EAQ 20 Visual Problems and Visual Assessment (2 EAQ)

Which finding related to primary open-angle glaucoma would the nurse expect to find when reviewing a patient's history and physical examination report? A· Absence of pain or pressure B· Blurred vision in the morning C· Seeing colored halos around lights D· Eye pain accompanied with nausea and vomiting

A

When providing preprocedure teachings for a patient with high degrees of myopia, what is the correct order for the nurse to explain the steps that the health care provider performs a laser-assisted in situ keratomileusis (Lasik) procedure? 1. 2. 3. 4. 5.

1. A flap is created in the cornea using a laser or surgical blade. 2. The flap is folded back on the middle section, or stroma, of the cornea. 3. Pulses from a computer-controlled laser vaporize a part of the stroma. 4. The flap is repositioned carefully. 5. The flap adheres on its own without sutures in a few minutes.

Which information would the nurse include when reinforcing the health teachings for a patient diagnosed with primary open-angle glaucoma? A· Pressure damage to the optic nerve may occur because of clogged drainage channels. B· The retinal nerve is damaged by an abnormal increase in the production of aqueous humor. C· The pupillary opening is blocked secondary to decreased aqueous humor in the anterior chamber. D· The lens enlarges with normal aging, pushing the iris forward, blocking the outflow of aqueous humor.

A

Which intervention would the nurse teach a patient about managing blepharitis? A· Gently cleaning the lid margins with baby shampoo B· Monitoring the spread of infection to the opposing eye C· Regular instillation of artificial tears to the affected eye D· Teaching the patient and family members good hygiene techniques

A

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· Macular degeneration B· Hypertensive retinopathy C· Benign prostatic hypertrophy D· Chronic obstructive pulmonary disease (COPD)

B

For which clinical manifestations would the nurse monitor the patient after a fluorescein angiography? Select all that apply. A. Redness of the eyes B. Yellowish discoloration of the skin C. Yellowish discoloration of the urine D. Nausea and vomiting after the procedure E. Red-colored urine indicative of presence of blood

B. Yellowish discoloration of the skin C. Yellowish discoloration of the urine D. Nausea and vomiting after the procedure Rationale: In fluorescein angiography, fluorescein is injected in 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. 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.

Which information would the nurse provide to the patient who needs a corneal transplant but refuses the procedure because of the vision difficulties lasting up to 12 months after transplant? A· If the transplant is performed soon after donor death, recovering vision is not as difficult. B· The astigmatism that the patient experiences may be corrected with glasses or rigid contact lenses. C· Increasing the amount of light and using a magnifier to read will be helpful if a transplant is not wanted. D· Newer procedures limit the transplanted tissue to the damaged areas of cornea only and have a faster recovery.

D

Which intervention assists in preventing further vision loss from chronic open-angle glaucoma? A· Tobacco smoking cessation B· Yearly ophthalmic examination C· Eating a diet high in green leafy vegetables and lysine D· Strict adherence to prescribed eyedrop medication schedule

D

Which intervention would be the nurse's priority to implement for the patient with poor visual acuity from age-related macular degeneration (AMD)? A· Teach about visual enhancement techniques. B· Teach nutritional strategies to improve vision. C· Assess coping strategies and support systems. D. Assess impact of vision on normal functioning

D

Which action would the nurse implement when performing an eye assessment of a patient's near visual acuity and a jaeger chart is not available? A. Use Snellen's chart for assessment. B. Skip the test, as it is not important. C. Ask the patient to come back the next day. D. Use a newspaper or the label on a container.

D. Use a newspaper or the label on a container. Rationale: 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 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

While in the preoperative area prior to cataract removal surgery, which intervention would the nurse implement after administering tropicamide (Mydriacyl) in both eyes of a patient? A· Brighten the room with extra lights. B· Provide the patient dark glasses to wear. C· Monitor for the patient for pulmonary effects of the drug. D· Reassure the patient that the surgery will be soon and uneventful

B

For the patient diagnosed with proliferative diabetic retinopathy, which surgical procedure to relieve traction on the retina will the nurse provide instructions for and schedule? A· Vitrectomy B· Cryotherapy C· Photodynamic therapy D· Ocular coherence tomography

A

With which age group would the nurse associate the development of presbyopia, because the eye loses flexibility and is unable to accommodate close vision? A· Adolescents and young adults B· Men and women older than 40 C· Men between the ages of 30 and 50 D· Women between the ages of 20 and 40

B

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 B· Urinary retention C· Cluster headaches D· Chronic constipation

A

For which procedure will the nurse provide additional information to the patient who states, "They are going to stick a very cold probe into my eye to produce a scar on my torn retina"? A· Cryopexy B· Scleral buckling C· Pneumatic retinopexy D· Laser photocoagulation

A

The health care provider's assessment identified optic nerve atrophy and peripheral visual field loss in the patient reporting sudden, severe eye pain accompanied by nausea and vomiting. When providing the patient's discharge instructions, which medication would the nurse correlate with this disorder? A· Betaxolol (Betoptic) B· Besifloxacin (Besivance) C· Tropicamide (Mydriacyl) D. Ranibizumab (Lucentis)

A

When assessing a patient for esotropia, which finding is clinically significant? A· Eye deviating in B· Eye deviating up C· Eye deviating out D· Eye deviating down

A

When assessing for the presence of allergic conjunctivitis, about which clinical manifestation would the nurse ask the patient? A· Itching B· Photophobia C· Protruding eyeball D· Purulent discharge

A

When assessing four patients reporting visual problems, the nurse would associate which patient's clinical manifestation with retinal detachment? Patient A Patient B Patient C Patient D

A

Which action would the nurse implement immediately when visiting a patient who is two days post-cataract surgery and reporting intense eye pain? A· Notify the surgeon. B· Administer eyedrops. C· Administer analgesics. D· Apply a cold compress.

A

Which clinical manifestation would the nurse document and report when suspecting a patient of having age-related macular degeneration (AMD)? A· Blurred, darkened vision B· Itching, burning, and redness C· Sudden, excruciating pain in the eye D· Decreased vision and abnormal color perception

A

Which condition is caused by a refractive error within the eye? A· Myopia B· Cataract C· Glaucoma D· Conjunctivitis

A

Which refractive error describes the vision of a patient for whom nearby objects are clear but objects at a distance are blurred? A. Myopia B. Hyperopia C. Presbyopia D. Astigmatism

A. Myopia Rationale: The individual with myopia (nearsightedness) can see nearby objects clearly, but objects at a distance appear blurred. The individual with hyperopia (farsightedness) can see distant objects clearly, but close objects appear blurred. Presbyopia is a loss of accommodation, causing an inability to focus on near objects. Astigmatism is an uneven curvature of the cornea, which results in visual distortion. p. 351

For the 52-year-old African American patient, which statement reflects understanding of content taught by the nurse on glaucoma prevention? A· "I will visit my eye doctor every one to two years." B· "I will wear protective sunglasses while outside." C· "I will take lutein and vitamin E supplements for eye health." D· "There is nothing that can be done to prevent vision loss from glaucoma."

A

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. B· Discourage the use of mild topical corticosteroids. C· Advise the patient to avoid the use of topical antibiotic ointments. D. Advise the patient to avoid implementing any treatment, because the condition is self-limiting

A

The adult child of a patient with macular degeneration asks how to avoid developing this condition. Which interventions would the nurse include when teaching? Select all that apply. A· Stop smoking or do not start. B· Avoid eye exposure to ultraviolet light. C· Wash hands before touching face or eyes. D· Wear eye protection while doing yard work. E· Eat green leafy vegetables (spinach or kale) regularly.

