davis edge quiz and iggy notes ch 45

Question 1

For which client does the nurse recommend annual evaluation by an ophthalmologist?
A. 35-year-old man with asthma
B. 21-year-old man with psoriasis
C. 24-year-old woman with diabetes
D. 38-year-old woman who has lost 50 pounds

Answer 1

Answer: C
Rationale: Diabetes mellitus increases the risk for a variety of visual sensory perception problems,
including early-onset glaucoma and cataract formation. Also, diabetes changes blood vessel quality in the
eye, increasing the risk for retinal hemorrhage and overgrowth of new blood vessels in the retina.

Question 2

The patient is a 56-year-old woman whose primary care provider has referred her to an ophthalmologist
because she is having manifestations of glaucoma. She has never been evaluated by an ophthalmologist,
even though she has used reading glasses for about 10 years. She seems very anxious and tells you that
she cannot stand to have her eyes touched directly. She also tells you that her mother developed an eye
infection and lost the vision in that eye after she had her intraocular pressure tested by an instrument with
small feet that scratched her eye.
1. Will this patient’s eyes be “touched” during a typical assessment of intraocular pressure?

Answer 2

1. Will this patient’s eyes be “touched” during a typical assessment of intraocular pressure?
   Yes, her eye will be directly touched by the tip of the Goldman’s applanation tonometer.

Question 3

The patient is a 56-year-old woman whose primary care provider has referred her to an ophthalmologist
because she is having manifestations of glaucoma. She has never been evaluated by an ophthalmologist,
even though she has used reading glasses for about 10 years. She seems very anxious and tells you that
she cannot stand to have her eyes touched directly. She also tells you that her mother developed an eye
infection and lost the vision in that eye after she had her intraocular pressure tested by an instrument with
small feet that scratched her eye.
2. What will you tell her about this procedure?

Answer 3

2. What will you tell her about this procedure?
   First, tell her that methods of assessing intraocular pressure have improved. At one time, the Schiotz
   tonometer, which did have a larger “foot” or base, was placed against the eye. This instrument could
   scratch the eye surface and was difficult to clean. The instrument used now is small and touches a
   much smaller area of the eye surface. There will have to be some touching of the eyes today, but she
   will not be aware of it. Some of the eyedrops placed today will actually anesthetize her eye surface so
   that she cannot feel any touching of the eye. Be sure to explain that the test is critical for assessing
   whether she might have glaucoma. Explain that this eye problem, if left untreated, does lead to
   blindness and that good management can prevent vision loss. Also tell her that medication for
   glaucoma can be dangerous if used when glaucoma is not present. So, assessment of her intraocular
   pressure is necessary.

Question 4

The patient is a 56-year-old woman whose primary care provider has referred her to an ophthalmologist
because she is having manifestations of glaucoma. She has never been evaluated by an ophthalmologist,
even though she has used reading glasses for about 10 years. She seems very anxious and tells you that
she cannot stand to have her eyes touched directly. She also tells you that her mother developed an eye
infection and lost the vision in that eye after she had her intraocular pressure tested by an instrument with
small feet that scratched her eye.

3. What assurance can you give her that she will not develop an infection from this evaluation?

Answer 4

3. What assurance can you give her that she will not develop an infection from this evaluation?
   Tell her that eye infections from an ophthalmic examination are now extremely rare. All people

involved use “sterile” technique (she may not know the term “aseptic”). The tonometer has a smooth
surface that does not scratch and is easily cleaned.

Question 5

The patient is a 56-year-old woman whose primary care provider has referred her to an ophthalmologist
because she is having manifestations of glaucoma. She has never been evaluated by an ophthalmologist,
even though she has used reading glasses for about 10 years. She seems very anxious and tells you that
she cannot stand to have her eyes touched directly. She also tells you that her mother developed an eye
infection and lost the vision in that eye after she had her intraocular pressure tested by an instrument with
small feet that scratched her eye.

4. Should you relay this patient’s concerns to the ophthalmologist? Why or why not?

Answer 5

4. Should you relay this patient’s concerns to the ophthalmologist? Why or why not?
   Yes, tell the ophthalmologist about her concerns. Then the ophthalmologist can reinforce the teaching
   and explanations you have provided and can also point out the steps that he or she is using to reduce
   the risk for trauma or infection transmission as they are being performed.

Question 6

Which visual acuity disorder results from an eyeball that is too long, thus allowing the focused image to fall in front of the retina?

