Chapter 58-Eyes
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 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 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." Explanation: The Snellen chart is a tool used to measure visual acuity. It is composed of a series of progressively smaller rows of letters and is used to test distance vision. The fraction 20/20 is considered the standard of normal vision. Most people can see the letters on the line designated as 20/20 from a distance of 20 feet. 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ASSESSMENT OF THE EYE, p. 1899.
A nurse is performing an eye examination. Which question would not be included in the examination? "Are you able to raise both eyebrows?" "What medications are you taking?" Have you experienced blurred, double, or distorted vision?" "Do any family members have any eye conditions?"
"Are you able to raise both eyebrows?" Explanation: Asking to raise both eyebrows is a test for cranial nerve VII, the facial nerve, and would not be included in an eye assessment. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ASSESSMENT OF THE EYE, pp. 1899-1901.
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." "I should avoid pulling or pushing any object that weighs more than 15 lbs." "Dots or flashing lights in my vision are to be expected for the first few days." "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." Explanation: After cataract surgery, the client needs to avoid lifting, pulling, or pushing any object that weighs more than 15 pounds to prevent putting excessive pressure on the surgical site. Sunglasses should be worn when outdoors during the day because the eye is sensitive to light. Dots, flashing lights, a decrease in vision, pain, and increased redness need to be reported to the physician immediately. The eye patch is worn for 24 hours after surgery, followed by eyeglasses worn during the day and a metal shield worn at night for 1 to 4 weeks. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, CATARACTS, pp. 1917-1918.
Which client statement would lead the nurse to suspect that the client is experiencing bacterial conjunctivitis? "My eyes hurt when I'm in the bright sunlight." "My eyes feel like they are on fire." "It feels like there is something stuck in my eye." "My eyelids were stuck together this morning."
"My eyelids were stuck together this morning." Explanation: Burning, a sensation of a foreign body, and pain in bright light (photophobia) are signs and symptoms associated with any type of conjunctivitis. The drainage related to bacterial conjunctivitis is usually present in the morning, and the eyes may be difficult to open because of adhesions caused by the exudate. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, Conjunctivitis, pp. 1927-1928.
When assessing the pressure of the anterior chamber of the eye, a nurse normally expects to find a pressure of: 20 to 30 mm Hg. over 30 mm Hg. 5 to 10 mm Hg. 10 to 20 mm Hg.
10 to 20 mm Hg. Explanation: Normally, pressure in the anterior chamber of the eye remains relatively constant at 10 to 20 mm Hg. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders.
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." "It is standard for the doctor to write a prescription for this medication." "Prescriptions of this medication are generally not given because it can cause corneal problems." "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." Explanation: Proparacaine hydrochloride can cause corneal softening and other complications if overused. Clients with corneal abrasions or other painful eye disorders have a tendency to overuse the medication, thus leading to the complications. It would not be appropriate to give the bottle with written instructions, and it is not a standard prescription for eye disorders because of the complications from overuse. Telling the client that you will let the doctor know does not provide the education needed about this medication. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, OCULAR MEDICATION ADMINISTRATION, p. 1908.
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." Explanation: A visual field examination or perimetry test measures peripheral vision and detects gaps in the visual field. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ASSESSMENT OF THE EYE, p. 1903.
Which type of glaucoma presents an ocular emergency? Normal tension glaucoma Acute angle-closure glaucoma Ocular hypertension Chronic open-angle glaucoma
Acute angle-closure glaucoma Explanation: Acute angle-closure glaucoma results in rapid progressive visual impairment. Normal tension glaucoma is treated with topical medication. Ocular hypertension is treated with topical medication. Chronic open-angle glaucoma is treated initially with topical medications, with oral medications added later. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, GLAUCOMA, pp. 1909-1912.
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 angle-closure. Acute angle-closure. Normal tension. Chronic open-angle.
Acute angle-closure. Explanation: Acute angle-closure glaucoma is characterized by the symptoms listed, as well as by being rapidly progressive and accompanied by pain. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, GLAUCOMA, p. 1912.
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. Adhere to the medication regimen. Keep a record of eye pressure measurements. Participate in the decision-making process.
Adhere to the medication regimen. Explanation: All of the teaching points are important but the most important is emphasizing the strict adherence to the medication regimen because glaucoma cannot be cured but its progression can be slowed. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, GLAUCOMA, p. 1913.
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 Explanation: Clients with macular problems are tested with an Amsler grid. It is made up of a geometric grid of identical squares with a central fixation point. The examiner instructs the client to stare at the central fixation spot on the grid and report if they see any distortion of the squares. Clients with macular problems may say some of the squares are faded or wavy. An Ishihara polychromatic plate, visual field, or slit lamp test will not diagnose macular degeneration. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ASSESSMENT OF THE EYE, p. 1902.
