Chapter 42: Assessment and Concepts of Care for Patients with Eye and Vision Problems

Which statements about vision testing of a client by the nurse are accurate? (SATA) A. The Snellen eye chart measures distance vision B. The light perception test determines if a client is unable to identify the presence or absense of light C. A Rosenbaum Pocket Vision Screener or a Jaeger card tests far vision D. Visual field testing determines the degree of a clients peripheral vision E. Color vision is usually tested using Ishihara color plates F. The six cardinal positions of gaze are used to assess muscle function

A, B, D, E, F All are correct except C, A Rosenbaum Pocket Vision Screener or Jaeger card test NEAR vision NOT far

Which assessment findings will the nurse consider normal when assessing a clients eyes? (SATA) A. Nystagmus in lateral gaze B. Presbyopia in a 35-year-old client C. Yellow sclera with small pigmented dots in a dark-skinned person D. Ptosis of the eyelids E. Pupil constriction within 1 minute in response to light F. Head tilting or squinting

A, B, C -Nystagmus, an involuntary and rapid twitching of the eyeball is a normal finding for the far lateral gaze. -Presbyopia is an age-related problem in which the lens loses its elasticity and is less able to change shape to focus the eye for close work. As a result, images fall behind the retina. This problem usually begins in adults in their 40s. -In dark-skinned adults, the normal sclera may appear yellow with small pigmented dots may be visible. NOT NORMAL ANSWERS: -The pupil should immediately constrict when a light is directed at it (brisk response). If the pupil takes more than 1 second to constrict the response is sluggish -Ptosis, head tilting, and squinting are not normal, head tilting or squinting often indicate the client is trying o attain clear vision

Which age-related changes in eyes and vision will the nurse expect for an older adult client? Select all that apply A. Cornea flattens with blur vision B. Ocular muscle strength is decreased C. Decreased discrimination among colors: green, blue, violet D. Tear production is decreased resulting in dry eyes E. Lens elasticity increases F. Eyes appear sunken

A, B, C, D, F E is not correct because there is a decreased elasticity in the lens which requires corrective lenses to read.

Which priority topics would the nurse teach the client and family for postop care after cataract surgery? (SATA) A. Proper instillation of antibiotic and steroid ointments B. Remind the client that mild itching and bloodshot appearance is normal C. Apply cool compresses for mild eyelid swelling D. Use acetaminophen or aspirin for mild discomfort E. Report yellow or green drainage to the eye health care provider immediately F. Final best vision will not occur until 4-6 weeks after surgery

A, B, C, E, F All are correct besides d, Aspirin is AVOIDED b/c it affects bleeding. If the pain is more severe then Tylenol #3 can be prescribed.

Which predisposing factors will the nurse ask about when taking a history of a client at risk for cataracts? (SATA) A. Recent or past trauma to the eyes B. Presence of diabetes or hypertension C. History of excessive alcohol intake D. Family hx of cataracts E. Prolonged use of corticosteroids or beta blockers F. Recent or past history of cancer

A, B, D, E While age is important because cataracts are most prevalent in the older adult, the nurse asks about other predisposing factors including: recent or past trauma to the eye, exposure to radioactive materials, x-rays, UV light, prolonged use of corticosteroids, beta blockers, chlorpromazine, presense of intraocular disease (recurrent uveitis), presense of systemic disease (diabetes, hypoparathyroidism, hypertension), previous cataract, or family history of cataracts and smoking

When the nurse is instilling ophthalmic drops into a clients eyes, which steps are included in the correct procedure (SATA) A. Check the eyedrop name, strength, expiration date, color, and clarity B. Wash hands and remove cap from bottle C. Instruct the client to tilt the head backward, open eyes, and look down at floor D. Gently pull the lower lid against the clients cheek, forming a small pocket E. Hold the eyedrop bottle (with cap off) like a pencil, with tip pointing down F. Without touching any part of the eye or lid with the tip of the bottle, gently squeeze and release the prescribed number of drops into the pocket G. Gently release the lower lid and tell the client to close eye gently H. Gently blow away any excess drug or tears with tissue I. Ask the client to keep eyes closed for about 1 minute

A, B, D, E, F, G, H, I C is not correct, the client is instructed to tilt the head backward, open eyes, and look UP at ceiling

