Lewis Ch. 22 Visual and Auditory Problems

For the patient with a retinal break, what extraocular techniques may be used with sclera buckling to seal the break by creating an inflammatory reaction that causes a chorioretinal adhesion or scar (select all that apply)? a. Cryopexy b. Vitrectomy c. Pneumatic retinopexy d. Laser photocoagulation e. Penetrating keratoplasty

a, d. Vitrectomy is an intraocular procedure but it may be used with sclera buckling. Pneumatic retinopexy is an intraocular procedure that may be used with photocoagulation or cryotherapy. Penetrating keratoplasty is used for corneal scars or opacities and removes the cornea.

20. A patient with Ménière's disease is admitted with vertigo, nausea, and vomiting. Which nursing intervention will be included in the care plan? a. Keep the patient's room darkened. b. Encourage oral fluids to 3000 ml daily. c. Change the patient's position every 2 hours. d. Keep the head of the bed elevated 30 degrees.

ANS: A A darkened, quiet room will decrease the symptoms of the acute attack of Ménière's disease. Since the patient will be nauseated during an acute attack, fluids are administered intravenously. Position changes will cause vertigo and nausea. The head of the bed can be positioned for patient comfort.

2. A patient is seen in the ophthalmology clinic and diagnosed with recurrent staphylococcal and seborrheic blepharitis. The nurse will plan to teach the patient about a. saline irrigation of the eyes. b. surgical removal of the lesion. c. using baby shampoo to clean the lids. d. the use of cool compresses to the eyes.

ANS: C Baby shampoo is used to soften and remove crusts associated with blepharitis. The other interventions are not used in treating this disorder.

18. A patient with chronic otitis media is scheduled for a tympanoplasty. Before surgery, the nurse teaches the patient that postoperative expectations include a. keeping the head elevated. b. the need for prolonged bed rest. c. avoidance of coughing or blowing the nose. d. continuous antibiotic irrigation of the ear canal.

ANS: C Coughing or blowing the nose increases pressure in the eustachian tube and middle ear cavity and disrupts postoperative healing. There is no postoperative need for prolonged bed rest, elevation of the head, or continuous antibiotic irrigation.

14. A patient who is being admitted to the hospital for abdominal pain and nausea tells the nurse about a history of glaucoma. Which of these prescribed medications should the nurse question? a. morphine sulfate 4 mg IV b. diazepam (Valium) 5 mg IV c. betaxolol (Betoptic) 0.25% eyedrops d. scopolamine patch (Transderm Scop) 1.5 mg

ANS: D Scopolamine is a parasympathetic blocker and will relax the iris, causing blockage of aqueous humor outflow and an increase in intraocular pressure. The other medications are appropriate for this patient.

9. In reviewing a 50-year-old patient's medical record, the nurse notes that the last eye examination revealed an intraocular pressure of 28 mm Hg. The nurse will plan to assess a. visual acuity. b. pupil reaction. c. color perception. d. peripheral vision

ANS: D The patient's increased intraocular pressure indicates glaucoma, which decreases peripheral vision. Because central visual acuity is unchanged by glaucoma, assessment of visual acuity could be normal even if the patient has worsening glaucoma. Color perception and pupil reaction to light are not affected by glaucoma.

34. Which assessment finding in a patient who was struck in the right eye with a baseball is a priority for the nurse to communicate to the health care provider in the emergency department? a. The patient complains of a right-sided headache. b. The sclerae on the right eye have broken blood vessels. c. The area around the right eye is bruised and tender to the touch. d. The patient complains of "a curtain" blocking part of the visual field.

ANS: D The patient's sensation that a curtain is coming across the field of vision suggests retinal detachment and the need for rapid action to prevent blindness. The other findings would be expected with the patient's history of being hit in the eye with a ball.

Retinopathy most commonly develops in patients with which co-morbidities (select all that apply)? A. Diabetes mellitus B. Kidney disease C. Hypertension D. Arteriosclerosis E. Glaucoma

Answer: A,C Retinopathy is a process of microvascular damage to the retina. It can develop slowly or rapidly and can lead to blurred vision and progressive vision loss. In adults, retinopathy is most often associated with diabetes mellitus and hypertension.

Inflammation and infection of the eye are (select all that apply) A. caused by irritants and microorganisms. B. have a higher incidence in elderly patients. C. chronic problems that result in a loss of vision. D. frequently treated with warm compresses and antibiotics.

Answer: A,D Inflammation or infection of the eye is caused by external irritants or microorganisms. Teach the patient appropriate interventions related to the specific disorder. Common interventions include the application of warm, moist compresses and antibiotics.

What is the causative agent in the development of a hordeolum? A. Escherichia coli B. Staphylococcus aureus C. Streptococcus D. Clostridium difficile

Answer: B An external hordeolum (commonly called a sty) is an infection of the sebaceous glands in the lid margin. The most common bacterial agent is S. aureus. The other bacteria do not usually cause this disorder.

When administering eyedrops to a patient with glaucoma, which nursing measure is most appropriate to minimize systemic effects of the medication? A. Apply pressure to each eyeball for a few seconds after administration. B. Have the patient close the eyes and move them back and forth several times. C. Have the patient put pressure on the inner canthus of the eye after administration. D. Have the patient try to blink out excess medication immediately after administration.

Answer: C Systemic absorption can be minimized by applying pressure to the inner canthus of the eye.

You expect the patient with "dry eyes" to also have a concurrent diagnosis of (select all that apply) A. glaucoma. B. cataracts. C. scleroderma. D. systemic lupus erythematous. E. rheumatoid arthritis.

Answer: C,D Keratoconjunctivitis sicca (dry eyes) is a common complaint, particularly by the elderly and individuals with certain systemic diseases such as scleroderma and systemic lupus erythematosus. The other disorders are not associated with this disease.

The patient undergoing corneal transplant asks you when full vision will be restored. You respond that full vision will be restored A. immediately. B. in 1 month. C. in 6 months. D. in 12 months.

Answer: D In corneal transplantation, the ophthalmic surgeon removes the full thickness of the patient's cornea and replaces it with a donor cornea that is sutured into place. Vision may not be restored for up to 12 months.

Patients with permanent visual impairment A. feel most comfortable with other visually impaired persons. B. may feel threatened when others make eye contact during a conversation. C. usually need others to speak louder so they can communicate appropriately. D. may experience the same grieving process that is associated with other losses.

Answer: D After loss of visual function or even the entire eye, the patient will grieve the loss. Help the patient through the grieving process.

Which characteristics of glaucoma are associated with only primary open-angle glaucoma (POAG) (select all that apply)? a. Gradual loss of peripheral vision b. Treated with iridotomy or iridectomy c. Causes loss of central vision with corneal edema d. May be caused by increased production of aqueous humor e. Treated with cholinergic agents such as pilocarpine (Pilocar) f. Resistance to aqueous outflow through trabecular meshwork

a, d, f. The other answers are associated with primary angleclosure glaucoma (PACG).

