Prep U Ch 63 Vision and Eye Disorders
A nurse is giving discharge teaching to a client with an eye injury. Which statement about preventing eye injuries should the nurse include? A - "Direct all spray nozzles away from your face before spraying." B - "Use a lighter or matches if you need to look at a car battery at night." C - "Make sure you stand next to, not in front, of a moving lawn mower." D - "When working in a workshop, you don't need to wear safety goggles unless you're the person using the tools."
A - "Direct all spray nozzles away from your face before spraying." (The nurse should instruct the client to direct all spray nozzles away from his face before spraying. The nurse should instruct the client to use a flashlight if checking a car battery at night to decrease the risk of explosion. Safety goggles should be worn at all times in a workshop by everyone; flying debris can cause injuries at any time. The client should never stand next to or in front of a moving lawn mower. Debris can be ejected from the blades and cause injury.)
Postoperative health teaching for a patient who has had an intraocular lens implant is a vital nursing responsibility. Which of the following statements applies to this situation? Select all that apply. A - Avoid bending the head forward for an extended time. B - Wipe the closed eye from the inner canthus outward. C - Avoid shampooing your hair for 48 hours. D - Do not lift, pull, or push objects heavier than 15 pounds. E - Avoid lying on the side of the affected eye for 72 hours.
A - Avoid bending the head forward for an extended time. B - Wipe the closed eye from the inner canthus outward. D - Do not lift, pull, or push objects heavier than 15 pounds (Hair shampooing may resume in 24 hours, if done cautiously. It is only necessary to avoid lying on the side of the affected eye for the first night after surgery. Refer to Box 49-7 in the text.)
An ophthalmologist diagnoses a patient with myopia. The nurse explains that this type of impaired vision is a refractive error characterized by: A - Blurred distance vision. B - Farsightedness. C - A shorter depth to the eyeball. D - Eyes that are shallow.
A - Blurred distance vision. (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.)
The nurse is giving instructions to a client who has been diagnosed with viral conjunctivitis. The nurse will teach the client which aspects of self-care related to this disorder? Select all that apply. A - Do not wear contact lenses until there is no more inflammation. B - Do not use the same towels or washcloths as other members of the family. C - Wash hands before touching eyes and frequently during the day. D - Stay at home for the first 24 hours. E - Place cool soaks on your eye each morning to remove purulent drainage.
A - Do not wear contact lenses until there is no more inflammation. B - Do not use the same towels or washcloths as other members of the family. C - Wash hands before touching eyes and frequently during the day. (Home care involves staying at home and away from others until the inflammation is no longer present. Warm soaks should be used each morning to remove any crusty type drainage. Contact lens should not be worn until the eye has healed. Hands should be washed before and after touching the eyes and frequently during the day and the client should use separate towels, washcloths and other linens until the infection has cleared.
Which of the following is the role of the nurse toward a patient who is to undergo eye examinations and tests? A - Ensuring that the patient receives eye care to preserve his or her eye function and prevent further visual loss B - Conducting various tests to determine the function and the structure of the eyes C - Advising the patient on the diet and exercise regimen to be followed D - Determining if further action is warranted
A - Ensuring that the patient receives eye care to preserve his or her eye function and prevent further visual loss (Although nurses may not be directly involved in caring for patients who are undergoing eye examinations and tests, it is essential that they ensure that patients receive eye care to preserve their eye function and/or prevent further visual loss. The nurse is not involved in conducting the various tests to determine the status of the eyes and in determining if further action is warranted. Patients who are to undergo eye examinations and tests are not required to modify their diet and exercise regimen.)
A client has been prescribed eye drops for the treatment of glaucoma. At the yearly follow-up appointment, the client tells the nurse that she has stopped using the medication because her vision did not improve. Which action by the nurse is appropriate? A - Explain the therapeutic effect and expected outcome of the medication. B - Talk with the doctor about switching to a different glaucoma medication. C - Refer the patient to the emergency department. D - Administer the medication immediately.
A - Explain the therapeutic effect and expected outcome of the medication. (The nurse needs to explain the therapeutic effect and expected outcome of the medication. The medication is not a cure for glaucoma, but can slow the progression. The client will not see improvements in vision with the use of the medication but should experience little to no deterioration of vision. The doctor may choose to switch the medication, but not because the vision is not improving; it would be based on not obtaining the set intraocular pressure. Administering the medication immediately or referring the client to the emergency department is not appropriate because this is not an emergent situation.)
