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.
