Chapter 42: Caring for Clients with Eye Disorders
After surgery for removal of cataract, a client is being discharged, and the nurse has completed discharge instruction. Which client statement indicates that the outcome of the teaching plan has been met? "I need to wear sunglasses for the first 3 to 4 days even when I'm inside." "Dots or flashing lights in my vision are to be expected for the first few days." "I should avoid pulling or pushing any object that weighs more than 15 lbs." "I need to keep the eye patch on for about a week after surgery."
"I should avoid pulling or pushing any object that weighs more than 15 lbs."
A client has been diagnosed with glaucoma and the nurse is preparing health education regarding the client's medication regimen. The client states that she is eager to "beat this disease" and looks forward to the time that she will no longer require medication. How should the nurse best respond? "You have a great attitude. This will likely shorten the amount of time that you need medications." "In fact, glaucoma usually requires lifelong treatment with medications." "Most people are treated until their intraocular pressure goes below 50 mm Hg." "You can likely expect a minimum of 6 months of treatment."
"In fact, glaucoma usually requires lifelong treatment with medications."
Which client statement would lead the nurse to suspect that the client is experiencing bacterial conjunctivitis? "My eyes feel like they are on fire." "My eyelids were stuck together this morning." "It feels like there is something stuck in my eye." "My eyes hurt when I'm in the bright sunlight."
"My eyelids were stuck together this morning."
A client got a sliver of glass in his eye when a glass container at work fell and shattered. The glass had to be surgically removed and the client is about to be discharged home. The client asks the nurse for a topical anesthetic for the pain in his eye. What should the nurse respond? "Overuse of these drops could soften your cornea and damage your eye." "You could lose the peripheral vision in your eye if you used these drops too much." "I'm sorry, this medication is considered a controlled substance and patients cannot take it home." "I know these drops will make your eye feel better, but I can't let you take them home."
"Overuse of these drops could soften your cornea and damage your eye."
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."
A nurse practitioner examines a patient and documents a best corrected visual acuity (BCVA) ratio in his better eye that qualifies him for government financial assistance based on the definition of legal blindness. What is that ratio? 20/120 20/140 20/160 20/200
20/200
The nurse is administering eye drops to a client with glaucoma. After instilling the client's first medication, how long should the nurse wait before instilling the client's second medication into the same eye? 30 seconds 1 minute 3 minutes 5 minutes
5 minutes
A patient is being seen in the ophthalmology clinic for a suspected detached retina. What clinical manifestations does the nurse recognize as significant for a retinal detachment? Select all that apply. A visual field of floating particles A definite area of blank vision Momentary flashes of light Pain Halos around the eyes
A visual field of floating particles A definite area of blank vision Momentary flashes of light
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 just undergone a scleral buckle procedure for a retinal detachment. Which nursing interventions are aimed at reducing the risk for injury related to the surgical procedure? Select all that apply. Apply a shield over the patched eye at bedtime for at least 3 weeks. Use a dim light in the room after sundown and at bedtime. Avoid washing hair for the first week after surgery. Lie on back to assist with holding the retina in place.
Apply a shield over the patched eye at bedtime for at least 3 weeks. Use a dim light in the room after sundown and at bedtime.
A client has become legally blind as a result of macular degeneration. When attempting to meet this client's psychosocial needs, what nursing action is most appropriate? Encourage the client to focus on use of other senses. Assess and promote the client's coping skills during interactions with the client. Emphasize that lifestyle will be unchanged once adaptation to vision loss has occurred. Promote the client's hope for recovery.
Assess and promote the client's coping skills during interactions with the client
A client has just arrived to the floor after an enucleation procedure following a workplace accident in which his left eye was irreparably damaged. Which of the following should the nurse prioritize during the client's immediate postoperative recovery? Teaching the client about options for eye prostheses Teaching the client to estimate depth and distance with the use of one eye Assessing and addressing the client's emotional needs Teaching the client about his postdischarge medication regimen
Assessing and addressing the client's emotional needs
The nurse is providing health education to a client newly diagnosed with glaucoma. The nurse teaches the client that this disease has a familial tendency. The nurse should encourage the client's immediate family members to undergo clinical examinations how often? At least monthly At least once every 2 years At least once every 5 years At least once every 10 years
At least once every 2 years
An ophthalmologist diagnoses a patient with myopia. The nurse explains that this type of impaired vision is a refractive error characterized by: Eyes that are shallow. A shorter depth to the eyeball. Blurred distance vision. Farsightedness.
Blurred distance vision.