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. A - Fluorescein angiography B - Indirect ophthalmoscopy C - Tonometry D - Slit lamp biomicroscopy E - Amsler grid testing F - Visual acuity testing
A - Fluorescein angiography B - Indirect ophthalmoscopy D - Slit lamp biomicroscopy F - Visual acuity testing (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.)
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 A - lung. B - lymph nodes. C - bone. D - brain.
A - lung. (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.)
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: A- perimetry test B - color vision test C- slit-lamp examination D - retinal angiography
A- perimetry test (A visual field test or perimetry test measures peripheral vision and detects gaps in the visual field.)
A client has undergone tonometry to evaluate for possible glaucoma. Which result would the nurse record as abnormal? A - 10 mm Hg B - 25 mm Hg C - 15 mm Hg D - 20 mm Hg
B - 25 mm Hg (Normally, intraocular pressure (IOP) ranges between 10 to 21 mm Hg. Any reading greater than 21 mm Hg indicates increased IOP.)
A client who is blind is awaiting elective surgery. What should the nurse do to promote this client's control over their hospital environment? A - Arrange the meal tray in a way that is easiest for the nurse to assist the client. B - Ask the client where to store his or her self-care items. C - Open all containers without prompting to be helpful. D - Keep personal care items where the nurse knows their location.
B - Ask the client where to store his or her self-care items (Ask the client's preference for where to store hygiene articles and other objects needed for self-care. Involving the client promotes his or her control over the environment. Personal care items should be kept in the same location at all times to provide the client with the ability to locate toiletries easily. At mealtime, describe where food is on the plate using the positions on the face of a clock. This measure assists the client to identify the location of food. Allow the client to open containers and offer help if needed. Having a choice facilitates independence.)
The patient with glaucoma is usually started on the lowest dose of medication. Which of the following is the preferred initial topical medication? A - Alpha-agonists B - Beta-blockers C - Prostaglandins D - Carbonic anhydrase inhibitors
B - Beta-blockers (Because of their efficacy, minimal dosing (can be used once each day), and low cost, beta-blockers are the preferred initial topical medications. Beta-blockers decrease the production of aqueous humor, with a resultant decrease in IOP.)
A young client is being seen by a pediatric ophthalmologist due to a recent skateboarding accident that resulted in trauma to the right cornea, and is now at risk of developing an infection. Which nursing intervention would be contraindicated for a client at risk for infection? A - Wash hands before examining the eyes or performing any procedure about the face. B - To ensure correct application of antibiotic ointment, gently drag tip of tube along lower lid while squeezing ointment on to lid. C - Avoid using a container of ophthalmic medication for anyone other than the client. D - Change gauze eye bandages using aseptic technique.
B - To ensure correct application of antibiotic ointment, gently drag tip of tube along lower lid while squeezing ointment on to lid. (Avoid contaminating the medication dropper or tube by holding the tip above the eye and adjacent tissue. Using a separate container of ophthalmic medication for each client prevents cross-contamination. Maintaining asepsis prevents the introduction and transmission of infection. Handwashing prevents infection.)
A client has just been diagnosed with early glaucoma. During a teaching session, the nurse should: A - provide instructions on eye patching. B - demonstrate eyedrop instillation. C - teach about intraocular lens cleaning. D - assess the client's visual acuity.
B - demonstrate eyedrop instillation. (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.)
The nurse realizes that a client understands how to correctly instill ophthalmic medications when the client: A - rubs the eye after administering medication. B - pulls the tissue near the cheek downward to instill medication. C - allows the tip of the container to touch the eyelid while administering the medication. D - wipes the lids and lashes prior to instillation in a direction toward the nose with moistened, soft gauze.
B - pulls the tissue near the cheek downward to instill medication. (Pull the cheek downward to form a sack in the lower lid. Instill the drops into the conjunctival pocket. The lid and lashes would be wiped in a direction away from the nose to avoid contamination. The tip of the container will be contaminated if it touches eye or eyelid. Do not rub the eye because it may irritate the eye.)
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 A - sees an object from 200 feet away that a person with normal vision sees from 20 feet away. B - sees an object from 20 feet away that a person with normal vision sees from 200 feet away. C - sees an object from 20 feet away just like a person with normal vision. D - sees an object from 200 feet away just like a person with normal vision.
