Chapter 63 Nursing School Test Banks

 

1.

The registered nurse taking shift report learns that an assigned patient is blind. How should the nurse best communicate with this patient?

A)

Provide instructions in simple, clear terms.

B)

Introduce herself in a firm, loud voice at the doorway of the room.

C)

Lightly touch the patients arm and then introduce herself.

D)

State her name and role immediately after entering the patients room.

Ans:

D

Feedback:

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 patient. 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.

2.

The nurse has taken shift report on her patients and has been told that one patient has an ocular condition that has primarily affected the rods in his eyes. Considering this information, what should the nurse do while caring for the patient?

A)

Ensure adequate lighting in the patients room.

B)

Provide a dimly lit room to aid vision by limiting contrast.

C)

Carefully point out color differences for the patient.

D)

Carefully point out fine details for the patient.

Ans:

A

Feedback:

The nurse should provide adequate lighting in the patients room, as the rods are mainly responsible for night vision or vision in low light. If the patients rods are impaired, the patient will have difficulty seeing in dim light. The cones in the eyes provide best vision for bright light, color vision, and fine detail.

3.

A patient who presents for an eye examination is diagnosed as having a visual acuity of 20/40. The patient asks the nurse what these numbers specifically mean. What is a correct response by the nurse?

A)

A person whose vision is 20/40 can see an object from 40 feet away that a person with 20/20 vision can see from 20 feet away.

B)

A person whose vision is 20/40 can see an object from 20 feet away that a person with 20/20 vision can see from 40 feet away.

C)

A person whose vision is 20/40 can see an object from 40 inches away that a person with 20/20 vision can see from 20 inches away.

D)

A person whose vision is 20/40 can see an object from 20 inches away that a person with 20/20 vision can see from 40 inches away.

Ans:

B

Feedback:

The Snellen chart is a tool used to measure visual acuity. It is composed of a series of progressively smaller rows of letters and is used to test distance vision. The fraction 20/20 is considered the standard of normal vision. Most people can see the letters on the line designated as 20/20 from a distance of 20 feet. A person whose vision is 20/40 can see an object from 20 feet away that a person with 20/20 vision can see from 40 feet away.

4.

During discharge teaching the nurse realizes that the patient is not able to read medication bottles accurately and has not been taking her medications consistently at home. How should the nurse intervene most appropriately in this situation?

A)

Ask the social worker to investigate alternative housing arrangements.

B)

Ask the social worker to investigate community support agencies.

C)

Encourage the patient to explore surgical corrections for the vision problem.

D)

Arrange for referral to a rehabilitation facility for vision training.

Ans:

B

Feedback:

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 patients with low vision, which include training in independent living skills and a variety of assistive devices for vision enhancement, orientation, and mobility, preventing patients from needing to enter a nursing facility. A rehabilitation facility is generally not needed by the patients 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 patient.

5.

The nurse is providing health education to a patient newly diagnosed with glaucoma. The nurse teaches the patient that this disease has a familial tendency. The nurse should encourage the patients immediate family members to undergo clinical examinations 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

Feedback:

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 not necessary and excessive.

6.

A patient 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 patients 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

Feedback:

Surgery is the treatment option of choice when the patients 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 patient with early stages of cataracts, but have limitations for the patient with impaired functioning.

7.

A patient presents at the ED after receiving a chemical burn to the eye. What would be the nurses initial intervention for this patient?

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

Feedback:

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 patient, patching will prevent irrigation of the eye.

8.

The nurse is administering eye drops to a patient with glaucoma. After instilling the patients first medication, how long should the nurse wait before instilling the patients second medication into the same eye?

A)

30 seconds

B)

1 minute

C)

3 minutes

D)

5 minutes

Ans:

D

Feedback:

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.

9.

A patient is being discharged home from the ambulatory surgical center after cataract surgery. In reviewing the discharge instructions with the patient, the nurse instructs the patient to immediately call the office if the patient experiences what?