1. Myopia
2. Astigmatism
3. Hyperopia
4. Presbyopia

Answer 6

1

Option 1:
Myopia, or near sightedness, is the disorder that results from an eyeball that is too long. When the eyeball is too long, it allows the focused image to fall in front of the retina.
Option 2:
A misshaped cornea results in astigmatism.
Option 3:
Hyperopia, or farsightedness, occurs for a short eyeball, which causes the image to fall behind the retina.
Option 4:
Presbyopia is a phenomenon that results from the loss of lens elasticity that occurs around the age of 45 years in an individual.

Question 7

Which eye trauma is characterized by the blood pooling in the anterior chamber of the eye?

1. Subconjunctival hemorrhage
2. Orbital fracture
3. Hyphema
4. Globe rupture

Answer 7

3

Option 1:
Subconjunctival hemorrhage is caused usually by minor trauma. Trivial actions such as coughing or sneezing hard can lead to subconjunctival hemorrhage.
Option 2:
Orbital fracture occurs due to the traumatic injury of the bone socket.
Option 3:
Hyphema is described by blood occurring in the anterior chamber of the eye. The phenomenon occurs when blood vessels in the iris rupture and bleed into the clear aqueous fluid of the anterior chamber.
Option 4:
Globe rupture occurs from penetrating or blunt injury that results to the damage of the sclera of the eyes.

Question 8

Which type of medication used for the treatment of glaucoma increases the outflow aqueous humor while decreasing the intraocular pressure?

1. Carbonicanhydrase inhibitors
2. Alpha antagonists
3. Prostaglandin drugs
4. Beta blocker drugs

Answer 8

3

Option 1:
Carbonicanhydrase inhibitors decrease the production of aqueous humor.
Option 2:
Alpha antagonists decrease the production of aqueous humor and increases drainage.
Option 3:
Prostaglandin drugs increase the outflow of the aqueous humor, thus decreasing Intraocular pressure.
Option 4:
Beta blocker drugs decrease the production of aqueous humor, thereby decreasing the intraocular pressure.

Question 9

Which medication is a carbonicanhydrase inhibitor?

1. Latanoprost
2. Apraclonidine
3. Dorzolamide
4. Pilocarpine

Answer 9

Option 1:
Latanoprost is a medication, which belongs to Prostaglandin group of compound.
Option 2:
Apraclonidine falls in the category of alpha antagonists.
Option 3:
Dorzolamide falls in the category of carbonicanhydrase inhibitors.
Option 4:
Pilocarpine falls in the category of miotic agents.

Question 10

Question 5. Which condition is not a single eye disease, but a group of eye conditions that present with increased intraocular pressure?

1. Macular degeneration
2. Cataracts
3. Glaucoma
4. Eye trauma

Answer 10

3

Option 1:
Macular degeneration is an age-related disease that gradually destroys sharp, central vision.
Option 2:
Cataracts involve the clouding of the eye’s crystalline lens.
Option 3:
Glaucoma is not as a single eye disease but a group of eye conditions that present with increased intraocular pressure.
Option 4:
Eye trauma can be segregated into blunt or penetrating trauma. Blunt trauma occurs when hit with a blunt object, such as a tennis ball. Penetrating trauma refers to injuries when a sharp object such as a knife pierces the eye.

Question 11

Which client is most at risk of developing normal tension glaucoma?

1. A Japanese client
2. An African-American client
3. A Mexican-American client
4. A Caucasian client

Answer 11

1

Option 1:
A client from Japanese ancestry has the highest risk of developing normal tension glaucoma.
Option 2:
An African-American client over the age of 40 has a risk of developing glaucoma, not normal tension glaucoma.
Option 3:
Mexican-Americans over the age of 60 years are prone to developing glaucoma, not normal tension glaucoma.
Option 4:
A Caucasian client is at the least risk for developing glaucoma.

Question 12

Which physical assessment examination verifies increased ocular pressures in clients with glaucoma?

1. Tonometer examination
2. Visual acuity test
3. Ophthalmoscope examination
4. Slit lamp evaluation

Answer 12

1

Option 1:
Tonometer examination verifies increased ocular pressures in clients with glaucoma.
Option 2:
Visual acuity tests are common assessment tests for clients with cataracts, so as to view increased opacity of the lens.
Option 3:
Ophthalmoscope examination reveals the detachment of the lens.
Option 4:
Slit lamp evaluation helps determine the opacity of the lens.

Question 13

Which is an example of beta-blocker drugs?

1. Metipranolol
2. Pilocarpine
3. Dipivefrin
4. Latanoprost

Answer 13

1

Option 1:
Metipranolol is an example of a beta-blocker drug.
Option 2:
Pilocarpine is an example of a miotic agent.
Option 3:
Dipivefrin is an example of an epinephrine compound.
Option 4:
Latanoprost is an example of a Prostaglandin drug.

Question 14

Which medication increases the outflow of aqueous humor?

