Eye Nclex review
The client is receiving an eye drop and an eye ointment to the right eye. Which action should the nurse take?
Administer the eye drop first, followed by the eye ointment.
A client with glaucoma and an acute exacerbation of chronic obstructive pulmonary disease (COPD) has a new prescription to receive carteolol HCl eye drops. Which action by the nurse is most appropriate?
Withhold the dose and notify the registered nurse.
A client reports to the health care clinic for an eye examination, and a diagnosis of primary open-angle glaucoma is suspected. Which question will elicit information regarding the signs/symptoms associated with this disorder?
"Have you had difficulty with peripheral vision?"
The nurse is reinforcing preoperative instructions to a client scheduled for cataract surgery and prepares a written list of instructions for the client. Which statement by the client indicates a need for further teaching?
"I can drink any liquids that I want to on the morning of the surgery."
A client is brought to the ambulatory care department by the spouse 1 day following a cataract extraction procedure. A diagnosis of hyphema is made, which occurred as a result of the surgical procedure. The nurse reinforces instructions to the client and spouse regarding the treatment for the complication and makes which statement?
"Maintain bed rest and patching of both eyes."
The nurse is providing discharge instructions to a client following a keratoplasty. Which statement by the client indicates the need for further teaching?
"Sutures are removed in 2 weeks."
The nurse interprets that a client diagnosed with glaucoma needs additional information about the expected effects of this condition when the client makes which statement?
"Taking my daily walk right around dusk each evening has proven to be so enjoyable."
Immediately following cataract repair, the client's affected conjunctiva and eyelids are edematous. Which statement by the nurse accurately characterizes these findings for the client?
"The edema is normal and should subside within 3 days."
Prescriptive glasses are prescribed for a client with bilateral aphakia, and the nurse reinforces instructions to the client regarding the use of the glasses. Which statement by the client indicates the need for further teaching?
"The prescriptive glasses will correct my visual field of sight."
A client has been diagnosed with open-angle glaucoma. Which signs and symptoms are found in open-angle glaucoma? Select all that apply.
1.Blurred or hazy vision 2.Colored rings around lights 3.Tonometry reading 30 mm Hg
Tonometry is performed on the client with a suspected diagnosis of glaucoma. The nurse reviews the test and determines that the intraocular pressure is normal if which result is noted?
15 mm Hg
A client has been diagnosed with cataracts. Which signs and symptoms should the nurse expect to note? Select all that apply.
2.Photophobia 3.Blurred vision 4.Decreased color perception
The nurse is assigned to care for a client with a diagnosis of detached retina. Which findings would indicate that bleeding has occurred as a result of retinal detachment? Select all that apply.
2.Vision may be cloudy 5.Complaints of a burst of black spots or floaters
The nurse is assigned to administer the prescribed eye drops for a client preparing for cataract surgery. Which type of eye drops should the nurse expect to be prescribed?
A mydriatic medication
The nurse is reviewing the preoperative prescriptions of a client scheduled for a keratoplasty. Which prescriptions noted in the client's chart should the nurse question?
Administer medication to dilate the affected pupil.
A nursing student is caring for a client in the health care clinic who has been diagnosed with glaucoma. The client has a history of heart disease. The nursing instructor asks the student about group of medications used to treat glaucoma that would be contraindicated?
Alpha2-adrenergic agonist
Which diagnostic test would verify the diagnosis of macular degeneration?
Amsler grid test
The nurse is reinforcing instructions to a client with a diagnosis of hordeolum regarding the treatment plan. Which instruction should the nurse include in the teaching plan for the client?
Apply a warm compress for 15 minutes 4 times daily.
A client arrives at the emergency department following a blow to the eye from a softball. Which intervention should be implemented by the nurse initially?
Apply ice to the affected eye.
A client is diagnosed with hyphema after experiencing a traumatic blow to the eye. The nurse explains to the client that which activity limitation needs to be implemented following this type of injury?
Bed rest with the head in semi-Fowler's position
A client is diagnosed with glaucoma. Which data gathered by the nurse indicate a risk factor associated with glaucoma?