To determine if an unconscious patient has contact lenses in place, what should be done by the nurse? a. Use a penlight to shine a light obliquely over the eyeball. b. Apply drops of fluorescein dye to the eye to stain the lenses yellow. c. Touch the cornea lightly with a dry cotton ball to see if the patient reacts. d. Tense the lateral canthus to cause a lens to be ejected if it is present in the eye.

a. A light shined at an angle over the cornea will illuminate a contact lens and fluorescein should not have to be used. Cotton balls should not be placed on the cornea and simply tensing the outer canthus will not dislodge the lens.

An appropriate nursing intervention for the patient during an acute attack of Meniere disease includes providing a. frequent repositioning. b. a quiet, darkened room. c. a television for diversion. d. padded side rails on the bed.

b. Nursing care should minimize vertigo by keeping the patient in a quiet, dark environment. Movement aggravates the whirling and roaring sensations and the patient should be moved only for essential care. Fluorescent lights or television flickering may also increase vertigo and should be avoided. Side rails should be raised when the patient is in bed but padding is not indicated.

36. Which of these nursing activities is appropriate for the RN working in the eye clinic to delegate to experienced nursing assistive personnel (NAP)? a. Application of a warm compress to a patient's hordeolum b. Assessment of a patient with possible bacterial conjunctivitis c. Instruction about hand washing for a patient with herpes keratitis d. Administration of antiviral drops to a patient with a corneal ulcer

ANS: A Application of cold and warm packs is included in NAP education and the ability to accomplish this safely would be expected for a nursing assistant working in an eye clinic. Medication administration, patient teaching, and assessment are high-level skills appropriate for the education and legal practice level of the RN.

28. A patient is scheduled for a right cataract extraction and intraocular lens implantation at an ambulatory surgical center in 2 weeks. During the preoperative assessment of the patient in the physician's office, it is most important for the nurse to assess a. the visual acuity of the patient's left eye. b. for a white pupil in the patient's right eye. c. how long that the patient has had the cataract. d. for a history of reactions to general anesthetics.

ANS: A Because it can take several weeks before the maximum improvement in vision occurs in the right eye, patient safety and independence are determined by the vision in the left eye. Cataract surgery is done using local anesthetics rather than general anesthetics. A white pupil in the operative eye would not be unusual for a patient scheduled for cataract removal and lens implantation. The length of time that the patient has had the cataract will not impact on the perioperative care.

24. A patient with hearing loss asks the nurse about the use of a cochlear implant. Which information will the nurse include when replying to the patient? a. Cochlear implants require training in order to receive the full benefit. b. Cochlear implants are not useful for patients with congenital deafness. c. Cochlear implants are most helpful as an early intervention for presbycusis. d. Cochlear implants improve hearing in patients with conductive hearing loss.

ANS: A Extensive rehabilitation is required after cochlear implants in order for patients to receive the maximum benefit. Hearing aids, rather than cochlear implants, are used initially for presbycusis. Cochlear implants are used for sensorineural hearing loss and would not be helpful for conductive loss. They are appropriate for some patients with congenital deafness.

23. An older adult patient with presbycusis is fitted with binaural hearing aids. Which information will the nurse include when teaching the patient how to use the hearing aids? a. Experiment with volume and hearing ability in a quiet environment initially. b. Keep the volume low on the hearing aids for the first week while adjusting to them. c. Add the second hearing aid after making the initial adjustment to the first hearing aid. d. Wear the hearing aids for about an hour a day at first, gradually increasing the time of use.

ANS: A Initially the patient should use the hearing aids in a quiet environment like the home, experimenting with increasing and decreasing the volume as needed. There is no need to gradually increase the time of wear. The patient should experiment with the level of volume to find what works well in various situations. Both hearing aids should be used.

7. A patient is diagnosed with adult inclusion conjunctivitis (AIC) caused by Chlamydia trachomatis. Which of these actions will be included in the plan of care? a. Discussing the need for sexually transmitted disease testing b. Applying topical corticosteroids to prevent further inflammation c. Assisting with applying for community visual rehabilitation services d. Educating about the use of antiviral eyedrops to treat the infection

ANS: A Patients with AIC have a high risk for concurrent genital Chlamydia infection and should be referred for STD testing. AIC is treated with antibiotics; antiviral and corticosteroid medications are not appropriate therapies. Although some types of Chlamydia infection do cause blindness, AIC does not lead to blindness, so referral for visual rehabilitation is not appropriate

33. A patient who had cataract extraction and intraocular lens implantation the previous day calls the eye clinic and gives the nurse all of the following information. Which information is the priority to communicate to the health care provider? a. The patient has eye pain rated at a 5 (on a 0-10 scale). b. The patient has questions about the ordered eyedrops. c. The patient has poor depth perception when wearing an eye patch. d. The patient complains that the vision has "not improved very much."

ANS: A Postoperative cataract surgery patients usually experience little or no pain, so pain at a 5 on a 10-point pain level may indicate complications such as hemorrhage, infection, or increased intraocular pressure. The other information given by the patient indicates a need for patient teaching but does not indicate that complications of the surgery may be occurring.

19. The nurse is assessing a patient who has recently been treated with amoxicillin (Amoxil) for acute otitis media of the right ear. Which assessment data obtained by the nurse is of most concern? a. The patient has a temperature of 100.6° F. b. The patient complains of "popping" in the ear. c. The patient frequently asks the nurse to repeat information. d. The patient states that the right ear has a feeling of fullness.

ANS: A The fever indicates that the infection may not be resolved and the patient might need further antibiotic therapy. A feeling of fullness, "popping" of the ear, and decreased hearing are symptoms of otitis media with effusion. These symptoms are normal for weeks to months after an episode of acute otitis media and usually resolve without treatment.

30. Which action should the RN who is working in the eye and ear clinic delegate to an LPN/LVN? a. Use a Snellen chart to check a patient's visual acuity. b. Evaluate a patient's ability to insert soft contact lenses. c. Teach a patient with otosclerosis about use of sodium fluoride and vitamin D. d. Assess the external auditory canal for signs of irritation caused by a hearing aid.

ANS: A Using standardized screening tests such as a Snellen chart to test visual acuity is included in LPN education and scope of practice. Evaluation, assessment, and patient education are higher level skills that require RN education and scope of practice.

8. Which topic will the nurse include in patient teaching after a patient has had outpatient cataract surgery and lens implantation? a. Use of oral opioids for pain control b. Administration of antibiotic eyedrops c. Importance of coughing and deep breathing exercises d. Need for bed rest for the first 24 hours after the surgery

ANS: B Antibiotic and corticosteroid eyedrops are commonly prescribed after cataract surgery, and the patient should be able to administer them using safe technique. Pain is not expected after cataract surgery and opioids will not be needed. Coughing and deep breathing exercises are not needed since a general anesthetic agent is not used. There is no bed rest restriction after cataract surgery.

