Chapter 65: Management of Clients with Visual Disorders Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 65: Management of Clients with Visual Disorders

MULTIPLE CHOICE

1. A client asks the nurse how glaucoma can best be prevented. The nurses response would include preventive information related to primary open-angle glaucoma, including which of the following?

a.

Assessment of the optic nerve and tonometry testing should be performed regularly with an annual eye examination.

b.

Eat a well-balanced diet with adequate amounts of vitamin A and make sure your house has appropriate lighting.

c.

Exercises that increase blood pressure should be limited, and abrupt temperature changes should be avoided.

d.

Wear protective eyewear, and do not engage in activity where you are likely to experience blows to the head and neck.

ANS: A

Because there are no early warning clinical manifestations for glaucoma, it is imperative that regular ophthalmic examinations include tonometry and assessment of the optic head (disc).

DIF: Application/Applying REF: p. 1700 OBJ: Intervention

MSC: Health Promotion and Maintenance Health Screening

2. The nurse recently diagnosed a client as experiencing Visual Sensory/Perceptual Alterations related to increased intraocular pressure. The priority for the plan of care would be

a.

encouraging compliance with drug therapy to prevent loss of vision.

b.

managing the severe pain experienced until the optic nerve atrophies.

c.

providing anticipatory guidance regarding the eventual loss of peripheral vision.

d.

recognizing that damage to the eye caused by glaucoma can be reversed.

ANS: A

The administration of eye drops is a critical component of self-care for the client with glaucoma. The vision that is lost is permanent; however, strict adherence to the treatment regimen can prevent further loss. Primary open-angle glaucoma, the most common type, is not painful.

DIF: Application/Applying REF: p. 1702 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

3. The nurse talking with a client with open-angle glaucoma would instruct the client to make a behavior change based on the statement

a.

I take an aspirin a day to prevent any problems with clotting.

b.

I usually drink at least 8 to 10 glasses of water a day.

c.

Now that the allergy season is here, I take antihistamines on a regular basis.

d.

I like to eat hot, spicy foods.

ANS: C

Many over-the-counter (OTC) medications, including antihistamines, can dilate the pupil, putting the client at risk for angle-closure glaucoma.

DIF: Application/Applying REF: p. 1701 OBJ: Intervention

MSC: Health Promotion and Maintenance Disease Prevention

4. The nurse would instruct a client being taught to administer pilocarpine eye drops for glaucoma that the client

a.

may feel some tingling in the fingers after administering the drops.

b.

may have some blurring of vision after the drops are instilled.

c.

will need to keep the eyes closed for 20 minutes after the drops are instilled.

d.

will need to take the pulse before administering the drops.

ANS: B

Pilocarpine is a miotic; it causes pupillary constriction to open Schlemms canal and may cause blurred vision after instillation.

DIF: Application/Applying REF: p. 1716 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

5. The nurse obtaining the history of a client admitted for retinal detachment would note that the assessment finding not consistent with retinal detachment is the clients report of

a.

a feeling of having a curtain pulled over my eyes.

b.

experiencing intense pain.

c.

floaters in the visual field.

d.

sudden flashes of bright light.

ANS: B

No pain is associated with detachment of the retina.

DIF: Analysis/Analyzing REF: p. 1707 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

6. A client with moderate age-related macular degeneration (AMD) asks the nurse about vitamins being advertised for this condition. Which is the best response by the nurse?

a.

Certain vitamins seem to delay vision loss in people with macular degeneration.

b.

There are no herbs or supplements that can help this condition.

c.

There are no research studies that back up those claims.

d.

Yes, mega-doses of vitamin B-12 have shown promise in several research studies.

ANS: A

The client with age-related macular degeneration is threatened with the loss of central vision. Some research findings do show that high-dose antioxidant vitamins (C, E, beta-carotene, and zinc) may delay progression of AMD and vision loss.

DIF: Comprehension/Understanding REF: p. 1711 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Complementary and Alternative Therapies

7. The nurse caring for a client after keratoplasty (corneal transplantation) would assess the client for possible graft rejection, as indicated by

a.

a cloudy, swollen cornea.

b.

eye discomfort.

c.

photophobia.

d.

tearing of the eye.

ANS: A

At the first indication of a graft rejection, when the cornea becomes cloudy and edematous and when there is an anterior chamber reaction (presence of white blood cells or protein), topical steroids are prescribed in frequent doses to control the inflammatory response and reverse the rejection reaction.

