Chapter 53: Eye and Vision Disorders Nursing School Test Banks

Chapter 53: Eye and Vision Disorders
Linton: Introduction to Medical-Surgical Nursing, 6th Edition

MULTIPLE CHOICE

1. A 60-year-old patient who has had an enucleation asks when he can get his prosthesis fitted. In approximately how many weeks should this patient expect to be fitted?
a. 2
b. 4
c. 8
d. 12
ANS: B
After an enucleation, the patient is fitted with a prosthesis in 1 month.

DIF: Cognitive Level: Knowledge REF: p. 1246 OBJ: 6
TOP: Enucleation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Basic Care and Comfort

2. A patient who has been taking opioid medication for postoperative pain exhibits pinpoint pupils. Which anatomic portion of the eye has been affected by the medication?
a. Sclera
b. Retina
c. Choroid
d. Bulbar conjunctiva
ANS: C
The choroid of the eye contains the pupil and iris.

DIF: Cognitive Level: Comprehension REF: p. 1220 OBJ: 1
TOP: Anatomy and Physiology of the Eye: Eyeball
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. Which portion of the eye makes it possible for a person to see in a darkened environment?
a. Macula
b. Rods
c. Cones
d. Optic nerve
ANS: B
The eye uses rods to accommodate to dim light. Cones are the color receptors, the optic nerve transmits all sensory input from the eye to the brain, and the macula is an oval-shaped yellow spot near the center of the retina that mediates clear, detailed vision.

DIF: Cognitive Level: Knowledge REF: p. 1220 OBJ: 1
TOP: Anatomy and Physiology of the Eye: Eyeball
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. When being interviewed, a 50-year-old patient says that he cannot see the newspaper as well as he used to. What is the reason this patient vision has changed from near to far?
a. The ciliary muscle changes the pupil size.
b. The lens of the eye changes shape as the ciliary muscle contracts and relaxes.
c. Nearsightedness has set in.
d. Clouding of the vitreous humor has occurred.
ANS: B
Accommodation or adjustment of the lens by contraction and expansion of the ciliary muscle allows an individual to see far or near.

DIF: Cognitive Level: Comprehension REF: p. 1221 OBJ: 1
TOP: Lens Adjustment KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. During the initial assessment of a very thin patient at the eye clinic, a nurse notes that the patient has very prominent eyes. What medical diagnosis might the nurse find in this patients history?
a. Diabetes
b. Glomerulonephritis
c. Graves disease
d. Hypertension
ANS: C
The appearance of the patient and the prominence of the eye (exophthalmos) would lead the nurse to inquire about a thyroid disorder such as Graves disease or hyperthyroidism.

DIF: Cognitive Level: Comprehension REF: p. 1222 OBJ: 1
TOP: Medical History KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

6. When asked about his vision, a patient says that the last time he had it tested, his vision was recorded as 20/50. What does this mean?
a. He can read at 20 feet what a person with normal vision can read at 50 feet.
b. He can read at 50 feet what a person with normal vision can read at 20 feet.
c. He needs to be 50 feet from objects to see them.
d. He can see objects the best between 20 and 50 feet.
ANS: A
The Snellen eye chart is read at 20 feet. The last line the patient can read with no more than two errors is recorded. This patient was able to read the 50-foot line at 20 feet, which means that he is reading at 20 feet what a person with normal vision can read at 50 feet.

DIF: Cognitive Level: Comprehension REF: p. 1223 OBJ: 1
TOP: Physical Examination: Eyes KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

7. Which intraocular pressure reading obtained by tonometry indicates a patient being evaluated for a visual impairment does not have glaucoma?
a. 18 mm Hg
b. 28 mm Hg
c. 45 mm Hg
d. 52 mm Hg
ANS: A
The normal intraocular pressure is between 12 and 21 mm Hg. If the patient had glaucoma, the intraocular pressure would be abnormally high.

