Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders PREP U

A nurse is performing an eye examination. Which question would not be included in the examination?

"Are you able to raise both eyebrows?"

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?

"This test measures peripheral vision and detects gaps in the visual field."

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

10 to 20 mm Hg.

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?

20/200

A patient is suspected of having glaucoma. What reading of IOP would demonstrate an increase resulting from optic nerve damage?

21 mm Hg or higher Intraocular pressure of greater than 21 mm Hg is a sign of primary open-angle glaucoma.

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

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

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

Cholinergics explanation: Cholinergic increase aqueous fluid outflow by contracting the ciliary muscle, causing meiosis and opening the trabecular meshwork. Beta-blockers decrease aqueous humor production. Alpha-adrenergic agonists decrease aqueous humor production. Carbonic anhydrase inhibitors decrease aqueous humor production.

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

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

Halos and glare

Which type of benign tumor of the eyelids is characterized by superficial, vascular capillary lesions that are strawberry-red in color?

Hemangioma Hemangiomas are vascular capillary tumors that may be bright, superficial, strawberry-red lesions or bluish and purplish deeper lesions. Milia are small, white, slightly elevated cysts of the eyelid that may occur in multiples. Xanthelasma are yellowish, lipoid deposits on both lids near the inner angle of the eye; these commonly appear as a result of the aging of the skin or a lipid disorder. Nevi are freckles.

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?

Improve outflow drainage

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

Laser-assisted in situ keratomileusis (LASIK)

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

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 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?

Marked blurring of vision 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.

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

Mucopurulent ocular discharge Bacterial conjunctivitis manifests with an acute onset of redness, burning, and discharge. Purulent discharge occurs in severe acute bacterial infections, whereas mucopurulent discharge appears in mild cases.

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?

Myopia

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

NSAIDs

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 ?

Notify the client prior to touching the client.

The nurse is assisting the eye surgeon in completing an examination of the eye. Which piece of equipment would the nurse provide to the physician to examine the optic disc under magnification?

Ophthalmoscope

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?

Prolonged use of corticosteroids

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

Scleral buckle he buckle holds the retina against the sclera until scarring seals the tear.

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:

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

The nurse is assessing an older client's vision. The nurse integrates knowledge of which of the following during the assessment?

The power of the lens to accommodate will be decreased

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?

To ensure correct application of antibiotic ointment, gently drag tip of tube along lower lid while squeezing ointment on to lid. Explanation: 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.

To straighten the ear canal in an adult for examination, the nurse practitioner would grasp the auricle and pull it:

Up and backward. Explanation: The tympanic membrane is inspected with an otoscope, which should be held in the examiner's right hand. Using the opposite hand, the auricle is grasped and gently pulled upward and back to straighten the canal in an adult.

A patient is suspected of having retinal detachment. The nurse would expect to prepare the patient for which of the following? Select all that apply.

Visual acuity testing Indirect ophthalmoscopy Slit lamp biomicroscopy Fluorescein angiography Testing for retinal detachment includes visual acuity testing, indirect ophthalmoscopy, slit lamp biomicroscopy, and fluorescein angiography. The Amsler grid is used to evaluate for macular degeneration. Tonometry is used to evaluate for glaucoma.

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

hyperopia

A young baseball player was fielding a ground ball when it bounced and struck the player in the left eye, leaving a large ecchymosis and edema. In client education, after applying an ice pack, the nurse explains the functions of the various structures of the eye. What glands, contained in the eyelids, produce tears?

lacrimal

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

light flashes and floaters in front of the eye.

A nurse notices that a client's left upper eyelid is drooping. The nurse has observed

ptosis

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

to prevent vision loss