1. Brinzolamide
2. Dipivefrin
3. Dorzolamide
4. Timolol

Answer 14

Option 1:
Brinzolamide belonging to the group of carbonicanhydrase inhibitors decreases the production of aqueous humor.
Option 2:
Dipivefrin, which belongs to the group of epinephrine compounds, increases the outflow of aqueous humor.
Option 3:
Dorzolamide belongs to the category of carbonicanhydrase inhibitors
Option 4:
Timolol is a beta-blocker drug, which reduces the production of aqueous humor.

Question 15

Which is the most likely cause of nausea or vomiting in a client with glaucoma?

1. Abrupt increase in intraocular pressure (IOP)
2. Breaking down of light-sensitive cells
3. Leakage of blood from blood vessels
4. Increased pressure building in the eye

Answer 15

4

Option 1:
Headache is caused by abrupt increase in IOP along with excessive pain.
Option 2:
Insidious onset of macular degeneration leads to breaking down of light-sensitive cells.
Option 3:
Leakage of blood from blood vessels in case of macular degeneration leads to loss of sharp, central vision in the client.
Option 4:
Increased pressure building in the eye leads to nausea and vomiting in the client.

Question 16

___
which belongs to the group of epinephrine compounds, increases the outflow of aqueous humor.

1. Brinzolamide
2. Dipivefrin
3. Dorzolamide
4. Timolol

Answer 16

2

Option 1:
Brinzolamide belonging to the group of carbonicanhydrase inhibitors decreases the production of aqueous humor.
Option 2:
Dipivefrin, which belongs to the group of epinephrine compounds, increases the outflow of aqueous humor.
Option 3:
Dorzolamide belongs to the category of carbonicanhydrase inhibitors
Option 4:
Timolol is a beta-blocker drug, which reduces the production of aqueous humor.

Question 17

____ belonging to the group of carbonicanhydrase inhibitors decreases the production of aqueous humor.
(select all that apply)

1. Brinzolamide
2. Dipivefrin
3. Dorzolamide
4. Timolol

Answer 17

1, 3

Option 1:
Brinzolamide belonging to the group of carbonicanhydrase inhibitors decreases the production of aqueous humor.
Option 2:
Dipivefrin, which belongs to the group of epinephrine compounds, increases the outflow of aqueous humor.
Option 3:
Dorzolamide belongs to the category of carbonicanhydrase inhibitors
Option 4:
Timolol is a beta-blocker drug, which reduces the production of aqueous humor.

Question 18

___ is a beta-blocker drug, which reduces the production of aqueous humor.

1. Brinzolamide
2. Dipivefrin
3. Dorzolamide
4. Timolol

Answer 18

4

Option 1:
Brinzolamide belonging to the group of carbonicanhydrase inhibitors decreases the production of aqueous humor.
Option 2:
Dipivefrin, which belongs to the group of epinephrine compounds, increases the outflow of aqueous humor.
Option 3:
Dorzolamide belongs to the category of carbonicanhydrase inhibitors
Option 4:
Timolol is a beta-blocker drug, which reduces the production of aqueous humor.

Question 19

rrange the precautionary steps the nurse takes when administering antibiotic eye drops to a client with conjunctivitis.

1 The nurse should instruct the client to tilt the head.
2The nurse should don nonsterile gloves.
3The nurse should verify number of drops.
4The nurse should retract the lower lid downward.
5The nurse should invert the medication bottle.
6The nurse should instruct the client to close the eyes.
7The nurse should squeeze the bottle to instill prescribe number of eye drops.
8The nurse should apply gentle pressure on the client’s nasolacrimal duct with a clean tissue.

Answer 19

Correct Sequence - 2,3,1,4,5,7,6,8

To instill the eye drop in the client’s eye, the nurse first should wash hands thoroughly and don the nonsterile gloves. In the next step, the nurse should verify the correct medication and time along with the number of drops. The nurse should instruct the client to tilt the head back with the eyes open, while looking upward. The nurse should retract the lower lid downward as the fourth step. The nurse should invert the medication bottle and gently rest the wrist on the client’s cheek. In the sixth step, the nurse should gently squeeze bottle and instill prescribed number of eye drops into conjunctival sac and then ask the client to gently close the eyes. As the final step, the nurse should apply gentle pressure with a clean tissue on the client’s nasolacrimal duct. This procedure helps in systematic absorption.

Question 20

Which is true regarding wet macular degeneration? Select all that apply.

1. It can be treated by photodynamic therapy.
2. It involves early, intermediate, and advanced stages.
3. Vision loss may occur in the advanced stage.
4. It involves the formation of small, white, or yellowish deposits called drusen on retina.
5. It involves production of abnormal blood vessels under the retina that tend to break and bleed.

