Chapter 49: Care of Patients with Eye and Vision Problems Nursing School Test Banks

Chapter 49: Care of Patients with Eye and Vision Problems

Test Bank

MULTIPLE CHOICE

1. A client is using an ophthalmic beta-blocking agent for the treatment of glaucoma. Which instruction does the nurse give to the client to prevent orthostatic hypotension?

a.

Change positions quickly after administering the drops.

b.

Take your pulse at least four times daily.

c.

Apply pressure to the inside corner of your eye when administering the drops.

d.

Lay down for 10 minutes after administering the drops.

ANS: C

Nasal punctal occlusion during eyedrop instillation keeps the drug in contact with the eye structures longer and decreases systemic absorption and side effects. Systemic distribution of the drug is what may cause orthostatic hypotension. The other answers will not help prevent orthostatic hypotension.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesAdverse Effects/Contraindications/Side Effects/Interactions)

MSC: Integrated Process: Nursing Process (Implementation)

2. Which is the most important information for the nurse to teach a client who is receiving cycloplegic drug therapy?

a.

Do not drive or operate machinery until the drug wears off.

b.

Use at least a 30 SPF sunscreen agent when going outdoors.

c.

Remain on bedrest for 24 hours in a prone position.

d.

Turn up the lights because acuity will be decreased in low-light environments.

ANS: A

Cycloplegic agents prevent accommodation of the iris, resulting in a widely dilated pupil. The pupil cannot accommodate to bright light, causing eye discomfort and pain. Turning up the lights will not assist the client to see more clearly. Bedrest and sunscreen are not measures needed for this drug.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

3. An older adult client who has a mature cataract in the right eye states, Now I have lost the sight in my right eye because I waited too long for treatment. How does the nurse best respond to the client?

a.

Yes, this type of blindness could have been prevented by earlier treatment.

b.

It is fortunate you came for treatment in time to save the sight of your other eye.

c.

Nothing you could have done would have made any difference.

d.

Surgery can still save the sight in your eye with removal of the cataract.

ANS: D

Although sight is increasingly impaired as a cataract matures, no other damage is done to the eye by waiting. Removal of the cataract will result in improved vision, regardless of how long the cataract has been present. No indication suggests that the client will develop a cataract in the other eye. The other statements are inaccurate.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Grief and Loss)

MSC: Integrated Process: Nursing Process (Caring)

4. Which statement indicates that the client understands teaching about the use of aspirin postcataract surgery?

a.

It may increase intraocular pressure after cataract surgery.

b.

It changes the ability of the blood to clot and increases the risk of bleeding.

c.

It reduces inflammation and might mask any symptoms of infection.

d.

It can cause nausea and vomiting and may increase intraocular pressure.

ANS: B

Aspirin disrupts platelet aggregation and increases the risk for bleeding after surgery. Aspirin may decrease inflammation but would not mask symptoms of infection. Aspirin does not cause increased intraocular pressure, nor does it typically cause nausea and vomiting. Aspirin should not mask signs of infection.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesAdverse Effects/Contraindications/Side Effects/Interactions)

MSC: Integrated Process: Nursing Process (Evaluation)

5. Which assessment alerts the nurse to the possible presence of a cataract in a client?

a.

Loss of central vision

b.

Loss of peripheral vision

c.

Dull aching in the eye and brow areas

d.

Blurred vision and reduced color perception

ANS: D

As the lens becomes opaque and less able to refract light appropriately, the client experiences blurred vision and a reduced ability to distinguish among different colors. The development of a cataract does not typically cause loss of peripheral or central vision, nor does it result in aching in the brow area.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1060

TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)

MSC: Integrated Process: Nursing Process (Assessment)

6. A client is recovering from cataract surgery and needs medication to prevent a potential eye infection. Which drug does the nurse question administering to the client?

a.

Tobramycin (Tobrex)

b.

Apraclonidine (Iopidine)

c.

Gentamicin (Genoptic)

d.

Ciprofloxacin (Ciloxan)

ANS: B

Apraclonidine is an adrenergic agonist that binds to eye receptors to reduce the amount of aqueous humor in the eye, resulting in decreased intraocular pressure. This medication usually is administered to clients with glaucoma. Tobramycin, gentamicin, and ciprofloxacin are anti-infectives.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes)

MSC: Integrated Process: Nursing Process (Implementation)

7. Which statement indicates that a client understands why his cataract surgery is being done first on the eye with the poorest vision?

a.

Insurance reimbursement dictates the timing of surgeries.

b.

The eye with poorer vision is at greater risk for permanent damage.

c.

The pressure in the poorer eye could increase, causing permanent damage.

d.

If a complication arises in that eye, I will still have some vision in the better eye.