A)

Slight morning discharge from the eye

B)

Any appearance of redness of the eye

C)

A scratchy feeling in the eye

D)

A new floater in vision

Ans:

D

Feedback:

Cataract surgery increases the risk of retinal detachment and the patient must be instructed to notify the surgeon of new floaters in vision, flashing lights, decrease in vision, pain, or increase in redness. Slight morning discharge, some redness, and a scratchy feeling may be expected for a few days after surgery.

10.

A patient comes to the ophthalmology clinic for an eye examination. The patient tells the nurse that he often sees floaters in his 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 patient may be exhibiting signs of glaucoma.

D)

This may be a result of weakened ciliary muscles.

Ans:

A

Feedback:

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 patient perceives as floaters. This is a normal aging process.

11.

A patients ocular tumor has necessitated enucleation and the patient will be fitted with a prosthesis. The nurse should address what nursing diagnosis when planning the patients discharge education?

A)

Disturbed body image

B)

Chronic pain

C)

Ineffective protection

D)

Unilateral neglect

Ans:

A

Feedback:

The use of an ocular prosthesis is likely to have a significant impact on a patients body image. Prostheses are not associated with chronic pain or ineffective protection. The patient experiences a change in vision, but is usually able to accommodate such changes and prevent unilateral neglect.

12.

The nurses assessment of a patient with significant visual losses reveals that the patient cannot count fingers. How should the nurse proceed with assessment of the patients visual acuity?

A)

Assess the patients vision using a Snellen chart.

B)

Determine whether the patient is able to see the nurses hand motion.

C)

Perform a detailed examination of the patients external eye structures.

D)

Palpate the patients periocular regions.

Ans:

B

Feedback:

If the patient 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.

13.

The nurse on the medicalsurgical unit is reviewing discharge instructions with a patient 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

Feedback:

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.

14.

A nurse is teaching a patient with glaucoma how to administer eye drops to achieve maximum absorption. The nurse should teach the patient 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

Feedback:

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.

15.

A patient with chronic open-angle glaucoma is being taught to self-administer pilocarpine. After the patient administers the pilocarpine, the patient states that her vision is blurred. Which nursing action is most appropriate?

A)

Holding the next dose and notifying the physician

B)

Treating the patient for an allergic reaction

C)

Suggesting that the patient put on her glasses

D)

Explaining that this is an expected adverse effect

Ans:

D

Feedback:

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 patient 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 physician need to be notified. Likewise, the patient does not need to be treated for an allergic reaction. Wearing glasses will not alter this temporary adverse effect.

16.

The nurse should recognize the greatest risk for the development of blindness in which of the following patients?

A)

A 58-year-old Caucasian woman with macular degeneration

B)

A 28-year-old Caucasian man with astigmatism

C)

A 58-year-old African American woman with hyperopia

D)

A 28-year-old African American man with myopia

Ans:

A

Feedback:

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.

17.

A 6-year-old child is brought to the pediatric clinic for the assessment of redness and discharge from the eye and is diagnosed with viral conjunctivitis. What is the most important information to discuss with the parents and child?

A)

Handwashing can prevent the spread of the disease to others.

B)

The importance of compliance with antibiotic therapy

C)

Signs and symptoms of complications, such as meningitis and septicemia

D)

The likely need for surgery to prevent scarring of the conjunctiva

Ans:

A

Feedback:

The nurse must inform the parents and child that viral conjunctivitis is highly contagious and instructions should emphasize the importance of handwashing and avoiding sharing towels, face cloths, and eye drops. Viral conjunctivitis is not responsive to any treatment, including antibiotic therapy. Patients with gonococcal conjunctivitis are at risk for meningitis and generalized septicemia; these conditions do not apply to viral conjunctivitis. Surgery to prevent scarring of the conjunctiva is not associated with viral conjunctivitis.

18.