B - sees an object from 20 feet away that a person with normal vision sees from 200 feet away (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.)
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 ________. A - retinoscopy; cataracts B - tonometry; intraocular pressure C - tonometry; macular degeneration D - retinoscopy; detached retina
B - tonometry; intraocular pressure (The procedure being performed is known as tonometry and it measures intraocular pressure.)
A nurse is performing an eye examination. Which question would not be included in the examination? A - "What medications are you taking?" B - Have you experienced blurred, double, or distorted vision?" C - "Are you able to raise both eyebrows?" D - "Do any family members have any eye conditions?"
C - "Are you able to raise both eyebrows?" (Asking to raise both eyebrows is a test for cranial nerve VII, the facial nerve, and would not be included in an eye assessment.)
Following an ophthalmologic exam, an anxious client asks the nurse, "How serious is a refraction error?" Which of the following is the best response from the nurse? A - "It is nothing serious." B - "Simple surgery can fix this problem." C - "It means corrective lenses are required." D - "This is normal for anyone your age."
C - "It means corrective lenses are required." (Refractive errors can be corrected with glasses or contact lenses. Telling a client that "nothing is serious" does not provide the necessary information to help alleviate fears. The word surgery can increase fears. If the refractive error is associated with aging, this is a normal finding but does not provide information to the condition.)
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? A - Participate in the decision-making process. B - Keep all follow-up appointments. C - Adhere to the medication regimen. D - Keep a record of eye pressure measurements.
C - Adhere to the medication regimen. (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.)
The nurse should monitor for which manifestation in a client who has undergone LASIK? A - Excessive tearing B - Cataract formation C - Halos and glare D - Stye formation
C - Halos and glare (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.)
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? A - To relieve pain B - Restore vision C - Improve outflow drainage D - Reverse optic nerve damage
C - Improve outflow drainage (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.)
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: A - Decreased eye muscle tone. B - Shrinkage of the vitreous body. C - Loss of accommodative power in the lens. D - Opacity in the lens.
C - Loss of accommodative power in the lens. (Presbyopia is a refractive change that occurs with age. The lens of the eye loses accommodative power. Opacity in the lens indicates a cataract.)
During an initial assessment, the nurse notes a symptom of a mild case of bacterial conjunctivitis and documents in the electronic medical record that the client is displaying which of the following ? A - Elevated intraocular pressure B - Severe pain C - Mucopurulent ocular discharge D - Blurred vision
C - Mucopurulent ocular discharge (Bacterial conjunctivitis manifests with an acute onset of redness, burning, and discharge. Purulent discharge occurs in severe acute bacterial infections, whereas mucopurulent discharge appears in mild cases.)
A client accidentally splashes chemicals into one eye. The nurse knows that eye irrigation with plain tap water should begin immediately and continue for 15 to 20 minutes. What is the primary purpose of this first aid treatment? A - To serve as a stopgap measure until help arrives B - To eliminate the need for medical care C - To prevent vision loss D - To hasten formation of scar tissue
C - To prevent vision loss (Prolonged eye irrigation after a chemical burn is the most effective way to prevent formation of permanent scar tissue and thus help prevent vision loss. After a potentially serious eye injury, the victim should always seek medical care. Eye irrigation isn't considered a stopgap measure.)
When obtaining the health history from a client with retinal detachment, a nurse expects the client to report: A - headaches, nausea, and redness of the eyes. B - frequent episodes of double vision. C - light flashes and floaters in front of the eye. D - a recent driving accident while changing lanes.
C - light flashes and floaters in front of the eye. (The sudden appearance of light flashes and floaters in front of the affected eye is characteristic of retinal detachment. Difficulty seeing cars in another driving lane suggests gradual loss of peripheral vision, which may indicate glaucoma. Headache, nausea, and redness of the eyes are signs of acute (angle-closure) glaucoma. Double vision is common in clients with cataracts.)
A nurse is teaching a client about medications for glaucoma. What is the main marker of glaucoma control with medication? A - Increasing the visual field B - Reducing the appearance of optic nerve head C- Lowering intraocular pressure to target pressure D- Changing the opacity of the lens
C- Lowering intraocular pressure to target pressure (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.)
An elderly client is scheduled for cataract surgery and asks the nurse, "Will I need to wear pop-bottle lenses after surgery?" Which is the most appropriate response from the nurse? A - "Contact lenses are preferred by most clients after this surgery." B - "No lens is necessary with cataract surgery." C - "They can make corrective lenses much thinner now." D - "An implanted lens has replaced the need for corrective glasses."