A, B, E

Which interventions would the nurse perform when administering acetazolamide (Diamox) to a patient with chronic glaucoma? Select all that apply. A· Monitor the patient's electrolyte levels. B· Ask if the patient is allergic to sulfa drugs. C· Avoid use if the patient has a history of asthma. D· Caution the patient about decreased visual acuity. E· Avoid use if the patient is on high-dose aspirin therapy.

A, B, E

Which actions would the nurse implement when using the sighted-guide technique to assist a patient who is blind? Select all that apply. A· Describe the environment to the patient while walking. B· Walk behind the patient, while touching the patient's back. C· Help the patient to sit by placing the patient's hand on the seat of the chair. D· Stand slightly in front and to one side of the patient; provide an elbow for support. E· Place a gait belt around the patient's waist and use the belt to guide the patient.

A, C, D

For which diagnostic study will the nurse prepare the patient suspected of having glaucoma and reporting blurred vision, headache, and pain? A. Perimetry B. Keratometry C. Stereoscopic vision D. Ultrasonography B-Scan

A. Perimetry Rationale: Perimetry (visual field test) is used to diagnose glaucoma. Keratometry measures corneal curvature. It is an assessment, not a diagnostic tool. Stereoscopic vision allows a patient to see objects in three dimensions. Ultrasonography B-scan is used to diagnose pathologic ocular conditions such as foreign bodies, tumors, and retinal detachments. p. 358, 370

Which conditions would the nurse associate with a patient's report of seeing "spider web-like" formations in the visual field over the last few days? Select all that apply A. Tears in the retina B. Vitreous liquefaction C. Shortening of the ciliary muscles D. Hemorrhage in the vitreous humor E. Overaction of the extraocular muscle

A. Tears in the retina B. Vitreous liquefaction D. Hemorrhage in the vitreous humor Rationale: Vitreous liquefaction is the most common cause of floaters and "spider web-like" images in the visual field. This can also be caused by trauma to the eye. Tears or holes in the retina and hemorrhage in the vitreous humor can also cause "spider web-like formations" in the visual field. Shortening of ciliary muscles affects the near vision of the person. Overaction of the extraocular muscle causes abnormal movement of the eyes. This is known as strabismus. p. 356

For the patient with severe myopia, which type of correction is scheduled when the patient states, "I can't wait to see after they implant contact lenses over my existing ones"? A· Photorefractive keratectomy (PRK) B· Phakic intraocular lenses (phakic IOLs) C· Refractive intraocular lenses (refractive IOLs) D· Laser-assisted in situ keratomileusis (LASIK)

B

About which treatment option, when prescribed by the health care provider, would the nurse provide additional information for the patient diagnosed with proliferative retinopathy? A· Filtration surgery B· Photodynamic therapy C· Laser photocoagulation D. Argon laser trabeculoplasty

C

Which surgery treats age-related macular degeneration (AMD) by destroying abnormal blood vessels without causing permanent damage to the retinal pigment epithelium and photoreceptor cells? A· Filtration surgery B· Photodynamic therapy C· Laser photocoagulation D· Argon laser trabeculoplasty

B

Which visual disorder would the nurse associate with the patient's clinical manifestations of itching, irritation, intolerance of light, and crusty debris on the lid margins and lashes? A· Cataract B· Blepharitis C· Retinal detachment D· Allergic conjunctivitis

B

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· Place the patient in a flat supine position. B· Stabilize the foreign object within the injury site. C· Instruct the patient to bend over and take deep breaths. D· Continuously irrigate the eye with sterile saline solution.

B

When performing an eye examination, which patient clinical manifestations would the nurse document as abnormal? Select all that apply. A. The pupils are equal and round. B. The right pupil is slightly smaller than the left one. C. The pupils dilate when introducing a light stimulus. D. The pupils constrict when introducing a light stimulus. E. The right pupil constricts faster than the left when subjected to a light.

B, C, E Rationale: Whenever light stimulus is given, the pupils constrict to regulate the amount of light falling on the retina. The iris regulates the size of the pupils. Under normal circumstances, both of the pupils are equal in diameter. The normal shape of pupils is round. Pupils do not dilate when light falls on them. The pupils dilate when the amount of light in the environment is less. Dilation of the pupils enables more light to enter the eye and helps the person to see better. pp. 356

Which explanation would the nurse provide when a patient with a sudden decrease in vision receives a diagnosis of papilledema and inquires as to what papilledema is? A· "Papilledema is caused by irritants and microorganisms." B· "Papilledema is fluid accumulation between two layers within the retina." C· "Sustained, severe high blood pressure can cause swelling of the optic disc and nerve, resulting in papilledema." D· "This condition is caused by the development of abnormal blood vessels in or near the macula inside your eye."

C

Which explanation would the nurse use when a patient asks, "How does glaucoma damage my eyesight?" A· Glaucoma leads to detachment of the retina. B· Chronic eye inflammation and damage caused the glaucoma. C· Increased intraocular pressure from the glaucoma causes the damage. D· Decreased blood flow to the retina occurs because of the glaucoma.

C

Which intervention would the nurse implement to provide relief of the patient's discomfort when presenting to the clinic with a red, swollen, circumscribed, acutely tender area near the eye and in the lid margin? A· Administration of artificial tears B· Insertion of Intacs on the cornea C· Application of a warm, moist compress four times a day D. Administration of nonsteroidal antiinflammatory eye drops

C

Which prescription would the nurse question prior to administering to a patient with keratitis caused by the herpes simplex virus (HSV)? A· Oral acyclovir (Zovirax) B· Trifluridine drops (Viroptic) C· Topical corticosteroids (Aristocort A) D· Topical vidarabine ointment (VIRA-A 3%)

C

Which response would the nurse use when asked why the lights were dimmed prior to instillation of the patient's pupil-dilating eyedrops? A· To decrease pain B· To prevent anxiety C· To minimize photophobia D· To minimize intraocular pressure

C

When interviewing a patient with a new diagnosis of glaucoma, which question is most relevant to the patient's condition? A. "Have you ever had surgery?" B. "When was the last test for visual acuity done?" C. "Do you have a history of cardiac or pulmonary disease?" D. "Has there been any recent change in your eyeglasses or contact lenses?"

C. "Do you have a history of cardiac or pulmonary disease?" Rationale: 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 blood pressure, 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. p. 371-372

When evaluating a patient's visual acuity, which assessment tool would the nurse use? A. Slit-lamp B. Audiometer C. Snellen chart D. Retinal angiography

C. Snellen chart Rationale: 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. p. 355, 357

The nurse is assessing a patient's distance and near visual acuity. What test should the nurse perform? A. Ishihara B. Tonometry C. Snellen chart D. Confrontation visual field

C. Snellen chart Rationale: The Snellen eye chart is used to test distance and near visual acuity. Ishihara is a test for color vision. Tonometry tests the intraocular pressure. The confrontation visual field test determines if a patient has a full field of vision without scotomas. p. 356

A patient is exhibiting deviation of eye position in one or more directions. Which abnormal visual system finding does the nurse document is occurring with this patient? A. Diplopia B. Cataract C. Strabismus D. Exophthalmos

C. Strabismus Rationale: 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. p. 357

For the patient who wears contact lenses, which intervention would the nurse teach the patient when diagnosed with bacterial conjunctivitis? A· Discard all opened or used contact lenses and lens care products. B· Disinfect contact lenses by soaking in a cleaning solution for 48 hours. C· Put all used cosmetics in a plastic bag for one week to kill any bacteria before reusing. D. Disinfect all lens care products with prescribed antibiotic drops for one week post infection.