DIF: Cognitive Level: Comprehension REF: p. 1224 OBJ: 3
TOP: Tonometry KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

8. What does a pneumatonometric study of the eye require?
a. Regional anesthesia
b. A pneumotonometer to be placed into the eye
c. A puff of air directed at the surface of the eye
d. An applanation performed with a slit-lamp microscope
ANS: C
A pneumotonometer directs a puff of air at the surface of the eye, measuring intraocular pressure by measuring the resistance to the air. The eye is anesthetized before the evaluation.

DIF: Cognitive Level: Comprehension REF: p. 1224 OBJ: 2
TOP: Tonometry KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

9. What is an appropriate nursing action to implement when performing eye irrigation?
a. Ask the patient to tip up her head and run the irrigation fluid over her open eye.
b. Direct the irrigating fluid from the inner canthus to the outer canthus.
c. Not allow the patient to blink.
d. Place the irrigating syringe directly onto the corner of the eye and allow the fluid to move across the eye.
ANS: B
The direction of the flow should be from the inner canthus to the outer canthus.

DIF: Cognitive Level: Application REF: p. 1226 OBJ: 3
TOP: Eye Irrigation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

10. What information should a nurse include when providing information to a patient using topical eye medications?
a. Look upward and drop the medication into the inner canthus.
b. Pull the lower eyelid down and drop the medication into the conjunctival sac.
c. Hold both eyelids open and drop the medication onto the sclera.
d. Tilt the head to the side and drop the medication into the outer canthus.
ANS: B
The eye drops should be dropped into the lower eyelid, and the nurse should press the tear duct to slow absorption.

DIF: Cognitive Level: Comprehension REF: p. 1229 OBJ: 3
TOP: Topical Medications KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

11. What does electroretinography measure?
a. A fluorescein dye is injected intravenously (IV) into a vein in the arm, and the retina is observed as the dye circulates.
b. Electrodes are placed on the scalp, each eye is stimulated, and retinal activity is assessed.
c. A small plunger is used to apply pressure on the sclera while the retinal vessels are evaluated.
d. A contact lens electrode is placed on the eye and exposed to flashes of light to evaluate the retinal response.
ANS: D
A contact lens electrode is placed on the eye, and retinal activity is assessed as lights are flashed into the eye. The other three options describe fluorescein angiography, visual-evoked response, and tonometry.

DIF: Cognitive Level: Knowledge REF: p. 1224-1225
OBJ: 2 TOP: Electroretinography
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

12. What information should a nurse relay to a patient when providing education about protecting vision?
a. After 40 years of age, eye examinations should be performed every 2 years.
b. Crusted eyelids on awakening are caused by decreased tear production.
c. Floaters are a sign of eye infection.
d. Blurred vision without pain is temporary eye strain.
ANS: A
Eye examinations every 2 years are recommended for persons older than 40 years of age. All the other options are indications that the person should consult a physician for an eye disorder.

DIF: Cognitive Level: Comprehension REF: p. 1231 OBJ: 4
TOP: Protection of the Eye and Vision KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

13. How should a nurse assist a visually impaired patient to ambulate?
a. Hold the visually impaired person by his or her nondominant arm and walk side by side.
b. Hold the nondominant hand, wrap the arm around his or her waist, and walk side by side.
c. Allow the visually impaired person to hold the helpers arm, with the helper slightly ahead.
d. Allow the visually impaired person to hold the shoulder of the helper and walk slightly behind the helper.
ANS: C
Allowing the visually impaired person to walk slightly behind the helper and holding the helpers arm is the most effective way to guide someone who is visually impaired.

DIF: Cognitive Level: Application REF: p. 1232-1233
OBJ: 6 TOP: Assisting the Visually Impaired with Ambulation
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

14. A newly diagnosed patient with macular degeneration flings her book at the television set and furiously says, I cant read this blasted book, and I cant see what is on the stupid TV! How should the nurse define this behavior?
a. Anger stage of grieving
b. Poor impulse control
c. Ineffective management of a therapeutic regimen
d. Psychotic reaction to loss
ANS: A
Frequently, a grieving process accompanies the realization that deteriorating vision and ultimate blindness are inevitable with macular degeneration.