Which statements about drug administered by the nurse for treatment of increased IOP in a client with glaucoma are accurate? (SATA) A. The prostaglandin agonist drugs reduce IOP by dilating blood vessels in the trabecular mesh, which then collects and drains aqueous humor at a faster rate B. Teach clients prescribed cholinergic agonists that eye color darkens, and eyelashes elongate, over time in the eye receiving the drug C. Cholinergic agonists reduce IOP by limiting the production of aqueous humor and making more room between the iris and the lens, which improves fluid outflow D. Carbonic anhydrase inhibitors directly and strongly inhibit production of aqueous humor E. Teach clients prescribed adrenergic agonists to wear dark glasses outdoors and also indoors when lighting is bright F. Teach clients prescribed beta blockers to check their pulse at least bid and notify the eye health care provider if the pulse is consistently below 60 bpm

A, C, D, E, F All are drugs used to treat IOP in glaucoma are correct except option B Prostaglandin agonists are the only drugs for glaucoma that cause eye color to darken and eyelashes to elongate over time in the eye or eyes receiving the drug

What will the nurse teach the client to prevent harm post after keratoplasty (corneal transplant)? (SATA) A. Do not use an ice pack on the eye B. Wear an eye shield at night for first week after surgery C. Avoid jogging and any other activity that promotes rapid or jerky head motions for several weeks after surgery D. Lie on operative side to reduce IOP E. Report the presence of purulent discharge immediately to the surgeon F. Examine the eye daily for the presence of infection or graft rejection

A, C, E, F B and D are not correct. -The client is taught to wear an eye patch over the eye at night for a month NOT a week -Lie on the NONoperative side to decrease IOP

How frequently will the nurse recommend a basic eye examination for a 50-year-old African American client? A. Every 2-4 years B. Every 3-5 years C. Every 1-3 years D. Every 1-2 years

A. Every 2-4 years A nurse recommends that a client of any race between the ages of 40-64 years have a basic eye exam every 2-4 years. African American clients are recommended to have a basic eye exam every 2-4 years from the age of 20-64 years. Adults over the age of 65 (any race) are recommended to have this exam every 1-2 years.

Which interprofessional collaboration will the nurse seek to assist a client diagnosed with glaucoma to cope who expresses anxiety over the possibility of sight loss? A. Mental health professional B. Eye health care provider C. Home health nurse D. Occupational therapist

A. Mental health professional The possibility or reality of the loss of vision can be distressing. The clients who experience anxiety or depression related to changes in their sight, collaboration with a mental health professional is a good idea. The nurse supports the client at regular visits and the mental health professional can provide ongoing counseling and support to the client during the transition

Which error in refraction does the nurse recognize when a client reports difficulty seeing objects at a distance? A. Myopia B. Hyperopia C. Emmetropia D. Astigmatism

A. Myopia Myopia (nearsightedness) occurs when the eye over-bends the light and images converge in front of the retina. Near vision is normal, but distance vision is poor. Myopia is corrected with a concave lens in eyeglasses or contacts. -Hyperopia (farsightedness) the client has poor near vision -Emmetropia is the perfect refraction of the eye in which light rays from a distant source are focuses into a sharp image on the retina -Astigmatism is caused by unevenly curved surfaces on or in the eye, especially the cornea. These uneven surfaces distort vision

With which specific interprofessional team member would the nurse collaborate to manage a client dry, age-related macular degeneration for which there is no cure? A. Registered dietitian nutritionist B. Eye health care provider C. Mental health professional D. Speech-language pathologist

A. Registered dietitian nutritionist Dry AMD has no cure. Management in the community setting is focused in slowing the progression of the vision loss and helping maximize remaining vision and quality of life. The risk for dry AMD can be reduced by increasing long-term dietary intake of Vitamins c, E, and zinc oxide, copper, and carotenoid lutein and zeaxanthin. The nutritionist is best equipped to collaborate with the nurse to increase dietary intake of the crucial elements.

Which signs and symptoms will the nurse expect when a client is in the early stage of cataract development? (SATA) A. Photophobia B. Decreased color perception C. Double vision D. Blurred vision E. Decreased depth perception F. Pain and eye redness

B (decreased color perception), D (blurred vision) Early signs and symptoms of cataracts are slightly blurred vision and decreased color perception. As lens cloudiness continues, blurred vision worsens and double vision occurs. The client may have difficulty with ADL's. Clients commonly report increasing difficulty seeing at night esp while driving. NO pain or eye redness is associated with age related cataract formation

Which signs and symptoms will the nurse instruct the client and family to immediately report to the eye health care provider after cataract surgery? (SATA) A. mild eye itching B. Sharp sudden pain in the eye C. Bleeding or increased discharge from eye D. Flashes of light or floating shapes seen in eye E. Decreased vision in eye with surgery F. Green or yellow, thick drainage from eye