A

The neighbor of a nurse states, "While I was walking, I got something in my eye." Which intervention would the nurse implement for a suspected foreign object in the patient's eye? A· Irrigate the eye with a sterile normal saline solution. B· Attempt to remove the object without causing further damage to the eye. C· Refrain from doing anything until the patient can be seen by an ophthalmologist. D· Loosely cover the eye with a sterile patch and refer the patient to emergency care.

D

When admitting a patient with glaucoma who reports an allergy to all sulfa drugs, which prescribed medication would the nurse question by contacting the health care provider? A· Carteolol (Ocupress) B· Dipivefrin (Propine) C· Carbachol (Miostat) D· Acetazolamide (Diamox)

D

Which intervention would the nurse implement for a patient who has undergone retinal surgery and injection of an intravitreal bubble? A· Monitor the BP. B· Prevent fluid volume excess. C· Maintain a darkened environment. D· Instruct on positioning and activity as preferred by the surgeon.

D

A nurse is obtaining a health history from a patient with decreased visual acuity. Which question related to sexuality is relevant for this patient? A. "Do you use birth control pills?" B. "Do you have regular periods?" C. "How many children do you have?" D. "Do you and your partner use condoms during intercourse?"

A. "Do you use birth control pills?"

Which intervention would the nurse implement when providing care for a patient who lost an eye after an industrial accident yesterday? A· Speak louder when talking to the patient. B· Avoid making eye contact during a conversation. C· Introduce the patient to other visually impaired persons. D· Assist the patient with the same grieving process associated with other losses. Assist the patient with the same grieving process associated with other losses.

D

Which medication would the nurse anticipate providing when the patient complains of eye irritation and soreness after using a homemade saline solution to store contacts? A· Tropicamide (Mydriacyl) B· Besifloxacin (Besivance) C· Acetazolamide (Diamox) D· Ketoconazole (Nizoral)

D

Which additional clinical manifestation would the nurse associate with the patient whose anterior cornea is cone-shaped? A· Pain B· Blurred vision C· Corneal inflammation D· Abnormal color perception

B

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

A. "Does your eye problem hamper your daily activities?" E. "Have you participated in any activity that may be harmful to your eyes?" Rationale: 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 if 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. p. 353

Which information would the nurse share with the patient preparing for an ultrasonography of the eye? A. "You will not experience pain during the test." B. "Nausea and yellow-orange urine may occur after the test." C. "Focusing on near objects may be difficult for three to four hours after the test." D. "Focus on the center dot located within the grid lines until the test is completed"

A. "You will not experience pain during the test." Rationale: Ultrasonography involves corneal anesthetization and is not painful. During refractometry, the patient's eyes are dilated to visualize the retina and optic nerve. Therefore the patient may have difficulty focusing on near objects for three to four hours after refractometry. Fluorescein angiography involves administering a dye into the patient's body via the intravenous route. Therefore the patient may have nausea and yellow-orange discoloration of the urine after fluorescein angiography. The Amsler grid test assesses the patient's vision by asking the patient to report the abnormalities he or she finds in the grids. During the Amsler grid test, the patient should fixate on the center dot and record the abnormalities of the grid lines. P. 358

The patient has described a loss of central vision. What test should the nurse teach the patient about to identify changes in macular function? A. Amsler grid test B. B-scan ultrasonography C. Fluorescein angiography D. Intraocular pressure testing with Tono-pen

A. Amsler grid test Rationale: 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. p. 359

During visual examination of a patient, the nurse notices that the patient has a red, watery eye and inflammation of the conjunctiva. What does the nurse anticipate the cause to be? A. Bacterial or viral infection B. Increased intraocular pressure C. Intraocular or periorbital tumors D. Inflammation of the anterior uvula tract

A. Bacterial or viral infection

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 B. Presbyopia C. Blepharodermachalasis D. Yellow discoloration of the sclera

A. Cataract Rationale: 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. p. 354

A patient expresses concern about the effect of vision loss on reading. This is an example of which component of a visual health history? A. Cognitive-perceptual B. Coping-stress tolerance C. Self-perception-self-concept D. Health perception-health management

A. Cognitive-perceptual Rationale: A visual deficit that affects a patient's ability to read is an example of a cognitive-perceptual problem. The coping-stress tolerance component explores how a patient is tolerating and coping with changes in vision. A self-perception-self-concept response is related to how a patient feels about himself or herself. Health perception-health management allows the healthcare professional to assess the patient's awareness of his or her visual health and self-care. p. 354

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 on vision? A. Determine the patient's full field of vision B. Appraising pupillary response for each eye C. Evaluating visual effects of corneal curvature D. Assessing near and distance visual acuity

A. Determine the patient's full field of vision Rationale: 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. p. 355

Which initial assessment question would the nurse ask when a college student reports to infirmary of eye pain during finals week? A. Do you wear contacts? B. Do you have any allergies? C. Do you have double vision? D. Can you describe the change in your vision.

A. Do you wear contacts? Rationale: College students frequently wear contact lenses and will be up late or all night studying for finals. If the student wears contacts, the wearing of them while studying, care of them, and length of wear time should be assessed before looking for a corneal abrasion from extended wear with fluorescein dye. There are no manifestations of allergies, diplopia, or visual changes mentioned. p. 352, 354

Which gerontologic findings related to assessment of the visual system would the nurse anticipate when planning care for an older adult patient? Select all that apply. A. Loss of hair pigment B. Darkened iris pigment C. Increased tear secretion D. Increased rigidity of the lens E. Atrophy of the corneal nerves F. Increased orbital fat and muscle tone

A. Loss of hair pigment D. Increased rigidity of the lens E. Atrophy of the corneal nerves Rationale: There is increased lens rigidity, resulting in presbyopia and loss of hair pigment. This loss is responsible for the graying of the eyebrows and eyelashes. Atrophy of the corneal nerves results in a decrease in the corneal sensitivity and reflex. The change in iris color that occurs in an aging patient is due to loss of pigment, which appears as a lightening of the iris. The older adult also experiences decreased secretion of tears, resulting in dryness of the eyes. Decreases in orbital fat and muscle tone result in entropion, ectropion, and mild ptosis. p. 353

A patient reports pain in the left eye, and the healthcare provider is using a fluorescein stain to assess the eye. What is a priority for the nurse in the care of this patient? A. Monitor for extravasation B. Monitor for retinal detachment C. Monitor the patient for nausea and vomiting D. Report yellow-orange discoloration of the urine

A. Monitor for extravasation Rationale: Fluorescein is toxic to tissue, so it is important to monitor the patient for extravasation at the intravenous 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. p. 359

When documenting a patient's health assessment, the nurse utilized the abbreviation: PERRLA. Which findings did the nurse document? Select all that apply. A. Pupils are round B. Retina responds to light C. Lacrimal apparatus is functioning D. Intraocular pressure is even and within normal E. Pupils constrict when the patient focuses on a nearer object

A. Pupils are round E. Pupils constrict when the patient focuses on a nearer object Rationale: The abbreviation for a normal pupillary response is PERRLA (pupils are equal [in size], round, react to light, and accommodation). Accommodation occurs when the pupil constricts when focusing on a nearer object. The retina is examined with use of an ophthalmoscope. The lacrimal apparatus contains the structures involved with tear formation and distribution to maintain eye moisture. Intraocular (within the eye) pressure is measured with various instruments and normally is 10 to 21 mm Hg. P. 355

During a patient's assessment of pupillary function, which steps would the nurse perform when assessing accommodation? SATA A. Request that the patient focus on the nurse's identified finger. B. Ask the patient to focus on any distant objects within the examination room. C. Place an index finger at a distance of 20 feet from the patient's nose D. Identifies one finger and locates it 3 inches from the patient's nose. E. Identifies a personal finger and locates it at a distance of 6 meters from the patient's nose.