DIF: Cognitive Level: Application REF: p. 1233 | p. 1246
OBJ: 6 TOP: Impact of Visual Impairment
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

15. What is the correct term to use for a patient with a vision disorder?
a. Blind
b. Handicapped
c. Partially blind
d. Visually impaired
ANS: D
The term visual impairment is a medically accepted term to use for patients with a vision loss.

DIF: Cognitive Level: Knowledge REF: p. 1231 OBJ: 5
TOP: Nursing Care of the Visually Impaired Patient KEY: Nursing Process Step: N/A
MSC: NCLEX: Psychosocial Integrity: Basic Care and Comfort

16. Which nursing diagnosis is not appropriate for a visually impaired patient?
a. Impaired sensory perception
b. Risk for delayed development
c. Self-care deficit
d. Ineffective coping
ANS: B
Patients with a visual impairment are not at risk for delayed development. They will have a nursing diagnosis of Impaired sensory perception, Ineffective coping, and Self-care deficit.

DIF: Cognitive Level: Comprehension REF: p. 1232-1233
OBJ: 6 TOP: Nursing Diagnosis, Goals, Outcomes
KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychological Integrity: Basic Care and Comfort

17. Which implementation is appropriate in the care plan for a visually impaired person?
a. Leaving the bed in the highest position
b. Keeping the door closed
c. Announcing your presence when you enter and leave the room
d. Leaving the radio on all the time to help the patient know the time of day
ANS: C
The nurse should announce her or his presence in the room and address the patient before touching him or her. The bed should be in the lowest position, and the door should be open to avoid social isolation.

DIF: Cognitive Level: Application REF: p. 1232 OBJ: 6
TOP: Implementation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

18. A patient with glaucoma is taking a beta-adrenergic blocking agent, timolol (Timoptic). For which potential side effect should the nurse assess the patient?
a. Wheezing
b. Hypertension
c. Sudden eye pain
d. Blurred vision
ANS: A
Beta-adrenergic blocking agents cause bronchospasm and tachycardia.

DIF: Cognitive Level: Comprehension REF: p. 1243 OBJ: 3
TOP: Beta-Adrenergic Blocking Agents KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

19. A 52-year-old patient reports that he must hold his paper farther and farther away from his face to read it. What is the nurses most informative response?
a. You are describing myopia. Glasses will help you read.
b. You may have astigmatism, but your eyes will finally adjust.
c. You have presbyopia. Nonprescription reading glasses will help you.
d. An eye infection may be the problem. Check with your physician for medication.
ANS: C
Presbyopia is a normal age-related change. Changes in the ciliary muscles cause the condition. Corrective lenses such as bifocals are used to correct this visual change.

DIF: Cognitive Level: Application REF: p. 1222 | p. 1237
OBJ: 5 TOP: Error of Refraction
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

20. A nurse explains that laser-assisted in situ keratomileusis (Lasik) and photorefractive keratectomy (PRK) are methods to correct refractive errors surgically. What do these procedures reshape?
a. Cornea
b. Lens
c. Iris
d. Pupil
ANS: A
Both surgical procedures are used to reshape the cornea. The clinician will need to determine which structure of the eye will need surgery to correct the vision.

DIF: Cognitive Level: Knowledge REF: p. 1238 OBJ: 5
TOP: Surgical Treatment for Refractive Errors
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

21. A patient reports to a home health care nurse of having cloudy vision and seeing spots and halos around lights. What should the nurse suspect based on these patient symptoms?
a. Cataracts
b. Glaucoma
c. Detached retina
d. Macular degeneration
ANS: A
Cataracts are the cause of cloudy vision and seeing spots or halos.

DIF: Cognitive Level: Comprehension REF: p. 1238 OBJ: 5
TOP: Internal Eye Disorders KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

22. How does closed-angle glaucoma differ from open-angle glaucoma?
a. The onset is acute.
b. Trabeculectomy is the initial treatment.
c. Treatment can be conservative.
d. Intraocular pressure drops suddenly.
ANS: A
Closed-angle glaucoma has an acute onset with eye pain and other systemic symptoms, such as nausea and vomiting. Reducing the intraocular pressure is an ocular emergency.

