Hinkle Ch. 58: Assessment and Management of Patients with Eye and Vision Disorders

A client who presents for an eye examination is diagnosed as having a visual acuity of 20/40. The client asks the nurse what these numbers specifically mean. What is a correct response by the nurse? - "A person whose vision is 20/40 can see an object from 40 feet away that a person with 20/20 vision can see from 20 feet away." - "A person whose vision is 20/40 can see an object from 20 feet away that a person with 20/20 vision can see from 40 feet away." - "A person whose vision is 20/40 can see an object from 40 inches away that a person with 20/20 vision can see from 20 inches away." - "A person whose vision is 20/40 can see an object from 20 inches away that a person with 20/20 vision can see from 40 inches away."

- "A person whose vision is 20/40 can see an object from 20 feet away that a person with 20/20 vision can see from 40 feet away."

A client is diagnosed with a corneal abrasion and the nurse has administered proparacaine hydrochloride per orders to assess visual acuity. The client requests a prescription for this medication because it completely took away the pain. What is the best response by the nurse? - "I will let the doctor know." - "Prescriptions of this medication are generally not given because it can cause corneal problems." - "It is standard for the doctor to write a prescription for this medication." - "Usually we will send you home with this bottle and written instructions for administering the medication."

- "Prescriptions of this medication are generally not given because it can cause corneal problems."

The nurse is giving a visual field examination to a 55-year-old male client. The client asks what this test is for. What would be the nurse's best answer? - "This test measures visual acuity." - "This test measures how well your eyes move." - "This test is to see how well your eyes are aging." - "This test measures peripheral vision and detects gaps in the visual field."

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

The nurse is instructing a nursing student when a new client comes to the eye clinic. The client reports suspecting a corneal abrasion. The nurse should explain what to the student nurse? - "To detect corneal abrasions, an ophthalmoscope is used." - "To detect corneal abrasions, ultrasonography is used." - "To detect corneal abrasions, a slit lamp is used." - "To detect corneal abrasions, retinal angiography is used."

- "To detect corneal abrasions, a slit lamp is used."

A client's vision is assessed at 20/200. The client asks what that means. Which is the most appropriate response by the nurse? - "You see an object from 200 feet away that a person with normal vision sees from 20 feet away." - "You see an object from 20 feet away just like a person with normal vision." - "You see an object from 200 feet away just like a person with normal vision." - "You see an object from 20 feet away that a person with normal vision sees from 200 feet away."

- "You see an object from 20 feet away that a person with normal vision sees from 200 feet away."

A 52-year-old comes to the clinic for a follow-up examination after being diagnosed with glaucoma. The client states, "I'm hoping that I don't have to use these drops for very long." Which response by the nurse would be most appropriate? - "Most clients need to use the drops for only about a few months." - "If the drops don't work, surgery may be needed to cure your condition." - "You'll need to use the drops for the rest of your life to control the glaucoma." - "These drops are just the first step to make sure that your vision doesn't get worse."

- "You'll need to use the drops for the rest of your life to control the glaucoma."

When assessing the pressure of the anterior chamber of the eye, a nurse normally expects to find a pressure of: - 5 to 10 mm Hg. - 10 to 20 mm Hg. - 20 to 30 mm Hg. - over 30 mm Hg.

- 10 to 20 mm Hg.

It is determined that a patient is legally blind and will be unable to drive any longer. Legal blindness refers to a best-corrected visual acuity (BCVA) that does not exceed what reading in the better eye? - 20/50 - 20/100 - 20/150 - 20/200

- 20/200

The ophthalmologist tells a patient that he has increased intraocular pressure (IOP). The nurse understands that increased pressure resulting from optic nerve damage is indicated by a reading of: - 0 to 5 mm Hg. - 6 to 10 mm Hg. - 11 to 20 mm Hg. - >21 mm Hg.

- >21 mm Hg.

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

- A new floater in vision

The nurse admits a client to the emergency department who has been referred by the eye clinic. Which condition is an emergency where the nurse should refer the client for medical treatment immediately? - Chalazion - Acute angle-closure glaucoma - Hordeolum - Blepharitis

- Acute angle-closure glaucoma

On ocular examination, the health care provider notes severely elevated IOP, corneal edema, and a pupil that is fixed in a semi-dilated position. The nurse knows that these clinical signs are diagnostic of the type of glaucoma known as: - Chronic open-angle. - Normal tension. - Acute angle-closure. - Chronic angle-closure.

- Acute angle-closure.

A major role for nursing in the management of glaucoma is health education. Which of the following is the most important teaching point that the nurse should advise the patient of? - Keep all follow-up appointments. - Keep a record of eye pressure measurements. - Adhere to the medication regimen. - Participate in the decision-making process.

- Adhere to the medication regimen.