35. The charge nurse observes a newly hired nurse performing all of the following interventions for a patient who has just arrived in the postanesthesia care unit after having right cataract removal and an intraocular lens implant. Which one requires that the charge nurse intervene? a. The nurse leaves the eye shield in place. b. The nurse encourages the patient to cough. c. The nurse elevates the patient's head to 45 degrees. d. The nurse applies corticosteroid drops to the right eye.

ANS: B Because coughing will increase intraocular pressure, patients are generally taught to avoid coughing during the acute postoperative time. The other actions are appropriate for a patient after having this surgery.

4. A patient is seen at a clinic for repeated hordeolum of the eyes during the last 6 months. To help prevent further infection, the nurse advises the patient to a. apply cold compresses at the first sign of recurrence. b. discard all open or used cosmetics used near the eyes. c. wash the scalp and eyebrows with an antiseborrheic shampoo. d. be evaluated for the presence of sexually transmitted diseases (STDs).

ANS: B Hordeolum (styes) are commonly caused by Staphylococcus aureus, which may be present in cosmetics that the patient is using. Warm compresses are recommended to treat hordeolum. Antiseborrheic shampoos are recommended for seborrheic blepharitis. Patients with adult inclusion conjunctivitis, which is caused by Chlamydia trachomatis, should be referred for STD testing.

27. The nurse at the outpatient surgery unit obtains all of this information about a patient who is scheduled for cataract extraction and implantation of an intraocular lens. Which information has the most immediate implications for the patient's care? a. The patient has not eaten anything for 8 hours. b. The patient takes three antihypertensive medications. c. The patient gets nauseated with general anesthesia. d. The patient has had blurred vision for several years.

ANS: B Mydriatic medications used for pupil dilation are sympathetic nervous system stimulants and may increase heart rate and blood pressure. Using punctal occlusion when administering the mydriatic and monitoring of blood pressure are indicated for this patient. Patients are expected to be NPO for 6 to 8 hours before the surgical procedure. Blurred vision is an expected finding with cataracts. Cataract extraction and intraocular lens implantation are done using local anesthesia.

12. To determine whether treatment is effective for a patient with primary open-angle glaucoma (POAG), the nurse will evaluate the patient for improvement in a. eye pain. b. visual field. c. blurred vision. d. depth perception.

ANS: B POAG develops slowly and without symptoms except for a gradual loss of visual field. Acute closed-angle glaucoma may present with excruciating pain, colored halos, and blurred vision. Problems with depth perception are not associated with POAG.

22. When the nurse is admitting a 78-year-old patient, the patient repeatedly asks the nurse to "speak up so that I can hear you." Which action should the nurse take? a. Overenunciate while speaking. b. Speak normally but more slowly. c. Increase the volume when speaking. d. Use more facial expressions when talking.

ANS: B Patient understanding of the nurse's speech will be enhanced by speaking at a normal tone, but more slowly. Increasing the volume, overenunciating, and exaggerating facial expressions will not improve the patient's ability to comprehend the nurse.

5. Which topic will the nurse plan to include when teaching the patient with herpes simplex keratitis of the left eye about management of the infection? a. How to apply an occlusive dressing to the affected eye b. Need for frequent hand washing and avoiding touching the eyes c. Application of antibiotic drops to the left eye several times daily d. Use of corticosteroid ophthalmic ointment to decrease inflammation

ANS: B The best way to avoid the spread of infection from one eye to another is to avoid rubbing or touching the eyes and to use careful hand washing when touching the eyes is unavoidable. Occlusive dressings are not used for herpes keratitis. Herpes simplex is a virus and antibiotic drops will not be prescribed. Topical corticosteroids typically are not ordered because they can contribute to a longer course of infection and more complications.

1. To evaluate the effectiveness of the prescribed bifocals for a patient with myopia and presbyopia, the nurse in the eye clinic will check the patient for a. strength of the eye muscles. b. both near and distant vision. c. cloudiness in the eye lenses. d. intraocular pressure changes.

ANS: B The lenses are prescribed to correct the patient's near and distant vision. The nurse also may assess for cloudiness of the lenses, increased intraocular pressure, and eye movement, but these data will not evaluate whether the patient's bifocals are effective.

15. A patient who has bacterial endophthalmitis in the left eye is restless, frequently asking whether the eye is healing and whether removal of the eye will be necessary. Based on the assessment data, which nursing diagnosis is appropriate? a. Grieving related to current loss of functional vision b. Anxiety related to the possibility of permanent vision loss c. Situational low self-esteem related to loss of visual function d. Risk for falls related to inability to see environmental hazards

ANS: B The patient's restlessness and questioning of the nurse indicate anxiety about the future possible loss of vision. Because the patient can see with the right eye, functional vision is relatively intact and the patient is not at a high risk for falls. There is no indication of impaired self-esteem at this time.

32. The nurse notes that nursing assistive personnel (NAP) perform all the following actions when caring for a patient with Ménière's disease who is experiencing an acute attack. Which action by NAP indicates that the nurse should intervene immediately? a. NAP raise the side rails on the bed. b. NAP turn on the patient's television. c. NAP turn the patient to the right side. d. NAP place an emesis basin at the bedside.

ANS: B Watching television may exacerbate the symptoms of an acute attack of Ménière's disease. The other actions are appropriate.

21. The home health nurse observes a patient taking these actions when self-administering eardrops. Which patient action indicates a need for more teaching? a. The patient leaves the ear wick in place while administering the drops. b. The patient lies down before and for 2 minutes after administering the drops. c. The patient gets the eardrops out of the refrigerator just before administering the drops. d. The patient holds the tip of the dropper 1 cm above the ear while administering the drops.

ANS: C Administration of cold eardrops can cause dizziness because of stimulation of the semicircular canals. The other patient actions are appropriate.

31. The camp nurse is caring for a patient who is complaining of bilateral eye pain after a campfire log exploded, sending sparks into the patient's eyes. Which of these actions will the nurse take first? a. Apply ice packs to the eyes. b. Flush the eyes with sterile saline. c. Cover the eyes with dry sterile patches and protective eye shields. d. Apply antiseptic ophthalmic ointment from the first aid kit to the eyes.

ANS: C Emergency treatment of a burn or foreign-body injury to the eyes includes protecting the eyes from further injury by covering them with dry sterile dressings and protective shields. Flushing of the eyes immediately is indicated only for chemical exposure. Except in the case of chemical exposure, the nurse should not begin treatment until the patient has been assessed by a health care provider and orders are available.

17. A patient with external otitis has an ear wick placed and a new prescription for antibiotic otic drops. After the nurse provides patient teaching, which patient statement indicates that more instruction is needed? a. "I may use aspirin or acetaminophen (Tylenol) for pain relief." b. "I should apply the eardrops to the cotton wick in my ear canal." c. "I should clean my ear canal daily with a cotton-tipped applicator." d. "I may use warm compresses to the outside of my ear for comfort."

