Chapter 58: Eye and Vision Disorders Flashcards
The registered nurse taking shift report learns that an assigned client is blind. How should the nurse best communicate with this client?
A. The nurse should provide instructions in simple, clear terms.
B. Using a loud voice, the nurse should offer an introduction while in the doorway of the room.
C. Lightly touch the client’s arm and then say the nurse’s name .
D. The nurse should state the nurse’s name and role immediately after entering the client’s room.
ANS: D
Rationale: There are several guidelines to consider when interacting with a person who is blind or has low vision. Identify yourself by stating your name and role, before touching or making physical contact with the client. When talking to the person, speak directly at him or her using a normal tone of voice. There is no need to raise your voice unless the person asks you to do so and there is no particular need to simplify verbal instructions.
During discharge teaching the nurse realizes that the client is not able to read medication bottles accurately and has not been taking her medications consistently at home. How should the nurse intervene?
A. Ask the social worker to investigate alternative housing arrangements.
B. Ask the social worker to investigate community support agencies.
C. Encourage the client to explore surgical corrections for the vision problem.
D. Arrange for referral to a rehabilitation facility for vision training.
ANS: B
Rationale: Managing low vision involves magnification and image enhancement through the use of low-vision aids and strategies and referrals to social services and community agencies serving those with visual impairment. Community agencies offer services to clients with low vision, which include training in independent living skills and a variety of assistive devices for vision enhancement, orientation, and mobility, preventing clients from needing to enter a nursing facility. A rehabilitation facility is generally not needed by the clients to learn to use the assistive devices or to gain a greater degree of independence. Surgical options may or may not be available to the client.
The nurse is providing health education to a client diagnosed with glaucoma. The nurse teaches the client that this disease has a familial tendency. The nurse knows that clinical examinations for family members at risk for glaucoma should occur how often?
A. At least monthly
B. At least once every 2 years
C. At least once every 5 years
D. At least once every 10 years
ANS: B
Rationale: Glaucoma has a family tendency and family members should be encouraged to undergo examinations at least once every 2 years to detect glaucoma early. Testing on a monthly basis is excessive.
A client is exploring treatment options after being diagnosed with age-related cataracts that affect her vision. What treatment is most likely to be used in this client’s care?
A. Antioxidant supplements, vitamin C and E, beta-carotene, and selenium
B. Eyeglasses or magnifying lenses
C. Corticosteroid eye drops
D. Surgical intervention
ANS: D
Rationale: Surgery is the treatment option of choice when the client’s functional and visual status is compromised. No nonsurgical (medications, eye drops, eyeglasses) treatment cures cataracts or prevents age-related cataracts. Studies recently have found no benefit from antioxidant supplements, vitamins C and E, beta-carotene, or selenium. Corticosteroid eye drops are prescribed for use after cataract surgery; however, they increase the risk for cataracts if used long-term or in high doses. Eyeglasses and magnification may improve vision in the client with early stages of cataracts, but have limitations for the client with impaired functioning.
A client presents at the ED after receiving a chemical burn to the eye. What would be the nurse’s initial intervention for this client?
A. Generously flush the affected eye with a dilute antibiotic solution.
B. Generously flush the affected eye with normal saline or water.
C. Apply a patch to the affected eye.
D. Apply direct pressure to the affected eye.
ANS: B
Rationale: Chemical burns of the eye should be immediately irrigated with water or normal saline to flush the chemical from the eye. Antibiotic solutions, lubricant drops, and other prescription drops may be prescribed at a later time. Application of direct pressure may extend the damage to the eye tissue and should be avoided. Patching will be incorporated into the treatment plan at a later time to assist with the process of re-epithelialization, but at this point in the care of the client, patching will prevent irrigation of the eye.
The nurse is administering eye drops to a client with glaucoma. After instilling the client’s first medication, how long should the nurse wait before instilling the client’s second medication into the same eye?
A. 30 seconds
B. 1 minute
C. 3 minutes
D. 5 minutes
ANS: D
Rationale: A 5-minute interval between successive eye drop administrations allows for adequate drug retention and absorption. Any time frame less than 5 minutes will not allow adequate absorption.
