Chapter 58 Disorders of Eye Prep U
A nurse is performing an eye examination. Which question would not be included in the examination?
"Are you able to raise both eyebrows?"
An 8th grade boy comes to the school nurse and tells the nurse that he had an eye exam the day before. He says the eye doctor told him he had astigmatism and that meant his eyeball wasn't shaped right. The boy is concerned because he says he went home and looked in the mirror and both eyes looked just alike. What is the school nurse's best response?
"Astigmatism means that the cornea of the eye is shaped differently than the cornea in most eyes."
Which client statement would lead the nurse to suspect that the client is experiencing bacterial conjunctivitis?
"My eyelids were stuck together this morning."
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?
"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 peripheral vision and detects gaps in the visual field."
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
The nurse is giving instructions to a client who has been diagnosed with viral conjunctivitis. The nurse will teach the client which aspects of self-care related to this disorder? Select all that apply.
- Do not wear contact lenses until there is no more inflammation. - Wash hands before touching eyes and frequently during the day. - Do not use the same towels or washcloths as other members of the family.
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.
- Obtain an ocular history - Test visual acuity - Examine the external eye - Perform direct ophthalmoscopy
When assessing the pressure of the anterior chamber of the eye, a nurse normally expects to find a pressure of:
10 to 20 mm Hg.
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?
20/200
When undergoing testing of visual acuity with a Snellen chart, the client can read the line labeled 20/50 but misses three letters on the line. The nurse documents this finding as which of the following?
20/50-3
A patient is suspected of having glaucoma. What reading of IOP would demonstrate an increase resulting from optic nerve damage?
21 mm Hg or higher
A client has undergone tonometry to evaluate for possible glaucoma. Which result would the nurse record as abnormal?
25 mm Hg
The accompanying illustration depicts the neural pathway for vision. Which of the numbered areas is responsible for receiving the stimulus from the retina?
4
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:
>21 mm Hg.
The nurse is establishing a visual test using the Snellen chart for a client experiencing visual changes. At which distance should the nurse instruct the client to stand?
A 20-foot distance
A patient comes to the clinic with a suspected eye infection. The nurse recognizes that the patient most likely has conjunctivitis, as evidenced by what symptom?
A mucopurulent ocular discharge
A client with AIDS develops cytomegalovirus (CMV) retinitis. Which of the following would the nurse expect as the drug least likely to be prescribed?
Abacavir
Which type of glaucoma presents an ocular emergency?
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:
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?
Adhere to the medication regimen.
Which term refers to the absence of the natural lens?
Aphakia
Following cataract removal, the client receives discharge instructions from the nurse. Which of the following instructions is most important?
Avoid heavy lifting for 1 week.
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
A nurse instructs a client to refrain from blinking after administering eye drops based on which rationale?
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?
Blurred vision results after application.
A patient has been diagnosed with bacterial conjunctivitis that was sexually transmitted. The nurse informs the patient that the isolated organism is which of the following?
Chlamydia trachomatis
Which of the following is the main refracting surface of the eye?
Cornea
Which of the following medications needs to be withheld for 5 to 7 days prior to cataract surgery?
Coumadin
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
The nurse should monitor for which manifestation in a client who has had LASIK surgery?
Halos and glare
Which type of benign tumor of the eyelids is characterized by superficial, vascular capillary lesions that are strawberry red in color?
Hemangioma
Which type of benign tumor of the eyelids is characterized by superficial, vascular capillary lesions that are strawberry-red in color?
Hemangioma
A client presents to the ED reporting a chemical burn to both eyes. Which is the priority nursing intervention?
Irrigate both eyes.
Which surgical procedure involves flattening the anterior curvature of the cornea by removing a stromal lamella?
Laser-assisted in situ keratomileusis (LASIK)
Which surgical procedure involves flattening the anterior curvature of the cornea by removing a stromal lamella layer?
Laser-assisted stromal in situ keratomileusis (LASIK)
A nurse is teaching a client about medications for glaucoma. What is the main marker of glaucoma control with medication?
Lowering intraocular pressure to target pressure
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
The nurse is performing an assessment of the visual fields for a patient with glaucoma. When assessing the visual fields in acute glaucoma, what would the nurse expect to find?
Marked blurring of vision
During an initial assessment, the nurse notes a symptom of a mild case of bacterial conjunctivitis and documents in the electronic medical record that the client is displaying which of the following ?
Mucopurulent ocular discharge
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
To avoid the side effects of corticosteroids, which medication classification is used as an alternative to treat inflammatory conditions of the eyes?
NSAIDs
To avoid the side effects of corticosteroids, which medication classification is used as an alternative to treating inflammatory conditions of the eyes?
Nonsteroidal anti-inflammatory drugs (NSAIDs)
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?
Ophthalmoscope
Which term refers to swelling of the optic disc due to increased intracranial pressure?
Papilledema
A client is diagnosed with blepharitis. What symptoms should a nurse monitor in this client?
Patchy flakes clinging to the eyelashes
A nurse is reviewing the medical records of several patients who have had their intraocular pressure (IOP) measured: Which patient would the nurse identify as having increased IOP suggesting glaucoma?
Patient D
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?
Prolonged use of corticosteroids
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?
Retinal Angiography
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
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 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.
Which medication is used to treat glaucoma by pulling the iris away from the drainage channels so that aqueous fluid can escape?
carbachol
A client is color blind. The nurse understands that this client has a problem with:
cones
A client suffered trauma to the sclera and is being treated for a subsequent infection. During client education, the nurse indicates where the sclera is attached. Which structure would not be included?
eyelids
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
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 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
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
A nurse notices that a client's left upper eyelid is drooping. The nurse has observed:
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
When the client tells the nurse that his vision is 20/200 and then asks what that means, the nurse informs the client that a person with 20/200 vision
sees an object from 20 feet away that a person with normal vision sees from 200 feet away.
Which of the following types of conjunctivitis is preceded by symptoms of an upper respiratory infection?
viral