ANS: D

The eye with the better sight is left alone until the outcome of the first surgery is known to reduce the chance that the client will lose sight in both eyes if complications arise from the surgery.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Evaluation)

8. The nurse is teaching a client about home care after cataract surgery. Which statement indicates that the client requires further teaching?

a.

I am glad that I dont need an eye patch after the surgery.

b.

I will try a cool compress to decrease the swelling around the operated eye.

c.

Dark sunglasses will be necessary when I am in the sun.

d.

Pain, nausea, and vomiting are normal after this surgery.

ANS: D

Eye pain accompanied by nausea and vomiting is an indication of increased intraocular pressure and/or hemorrhage. This is an emergent situation and the surgeon must be contacted by the client. The other responses are correct. The client will not need an eye patch, cool compresses will decrease the slight swelling, and dark glasses are necessary outdoors until the pupil responds to sunlight.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Evaluation)

9. A client has been educated about activities that can increase intraocular pressure. Which statement indicates that the client requires further teaching?

a.

I will avoid wearing tight shirt collars and ties.

b.

I will take stool softeners daily to prevent straining.

c.

I will try not to sneeze, cough, or blow my nose.

d.

I will not put my arms above my head.

ANS: D

Arm position does not influence intraocular pressure. All other activities listed decrease the incidence of increased intraocular pressure.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Evaluation)

10. The nurse assesses a client postcataract surgery and finds white, dry, crusty drainage on the clients eyelid and lashes. What does the nurse do next?

a.

Obtain a specimen of the drainage for culture.

b.

Clean away the drainage and apply the prescribed drops.

c.

Contact the physician for an antibiotic order.

d.

Arrange for the client to be seen by the ophthalmologist today.

ANS: B

White, dry, crusty drainage on the eyelid and lashes is expected after cataract surgery. Because the drainage is white and no other symptoms of infection are noted, a culture does not need to be done and an antibiotic will not be needed. Urgency is not an issue because this is an expected effect from the trauma of surgery. The physician does not need to be called.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

11. The nurse is assessing a client who wishes to be considered as a potential donor for corneal transplantation. Which medical diagnosis at the time of death excludes the client from consideration?

a.

Small cell lung cancer

b.

Chronic heart failure

c.

Profound nearsightedness

d.

History of detached retina

ANS: A

Clients of any age may donate corneas as long as the corneas are clear and the client is free from infectious disease or cancer at the time of death. The other problems would not keep a client from donating corneas.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1059

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Assessment)

12. The nurse assesses several clients. Which one is most likely to have secondary open-angle glaucoma?

a.

Client with gradual onset of blurred vision

b.

Client who has recently had eye surgery

c.

Client who sees halos around lights

d.

Client with reactive pupils and clear sclera

ANS: B

Secondary open-angle glaucoma results from another condition that interferes with drainage of the aqueous humor such as recent eye surgery. Cataracts usually start with a slow onset of blurred vision but do not lead to secondary open-angle glaucoma. A late manifestation of primary open-angle glaucoma is seeing halos around lights; this is not considered secondary open-angle glaucoma. The client with reactive pupils and clear sclera has normal assessment findings, not related to secondary open-angle glaucoma.

DIF: Cognitive Level: Comprehension/Understanding REF: Table 49-3, p. 1063

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Evaluation)

13. Which statement made by a client after corneal transplantation indicates a need for further teaching?

a.

I will wear an eye shield at night for at least 1 month.

b.

I will avoid bending at the waist and straining when moving my bowels.

c.

I wont worry if I have increased tearing, because it is normal.

d.

Ill notify the ophthalmologist if any signs of rejection occur.

ANS: C

Aqueous humor can leak from the incision site if wound closure is incomplete. Any fluid coming from the eye in the early postoperative period needs to be checked by the provider.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Evaluation)

14. Which clinical manifestation alerts the nurse to the possibility of a vitreous humor hemorrhage?

a.

Presence of a red reflex

b.

Reddened whites of the eye

c.

Red haze or floaters in the line of vision

d.

Swelling of the upper and lower eyelids

ANS: C

Mild seepage of blood into the vitreous humor causes the clients vision to have an overall red haze or floaters. With a vitreous humor hemorrhage, the red reflex is reduced. Reddened whites of the eye and swelling of the eyelids would indicate irritation and infection of the eye.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1067

TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)

MSC: Integrated Process: Nursing Process (Assessment)

15. The nurse is providing discharge teaching for a client with posterior uveitis. Which is the most important precaution for the nurse to teach the client?

a.

Correct technique for eyedrop instillation

b.

Clinical manifestations of retinal hemorrhage

c.

Correct technique for insertion of contact lenses

d.