A client comes to the ophthalmology clinic for an eye examination. The client tells the nurse that the client often sees floaters in the client’s vision. How should the nurse best interpret this subjective assessment finding?
A. This is a normal aging process of the eye.
B. Glasses will minimize this phenomenon.
C. The client may be exhibiting signs of glaucoma.
D. This may be a result of weakened ciliary muscles.
ANS: A
Rationale: As the body ages, the perfect gel-like characteristics of the vitreous humor are gradually lost, and various cells and fibers cast shadows that the client perceives as floaters. This is a normal aging process in most cases.
A client’s ocular tumor has necessitated enucleation and the client will be fitted with a prosthesis. The nurse should address what nursing diagnosis when planning the client’s discharge education?
A. Disturbed body image
B. Chronic pain
C. Ineffective protection
D. Unilateral neglect
ANS: A
Rationale: The use of an ocular prosthesis is likely to have a significant impact on a client’s body image. Prostheses are not associated with chronic pain or ineffective protection. The client experiences a change in vision, but is usually able to accommodate such changes and prevent unilateral neglect.
The nurse’s assessment of a client with significant visual losses reveals that the client cannot count fingers. How should the nurse proceed with assessment of the client’s visual acuity?
A. Assess the client’s vision using a Snellen chart.
B. Determine whether the client is able to see the nurse’s hand motion.
C. Perform a detailed examination of the client’s external eye structures.
D. Palpate the client’s periocular regions.
ANS: B
Rationale: If the client cannot count fingers, the examiner raises one hand up and down or moves it side to side and asks in which direction the hand is moving. An inability to count fingers precludes the use of a Snellen chart. Palpation and examination cannot ascertain visual acuity.
The nurse on the medical–surgical unit is reviewing discharge instructions with a client who has a history of glaucoma. The nurse should anticipate the use of what medications?
A. Potassium-sparing diuretics
B. Cholinergics
C. Antibiotics
D. Loop diuretics
ANS: B
Rationale: Cholinergics are used in the treatment of glaucoma. The action of this medication is to increase aqueous fluid outflow by contracting the ciliary muscle and causing miosis and opening the trabecular meshwork. Diuretics and antibiotics are not used in the management of glaucoma.
A nurse is teaching a client with glaucoma how to administer eye drops to achieve maximum absorption. The nurse should teach the client to perform what action?
A. Instill the medication in the conjunctival sac.
B. Maintain a supine position for 10 minutes after administration.
C. Keep the eyes closed for 1 to 2 minutes after administration.
D. Apply the medication evenly to the sclera
ANS: A
Rationale: Eye drops should be instilled into the conjunctival sac, where absorption can best take place, rather than distributed over the sclera. It is unnecessary to keep the eyes closed or to maintain a supine position after administration.
A client with chronic open-angle glaucoma is being taught to self-administer pilocarpine. After the client administers the pilocarpine, the client states that the client’s vision is blurred. Which nursing action is most appropriate?
A. Holding the next dose and notifying the health care provider
B. Treating the client for an allergic reaction
C. Suggesting that the client put on her glasses
D. Explaining that this is an expected adverse effect
ANS: D
Rationale: Pilocarpine, a miotic drug used to treat glaucoma, achieves its effect by constricting the pupil. Blurred vision lasting 1 to 2 hours after instilling the eye drops is an expected adverse effect. The client may also note difficulty adapting to the dark. Because blurred vision is an expected adverse effect, the drug does not need to be withheld, nor does the health care provider need to be notified. Likewise, the client does not need to be treated for an allergic reaction. Wearing glasses will not alter this temporary adverse effect.
The nurse should recognize the greatest risk for the development of blindness in which of the following clients?
A. A 58-year-old Caucasian woman with macular degeneration
B. A 28-year-old Caucasian man with astigmatism
C. A 58-year-old black woman with hyperopia
D. A 28-year-old black man with myopia
ANS: A
Rationale: The most common causes of blindness and visual impairment among adults 40 years of age or older are diabetic retinopathy, macular degeneration, glaucoma, and cataracts. The 58-year-old Caucasian woman with macular degeneration has the greatest risk for the development of blindness related to her age and the presence of macular degeneration. Individuals with hyperopia, astigmatism, and myopia are not in a risk category for blindness.
he nurse is admitting a 55-year-old client diagnosed with a left eye retinal detachment. While assessing this client, what characteristic symptom would the nurse expect to find?