ANS: C Insertion of instruments such as cotton-tipped applicators into the ear should be avoided. The other patient statements indicate that the teaching has been successful.

29. When admitting a patient for surgery, the nurse learns that the patient has functional blindness and that the spouse has cared for the patient for many years. During the initial assessment of the patient, it is most important for the nurse to a. obtain more information about the cause of the patient's vision loss. b. obtain information from the spouse about the patient's special needs. c. make eye contact with the patient and ask about any need for assistance. d. perform an evaluation of the patient's visual acuity using a Snellen chart.

ANS: C Making eye contact with a partially sighted patient allows the patient to hear the nurse more easily and allows the nurse to assess the patient's facial expressions. The patient (rather than the spouse) should be asked about any need for assistance. The information about the cause of the vision loss and assessment of the patient's visual acuity are not priorities during the initial assessment.

13. A patient with glaucoma who has been using timolol (Timoptic) drops for several days tells the nurse that the eyedrops cause eye burning and visual blurriness for a short time after administration. The best response to the patient's statement is a. "These are normal side effects of the drug, which should become less noticeable with time." b. "If you occlude the puncta after you administer the drops, it will help relieve these side effects." c. "The drops are uncomfortable, but it is very important for you to use them as prescribed to retain your vision." d. "These symptoms are caused by glaucoma and may indicate a need for an increased dosage of the eyedrops."

ANS: C Patients should be instructed that eye discomfort and visual blurring are expected side effects of the ophthalmic drops but that the drops must be used to prevent further visual-field loss. The temporary burning and visual blurriness might not lessen with ongoing use, are not relieved by avoiding systemic absorption, and are not symptoms of glaucoma.

16. To decrease the risk for future hearing loss, which action should the nurse working with college students at the on-campus health clinic implement? a. Arrange to include otoscopic examinations for all patients. b. Administer rubella immunizations to all students at the clinic. c. Discuss the importance of limiting exposure to very amplified music. d. Teach patients to regularly irrigate the ear to decrease cerumen impaction.

ANS: C The nurse should discuss the impact of amplified music on hearing with young adults and discourage listening to very amplified music, especially for prolonged periods. Cerumen may need to be regularly removed for older patients, but this is not a routine need for younger adults. Only women of childbearing age who have not been previously vaccinated or exposed to rubella will require immunization. Otoscopic examinations are not necessary for all patients.

37. A patient with a head injury after a motor vehicle accident arrives in the emergency department (ED) complaining of shortness of breath and severe eye pain. Which action will the nurse take first? a. Elevate the head to 45 degrees. b. Administer the ordered analgesic. c. Check the patient's oxygen saturation. d. Examine the eye for evidence of trauma.

ANS: C The priority action for a patient after a head injury is to assess and maintain airway and breathing. Because the patient is complaining of shortness of breath, it is essential that the nurse assess the oxygen saturation. The other actions also are appropriate but are not the first action the nurse will take.

10. A patient with a left retinal detachment has a pneumatic retinopexy procedure. Which information will be included in the discharge teaching plan? a. The use of bilateral eye patches to reduce movement of the operative eye b. The need to wear dark or tinted glasses to protect the eyes from bright light c. The procedure for sterile dressing changes when the eye dressing is saturated d. The purpose of maintaining the head in a prescribed position for several weeks

ANS: D Following pneumatic retinopexy, the patient will need to position the head so the air bubble remains in contact with the retinal tear. The dark lenses and bilateral eye patches are not required after this procedure. Saturation of any eye dressings would not be expected following this procedure.

25. Which teaching will the nurse implement for a patient who has just been diagnosed with viral conjunctivitis? a. Explain the purpose of antiviral eyedrops. b. Show how to perform eye irrigation safely. c. Instruct about how to insert soft contact lenses. d. Demonstrate appropriate hand-washing technique.

ANS: D Hand washing is the major means to prevent the spread of conjunctivitis. Antiviral drops and eye irrigation will not be helpful in shortening the disease process. Contact lenses should not be used when patients have conjunctivitis because they can further irritate the conjunctiva.

26. Which information will the nurse include when teaching a patient with keratitis caused by herpes simplex type 1? a. Application of corticosteroid ophthalmic ointment to the eyes. b. Application of povidone-iodine (Betadine) gel around the eye. c. Avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs). d. Importance of taking all of the ordered oral acyclovir (Zovirax).

ANS: D Oral acyclovir may be ordered for herpes simplex infections. Corticosteroid ointments are usually contraindicated because they prolong the course of the infection. Although Betadine gel may be applied to the skin around the eyes for herpes zoster (varicella) infections, it is not used for herpes simplex infections. NSAIDs can be used to treat the pain associated with keratitis.

11. A patient with age-related macular degeneration has just had photodynamic therapy. Which statement by the patient indicates that the discharge teaching has been effective? a. "I will need to use bright lights to read for at least the next week." b. "I will use drops to keep my pupils dilated until my appointment." c. "I will not use facial lotions near my eyes during the recovery period." d. "I will keep covered with long-sleeved shirts and pants for the next 5 days."

ANS: D The photosensitizing drug used for photodynamic therapy is activated by exposure to bright light and can cause burns in areas exposed to light for 5 days after the treatment. There are no restrictions on use of facial lotions, medications to keep the pupils dilated would not be appropriate, and bright lights would increase the risk for damage caused by the treatment.

6. A new patient with 20/200 vision (with the use of corrective lenses) is being cared for by the nurse in the eye clinic. The nurse will plan to teach the patient about a. how to use a cane safely. b. how to access audio books. c. where Braille instruction is available. d. where to obtain specialized magnifiers.

ANS: D Various types of magnifiers can enhance the remaining vision enough to allow the performance of many tasks and activities of daily living (ADLs). Audio books, Braille instruction, and canes usually are reserved for patients with no functional vision.

3. Which action should the nurse take when assisting a totally blind patient to walk to the bathroom? a. Take the patient by the arm and lead the patient slowly to the bathroom. b. Have the patient place a hand on the nurse's shoulder and guide the patient. c. Stay beside the patient and describe any obstacles on the path to the bathroom. d. Walk slightly ahead of the patient and allow the patient to hold the nurse's elbow.

ANS: D When using the sighted-guide technique, the nurse walks slightly in front and to the side of the patient and has the patient hold the nurse's elbow. The other techniques are not as safe in assisting a blind patient.

What characteristics of hearing loss are associated with conductive loss (select all that apply)? a. Presbycusis b. Speaks softly c. Related to otitis media d. Result of ototoxic drugs e. Hears best in noisy environment f. May be caused by impacted cerumen

b, c, e, f. The remaining answers are characteristics of sensorineural hearing loss.

