Exam 1: Cataract Questions

A client's relative asks the nurse what a cataract is. Which explanation should the nurse provide? 1. An opacity of the lens 2. A thin film over the cornea 3. A crystallization of the pupil 4. An increase in the density of the conjunctiva

1 rationale: A cataract is a clouding (opacity) of the crystalline lens or its capsule. A thin film over the cornea, a crystallization of the pupil, and an increase in the density of the conjunctiva are not the pathophysiology related to cataracts.

After a left cataract extraction, a client reports severe discomfort in the operated eye. The nurse concludes that this problem may be caused by which condition? 1. Hemorrhage into the eye 2. Expected postoperative discomfort 3. Isolation related to sensory deprivation 4. Pressure on the eye from the protective shield

1 rationale: Acute postoperative pain is a sign of increased intraocular pressure and is caused by hemorrhaging; this is a medical emergency. Postoperative discomfort usually is minimal. Isolation and sensory deprivation will not occur because only one eye is patched. The shield may be slightly uncomfortable but will not cause severe discomfort.

After cataract surgery, a client reports feeling nauseated. How can the nurse help relieve the nausea? 1. administer the prescribed antiemetic drug 2. Provide some dry crackers for the client to eat. 3. Explain that this is expected following surgery. 4. Teach how to breathe deeply until the nausea subsides.

1 rationale: An antiemetic will prevent vomiting; vomiting increases intraocular pressure and should be avoided. Providing some dry crackers for the client to eat, explaining that this is expected following surgery, and teaching how to breathe deeply until the nausea subsides. are unsafe; vomiting increases intraocular pressure, and aggressive intervention is required.

Assessment of a newborn reveals congenital cataracts, microcephaly, deafness, and cardiac anomalies. Which infection does the nurse suspect that the newborn's mother contracted during her pregnancy? 1. rubella 2. herpes virus type 2 3. toxoplasmosis gondii 4. chlamydia trachomatis

1 rationale: Congenital rubella (German measles) syndrome results in abnormalities that vary, depending on the gestational age of the fetus when the maternal infection was contracted; the most severe results occur if the mother was infected during the first trimester, when organogenesis is taking place. Neonatal signs of herpes virus type 2 include fever, coryza, tachycardia, and hemorrhage. Except for microcephaly, the assessments noted by the nurse are not caused by the toxoplasmosis protozoa; this problem is associated with growth retardation, hydrocephalus, chorioretinitis, thrombocytopenia, jaundice, and fever. A chlamydial infection causes neonatal conjunctivitis and pneumonia.

A client is being prepared for discharge from an ambulatory surgical clinic after a cataract extraction and an intraocular lens implant. Which statement indicates to the nurse that the discharge teaching is effective? 1. "I should call the clinic if my eye begins to hurt." 2. "I am so glad that I can take a shower tomorrow." 3. "There will be bright flashes of light for a few days." 4. "My vision should show some improvement by tomorrow."

1 rationale: Pain after a cataract extraction and intraocular lens implant may indicate infection, increased intraocular pressure, or hemorrhage and should be reported immediately. Soap may irritate the eye, and showers or shampooing of the hair should be avoided as instructed. Seeing bright flashes of light is a symptom of retinal detachment and is not expected. Although rapid vision improvement may occur in some people, others may require several weeks to achieve improved visual acuity.

What could be the reason for cataracts in a 36-year-old client? Select all that apply. 1. prolonged exposure to heat 2. prolonged exposure to pesticides 3. prolonged exposure to cement dust 4. prolonged exposure to metal powders 5. prolonged exposure to anesthetic gases

1, 4 rationale: Glass workers are exposed to heat and metal powders for prolonged periods, which may increase their risk of developing cataracts. A prolonged exposure to pesticides may cause pesticide poisoning. Prolonged exposure to cement dust may cause bronchitis. Prolonged exposure to anesthetic gases may have reproductive effects.

The nurse is providing preoperative teaching for a client who is to have cataract surgery. Which is appropriate for the nurse to include concerning what the client should do after surgery? Select all that apply . 1. Do not blow your nose. 2. Remain flat for three hours. 3. Eat a soft diet for two days. 4. Breathe and cough deeply. 5. Avoid bending from the waist.

1, 5 rationale: The client needs to avoid activities that cause a sudden rise in intraocular pressure, such as bending from the waist, blowing the nose, sneezing, and coughing. It is not necessary to remain flat in bed for three hours after surgery, and the diet is not restricted.

Immediately after cataract surgery a client reports feeling nauseated. What should the nurse do? 1. Provide some dry crackers to eat 2. Administer the prescribed antiemetic 3. Explain that this is expected after surgery 4. Encourage deep breathing until the nausea subsides

2 rationale: An antiemetic will prevent vomiting; vomiting increases intraocular pressure and should be avoided. Aggressive intervention is required rather than dry crackers. Explaining that this is expected after surgery is incorrect. Deep breathing will not minimize nausea; aggressive intervention is required to prevent vomiting.

After cataract surgery the nurse teaches a client how to self-administer eyedrops. The nurse reinforces the use of what technique? 1. Placing the drops on the cornea of the eye 2. Raising the upper eyelid with gentle traction 3. Holding the dropper tip above the conjunctival sac 4. Squeezing the eye shut after instilling the medication

3 rationale: Drops are placed within the lower lid (conjunctival sac). To protect against physical injury and infection, the dropper tip should not touch the eye. The lower lid is retracted for placement of eyedrops. Squeezing the eyes shut after administration of the medication should be avoided; this will squeeze medication out of the eye.

A nurse performs preoperative teaching for a client who is to have cataract surgery. Which is most important for the nurse to include concerning what the client should do after surgery? 1. remain flat for three hours 2. eat a soft diet for two days 3. breathe and cough deeply 4. avoid bending from the wasit

4 rationale: Bending increases intraocular pressure and must be avoided. Remaining flat for three hours and eating a soft diet for two days are not necessary. Coughing deeply increases intraocular pressure and is contraindicated.

A client with type 2 diabetes is admitted to the ambulatory surgery unit for elective cataract surgery. Before surgery the client asks the nurse, "How will my diabetes be managed while I am here?" What is the best response by the nurse? 1. "What did your surgeon tell you?" 2. "Has the anesthesiologist talked to you yet?" 3. "Your surgeon will write your postoperative prescriptions." 4. "I'm not quite certain I understand what you are asking."

4 rationale: The nurse needs to know specifically what the client is asking; this response permits clarification. Asking what the surgeon has said collects more information, but it will not clarify what the client wants to know. Asking what the anesthesiologist has said does not relate to what the client wants to know. The nurse is making an assumption about medical management.