Eye Disease
The nurse is caring for a client in the early stage of macular degeneration. What dietary changes should the nurse recommend to slow the progression of the disease? A) High-antioxidant diet B) Low-antioxidant diet C) Low-fat diet D) High-fat diet
Answer: A A diet high in antioxidants-such as fish; green, leafy vegetables; copper; and zinc-has been shown to slow the progression of macular degeneration in its early to intermediate stage when it is nonexudative. Neither low- nor high-fat diets slow the progression of macular degeneration.
Which assessment finding supports the nurse's conclusion that a client is at risk for cataracts? A) Age 75 years B) Hypertension C) Moderate alcohol use D) Smoker
Answer: A Age is the greatest single risk factor for cataracts. Environmental and lifestyle factors, such as long-term exposure to sunlight, increase the risk for cataracts; cigarette smoking and heavy alcohol consumption are associated with earlier cataract development. This client's age would indicate a predisposition for cataract formation, but not hypertension or only moderate alcohol use. Being a smoker would indicate such a predisposition, but this is still not as great a risk factor as the client's age.
A client has been diagnosed with cataracts of both eyes. The client's vision and activities of daily living have become severely impaired. What collaborative intervention does the nurse anticipate for this client? A) Corrective lenses for the cataracts B) Two surgical procedures, separated by a few weeks, to remove the cataracts C) Two surgical procedures to remove both cataracts at the same time D) Eyedrops to treat the cataracts
Answer: B Surgery is the only treatment for cataracts. The client will have one cataract removed, and then, in a few weeks, the other cataract will be removed. Cataracts cannot be treated with eyedrops or corrective lenses.
Which statement about cataract surgery is correct? A) Cataract surgery should be quick but may have to take place in stages. B) Cataract surgery may only be done on an inpatient basis with general anesthesia. C) Cataract surgery is not recommended except in cases of opacification of the remaining posterior capsule. D) Cataract surgery is typically bilateral and can be performed in a single day.
Answer: A Cataract surgery should be quick because it typically is done on an outpatient basis with only local anesthesia. If the patient presents with bilateral cataracts, however, surgery is typically performed on only one eye at a time, with an interval of days to several weeks before surgery is performed on the second eye. Cataract surgery is not typically done on an inpatient basis and does not usually involve general anesthesia. Opacification of the remaining posterior capsule is a secondary cataract, which may form following cataract surgery and also should be removed. If a client has bilateral cataracts, the surgery to remove them would typically be performed on different days.
The nurse is planning care for a client scheduled for cataract surgery. Which intervention should the nurse include in the plan of care to help provide a safe environment for the client following surgery? A) Ensuring fall hazards are removed from the client's home and additional lighting is provided B) Educating the client about what self-care activities are necessary following surgery C) Making the client's close family aware of the self-care instructions the client has received D) Ensuring the client's employer does not expect the client to return to standard duties until clearance for such activities by the healthcare provider
Answer: A The removal of fall hazards from the client's home and provision of additional lighting best demonstrates providing a safe environment for the client following surgery. It's important for the client to understand what self-care activities are necessary, and it's good that the client's close family members are aware of the self-care instructions the client has received and that the client's employer doesn't expect an immediate return to standard duties, but these don't relate directly to providing a safe environment.
The home care nurse is assessing a client with macular degeneration. What interventions would be appropriate to ensure home safety for this client? Seslect all that apply. A) Keep the stairs free of clutter. B) Wear socks without shoes when walking in the home. C) Use one electrical outlet for devices. D) Have grab bars installed in the bathroom. E) Remove scatter rugs from the floors in the home.
Answer: A, D, E The client with macular degeneration is at risk for injury. To reduce this risk, the nurse should instruct and plan to help the client remove scatter rugs from the floors in the home, have grab bars installed in the bathroom, and keep the stairs free of clutter. The client should not walk without proper footwear. Using one electrical outlet in the home could cause an electrical hazard.