A patient has been diagnosed with hyphema. Which of the following medication classifications stabilizes clot formation at the site of hemorrhage? Antiplatelets Corticosteroids Diuretics Antifibrinolytics
Antifibrinolytics Explanation: An antifibrinolytic agent, aminocaproic acid (Amicar), stabilizes clot formation at the site of hemorrhage. Corticosteroids, antiplatelets, and diuretics do not have this action. Aspirin is contraindicated. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, Ocular Trauma, p. 1925.
The nurse is demonstrating how to perform punctal occlusion. Which activities does the nurse perform? Applies firm pressure to the upper and lower eyelids at the outer edges to keep eyelids in approximation 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 gentle pressure bilaterally on the bridge of the nose to the inner canthus of each eye
Applies gentle pressure bilaterally on the bridge of the nose to the inner canthus of each eye Explanation: Punctal occlusion is done by applying gentle pressure to the inner canthus of each eye for 1 to 2 minutes immediately after eye drops are instilled. The nurse does not apply pressure to the eyeball when administering medications. The lower eyelid is held down to expose the conjunctival sac. The other action described will not aid in the retention or absorption of medication. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, GLAUCOMA, pp. 1909-1911.
A nurse is caring for a client scheduled to have angiography of the right eye in 1 hour. What is the highest priority nursing intervention? Assess for dark yellow to orange urine. Assess blood urea nitrogen (BUN) and creatinine levels. Educate the client about the feeling of warmth and metallic taste that may occur during the procedure. Instruct the client to hold their head still during the procedure.
Assess blood urea nitrogen (BUN) and creatinine levels. Explanation: The nurse should assess the BUN and creatinine levels to ensure the client has adequate renal function to excrete the contrast used. Inability to excrete the contrast could lead to complications. Instructing the client to hold his or her head still and educating about the feeling of warmth and metallic taste that might occur are appropriate interventions; assessing renal function remains the highest priority. Assessing for dark yellow to orange urine is appropriate in the postprocedural time frame, so it would not be the highest priority. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ASSESSMENT OF THE EYE, pp. 1902-1903.
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? AST and ALT Hemoglobin and hematocrit BUN and creatinine Platelet count
BUN and creatinine Explanation: Angiography is done using fluorescein or indocyanine green as contrast agents. Fluorescein angiography is used to evaluate clinically significant macular edema, document macular capillary nonperfusion, and identify retinal and choroidal neovascularization (growth of abnormal new blood vessels) in age-related macular degeneration. It is an invasive procedure in which fluorescein dye is injected, usually into an antecubital vein. Prior to the angiography, the patient's blood urea nitrogen (BUN) and creatinine should be checked to ensure that the kidneys will excrete the contrast agent (Fischbach & Dunning, 2011). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ASSESSMENT OF THE EYE, p. 1902.
An ophthalmologist diagnoses a patient with myopia. The nurse explains that this type of impaired vision is a refractive error characterized by: Farsightedness. Blurred distance vision. Eyes that are shallow. A shorter depth to the eyeball.
Blurred distance vision. Explanation: People who have myopia are said to be nearsighted. They have deeper eyeballs; thus, the distant visual image focuses in front of, or short of, the retina. Myopic people experience blurred distance vision. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, IMPAIRED VISION, p. 1903.
A client who had a corneal transplant a few months ago arrives at the emergency department reporting eye discomfort. When assessing the client, which of the following would lead the nurse to suspect graft failure? Halos around lights Pale conjunctiva Blurred vision Reduced tearing
Blurred vision Explanation: Signs and symptoms of graft failure include eye discomfort, blurred vision, tearing, and redness of the eye. Halos around lights are associated with glaucoma. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, Corneal Surgeries, pp. 1918-1919.
The nurse is caring for a client with increased fluid accumulation in the eye. When assessing the client, which structure within the eye is noted to drain fluid from the anterior chamber? Canal of Schlemm Canthus Choroid Fovea centralis
Canal of Schlemm Explanation: The canal of Schlemm drains the anterior chamber of the eye. By draining the fluid, it decreases the fluid amount and pressure in the eye. The other options have no draining ability. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ASSESSMENT OF THE EYE, p. 1898.
The nurse is caring for geriatric clients who state that they are prescribed reading glasses. Some individuals state needing assistance with seeing writing far away, and others need assistance with closer vision. The nurse is correct to understand that the aging visual changes relate to which of the following? Changes in accommodation Changes in refraction Changes in central vision Changes in the visual field SUBMIT ANSWER
Changes in accommodation Explanation: The changes that occur in vision during aging, which include difficulty reading and the need for reading glasses, include changes in accommodation. Accommodation occurs when the ciliary muscles contract or relax to focus an image on the retina. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, IMPAIRED VISION, p. 1904.
Which nursing intervention should be included during the assessment of a client with an eye disorder? Check the extraocular muscles by instructing the client to keep his or her head still when following an object. Examine the retina with a direct ophthalmoscope. Instruct the client to stare at the central fixation spot on an Amsler grid and report if he or she sees any distortion of the squares. Use a tonometer to indent or flatten the surface of the eye.