A. Request that the patient focus on the nurse's identified finger. B. Ask the patient to focus on any distant objects within the examination room. D. Identifies one finger and locates it 3 inches from the patient's nose. Rationale: In order to check the accommodation capacity of the patient's eyes, the nurse has to first ask the patient to focus on a distant object. The patient is then instructed to focus on the nurse's finger, which is placed 3 inches from the patient's nose. The normal response is convergence and constriction of the eyes. A Snellen chart is used for testing visual acuity. The distance of 20 feet, or 6 meters, is maintained while reading a Snellen chart. p. 357

When planning the discharge of a patient after eye surgery, which activities would the nurse instruct the patient to avoid? Select all that apply. A· Eating B· Lifting C· Coughing D· Bending over E· Breathing deeply

B, C, D

The sclera of an older African American adult patient's eyes has a slight yellowish cast with small blood vessels visible along the edges in the conjunctiva. Which conclusion would the nurse document from the assessment findings? A. The assessment findings are within the normal range. B. The patient should have serum coagulation tests done. C. The patient likely has a history of uncontrolled hypertension. D. The patient needs serum liver function tests to determine hepatic function

A. The assessment findings are within the normal range. Rationale: 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. p. 357

Prior to an ophthalmic examination, which clinical observation would the nurse associate with the patient experiencing double vision? A B C D

B Rationale: Patient B is holding his or her head in skewed or oblique position, which is indicative of the patient having diplopia. Patients who have diplopia have double vision and hold the head in a skewed position in an attempt to see a single image. Patient A has dressed himself or herself in an unusual color combination, which is indicative of color blindness. Patient C covers his or her eyes to block the light, which is indicative of photophobia. Patient D is making eye contact with the nurse, which is positive behavior. Pp. 355, 353

Which assessments would the nurse perform when completing a focused visual examination? A. Keratometry B. Peripheral vision C. Extraocular movement D. Color vision and night vision E. Distance and near visual acuity F. PERRLA (pupils equal, round, reactive to light and accommodation)

B, C, E, F Rationale: The nurse completing a focused visual assessment includes examination using PERRLA, which focuses on whether the pupils are equal, round, reactive to light, and able to focus on objects that are close up and far away (accommodation). The nurse will also perform assessments of peripheral vision, extraocular movement, and distance and near visual acuity. Keratometry measures corneal curvature and is not part of a focused visual assessment. p. 355

Which response would the nurse use when a patient diagnosed with astigmatism ask the impact of this problem to vision health? A. "Astigmatism is a clouding of the lens causing glare problems." B. "This problem distorts your vision because of corneal is uneven." C. "Astigmatism limits visual acuity because of damage to the optic nerve." D. "The excess fluid accumulation within your eye causes elevated eye pressures"

B. "This problem distorts your vision because of corneal is uneven." Rationale: Astigmatism, a refractive error causing distorted vision, occurs when the surface of the cornea is not smooth. Damage to the optic nerve results in loss of part or all of the visual field. Cataracts, the clouding of the lens, often occur with age and leads to problems seeing, including glare. Glaucoma is a disease causing damage to the optic nerve from elevated intraoptic pressure. p. 358

A patient comes to the clinic for an ophthalmic checkup. A nurse performs an assessment of visual acuity using a Snellen chart. The patient should be positioned how many feet away from the Snellen chart? A. 6 feet away B. 20 feet away C. 24 feet away D. 30 feet away

B. 20 feet away

Which medication would the nurse associate with patient's report of a sandy, gritty sensation in the eye along with irritation and discomfort? A. Corticosteroids B. Antihistamines C. Aminoglycosides D. β-adrenergic blockers

B. Antihistamines Rationale: A sandy, gritty sensation in the eye that is accompanied by irritation and discomfort indicates corneal dryness. Decongestants and antihistamines cause ocular dryness. Long-term use of corticosteroids may result in glaucoma or cataracts. Medications that are used over-the-counter usually have ocular effects. Aminoglycosides are ototoxic and, therefore, can cause hearing loss, tinnitus, or vertigo. β-adrenergic blockers are used for treating glaucoma. p. 353

Which clinical manifestation would the patient experience when a health care provider identifies smaller and stiffer than normal ciliary muscles during an ophthalmic examination? A. Clouding in the lens B. Decrease in near vision C. Decreased diameter of pupils D. Difficulty in perception of colors

B. Decrease in near vision Rationale: Ciliary muscles are the muscles responsible for near vision. If these muscles become smaller or stiffer, the person has difficulty in adjusting near vision. A cataract is a very common age-related disorder. This is formed due to biochemical changes in the lens proteins, which results in clouding of the lens. Changes in perception of colors are not related to the dilator muscle. The diameter of the pupil is regulated by the muscle called the iris. Stiffening or rigidity of the iris causes decreased diameter of pupils. Color perception is carried by cones in the retina. A decrease in the number of cones causes difficulty in perception of colors. p. 350, 352

Which question will the nurse ask a patient based on the following eye assessment findings? A. Do you have loss of central vision? B. Do you have trouble seeing at night? C. Do you notice floaters in your visual fields? D. Do you notice a change in color perception?

B. Do you have trouble seeing at night? Rationale: 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? P. 352, 354, 364

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· Vacillating pupil B· Constant tearing C· Decreased peripheral vision D· Colored halos around lights

C

When performing an eye assessment, which of the patient's prescribed medications would the nurse associate with the patient's pupil size of 1 to 2 mm? A· Carteolol (Ocupress) B· Dipivefrin (Propine) C· Carbachol (Miostat) D· Latanoprost (Xalatan)

C

A patient has ptosis resulting from myasthenia gravis. Which assessment finding would the nurse expect to see in this patient? A. Redness and swelling of the conjunctiva B. Drooping of the upper lid margin in one or both eyes C. Redness, swelling, and crusting along the lid margin D. Small, superficial white nodules along the lid margin

B. Drooping of the upper lid margin in one or both eyes Rationale: Ptosis is the term used to describe drooping of the upper lid margin, which may be either unilateral or bilateral. Ptosis can be a result of mechanical causes, such as an eyelid tumor or excess skin, or from myogenic causes, such as myasthenia gravis. Ptosis is not related to redness and swelling of the conjunctiva or lid margin or small, superficial white nodules along the lid margin. p. 357

Which instructions would the nurse provide the patient scheduled for an Amsler Grid test? Select all that apply. A. Keep the test card at a distance of 10 feet. B. Hold the test card at a comfortable distance. C. Report any abnormality like lines appearing wavy. D. Focus on the center dot that is present on the card. E. Focus on all four corners of the card in a clockwise pattern.