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
The nurse on the medical-surgical unit is reviewing discharge instructions with a client who has a history of glaucoma. The nurse should anticipate the use of what medications? Potassium-sparing diuretics Cholinergics Antibiotics Loop diuretics
Cholinergics
A client has been diagnosed with myopia. In the treatment of myopia, what type of lenses will improve the client's vision? concave lenses convex lenses refractive lenses contact lenses
Concave lenses
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 public health nurse is teaching a health promotion workshop that focuses on vision and eye health. What should this nurse cite as the most common causes of blindness and visual impairment among adults over the age of 40? Select all that apply. Diabetic retinopathy Trauma Macular degeneration Cytomegalovirus Glaucoma
Diabetic retinopathy Macular degeneration Glaucoma
A client's ocular tumor has necessitated enucleation and the client will be fitted with a prosthesis. The nurse should address what nursing diagnosis when planning the client's discharge education? Disturbed body image Chronic pain Ineffective protection Unilateral neglect
Disturbed body image
What is the correct advice regarding food for a client who underwent a cataract surgery? Eat soft, easily chewed foods. Eat red meat two to four times per week. Increase intake of vitamins A and C. Eat spinach or collard greens two to four times per week.
Eat soft, easily chewed foods.
A client has had a sudden loss of vision after head trauma. How should the nurse best describe the placement of items on the dinner tray? Explain the location of items using clock cues. Explain that each of the items on the tray is clearly separated. Describe the location of items from the bottom of the plate to the top. Ask the client to describe the location of items before confirming their location.
Explain the location of items using clock cues
A client with chronic open-angle glaucoma is being taught to self-administer pilocarpine. After the client administers the pilocarpine, the client states that her vision is blurred. Which nursing action is most appropriate? Holding the next dose and notifying the physician Treating the client for an allergic reaction Suggesting that the client put on her glasses Explaining that this is an expected adverse effect
Explaining that this is an expected adverse effect
A patient is brought into the emergency department with chemical burns to both eyes. What is the priority action of the nurse for this patient's care? Administering local anesthetics and antibacterial drops for 24 to 36 hours Applying hot compresses at 15-minute intervals Flushing the lids, conjunctiva, and cornea with tap water or normal saline Cleansing the conjunctiva with a small cotton-tipped applicator
Flushing the lids, conjunctiva, and cornea with tap water or normal saline
A client has just returned to the surgical floor after undergoing a retinal detachment repair. The postoperative orders specify that the client should be kept in a prone position until otherwise ordered. What should the nurse do? Call the physician and ask for the order to be confirmed. Follow the order because this position will help keep the retinal repair intact. Instruct the client to maintain this position to prevent bleeding. Reposition the client after the first dressing change.
Follow the order because this position will help keep the retinal repair intact.
The nurse should monitor for which manifestation in a client who has undergone LASIK? Excessive tearing Cataract formation Halos and glare Stye formation
Halos and glare
A 6-year-old is brought to the pediatric clinic for the assessment of redness and discharge from the eye and is diagnosed with viral conjunctivitis. What is the most important information to discuss with the parents and child? Handwashing can prevent the spread of the disease to others. The importance of compliance with antibiotic therapy Signs and symptoms of complications, such as meningitis and septicemia The likely need for surgery to prevent scarring of the conjunctiva
Handwashing can prevent the spread of the disease to others.
A nurse is teaching a client with glaucoma how to administer eye drops to achieve maximum absorption. The nurse should teach the client to perform what action? Instill the medication in the conjunctival sac. Maintain a supine position for 10 minutes after administration. Keep the eyes closed for 1 to 2 minutes after administration. Apply the medication evenly to the sclera
Instill the medication in the conjunctival sac.
A client presents to the ED reporting a chemical burn to both eyes. Which is the priority nursing intervention? Irrigate both eyes. Obtain the Material Safety Data Sheet (MSDS). Assess visual acuity. Assess the pH of the corneal surface.
Irrigate both eyes.
Several residents of a long-term care facility have developed signs and symptoms of viral conjunctivitis. What is the most appropriate action of the nurse who oversees care in the facility? Arrange for the administration of prophylactic antibiotics to unaffected residents. Instill normal saline into the eyes of affected residents two to three times daily. Swab the conjunctiva of unaffected residents for culture and sensitivity testing. Isolate affected residents from residents who have not developed conjunctivitis.
Isolate affected residents from residents who have not developed conjunctivitis
Which action should the nurse recommend to a client with blepharitis? Soak the area in warm water Incision and drainage Keep lid margins clean Sleep with the face parallel to the floor
Keep lid margins clean
When obtaining the health history from a client with retinal detachment, a nurse expects the client to report: light flashes and floaters in front of the eye. a recent driving accident while changing lanes. headaches, nausea, and redness of the eyes. frequent episodes of double vision.