Cardiovascular disease
A client who had previously undergone cataract surgery tells the nurse that she has begun seeing flashing lights and floaters in the eye. Based on the client's history, the nurse interprets that the client is at risk for which?
Detached retina
The nurse is collecting data from a client who has a history of untreated cataracts. The nurse checks the client for which associated manifestation?
Difficulty with driving a car at night
The nurse is gathering data from a client with a history of untreated cataracts. The nurse asks the client about the presence of which sign of a cataract?
Difficulty with driving at night and blurred vision
Betaxolol hydrochloride eye drops have been prescribed for the client with glaucoma. Which nursing action is most appropriate related to monitoring for the side/adverse effects of this medication?
Monitoring blood pressure
The nurse is providing instructions to a client who will be self-administering eye drops. To minimize the systemic effects that eye drops can produce, the client is instructed to perform which action?
Occlude the nasolacrimal duct with a finger over the inner canthus for 30 to 60 seconds after instilling the drops.
During the early postoperative stage, the client who had a cataract extraction complains of nausea and severe eye pain over the operative site. Which action should the nurse implement?
Report the client's complaints.
The nurse is caring for a client after enucleation and notes the presence of bright red drainage on the dressing. The nurse should take which appropriate action?
Report the finding to the registered nurse (RN).
These are signs and symptoms of glaucoma. Which sign or symptom is found only in narrow-angle glaucoma?
Severe pain in and around eye
The nurse is inserting soft contact lenses into the eyes of a client. Which direction does the nurse tell the client to look?
Straight ahead
The nurse is assisting in performing a confrontation test on a client seen in the clinic. The nurse understands that this test is performed to determine what?
The ability to demonstrate effective peripheral vision
In preparation for cataract surgery, the nurse is to administer cyclopentolate eye drops. The nurse administers the eye drops knowing that which is the purpose of this medication?
To dilate the pupil of the operative eye
The nurse is reinforcing discharge instructions to a client going home after same-day eye surgery. During the postoperative period, the nurse stresses that the client may safely perform which activity?
Watch television.
The nurse is reinforcing discharge instructions to a client who has had ocular surgery of the left eye. Which statement by the client indicates a need for further teaching?
"I need to call the doctor if I develop any fever."
The nurse reinforces home care instructions to a client after cataract removal and placement of an intraocular implant in the right eye. Which statement by the client indicates a need for further teaching?
"I need to remove the eye dressing as soon as I get home and place a warm pack on my eye."
A clinic nurse is reinforcing home care instructions to a client with a diagnosis of glaucoma. Which statement by the client indicates an understanding of the treatment plan for glaucoma?
"I need to take my eye drops for the rest of my life."
The instructor is quizzing the student nurse concerning care of a visually impaired client. Which statement indicates a need for further teaching?
"I will take the client's arm to lead while we are walking."
A client is being discharged from the ambulatory care unit following cataract removal, and the nurse provides instructions regarding home care. Which statement by the client indicates an understanding of the instructions?
"I will wear my eye shield at night and my glasses during the day."
A client has bilateral aphakia. When reinforcing teaching instructions regarding the prescribed eyeglasses, the nurse determines the need for further teaching when the client makes which statement?
"My peripheral vision will not be distorted."
The nurse has reinforced instructions to a client who is scheduled for a cataract extraction. Which statement by the client indicates a need for further teaching?
"No eating or drinking for at least 18 hours before the surgery."
The nurse is reviewing the medical record of a client diagnosed with conjunctivitis. Which signs and symptoms should the nurse expect to be noted? Select all that apply.
1.Itching 3.Redness 5.Sensation of foreign object
Which are age-related changes to the eyes? Select all that apply.
1.Presbyopia 2.Arcus senilis 3.Yellow-tinged sclera 6.Decreased ability to see in dim light
The nurse is preparing to administer eye drops. Which interventions should the nurse take to administer the drops? Select all that apply.
1.Wash hands. 2.Put on gloves. 3.Place the drop in the conjunctival sac. 4.Pull the lower lid down against the cheekbone.
A client arrives at the emergency department for treatment of an injury to the eye after being hit by a baseball bat. On data collection, the nurse notes that the eye is bleeding. Which nursing action is appropriate?