Answer 20

1, 5

Option 1:
Wet macular degeneration is treated with photodynamic therapy that prevents further loss of vision.
Option 2:
Dry macular degeneration progresses in three stages. Only one stage and the most severe form may occur in wet macular degeneration.
Option 3:
Rapid and severe loss of central vision may occur in wet macular degeneration. Vision loss in the advanced stage may occur in dry macular degeneration.
Option 4:
Small, white, or yellowish deposits called drusen on retina are formed in dry macular degeneration.
Option 5:
In wet macular degeneration, abnormal blood vessels are formed under the retina towards the macula that may tend to break and cause bleeding.

Question 21

After a client reports the sudden appearance of floaters in the left eye, the primary health-care provider finds a tear along the retinal periphery. Which treatment is most likely to be beneficial for the client?

1. Cryopexy
2. Photodynamic therapy
3. Laser photocoagulation
4. Pan retinal photocoagulation (PRP)

Answer 21

1

Option 1:
The presence of floaters in the eye and a tear along the retinal periphery indicates retinal detachment. Cryopexy is the preferred surgical management in a client with a tear along the peripheral part of the retina, which is difficult to reach with a laser.
Option 2:
Photodynamic therapy is used to treat macular degeneration.
Option 3:
Laser photocoagulation is used to repair a retinal tear or a hole that can be reached with a laser.
Option 4:
PRP is used in clients with diabetic retinopathy to shrink abnormal new blood vessels that bleed into the vitreous.

Question 22

Which drug is the primary health-care provider most likely to prescribe when performing photodynamic therapy in a client with wet macular degeneration?

1. Verteporfin
2. Latanoprost
3. Dorzolamide
4. Apraclonidine

Answer 22

1

Option 1:
Verteporfin is a light activated drug used to eliminate abnormal blood vessels in the eye associated with the wet form of macular degeneration.
Option 2:
Latanoprost is a prostaglandin drug used to decrease intraocular pressure.
Option 3:
Dorzolamide is a carbonicanhydrase inhibitor used to decrease the production of aqueous humor.
Option 4:
Apraclonidine is an alpha antagonist used to reduce the production of aqueous humor and increase the drainage.

Question 23

Which is the priority intervention for a client with a chemical eye injury?

1. Performing a Snellen test
2. Instilling antibiotic eye drops
3. Covering the eye with an eye patch
4. Irrigating the eye with normal saline

Answer 23

4

Option 1:
The nurse should perform a Snellen test after irrigating the eye to evaluate visual acuity.
Option 2:
Eye drops should be instilled after irrigating the eye and performing the assessments.
Option 3:
The eye should be covered with an eye patch to prevent further injury, but this is not an immediate action.
Option 4:
In a client with chemical eye injury, the immediate action should be irrigating the eye with sterile normal saline. This action promotes removing the chemical from the eye to prevent further injury.

Question 24

Which physiological change in a client is associated with presbyopia?

1. Weakening of orbital muscles
2. Blockage of the canal of Schlemm
3. Loss of lens and ciliary muscle elasticity
4. Growth of abnormal blood vessels between the retina and the choroid

Answer 24

3

Option 1:
Weakening of orbital muscles may result in amblyopia.
Option 2:
Blockage of the canal of Schlemm may lead to glaucoma.
Option 3:
Loss of lens and ciliary muscle elasticity may result in presbyopia, which occurs with aging.
Option 4:
The growth of abnormal blood vessels between the retina and the choroid cause damage to macula leading to macular degeneration.

Question 25

Which test is most likely to help the primary health-care provider to evaluate the extent of opacity present in a client with cataracts?

1. Tonometer
2. Amsler grid
3. Ophthalmoscope
4. Slit-lamp examination

Answer 25

4

Option 1:
A tonometer is used to measure the intraocular pressure inside the eye.
Option 2:
An Amsler grid is used in a client with macular degeneration.
Option 3:
An ophthalmoscope is used to assess bulging vessels in the internal eye.
Option 4:
A slit-lamp is used to detect the extent of opacity in a client with cataracts.

Question 26

A client reports inability to see objects placed at a distance. Which condition does the client most likely have?

1. Astigmatism
2. Myopia
3. Presbyopia
4. Amblyopia

Answer 26

2

Option 1:
In astigmatism, the client reports blurred vision of objects that are both near and distant.
Option 2:
An irregularly shaped cornea may lead to myopia. In this, the client reports inability to see objects placed at a distance.
Option 3:
Presbyopia results from a loss of lens elasticity that may lead to an inability to focus on closely-held objects.
Option 4:
Dysfunction orbital muscles may lead to amblyopia.