A client has been referred to an ophthalmologist for suspected macular degeneration. The nurse knows to prepare what test for the physician to give the client? - Ishihara polychromatic plates - Visual field - Amsler grid - Slit lamp

- Amsler grid

Which term refers to the absence of the natural lens? - Aphakia - Scotoma - Keratoconus - Hyphema

- Aphakia

The nurse is demonstrating how to perform punctal occlusion. Which activities does the nurse perform? - Applies gentle pressure bilaterally on the bridge of the nose to the inner canthus of each eye - Holds down the lower lid of the eye by applying pressure on the eyeball and the cheekbone - Applies gentle pressure to the upper eyelid to keep the lid open while telling the client to gaze upward - Applies firm pressure to the upper and lower eyelids at the outer edges to keep eyelids in approximation

- Applies gentle pressure bilaterally on the bridge of the nose to the inner canthus of each eye

The nurse is providing discharge education to an adult client who will begin a regimen of ocular medications for the treatment of glaucoma. How can the nurse best determine if the client is able to self-administer these medications safely and effectively? - Assess the client for any previous inability to self-manage medications. - Ask the client to demonstrate the instillation of her medications. - Determine whether the client can accurately describe the appropriate method of administering her medications. - Assess the client's functional status.

- Ask the client to demonstrate the instillation of her medications.

A patient is to have an angiography done using fluorescein as a contrast agent to determine if the patient has macular edema. What laboratory work should the nurse monitor prior to the angiography? - BUN and creatinine - AST and ALT - Hemoglobin and hematocrit - Platelet count

- BUN and creatinine

A nurse instructs a client to refrain from blinking after administering eye drops based on which rationale? - Blinking keeps substances from entering the eye. - Blinking causes the eye drop to be expelled from the conjunctival sac. - Blinking limits the size of the conjunctival sac for the needed amount of eye drop. - Blinking slows absorption of the instilled eye drops.

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

The nurse is administering an ophthalmic ointment to a patient with conjunctivitis. What disadvantage of the application of an ointment does the nurse explain to the patient? - It does not work as rapidly as eye drops do. - Blurred vision results after application. - It has a lower concentration than eye drops. - It has more side effects than eye drops.

- Blurred vision results after application.

Which medication classification increases aqueous fluid outflow in the client with glaucoma? - Beta-blockers - Alpha-adrenergic agonists - Carbonic anhydrase inhibitors - Cholinergics

- Cholinergics

Which of the following is the main refracting surface of the eye? - Cornea - Iris - Pupil - Conjunctiva

- Cornea

What type of medication would the nurse use in combination with mydriatics to dilate the patient's pupil? - Anti-infectives - Corticosteroids - Cycloplegics - NSAIDs

- Cycloplegics

The nurse has taken shift report on a group of clients and has been told that one client has an ocular condition that has primarily affected the rods in his eyes. Considering this information, what should the nurse do while caring for the client? - Ensure adequate lighting in the client's room. - Provide a dimly lit room to aid vision by limiting contrast. - Carefully point out color differences for the client. - Carefully point out fine details for the client.

- Ensure adequate lighting in the client's room.

Which of the following is the role of the nurse toward a patient who is to undergo eye examinations and tests? - Ensuring that the patient receives eye care to preserve his or her eye function and prevent further visual loss - Conducting various tests to determine the function and the structure of the eyes - Determining if further action is warranted - Advising the patient on the diet and exercise regimen to be followed

- Ensuring that the patient receives eye care to preserve his or her eye function and prevent further visual loss

The nurse asks a client to follow the movement of a pencil up, down, right, left, and both ways diagonally. The nurse is assessing which of the following? - Pupillary reaction - Extraocular muscle function - Eyelid drooping - Eyeball oscillation movements

- Extraocular muscle function

The nurse should monitor for which manifestation in a client who has had LASIK surgery? - Excessive tearing - Cataract formation - Halos and glare - Stye formation

- Halos and glare

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

- Hemangioma

The upper eyelid normally covers the uppermost portion of the iris and is innervated by which cranial nerve? - III - I - IV - II

- III

A client with chronic open-angle glaucoma is now presenting with eye pain and intraocular pressure of 50 mm Hg. An immediate iridotomy is scheduled. Which of the following describes the desired effects of this procedure? - Reverse optic nerve damage - Restore vision - Improve outflow drainage - To relieve pain

- Improve outflow drainage

Which surgical procedure involves flattening the anterior curvature of the cornea by removing a stromal lamella? - Photorefractive keratectomy (PRK) - Laser-assisted in situ keratomileusis (LASIK) - Keratoconus - Keratoplasty

- Laser-assisted in situ keratomileusis (LASIK)

A nurse conducted a history and physical for a newly admitted patient who states, "My arms are too short. I have to hold my book at a distance to read." The nurse knows that the patient is most likely experiencing: - Opacity in the lens. - Loss of accommodative power in the lens. - Shrinkage of the vitreous body. - Decreased eye muscle tone.