Cover the eye with cold, sterile saline gauze.
The nurse should check for vision loss in a client with which condition?
Diabetes mellitus
The nurse is attempting to inspect the lacrimal apparatus of a client's eye. Because of its anatomical location, the nurse should do which action?
Retract the upper eyelid and ask the client to look down.
The nurse is assisting with developing a teaching plan for the client with glaucoma. Which instruction should the nurse suggest to include in the plan of care?
Eye medications may need to be administered for the rest of your life.
A client arrives at the emergency department after experiencing a traumatic blow to the eye and a hyphema is diagnosed. In which position should the nurse place the client?
In semi-Fowler's position
A client arrives in the emergency department with an eye injury resulting from metal fragments that hit the eye while the client was drilling into metal. The nurse checks the eye and notes small pieces of metal floating on the eyeball. Which action should the nurse take first?
Irrigate the eye with sterile saline.
A client arrives in the emergency department with a chemical eye injury. The nurse immediately performs which action?
Irrigates the eye with copious amounts of sterile normal saline
A client has been diagnosed with glaucoma. The nurse who is teaching the client principles of self-care should encourage the client to limit or refrain from which usual activity on a repeated basis?
Picking objects up off the floor
While at home, the nurse receives a telephone call from a neighbor who reports that while accidentally breaking a mirror, a piece of glass flew into her eye. Which is the appropriate initial nursing action after observing that the large glass shard is protruding from the neighbor's eye?
Secure a paper cup over the affected eye.
A client arrives in the emergency department following an eye injury from a chemical solution. Which is the initial nursing action?
Test the eye pH with litmus paper.
A client with glaucoma asks the nurse if complete vision will return. The nurse should make which response to the client?
"Although some vision has been lost and cannot be restored, further loss may be prevented by adhering to the treatment plan."
The nurse is giving the client discharge instructions concerning glaucoma. Which client statement indicates a need for further teaching?
"I will only take the eye drops until my vision improves."
The nurse is providing discharge instructions to a client who is postoperative cataract surgery on the left eye. Which statement indicates a need for further teaching?
"If I have severe eye pain, I will take the narcotic pain pill that my doctor will prescribe for me."
The nurse has reinforced instructions to a client following a right keratoplasty. Which statement by the client indicates a need for further teaching?
"In 1 week, I'll return to have the sutures removed."
The nurse in the outpatient unit is preparing a client who is scheduled for a laser trabeculoplasty for the treatment of primary open-angle glaucoma. Which instructions should the nurse reinforce to the client?
"You may return to work 1 or 2 days following the procedure."
The nurse collects data from a client with a diagnosis of macular degeneration of the eye. The nurse should expect the client to report which symptoms? Select all that apply.
1.Blurred central vision 2.Bending of straight lines 5.Inability to see color vividness
The nurse is reviewing the results of an eye examination on a client. Which tests can detect glaucoma? Select all that apply.
1.Tonometry 3.Visual field check
A client arrives in the emergency department with a foreign body in the eye. Which action should the nurse plan to perform first?
Apply an eye patch to both eyes.
A client sustains a contusion of the eyeball after a traumatic injury with a blunt object. The nurse should take which immediate action?
Apply ice to the affected eye.
The nurse is caring for a client following enucleation. Which postsurgical observation requires immediate attention by the nurse?
Bright red drainage on the dressing
A client is brought to the emergency department by the ambulance team after collapse at home. Cardiopulmonary resuscitation is attempted but is unsuccessful. The wife of the client tells the nurse that the client is an organ donor and that their eyes are to be donated. Which action should the nurse take next?
Close the eyes, elevate the head of the bed, and place a small ice pack on the eyes.
A client who has undergone cataract removal without an intraocular lens implant is visibly upset because his vision is still blurry. Which action should the nurse perform to provide realistic reassurance to this client?
Explain that vision will improve with adjustment to aphakic lenses.
The nurse is preparing a plan of care for a client being admitted to the hospital with a diagnosis of retinal detachment. Which measure should the nurse include in the plan of care?
Place an eye patch over the affected eye.