Proper timing of opioid analgesics

ANS: A

Treatment of posterior uveitis is symptomatic, with eyedrops used to dilate the pupil and decrease the inflammatory response. The client may have to instill eyedrops as frequently as every hour. This condition consists of inflammation of the retinanot a hemorrhage. Opioids are not prescribed to lessen the pain, but cool or warm compresses may be used for ocular pain.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

16. A client with macular degeneration would like to watch television. Where does the nurse place the television for best visualization of the screen?

a.

As close to the clients face as possible

b.

As far away as possible, with low lights

c.

Directly in front of the client

d.

On either side of the client

ANS: D

Macular degeneration decreases central vision but usually does not affect peripheral vision. Clients looking straight ahead can see people and objects off to the side. Therefore the television should be placed on either side of the client. The other options would not help the client with macular degeneration to see the screen.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

17. In the emergency department, the nurse is caring for a client diagnosed with a hyphema. Which statement by the client indicates a need for further teaching?

a.

When I get home, I can lie flat in bed and turn from side to side.

b.

For a few days, I cannot even read a book or watch television.

c.

I will need to protect the eye with a patch and shield.

d.

I need to stay on bedrest and will try not to make any sudden movement.

ANS: A

A hyphema is a hemorrhage in the anterior chamber of the eye due to blunt force such as a motor vehicle accident. For management of this condition, the client must be on bedrest but must remain in a semi-Fowlers position to prevent accumulation of blood around the optical center of the cornea. The client cannot lie flat in bed and rotate from side to side. The client cannot read a book or watch television and must protect the eye if paralytic eyedrops were used. The client needs to be as still as possible to prevent further bleeding.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlHome Safety) MSC: Integrated Process: Teaching/Learning

18. A client has just returned from having surgery, and sulfahexafluoride gas was used intraocularly. How does the nurse position the client?

a.

Completely supine, with sandbags beside the head

b.

On the nonoperative side in the Trendelenburg position

c.

On the operative side in the Trendelenburg position

d.

On the abdomen, with the affected eye up

ANS: D

Sulfahexafluoride gas has a lower specific gravity than the vitreous humor. It will float to the highest position. The client should be positioned so that the gas will float up and against the newly reattached retina. The other positions are incorrect after this procedure.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

19. A client comes to the emergency department with periorbital ecchymosis of the right eye. Which is the nurses priority action?

a.

Apply an ice pack to the affected eye.

b.

Patch the eye to prevent eye movement.

c.

Assess the clients vision in both eyes.

d.

Irrigate the affected eye with normal saline.

ANS: A

Ice will cause capillary vasoconstriction, thereby decreasing swelling and capillary oozing. Treatment with ice begins at the time of injury. Whenever the eye or surrounding tissue is injured, visual acuity is assessed next.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Management of CareEstablishing Priorities)

MSC: Integrated Process: Nursing Process (Implementation)

20. The nurse is teaching a client how to apply eye medication. Which is the correct technique for applying ointment into the eye?

a.

From the middle out

b.

From the inner canthus to the outer canthus

c.

From the outer canthus to the inner canthus

d.

Against the inner aspect of the eyelid

ANS: B

Ointment should be applied by pulling down the lower lid and forming a pocket. Application should proceed from the inner canthus toward the outer canthus, with the client tilting the head backward and looking up at the ceiling.

DIF: Cognitive Level: Knowledge/Remembering REF: Chart 49-1, p. 1053

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlStandard Precautions/Transmission-Based Precautions/Surgical Asepsis)

MSC: Integrated Process: Nursing Process (Implementation)

21. A client has conjunctivitis in both eyes and is being treated with topical antibiotics. Which statement by the client indicates a need for further teaching?

a.

Ill avoid sharing washcloths or towels with other family members.

b.

I will wash my hands after applying the eye ointment to each eye.

c.

I will call the ophthalmologist if the drainage continues after the antibiotics are started.

d.

Ill use the same tube of topical ointment for each infected eye.

ANS: D

Bacterial conjunctivitis is highly contagious; therefore the client must avoid sharing anything with others that has the potential to come in contact with the infected eye, such as washcloths or towels. The client needs to protect from reinfection by washing hands frequently during application of the antibiotic ointment and must let the eye doctor know if drainage continues after treatment is begun. Separate tubes of eye ointment should be used, with one specifically labeled for each eye.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Nursing Process (Evaluation)

22. A client is having intraocular pressure measured for both eyes. Which response by the client best indicates that the client understands why this is necessary every year?

a.

Elevated eye pressure can cause high blood pressure.

b.

If eye pressure is too high, your eyes will dry out.

c.

Elevated eye pressure can press on blood vessels in the eye.

d.

Increased eye pressure causes the tear ducts to become blocked.