B, C, D, E, F Mild eye itching is normal and expected following surgery

For which disease or conditions will the nurse monitor clients carefully b/c they can adversely affect eyes and vision (SATA) A. Inflammatory bowel disease B. Pregnancy C. Diabetes D. Hypertension E. Osteoarthritis F. Thyroid problems

B, C, D, F Diabetes, hypertension, lupus, sarcoidosis, thyroid problems, immune deficiency syndrome, cardiac disease, MS, and pregnancy

Which assessment does the nurse use to determine if a client documentation will include PERRLA? A. Assess for presence, relief, or decrease in pain B. Assess size, shape, and reactivity of pupil C. Assess pupils, retina, and light refraction D. Assess for signs of presbyopia or retinal detachment

B. Assess size, shape, and reactivity PERRLA: pupils equal, round, reactive to light, and accomodation

To avoid harm after a scleral buckling procedure for retinal detachment, which instruction does the nurse provide the client? A. Turn your head from side to side once an hour to ensure the effects of gravity are distributed equally B. Avoid reading, writing, and work that requires close vision in the first week after surgery C. Keep your head in the horizontal position for at least 12 hours daily D. Place a patch over your eyes at night only and apply ice beneath the patch

B. Avoid reading, writing, and work that requires close vision in the first week after surgery These activities cause rapid eye movements and detachment. The client is taught about restricted activity and head movement before surgery to prevent further tearing or detachment. An eye patch is placed over the affected eye to reduce eye movement. The clients head does NOT need to be flat or horizontal for 12 hours daily and ice packs are AVOIDED

Which finding does the nurse expect to see when examining a client with a mature cataract using an ophthalmoscope A. Dilated pupil B. Bluish white pupil C. Yellow tinge to sclera D. Enlarged retina

B. Bluish-white pupil As a cataract matures, the opacity makes it difficult to see the retina, and the red reflex may be absent. When this occurs, the nurse examines the client with an ophthalmoscope the pupil is bluish white.

Which first sign will the nurse expect when evaluating a client for primary open-angle glaucoma (POAG)? A. Brow pain with nausea and vomiting B. Gradual loss of visual fields C. Seeing halos and floaters D. Sudden severe pain around the eyes

B. Gradual loss of visual fields POAG is the most common form of primary glaucoma. Usually affects both eyes and has no signs or symptoms in the early stages. It develops slowly with gradual loss of visual fields that may go unnoticed because central vision is first unaffected

How does the nurse expect a decreased ability of the iris and pupil to dilate to affect an older client's vision A. Difficulty with tear production resulting in dry eyes B. Increased difficulty with vision in dark environments c. Difficulty seeing objects that are close D. Difficulty with vision because of cataract formation

B. Increased difficulty with vision in dark environments Decrease in ability to dilate results in small pupil size and poor adaptation to darkness. The nurse teaches the client that good lighting is needed to avoid bumping into objects, tripping, and falling.

Which priority instruction does the nurse teach a client with glaucoma who is prescribed eyedrops to decrease IOP? A. Wait 15 minutes between eyedrop drug instillations B. Perform punctual occlusion after using eyedrops for glaucoma therapy C. If a dose is missed, skip it and administer the next dose when it is due D. Blink several times after each eyedrop instillation

B. Perform punctual occlusion Placing pressure on the corner of the eye near the nose immediately after eyedrop instillation to prevent systemic absorption of the drug. The time between drugs should be 5-10 minutes. To decrease IOP it is essential that the client does NOT miss doses. After each dose the client should close eyes NOT blink several times

Which issue will the nurse consider priority when caring for a client with cataracts and impaired vision? A. Self-care needs B. Safety C. Mobility D. Communication

B. Safety Cataracts is impaired visual sensory perception which is a safety risk. Clients often live with reduced vision for years before the cataract is removed.

What is the next management action the nurse expects when a client with glaucoma does not response to prescribed eyedrops with a decreased IOP? A. Insertion of an implanted shunt B. A scleral buckling procedure C. A laser trabeculoplasty D. Visual field testing

C. A laser trabeculoplasty Surgery can be performed when drugs for open angle glaucoma are not effective at controlling IOP. Two common procedures are laser trabeculoplasty and trabeculectomy. A laster plasty burns the trabecular meshwork, scarring it and causing the meshwork fibers to tighten. Tight fibers increase the size of the spaces between the fibers, improving outflow of aqueous humor and reducing IOP. Ectomy is a surgical procedure that creates a new channel for fluid outflow. Both are ambulatory surgery procedures.

