NSG 323 Vision Section

1. Nurse Kaye is carrying out her operative teachings for an older client who will have cataract surgery on the right eye. The nurse concludes that the client needs further understanding about the teachings if he says: A. "I will sleep on my left side after surgery." B. "I will wipe my nose gently if it is congested after surgery." C. "I will call my physician if I have sharp and sudden pain or a fever after surgery." D. "I will bend below my waist frequently to increase circulation after surgery."

1. Answer: D. "I will bend below my waist frequently to increase circulation after surgery." D: Immediately after the procedure, the client should avoid bending over, to prevent putting extra pressure on the eye. A: Sleeping on the left side avoids injuring the operated side. B: Wiping the nose gently avoids increasing the intraocular pressure. C: The patient must recognize any signs and symptoms of complications.

2. After cataract surgery, the patient is encouraged to: A. Maintain bed rest for 1 week. B. Lie on his or her stomach while sleeping. C. Avoid bending his or her head below the waist. D. Lift weights to increase muscle strength.

2. Answer: C. Avoid bending his or her head below the waist. C & B: Bending the head below the waist and lying on the stomach increase the intraocular pressure and affect the newly operated eye. A: Bed rest for a week is unnecessary for post cataract surgery patients. D: Lifting heavy objects ate contraindicated after a cataract surgery.

When developing a teaching session on glaucoma for the community, which of the following statements would the nurse stress? 1. Glaucoma is easily corrected with eyeglasses 2. White and Asian individuals are at the highest risk for glaucoma. 3. Yearly screening for people ages 20-40 years is recommended. 4. Glaucoma can be painless and vision may be lost before the person is aware of a problem.

23. Answer: 4. Glaucoma can be painless and vision may be lost before the person is aware of a problem. Open-angle glaucoma causes a painless increase in intraocular pressure (IOP) with loss of peripheral vision. A variety of miotics and agents to decrease IOP and occasional surgery are used to treat glaucoma. Blacks have a threefold greater chance of developing with an increased chance of blindness than other groups. Individuals older than 40 should be screened.

3. Upon assessment, the patient told the nurse that she was experiencing the three common symptoms found with cataracts and these are listed below except for: A. Blurred vision. B. Glare. C. Halos. D. Eye pain.

3. Answer: D. Eye pain. D: Pain is not present in cataract; only in glaucoma. A, B, C are the three common symptoms found with cataract.

4. On ophthalmic examination, the physician noted the major objective finding seen with cataracts: A. Tunnel vision. B. Glare. C. Opaque lens. D. Eye pain.

4. Answer: C. Opaque lens. C: The lens of the eye turns milky white in cataracts, and this is the major objective finding seen. A & D: Tunnel vision and eye pain are common in patients with glaucoma. B: Patients with cataracts experience glare, but this is not a major finding in cataract

5. The nurse is right when she instructs the patient to avoid: A. Getting up from bed for 2 weeks after surgery. B. Chewing on the same side of the operated area. C. Taking anticoagulants. D. Using eyeglasses when going outside.

5. Answer: C. Taking anticoagulants. C: Taking anticoagulants predisposes the patient to hemorrhage A & B: Complete bed rest for 2 weeks and chewing on the side of the operated area unnecessary for a post cataract surgery patient D: The sunglasses protect the eyes from potential infectious agents such as dust and smoke.

The client with glaucoma asks the nurse is complete vision will return. The most appropriate response is: 1. "Although some vision as been lost and cannot be restored, further loss may be prevented by adhering to the treatment plan." 2. "Your vision will return as soon as the medications begin to work." 3. "Your vision will never return to normal." 4. "Your vision loss is temporary and will return in about 3-4 weeks."

Answer: 1. "Although some vision as been lost and cannot be restored, further loss may be prevented by adhering to the treatment plan." Vision loss to glaucoma is irreparable. The client should be reassured that although some vision has been lost and cannot be restored, further loss may be prevented by adhering to the treatment plan. Option C does not provide reassurance to the client.

Cataract surgery results in aphakia. Which of the following statements best describes this term? 1. Absence of the crystalline lens 2. A "keyhole" pupil 3. Loss of accommodation 4. Retinal detachment

Answer: 1. Absence of the crystalline lens Aphakia means without lens, a keyhole pupil results from iridectomy. Loss of accommodation is a normal response to aging. A retinal detachment is usually associated with retinal holes created by vitreous traction.

For a client having an episode of acute narrow-angle glaucoma, a nurse expects to give which of the following medications? 1. Acetazolamide (Diamox) 2. Atropine 3. Furosemide (Lasix) 4. Urokinase (Abbokinase)

Answer: 1. Acetazolamide (Diamox) Acetazolamide, a carbonic anhydrase inhibitor, decreases intraocular pressure (IOP) by decreasing the secretion of aqueous humor. Atropine dilates the pupil and decreases outflow of aqueous humor, causing further increase in IOP. Lasix is a loop diuretic, and Urokinase is a thrombolytic agent; they aren't used for the treatment of glaucoma.

