Deck 62: Assessment and Management of Patients With Eye and Vision Disorders

Question 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.

Answer 1

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

Question 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.

Answer 2

Ensure adequate lighting in the patients room.

Question 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.

Answer 3

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.

Question 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.

Question 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

Question 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 $\mathrm{C}$ and $\mathrm{E}$ , beta-carotene, and selenium
B) Eyeglasses or magnifying lenses
C) Corticosteroid eye drops
D) Surgical intervention

Question 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.

Question 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

Question 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

Question 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.

Question 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

Question 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.

Question 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

Question 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

Question 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

Question 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

Question 17

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

Question 18

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.

Question 19

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.

Question 20

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.

Question 21

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.

Question 22

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

Question 23

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

Question 24

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.

Question 25

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 $50 \mathrm{~mm} \mathrm{Hg}$ .
D) You can likely expect a minimum of 6 months of treatment.

Question 26

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.

Question 27

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

Question 28

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.

Question 29

A patient with low vision has called the clinic and asked the nurse for help with acquiring some lowvision 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.

Question 30

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.

Question 31

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.

Question 32

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

Question 33

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

Question 34

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

Question 35

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.

Question 36

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.

Question 37

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.

Question 38

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.

Question 39

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