D - "An implanted lens has replaced the need for corrective glasses." (Vision is usually restored after cataract surgery with an intraocular lens implant. Contact lenses can be used but can be burdensome for the elderly. Corrective glass lenses can cause a distortion of peripheral vision and only required one lens (over operative eye). To restore vision after cataract surgery, a lens is required.)
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? A - "This test measures visual acuity." B - "This test measures how well your eyes move." C - "This test is to see how well your eyes are aging." D - "This test measures peripheral vision and detects gaps in the visual field."
D - "This test measures peripheral vision and detects gaps in the visual field." (A visual field examination or perimetry test measures peripheral vision and detects gaps in the visual field.)
A client is receiving phenylephrine eye drops in preparation for ophthalmoscopy. The client receives the final dose of drops at 10:30 a.m. The nurse informs the client that he will begin to notice the effects of the drug beginning to wear off around what time? A - 12:30 p.m. B - 11:30 a.m. C - 2:30 p.m. D - 1:30 p.m.
D - 1:30 p.m. (Phenylephrine drops cause mydriasis and the client will begin to notice recovery from this effect in approximately 3 to 5 hours. Since the client received the drops at 10:30 a.m., he should begin to notice a change around 1:30 p.m.)
The nurse is demonstrating how to perform punctal occlusion. Which activities does the nurse perform? A - Applies firm pressure to the upper and lower eyelids at the outer edges to keep eyelids in approximation B- Holds down the lower lid of the eye by applying pressure on the eyeball and the cheekbone C - Applies gentle pressure to the upper eyelid to keep the lid open while telling the client to gaze upward D - Applies gentle pressure bilaterally on the bridge of the nose to the inner canthus of each eye
D - Applies gentle pressure bilaterally on the bridge of the nose to the inner canthus of each eye (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.)
Which of the following is the main refracting surface of the eye? A - Iris B - Pupil C - Conjunctiva D - Cornea
D - Cornea (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.)
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? A - Avoid using the terms "see" or "look." B - Talk to the client in a loud tone of voice. C - Touch the client before identifying himself or herself. D - Face the client when speaking directly to him.
D - Face the client when speaking directly to him. (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.)
Which surgical procedure involves flattening the anterior curvature of the cornea by removing a stromal lamella layer? A - Photorefractive keratectomy (PRK) B - Keratoconus C - Keratoplasty D - Laser-assisted stromal in situ keratomileusis (LASIK)
D - Laser-assisted stromal in situ keratomileusis (LASIK) (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.)
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: A - Shrinkage of the vitreous body. B - Decreased eye muscle tone. C - Opacity in the lens. D - Loss of accommodative power in the lens.
D - Loss of accommodative power in the lens (Presbyopia is a refractive change that occurs with age. The lens of the eye loses accommodative power. Opacity in the lens indicates a cataract.)
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? A - Constricted pupil B - Watery ocular discharge C - Clear cornea D - Marked blurring of vision
D - Marked blurring of vision (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.)
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? A - Hyperopia B - Emmetropia C - Astigmatism D - Myopia
D - Myopia (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.)
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? A - Phacoemulsification B - Pars plana vitrectomy C - Pneumatic retinopexy D - Scleral buckle
D - Scleral buckle (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.)
The nurse is assessing an older client's vision. The nurse integrates knowledge of which of the following during the assessment? A - The depth of the eyeball will be increased, leading to myopia. B - Increased fat will be around the orbit. C - The skin around the eyes will be more elastic. D - The power of the lens to accommodate will be decreased.
D - The power of the lens to accommodate will be decreased. (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.)
A client has developed diabetic retinopathy and is seeing the physician regularly to prevent further loss of sight. From where do the nerve cells of the retina extend? A - trigeminal nerve B - oculomotor nerve C - trochlear nerve D - optic nerve
D - optic nerve (The nerve cells of the retina extend from the optic nerve.)
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? A - chalazion B- eye trauma C- angle-closure glaucoma D - retinal detachment
D - retinal detachment (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.)
A client has noticed recently having clearer vision at a distance than up close. What is the term used to describe this client's visual condition? hyperopia
Hyperopia is farsightedness. People who are hyperopic see objects that are far away better than objects that are close.