A. Flashing lights in the visual field
B. Sudden eye pain
C. Loss of color vision
D. Colored halos around lights
ANS: A
Rationale: Flashing lights in the visual field is a common symptom of retinal detachment. Clients may also report spots or floaters or the sensation of a curtain being pulled across the eye. Retinal detachment is not associated with eye pain, loss of color vision, or colored halos around lights.
Several residents of a long-term care facility have developed signs and symptoms of viral conjunctivitis. What is the most appropriate action of the nurse who oversees care in the facility?
A. Arrange for the administration of prophylactic antibiotics to unaffected residents.
B. Instill normal saline into the eyes of affected residents two to three times daily.
C. Swab the conjunctiva of unaffected residents for culture and sensitivity testing.
D. Isolate affected residents from residents who have not developed conjunctivitis.
ANS: D
Rationale: To prevent spread during outbreaks of conjunctivitis caused by adenovirus, health care facilities must set aside specified areas for treating clients diagnosed with or suspected of having conjunctivitis caused by adenovirus. Antibiotics and saline flushes are ineffective and normally there is no need to perform testing of individuals lacking symptoms.
A client has just returned to the surgical floor after undergoing a retinal detachment repair. The postoperative orders specify that the client should be kept in a prone position until otherwise ordered. What should the nurse do?
A. Clarify the order with the surgeon.
B. Follow the order because this bed position is correct.
C. Reposition the client after the first dressing change.
D. Ask the client to lie in a semi-Fowler position.
ANS: B
Rationale: For care of the client after surgical retina detachment repair, postoperative positioning of the client is critical because the injected bubble must float into a position overlying the area of detachment, providing consistent pressure to reattach the sensory retina. The client must maintain a prone position that would allow the gas bubble to act as a tamponade for the retinal break. Clients and family members should be made aware of these special needs beforehand so that the client can be made as comfortable as possible. It would be inappropriate to deviate from this order and there is no obvious need to confirm the order.
A client has informed the home health nurse that he/she has recently noticed distortions when looking at the Amsler grid that is mounted on the refrigerator. What is the nurse’s most appropriate action?
A. Reassure the client that this is an age-related change in vision.
B. Arrange for the client to have his/her visual acuity assessed.
C. Arrange for the client to be assessed for macular degeneration.
D. Facilitate tonometry testing.
ANS: C
Rationale: The Amsler grid is a test often used for clients with macular problems, such as macular degeneration. Distortions would not be attributed to age-related changes and there is no direct need for testing of intraocular pressure or visual acuity.
A 56-year-old client has come to the clinic for a routine eye examination and is told bifocals are needed. The client asks the nurse what change in the eyes has caused this need for bifocals. How should the nurse respond?
A. “You know, you are getting older now and we change as we get older.”
B. “The parts of our eyes age, just like the rest of us, and this is nothing to cause you to worry.”
C. “There is a gradual thickening of the lens of the eye and it can limit the eye’s ability for accommodation.”
D. “The eye gets shorter, back to front, as we age and it changes how we see things.”
ANS: C
Rationale: As a result of a loss of accommodative power in the lens with age, many adults require bifocals or other forms of visual correction. This is not attributable to a change in the shape of the ocular globe. The nurse should not dismiss or downplay the client’s concerns.
The nurse is teaching a client to care for a new ocular prosthesis. What should the nurse emphasize during the client’s health education?
A. The need to limit exposure to bright light
B. The need to maintain a low Fowler position when removing the prosthesis
C. The need to perform thorough hand hygiene before handling the prosthesis
D. The need to apply antiviral ointment to the prosthesis daily
ANS: C
Rationale: Proper hand hygiene must be observed before inserting and removing an ocular prosthesis. There is no need for a low Fowler position or for limiting light exposure. Antiviral ointments are not routinely used.
Cytomegalovirus (CMV) is the most common cause of retinal inflammation in clients with AIDS. What drug, surgically implanted, is used for the acute stage of CMV retinitis?