Light flashes and floaters in front of the eye
A nurse is teaching a client about medications for glaucoma. What is the main marker of glaucoma control with medication? Changing the opacity of the lens Lowering intraocular pressure to target pressure Reducing the appearance of optic nerve head Increasing the visual field
Lowering intraocular pressure to target pressure
A client is diagnosed with an exudative retinal detachment. When reviewing the client's history, the nurse would identify which of the following as a possible underlying cause? Trauma Diabetes Macular degeneration Hypertension
Macular degeneration
Assessment of visual acuity reveals that the client has blurred vision when looking at distant objects but no difficulty seeing near objects. The nurse documents this as which of the following? Myopia Astigmatism Hyperopia Emmetropia
Myopia
A legally blind client is in 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.
When administering a client's eye drops, the nurse recognizes the need to prevent absorption by the nasolacrimal duct. How can the nurse best achieve this goal? Ensure that the client is well hydrated at all times. Encourage self-administration of eye drops. Occlude the puncta after applying the medication. Position the client supine before administering eye drops.
Occlude the puncta after applying the medication.
A client has noticed needing to hold printed material at arms length to make the print readable. What is the term used to describe this visual condition? presbyopia tunnel vision color blindness emmetropia
Presbyopia
Nursing students are reviewing information about the causes associated with low vision and blindness. The students demonstrate a need for additional review when they identify which of the following as a common cause in older adults? Macular degeneration Diabetic retinopathy Glaucoma Presbyopia
Presbyopia
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
A client with a diagnosis of retinal detachment has undergone a vitreoretinal procedure on an outpatient basis. What subject should the nurse prioritize during discharge education? Risk factors for postoperative cytomegalovirus (CMV) Compensating for vision loss for the next several weeks Nonpharmacologic pain management strategies Signs and symptoms of increased intraocular pressure
Signs and symptoms of increased intraocular pressure
The registered nurse taking shift report learns that an assigned client is blind. How should the nurse best communicate with this client? Provide instructions in simple, clear terms. Introduce herself in a firm, loud voice at the doorway of the room. Lightly touch the client's arm and then introduce herself. State her name and role immediately after entering the client's room.
State her name and role immediately after entering the client's room.
A client is being treated for glaucoma. What is the rationale for the nurse's instruction to maintain regular bowel habits? Straining at stool increases intraocular pressure. The client's medications may lead to diarrhea. Problems with constipation may compound problems with lens clarity. The client's medications may cause constriction of all blood vessels, contributing to hemorrhoids.
Straining at stool increases intraocular pressure.
A client is exploring treatment options after being diagnosed with age-related cataracts that affect her vision. What treatment is most likely to be used in this client's care? Antioxidant supplements, vitamin C and E, beta-carotene, and selenium Eyeglasses or magnifying lenses Corticosteroid eye drops Surgical intervention
Surgical intervention
A hospitalized client with impaired vision must get a picture in his or her mind of the hospital room and its contents in order to mobilize independently and safely. What must the nurse monitor in the client's room? That a commode is always available at the bedside That all furniture remains in the same position That visitors do not leave items on the bedside table That the client's slippers stay under the bed
That all furniture remains in the same position
Prior to an eye exam for possible macular degeneration, the nurse completes a history of symptoms. The nurse is aware that a diagnostic sign of age-related dry macular degeneration is: The abrupt onset of symptoms. Reporting that a straight line appears crooked. The appearance of tiny, yellow spots in the field of vision. Reporting that letters in words appear broken.
The appearance of tiny, yellow spots in the field of vision.
The nurse is assessing a new adult client. What characteristic of this client's status should the nurse identify as increasing the client's risk for glaucoma? The client uses over-the-counter NSAIDs. The client has a history of stroke. The client has diabetes. The client has Asian ancestry.
The client has diabetes.
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
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.
Which of the following types of conjunctivitis is preceded by symptoms of an upper respiratory infection? Viral Allergic Toxic Vernal
Viral
A client has received a diagnosis of hyperopia and is wondering if there is a physical condition that has caused these vision changes. In explaining hyperopia, what does the nurse indicate is the cause of this client's vision changes? eyeballs that are shorter than normal irregularly shaped corneas unequal curvatures in the cornea eyeballs that are longer than normal
eyeballs that are shorter than normal
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 client with an inflammatory ophthalmic disorder has been receiving repeated courses of a corticosteroid ointment, one-half inch in the lower conjunctival sac four times a day as directed. The client reports a headache and blurred vision. The nurse suspects that these symptoms represent: common adverse reactions to corticosteroid therapy. expected drug effects that should diminish over time. incorrect ointment application. increased intraocular pressure (IOP).
increased intraocular pressure (IOP).
The nurse realizes that a client understands how to correctly instill ophthalmic medications when the client: pulls the tissue near the cheek downward to instill medication. wipes the lids and lashes prior to instillation in a direction toward the nose with moistened, soft gauze. allows the tip of the container to touch the eyelid while administering the medication. rubs the eye after administering medication.
pulls the tissue near the cheek downward to instill medication.