DIF: Cognitive Level: Knowledge REF: p. 1240-1242
OBJ: 5 TOP: Open-Angle versus Closed-Angle Glaucoma
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

23. What is the cause of glaucoma?
a. Cloudiness in the lens
b. Increase in intraocular pressure
c. Failed eye surgery
d. Retinal tears
ANS: B
Glaucoma is caused by an increase in intraocular pressure.

DIF: Cognitive Level: Knowledge REF: p. 1240 OBJ: 5
TOP: Glaucoma KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

24. A patient in the emergency department complains of severe pain in his eye and is seeing halos around lights and feeling nauseous. Which diagnosis should the nurse suspect?
a. Open-angle glaucoma
b. Angle-closure glaucoma
c. Cataracts
d. Retinal detachment
ANS: B
Sudden onset of acute eye pain with nausea and vomiting and halos around lights are all symptoms of angle-closure glaucoma. The acute pain is caused by sudden blockage of the fluid channels in the eye.

DIF: Cognitive Level: Comprehension REF: p. 1242 OBJ: 5
TOP: Glaucoma KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

25. Which surgical implementation is most effective with retinal detachment?
a. Removing the lens
b. Macular bonding
c. Lasik surgery
d. Scleral buckling
ANS: D
Scleral buckling is used to hold the retinal repair in place. The band is left in place to keep together the layers of the eye tissue.

DIF: Cognitive Level: Knowledge REF: p. 1245 OBJ: 5
TOP: Retinal Detachment KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

MULTIPLE RESPONSE

26. A nurse assesses an 80-year-old patient for age-related changes to the eye. What potential changes should the nurse anticipate? (Select all that apply.)
a. Decreased tear production
b. Eyeball sunk deep in orbit
c. Hyperopia
d. Eye lashes diminished
e. Arcus senilis
ANS: A, B, C, E
Eyelash diminution is not a consistent finding in older adults. All of the other options are common eye changes related to advancing age.

DIF: Cognitive Level: Comprehension REF: p. 1222 OBJ: 1
TOP: Age-Related Changes in the Eye KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

27. What makes up the refractive media of the eye? (Select all that apply.)
a. Aqueous humor
b. Retina
c. Vitreous humor
d. Cornea
e. Lens
ANS: A, C, D, E
The retina is not part of the refractive media. All of the other options are components of the refractive media.

DIF: Cognitive Level: Knowledge REF: p. 1221 OBJ: 1
TOP: Refractive Media KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

28. What actions should a nurse implement when assessing a patients accommodation? (Select all that apply.)
a. Hold his or her finger approximately 20 inches in front of the patients eyes.
b. Observe for pupillary constriction.
c. Assess for convergence.
d. Note blinking.
e. Move his or her finger slowly toward the patients nose.
ANS: A, B, C, E
Assessment for blinking is not part of the accommodation assessment. All of the other options are part of the accommodation assessment. The nurse holds his or her finger approximately 20 inches in front of the patients eyes and slowly moves the finger toward the patients nose, assessing for pupillary constriction and convergence.

DIF: Cognitive Level: Application REF: p. 1223 OBJ: 2
TOP: Testing for Accommodation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

29. A patient who has had surgery this morning for cataracts is now going home. What should the nurse include when providing discharge instructions? (Select all that apply.)
a. Sleep on the affected side.
b. Use stool softeners.
c. Avoid bending over.
d. Avoid lifting anything heavier than 5 lb.
e. Do not wear an eye shield at night.
ANS: B, C, D
After cataract surgery, the patient should sleep on the unaffected side with the eye shield in place. He or she should avoid heavy lifting and use stool softeners to prevent straining.

DIF: Cognitive Level: Application REF: p. 1240 OBJ: 3
TOP: Discharge Instructions for Cataract Surgery
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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