DIF: Application/Applying REF: p. 1712 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

8. A client has had an enucleation for ocular melanoma. Which of the following instructions takes priority when dismissing this client?

a.

Be extra cautious when going up or down stairs.

b.

If the plastic conformer comes out, wash it and replace it.

c.

Keep soap and water out of your eye socket.

d.

You can wear an eye patch sometimes, but not all of the time.

ANS: A

All are correct discharge instructions. However, option a is the priority because it involves client safety. The loss of one eye and resultant monovision causes the client to lose depth perception. The client should be extremely cautious on stairs, while walking or crossing streets, or driving.

DIF: Application/Applying REF: p. 1714 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Accident Prevention

9. A nurse is conducting wellness seminars in the community. One health promotion activity the nurse could advise the audience to reduce the chances of developing cataracts is to

a.

drink plenty of water.

b.

limit the amount of alcohol you drink.

c.

take a lot of vitamins A and E.

d.

wear sunglasses when outside.

ANS: D

The single most important risk factor for developing cataracts is the cumulative exposure to the suns ultraviolet rays. Wearing sunglasses that block both UV-A and UV-B will help reduce exposure to this risk factor.

DIF: Comprehension/Understanding REF: p. 1704 OBJ: Intervention

MSC: Health Promotion Disease Prevention

10. The nurse would consider that discharge teaching for a client after cataract surgery was not effective when the client states I will

a.

avoid lifting more than 5 pounds for a while.

b.

only experience mild pain.

c.

sleep on the side they operated on.

d.

wear my eye shield to protect my eye.

ANS: C

The postsurgical cataract client should wear eye shields, avoid lifting more than 5 pounds until cleared by the ophthalmologist, and should only experience mild pain, for which acetaminophen (Tylenol) should be effective. These clients should avoid sleeping on the operated side.

DIF: Evaluation/Evaluating REF: p. 1706 OBJ: Evaluation

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

11. In planning the care of a client with Crohns disease for 10 years who has developed Sjgrens syndrome, the nurse would include

a.

applying frequent cool soaks.

b.

cleansing the eye to remove crusts.

c.

instilling lubricating eye drops frequently.

d.

reducing lighting in the room.

ANS: C

Sjgrens syndrome is a condition is which tear secretion is reduced and is associated with several systemic disorders, including Crohns disease. Frequent instillation of lubricating eye drops or ointment is effective in most cases. The other options are not treatments for this condition.

DIF: Application/Applying REF: p. 1717 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Expected Effects/Outcomes

12. The nurse would counsel clients who have experienced optic neuritis that they should see a physician regularly because they are at high risk for

a.

diabetes mellitus.

b.

glaucoma.

c.

multiple sclerosis.

d.

permanent blindness.

ANS: C

There is a close association between optic neuritis and multiple sclerosis.

DIF: Application/Applying REF: p. 1718 OBJ: Intervention

MSC: Health Promotion and Maintenance Health Screening

13. The nurse evaluating a clients retinal arterioles during a funduscopic examination would record a grade indicating severe hypertensive retinopathy as

a.

grade D.

b.

grade 1.

c.

grade 4.

d.

grade 10.

ANS: C

Hypertensive retinopathy is graded for severity on a scale of 1 to 4, with 4 being the most severe.

DIF: Knowledge/Remembering REF: p. 1718 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

14. The nurse providing normal postoperative care to a client who underwent laser trabeculoplasty as part of glaucoma management would

a.

give food and fluids immediately on arrival.

b.

instruct the client to lie on the operative side.

c.

maintain an eye patch and plastic shield in place.

d.

tell the client to expect eye pain and nausea.

ANS: C

When the client returns from the operating room, the eye is covered with a patch and a metal or plastic shield for protection. The nurse instructs the client not to lie on the operative side to avoid pressure on the surgical site. When the effects of perioperative sedation have diminished, the client may walk and eat as desired.

DIF: Application/Applying REF: p. 1703 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

15. As part of preoperative counseling for the client contemplating cataract surgery, the nurse would explain that postoperative follow-up is done

a.

at 1, 3, and 6 weeks after surgery and again at 6 months.

b.

at 2, 4, and 6 weeks after surgery.

c.

the day after, 1 week after, and 1 month after surgery.

d.

the day after surgery and again in 6 months.

ANS: C

After cataract surgery, clients are expected to return for a follow-up visit the next morning and again at 1 week and at 1 month.