B. Hold the test card at a comfortable distance. C. Report any abnormality like lines appearing wavy. D. Focus on the center dot that is present on the card Rationale: An Amsler Grid test can be carried out by the patient. This test is done to identify any changes in macular function. The correct procedure for an Amsler Grid test is as follows: The patient holds the card at a comfortable reading distance, and focuses on a dot present in the center of the chart. The test card is held at the same distance a person holds a book for reading. The person has to focus on the center dot and not on the corners. If there is pathology involved, the patient may feel that the lines around the dot are wavy, distorted, or even missing. If the patient finds any abnormality in the surrounding line, he should make a note of it and take advice from a primary health care practitioner. The distance of 10 feet is not required for this test. The patient does not focus on the four corners of the card.p. 358

A patient has a hemorrhage in the fundus area of the eye. Where does the nurse determine that blood is accumulating? A. In the aqueous humor B. In the retinal background C. Between the cornea and the lens D. In the space between the iris and the lens

B. In the retinal background Rationale: The fundus is the retinal background. Normally, no hemorrhages or exudates are 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. P. 357

Which disorder would the nurse associate with a patient who works in the hospital's radiology department and has bilateral small, yellowish spots on the conjunctiva? A. Pterygium B. Pinguecula C. Presbyopia D. Arcus Senilis

B. Pinguecula Rationale: Small, yellowish spots on the medial aspect of the conjunctiva are associated with pinguecula, which occurs as a result of tissue damage related to chronic exposure to ultraviolet light. Because the patient works in the radiology department, the likelihood of exposure to ultraviolet light is high. Pterygium is an abnormality of the cornea that is associated with chronic exposure to sunlight, which manifests as thickened, triangular, pale tissue extending from the inner canthus to the nasal border. Presbyopia is a refractive error that is associated with the loss of near vision. This condition manifests as increased rigidity of the lens, not yellow spots on the conjunctiva. Arcus senilis is an abnormality of the cornea that occurs because of cholesterol deposition in the peripheral cornea and manifests as a milky white and grayish ring around the eye. P. 352

Which assessment would the nurse perform when determining a patient's pupillary function? A. Perimetry B. Reaction to light C. Amsler Grid Test D. Following six cardinal fields of gaze

B. Reaction to light Rationale: Pupil function is determined by inspection and reaction to light. Perimetry is visual field testing. The Amsler Grid Test is a self-administered test used to monitor macular problems. The six cardinal fields of gaze are used to assess extraocular movement and cranial nerves III, IV, and VI. p. 355, 357

When teaching a patient about a new prescription, which disorder would the nurse associate with a patient's prescription for ketoconazole (Nizoral) eyedrops? A· Myopia B· Astigmatism C· Acanthamoeba keratitis D· Generalized poor hygiene of the eye

C

Which condition would the nurse document when a child has an asymmetric eye position during visual health assessment? A. Blepheritis B. Strabismus C. Hordeolum D. Conjunctivitis

B. Strabismus Rationale: 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. p. 356-363-364

The nurse darkens the room and shines a penlight on the cornea and asks the patient to follow finger movement 10 inches from the patient's nose. Which cranial nerve paralysis should be examined? Select all that apply. A. Facial nerve B. Trochlear nerve C. Abducens nerve D. Trigeminal nerve E. Oculomotor nerve

B. Trochlear nerve C. Abducens nerve E. Oculomotor nerve Rationale: 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. The facial nerve helps in the opening and closing movements of the eyelids. The trigeminal nerve helps in the dilation of the iris. p. 357

For which contraindication would the nurse assess the patient before administering a new prescription for timolol (Timoptic; Istalol) eyedrops as treatment of glaucoma? A· Sinusitis B· Migraine headaches C· Chronic urinary tract infection D· Chronic obstructive pulmonary disease (COPD)

D

For the patient recently blinded from a motor vehicle accident, which patient goal has the highest priority? A· Use suitable coping strategies to reduce stress. B· Identify the patient's strengths and support system. C· Verbalize feelings related to visual impairment. D· Transition successfully to the sudden vision loss.

C

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· Implement restriction of driving privileges, immediately. B· Use occupational and physical therapy to enhance functional ability. C· Encourage medication compliance to reduce progression of vision loss. D· Manage surgical pain with oral antiinflammatories and opioids as needed.

C

Which clinical manifestations would the patient report when experiencing an ophthalmic condition resulting in a decrease in tear production? A. "I see a double of every object." B. "I cannot see clearly in dim light or at night." C. "I have a sandy, gritty, and irritating sensation in my eyes." D. "I cannot read books, newspapers, or anything close to me."

C. "I have a sandy, gritty, and irritating sensation in my eyes." Rationale: 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. p. 352

Which instructions would the nurse provide the patient scheduled for refractometry as part of the visual assessment? Select all that apply. A. "Are you allergic to iodine or contrast media?" B. "You will feel slight burning during this procedure." C. "Please try to hold your head still during the examination." D. "You may find it difficult to focus on near objects for three to four hours." E. "You might notice that your urine will turn a darker yellow-orange color today."

C. "Please try to hold your head still during the examination." D. "You may find it difficult to focus on near objects for three to four hours." Rationale: The patient may need help to hold the head still during the examination. Pupil dilation makes it difficult to focus on near objects, and dilation may last three to four hours. The refractometry procedure is painless. Concerns about iodine/contrast media allergy and the possibility of urine color changes occur with fluorescein angiography, not refractometry. P. 358

Which action would the nurse implement when performing an assessment of the patient's cranial nerve VII? A. Ass the ability of the patient's pupils to constrict equally to light B. Ascertain the patient's ability to bend light entering the eye C. Establish the patient's ability to close and open the eyelids D. Determine whether the patient is able to control the amount of light entering the eye.

C. Establish the patient's ability to close and open the eyelids Rationale: 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. P. 349

Which condition would the nurse associate with an infection of a sebaceous gland when the patient presents with a small, white, superficial nodule on the margin of the eyelid? A. Blepharitis B. Strabismus C. Hordeolum D. Conjunctivitis

C. Hordeolum Rationale: An eye infection that is accompanied by a small, white, superficial nodule along the lid margin and an infection of the sebaceous gland of eyelid indicate that the patient has hordeolum. It is caused by a Staphylococcus infection. Blepharitis is a bacterial infection in the lid margins, which manifests as redness, swelling, and crusting along the lid margins. Strabismus is the deviation in the position of the eye in one or more directions; it is not associated with bacterial infection. Conjunctivitis is a bacterial infection of the eye, which manifests as redness and swelling of the conjunctiva. p. 356, 361-362

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. Blepharitis B. Hordeolum C. Hyperthyroidism D. Macular disease

C. Hyperthyroidism Rationale: 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. p. 356

For which clinical manifestation would the nurse teach discharge interventions when a patient's prescription includes alternating patching of one eye at a time for treatment of diplopia. A. Conjunctivitis B. Dryness in the patched eye C. Impaired stereoscopic vision (correct answer per Dr Plotkin) D. Increased risk for cataract formation

C. Impaired stereoscopic vision The patient with diplopia (double vision) alternately patches the eye to allow normal vision. The patient will be at increased risk for falls because patching causes impaired stereoscopic (three-dimensional) vision. The patient could fall because of impaired ability to judge distance. Conjunctivitis is redness from infection or inflammation of the conjunctiva, the mucous membrane that covers eyelids and forms a pocket under each eyelid. Dryness is not a usual problem with a patched eye because patching limits exposure to air and the environment. Cataracts occur with the aging process. p. 358, 366.

