or older are diabetic retinopathy, macular degeneration, glaucoma, and cataracts. Therefore, trauma and cytomegalovirus are incorrect.

A client is scheduled for enucleation and the nurse is providing anticipatory guidance about postoperative care. What aspects of care should the nurse describe to the client? Select all that apply. a. Application of topical antibiotic ointment b. Maintenance of a supine position for the first 48 hours postoperative c. Fluid restriction to prevent orbital edema d. Administration of loop diuretics to prevent orbital edema e. Use of an ocular pressure dressing

a, e Clients who undergo eye removal need to know that they will usually have a large ocular pressure dressing, which is typically removed after a week, and that an ophthalmic topical antibiotic ointment is applied in the socket three times daily. Fluid restriction, supine positioning, and diuretics are not indicated.

The nurse on the medical-surgical unit is reviewing discharge instructions with a client who has a history of glaucoma. The nurse should anticipate the use of what medications? a. Potassium-sparing diuretics b. Cholinergics c. Antibiotics d. Loop diuretics

b Cholinergics are used in the treatment of glaucoma. The action of this medication is to increase aqueous fluid outflow by contracting the ciliary muscle and causing miosis and opening the trabecular meshwork. Diuretics and antibiotics are not used in the management of glaucoma.

The nurse is providing health education to a client newly diagnosed with glaucoma. The nurse teaches the client that this disease has a familial tendency. The nurse should encourage the client's immediate family members to undergo clinical examinations how often? a. At least monthly b. At least once every 2 years c. At least once every 5 years d. At least once every 10 years

b Glaucoma has a family tendency and family members should be encouraged to undergo examinations at least once every 2 years to detect glaucoma early. Testing on a monthly basis is excessive.

A client has been diagnosed with glaucoma and the nurse is preparing health education regarding the client's medication regimen. The client states that she is eager to "beat this disease" and looks forward to the time that she will no longer require medication. How should the nurse best respond? a. "You have a great attitude. This will likely shorten the amount of time that you need medications." b. "In fact, glaucoma usually requires lifelong treatment with medications." c. "Most people are treated until their intraocular pressure goes below 50 mm Hg." d. "You can likely expect a minimum of 6 months of treatment."

b Glaucoma requires lifelong pharmacologic treatment. Normal intraocular pressure is between 10 and 21 mm Hg.

A nurse is teaching a client about medications for glaucoma. What is the main marker of glaucoma control with medication? a. Changing the opacity of the lens b. Lowering intraocular pressure to target pressure c. Reducing the appearance of optic nerve head d. Increasing the visual field

b 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.

A hospitalized client with impaired vision must get a picture in his or her mind of the hospital room and its contents in order to mobilize independently and safely. What must the nurse monitor in the client's room? a. That a commode is always available at the bedside b. That all furniture remains in the same position c. That visitors do not leave items on the bedside table d. That the client's slippers stay under the bed

b All articles and furniture must remain in the same positions throughout the client's hospitalization. This will reduce the client's risks for falls. Visual impairment does not necessarily indicate a need for a commode. Keeping slippers under the bed and keeping the bedside table clear are also appropriate, but preventing falls by maintaining the room arrangement is a priority.

Which client statement would lead the nurse to suspect that the client is experiencing bacterial conjunctivitis? a. "My eyes feel like they are on fire." b. "My eyelids were stuck together this morning." c. "It feels like there is something stuck in my eye." d. "My eyes hurt when I'm in the bright sunlight."

b Burning, a sensation of a foreign body, and pain in bright light (photophobia) are signs and symptoms associated with any type of conjunctivitis. The drainage related to bacterial conjunctivitis is usually present in the morning, and the eyes may be difficult to open because of adhesions caused by the exudate.

A client has just returned to the surgical floor after undergoing a retinal detachment repair. The postoperative orders specify that the client should be kept in a prone position until otherwise ordered. What should the nurse do? a. Call the physician and ask for the order to be confirmed. b. Follow the order because this position will help keep the retinal repair intact. c. Instruct the client to maintain this position to prevent bleeding. d. Reposition the client after the first dressing change.

b For pneumatic retinopexy, postoperative positioning of the client is critical because the injected bubble must float into a position overlying the area of detachment, providing consistent pressure to reattach the sensory retina. The client must maintain a prone position that would allow the gas bubble to act as a tamponade for the retinal break. Clients and family members should be made aware of these special needs beforehand so that the client can be made as comfortable as possible. It would be inappropriate to deviate from this order and there is no obvious need to confirm the order.