An older adult client is using prescription eyedrops to treat her glaucoma. When providing client teaching about this medication, which of the following should the nurse mention as potential side effects? Select all that apply. A) Blurred vision B) Intermittent loss of eyesight C) Headaches D) Clouding of the eyes E) Change in eye color
Answer: A, E The client is taking a prostaglandin analog as eyedrops, which can cause the side effect of a change in iris color. Other potential side effects are blurred vision, eye pain (itching, burning, stinging), and eye redness, but not intermittent eyesight loss, headaches, or clouding of the eyes.
A client is undergoing surgery to manage glaucoma. When providing postoperative teaching to this client, the nurse should emphasize that the client is now at increased risk for which form of cataracts? A) Congenital B) Secondary C) Radiation D) Traumatic
Answer: B A secondary cataract may form following surgery to correct another eye disorder. Congenital cataracts are hereditary and appear at birth or in early childhood. Traumatic cataracts result from injury to the eye, and radiation cataracts result from long-term exposure to radiation.
The nurse is providing teaching to a client related to maintaining healthy vision. Which of the following should the nurse identify as a modifiable risk factor for macular degeneration? A) Caucasian ancestry B) Smoking 1 pack of cigarettes per day C) 62 years of age D) Family history of AMD
Answer: B Although aging is the most significant risk factor for the development of macular degeneration, and being Caucasian and having a family history of AMD are also risk factors, of the options listed, only smoking is modifiable, meaning that it is a risk factor the client can control.
The nurse is planning care for a client with glaucoma who is experiencing anxiety as a result of the diagnosis. Which intervention should the nurse select to address this need? A) Assure the client there is nothing to be afraid of. B) Support the client's use of coping mechanisms. C) Turn off the lights when leaving the client's room. D) Refer the client to a counseling psychologist.
Answer: B Anxiety is a common response to a new diagnosis of glaucoma. Here, the most appropriate intervention would be for the nurse to support the client's use of coping mechanisms. Although referral to a psychologist may be necessary at some point, it typically is not an initial course of action. Assuring the client there is nothing to be afraid of minimizes the client's concerns and is not appropriate. Turning off the lights is not an intervention that will lessen the client's anxiety.
The nurse is providing teaching to a client who was prescribed an ophthalmic beta blocker for glaucoma. The client is having difficulty understanding how to self-administer the medication. Which instruction by the nurse is best? A) "Occlude your lacrimal duct." B) "Close your eyes." C) "Guard against systemic absorption." D) "Use punctal occlusion."
Answer: B Because systemic absorption may occur with beta blockers, the nurse should teach the client to close the eyes and occlude the lacrimal duct after administration to help reduce systemic absorption. The simplest way to provide this teaching in a way the client will readily understand is by instructing the client to close the eyes. Using terms such as "occlude your lacrimal duct," "guard against systemic absorption," or "use punctal occlusion" require additional explanation to be properly understood by the client.
Which best describes photophobia? A) Fear of light B) Aversion to light C) Reactive to light D) Need for light
Answer: B Photophobia is a sensitivity to light that clients with angle-closure glaucoma may sometimes experience, so aversion to light is closest to describing photophobia. It is not necessarily fear; phobia can be fear or aversion. There are many different types of reactivity to light, but photophobia is specifically a negative reaction. Photophobia typically involves the avoidance of light, not the need for it.
After being diagnosed with cataracts, a client believes the right eye has a cataract but not the left eye, as there are no vision changes with the left eye. Which response by the nurse is accurate? A) "Only your doctor can tell if you have a cataract in your left eye." B) "Cataracts develop at different rates, so one eye may be more affected than the other." C) "The changes being confined to one eye indicate a less severe cataract." D) "Surgery is still necessary for both eyes."
Answer: B The nurse should respond that cataracts tend to occur in both eyes and develop at different rates, and one cataract generally matures more rapidly than the other. The nurse should not tell the client that the healthcare provider is the only one who can tell if the client has a cataract in the left eye. The lack of vision changes in the left eye does not necessarily indicate the severity of the condition, and surgery might not be necessary for either eye.