Which action would the nurse implement when assessing a patient for corneal light reflex? A. Turn on the lights in the room after a five-minute period of darkness B. Ask the patient to focus on the examination ceiling. C. Shine a penlight directly on the cornea of each eye. D. Ask the patient to follow finger movement without moving his or her head.

C. Shine a penlight directly on the cornea of each eye.

When assessing a patient's dilator muscle atrophy of the eye, which clinical manifestation would the nurse expect to identify? A. Formation of cataracts B. Excessive dryness of the eyes C. Slow recovery of pupil size after light stimuli D. Changes in perception of colors, especially blue and violet

C. Slow recovery of pupil size after light stimuli Rationale: Dilator muscle atrophy or weakness affects the ability of the pupils to contract and relax. As age progresses, this muscle becomes weak. Due to weakness or atrophy, the recovery of pupil size after stimulation by light is delayed. Cataracts are formed due to biochemical changes in the lens proteins, which result in clouding of the lens. Excessive dryness is caused due to reduced production of tears or due to malposition of the eyelids. Changes in perception of colors are not related to the dilator muscle. Color perception is carried by cones in the retina. A decrease in the number of cones causes this problem. p. 352

Which interpretation would the nurse associate with the 40-year-old patient stating, "I've noticed, over the last three months, that close objects are really blurred," and the ophthalmic consultation report indicating increased rigidity of the patient's lens? A. Astigmatism has developed B. progression of hyperopia is occurring C. The patient has developed presbyopia D. Myopia is in the early stage of development

C. The patient has developed presbyopia Rationale: A 40-year-old patient having blurred vision of objects closer to the visual field and rigidity of the lens indicate that the patient presbyopia. Presbyopia is the loss of accommodation, which occurs because of the increased rigidity of the lens. It causes an inability to focus on objects that are near. Presbyopia occurs as a normal process of aging. . p. 352, 358-359

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

C. The patient has impaired stereopsis. Rationale: allows a patient to visualize in 3 dimensions. a patient who has impaired stereopsis will be unable to judge the distance between vehicles or between steps, which may result in accidents.

Which explanation would the nurse associate with a white patient's sclera having a yellowish discoloration? A. The patient has a thin sclera. B. The patient is normal finding for the ethnic group. C. There is an accumulation of lipid deposits. D. A subconjunctival hemorrhage occurred

C. There is an accumulation of lipid deposits. Rationale: The excessive deposition of lipids in the sclera may result in a yellowish discoloration of 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. p. 352, 357

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· Blepharitis B· Hordeolum C· Astigmatism D· Herpes zoster ophthalmicus

D

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

D

For the patient diagnosed with bacterial conjunctivitis, which clinical manifestations would the nurse expect the patient to exhibit? A· Itching, burning, irritation, and photophobia B· Tearing, redness, photophobia, and foreign body sensation C· Red, swollen, circumscribed, and acutely tender area in the lid margin D· Discomfort, pruritus, redness, and a mucopurulent drainage in the eye

D

For the patient with glaucoma who is taking timolol (Timoptic), which instruction would the nurse reinforce with patient teaching? A· Use these drops on an as needed basis for eye irritation. B· You will notice an improvement in vision within one month. C· Maintain a supine position for 30 minutes after the drops are instilled. D· You may experience blurred vision for several minutes after administration.

D

When admitted with pneumonia and a history of bilateral cataracts, which interventions would the nurse implement to facilitate an elderly patient's ability to see? Select all that apply. A· Administer prescribed analgesics. B· Patch the eye that has less visual acuity. C· Obtain dark glasses for the patient to wear. D· Increase the amount of light for near vision. E· Obtain teaching materials with enlarged print.

D, E

When interviewing a patient experiencing visual impairment, which elimination question would the nurse ask to determine intraocular pressure changes? A. "Do you defecate on a regular basis?" B. "How many stools do you have in a day?" C. "What are the characteristics of your stools?" D. "Do you have to strain when having a bowel movement?"

D. "Do you have to strain when having a bowel movement?" Rationale: It is important for the nurse to ask the patient if the patient has to strain during stools. Straining during defecation increases the intraocular pressure. While assessing the elimination pattern in relation to eye complaints, knowing the characteristics of stools is not important. The regularity, characteristic, and frequency of stools are important parameters while assessing the gastrointestinal system. However, they are not related to visual impairment. p. 353-354

When performing a visual examination, which assessment finding would the nurse document when a small blood spot is observed on the sclera of the patient's right eye? A. Anisocoria B. Conjunctivitis C. Allergic reaction D. Subconjunctival hemorrhage

D. Subconjunctival hemorrhage Rationale: Subconjunctival hemorrhage is characterized by the appearance of a blood spot on the conjunctiva. The blood spot may be small, or it can affect the entire sclera. Anisocoria describes constricted pupils that are unequal. Conjunctivitis manifests as redness and swelling of the conjunctiva that may be itchy. Allergic reactions are characterized by redness, excessive tearing, and itching of the lid margins. p. 356

A nurse is interviewing a patient with irritation of the eyes. To assess eye health, the nurse should ask what sleep hygiene-related question? A. "What time do you go to sleep at night?" B. "What position do you generally sleep in?" C. "What kind of dreams do you generally have?" D. "How many hours of sleep do you get in 24 hours?"

D. "How many hours of sleep do you get in 24 hours?"

Which potential rationale would the nurse associate with the patient's statement, "I see two of everything"? A. Reduced tear formation has occurred. B. An inflammation of the cornea exist. C. There is an abnormality in size of the patient's pupils. D. An abnormality of the extraocular muscle developed.

D. An abnormality of the extraocular muscle developed. Rationale: The patient's statement, "I see two of all everything," indicates that the patient has double vision. This indicates that the patient has diplopia, which is associated with an abnormality of the extraocular muscle. Reduced tear formation will result in dry eyes and a gritty sensation, but not double vision. The presence of inflammation in the cornea results in photophobia. An abnormality in pupil size is associated with central nervous system disorders and is referred to as anisocoria. P. 356

Which condition would the nurse associate with patient's laboratory report of a total serum cholesterol of 220 mg/dL and the presence of a milky white and grayish ring encircling the periphery of the patient's corneas? A. Pterygium B. Glaucoma C. Blepharitis D. Arcus senilis

D. Arcus senilis Rationale: A total serum cholesterol of less than 180 mg/dL is considered optimal. The patient's serum total cholesterol of 220 mg/dL is high. Arcus senilis is an abnormality of the eye associated with high cholesterol levels. Cholesterol is deposited in the eye margin; therefore, the patient will see a milky white and grayish ring encircling the periphery of the cornea. Pterygium is an abnormality of the cornea that is associated with chronic exposure to sunlight, which manifests as thickened, triangular, pale tissue extending from the inner canthus to the nasal border. A patient who has glaucoma will have increased intraocular pressure, not cholesterol levels. Blepharitis is a bacterial infection in lid margins, which manifests as redness, swelling, and crusting along the lid margins. p. 352

A patient reports visual distortion and is assessed to have an. Which refractive error would the nurse associated with a patient's uneven cornea and complaints of visual distortion? A. Myopia B. Hyperopia C. Presbyopia D. Astigmatism

D. Astigmatism Rationale: 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 clearly see close objects. Presbyopia is the inability to focus on objects that are near and the condition increases with age. Myopia, hyperopia, and prebyopia are associated with an elongation or shortening of the eyeball, but not an uneven cornea. P. 359

For the patient recovery from an eye surgery, which rationale would the nurse provide the patient when teaching not to strain when defecating? A. Straining places you at risk for developing anisocoria. B. You develop a risk of photophobia headaches if you strain C. When you strain, an increased rigidity of the lens develops. D. Increased intraocular pressure pressures occur when straining to defecate.