When the medial rectus muscle is not functioning correctly which eye movement will the nursing note the client has difficulty with? A. looking upward B. Looking downward C. Gazing toward the nose D. Gazing toward the ear

C. Gazing toward the nose When the medial rectus muscle is working correctly and contracts alone, it turns the eye toward the nose. Thus, when it is not functioning the client would have difficulty gazing toward the nose

For which client situation will the nurse contact the eye health care provider immediately? A. Client whose intraocular pressure by tonometry is 14 mm Hg B. Client scheduled for CT scan to assess the eyes and the bony structures around the eyes C. Client scheduled for MRI whose eye was injured by a piece of metal D. Client scheduled for ultrasonography to assess the orbit and eye

C. MRI of eye with metal in it MRI is used to examine the orbits and optic nerves and to evaluate ocular tumors. It CANNOt be used to evaluate injuries involving metal in the eyes. Metal in the eye is an absolute contraindication for MRI because the metal could move during the procedure and cause more damage. The nurse must contact the eye health care provider immediately.

Which signs or symptom does the nurse expect when a patient has early retinitis pigmentosa (RP)? A. Cataracts B. Headache C. Night blindness D. Poor distance vision

C. Night blindness The earliest symptoms of RP are usually noticed in childhood. They may report night blindness and loss of peripheral vision. Overtime decreased acuity progresses to total blindness.

Which instruction will the nurse teach a client with bilateral eye infections and two bottles of the same antibiotic solution are prescribed? A. Obtain one bottle from the pharmacy and return the second bottle if the infection does not clear B. Obtain one bottle for both eyes b/c the second bottle is not necessary C. Obtain both bottles and label one for the right eye and one for the left eye D. Obtain both bottles and save the second b/c infection will likely recur

C. Obtain both bottles and label one for each eye If both eyes are infected, separate bottles of drugs are needed for each eye. The nurse teaches the client to clearly label the bottles and not switch the drugs from eye to eye

What is the nurses best response when a young athletic client who suffered a traumatic eye injury with enucleation states "What's the point of learning about how to take care of this empty hold in my face?" A. "Would you like information about joining a support group?" B. "Let's take things one step at a time. I'll come back later." C. "You seem frustrated. Tell me about how this accident will affect your life." D. "Preventing infection will prevent further disfigurement and problems."

C. You seem frustrated, tell me how it will affect ur life The nurse indicates to the client willingness to be attentive and listen to his or her concerns. The others are not focused on the patients concerns.

Which cranial nerve is the nurse assessing when asking a client to open and close the eyelids? A. Cranial nerve 2 (optic) B. Cranial nerve 3 (oculomotor) C. Cranial nerve 5 (trigeminal) D. Cranial nerve 7 (facial)

D. Cranial nerve 7 (facial) The nurse is assessing the facial nerve 7-facial which innervates the lacrimal glands and muscles for eyelid closure, when asking a client to open and close eyelids

Which activities will the nurse instruct a client receiving discharge teaching after cataract surgery are acceptable? A. Vacuuming or mopping are OK, but d not bend over to scrub B. Driving during the day is ok, but do not drive at night C. Having sexual intercourse with a familiar partner is ok D. Meal preparation and washing dishes are ok

D. Meal prep and washing dishes are okay. Cooking and light housekeeping are permitted. -Vacuuming is avoided for several weeks b/c of forward flexion involved and the rapid jerky movements. -Do not drive until vision is clear -Avoid activities that increase IOP such as sex

What priority information would the nurse include when documenting a clients IOP? A. Clients body position during IOP measurement B. IOP measurement completed in a dark room C. Time of mydriatic drops and response to IOP measurement D. Type and time of IOP measurement

D. Type and time of IOP measurements IOP varies throughout the day and typically peaks are certain times of the day. Therefore, the nurse will be sure to document the type and time of IOP measurement.

Which specific priority teaching for eye protection will the nurse provide for a client who spends a great deal of time in the sun? A. Use sunscreen whenever you are in the sun longer than 30 mins B. Wear a large hat when you are working in the yard C. Sit in the shade whenever you can D. Use sunglasses that filter UV light when outdoors

D. Use sunglasses that filter UV light when outdoors The risks for cataract formation and for cancer of the eye (ocular melanoma) increases with exposure to UV light. The nurse teaches adults to protect the eyes by using sunglasses that filter UV light whenever they are outdoors, tanning salons, and when work involves UV expose

Which activity will the nurse expect a client with myopia to have difficulty with when he or she has forgotten to bring glasses to the hospital? A. Eating lunch B. Looking at an informational brochure C. Using a cell phone D. Watching the TV

D. Watching TV Myopia is nearsightedness, where the eye over-refracts the light and the bent images fall in front of (not on) the retina. Distance vision is poor, so tv may be difficult.