The nurse is caring for a client who has been using timolol (Timoptic) to manage glaucoma. Which assessment finding supports an adverse effect associated with systemic absorption of the drug? A) Eye pain B) Heart rate of 57 C) Urinary frequency D) Blurred vision
Answer: B The onset of bradycardia must be evaluated. Timoptic is a beta-adrenergic blocker. It is associated with bradycardia in some clients. Frequent urination is associated with the use of carbonic anhydrase inhibitors. Eye pain and dim or blurred vision are associated with the use of miotic medications.
Which of the following clients most likely will require assistance with properly taking medications for macular degeneration? A) 72-year-old client, no dementia, no arthritis, hypertension B) 67-year-old client, dementia, arthritis, no hypertension C) 47-year-old client, no comorbidities D) 52-year-old client, gastroesophageal reflux disease (GERD), hypertension
Answer: B Two common conditions in older adults that may affect treatment of macular degeneration are tremors and cognitive decline. Hand tremors may make it difficult for the older adult to adequately apply eyedrops, and cognitive decline may cause older adults to forget to take their medications. Therefore, older adults with these conditions may need a family member or friend who can help them remember to take their medications and potentially apply eyedrops for them. The client with dementia and arthritis, although not the oldest of these clients, has conditions that are most likely to make taking medications properly difficult.
What class of drugs both decreases production of aqueous humor in the eye and increases drainage of aqueous humor from the uveoscleral pathway? A) Beta-adrenergic blockers B) Prostaglandin analogs C) Alpha2-adrenergic agonists D) Cholinergic agonists
Answer: C Alpha2-adrenergic agonists both decrease production of aqueous humor in the eye and increase drainage of aqueous humor from the uveoscleral pathway. Beta-adrenergic blockers decrease the production of aqueous humor in the eye, but they do not increase drainage of aqueous humor. Prostaglandin analogs increase drainage of aqueous humor from the uveoscleral pathway, but they do not decrease aqueous humor production. Cholinergic agonists increase drainage of aqueous humor through the trabecular meshwork via pupillary constriction.
The nurse is evaluating instructions provided to a client with glaucoma. Which client statement indicates that teaching has been effective? A) "The eyedrops only need to be used when my eyes hurt." B) "I can stop the eyedrops when the glaucoma has resolved." C) "I must use my eyedrops as prescribed for the rest of my life." D) "I will need to continually increase the dose of my eyedrops."
Answer: C Glaucoma can be controlled but not cured; the client must use eyedrops for the rest of his life. Eyedrops must be used continuously as prescribed; most clients with glaucoma do not experience eye pain. Increasing the dosage of eyedrops is only necessary if the ocular pressure is not controlled; this must be determined by the healthcare provider, not the client.
Which of the following scenarios is consistent with secondary congenital glaucoma? A) A newborn is diagnosed with glaucoma at birth. B) An infant is diagnosed at 6 months with glaucoma. C) A 1-year-old infant develops glaucoma following neurofibromatosis. D) A 5-year-old child is diagnosed with glaucoma.
Answer: C Secondary congenital glaucoma results from disorders of the eye or the body, including Sturge-Weber syndrome, Axenfeld-Rieger syndrome, aniridia, and neurofibromatosis, so the 1-year-old infant who develops glaucoma following neurofibromatosis has secondary congenital glaucoma. The newborn diagnosed at birth with glaucoma has congenital glaucoma, the infant diagnosed at 6 months has infantile glaucoma, and the child diagnosed at 5 years has juvenile glaucoma.
An older adult client with bilateral cataracts, arthritis, and a hearing deficit is scheduled for cataract surgery. Which is the priority nursing diagnosis for this client? A) Disturbed Body Image B) Decisional Conflict: Cataract removal C) Risk for Ineffective Health Maintenance D) Ineffective Coping
Answer: C The client has arthritis, which is a chronic condition and may interfere with the client's ability to manage self-care and postoperative care after cataract removal. Risk for Ineffective Health Maintenance is the diagnosis with the highest priority for the client at this time. There is no evidence to suggest the client is not coping or is experiencing decisional conflict regarding the removal of the cataracts. The client might have a disturbed body image; however, postoperative care is the highest priority at this time.
