Lewis Ch 20: Assessment and Management of Visual Problems Flashcards
The nurse is performing an eye examination on a 76-yr-old patient. Which finding indicates that the nurse should refer the patient for a more extensive assessment?
a. The patient’s sclerae are light yellow.
b. The patient reports persistent photophobia.
c. The pupil recovers slowly after responding to a bright light.
d. There is a whitish gray ring encircling the periphery of the iris.
b. The patient reports persistent photophobia.
Photophobia is not a normally occurring change with aging and would require further assessment. The other assessment data are common gerontologic differences in assessment and would not be unusual in a 76-yr-old patient.
Which finding by the nurse performing an eye examination indicates that the patient has normal accommodation?
a. After covering one eye for 1 minute, the pupil constricts as the cover is removed.
b. Shining a light into the patient’s eye causes pupil constriction in the opposite eye.
c. A blink reaction occurs after touching the patient’s pupil with a piece of sterile cotton.
d. The pupils constrict while fixating on an object being moved toward the patient’s eyes
d. The pupils constrict while fixating on an object being moved toward the patient’s eyes
Accommodation is defined as the ability of the lens to adjust to various distances. The pupils constrict while fixating on an object that is being moved from far away to near the eyes. The other responses may also be elicited as part of the eye examination, but they do not indicate accommodation.
Which assessment finding alerts the nurse to provide patient teaching about cataract development?
a. Unequal pupil size
b. Sensitivity to light
c. Loss of peripheral vision
d. History of hyperthyroidism
b. Sensitivity to light
Classic signs of cataracts include blurred vision and light sensitivity. Thyroid problems are a major cause of exophthalmos. Unequal pupil is not indicative of cataracts. Loss of peripheral vision is a sign of glaucoma.
Assessment of a patient’s visual acuity reveals that the left eye can see at 20 feet what a person with normal vision can see at 50 feet and the right eye can see at 20 feet what a person with normal vision can see at 40 feet. Which finding should the nurse record?
a. OS 20/50; OD 20/40
b. OU 20/40; OS 50/20
c. OD 20/40; OS 20/50
d. OU 40/20; OD 50/20
a. OS 20/50; OD 20/40
When documenting visual acuity, the first number indicates the standard (for normal vision) of 20 feet and the second number indicates the line that the patient is able to read when standing 20 feet from the Snellen chart. OS is the abbreviation for left eye, and OD is the abbreviation for right eye. The remaining three answers do not correctly describe the patient’s visual acuity.
A 65-yr-old patient is being evaluated for glaucoma. Which information given by the patient has implications for the patient’s treatment plan?
a. “I take metoprolol (Lopressor) for angina.”
b. “I take aspirin when I have a sinus headache.”
c. “I have had frequent episodes of conjunctivitis.”
d. “I have not had an eye examination for 10 years.”
a. “I take metoprolol (Lopressor) for angina.”
It is important to note whether the patient takes any -adrenergic blockers because this classification of medications is also used to treat glaucoma, and there may be an increase in adverse effects. The use of aspirin does not increase intraocular pressure and is safe for patients with glaucoma. Although older patients should have yearly eye examinations, treatment will not be affected by the 10-year gap in eye care. Conjunctivitis does not increase the risk for glaucoma.
The nurse is testing the visual acuity of a patient in the outpatient clinic. Which instructions should the nurse give for this test?
a. “Stand 20 feet away from the wall chart.”
b. “Look at an object far away and then near to you.”
c. “Follow the examiner’s finger with your eyes only.”
d. “Look straight ahead while I check your eyes with a light.”
a. “Stand 20 feet away from the wall chart.”
When the Snellen chart is used to check visual acuity, the patient should stand 20 ft away. Accommodation is tested by looking at an object at both near and far distances. Shining a pen light into the eyes tests for pupil response. Following the examiner’s fingers with the eyes tests extraocular movements.
A patient who underwent eye surgery must wear an eye patch until the scheduled postoperative clinic visit. Which patient problem will the nurse address in the plan of care?
a. Risk for falls
b. Difficulty coping
c. Disturbed body image
d. Inability to care for home
a. Risk for falls
The loss of stereoscopic vision created by the eye patch impairs the patient’s ability to see in three dimensions and to judge distances. This increases the risk for falls. There is no evidence in the assessment data for inability to care for home, disturbed body image, or difficulty coping.
Which information will the nurse provide to the patient scheduled for refractometry?
a. “You should not take any of your eye medicines before the examination.”
b. “You will need to wear sunglasses for a few hours after the examination.”
c. “The doctor will shine a bright light into your eye during the examination.”
d. “The surface of your eye will be numb while the doctor does the examination.”
b. “You will need to wear sunglasses for a few hours after the examination.”
The pupils are dilated using cycloplegic medications during refractometry. This effect will last several hours and cause photophobia. The other teaching would not be appropriate for a patient who was having refractometry.
The nurse is assessing a 65-yr-old patient for presbyopia. Which instruction will the nurse give the patient before the test?
a. “Hold this card and read the print out loud.”
b. “Cover one eye while reading the wall chart.”
c. “You’ll feel a short burst of air directed at your eyeball.”
d. “A light will be used to look for a change in your pupils.”
a. “Hold this card and read the print out loud.”
