Deck 65: Management of Clients with Visual Disorders

Question 1

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.

Answer 1

encouraging compliance with drug therapy to prevent loss of vision.

Question 2

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."

Answer 2

"Be extra cautious when going up or down stairs."

Question 3

A client asks the nurse how glaucoma can best be prevented. The nurse's 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.

Answer 3

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

Question 4

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 client's 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.

Question 5

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.

Question 6

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.

Question 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.

Question 8

The nurse evaluating a client's 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.

Question 9

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.

Question 10

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.

Question 11

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.

Question 12

A client is scheduled for enucleation of the eye because of advanced ocular melanoma. The nurse finds the client crying and saying, "I'm sure I will just look horrid. I can't let anyone see me after the operation ever again!" The best response by the nurse would be

A) "Don't worry. With your prosthetic in, you'll look almost normal."
B) "I'm 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."

Question 13

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."

Question 14

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.

Question 15

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."

Question 16

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."

Question 17

The nurse is concerned about a client's 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.

Question 18

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.

Question 19

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 ophthalmologist's 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)

Question 20

In planning the care of a client with Crohn's disease for 10 years who has developed Sjögren's 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.

Question 21

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 client's 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.