Check the extraocular muscles by instructing the client to keep his or her head still when following an object. Explanation: When assessing a client with an eye disorder, the nurse should check the extraocular muscles by instructing the client to keep his or her head still when following an object. A qualified examiner, not the nurse, should assess the client by examining the retina with a direct ophthalmoscope, using a tonometer, or an Amsler grid. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders.
Which of the following is the main refracting surface of the eye? Conjunctiva Pupil Iris Cornea
Cornea Explanation: The cornea is a transparent, avascular, domelike structure that covers the iris, pupil, and anterior chamber. It is the most anterior portion of the eyeball and is the main refracting surface of the eye. The iris is the colored part of the eye. The pupil is a space that dilates and constricts in response to light. Normal pupils are round and constrict symmetrically when a bright light shines on them. The conjunctiva provides a barrier to the external environment and nourishes the eye. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ASSESSMENT OF THE EYE, p. 1898.
What type of medication would the nurse use in combination with mydriatics to dilate the patient's pupil? Corticosteroids Cycloplegics NSAIDs Anti-infectives
Cycloplegics Explanation: Mydriasis, or pupil dilation, is the main objective of the administration of mydriatics and cycloplegics (Table 63-3). These two types of medications function differently and are used in combination to achieve the maximal dilation that is needed during surgery and fundus examinations to give the ophthalmologist a better view of the internal eye structures. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, Common Ocular Medications, p. 1908.
The nurse is preparing a presentation for a group of older adults on the topic of open-angle glaucoma. Which symptoms would be included as indications of open-angle glaucoma? Select all that apply. Severe pain Halos around lights Decreasing peripheral vision Blurred vision Difficulty adjusting eyes in low lighting Bright flashing lights
Difficulty adjusting eyes in low lighting Halos around lights Blurred vision Decreasing peripheral vision Explanation: Decreased peripheral vision, difficulty adjusting eyes in low lighting, halos, and blurred vision are typical symptoms of open-angle glaucoma. Bright flashes of light may be an indication of retinal detachment. Severe pain is usually associated with angle-closure glaucoma or eye trauma. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, GLAUCOMA, pp. 1909-1911.
The nurse is providing care to a client who has been admitted to the hospital for treatment of an infection. The client is visually impaired. Which of the following would be most appropriate for the nurse to do when interacting with the client? Touch the client before identifying himself or herself. Face the client when speaking directly to him. Talk to the client in a loud tone of voice. Avoid using the terms "see" or "look."
Face the client when speaking directly to him. Explanation: When interacting with a client with a visual impairment, the nurse should face the client and speak directly to the client using a normal tone of voice. It is not necessary to raise the voice unless the client asks the nurse to do so and it is not necessary to avoid the terms, "see" or "look" when interacting with the client. The nurse should identify himself or herself when approaching the client and before making any physical contact. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, IMPAIRED VISION, p. 1906.
Which of the following eye disorders is caused by an elevated intraocular pressure (IOP)? Hyperopia Glaucoma Cataracts Myopia
Glaucoma Explanation: In glaucoma, there is an abnormally high IOP. Cataracts occur when there is a clouding of the lens. Hyperopia is farsightedness. Myopia is nearsightedness. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, GLAUCOMA, p. 1909.
The nurse should monitor for which manifestation in a client who has had LASIK surgery? Halos and glare Stye formation Cataract formation Excessive tearing
Halos and glare Explanation: After LASIK surgery, symptoms of central islands and decentered ablations can occur that include monocular diplopia or ghost images, halos, glare, and decreased visual acuity. These procedures do not cause excessive tearing or result in cataract or stye formation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, CORNEAL DISORDERS, pp. 1919-1920.
The nurse should monitor for which manifestation in a client who has undergone LASIK? Halos and glare Cataract formation Stye formation Excessive tearing
Halos and glare Explanation: Symptoms of central islands and decentered ablations can occur after LASIK surgery; these include monocular diplopia or ghost images, halos, glare, and decreased visual acuity. These procedures do not cause excessive tearing or result in cataract or stye formation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, CORNEAL DISORDERS, p. 1920.
Which type of benign tumor of the eyelids is characterized by superficial, vascular capillary lesions that are strawberry-red in color? Hemangioma Milia Nevi Xanthelasma
Hemangioma Explanation: Hemangiomas are vascular capillary tumors that may be bright, superficial, strawberry-red lesions or bluish and purplish deeper lesions. Milia are small, white, slightly elevated cysts of the eyelid that may occur in multiples. Xanthelasma are yellowish, lipoid deposits on both lids near the inner angle of the eye; these commonly appear as a result of the aging of the skin or a lipid disorder. Nevi are freckles. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, Benign Tumors of the Eyelids, p. 1930.
A client has undergone enucleation. What complication of enucleation should be addressed by the nurse? Nausea and vomiting Hypotension Hemorrhage Pneumonia
Hemorrhage Explanation: The nurse should take measures to prevent hemorrhage, a complication of enucleation, by applying a pressure dressing. Nausea and vomiting may be common side effects of surgery. Enucleation does not increase risk of developing hypotension or pneumonia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, SURGICAL PROCEDURES AND ENUCLEATION, p. 1931.