You are preparing preoperative medications for the patient undergoing cataract removal. The surgeon will likely prescribe which type of medication? A. Mydriatic B. Miotic C. Antidysrhythmic D. Diuretic

Answer: A Instill dilating drops and a nonsteroidal antiinflammatory eyedrop to reduce inflammation and to help maintain pupil dilation. One type of drug used for dilation is a mydriatic, an α-adrenergic agonist that produces pupillary dilation by contraction of the iris dilator muscle. A miotic is contraindicated. No information suggests that the patient needs an antidysrhythmic or diuretic.

You expect the patient with dry eye disorder to make which subjective complaint? A. There is sand in my eye. B. I don't have good peripheral vision. C. It seems there is a curtain over my eyes. D. My eyes just keep watering, and nothing seems to help.

Answer: A Keratoconjunctivitis sicca (dry eyes) is a common complaint, particularly by the elderly and individuals with certain systemic diseases such as scleroderma and lupus erythematosus. Patients with dry eyes complain of irritation or "sand in my eye" and say that the sensation typically worsens through the day.

The patient experiencing retinal detachment will report which sign or symptom? A. Floaters or cobwebs in the field of vision B. Acute pain C. Blood red cornea D. Sudden loss of vision

Answer: A Patients with a detaching retina describe symptoms that include photopsia (light flashes), floaters, and a "cobweb," "hairnet," or ring in the field of vision. After the retina has detached, the patient has a painless loss of peripheral or central vision, described as "a curtain" coming across the field of vision.

Which finding related to primary open-angle glaucoma do you expect to discover when reviewing a patient's history and physical examination report? A. Absence of pain or pressure B. Blurred vision in the morning C. Seeing colored halos around lights D. Eye pain accompanied with nausea and vomiting

Answer: A Primary open-angle glaucoma is typically symptom free, which explains why patients can have significant vision loss before the diagnosis unless regular eye examinations are being performed.

You anticipate which findings on ophthalmic examination of the eyes of a patient with the dry form of AMD? A. Yellowish deposits on the retina B. Dilation of the retinal vessels C. Scaring on the posterior capsule D. Lipid deposits on the iris

Answer: A The dry form of AMD starts with an abnormal accumulation of yellowish extracellular deposits called drusen in the retinal pigment epithelium. Atrophy and degeneration of macular cells then result.

Which instructions are the most appropriate for a patient using contact lenses who is diagnosed with bacterial conjunctivitis? A. Discard all opened or used lens care products. B. Disinfect contact lenses by soaking in a cleaning solution for 48 hours. C. Put all used cosmetics in a plastic bag for 1 week to kill any bacteria before reusing. D. Disinfect all lens care products with the prescribed antibiotic drops for 1 week after infection.

Answer: A The patient who wears contact lenses and develops infections should discard all opened or used lens care products and cosmetics to decrease the risk of reinfection from contaminated products.

Which assessment indicates that the patient may have a cataract? A. Abnormal color perception B. Pain at night C. Decreased peripheral vision D. Flashing of lights

Answer: A The patient with cataracts may complain of a decrease in vision, abnormal color perception, and glare. Glare results from light scatter caused by the lens opacities, and it may be significantly worse at night when the pupil dilates.

Postoperative teaching of the patient who has undergone cataract surgery includes which information (select all that apply)? A. Eye discomfort is often relieved with mild analgesics. B. A decline in visual acuity is common during the first few weeks. C. Notify the surgeon if an increase in redness or drainage is noticed. D. Nighttime eye shielding and activity restrictions are essential to prevent eye pain.

Answer: A, C After cataract surgery, the patient and caregiver should be taught the following information before discharge. Use topical antibiotics, topical corticosteroids, or other antiinflammatory agents and mild analgesia if necessary. If an eye shield is used, it usually is worn overnight and removed during the first postoperative visit. Follow activity restrictions set by the surgeon, who may restrict activities that increase the intraocular pressure, such as bending or stooping, coughing, or lifting. Complications to report include intense pain that may indicate hemorrhage, infection, or increased intraocular pressure; increased or purulent drainage; increased redness; or any decrease in visual acuity.

Instruct the patient with extended-wear contact lenses that A. the lenses may be moistened with saliva if necessary. B. they may be worn for up to 2 weeks, depending on the type of lenses. C. any saline solution may be used for moistening as long as it is hypertonic. D. the person may continue lens wear if he or she experiences only mild to moderate irritation or redness.

Answer: B Extended-wear contact lenses may be worn for up to 2 weeks, depending on the type. Contact lenses should be moistened only with appropriate solutions; saline solution is not hypertonic. If the patient with contacts experiences redness, sensitivity, vision problems, or pain, the contact lenses should be removed immediately.

Which of the following statements is most appropriate when teaching a patient about timolol (Timoptic) eyedrops in the treatment of glaucoma? A. You may feel some palpitations after instilling the eyedrops. B. You may have some temporary blurring of vision after instilling the eyedrops. C. You should keep your eyes closed for 15 minutes after instilling the eyedrops. D. You should withhold this medication if your blood pressure becomes elevated.

Answer: B It is common for patients to have temporary blurring of vision for a few minutes after instilling the eyedrops. This should not cause concern for the patient.

You anticipate the patient with dry, age-related macular degeneration (AMD) to complain of which vision change? A. Appearance of a curtain in the front of the eye B. Close vision tasks that are more difficult C. Photophobia with room light D. Need to turn the head to see things to the side

Answer: B People with dry AMD, which is the most common form (90% of all cases), may notice close vision tasks becoming more difficult. A curtain is a symptom of retinal detachment. Photophobia may result from many causes, even medications, but not AMD. Glaucoma affects peripheral vision.

Postoperative care for the patient after surgical repair of a retinal detachment my include A. an eye shield for 24 hours. B. bed rest. C. avoidance of caffeinated beverages. D. the head secured by bilateral sandbags.

Answer: B Postoperatively, the patient may be on bed rest and may require special positioning to maintain proper position of an intravitreal bubble. The patient may need multiple topical medications, including antibiotics, antiinflammatory agents, or dilating agents. The level of activity restriction after retinal detachment surgery varies greatly.

Presbyopia occurs in older individuals because A. the retina degenerates. B. the lens becomes inflexible. C. the corneal curvature becomes irregular. D. it is associated with cataract development.

Answer: B Presbyopia is loss of accommodation that is associated with age. As the eye ages, the lens becomes larger, firmer, and less elastic.

The priority nursing diagnosis to include when devising a plan of care for the patient scheduled for cataract surgery is A. anxiety related to lack of knowledge regarding surgery. B. self-care deficit related to visual deficits. C. imbalanced nutrition related to an inability to chew. D. disturbed sensory perception related to vision loss.

Answer: B The priority nursing diagnosis is the one that threatens the patient's well-being the most. In this instance, because the patient's vision is limited, self-care deficit is the priority. Anxiety is important, but not all patients experience this response. Nutrition is not affected, and the patient does not experience vision loss.