Which group of medications causes pupillary constriction? a. Mydriatics b. Miotics c. Beta-blockers d. Adrenergic agonists

b 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.

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? a. It does not work as rapidly as eye drops do. b. Blurred vision results after application. c. It has a lower concentration than eye drops. d. It has more side effects than eye drops.

b Ophthalmic ointments have extended retention time in the conjunctival sac and provide a higher concentration than eye drops. The major disadvantage of ointments is the blurred vision that results after application. In general, eyelids and eyelid margins are best treated with ointments.

A client has become legally blind as a result of macular degeneration. When attempting to meet this client's psychosocial needs, what nursing action is most appropriate? a. Encourage the client to focus on use of other senses. b. Assess and promote the client's coping skills during interactions with the client. c. Emphasize that lifestyle will be unchanged once adaptation to vision loss has occurred. d. Promote the client's hope for recovery.

b The nurse should empathically promote the client's coping with her loss. Focusing on the remaining senses could easily be interpreted as downplaying the client's loss, and recovery is not normally a realistic possibility. Even with successful adaptation, the client's lifestyle will be profoundly affected.

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. a. Place cool soaks on your eye each morning to remove purulent drainage. b. Do not wear contact lenses until there is no more inflammation. c. Stay at home for the first 24 hours. d. Wash hands before touching eyes and frequently during the day. e. Do not use the same towels or washcloths as other members of the family.

b, d, e 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.

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? a. Keep all follow-up appointments. b. Keep a record of eye pressure measurements. c. Adhere to the medication regimen. d. Participate in the decision-making process.

c All of the teaching points are important but the most important is emphasizing the strict adherence to the medication regimen because glaucoma cannot be cured but its progression can be slowed.

The nurse is assessing a new adult client. What characteristic of this client's status should the nurse identify as increasing the client's risk for glaucoma? a. The client uses over-the-counter NSAIDs. b. The client has a history of stroke. c. The client has diabetes. d. The client has Asian ancestry.

c Diabetes is a risk factor for glaucoma, but Asian ancestry, NSAIDs, and stroke are not risk factors for the disease.

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: a. The abrupt onset of symptoms. b. Reporting that a straight line appears crooked. c. The appearance of tiny, yellow spots in the field of vision. d. Reporting that letters in words appear broken.

c Drusen are tiny yellow spots that patients who have dry AMD report.

A client is diagnosed with an exudative retinal detachment. When reviewing the client's history, the nurse would identify which of the following as a possible underlying cause? a. Trauma b. Diabetes c. Macular degeneration d. Hypertension

c Exudative retinal detachment results from the production of a serous fluid under the retina from the choroid from such conditions as uveitis and macular degeneration. Trauma and diabetes (specifically, retinopathy associated with diabetic neovascularization) are associated with rhegmatogenous retinal detachment. Hypertension is associated with retinal vascular occlusion.

A client has just been diagnosed with early glaucoma. During a teaching session, the nurse should: a. provide instructions on eye patching. b. assess the client's visual acuity. c. demonstrate eyedrop instillation. d. teach about intraocular lens cleaning

c Eyedrop instillation is a critical component of self-care for a client with glaucoma. After demonstrating eyedrop instillation to the client and family, the nurse should verify their ability to perform this measure properly. An eye patch isn't necessary unless the client has undergone surgery. Visual acuity assessment isn't necessary before discharge. Intraocular lenses aren't implanted in clients with glaucoma.

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

c 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.

The nurse should monitor for which manifestation in a client who has undergone LASIK? a. Excessive tearing b. Cataract formation c. Halos and glare d. Stye formation

c Symptoms of central islands and decentered ablations can occur after LASIK surgery; these 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.

A legally blind client is in pre-op area prior to an appendectomy. What steps does the nurse take to effectively communicate with this client ? a. Make direct eye contact with the client when communicating. b. Sit near the client to provide reassurance of the strange surroundings. c. Notify the client prior to touching the client. d. Inform the client that the nurse will be working nearby.

c The nurse should announce upon arrival the bedside every time because many voices sound similar. The nurse should use the client's name initially so the client knows the nurse is communicating with the client directly. The nurse should speak before touching the client as not to startle the client. The nurse should notify the client when approaching and leaving the bedside each time. Orient the client to their surroundings using verbal descriptions and directions such as left, or right.