The client with chronic open-angle glaucoma is receiving timolol eye drops. Which evaluation finding would indicate to the nurse the treatment is working? Decrease in nausea and vomiting Halos around lights Reduced peripheral vision Intraocular pressure 15 mm Hg
Intraocular pressure 15 mm Hg Explanation: Timolol is a beta-blocker that is used topically to decrease the flow rate of aqueous humor in the eye. As flow rate decreases, the intraocular pressure decreases. IOP of 12 to 21 mm Hg is within normal range. Reduced peripheral vision, halos around lights, and blurred vision are all symptoms of open-angle glaucoma. Nausea and vomiting are more likely to occur with acute angle-closure glaucoma. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, GLAUCOMA, p. 1913.
A client comes to the eye clinic for a routine check-up. The client tells the nurse he thinks he is color blind. What screening test does the nurse know will be performed on this client to assess for color blindness? Jaeger Ishihara Rosenbaum Snellen
Ishihara Explanation: Color vision is assessed with Ishihara polychromatic plates. The client receives a series of cards on which the pattern of a number is embedded in a circle of colored dots. The numbers are in colors that color-blind persons commonly cannot see. Clients with normal vision readily identify the numbers. The Jaeger and the Rosenbaum test near vision while the Snellen tests far vision. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ASSESSMENT OF THE EYE, p. 1902.
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: Loss of accommodative power in the lens. Decreased eye muscle tone. Shrinkage of the vitreous body. Opacity in the lens.
Loss of accommodative power in the lens. Explanation: Presbyopia is a refractive change that occurs with age. The lens of the eye loses accommodative power. Opacity in the lens indicates a cataract. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, IMPAIRED VISION, p. 1904.
A nurse is preparing a presentation for a local senior citizen's group about changes in the eye that accompany aging. Which of the following would the nurse most likely include? Select all that apply. Increased orbital fat Loss of eyelid skin elasticity Loss of lens accommodative power Development of lens opacities Expansion of the vitreous body
Loss of lens accommodative power Development of lens opacities Loss of eyelid skin elasticity Explanation: Age-related changes in the eye include loss of accommodative power of the lens, development of opacities in the lens, decreased orbital fat, shrinkage of the vitreous body, and loss of skin elasticity. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, IMPAIRED VISION, p. 1905.
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 Changing the opacity of the lens Increasing the visual field Reducing the appearance of optic nerve head
Lowering intraocular pressure to target pressure Explanation: The main marker of the efficacy of the medication in glaucoma control is lowering of the intraocular pressure to the target pressure. Opacity of the lenses relates to cataract formation. The appearance of the optic nerve head and the visual field are not goals with glaucoma medication. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, GLAUCOMA, p. 1913.
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? Constricted pupil Watery ocular discharge Clear cornea Marked blurring of vision
Marked blurring of vision Explanation: Glaucoma is often called the "silent thief of sight" because most patients are unaware that they have the disease until they have experienced visual changes and vision loss. The patient may not seek health care until he or she experiences blurred vision or "halos" around lights, difficulty focusing, difficulty adjusting eyes in low lighting, loss of peripheral vision, aching or discomfort around the eyes, and headache. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, GLAUCOMA, p. 1913.
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? Hyperopia Emmetropia Myopia Astigmatism
Myopia Explanation: Myopia, or nearsightedness, refers to the condition in which the client can see near objects but has blurred distant vision. Astigmatism is an irregularity in the curve of the cornea, which affects both near and distant vision. Hyperopia, or farsightedness, refers to the client's ability to see distant objects clearly but near objects as blurry. Emmetropia refers to normal eyesight in which the image focuses precisely on the retina. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, IMPAIRED VISION, p. 1903.
During a routine eye examination, a patient complains that she is unable to read road signs at a distance when driving her car. What should the patient be assessed for? Presbyopia Astigmatism Myopia Anisometropia
Myopia Explanation: Some people have deeper eyeballs, in which case the distant visual image focuses in front of, or short of, the retina; those with myopia Impaired Vision are said to be nearsighted and have blurred distance vision. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, IMPAIRED VISION, p. 1903.
To avoid the side effects of corticosteroids, which medication classification is used as an alternative to treat inflammatory conditions of the eyes? Cycloplegics Mydriatics Miotics NSAIDs
NSAIDs Explanation: NSAIDs are used as an alternative in controlling inflammatory eye conditions and postoperatively to reduce inflammation. Miotics are used to cause the pupil to constrict. Mydriatics cause the pupil to dilate. Cycloplegics cause paralysis of the iris sphincter. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, OCULAR MEDICATION ADMINISTRATION, p. 1909.
Viewed through the pupil, the landmarks of the retina are which of the following? Select all that apply. Retinal vessels Macula Optic disk Iris Pupil
Optic disk Retinal vessels Macula Explanation: Viewed through the pupil, the landmarks of the retina are the optic disk, the retinal vessels, and the macula. The pupil and iris are not landmarks of the retina. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ASSESSMENT OF THE EYE, p. 1899.