Corneal removal from the donor should occur within which period after death? A. 1 hour B. 4 hours C. 5 days D. 10 days

Answer: B The time between the corneal donor's death and removal of the tissue should be as short as possible. Most surgeons prefer this interval to be 4 hours or less.

While teaching a patient how to administer antibiotic eardrops, which of the following actions is included in your plan? A. Cool the drops so that they decrease swelling in the canal. B. Be careful to avoid touching the tip of the dropper bottle to the ear. C. Placement of a cotton wick to assist in administering the drops is not recommended. D. Keep the patient's head tilted for 5 to 7 minutes after administering the drops to prevent them from running out of the ear canal.

Answer: B The tip of the dropper should not touch the ear during administration to prevent contamination of the entire bottle of drops. Hands should be washed before and after administration of otic drops (eardrops). The drops should be administered at room temperature because cold drops can cause vertigo and heated drops can burn the tympanum. The ear is positioned so that the drops can run into the canal. This position should be maintained for 2 minutes after eardrop administration to allow the drops to spread. Drops can be placed onto a wick of cotton that is placed in the canal. Instruct the patient not to push the cotton farther into the ear. Careful handling and disposal of material saturated with drainage is important.

When teaching a patient about the pathophysiology related to open-angle glaucoma, which of the following statements is most appropriate? A. The retinal nerve is damaged by an abnormal increase in the production of aqueous humor. B. Decreased drainage of aqueous humor in the eye creates damaging pressure on the optic nerve. C. The lens enlarges with normal aging, pushing the iris forward, which then covers the outflow channels of the eye. D. Decreased flow of aqueous humor into the anterior chamber by the lens of the eye blocks the papillary opening.

Answer: B With primary open-angle glaucoma, there is increased intraocular pressure because the aqueous humor cannot drain from the eye. This damages the optic nerve over time.

The primary treatment for a hordeolum is A. antibiotics. B. steroid cream. C. warm, moist compresses. D. surgical drainage.

Answer: C Instruct the patient to apply warm, moist compresses at least four times per day until it improves. This may be the only treatment necessary.

The major symptom of refractive errors is A. red eyes. B. headache. C. blurred vision. D. eye pain.

Answer: C Blurred vision is the major symptom of refractive disorders. The cause is the eye's inability to focus light on the retina correctly. Reference: 403

When planning care for a patient with disturbed sensory perception related to increased intraocular pressure caused by primary open-angle glaucoma, which of the following elements should you focus on? A. Recognizing that eye damage caused by glaucoma can be reversed in the early stages B. Giving anticipatory guidance about the eventual loss of central vision that will occur C. Encouraging compliance with drug therapy for the glaucoma to prevent loss of vision D. Managing the pain experienced by patients with glaucoma that persists until the optic nerve atrophies

Answer: C Drug therapy is necessary to prevent vision loss that may occur as a consequence of glaucoma. Encourage the patient to remain compliant with drug therapy.

When teaching a patient with glaucoma while administering a scheduled dose of pilocarpine, which of the following statements would you include? A. Prolonged eye irritation is an expected adverse effect of this medication. B. This medication needs to be continued for at least 5 years after your initial diagnosis. C. This medication will help to raise intraocular pressure to a near-normal level. D. It is important not to do activities requiring visual acuity immediately after administration.

Answer: D Because pilocarpine causes blurred vision and difficulty in focusing, it is important not to engage in any activities requiring visual acuity until the vision clears

The most important intervention for the patient with epidemic keratoconjunctivitis (EKC) is A. applying patches to the affected eyes. B. accurately measuring intraocular pressure. C. monitoring distant visual acuity every 4 hours. D. teaching the patient and family members good hygiene techniques.

Answer: D EKC is the most serious type of ocular adenoviral disease. EKC is spread by direct contact, including sexual activity. Teach the patient and caregiver the importance of good hygienic practices to avoid spreading the disease.

When administering a scheduled dose of pilocarpine, you should place the drops in which of the following areas? A. Inner canthus B. Outer canthus C. Center of the eyeball D. Lower conjunctival sac

Answer: D Ocular medications such as pilocarpine should be instilled into the lower conjunctival sac. Never apply eyedrops directly to the cornea.

You are preparing the patient who had cataract surgery for discharge. In evaluating the teaching plan, you ask the patient about his plans for care at home. Which statement by him indicates the teaching has been successful? A. "I will not bathe until I return for my second office visit." B. "I will need to have a liquid diet to prevent the need for chewing." C. "I will not need my eye shield at home." D. "I will not wear a tight belt or lift anything over 10 pounds."

Answer: D There is some evidence that postoperative activity restrictions and nighttime eye shielding are unnecessary. However, many ophthalmologists still prefer that the patient avoid activities that increase the intraocular pressure (IOP), such as bending or stooping, coughing, or lifting. The patient may bathe at any time. The patient may eat whatever he or she wishes.

Before administrating timolol (Timoptic) eyedrops for treatment of glaucoma, you assess the patient for which contraindication for the use of this medicine? A. Sinusitis B. Migraine headaches C. Chronic urinary tract infection D. Chronic obstructive pulmonary disease (COPD)

Answer: D Timolol is a nonselective β-adrenergic blocker that can lead to bronchoconstriction and bronchospasm. For this reason, it should not be used in patients with COPD.

What best describes pinkeye? a. Blindness b. Acute bacterial conjunctivitis c. Epidemic keratoconjunctivitis d. Chronic inflammation of sebaceous glands

b. Epidemic keratoconjunctivitis is an ocular adenoviral disease. Sebaceous glands do not exist on the cornea.

Endophthalmitis can be a complication of intraocular surgery or penetrating ocular injury. What manifestations are expected when the nurse assesses a patient with this disorder (select all that apply)? a. Ocular pain b. Photophobia c. Eyelid edema d. Reddened sclera e. Bleeding conjunctiva f. Decreased visual acuity

a, b, f. There are also headaches, reddened and swollen conjunctiva, and corneal edema. Eyelid edema, reddened sclera, and bleeding conjunctiva do not occur with endophthalmitis.

What makes up the triad of symptoms that occur with inner ear problems (select all that apply)? a. Vertigo b. Nausea c. Tinnitus d. Sensorineural hearing loss e. Inflammation of the ear canal

a, c, d. Vertigo, tinnitus, and sensorineural hearing loss are the triad of symptoms that occur with inner ear problems.

Which characteristics of glaucoma are associated with only primary angle-closure glaucoma (PACG) (select all that apply)? a. Caused by lens blocking papillary opening b. Treated with trabeculoplasty or trabeculectomy c. Causes loss of central vision with corneal edema d. Treated with β-adrenergic blockers such as betaxolol (Betoptic) e. Causes sudden, severe eye pain associated with nausea and vomiting f. Treated with hyperosmotic oral and IV fluids to lower intraocular pressure

a, c, e, f. The other answers are associated with primary open-angle glaucoma (POAG).