The nurse is admitting a 55-year-old male patient diagnosed with a retinal detachment in his left eye. While assessing this patient, 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

Feedback:

Flashing lights in the visual field is a common symptom of retinal detachment. Patients 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.

19.

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

Feedback:

To prevent spread during outbreaks of conjunctivitis caused by adenovirus, health care facilities must set aside specified areas for treating patients diagnosed with or suspected of having conjunctivitis caused by adenovirus. Antibiotics and saline flushes are ineffective and normally no need to perform testing of individuals lacking symptoms.

20.

A patient has just returned to the surgical floor after undergoing a retinal detachment repair. The postoperative orders specify that the patient should be kept in a prone position until otherwise ordered. What should the nurse do?

A)

Call the physician and ask for the order to be confirmed.

B)

Follow the order because this position will help keep the retinal repair intact.

C)

Instruct the patient to maintain this position to prevent bleeding.

D)

Reposition the patient after the first dressing change.

Ans:

B

Feedback:

For pneumatic retinopexy, postoperative positioning of the patient 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 patient must maintain a prone position that would allow the gas bubble to act as a tamponade for the retinal break. Patients and family members should be made aware of these special needs beforehand so that the patient 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.

21.

A patient has informed the home health nurse that she has recently noticed distortions when she looks at the Amsler grid that she has mounted on her refrigerator. What is the nurses most appropriate action?

A)

Reassure the patient that this is an age-related change in vision.

B)

Arrange for the patient to have her visual acuity assessed.

C)

Arrange for the patient to be assessed for macular degeneration.

D)

Facilitate tonometry testing.

Ans:

C

Feedback:

18, The Amsler grid is a test often used for patients 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.

22.

A 56-year-old patient has come to the clinic for his routine eye examination and is told he needs bifocals. The patient asks the nurse what change in his eyes has caused his 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 eyes ability for accommodation.

D)

The eye gets shorter, back to front, as we age and it changes how we see things.

Ans:

C

Feedback:

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 patients concerns.

23.

The nurse is teaching a patient to care for her new ocular prosthesis. What should the nurse emphasize during the patients health education?

A)

The need to limit exposure to bright light

B)

The need to maintain a low Fowlers 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

Feedback:

Proper hand hygiene must be observed before inserting and removing an ocular prosthesis. There is no need for a low Fowlers position or for limiting light exposure. Antiviral ointments are not routinely used.

24.

Cytomegalovirus (CMV) is the most common cause of retinal inflammation in patients 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

Feedback:

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.

25.

A patient got a sliver of glass in his eye when a glass container at work fell and shattered. The glass had to be surgically removed and the patient is about to be discharged home. The patient asks the nurse for a topical anesthetic for the pain in his eye. 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)

Im sorry, this medication is considered a controlled substance and patients cannot take it home.

D)

I know these drops will make your eye feel better, but I cant let you take them home.

Ans:

A

Feedback:

Most patients are not allowed to take topical anesthetics home because of the risk of overuse. Patients 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.

26.

A patient has been diagnosed with glaucoma and the nurse is preparing health education regarding the patients medication regimen. The patient states that she is eager to beat this disease and looks forward to the time that she 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

Feedback:

Glaucoma requires lifelong pharmacologic treatment. Normal intraocular pressure is between 10 and 21 mm Hg.

27.

An older adult patient has been diagnosed with macular degeneration and the nurse is assessing him for changes in visual acuity since his last clinic visit. When assessing the patient for recent changes in visual acuity, the patient states that he sees the lines on an Amsler grid as being distorted. What is the nurses most appropriate response?

A)

Ask if the patient has been using OTC vasoconstrictors.

B)

Instruct the patient to repeat the test at different times of the day when at home.

C)

Arrange for the patient to visit his ophthalmologist.

D)

Encourage the patient to adhere to his prescribed drug regimen.