Which of the following would be an inaccurate clinical manifestation of a retinal detachment? Pain Bright flashing lights Sudden onset of a greater number of floaters Cobwebs
Pain Explanation: Patient may report the sensation of a shade or curtain coming across the vision of one eye, cobwebs, bright flashing lights, or the sudden onset of a great number of floaters. Patients do no complain of pain. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, Retinal Detachment, p. 1921.
Which term refers to swelling of the optic disc due to increased intracranial pressure? Papilledema Photophobia Chemosis Ptosis
Papilledema Explanation: Papilledema is swelling of the optic disc due to increased intracranial pressure. Chemosis is edema of the conjunctiva. Ptosis is a drooping eyelid. Photophobia is ocular pain on exposure to light. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ASSESSMENT OF THE EYE, p. 1902.
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? Presbyopia Cataract Myopia Macular degeneration
Presbyopia Explanation: Refractive changes, such as presbyopia, occur in older adults where the lens cannot readily accommodate aging. In such cases, the client is observed holding reading materials at an increasing distance to focus properly. In case of a cataract, the client should report increased glare, decreased vision, and changes in color perception. Macular degeneration affects the central vision. Myopia is the inability to see things at a distance clearly. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ASSESSMENT OF THE EYE, p. 1904.
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 Explanation: Risk factors associated with glaucoma include prolonged use of topical or systemic corticosteroids, older age, myopia, and a history of cardiovascular disease. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, GLAUCOMA, p. 1911.
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? Pneumatic retinopexy Pars plana vitrectomy Phacoemulsification Scleral buckle
Scleral buckle Explanation: The scleral buckle is a procedure in which a piece of silicone plastic or sponge is sewn onto the sclera at the site of the retinal tear. The buckle holds the retina against the sclera until scarring seals the tear. The other surgeries do not use this type of procedure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, RETINAL DISORDERS, p. 1921.
A patient was recently diagnosed with a cortical cataract in his left eye. His wife asks the nurse for information about his diagnosis. The nurse explains that: The cataract should have little or no effect on his vision. He would experience nearsightedness, which will worsen as the cataract progresses. His near vision will be diminished, and his eye will be increasingly sensitive to glare from bright lights. The cataract's density will increase and eventually severely blur his vision.
The cataract should have little or no effect on his vision. Explanation: A cortical cataract involves the anterior, posterior, or equatorial cortex of the lens. A cataract in the equator or periphery of the cortex does not interfere with the passage of light through the center of the lens and has little effect on vision. Cortical cataracts progress at a highly variable rate. Vision is worse in very bright light. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders.
A patient is suspected of having retinal detachment. The nurse would expect to prepare the patient for which of the following? Select all that apply. Amsler grid testing Indirect ophthalmoscopy Fluorescein angiography Tonometry Visual acuity testing Slit lamp biomicroscopy
Visual acuity testing Indirect ophthalmoscopy Slit lamp biomicroscopy Fluorescein angiography Explanation: Testing for retinal detachment includes visual acuity testing, indirect ophthalmoscopy, slit lamp biomicroscopy, and fluorescein angiography. The Amsler grid is used to evaluate for macular degeneration. Tonometry is used to evaluate for glaucoma. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, Retinal Detachment, p. 1921.
A client is color blind. The nurse understands that this client has a problem with: lens. cones. rods. aqueous humor.
cones. Explanation: Cones provide daylight color vision, and their stimulation is interpreted as color. If one or more types of cones are absent or defective, color blindness occurs. Rods are sensitive to low levels of illumination but can't discriminate color. The lens is responsible for focusing images. Aqueous humor is a clear watery fluid and isn't involved with color perception. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ASSESSMENT OF THE EYE, p. 1899.
A client has just been diagnosed with early glaucoma. During a teaching session, the nurse should: teach about intraocular lens cleaning. demonstrate eyedrop instillation. provide instructions on eye patching. assess the client's visual acuity.
demonstrate eyedrop instillation. Explanation: Eyedrop instillation is a critical component of self-care for a client with glaucoma. After demonstrating eyedrop instillation to the client and family, the nurse should verify their ability to perform this measure properly. An eye patch isn't necessary unless the client has undergone surgery. Visual acuity assessment isn't necessary before discharge. Intraocular lenses aren't implanted in clients with glaucoma. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, GLAUCOMA, p. 1910.
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? emmetropia astigmatism hyperopia myopia
hyperopia Explanation: Hyperopia is farsightedness. People who are hyperopic see objects that are far away better than objects that are close. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, IMPAIRED VISION, p. 1903.
Which would be an advanced stage finding in a client with wet macular degeneration? diminished perception of color inability to see images by looking at them directly distortion of vision blurred vision when reading or doing close-up work
inability to see images by looking at them directly Explanation: When the macula becomes irreparably damaged, clients compare their vision to a target in which the bulls-eye area of the image is absent. In clients with dry macular degeneration, blurred vision is the first symptom of disease. Vision distortion is an early finding in clients with wet macular degeneration. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, Age-Related Macular Degeneration, pp. 1922-1923.