What characteristics of hearing loss are associated with sensorineural loss (select all that apply)? a. Hearing aid is helpful b. Related to otitis media c. Caused by noise trauma d. Linked with otosclerosis e. Associated with Meniere disease

a, c, e. The remaining answers are characteristics of conductive hearing loss.

Myopia is present in 25% of Americans. Which characteristics are associated with myopia (select all that apply)? a. Excessive light refraction b. Abnormally short eyeball c. Unequal corneal curvature d. Corrected with concave lens e. Image focused in front of retina

a, d, e. Myopic people may have abnormally long eyeballs, not abnormally short ones, which occurs in hyperopia. Unequal corneal curvature results in astigmatism.

What surgical choices are available for correction of a refractive error (select all that apply)? a. LASIK b. Contact lenses c. Corrective lenses d. Photorefractive keratectomy (PRK) e. Surgical implantation of intraocular lens

a, d, e. Refractive errors are the most common visual problem and treatment may include nonsurgical corrections such as corrective glasses and contact lenses. Surgical therapy includes LASIK, PRK, LASEK, and intraocular lens implants.

A patient with bilateral cataracts is scheduled for an extracapsular cataract extraction with an intraocular lens implantation of one eye. What should be done by the nurse preoperatively? a. Assess the visual acuity in the unoperated eye to plan the need for postoperative assistance. b. Inform the patient that the operative eye will need to be patched for 3 to 4 days postoperatively. c. Assure the patient that vision in the operative eye will be improved to near normal on the first postoperative day. d. Teach the patient routine coughing and deep-breathing techniques to use postoperatively to prevent respiratory complications.

a. Assessment of the visual acuity in the patient's unoperated eye enables the nurse to determine how visually compromised the patient may be while the operative eye is patched and healing and to plan for assistance until vision improves. The patch on the operative eye is usually removed within 24 hours and although vision in the eye may be good, it is not unusual for visual acuity to be reduced immediately after surgery. Activities that are thought to increase intraocular pressure, such as bending, coughing, and Valsalva maneuver, are restricted postoperatively.

What describes inflammation of the cornea? a. Keratitis b. Blepharitis c. Hordeolum d. Conjunctivitis

a. Blepharitis is inflammation of the eyelid. Hordeolum is an infection of the sebaceous glands in the lid margin. Conjunctivitis is infection or inflammation of the conjunctiva.

While caring for a patient with otosclerosis, which finding would the nurse expect in the patient's history and physical? a. A strong family history of the disease b. Symptoms of sensorineural hearing loss c. A positive Rinne test and lateralization to the good or better ear on Weber testing d. An immediate and consistent improvement in hearing at the time of surgical treatment

a. Otosclerosis is an autosomal dominant hereditary disease that causes fixation of the footplate of the stapes, leading to conductive hearing loss. Tuning fork testing in conductive hearing loss would result in a negative Rinne test and lateralization to the poor ear or the ear with greater hearing loss upon Weber testing. During a stapedectomy, the patient often reports an immediate improvement in hearing but the hearing level decreases temporarily postoperatively.

Following a pneumatic retinopexy, what does the nurse need to know about the postoperative care for the patient? a. Specific positioning and activity restrictions are likely to be required for several days. b. The patient is frequently hospitalized for 7 to 10 days on bed rest until healing is complete. c. Patients experience little or no pain, and development of pain indicates hemorrhage or infection. d. Reattachment of the retina commonly fails, and patients can be expected to grieve for loss of vision.

a. Postoperatively the patient must position the head so that the bubble is in contact with the retinal break and may have to maintain this position for up to 16 hours a day for 5 days. The patient may go home within a few hours of surgery or may remain in the hospital for several days. No matter what the type of repair, reattachment is successful in 90% of retinal detachments. Postoperative pain is expected and is treated with analgesics.

What is one of the nurse's roles in preservation of hearing? a. Advise patients to keep the ears clear of wax with cotton-tipped applicators. b. Monitor patients at risk for drug-induced ototoxicity for tinnitus and vertigo. c. Promote the use of ear protection in work and recreational activity with noise levels above 120 dB. d. Advocate for MMR (measles, mumps, rubella) immunization in susceptible women as soon as pregnancy is confirmed.

b. Patients receiving ototoxic drugs should be monitored for tinnitus, hearing loss, and vertigo to prevent further damage caused by the drugs. Ears should not be cleaned with anything but a washcloth and finger and ear protection should be used in any environment with noise levels above 90 dB. Exposure to the rubella virus during the first 16 weeks of pregnancy may cause fetal deafness and the vaccine should never be given during pregnancy.

The nurse identifies a nursing diagnosis of risk for injury for a patient following a stapedectomy based on what knowledge about this surgery? a. Nystagmus may result from perilymph disturbances caused by surgery. b. Stimulation of the labyrinth during surgery may cause vertigo and loss of balance. c. Blowing the nose or coughing may precipitate dislodgement of the tympanic graft. d. Postoperative tinnitus may decrease the patient's awareness of environmental hazards.

b. Stimulation of the labyrinth intraoperatively may cause postoperative dizziness, increasing the risk for falls. Nystagmus on lateral gaze may result from perilymph disturbances but does not constitute a risk for injury. A tympanic graft is not performed in a stapedectomy, nor is postoperative tinnitus common.

Priority Decision: What nursing action is most important for the patient with age-related macular degeneration (AMD)? a. Teach the patient how to use topical eyedrops for treatment of AMD. b. Emphasize the use of vision enhancement techniques to improve what vision is present. c. Encourage the patient to undergo laser treatment to slow the deposit of extracellular debris. d. Explain that nothing can be done to save the patient's vision because there is no treatment for AMD.

b. The patient with AMD can benefit from low-vision aids despite increasing loss of vision and it is important to promote a positive outlook by not giving patients the impression that "nothing can be done" for them. Laser treatment may help a few patients with choroidal neovascularization and photodynamic therapy is indicated for a small percentage of patients with wet AMD but there is no treatment for the increasing deposit of extracellular debris in the retina.

What characteristics describe the care of a patient with chronic otitis media (select all that apply)? a. It is most commonly treated with antibiotics. b. It is an infection in the inner ear that may lead to headaches. c. Impairment of the eustachian tube is most commonly associated with effusion. d. Formation of an acoustic neuroma may destroy the structures of the middle ear or invade the dura of the brain. e. The patient who has had a myringotomy with placement of a tympanostomy tube should be instructed to avoid getting water in the ear.

c, e. Antibiotics are used to treat acute otitis media. Both acute and chronic otitis media occur in the middle ear. A cholesteatoma may destroy structures in the middle ear or invade the dura of the brain.