Ans:

C

Feedback:

With a change in the patients perception of the grid, the patient 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.

28.

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 causes 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

Feedback:

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.

29.

The nurse is providing discharge education to an adult patient who will begin a regimen of ocular medications for the treatment of glaucoma. How can the nurse best determine if the patient is able to self-administer these medications safely and effectively?

A)

Assess the patient for any previous inability to self-manage medications.

B)

Ask the patient to demonstrate the instillation of her medications.

C)

Determine whether the patient can accurately describe the appropriate method of administering her medications.

D)

Assess the patients functional status.

Ans:

B

Feedback:

The patient or the caregiver at home should be asked to demonstrate actual eye drop administration. This method of assessment is more accurate than asking the patient to describe the process or determining earlier inabilities to self-administer medications. The patients functional status will not necessarily determine the ability to administer medication safely.

30.

A patient with low vision has called the clinic and asked the nurse for help with acquiring some low-vision aids. What else can the nurse offer to help this patient manage his low vision?

A)

The patient uses OTC NSAIDs.

B)

The patient has a history of stroke.

C)

The patient has diabetes.

D)

The patient has Asian ancestry.

Ans:

C

Feedback:

Diabetes is a risk factor for glaucoma, but Asian ancestry, NSAIDs, and stroke are not risk factors for the disease.

31.

The public health nurse is addressing eye health and vision protection during an educational event. What statement by a participant best demonstrates an understanding of threats to vision?

A)

Im planning to avoid exposure to direct sunlight on my next vacation.

B)

Ive never exercised regularly, but Im going to start working out at the gym daily.

C)

Im planning to talk with my pharmacist to review my current medications.

D)

Im certainly going to keep a close eye on my blood pressure from now on.

Ans:

D

Feedback:

Hypertension is a major cause of vision loss, exceeding the significance of inactivity, sunlight, and adverse effects of medications.

32.

A patient has had a sudden loss of vision after head trauma. How should the nurse best describe the placement of items on the dinner tray?

A)

Explain the location of items using clock cues.

B)

Explain that each of the items on the tray is clearly separated.

C)

Describe the location of items from the bottom of the plate to the top.

D)

Ask the patient to describe the location of items before confirming their location.

Ans:

A

Feedback:

The food trays composition is likened to the face of a clock. It is unreasonable to expect the patient to describe the location of items or to state that items are separated.

33.

A hospitalized patient with impaired vision must get a picture in his or her mind of the hospital room and its contents in order to mobilize independently and safely. What must the nurse monitor in the patients room?

A)

That a commode is always available at the bedside

B)

That all furniture remains in the same position

C)

That visitors do not leave items on the bedside table

D)

That the patients slippers stay under the bed

Ans:

B

Feedback:

All articles and furniture must remain in the same positions throughout the patients hospitalization. This will reduce the patients risks for falls. Visual impairment does not necessarily indicate a need for a commode. Keeping slippers under the bed and keeping the bedside table clear are also appropriate, but preventing falls by maintaining the room arrangement is a priority.

34.

A patient has just arrived to the floor after an enucleation procedure following a workplace accident in which his left eye was irreparably damaged. Which of the following should the nurse prioritize during the patients immediate postoperative recovery?

A)

Teaching the patient about options for eye prostheses

B)

Teaching the patient to estimate depth and distance with the use of one eye

C)

Assessing and addressing the patients emotional needs

D)

Teaching the patient about his post-discharge medication regimen

Ans:

C

Feedback:

When surgical eye removal is unexpected, such as in severe ocular trauma, leaving no time for the patient and family to prepare for the loss, the nurses role in providing emotional support is crucial. In the short term, this is a priority over teaching regarding prostheses, medications, or vision adaptation.

35.

A patient with a diagnosis of retinal detachment has undergone a vitreoretinal procedure on an outpatient basis. What subject should the nurse prioritize during discharge education?