A. Pilocarpine
B. Penicillin
C. Ganciclovir
D. Gentamicin
ANS: C
Rationale: The surgically implanted sustained-release insert of ganciclovir enables higher concentrations of ganciclovir to reach the CMV retinitis. Pilocarpine is a muscarinic agent used in open-angle glaucoma. Gentamicin and penicillin are antibiotics that are not used to treat CMV retinitis.
A client got a sliver of glass in his/her eye when a glass container at work fell and shattered. The glass had to be surgically removed and the client is about to be discharged home. The client asks the nurse for a topical anesthetic for eye pain. What should the nurse respond?
A. “Overuse of these drops could soften your cornea and damage your eye.”
B. “You could lose the peripheral vision in your eye if you used these drops too much.”
C. “I’m sorry, this medication is considered a controlled substance and clients cannot take it home.”
D. “I know these drops will make your eye feel better, but I can’t let you take them home.”
ANS: A
Rationale: Most clients are not allowed to take topical anesthetics home because of the risk of overuse, even though they are not classified as controlled substances. Clients with corneal abrasions and erosions experience severe pain and are often tempted to overuse topical anesthetic eye drops. Overuse of these drops results in softening of the cornea. Prolonged use of anesthetic drops can delay wound healing and can lead to permanent corneal opacification and scarring, resulting in visual loss. The nurse must explain the rationale for limiting the home use of these medications.
A client has been diagnosed with glaucoma and the nurse is preparing health education regarding the client’s medication regimen. The client states that eagerness to “beat this disease” and looks forward to the time that the client will no longer require medication. How should the nurse best respond?
A. “You have a great attitude. This will likely shorten the amount of time that you need medications.”
B. “In fact, glaucoma usually requires lifelong treatment with medications.”
C. “Most people are treated until their intraocular pressure goes below 50 mm Hg.”
D. “You can likely expect a minimum of 6 months of treatment.”
ANS: B
Rationale: Glaucoma requires lifelong pharmacologic treatment. Normal intraocular pressure is between 10 and 21 mm Hg.
An older adult client has been diagnosed with macular degeneration and the nurse is assessing for changes in visual acuity since last visit. When assessing the client for recent changes in visual acuity, the client states that the lines on an Amsler grid as being distorted. What is the nurse’s most appropriate response?
A. Ask if the client has been using OTC vasoconstrictors.
B. Instruct the client to repeat the test at different times of the day when at home.
C. Arrange for the client to visit an ophthalmologist .
D. Encourage the client to adhere to prescribed drug regimen.
ANS: C
Rationale: With a change in the client’s perception of the grid, the client should notify the ophthalmologist immediately and should arrange to be seen promptly. This is a priority over encouraging drug adherence, even though this is also important. Vasoconstrictors are not a likely cause of this change and repeating the test at different times is not relevant.
A public health nurse is teaching a health promotion workshop that focuses on vision and eye health. What should this nurse cite as the most common cause(s) of blindness and visual impairment among adults over the age of 40? Select all that apply.
A. Diabetic retinopathy
B. Trauma
C. Macular degeneration
D. Cytomegalovirus
E. Glaucoma
ANS: A, C, E
Rationale: The most common causes of blindness and visual impairment among adults 40 years of age or older are diabetic retinopathy, macular degeneration, glaucoma, and cataracts. Therefore, trauma and cytomegalovirus are incorrect.
The nurse is assessing a new adult client. What characteristic of this client’s status should the nurse identify as increasing the client’s risk for glaucoma?
A. The client uses over-the-counter NSAIDs.
B. The client has a history of stroke.
C. The client has diabetes.
D. The client has Asian ancestry.
ANS: C
Rationale: Diabetes is a risk factor for glaucoma, but Asian ancestry, NSAIDs, and stroke are not risk factors for the disease.
The public health nurse is addressing eye health and vision protection during an educational event. What statement by a participant best demonstrates an understanding of threats to vision?