The nurse notes that the client's physical examination record states the client's eyes moved normally through the six cardinal fields of gaze. The nurse makes which interpretation?
The client has normal ocular movements.
The nurse is reinforcing instructions to a client regarding the use of ice packs to treat an eye injury. The nurse instructs the client to do which action?
Wrap a plastic bag filled with ice with a pillowcase and place it on the eye.
A miotic medication has been prescribed for the client with glaucoma. The client asks the nurse about the purpose of the medication. The nurse should tell the client which purpose?
"The medication causes the pupil to constrict and will lower the pressure in the eye."
The nurse in a health care clinic is assisting in testing the client for accommodation. Arrange the actions and observations in the order that they should occur. All options must be used.
1 Focus on distant object. 2 Pupils dilate. 3 Focus on close object. 4 Pupils constrict. 5 Document findings.
The nurse is reinforcing home-care instructions to a client and family regarding care after left cataract surgery with lens implant. Which statements made by the client indicate an understanding of the instructions? Select all that apply.
2."I will not sleep lying on my left side." 3."I will sit at the table to eat breakfast." 4."I will sit in my recliner with my feet elevated." 5."I will not lift anything heavier than 10 pounds."
A clinic nurse is reviewing the record of a client recently diagnosed with a cataract. Which clinical manifestations associated with this disorder should the nurse expect to be documented in the client's record? Select all that apply.
3.Increasing nearsightedness 4.Need for more light when reading 5.Painless progressive loss of vision
A client has been newly diagnosed with glaucoma. As part of the discharge instructions, the nurse should plan to reinforce which information?
The need for lifelong medication therapy
The nurse is assigned to care for a client with a detached retina. Which finding should the nurse expect to be documented in the client's record?
A sense of a curtain falling across the field of vision
The nurse reinforces instructions to a client with glaucoma regarding measures that will prevent an increase in intraocular pressure in the eyes. Which statement by the client indicates a need for further teaching?
"I can tie my shoelaces by bending over slowly."
The nurse is reinforcing home care instructions to a client who has a hordeolum (sty) of the right eye. Which statement by the client indicates an understanding of the instructions?
"I should apply antibiotic ointment as prescribed."
The nurse is reviewing the plan of care developed by a nursing student for a client scheduled for keratoplasty. The nurse discusses the plan with the student if which incorrect intervention is listed in the plan?
Administering medications that will dilate the pupil
The nurse caring for a client in the postoperative period following an enucleation notes bloody staining on the surgical eye dressing. Which is the appropriate nursing action?
Contact the registered nurse.
After an eye examination, a client has been diagnosed with acute angle-closure glaucoma. The nurse collecting data from the client asks the client about an accompanying history of which sign/symptom?
Eye pain
The nurse is providing client teaching regarding glaucoma. Which instructions are important to include in the teaching plan? Select all that apply.
Follow a low-sodium, minimal-caffeine diet with plenty of fiber. Be sure to report halos of light or increased eye pain to your primary health care provider.
A client sustains a chemical eye injury from a splash of battery acid. The nurse should prepare the client for which immediate measure?
Irrigating the eye with sterile normal saline
The nurse in the ambulatory care unit is caring for a client following cataract extraction. The client suddenly complains of nausea and severe eye pain in the surgical eye. The nurse should take which action?
Notify the registered nurse.
The nurse is caring for a client following enucleation. On data collection, the nurse notes staining and bleeding on the dressing. The nurse should take which action?
Notify the registered nurse.
A client with retinal detachment is admitted to the outpatient nursing unit in preparation for a scleral buckling procedure. Which prescription should the nurse anticipate?
Placing an eye patch over the client's affected eye
After a routine eye examination, a client has been told there are refractive errors in both eyes. The nurse explains to the client that this problem is primarily treated with which intervention?
Prescription of corrective lenses
A client is being discharged from the ambulatory care unit following cataract removal. Which instruction from the discharge teaching plan should the nurse reinforce?
Take acetaminophen if any discomfort occurs.
A client reporting recent right eye discomfort is diagnosed with chalazion of the right eye. The nurse reinforces instructions to the client regarding care to the eye. Which statement by the client indicates an understanding of the measures?