A)

Risk factors for postoperative cytomegalovirus (CMV)

B)

Compensating for vision loss for the next several weeks

C)

Non-pharmacologic pain management strategies

D)

Signs and symptoms of increased intraocular pressure

Ans:

D

Feedback:

Patients must be educated about the signs and symptoms of complications, particularly of increasing IOP and postoperative infection. CMV is not a typical complication and the patient should not expect vision loss. Vitreoretinal procedures are not associated with high levels of pain.

36.

A patient is ready to be discharged home after a cataract extraction with intraocular lens implant and the nurse is reviewing signs and symptoms that need to be reported to the ophthalmologist immediately. Which of the patients statements best demonstrates an adequate understanding?

A)

I need to call the doctor if I get nauseated.

B)

I need to call the doctor if I have a light morning discharge.

C)

I need to call the doctor if I get a scratchy feeling.

D)

I need to call the doctor if I see flashing lights.

Ans:

D

Feedback:

Postoperatively, the patient who has undergone cataract extraction with intraocular lens implant should report new floaters in vision, flashing lights, decrease in vision, pain, or increase in redness to the ophthalmologist. Slight morning discharge and a scratchy feeling can be expected for a few days. Blurring of vision may be experienced for several days to weeks.

37.

A patient has lost most of her vision as a result of macular degeneration. When attempting to meet this patients psychosocial needs, what nursing action is most appropriate?

A)

Encourage the patient to focus on her use of her other senses.

B)

Assess and promote the patients coping skills during interactions with the patient.

C)

Emphasize that her lifestyle will be unchanged once she adapts to her vision loss.

D)

Promote the patients hope for recovery.

Ans:

B

Feedback:

The nurse should empathically promote the patients coping with her loss. Focusing on the remaining senses could easily be interpreted as downplaying the patients loss, and recovery is not normally a realistic possibility. Even with successful adaptation, the patients lifestyle will be profoundly affected.

38.

When administering a patients eye drops, the nurse recognizes the need to prevent absorption by the nasolacrimal duct. How can the nurse best achieve this goal?

A)

Ensure that the patient is well hydrated at all times.

B)

Encourage self-administration of eye drops.

C)

Occlude the puncta after applying the medication.

D)

Position the patient supine before administering eye drops.

Ans:

C

Feedback:

Absorption of eye drops by the nasolacrimal duct is undesirable because of the potential systemic side effects of ocular medications. To diminish systemic absorption and minimize the side effects, it is important to occlude the puncta. Self-administration, supine positioning, and adequate hydration do not prevent this adverse effect.

39.

A patient with glaucoma has presented for a scheduled clinic visit and tells the nurse that she has begun taking an herbal remedy for her condition that was recommended by a work colleague. What instruction should the nurse provide to the patient?

A)

The patient should discuss this new remedy with her ophthalmologist promptly.

B)

The patient should monitor her IOP closely for the next several weeks.

C)

The patient should do further research on the herbal remedy.

D)

The patient should report any adverse effects to her pharmacist.

Ans:

A

Feedback:

Patients should discuss any new treatments with an ophthalmologist; this should precede the patients own further research or reporting adverse effects to the pharmacist. Self-monitoring of IOP is not possible.

40.

A patient is scheduled for enucleation and the nurse is providing anticipatory guidance about postoperative care. What aspects of care should the nurse describe to the patient? Select all that apply.

A)

Application of topical antibiotic ointment

B)

Maintenance of a supine position for the first 48 hours postoperative

C)

Fluid restriction to prevent orbital edema

D)

Administration of loop diuretics to prevent orbital edema

E)

Use of an ocular pressure dressing

Ans:

A, E

Feedback:

Patients who undergo eye removal need to know that they will usually have a large ocular pressure dressing, which is typically removed after a week, and that an ophthalmic topical antibiotic ointment is applied in the socket three times daily. Fluid restriction, supine positioning, and diuretics are not indicated.

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