During the early postoperative period, the client who had a cataractextraction complains of nausea and severe eye pain over the operative site. The initial nursing action is to: 1. Call the physician 2. Administer the ordered main medication and antiemetic 3. Reassure the client that this is normal. 4. Turn the client on his or her operative side

Answer: 1. Call the physician Severe pain or pain accompanied by nausea is an indicator of increased intraocular pressure and should be reported to the physician immediately. The other options are inappropriate.

Tonometry is performed on the client with a suspected diagnosis of glaucoma. The nurse analyzes the test results as documented in the client's chart and understands that normal intraocular pressure is: 1. 2-7 mmHg 2. 10-21 mmHg 3. 22-30 mmHg 4. 31-35 mmHg

Answer: 2. 10-21 mmHg Tonometry is the method of measuring intraocular fluid pressure using a calibrated instrument that indents or flattens the corneal apex. Pressures between 10 and 21 mmHg are considered within normal range.

The client is being discharged from the ambulatory care unit following cataract removal. The nurse provides instructions regarding home care. Which of the following, if stated by the client, indicates an understanding of the instructions? 1. "I will take Aspirin if I have any discomfort." 2. "I will sleep on the side that I was operated on." 3. "I will wear my eye shield at night and my glasses during the day." 4. "I will not lift anything if it weighs more that 10 pounds."

Answer: 3. "I will wear my eye shield at night and my glasses during the day." The client is instructed to wear a metal or plastic shield to protect the eye from accidental and is instructed not to rub the eye. Glasses may be worn during the day. Aspirin or medications containing aspirin are not to be administered or taken by the client and the client is instructed to take acetaminophen as needed for pain. The client is instructed not to sleep on the side of the body on which the operation occurred. The client is not to lift more than 5 pounds.

In preparation for cataract surgery, the nurse is to administer prescribed eye drops. The nurse reviews the physicians orders, expecting which type of eye drops to be instilled? 1. An osmotic diuretic 2. A miotic agent 3. A mydriatic medication 4. A thiazide diuretic

Answer: 3. A mydriatic medication A mydriatic medication produces mydriasis or dilation of the pupil. Mydriatic medications are used preoperatively in the cataract client. These medication act by dilating the pupils. They also constrict blood vessels. An osmotic diuretic may be used to decrease intraocular pressure. A miotic medication constricts the pupil. A thiazide diuretic is not likely to be prescribed for a client with a cataract.

The nurse is performing an assessment in a client with a suspected diagnosis of cataract. The chief clinical manifestation that the nurse would expect to note in the early stages of cataract formation is: 1. Eye pain 2. Floating spots 3. Blurred vision 4. Diplopia

Answer: 3. Blurred vision A gradual, painless blurring of central vision is the chief clinical manifestation of a cataract. Early symptoms include slightly blurred vision and a decrease in color perception.

The nurse is developing a plan of care for the client scheduled for cataractsurgery. The nurse documents which more appropriate nursing diagnosis in the plan of care? 1. Self-care deficit 2. Imbalanced nutrition 3. Disturbed sensory perception 4. Anxiety

Answer: 3. Disturbed sensory perception The most appropriate nursing diagnosis for the client scheduled for cataract surgery is Disturbed sensory perception (visual) related to lens extraction and replacement. Although the other options identify nursing diagnoses that may be appropriate, they are not related specifically to cataract surgery.

A male client has just had a cataract operation without a lens implant. In discharge teaching, the nurse will instruct the client's wife to: 1. Feed him soft foods for several days to prevent facial movement 2. Keep the eye dressing on for one week 3. Have her husband remain in bed for 3 days 4. Allow him to walk upstairs only with assistance.

Answer: 4. Allow him to walk upstairs only with assistance. Without a lens, the eye cannot accommodate. It is difficult to judge distance and climb stairs when the eyes cannot accommodate. Therefore, the client should walk up and down stairs only with assistance.

The nurse is developing a teaching plan for the client with glaucoma. Which of the following instructions would the nurse include in the plan of care? 1. Decrease fluid intake to control the intraocular pressure 2. Avoid overuse of the eyes 3. Decrease the amount of salt in the diet 4. Eye medications will need to be administered lifelong.

Answer: 4. Eye medications will need to be administered lifelong. The administration of eye drops is a critical component of the treatment plan for the client with glaucoma. The client needs to be instructed that medications will need to be taken for the rest of his or her life.

Which of the following instruments is used to record intraocular pressure? 1. Goniometer 2. Ophthalmoscope 3. Slit lamp 4. Tonometer

Tonometer A tonometer is a device used in glaucoma screening to record intraocular pressure. A goniometer measures joint movement and angles. An ophthalmoscope examines the interior of the eye, especially the retina. A slit lamp evaluates structures in the anterior chamber in the eye.