"I should apply warm packs to my eye."
A client arrives at the emergency department following an eye injury in which an acid used to clean the brick on the fireplace splashed into the eye. Which question should the nurse ask initially?
"Did you flush the eye following the injury?"
The nurse is providing client and family instructions for a client who has been recently diagnosed with glaucoma. Which statement indicates that the client's family member needs further teaching regarding the eye drop application of pilocarpine hydrochloride? Select all that apply.
"I should apply the eye drops directly over my family member's pupil. "I have to contact the prescriber if my family member develops a small pupil." "I need to wipe off the tip of the eye drop bottle with a tissue between administrations."
A client diagnosed with primary open-angle glaucoma has been prescribed pilocarpine ophthalmic drops. The nurse has given the client instructions on how to administer the eye drops. Which client statement indicates a need for further teaching?
"I will drop the eye drop in the middle of my eye."
The nurse is reinforcing discharge instructions to a client following right eye corneal transplantation surgery. The nurse determines that the client understands the instructions if the client makes which statement?
"I will lie on my back or left side."
The nurse is giving home care instructions to a client with conjunctivitis. Which client statement indicates a need for further teaching?
"I will use a sterile gauze to rub any matter from my eyes."
A client with glaucoma has suffered significant eye damage before diagnosis and now has impaired vision. The nurse determines that the client needs further assistance in adapting to this situation if the client makes which statement?
"There is no difficulty driving at dusk."
The nurse is reviewing the health record of a client diagnosed with a cataract. Which are signs and symptoms of cataract formation? Select all that apply.
2.Floaters in visual field 3.Difficulty in night vision 5.Decreased color perception
A client has been diagnosed with macular degeneration. The nurse should expect to expect which signs and symptoms noted with macular degeneration? Select all that apply.
1.Blurred vision 4.Inability to see the vividness of colors 5.Objects that appear to be the wrong size
Which nursing interventions are appropriate for a client recovering from surgery for retinal detachment? Select all that apply.
1.Monitor for hemorrhage. 2.Administer eye medications. 3.Maintain the eye patch or shield. 4.Assist with activities of daily living. 6.Educate regarding symptoms of retinal detachment.
The nurse is preparing to reinforce a teaching plan for a client who is undergoing cataract extraction with intraocular implant. Which home care measures should the nurse include in the plan? Select all that apply.
1.To avoid activities that require bending over 3.To take acetaminophen for minor eye discomfort 4.To place an eye shield on the surgical eye at bedtime. 6.To contact the surgeon if a decrease in visual acuity occurs
The nurse is reinforcing discharge teaching to a client following right eye cataract surgery. The nurse determines that the client needs further teaching about ways to avoid strain on the operative eye when the client makes which statements? Select all that apply.
2."I can lie on my right side." 5."I will wear my eye shield only during the daytime."
A client who was hit in the eye with a baseball bat sustains a contusion of the eyeball. The emergency department nurse implements which immediate action?
Applies ice to the affected eye
Pilocarpine hydrochloride is prescribed for the client with glaucoma. Which medication should the nurse plan to have available in the event of systemic toxicity?
Atropine sulfate
The nurse is caring for a client with glaucoma. Which medication prescribed for the client should the nurse question?
Atropine sulfate
A client who sustained an eye injury arrives at the emergency department. Which is the initial nursing action?
Obtain a history regarding the cause of the injury.
A client arrives in the emergency department after an automobile crash. The client's forehead hit the steering wheel and a hyphema has been diagnosed. Which position should the nurse prepare to position the client?
On bed rest in a semi-Fowler's position
The nurse in the recovery room area is preparing to care for a client following cataract extraction of the right eye. Which position does the nurse prepare to place the client?
On the left side with the head of the bed elevated
The nurse is assigned to care for a client following a cataract extraction. The nurse plans to place the client in which position?
On the nonoperative side
A client has been admitted to the telemetry unit with a diagnosis of bradycardia. The nurse is reviewing the client's prescriptions with the registered nurse. The client has a history of open-angle glaucoma. Which prescription should the nurse suggest should be questioned?
Atropine intravenously