What is an important health promotion nursing intervention related to glaucoma? a. Teaching individuals at risk for glaucoma about early signs and symptoms of the disease b. Preparing patients with glaucoma for lifestyle changes necessary to adapt to eventual blindness c. Promoting regular measurements of intraocular pressure for early detection and treatment of glaucoma d. Informing patients that glaucoma is curable if eye medications are administered before visual impairment has occurred

c. Because glaucoma develops slowly and without symptoms, it is important that intraocular pressure be evaluated every 2 to 4 years in persons between the ages of 40 and 64 and every 1 to 2 years in those over 65 years old. More frequent measurement of intraocular pressure should be done in a patient with a family history of glaucoma, African American patients, and a patient with diabetes or cardiovascular disease. The disease is chronic but vision impairment is preventable in most cases with treatment.

A patient is admitted to the emergency department with a wood splinter imbedded in the right eye. Which intervention by the nurse is most appropriate? a. Irrigate the eye with a large amount of sterile saline. b. Carefully remove the splinter with a pair of sterile forceps. c. Cover the eye with a dry sterile patch and a protective shield. d. Apply light pressure on the closed eye to prevent bleeding or loss of aqueous humor.

c. Emergency management of foreign bodies in the eye includes covering and shielding the eye, with no attempt to treat the injury, until an ophthalmologist can evaluate the injury. Irrigations are performed as emergency management in chemical exposure. Pressure should never be applied because it might further injure the eye.

When teaching a patient to use a hearing aid, where does the nurse encourage the patient to initially use the aid? a. Outdoors, where sounds are distinct b. At social functions, where simultaneous conversations take place c. In a quiet, controlled environment to experiment with tone and volume d. In public areas such as malls or stores, where others will not notice its use

c. Initial adjustment to a hearing aid should include voices and household sounds and experimenting with volume in a quiet environment. The next recommended exposure is small parties; the outdoors; and, finally, uncontrolled areas, such as shopping areas.

What knowledge guides the nurse in providing care for a patient with an acoustic neuroma? a. Widespread metastasis usually occurs before symptoms of the tumor are noticed. b. Facial nerve function will be sacrificed during surgical treatment to preserve hearing. c. Early diagnosis and treatment of the tumor can preserve hearing and vestibular function. d. Treatment is usually delayed until hearing loss is significant because a neuroma is a benign tumor.

c. The benign acoustic neuroma can compress the facial nerve and arteries in the internal auditory canal and may expand into the cranium but if removed when small, hearing and vestibular function can be preserved. During surgery for a tumor that has expanded into the cranium, preservation of hearing and the facial nerve is reduced.

A 60-year-old patient is being prepared for outpatient cataract surgery. When obtaining admission data from the patient, what would the nurse expect to find in the patient's history? a. A painless, sudden, severe loss of vision b. Blurred vision, colored halos around lights, and eye pain c. A gradual loss of vision with abnormal color perception and glare d. Light flashes, floaters, and a "cobweb" in the field of vision with loss of central or peripheral vision

c. The lens opacity of cataracts causes a decrease in vision, abnormal color perception, and glare. Blurred vision, halos around lights, and eye pain are characteristic of glaucoma. Light flashes, floaters, and "cobwebs" or "hairnets" in the field of vision followed by a painless, sudden loss of vision are characteristic of detached retina

A patient with wet AMD is treated with photodynamic therapy. What does the nurse instruct the patient to do after the procedure? a. Maintain the head in an upright position for 24 hours. b. Avoid blowing the nose or causing jerking movements of the head. c. Completely cover all the skin to avoid a thermal burn from sunlight. d. Expect to experience blind spots where the laser has caused retinal damage.

c. Verteporfin, the dye used with photodynamic therapy to destroy abnormal blood vessels, is a photosensitizing drug that can be activated by exposure to sunlight or other high-intensity light. Patients must cover all of their skin to avoid thermal burns when exposed to sunlight. Blind spots occur with laser photocoagulation used for dry AMD. Head movements and position are not of concern following this procedure.

A patient tells the nurse on admission to the health care facility that he recently has been classified as legally blind. What does the nurse understand about the patient's vision? a. Has lost usable vision but has some light perception b. Will need time for grieving and adjusting to living with total blindness c. Will be dependent on others to ensure a safe environment for functioning d. May be able to perform many tasks and activities with vision enhancement techniques

d. A person who is legally blind may have some usable vision that will benefit from vision enhancement techniques. A person with total blindness has no light perception and no usable vision and a person with functional blindness has the loss of usable vision but some light perception. As only 4% of blindness occurs suddenly from injuries, the grieving is probably already in process. Dependency on others from visual impairment is individual and cannot be assumed.

The patient is diagnosed with presbyopia. When he asks the nurse what that is, what is the best explanation the nurse can give to the patient? a. Abnormally long eyeballs b. Absence of crystalline lens c. Correctable with cylinder lens d. Loss of accommodation associated with age

d. Absence of crystalline lens is aphakia. Astigmatism is corrected with a cylinder lens. People with myopia have abnormally long eyeballs.

What should the nurse teach all patients with conjunctival infections to use? a. Artificial tears to moisten and soothe the eyes b. Dark glasses to prevent the discomfort of photophobia c. Warm moist compresses to the eyes to promote drainage and healing d. Frequent and thorough hand washing to avoid spreading the infection

d. All infections of the conjunctiva or cornea are transmittable and frequent, thorough hand washing is essential to prevent spread from one eye to the other or to other persons. Artificial tears are not normally used in external eye infections. Photophobia is not experienced by all patients with eye infections and cold compresses are indicated for some infections.

A patient with early cataracts tells the nurse that he is afraid cataract surgery may cause permanent visual damage. What should the nurse teach the patient? a. The cataracts will only worsen with time and should be removed as early as possible to prevent blindness. b. Cataract surgery is very safe and with the implantation of an intraocular lens, the need for glasses will be eliminated. c. Progression of the cataracts can be prevented by avoidance of ultraviolet (UV) light and good dietary management. d. Vision enhancement techniques may improve vision until surgery becomes an acceptable option to maintain desired activities.

d. Although cataracts do become worse with time, surgical extraction is considered an elective procedure and is usually performed when the patient decides that he or she wants or needs to see better for his or her lifestyle. There are no known measures to prevent cataract development or progression. Surgical extraction is safe but the patient will still need glasses for near vision and for any residual refractive error of the implanted lens.

Which nursing action should be included in the management of the patient with external otitis? a. Irrigate the ear canal with body temperature saline several hours after instilling lubricating eardrops. b. Insert an ear wick into the external canal before each application of eardrops to disperse the medication. c. Teach the patient to prevent further infections by instilling antibiotic drops into the ear canal before swimming. d. Administer eardrops without touching the dropper to the auricle and position the ear upward for 2 minutes afterward.

d. Antibiotic eardrops for external otitis should be applied without touching the auricle to avoid contaminating the dropper and the solution and the patient should hold the ear upward for several minutes to allow the drops to run down the canal. The drops may be placed onto an ear wick that is placed in the canal but it remains in the ear throughout the course of treatment. The use of lubricating eardrops followed by irrigation is performed for impacted cerumen. "Swimmer's ear" is best prevented by avoiding swimming in contaminated waters; prophylactic antibiotics are not used.