A. “I’m planning to avoid exposure to direct sunlight on my next vacation.”
B. “I’ve never exercised regularly, but I’m going to start working out at the gym daily.”
C. “I’m planning to talk with my pharmacist to review my current medications.”
D. “I’m certainly going to keep a close eye on my blood pressure from now on.”
ANS: D
Rationale: Hypertension is a major cause of vision loss, exceeding the significance of inactivity, sunlight, and adverse effects of medications.
A client has had a sudden loss of vision after head trauma. How should the nurse best describe the placement of items on the dinner tray?
A. Explain the location of items using clock cues.
B. Explain that each of the items on the tray is clearly separated.
C. Describe the location of items from the bottom of the plate to the top.
D. Ask the client to describe the location of items before confirming their location.
ANS: A
Rationale: The food tray’s composition is likened to the face of a clock. It is unreasonable to expect the client to describe the location of items or to state that items are separated.
A hospitalized client with impaired vision must get a picture in his or her mind of the hospital room and its contents in order to mobilize independently and safely. What must the nurse monitor in the client’s room?
A. That a commode is always available at the bedside
B. That all furniture remains in the same position
C. That visitors do not leave items on the bedside table
D. That the client’s slippers stay under the bed
ANS: B
Rationale: All articles and furniture must remain in the same positions throughout the client’s hospitalization. This will reduce the client’s risks for falls. Visual impairment does not necessarily indicate a need for a commode. Keeping slippers under the bed and keeping the bedside table clear are also appropriate, but preventing falls by maintaining the room arrangement is a priority.
A client has just arrived to the floor after an enucleation procedure following a workplace accident in which the client’s left eye was irreparably damaged. Which of the following should the nurse prioritize during the client’s immediate postoperative recovery?
A. Teaching the client about options for eye prostheses
B. Teaching the client to estimate depth and distance with the use of one eye
C. Assessing and addressing the client’s emotional needs
D. Teaching the client about his postdischarge medication regimen
ANS: C
Rationale: When surgical eye removal is unexpected, such as in severe ocular trauma, leaving no time for the client and family to prepare for the loss, the nurse’s role in providing emotional support is crucial. In the short term, this is a priority over teaching regarding prostheses, medications, or vision adaptation.
A client with a diagnosis of retinal detachment has undergone a vitreoretinal procedure on an outpatient basis. What subject should the nurse prioritize during discharge education?
A. Risk factors for postoperative cytomegalovirus (CMV)
B. Compensating for vision loss for the next several weeks
C. Nonpharmacologic pain management strategies
D. Signs and symptoms of increased intraocular pressure
ANS: D
Rationale: Clients must be educated about the signs and symptoms of complications, particularly of increasing IOP and postoperative infection. CMV is not a typical complication and the client should not expect vision loss. Vitreoretinal procedures are not associated with high levels of pain.
A client is ready to be discharged home after a cataract extraction with intraocular lens implant and the nurse is reviewing signs and symptoms that need to be reported to the ophthalmologist immediately. Which of the client’s statements best demonstrates an adequate understanding?
A. “I need to call the doctor if I get nauseated.”
B. “I need to call the doctor if I have a light morning discharge.”
C. “I need to call the doctor if I get a scratchy feeling.”
D. “I need to call the doctor if I see flashing lights.”
ANS: D
Rationale: Postoperatively, the client who has undergone cataract extraction with intraocular lens implant should report new floaters in vision, flashing lights, decrease in vision, pain, or increase in redness to the ophthalmologist. Slight morning discharge and a scratchy feeling can be expected for a few days. Blurring of vision may be experienced for several days to weeks.
A client has become legally blind as a result of macular degeneration. When attempting to meet this client’s psychosocial needs, what nursing action is most appropriate?
A. Encourage the client to focus on use of other senses.
B. Assess and promote the client’s coping skills during interactions with the client.
C. Emphasize that lifestyle will be unchanged once adaptation to vision loss has occurred.
D. Promote the client’s hope for recovery.
ANS: B
Rationale: The nurse should empathically promote the client’s coping with her loss. Focusing on the remaining senses could easily be interpreted as downplaying the client’s loss, and recovery is not normally a realistic possibility. Even with successful adaptation, the client’s lifestyle will be profoundly affected.