DIF: Knowledge/Remembering REF: p. 1706 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

16. The nurse is concerned about a clients slowly healing corneal ulcer because such an injury can lead to

a.

cataract formation.

b.

perforation of the anterior chamber.

c.

retinal detachment.

d.

secondary glaucoma.

ANS: D

Slowly healing corneal injuries may lead to secondary glaucoma.

DIF: Comprehension/Understanding REF: p. 1700 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

17. A client wants eye glasses surgery to fix nearsightedness, but was told several years ago that the corneas were too thin and flat for traditional laser in situ keratomileusis (LASIK) surgery. The nurse working in an ophthalmologists office counsels the client to ask about which procedure?

a.

Corneal ring implants

b.

Laser epithelial keratomileusis (LASEK)

c.

Pneumatic retinopexy

d.

Radial keratotomy (RK)

ANS: B

RK involves making tiny cuts in the cornea to flatten it and help with nearsightedness. This traditional eye surgery is occasionally used, but has mostly been replaced by LASIK. However, one contraindication to this procedure was having corneas that were too thin or flat. LASEK was designed for these cases. LASEK peels back a thin layer of the cornea to reshape the middle layer to correct nearsightedness. Corneal rings are inserted to flatten the cornea and reduce nearsightedness. A pneumatic retinopexy treats retinal detachment with a small gas bubble injected into the vitreous body.

DIF: Comprehension/Understanding REF: p. 1716 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

18. A client is scheduled for enucleation of the eye because of advanced ocular melanoma. The nurse finds the client crying and saying, Im sure I will just look horrid. I cant let anyone see me after the operation ever again! The best response by the nurse would be

a.

Dont worry. With your prosthetic in, youll look almost normal.

b.

Im sure this is very hard for you. I can sit with you for a while.

c.

Let me call our chaplain to come see you; he is very understanding.

d.

Well at least they think they can get all the cancer by removing your eye.

ANS: B

Therapeutic communication and offering ones self are important nursing interventions for helping a client cope with the devastating diagnosis and treatment of ocular melanoma.

DIF: Application/Applying REF: p. 1714 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Unexpected Body Image Changes

19. An elderly client had surgery to repair a retinal detachment and is being discharged to home the next day. The nurse is concerned that the client will not be able to adjust to the decreased vision. The most appropriate action by the nurse is to

a.

arrange admission to a long-term care facility.

b.

consult with a home health care agency for assistance at home.

c.

request the physician keep the client in the hospital for a couple more days.

d.

send the client home with instructions written in large type.

ANS: B

Because this was most likely an emergency procedure, the client will not have made any arrangements to help while he/she is adapting to the changes in vision or waiting for vision to return. A home health care agency can most appropriately help the client stay in the home until sight is restored or the client is able to adapt.

DIF: Application/Applying REF: p. 1708 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Collaboration with Interdisciplinary Team

MULTIPLE RESPONSE

1. A nurse in an outpatient surgical setting is assessing a client scheduled for cataract removal. The nurse would expect to find that the client has (Select all that apply)

a.

a shadow across the visual field.

b.

better vision in low light.

c.

blurred vision, photophobia, and glare.

d.

nausea and vomiting, worse with eye movements.

e.

sudden onset of acute eye pain.

ANS: B, C

A cataract is an opacity of the lens. Classic manifestations are blurred or double vision, photophobia, and glare. Clients usually see better in low light. A shadow across the visual field is characteristic of retinal detachment. Nausea and vomiting, and acute eye pain often accompany acute angle-closure glaucoma, although the nausea may or may not be worse with eye movement.

DIF: Comprehension/Understanding REF: p. 1704 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

2. A client has had vision loss because of glaucoma. The nurse identifies the diagnosis: Anticipatory Grieving related to loss of vision. Which interventions does the nurse include in the clients plan of care? (Select all that apply.)

a.

Allow the client to verbalize feelings.

b.

Assess causative and contributing factors.

c.

Examine the need for vocational rehabilitation.

d.

Help the client explore avenues of support.

e.

Instruct the client on home safety precautions.

ANS: A, B, C, D

All interventions are important for the client with significant vision loss; however, home safety precautions relates to the diagnosis Risk for Injury. Anticipatory grieving is an important diagnosis, as clients will most likely need to grieve the loss of normal vision and the need to make compromises and adaptations in daily life.

DIF: Application/Applying REF: p. 1702 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Grief and Loss

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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