A client has just arrived to the floor after an enucleation procedure following a workplace accident in which his left eye was irreparably damaged. Which of the following should the nurse prioritize during the client's immediate postoperative recovery? a. Teaching the client about options for eye prostheses b, Teaching the client to estimate depth and distance with the use of one eye c. Assessing and addressing the client's emotional needs d. Teaching the client about his postdischarge medication regimen

c When surgical eye removal is unexpected, such as in severe ocular trauma, leaving no time for the client and family to prepare for the loss, the nurse's role in providing emotional support is crucial. In the short term, this is a priority over teaching regarding prostheses, medications, or vision adaptation.

The nurse is administering eye drops to a client with glaucoma. After instilling the client's first medication, how long should the nurse wait before instilling the client's second medication into the same eye? a. 30 seconds b. 1 minute c. 3 minutes d. 5 minutes

d A 5-minute interval between successive eye drop administrations allows for adequate drug retention and absorption. Any time frame less than 5 minutes will not allow adequate absorption.

When conducting an eye exam, the nurse practitioner is aware that a diagnostic clinical manifestation of glaucoma is: a. A significant loss of central vision. b. Diminished acuity. c. Pain associated with a purulent discharge. d. The presence of halos around lights.

d Most patients are unaware that they have glaucoma until they experience visual changes and vision loss. Usually the patient notices blurred vision and the presence of "halos" around lights.

A client with chronic open-angle glaucoma is being taught to self-administer pilocarpine. After the client administers the pilocarpine, the client states that her vision is blurred. Which nursing action is most appropriate? a. Holding the next dose and notifying the physician b. Treating the client for an allergic reaction c. Suggesting that the client put on her glasses d. Explaining that this is an expected adverse effect

d Pilocarpine, a miotic drug used to treat glaucoma, achieves its effect by constricting the pupil. Blurred vision lasting 1 to 2 hours after instilling the eye drops is an expected adverse effect. The client may also note difficulty adapting to the dark. Because blurred vision is an expected adverse effect, the drug does not need to be withheld, nor does the physician need to be notified. Likewise, the client does not need to be treated for an allergic reaction. Wearing glasses will not alter this temporary adverse effect.

A client is being discharged home from the ambulatory surgical center after cataract surgery. In reviewing the discharge instructions with the client, the nurse instructs the client to immediately call the office if the client experiences what? a. Slight morning discharge from the eye b. Any appearance of redness of the eye c. A "scratchy" feeling in the eye d. A new floater in vision

d Cataract surgery increases the risk of retinal detachment and the client must be instructed to notify the surgeon of new floaters in vision, flashing lights, decrease in vision, pain, or increase in redness. Slight morning discharge, some redness, and a scratchy feeling may be expected for a few days after surgery.

A client with a diagnosis of retinal detachment has undergone a vitreoretinal procedure on an outpatient basis. What subject should the nurse prioritize during discharge education? a. Risk factors for postoperative cytomegalovirus (CMV) b. Compensating for vision loss for the next several weeks c. Nonpharmacologic pain management strategies d. Signs and symptoms of increased intraocular pressure

d Clients must be educated about the signs and symptoms of complications, particularly of increasing IOP and postoperative infection. CMV is not a typical complication and the patient should not expect vision loss. Vitreoretinal procedures are not associated with high levels of pain.

A client is exploring treatment options after being diagnosed with age-related cataracts that affect her vision. What treatment is most likely to be used in this client's care? a. Antioxidant supplements, vitamin C and E, beta-carotene, and selenium b. Eyeglasses or magnifying lenses c. Corticosteroid eye drops d. Surgical intervention

d Surgery is the treatment option of choice when the client's functional and visual status is compromised. No nonsurgical (medications, eye drops, eyeglasses) treatment cures cataracts or prevents age-related cataracts. Studies recently have found no benefit from antioxidant supplements, vitamins C and E, beta-carotene, or selenium. Corticosteroid eye drops are prescribed for use after cataract surgery; however, they increase the risk for cataracts if used long-term or in high doses. Eyeglasses and magnification may improve vision in the client with early stages of cataracts, but have limitations for the client with impaired functioning.

The registered nurse taking shift report learns that an assigned client is blind. How should the nurse best communicate with this client? a. Provide instructions in simple, clear terms. b. Introduce herself in a firm, loud voice at the doorway of the room. c. Lightly touch the client's arm and then introduce herself. d. State her name and role immediately after entering the client's room.

d There are several guidelines to consider when interacting with a person who is blind or has low vision. Identify yourself by stating your name and role, before touching or making physical contact with the client. When talking to the person, speak directly at him or her using a normal tone of voice. There is no need to raise your voice unless the person asks you to do so and there is no particular need to simplify verbal instructions.