- Loss of accommodative power in the lens.

Which part of the retina is responsible for central vision? - Macula - Optic disk - Sclera - Fundus

- Macula

An older adult patient has noticed a significant amount of vision loss in the last few years. What does the nurse recognize as the most common cause of visual loss in older adults? - Macular degeneration - Ocular trauma - Retinal vascular disease - Uveitis

- Macular degeneration

The nurse is assessing a client using an Amsler Grid. The nurse is assessing for which of the following? - Visual acuity - Macular problems - Intraocular pressure - Visual field

- Macular problems

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

- Nonsteroidal anti-inflammatory drugs (NSAIDs)

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

- Notify the client prior to touching the client.

A nurse practitioner is assessing a patient who is experiencing changes in her vision. The nurse performs the following steps. Place them in the order in which the nurse would complete them. Use all options. - Test visual acuity - Obtain an ocular history - Perform direct ophthalmoscopy - Examine the external eye

- Obtain an ocular history - Test visual acuity - Examine the external eye - Perform direct ophthalmoscopy

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

- Ophthalmoscope

Which is not a clinical manifestation of a retinal detachment? - Sudden onset of a greater number of floaters - Cobwebs - Bright flashing lights - Pain

- Pain

An aging client is brought to the eye clinic by the son. The son states he has seen his parent holding reading materials at an increasing distance to focus properly. What age-related changes does this indicate? - Cataract - Presbyopia - Myopia - Macular degeneration

- Presbyopia

The nurse is reviewing the medical record of a client with glaucoma. Which of the following would alert the nurse to suspect that the client was at increased risk for this disorder? - Age younger than 40 years - Hyperopia since age 20 years - History of respiratory disease - Prolonged use of corticosteroids

- Prolonged use of corticosteroids

A 68-year-old client reports a change in vision when driving during the night. Which strategies would the nurse recommend to mitigate this problem? - Utilize an eye shield during the day to promote and protect night vision. - Wear darkly tinted sunglasses since the eyes are now more sensitive to glare. - Propose reading eyeglasses for presbyopia, which is changing only their night vision. - Recommend contrast sensitivity testing measures to determine visual function.

- Recommend contrast sensitivity testing measures to determine visual function.

Which statement is accurate regarding refractive surgery? - Refractive surgery will alter the normal aging of the eye. - Refractive surgery may be performed on all clients, even if they have underlying health conditions. - Refractive surgery may be performed on clients with an abnormal corneal structure as long as they have a stable refractive error. - Refractive surgery is an elective, cosmetic surgery performed to reshape the cornea.

- Refractive surgery is an elective, cosmetic surgery performed to reshape the cornea.

The nurse is caring for a client ordered for multiple eye screening. Following which procedure will the nurse instruct the client on a yellow coloring to the skin and urine as being normal? - Ultrasonography - Retinal Imaging - Retinal Angiography - Retinoscopy

- Retinal Angiography

A diabetic patient is scheduled for surgery for repair of a detached retina that was caused by proliferative retinopathy. The nurse prepared the patient for surgery, aware that the type of detachment is most likely classified as which of the following? - Rhegmatogenous - Traction - Exudative - Traction combined with rhegmatogenous

- Rhegmatogenous

Which of the following surgical procedures involves taking a piece of silicone plastic or sponge and sewing it onto the sclera at the site of a retinal tear? - Scleral buckle - Pars plana vitrectomy - Pneumatic retinopexy - Phacoemulsification

- Scleral buckle

When the patient tells the nurse that his vision is 20/200, and asks what that means, the nurse informs the patient that a person with 20/200 vision: - Sees an object from 200 feet away that a person with normal vision sees from 20 feet away. - Sees an object from 20 feet away that a person with normal vision sees from 200 feet away. - Sees an object from 20 feet away that a person with normal vision sees from 20 feet away. - Sees an object from 200 feet away that a person with normal vision sees from 200 feet away.

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

Which of the following occurs when there is deviation from perfect ocular alignment? - Strabismus - Ptosis - Chemosis - Nystagmus

- Strabismus

A client is prescribed pilocarpine. When preparing the client's teaching plan about this drug, which of the following would the nurse integrate? - It acts to decrease aqueous humor production. - The client may experience difficulty seeing in the dark. - The client's pupils will most likely be dilated. - The client may experience a dry mouth and nose.

- The client may experience difficulty seeing in the dark.

A client with glaucoma has presented for a scheduled clinic visit and tells the nurse that she has begun taking an herbal remedy for her condition that was recommended by a work colleague. What instruction should the nurse provide to the client? - The client should discuss this new remedy with her ophthalmologist promptly. - The client should monitor her IOP closely for the next several weeks. - The client should do further research on the herbal remedy. - The client should report any adverse effects to her pharmacist.