When administering a client’s eye drops, the nurse recognizes the need to prevent absorption by the nasolacrimal duct. How can the nurse best achieve this goal?
A. Ensure that the client is well hydrated at all times.
B. Encourage self-administration of eye drops.
C. Occlude the puncta after applying the medication.
D. Position the client supine before administering eye drops.
ANS: C
Rationale: Absorption of eye drops by the nasolacrimal duct is undesirable because of the potential systemic side effects of ocular medications. To diminish systemic absorption and minimize the side effects, it is important to occlude the puncta. Self-administration, supine positioning, and adequate hydration do not prevent this adverse effect.
A client is scheduled for enucleation and the nurse is providing anticipatory guidance about postoperative care. What aspects of care should the nurse describe to the client? Select all that apply.
A. Application of topical antibiotic ointment
B. Maintenance of a supine position for the first 48 hours’ postoperative
C. Fluid restriction to prevent orbital edema
D. Administration of loop diuretics to prevent orbital edema
E. Use of an ocular pressure dressing
ANS: A, E
Rationale: Clients who undergo eye removal need to know that they will usually have a large ocular pressure dressing, which is typically removed after a week, and that an ophthalmic topical antibiotic ointment is applied in the socket three times daily. Fluid restriction, supine positioning, and diuretics are not indicated.
A client comes to the clinic for an evaluation. While reviewing the client’s history, the nurse notes that the client has a history of dry eyes. The nurse interprets this information as indicating a problem with which structure?
A. lacrimal apparatus
B. sclera
C. cornea
D. pupil
ANS: A
Rationale: The lacrimal apparatus are located in the eyelid and inner canthus and are essential for tear formation and drainage needed to lubricate the eyes. The sclera, commonly known as the white of the eye, is a dense, fibrous structure that helps maintain the shape of the eyeball and protects the intraocular contents from trauma. 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 pupil is a space that dilates and constricts in response to light.
A nurse is conducting an examination of a client’s inner eye. When viewing the retina, which structure(s) would the nurse identify as a retinal landmark? Select all that apply.
A. optic disk
B. macula
C. posterior chamber
D. vitreous humor
E. ciliary body
ANS: A, B
Rationale: Viewed through the pupil, the landmarks of the retina are the optic disc, the retinal vessels, and the macula. The posterior chamber is a small space between the vitreous and the iris. Vitreous humor is a clear, gelatinous substance which occupies about two thirds of the eye’s volume and helps maintain the shape of the eye. The ciliary body controls accommodation through the zonular fibers and the ciliary muscles.
A nurse is interviewing a middle-aged client at the clinic. During the interview, the client states, “I’ve noticed that I keep having to move the newspaper farther away to read it. Soon my arms will be too short!” The nurse interprets this finding as indicative of which age-related change?
A. loss of accommodation
B. shrinkage of the vitreous body
C. meibomian gland dysfunction (MBG)
D. loss of skin elasticity
ANS: A
Rationale: Loss of accommodative power in the lens with age leads to the need to hold reading materials at increasing distances in order to focus. Shrinkage of the vitreous body can lead to retinal tears and detachment. Meibomian gland dysfunction can lead to complaints related to dry eyes. Loss of skin elasticity and orbital fat can lead to lid margins turning in or out.
While inspecting the external eye of a client, the nurse notes that the client’s right eyelid droops. Which term would the nurse use to document this finding?
A. ptosis
B. entropion
C. ectropion
D. presbyopia
ANS: A
Rationale: Ptosis refers to a drooping eyelid. Sometimes, the upper or lower lid turns out, referred to as ectropion, affecting closure. Additionally, the eyelid may invert; this is termed entropion and causes irritation of the eye. Presbyopia is a term used for impaired near vision and is often found in middle-aged and older persons.
A nurse is assisting the ophthalmologist who is performing direct ophthalmoscopy. When conducting this examination, which structure would the nurse expect to be examined last?
A. red reflex
B. vasculature
C. optic disc
D. macula
ANS: D
Rationale: The last area of the fundus to be examined is the macula, because this area is the most sensitive to light. The examination begins with inspection of the red reflex and then followed by the vasculature, as a large vessel becomes larger in diameter, leading to the optic disc.