D. Increased intraocular pressure pressures occur when straining to defecate. Rationale: After eye surgery, it is important for the patient to resist straining, such as when trying to defecate. Straining from constipation may lead to increased intraocular pressure in the ears and eyes. Anisocoria is the unequal size of the eye pupils, which is a physiologic condition or is associated with trauma. Persistent, abnormal intolerance of the eyes to light is called photophobia, which is associated with infection or inflammation in the uveal tract. Patients who have a loss of near vision that is associated with age will have increased lens rigidity. p. 353-354

Which condition would the nurse suspect in the older adult patient who states, "I feel like there is sand in my eyes." A· Cataract B· Strabismus C· Keratoconus D· Keratoconjunctivitis sicca

D. Keratoconjunctivitis sicca (Dry eye disorder)

Which tool is used in the physical assessment of the retina and optic nerve? A. Penlight B. Refractometry C. Ultrasonography D. Ophthalmoscope

D. Ophthalmoscope

The nurse documents a patient's Snellen chart reading as: Right eye: 20/30; Left eye: 20/40. What does the nurse determine is the correct interpretation of this reading? A. The patient likely has presbyopia. B. The patient does not have color blindness. C. The vision acuity is stronger in the left eye. D. The patient has a refractory error consistent with myopia

D. The patient has a refractory error consistent with myopia.

Which actions would the nurse implement when a patient presents with a sty on their left eye? Select all that apply. A· Teach the patient to perform lid scrubs daily. B· Prepare the patient for surgical removal of the sty. C· Administer appropriate antibiotic ointments or drops, as prescribed. D· Teach the patient to gently cleanse the lid margins with baby shampoo. E· Instruct the patient to apply warm, moist compresses at least four times a day.

A, C, E

Which interventions would the nurse implement to ease the patient's itching, burning sensation and eye redness from allergic conjunctivitis? Select all that apply. A· Administer artificial tears, as prescribed. B· Instruct the patient to wash hands regularly. C· Instruct the patient to avoid the allergen if it is known. D· Administer topical antihistamines and corticosteroids. E· Instruct the patient to use individual or disposable towels.

A, C, D

Which instruction would the nurse include in a patient's discharge teachings after undergoing cataract extraction and intraocular lens implantation? A· Avoid straining during bowel movements. B· Keep consuming a full-liquid diet for 24 hours. C· Refrain from reading or watching TV for at least 12 hours. D· Keep a patch over the affected eye until the surgeon's follow-up appointment.

A

Which instruction would the nurse provide to the patient prescribed verteporfin (Visudyne) for age-related macular degeneration (AMD)? A· "Avoid direct exposure to sunlight while on this particular treatment." B· "You can wear clothes with short sleeves after receiving this medication." C· "Do not eat lutein-containing, green, leafy vegetables while taking this medication." D· "Be sure to eat vitamin E-containing foods, but avoid all vitamin C-containing foods."

A

Which statement would the nurse use to reinforce medication teaching when administering the scheduled dose of pilocarpine (Pilocar)? A· "You will need someone to drive you home today." B· "This medication should be used as needed to reduce eye pain." C· "Eye irritation is to be expected during the first two weeks of use." D· "This medication will help to raise intraocular pressure to a near normal level."

A

Which risk factors are associated with development of cataracts? Select all that apply. A· Advanced age B· History of diabetes mellitus C· Exposure to ultraviolet light D· Eating a diet high in lutein E· History of chronic open-angle glaucoma F· History of prolonged therapy with systemic corticosteroids

A, B, C, F

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

A, B, D

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

A, C, E

While performing a medication reconciliation with a newly admitted patient's home medications, the nurse notes the patient is taking pilocarpine eye drops. Which desired effects would the nurse associate with this medication? Select all that apply. A· Facilitates aqueous humor outflow B· Reverses damage to the optic nerve C· Improves the patient's vision in dim light D· Lessens the amount of pupillary dilation E· Decreases the amount of fluid within the eye

A, D

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. A· "Wash hands regularly to prevent the spread of diseases." B· "Avoid removing contact lenses if there is redness and pain in the eye." C· "Wearing sunglasses and having proper nutrition does not prevent cataract development." D· "Wear eye protection during hazardous work activities to reduce the risk of eye injuries." E· "Regular eye checkups help in early detection of disease and prevent further loss of vision."

A, D, E

Which intervention would the nurse implement to ensure safe administration of a patient's newly prescribed medication, bimatoprost (Lumigan)? A· Teach the patient to instill three drops in each eye, three times a day. B· Advise the patient to wash hands with water and then instill the medicine. C· Inform the patient of the need to rinse eyes immediately after instilling the medicine. D· Instruct the patient to remove contact lenses 15 minutes before instilling the drops.

D

Which intervention would the nurse implement when providing care for a patient who lost an eye after an industrial accident yesterday? A· Speak louder when talking to the patient. B· Avoid making eye contact during a conversation. C· Introduce the patient to other visually impaired persons. D. Assist the patient with the same grieving process associated with other losses.

D

For which contributing factor would the nurse closely monitor in the patient experiencing retinal hemorrhages, anoxic cotton-wool spots, and macular swelling in the eye? A· Glucose level B· BP C· Intraocular pressure D· Thyroid hormone levels

B

The nurse teaches that which part of the eye becomes inflamed for the patient who developed keratitis? A· Sclera B· Cornea C· Conjunctiva D· Eyelid margins

B

When assessing four assigned patients with different refractive errors, which patient would the nurse suspect as having hyperopia? Patient A Patient B Patient C Patient D

B

When reviewing refractive errors of the eye, which statement would the nurse identify as correct? A· Presbyopia occurs when the eyeball elongates. B· Astigmatism is caused by an irregular corneal curvature. C· Myopia is an inability to accommodate for near objects. D· Hyperopia is an inability to accommodate for objects at a distance.

B

When teaching a patient about increased intraocular pressures caused by primary openangle glaucoma, which intervention would the nurse include? A· Give anticipatory guidance about the eventual loss of central vision that will occur. B· Encourage compliance with drug therapy for the glaucoma to prevent loss of vision. C· Recognize that eye damage caused by glaucoma can be reversed in the early stages. D· Manage the pain experienced by patients that persists until the optic nerve atrophies.

B

Which action would the nurse implement when a patient with a history of asthma receives a prescription for timolol to treat chronic glaucoma? A· Explain to patient that carteolol may cause vomiting. B· Do not administer timolol and notify the health care provider. C· Ask the health care provider to decrease the dose of carteolol. D· Suggest the patient only use carteolol for a short period of time.

B

Which eye disorder would the nurse associate with the patient scheduled for a penetrating keratoplasty procedure? A· Retinopathy B· Corneal scars C· Chronic open-angle glaucoma D· Age-related macular degeneration

B

Which instruction would the nurse provide the patient who calls the clinic reporting a sty on their upper eyelid for several weeks, and warm moist compresses have not improved the situation? A· "Go to the pharmacy to get some eyedrops." B· "Come in so the ophthalmologist can remove the lesion for you." C· "The health care provider will need to inject it with an antibiotic." D· "Wash the lid margins with baby shampoo to remove the crusting."