The Jaeger card is used to assess near vision problems and presbyopia in persons older than 40 years of age. The card should be held 14 inches away from eyes while the patient reads words in various print sizes. Using a penlight to determine pupil change is testing pupil response. A short burst of air may be used to test intraocular pressure but is not used for testing presbyopia. Covering one eye at a time while reading a wall chart at 20 feet describes the Snellen test.
What should the nurse teach the patient before fluorescein angiography?
a. Hold a card and fixate on the center dot.
b. Report any burning or pain at the IV site.
c. Remain still while the cornea is anesthetized.
d. Let the examiner know when images shown appear clear.
b. Report any burning or pain at the IV site.
Fluorescein angiography involves injecting IV dye. If extravasation occurs, fluorescein is toxic to the tissues. Teach the patient to report any signs of extravasation, such as pain or burning. The nurse should closely monitor the IV site as well. The cornea is anesthetized during ultrasonography. Refractometry involves measuring visual acuity and asking the patient to choose lenses that are the sharpest; it is a painless test. The Amsler grid test involves using a hand-held card with grid lines. The patient fixates on the center dot and records any abnormalities of the grid lines.
The nurse in the eye clinic is examining a 67-yr-old patient who says, “I see small spots that move around in front of my eyes.” Which action will the nurse take first?
a. Immediately have the ophthalmologist evaluate the patient.
b. Explain that spots and “floaters” are a normal part of aging.
c. Warn the patient that these spots may indicate retinal damage.
d. Use an ophthalmoscope to examine the posterior eye chambers.
d. Use an ophthalmoscope to examine the posterior eye chambers.
Although “floaters” are usually caused by vitreous liquefaction and are common in aging patients, they can be caused by hemorrhage into the vitreous humor or by retinal tears, so the nurse’s first action will be to examine the retina and posterior chamber. Although the ophthalmologist will examine the patient, the presence of spots or floaters in a 65-year-old patient is not an emergency. The spots may indicate retinal damage, but the nurse should assess the eye further before discussing this with the patient.
Which action can the nurse working in the emergency department delegate to an experienced unlicensed assistive personnel (UAP)?
a. Ask a patient with decreased visual acuity about medications taken at home.
b. Perform Snellen testing of visual acuity for a patient with a history of cataracts.
c. Obtain information from a patient about any history of childhood ear infections.
d. Inspect a patient’s external ear for redness, swelling, or presence of skin lesions.
b. Perform Snellen testing of visual acuity for a patient with a history of cataracts.
The Snellen test does not require nursing judgment and is appropriate to delegate to UAP who have been trained to perform it. History taking about infection or medications and assessment are actions that require critical thinking and should be done by the RN.
The nurse working in the clinic receives telephone calls from several patients who want appointments as soon as possible. Which patient should be seen first?
a. 71-yr-old who has noticed increasing loss of peripheral vision
b. 74-yr-old who has difficulty seeing well enough to drive at night
c. 60-yr-old who is reporting dry eyes with decreased tear formation
d. 64-yr-old who states that it is becoming difficult to read news print
a. 71-yr-old who has noticed increasing loss of peripheral vision
Increasing loss of peripheral vision is characteristic of glaucoma, and the patient should be scheduled for an examination as soon as possible. The other patients have symptoms commonly associated with aging: presbyopia, decreased tear formation, and impaired night vision.
What should the nurse assess to evaluate the effectiveness of treatment for the patient’s myopia and presbyopia?
a. Strength of the eye muscles.
b. Both near and distant vision.
c. Cloudiness in the eye lenses.
d. Intraocular pressure changes.
b. Both near and distant vision.
Lenses are prescribed to correct the patient’s near and distant vision. The nurse may assess for
cloudiness of the lenses, increased intraocular pressure, and eye movement, but these data do not evaluate whether the patient’s bifocals are effective.
What should the nurse teach a patient with recurrent staphylococcal and seborrheic blepharitis to do?
a. Irrigate the eyes with saline solution.
b. Schedule an appointment for eye surgery.
c. Use a gentle baby shampoo to clean the eyelids.
d. Apply cool compresses to the eyes three times daily.
c. Use a gentle baby shampoo to clean the eyelids.
Baby shampoo is used to soften and remove crusts associated with blepharitis. The other interventions are not used in treating this disorder.
What is the safest technique for the nurse to use when assisting a blind patient to ambulate to the bathroom?
a. Lead the patient slowly to the bathroom, holding on to the patient by the arm.
b. Stay beside the patient and describe any obstacles on the path to the bathroom.
c. Walk slightly ahead of the patient, allowing the patient to hold the nurse’s elbow.
d. Have the patient place a hand on the nurse’s shoulder and guide the patient forward.
c. Walk slightly ahead of the patient, allowing the patient to hold the nurse’s elbow.
When using the sighted-guide technique, the nurse walks slightly in front and to the side of the patient and has the patient hold the nurse’s elbow. The other techniques are not as safe in assisting a blind patient.