The nurse is preparing discharge instructions for a client with age-related macular degeneration (AMD) and type 1 diabetes mellitus. What should the nurse include in this client's teaching plan? A) Information on assisted-living facilities B) Information on the need to have routine eye examinations every 5 years C) Referral to home care to ensure safety with administering insulin and AMD medications at home D) Information on Stargardt disease
Answer: C The client has macular degeneration and type 1 diabetes, which means the client needs insulin at least once per day. The nurse should refer the client for home care to ensure that the client can safely provide insulin at home as well as assist with other medications the client might need for management of AMD. The client may or may not need to move to an assisted-living facility. Stargardt disease is the most common type of juvenile macular degeneration and not likely relevant to this client. Routine eye examinations for this client should be done every 2 years.
The nurse is planning instruction for a client who is newly diagnosed with glaucoma. What should be included in this teaching? Select all that apply. A) Manage eye pain with over-the-counter analgesics. B) Clouding of the affected eye(s) is expected. C) Self-administer prescribed eye medication properly. D) Attend follow-up appointments with the physician. E) Avoid over-the-counter medication unless discussed with the physician.
Answer: C, D, E When instructing a client on how to manage the diagnosis of glaucoma, the nurse should include why the client needs to avoid over-the-counter medication unless discussed with the physician, the method to self-administer prescribed eye medication, and the importance of attending follow-up appointments with the physician. Eye pain or clouding of affected eyes is not to be expected and should be reported to the physician.
Which diagnostic technique is used to confirm the location and extent of cataracts? A) Visually inspecting the optic fundus using an ophthalmoscope B) Using tonometry to indirectly measure intraocular pressure C) Revealing a dark area instead of the red reflex through ophthalmoscopy D) Identifying patient history consistent with risk of cataracts and examining the eye to diagnose the cataract
Answer: D Cataracts are diagnosed on the basis of the patient's history and eye examination. The Snellen and Rosenbaum charts are used. A dilated eye exam with either an ophthalmoscope or slit-lamp examination provides a magnified view of the structures of the eye. Ophthalmoscope examination confirms the diagnosis by identifying the location and extent of a cataract. Revealing a dark area is something that would happen only as the cataract matures. Visually inspecting the optic fundus and using tonometry to measure intraocular pressure are diagnostic tests for glaucoma.
Laser surgery and photodynamic therapy are both treatments for what disease of the eye? A) Congenital cataracts B) Age-related cataracts C) Nonexudative macular degeneration D) Exudative macular degeneration
Answer: D Exudative (wet) macular degeneration may be treated by laser surgery or photodynamic therapy. Macular degeneration of the nonexudative (dry) kind is treated with high-dose antioxidants and zinc. Neither laser surgery nor photodynamic therapy is used to treat age-related or congenital cataracts
A nurse is caring for several pediatric clients who are affected by cataracts. Of these clients, which is the most obvious candidate for surgical removal of the cataract? A) Two-month-old infant who is asymptomatic B) Six-month-old infant with difficulty noticing toys or faces C) Three-month-old infant with diminished reaction to bright light D) One-month-old infant with no reaction to bright light and failure to notice toys or faces
Answer: D If vision impairment is significant, the infant should undergo surgical removal of the cataract within the first 2 months of life. For children older than 2 months, cataract surgery should be performed at the discretion of the healthcare provider. The asymptomatic 2-month-old infant is not displaying signs of significant vision impairment, but the 1-month-old infant is. The 3- and 6-month-old infants are showing signs of vision impairment but are both at an age at which surgery may only be performed if the healthcare providers decides it is necessary.
An older adult client with intermediate dry macular degeneration calls the nurse complaining that his vision is suddenly much more distorted and colors do not seem right. Which action by the nurse is priority? A) Talk with the client to assess for other hallucinations that might be occurring. B) Check the client's medications for side effects of vision changes. C) Ensure the client's safety by raising the bedrails. D) Contact the healthcare provider for an immediate ophthalmologic evaluation.
Answer: D Individuals with dry intermediate macular degeneration can progress to exudative macular degeneration. A sudden distortion in vision and impaired color vision are signs of exudative macular degeneration and require prompt evaluation and treatment. Thus, the nurse needs to contact the healthcare provider so that the client can be seen by an ophthalmologist. The client most likely is not experiencing a side effect of medications. Ensuring the client's safety is important; however, the nurse needs to do more than raising the bedrails. The client is not hallucinating, although hallucinations are a sign of exudative macular degeneration as well.