B

Which instruction would the nurse teach the patient about newly prescribed timolol (Timoptic) eyedrops for treatment of glaucoma? A· "You may feel some palpitations after instilling these eyedrops." B· "A temporary headache may occur after instilling these drops." C· "Withhold this medication if your blood pressure becomes elevated." D. "Keep your eyes closed for 15 minutes after instilling these eyedrops."

B

Which physiologic change would the nurse recall as being responsible for a patient's inability to see near objects? A· The cornea develops an irregular curvature. B· Light rays begin to focus behind the retina. C· Incoming light rays are bending unequally. D· Light rays begin to focus in front of the retina.

B

Which statement would the nurse include when teaching a patient the pathophysiology of their open-angle glaucoma? A· "The retinal nerve is damaged by an abnormal increase in the production of aqueous humor." B· "There is decreased draining of aqueous humor in the eye, causing pressure damage to the optic nerve." C· "The lens enlarges with normal aging, pushing the iris forward, which then covers the outflow channels of the eye." D· "There is a decreased flow of aqueous humor into the anterior chamber caused by the lens of the eye blocking the papillary opening."

B

When a patient is prescribed dipivefrin (Propine) for the treatment of glaucoma, the nurse would teach the patient to monitor the development of which potential side effects? Select all that apply. A· Depression B· Tachycardia C· Hypertension D· Bronchospasm E· Taste alteration

B, C

Which interventions would the nurse implement to prevent postoperative complications of the patient schedule for cataract surgery? SATA A· Administer antiviral medications to prevent infections. B· Teach the patient to instill medicine utilizing aseptic techniques. C· Teach the patient about proper hygiene and eye care techniques. D· Instruct the patient to discontinue all prescribed medicine two days after surgery. E· Advised the patient to avoid actions that can increase their intraocular pressures.

B, C, E

The patient with acute glaucoma has a history of high-dose aspirin therapy and has a new prescription for acetazolamide (Diamox). Which medication change would the nurse expect when notifying the provider of the concomitant issue? A· The dose of acetazolamide will be decreased by half the dose. B· There will not be a prescription change for either of the medications. C· Due to potential gastric disturbances, the acetazolamide will be changed. D· Administration times will be rescheduled to avoid taking the two medications at the same time.

C

Which clinical manifestation would the nurse expect to identify in the patient diagnosed with strabismus? A· Inability of the eye to accommodate for near objects B· Discomfort, pruritus, redness, and a mucopurulent eye drainage C· Red, swollen, and acutely tender superficial area in the lid margin D· Inability to focus both eyes on the same object, simultaneously.

D

The nurse assists the health care provider to rinse a patient's eye with saline solution and instill a dye onto the conjunctiva of the injured eye. Which statement would the nurse use to explain the purpose of the dye to the patient? A· To disinfect the injured tissues of the cornea B· To help seal and heal the injured tissues within the eye C· To stain the eye tissue so disruptions can be identified easily D· To bind with foreign particles and enhance flushing from injured tissue

C

The nurse teaches cataract surgery discharge instructions and includes that the development of which clinical manifestation warrants the patient contacting the surgeon immediately? A· Glare B· Itching C· Eye pain D· Blurred vision

C

The patient with a detached retina states, "Before you patched my eye, I saw a lot of spots." Which rational would the nurse use to explain the "spots"? a· Contamination of the eye's aqueous humor created the blank spots. b· Pieces of the retina are floating within the eye and creating the objects you see. c· The spots are blood cells released into the eye by the detached retina d· Spasms of the retinal blood vessels traumatized by the detached retina caused the spots.

C

Which condition involves inflammation of the vitreous cavity of the eye? A· Uveitis B· Blepharitis C· Otitis media D· Endophthalmitis

D

Which extraocular eye disorder would the nurse associate with the patient experiencing inflammation of the cornea and exophthalmos? A· Strabismus B· Keratoconus C· Exposure keratitis D· Keratoconjunctivitis sicca

C

Which initial clinical manifestation would a patient report with a retinal detachment? A· Redness of the conjunctiva B· Increased glare with artificial light C· Seeing flashes of light and floaters D· Severe pain when moving the eyes

C

Which instruction is most important for the nurse to include in the discharge teaching of a patient being discharged home after cataract surgery? A· Restrict activity at home. B· Wear a nighttime eye shield. C· Do not bend, stoop, cough, or lift. D· Wash hands before touching the eye.

C

Which intervention would the nurse implement to minimize systemic effect of medications administered to a patient with glaucoma? A· Apply pressure to each eyeball for a few seconds after administration. B· After closing the eyes, have the patient move them back and forth several times. C· Have the patient place pressure on the eye puncta for two minutes after administration. D· Instruct the patient try to blink out excess medication immediately after administration.

C

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· Scotoma B· Blepharitis C· Endophthalmitis D· Cytomegalovirus retinitis

C

Which condition would the nurse provide additional information for when observing a patient with systemic lupus erythematosus (SLE) frequently rubbing his or her eyes from decreased tear production? A· Cataract B· Strabismus C· Keratoconus D· Keratoconjunctivitis sicca

D

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? A· Instruct the patient to quit smoking during the immediate postsurgical period. B· Suggest that the patient consider using supplements of vitamins and minerals. C· Advise the patient to eat lots of dark green, leafy vegetables containing lutein. D· Instruct the patient to avoid direct exposure to sunlight for five days after treatment.

D

The nurse would teach the patient diagnosed with a hordeolum which intervention for selfmanagement of the red, swollen, circumscribed, and acutely tender area in the lid margin? A· Advise the patient to not perform lid scrubs for 10 days. B· Suggest wearing glasses instead of contacts to reduce development of the infection. C· Advise the patient to avoid any further treatment, as the condition is a normal protective mechanism. D· Suggest applying warm, moist compresses at least four times a day until the condition improves.

D

When performing an assessment on a patient with glaucoma, which antiglaucoma medication would the nurse associate with the patient's brown iris pigmentation? A· Carteolol (Ocupress) B· Dipivefrin (Propine) C· Carbachol (Miostat) D· Latanoprost (Xalatan)

D

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· History of frequent falls B· Visual acuity (Diplopia) C· Extraocular movements intact D· Denial of eye pain or pressure

D

Which action would be the nurse's priority when noting blood in the anterior chamber of the patient's eye after sustaining an eye injury, as well as redness of the sclera? A· Provide oral fluids for the patient. B· Apply pressure on the affected eye. C· Instruct the patient to blow their nose. D· Elevate the head of bed to 45 degrees.

D

Which intervention would the nurse teach a patient with glaucoma to perform when instilling their scheduled dose of pilocarpine (Isopto Carpine) drops? A· "Prolonged eye irritation is an expected adverse effect of this medication." B· "This medication will help to raise intraocular pressure to a near normal levels." C· "This medication needs to be continued for at least five years after the initial diagnosis." D· "Do not perform any activities requiring visual acuity immediately after administration."

D

Which rationale would the nurse associate with the health care provider's order of cycloplegics for a patient preparing for surgical intervention of a visual disorder? A· To prevent anxiety B· To reduce inflammation C· To minimize photophobia D· To block the effect of acetylcholine on ciliary body muscles

D