ANS: C

Intraocular pressure is the pressure generated by the fluids inside the globe of the eye. As intraocular pressure increases to above normal, it compresses the blood vessels and the optic nerves. As the blood vessels are compressed, oxygenation to the internal eye structures, including the nerves and photoreceptors, is diminished. The nerves and photoreceptors require a constant supply of oxygen and will die if blood flow is inadequate, leading to blindness. The other statements are inaccurate.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialDiagnostic Tests) MSC: Integrated Process: Teaching/Learning

23. A client just underwent a keratoplasty. Which activity does the nurse suggest that the client begin possibly 1 week after surgery?

a.

Continue with salsa dance lessons.

b.

Jog only one-half mile versus the usual 2 miles.

c.

Return to employment as a receptionist.

d.

Help the family move furniture from room to room.

ANS: C

Activities that raise the intraocular pressure (e.g., jogging, dancing, any movement that can cause jerky head motion) should be discouraged for at least 3 weeks after surgery. No heavy lifting should be done for 6 to 8 weeks. A sedentary job such as a receptionist can be tolerated a week after surgery.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

MULTIPLE RESPONSE

1. A client with acute-angle glaucoma has several medications ordered. Which medications does the nurse question? (Select all that apply.)

a.

Acetazolamide (Diamox)

b.

Pilocarpine (Pilocar)

c.

Atropine (Isopto Atropine)

d.

Latanoprost (Xalatan)

e.

Timolol (Timoptic)

f.

Epinephrine

ANS: C, F

Atropine and epinephrine are mydriatics, which decrease the outflow of aqueous humor, resulting in increased intraocular pressure (IOP). Diamox is a carbonic anhydrase inhibitor that decreases the formation of aqueous humor. Pilocar is a miotic that enhances outflow of aqueous humor. Xalatan is a prostaglandin agonist that improves outflow, and Timoptic is a beta blocker that decreases the formation of aqueous humor. All these help decrease IOP.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes)

MSC: Integrated Process: Nursing Process (Implementation)

2. The nurse is teaching a postoperative client who had a keratoplasty. Which responses by the client require further teaching about safety in the home? (Select all that apply.)

a.

We use throw rugs in the bathroom.

b.

Our neighbors will be bringing food for a week.

c.

We may have two extension cords in the living room.

d.

Most of the furniture is placed against the wall, except for one rocking chair.

e.

Every room has at least one window.

f.

The hallway has low lighting.

ANS: A, C, D, F

Throw rugs pose a danger of slipping or tripping. The client cannot see if the rug is flat or elevated. Extension cords should be placed under or behind the furniture to decrease the possibility of tripping. Furniture should be out of the normal walking pathway. Low lighting in the hallway may pose a problem when the client has a patch and shield over the operated eye. Lighting from a window should not be a problem. When neighbors bring food, the chance of burns occurring while cooking with limited vision is reduced.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Nursing Process (Evaluation)

3. A blind client is admitted to the hospital unit. Orientation to the unit includes which information? (Select all that apply.)

a.

Introduce the staff to the client.

b.

Describe the room to the client using one reference point.

c.

Walk the client to the bathroom and describe it.

d.

Tell the client to use the call light if he or she wants to go to the bathroom.

e.

Explain the routine of the unit and how to operate the bed controls.

f.

Assist in putting the clients belongings away.

ANS: B, C, E, F

The client needs to know where everything is located to be independent and safe from falls. Clients need to be shown where things are and how to do things such as turn on the call light and raise the head of the bed. The client should be introduced to the staff, not the reverse, and should first be shown how to use the call light.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlAccident/Injury Prevention)

MSC: Integrated Process: Nursing Process (Implementation)

OTHER

1. A client has an eye prosthesis and needs to have it inserted into the eye socket. Place the following steps of how to insert an eye prosthesis in the correct order. (Select in order of priority.)

a. Wash your hands.

b. Explain the procedure to the client.

c. Remove the prosthesis from its container and rinse it with tepid water.

d. Cover the work area with a cloth or towel.

e. Don gloves.

f. Place the prosthesis between the thumb and forefinger of your dominant hand with the notched end of the prosthesis closest to the clients nose.

g. Insert the prosthesis with the top edge slipping under the upper lid.

h. Lift the clients upper lid using your nondominant hand.

i. Retract the lower lid slightly until the bottom edge of the prosthesis slips behind it.

j. Release your hand slowly.

k. Gently release the upper eyelid.

ANS:

b, a, d, e, c, h, f, g, k, i, j

The proper procedure for inserting an eye prosthesis is to explain the procedure, wash hands, prepare your work area with a cloth or towel, apply gloves, remove the prosthesis from its container and rinse it, use your nondominant hand to open the clients upper eyelid, hold the prosthesis properly, insert the prosthesis with the top edge slipping under the lid, release the lid, retract the lower lid until the prosthesis slides into place behind the lower lid, and take your hand away slowly.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlAccident/Injury Prevention)

MSC: Integrated Process: Nursing Process (Implementation)

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