- The client should discuss this new remedy with her ophthalmologist promptly.

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

- The presence of halos around lights.

A young client is being seen by a pediatric ophthalmologist due to a recent skateboarding accident that resulted in trauma to the right cornea, and is now at risk of developing an infection. Which nursing intervention would be contraindicated for a client at risk for infection? - To ensure correct application of antibiotic ointment, gently drag tip of tube along lower lid while squeezing ointment on to lid. - Avoid using a container of ophthalmic medication for anyone other than the client. - Change gauze eye bandages using aseptic technique. - Wash hands before examining the eyes or performing any procedure about the face.

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

A client accidentally splashes chemicals into one eye. The nurse knows that eye irrigation with plain tap water should begin immediately and continue for 15 to 20 minutes. What is the primary purpose of this first aid treatment? - To hasten formation of scar tissue - To prevent vision loss - To eliminate the need for medical care - To serve as a stopgap measure until help arrives

- To prevent vision loss

To straighten the ear canal in an adult for examination, the nurse practitioner would grasp the auricle and pull it: - Up and backward. - Upward and outward. - Slightly outward. - Downward.

- Up and backward.

A patient is diagnosed with glaucoma. When reviewing the patient's history and physical examination, the nurse finds the following information documented: Age: 42 years Thick corneaAsian-American ancestry History of diabetes mellitus Farsightedness Prolonged periods of systemic corticosteroid use for Crohn's disease Which of the findings would the nurse identify as possible risk factors for glaucoma for this patient? Select all that apply. - Asian ancestry - Farsightedness - Use of systemic corticosteroids - Thick cornea - Age - History of diabetes

- Use of systemic corticosteroids - History of diabetes

Which of the following types of conjunctivitis is preceded by symptoms of an upper respiratory infection? - Viral - Allergic - Toxic - Vernal

- Viral

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

- demonstrate eyedrop instillation.

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

- hyperopia

A nurse is obtaining a history from a new client with glaucoma. The client indicates having read about the diagnosis and understanding that this type of glaucoma is due to the degeneration and obstruction of the trabecular meshwork, whose original function is to absorb the aqueous humor. The loss of absorption will lead to an increased resistance, and thus a chronic, painless buildup of pressure in the eye. Which type of glaucoma has the client described? - open angle - angle closure - congenital - secondary

- open angle

A client has developed diabetic retinopathy and is seeing the physician regularly to prevent further loss of sight. From where do the nerve cells of the retina extend? - optic nerve - oculomotor nerve - trochlear nerve - trigeminal nerve

- optic nerve

A client with multiple sclerosis is being seen by a neuro-ophthalmologist for a routine eye exam. The nurse explains to the client that during the examination, the client will be asked to maintain a fixed gaze on a stationary point while an object is moved from a point on the side, where it can't be seen, toward the center. The client will indicate when the object becomes visible The nurse further explains that the test being performed is called a: - perimetry test - color vision test - slit-lamp examination - retinal angiography

- perimetry test

A nurse notices that a client's left upper eyelid is drooping. The nurse has observed: - ptosis - ptolemy - proptosis - nystagmus

- ptosis

After a fall at home, a client hits their head on the corner of a table. Shortly after the accident, the client arrives at the ED, unable to see out of their left eye. The client tells the nurse that symptoms began with seeing spots or moving particles in the field of vision but that there was no pain in the eye. The client is very upset that the vision will not return. What is the most likely cause of this client's symptoms? - retinal detachment - angle-closure glaucoma - eye trauma - chalazion

- retinal detachment

A client is scheduled to undergo surgery to remove a cataract in the left eye using phacoemulsification. When phacoemulsification is used, a: - small portion of the anterior capsule is removed. Ultrasound is emitted through a probe, and suction is used to extract the lens. - longer incision is made, and a laser is used to eradicate the cataract. Suction is then used to extract the lens. - longer incision is made, and the lens is extracted in one piece. - small incision is made, a laser is used to eradicate the cataract, and the lens is extracted in one piece.

- small portion of the anterior capsule is removed. Ultrasound is emitted through a probe, and suction is used to extract the lens.

A client is having a routine eye examination. The procedure being performed is done by using an instrument to indent or flatten the surface of the eye. This is known as ________ and it is routinely done to test for ________. - tonometry; intraocular pressure - retinoscopy; detached retina - tonometry; macular degeneration - retinoscopy; cataracts

- tonometry; intraocular pressure

Which type of glaucoma presents an ocular emergency? - Normal tension glaucoma - Ocular hypertension - Acute angle-closure glaucoma - Chronic open-angle glaucoma

- Acute angle-closure glaucoma