A nurse notices that a client's left upper eyelid is drooping. The nurse has observed: ptolemy proptosis nystagmus ptosis
ptosis Explanation: Ptosis is drooping or falling of the upper or lower eyelid. Ptolemy is not a medical condition. Proptosis is the extended or protruded upper eyelid that delays closing or remains partially open. Nystagmus is uncontrolled oscillating movement of the eyeball. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ASSESSMENT OF THE EYE, p. 1901
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). Explanation: Headache and blurred vision are symptoms of increased IOP, such as from glaucoma. Ophthalmic corticosteroids may trigger an episode of acute glaucoma in susceptible clients. Although the effects of some drugs may diminish with continued use, this doesn't happen with ophthalmic corticosteroids. Incorrect ointment application doesn't cause headache or blurred vision. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, GLAUCOMA, p. 1911.
The nurse is explaining metastatic rhabdomyosarcoma to a group of parents with children diagnosed with the disease. The most common site of metastasis in clients diagnosed with rhabdomyosarcoma is the bone. lung. lymph nodes. brain.
lung. Explanation: The most common site of metastasis in clients diagnosed with rhabdomyosarcoma is the lungs. The brain, bone, and lymph nodes are not common sites of the metastasis in this type of tumor. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ORBITAL AND OCULAR TUMORS, p. 1930.
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? angle-closure glaucoma retinal detachment chalazion eye trauma
retinal detachment Explanation: A detached retina is associated with a hole or tear in the retina caused by stretching or degenerative changes. Retinal detachment may follow a sudden blow, penetrating injury, or eye surgery. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, Retinal Detachment, pp. 1920-1921.
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 200 feet away just like a person with normal vision. sees an object from 20 feet away just like a person with normal 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 200 feet away. Explanation: The fraction 20/20 is considered the standard of normal vision. Most people can see the letters on an eye chart designated as 20/20 from a distance of 20 feet. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, IMPAIRED VISION, pp. 1903-1904.
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 ________. retinoscopy; cataracts tonometry; macular degeneration tonometry; intraocular pressure retinoscopy; detached retina
tonometry; intraocular pressure Explanation: The procedure being performed is known as tonometry and it measures intraocular pressure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ASSESSMENT OF THE EYE, p. 1901.
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? "If the drops don't work, surgery may be needed to cure your condition." "Most clients need to use the drops for only about a few months." "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." Explanation: The client is demonstrating a lack of understanding about the condition and its treatment. The nurse needs to provide additional information to the client that the condition can be controlled but not cured. The statement about lifelong therapy would be most appropriate. Eye medications would most likely be needed for the long term, not just a few months. Surgery may be used in conjunction with medication therapy; however, neither method cures the condition. The goal of therapy is to reduce the intraocular pressure to prevent optic nerve damage. In some clients, medication may be all that is needed. In other cases, additional or combination treatment with surgery or laser procedures may be necessary. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, GLAUCOMA, p. 1914.
The nurse is educating a patient with glaucoma about medications. What medications will the nurse educate the patient about that decrease aqueous production? Select all that apply. Carbonic anhydrase inhibitors Beta-blockers Miotics Calcium channel blockers Alpha-adrenergic agonists SUBMIT ANSWER
Alpha-adrenergic agonists Carbonic anhydrase inhibitors Beta-blockers Explanation: Many ocular medications are used to treat glaucoma (Table 63-5), including miotics (medications that cause pupillary constriction), beta-blockers, alpha2-agonists (i.e., adrenergic agents), carbonic anhydrase inhibitors, and prostaglandins. Cholinergics (i.e., miotics) increase the outflow of the aqueous humor by affecting ciliary muscle contraction and pupil constriction, allowing flow through a larger opening between the iris and the trabecular meshwork. Alpha2-adrenergic agonists, beta-blockers, and carbonic anhydrase inhibitors decrease aqueous production. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, GLAUCOMA, p. 1913.
Which medication classification increases aqueous fluid outflow in the client with glaucoma? Alpha-adrenergic agonists Beta-blockers Cholinergics Carbonic anhydrase inhibitors
Cholinergics Explanation: Cholinergics increase aqueous fluid outflow by contracting the ciliary muscle, causing miosis and opening the trabecular meshwork. Beta-blockers decrease aqueous humor production. Alpha-adrenergic agonists decrease aqueous humor production. Carbonic anhydrase inhibitors decrease aqueous humor production. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, GLAUCOMA, pp. 1912-1913.
The upper eyelid normally covers the uppermost portion of the iris and is innervated by which cranial nerve? II III I IV
III Explanation: The upper lid is innervated by the oculomotor nerve (CN III). Cranial nerve I is the olfactory nerve, cranial nerve II is the optic nerve, and cranial nerve IV is the trochlear nerve. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ASSESSMENT OF THE EYE, p. 1897.