A client is receiving verteporfin treatment for macular degeneration. The client asks the nurse what the expected outcome of treatment is. Which response by the nurse is most appropriate? A) It will increase the effectiveness of surgery. B) It will reverse the effects on the disease. C) It will promote the development of new blood vessels. D) The progression of the disease will be slowed.
Answer: D One treatment for macular degeneration is the use of verteporfin, a drug that tends to adhere to the surface of new blood vessels. This medication is injected systemically. Light is then shined into the affected eye, activating the drug and destroying new blood vessels. The best outcome for this treatment is that it will slow the disease. This does not reverse the symptoms of the disease. New vessel growth is not desirable. The client's condition will be slowed at best; it is not likely to improve. Surgical therapy is rare as a treatment for AMD and this medication does not improve the efficacy of surgery.
Which assessment finding is consistent with a diagnosis of open-angle glaucoma? A) A client loses vision intermittently several times over the course of several hours. B) A client has an episode of lost vision when experiencing a panic attack. C) A client loses the ability to see at all during a city-wide blackout. D) A client experiences gradually diminishing vision in both eyes over an extended period.
Answer: D Open-angle glaucoma tends to be a chronic and gradually progressive disease. It typically affects both eyes, although the pressures and progression may not be symmetric. Patients with angle-closure glaucoma may have intermittent episodes lasting several hours before they have a more typical prolonged attack of angle-closure glaucoma. Because of the effect of pupil dilation on aqueous outflow in angle-closure glaucoma, episodes often occur in association with darkness, emotional upset, or other factors that cause the pupil to dilate.
A nurse is caring for a client with glaucoma who is prescribed an ophthalmic beta-adrenergic blocking agent. When teaching the client about the therapeutic action of this medication, which of the following statements should the nurse include? A) "This drug reduces pressure in the eye by relaxing the muscles of the eye." B) "This medication only needs to be taken when eye pain is experienced." C) "Systemic absorption may occur, resulting in hypotension, bradycardia, and shortness of breath." D) "This drug reduces intraocular pressure by decreasing the production of fluid in the eye."
Answer: D Ophthalmic beta-adrenergic blocking agents are one type of pharmacologic therapy used in the treatment of glaucoma. This class of medication works to reduce intraocular pressure by decreasing the production of aqueous humor in the ciliary body. Systemic absorption is a potential side effect of this type of drug, not the therapeutic action of the drug. This type of drug should be taken once or twice a day, not on as-needed basis when pain occurs. Relaxation of the ciliary muscle is an effect of prostaglandin analog drugs, another class of medications used in the treatment of glaucoma.
An older adult client tells the nurse that reading is easier when the material is held to the left or right. What should the nurse suspect this client is experiencing? A) Cataract B) Detached retina C) Exudative macular degeneration D) Nonexudative macular degeneration
Answer: D Symptoms of age-related macular degeneration usually develop gradually and include needing more light to read, blurriness of print, or a blurred or blind spot in the central vision. The macular degeneration is likely nonexudative (dry) because that is the more common kind and it develops before the exudative (wet) type. Cloudy vision is seen with cataracts. When the retina detaches, the client experiences floaters, or spots, and lines or flashes of light in the visual field.
Which of the following diagrams would the nurse use when describing open-angle glaucoma to a client? A) A diagram showing a completely closed anterior chamber angle B) A diagram showing a completely occluded outflow of aqueous humor C) A diagram showing a blockage of the trabecular meshwork and canal of Schlemm D) A diagram showing congestion of the trabecular meshwork and reduced flow of aqueous humor through the canal of Schlemm
Answer: D The diagram showing congestion of the trabecular meshwork and reduced flow of aqueous humor through the canal of Schlemm demonstrates open-angle glaucoma. In open-angle glaucoma, the anterior chamber angle would be normal but outflow of aqueous humor would be reduced, although not to the degree that it was completely prevented, causing a rising intraocular pressure.