The nurse is obtaining a visual history from a client who has noted an increase in glare and changes in color perception. Which assessment would the nurse anticipate to confirm a definitive diagnosis? Identification of white circle around the cornea Identification of yellowish aging spot on the retina Identification of redness of the sclera Identification of opacities on the lens
Identification of opacities on the lens Explanation: The client states an increased glare and changes in color perception, which indicates a cataract. Identification of opacities on the lens confirms that diagnosis. A white circle around the cornea and a yellowish aging spot are also symptoms of aging but with different symptoms. Redness of the sclera indicates irritation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, CATARACTS, p. 1915.
The nurse is obtaining a visual history from a client who has noted an increase in glare and changes in color perception. Which assessment would the nurse anticipate to confirm a definitive diagnosis? Identification of yellowish aging spot on the retina Identification of white circle around the cornea Identification of opacities on the lens Identification of redness of the sclera
Identification of opacities on the lens Explanation: The client states an increased glare and changes in color perception, which indicates a cataract. Identification of opacities on the lens confirms that diagnosis. A white circle around the cornea and a yellowish aging spot are also symptoms of aging but with different symptoms. Redness of the sclera indicates irritation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, CATARACTS, p. 1915.
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? Improve outflow drainage Reverse optic nerve damage To relieve pain Restore vision
Improve outflow drainage Explanation: Laser iridotomy or standard iridotomy is a surgical procedure that provides additional outlet drainage of aqueous humor. This is done to lower the IOP as quickly as possible since permanent vision loss can occur in 1 to 2 days. Once optic nerve damage occurs, it cannot be reversed, and vision is not restored. Pain that occurs with rising IOP will be controlled once pressure is lowered through improved outflow drainage. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, GLAUCOMA, p. 1912.
Which action should the nurse recommend to a client with blepharitis? Sleep with the face parallel to the floor Keep lid margins clean Soak the area in warm water Incision and drainage
Keep lid margins clean Explanation: Instructions on lid hygiene (to keep the lid margins clean and free of exudates) are given to the client. Treatment of a stye includes warm soaks of the area and incision and drainage. The client is not required to sleep with the face parallel to the floor. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, INFECTIOUS AND INFLAMMATORY CONDITIONS, pp. 1926-1927.
The nurse is preparing a presentation for a local community group comparing photorefractive keratectomy and LASIK refractive surgeries. Which of the following would the nurse include? PRK requires that a thin flap be made to allow access to the cornea. LASIK is appropriate for people with very thin corneas. LASIK involves working with the cornea on a deeper level. PRK is used primarily for people without an astigmatism.
LASIK involves working with the cornea on a deeper level. Explanation: LASIK involves the creation of a corneal flap to allow access to the corneal stroma at a deeper level. PRK is used to treat myopia and hyperopia with or without an astigmatism and is now reserved for clients unsuitable for LASIK, such as those with very thin corneas. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, CORNEAL DISORDERS, p. 1920.
Which surgical procedure involves flattening the anterior curvature of the cornea by removing a stromal lamella? Keratoplasty Laser-assisted in situ keratomileusis (LASIK) Photorefractive keratectomy (PRK) Keratoconus
Laser-assisted in situ keratomileusis (LASIK) Explanation: LASIK involves flattening the anterior curvature of the cornea by removing a stromal lamella or layer. PRK is used to treat myopia and hyperopia with or without astigmatism. Keratoconus is a cone-shaped deformity of the cornea. Keratoplasty involves replacing abnormal host tissue with healthy donor (cadaver) corneal tissue. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, Refractive Surgeries, p. 1920.
Which part of the retina is responsible for central vision? Macula Fundus Optic disk Sclera
Macula Explanation: The macula is the area of the retina responsible for central vision. The optic disk is the point of entrance of the optic nerve into the retina. The sclera helps maintain the shape of the eyeball and protects the intraocular contents from trauma. The fundus is the largest chamber of the eye and contains the vitreous humor. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ASSESSMENT OF THE EYE, p. 1899.
Which is the most common cause of visual loss in people older than 65 years of age? Macular degeneration Retinal detachment Cataracts Glaucoma
Macular degeneration Explanation: Macular degeneration is the most common cause of visual loss in people older than 65 years of age. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, Age-Related Macular Degeneration, pp. 1922-1923.
The nurse is assessing a client using an Amsler Grid. The nurse is assessing for which of the following? Visual field Visual acuity Macular problems Intraocular pressure
Macular problems Explanation: The Amsler grid is a test used to assess clients for macular problems. Visual acuity is tested using the Snellen chart. Intraocular pressure is measured using tonometry. Perimetry testing evaluates the field of vision. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ASSESSMENT OF THE EYE, p. 1902.
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? Propose reading eyeglasses for presbyopia, which is changing only their night vision. Recommend contrast sensitivity testing measures to determine visual function. 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.
Recommend contrast sensitivity testing measures to determine visual function. Explanation: With aging, structural and functional changes occur in the eye. Clients having visual changes while driving should have a contrast sensitivity testing done. Contrast sensitivity testing measures visual acuity in different degrees of light and dark, which determines visual function. Glare testing is also used to determine visual function. Those affected by loss of contrast sensitivity and glare have difficulty functioning in low light, or driving at night or in foggy conditions. With the results from testing, appropriate strategies can be recommended. Presbyopia, the loss of accommodative power in the lens, interferes with the ability to adequately focus (difficulty seeing small print) and is the factor responsible for most older adults requiring some form of corrective lenses. Presbyopia interferes with vision during the day and night. An eye shield is proposed for clients' postoperative management after cataract surgery. Wearing yellow tinted, not darkly tinted, glasses may help cut night glare during driving. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, Anatomic and Physiologic Overview, p. 10.
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 Retinoscopy Retinal Angiography Retinal Imaging
Retinal Angiography Explanation: The nurse is most correct to instruct the client that his skin and urine may turn yellow following a retinal angiography. Sodium fluorescein is a water-soluble dye that is injected into a vein. The dye then travels to the retinal arteries and capillaries, where pictures are obtained of the vascular supply. The other options do not include a dye injection. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ASSESSMENT OF THE EYE, p. 1902.
A client with glaucoma has presented for a scheduled clinic visit and tells the nurse that they have begun taking an herbal remedy that was recommended by a work colleague. What instruction should the nurse provide to the client? The client should discuss this new remedy with their ophthalmologist promptly. The client should report any adverse effects to their pharmacist. The client should do further research on the herbal remedy. The client should monitor intraocular pressure closely for the next several weeks.
The client should discuss this new remedy with their ophthalmologist promptly. Explanation: Clients should discuss any new treatments with an ophthalmologist; this should precede the client's own further research or reporting adverse effects to the pharmacist. Self-monitoring of IOP is not possible. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, GLAUCOMA, p. 1914.
The nurse is evaluating the client while taking the color vision test. Which response would the nurse anticipate when caring for a client with normal color vision? The nurse would anticipate responding to the color names in the pictures. The nurse would anticipate the client identifying numbers and shapes. The nurse would anticipate a cross-eyed appearance. The nurse would anticipate no differentiation in between colors.
The nurse would anticipate the client identifying numbers and shapes. Explanation: The nurse is correct to anticipate the client being able to identify numbers and shapes dictated by different color codes. The other options do not test for color vision or indicate an inability to differentiate colors. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ASSESSMENT OF THE EYE, p. 1902.
The nurse is assessing an older client's vision. The nurse integrates knowledge of which of the following during the assessment? The power of the lens to accommodate will be decreased. Increased fat will be around the orbit. The depth of the eyeball will be increased, leading to myopia. The skin around the eyes will be more elastic.
The power of the lens to accommodate will be decreased. Explanation: In the older adult, the accommodative power of the lens decreases, resulting in the need to hold reading materials at increasing distances to focus. Orbital fat and skin elasticity decrease. The depth of the eyeball does not change with age. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, IMPAIRED VISION, p. 1904.
A patient visits a clinic for an eye examination. He describes his visual changes and mentions a specific diagnostic clinical sign of glaucoma. What is that clinical sign? Diminished acuity The presence of halos around lights Pain associated with a purulent discharge A significant loss of central vision
The presence of halos around lights Explanation: Colored halos around lights is a classic symptom of acute-closure glaucoma. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, GLAUCOMA, p. 1912.
The nurse at the eye clinic is caring for a patient with suspected glaucoma. What complaint would be significant for a diagnosis of glaucoma? A significant loss of central vision Pain associated with a purulent discharge The presence of halos around lights Diminished acuity
The presence of halos around lights Explanation: Glaucoma is often called the "silent thief of sight" because most patients are unaware that they have the disease until they have experienced visual changes and vision loss. The patient may not seek health care until he or she experiences blurred vision or "halos" around lights, difficulty focusing, difficulty adjusting eyes in low lighting, loss of peripheral vision, aching or discomfort around the eyes, and headache. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, GLAUCOMA, p. 1912.
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 congenital angle closure secondary
open angle Explanation: The client described open-angle glaucoma. This type of glaucoma develops painlessly, and visual changes occur slowly. As the IOP rises, it causes edema of the cornea, atrophy of nerve fibers in the peripheral areas of the retina, and degeneration of the optic nerve. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, GLAUCOMA, p. 1912.
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: slit-lamp examination retinal angiography color vision test perimetry test
perimetry test Explanation: A visual field test or perimetry test measures peripheral vision and detects gaps in the visual field. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, ASSESSMENT OF THE EYE, p. 1903.
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 emmetropia hyperopia myopia
presbyopia Explanation: Presbyopia is associated with aging and results in difficulty with near vision. People with presbyopia hold reading material or handwork at a distance to see it more clearly. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 58: Assessment and Management of Patients with Eye and Vision Disorders, IMPAIRED VISION, p. 1905.
