What surgical choices are available for correction of a refractive error (select all that apply)?

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Terms in this set (31)

1. Myopia is present in 25% of Americans. which characteristics are associated with myopia (select all that apply)?

a. excessively refraction
b. abnormally short eyeball
c. unequal corneal curvature
d. corrected with concave lens
e. image focused in front of retina

a, d, e.
myopia is characterized by excessive light refraction, the image focused in front of the retina, and correction with a concave or divergent lens. biopic people may have abnormally long eyeballs, not abnormally short ones, which occurs in hyperopia which is corrected with a convex lens. unequal corneal curvature results in astigmatism

1. the patient is diagnosed with presbyopia. when he asked the nurse what that is, what is the best explanation the nurse can give to the patient?

a. absence of the lens
b. abnormally long eyeballs
c. correctable with cylinder lens
d. loss of accommodation associated with age

d.
presbyopia is accommodation loss of aging. absence of lens is aphakia. myopia occurs with abnormally long eyeballs. astigmatism is corrected with the cylinder lens

1. to determine if an unconscious patient has contact lenses in place, what should be done by the nurse?

a. use a pen light to shine a light obliquely over the eye ball
b. apply drops of fluorescein dye to the eye to stain the lens is yellow
c. touch the cornea lately with a dry cotton ball to see if the patient reacts
d. tense the lateral canthus to cause a lens to be ejected if it is present in the eye

a.
a light shown at an angle over the cornea will illuminate a contact lens, and fluorescein should not have to be used. cotton ball should not be placed on the cornea, and simply tensing the outer canthus, will not dislodge the lens

1. what surgical choices are available for correction of a refractive error (select all that apply)?

a. lasik
b. contact lenses
c. corrective lenses
d. intraocular lens implantation
e. photorefractive keratectomy (PRK)

a, d, e.
Surgical therapies include lasik, intraocular lens implants, PRK, and LASEK. refractive errors are the most common visual problems and non surgical correction may include glasses and contact lenses

1. a patient tells the nurse an admission to the health care facility that he has finally been classified as legally blind. what does the nurse understand about the patients vision?

a. he has lost usable vision but has some light perception
b. he will need more time for grieving and adjusting to living with total blindness
c. he will need dependent on others to ensure a safe environment for functioning
d. may be able to perform many tasks and activities with vision enhancement techniques

d.
a person who is legally blind house is central visual acuity of 20/200 or less in the better eye with correction or a peripheral visual field of 20 degrees or less. there may be some usable vision that will benefit from vision enhancement techniques. a person with total blindness has no light perception and no usable vision, but that is not this person. only a small percentage of blindness occurs suddenly from injuries, the grieving is probably already in process. Dependency on others from visual impairment is individual and cannot be assumed

1. identify 5 nursing measures that should be implemented to increase a visually impaired patient safety and comfort

a. address the patient, not others with the patient, in normal conversation tones
b. face the patient and make eye contact
c. introduce self when approaching the patient and let the patient know when you are leaving
d. Orient to sounds, activities, in physical surroundings
e. use cited guide technique to ambulate and Orient patients

1. a patient is admitted to the emergency Department with a wood splinter embedded in the right eye. which intervention by the nurse is most appropriate?

a. irrigate the eye with a large amount of sterile Saline
b. carefully remove the splinter with a pair of sterile forceps
c. cover the eye with a dry sterile Patch and protective shield
d. apply light pressure on the closed eye to prevent bleeding or loss of aqueous humor

c.
Emergency Management of foreign bodies in the eye includes stabilizing the foreign object by covering and shielding the eye, with no attempt to treat the injury, until an ophthalmologist can evaluate the injury. irrigations are performed as Emergency Management and chemical exposure. pressure should never be applied because it could further injure the eye

1. What does describes pink eye?

a. blindness
b. acute bacterial conjunctivitis
c. epidemic keratoconjunctivitis
d. chronic inflammation of sebaceous glands

b.
acute bacterial conjunctivitis describes pink eye. pink eye does not cause blindness. epidemic keratoconjunctivitis is an ocular adenoviral disease. Chalazion is a chronic inflammatory granuloma of sebaceous glands on the eye lid

1. when the patient describes inflammation of the cornea, what does the nurse know this is called?

a. keratitis
b. blepharitis
c. hordeolum
d. conjunctivitis

a..
keratitis is inflammation of the cornea. Blepharitis is inflammation of the eyelid. hordeolum is an infection of the sebaceous glands in the lid margin. conjunctivitis is infection or inflammation of the conjunctiva

2. what should the nurse tell all patients with conjunctival infections to use?

a. artificial tears to moisten and soothe the eyes
b. dark glasses to prevent the discomfort of photophobia
c. iced moist compresses to the eyes to promote comfort and healing
d. frequent in thorough hand washing to avoid spreading live infection

d.
all infections of the conjunctiva or cornea are transmittable, and frequent, thorough hand washing is essential to prevent spread from one eye to the other or to other persons. artificial tears are not normally used for eye infections . photophobia is not experienced by all patients with eye infections.. warm or cool, not iced, compresses are indicated for some infections

1. endophthalmitis Can be a complication of intraocular surgery or penetrating ocular injury. what manifestations are expected when the nurse assesses the patient with this disorder (select all that apply)?

a. ocular pain
b. photophobia
c. eyelid edema
d. reddened sclera
e. bleeding conjunctiva
f. decreased visual acuity

a, b, f.
ocular pain, photophobia, decreased visual acuity, and also headaches, reddened and swollen conjunctive, and corneal edema occur with endophthalmitis. eyelid edema, reddened sclera, and bleeding conjunctive a do not occur with endophthalmitis

1. a patient with early cataracts housing nurse that he is afraid cataract surgery may cause permanent visual damage. what should the nurse teach the patient?

a. the cataracts will only worsen with time and should be removed as early as possible to prevent blindness
b. cataract surgery is very safe and with the implementation of an intraocular lens the need for glasses will be eliminated
c. progression of the cataracts can be prevented by avoidance of ultraviolet light and good dietary management
d. vision enhancement techniques may improve vision until surgery becomes an Acceptable option to maintain desired activities

d.
vision enhancement techniques may be used until the patient feels in need for cataract surgery. although cataracts do become worse of time surgical extraction is considered an elective procedure. surgical extraction is generally safe but infections can occur. the patient will still need glasses for near vision and for any residual refractive error of the implanted lens. there are no proven measures to prevent cataract development or progression

1. a 60 year old patient is being prepared for outpatient cataract surgery. when obtaining admission data from the patient, why would the nurse expect to find in the patient's history?

a. a painless, sudden, severe loss of vision
b. blurred vision, colored Halos around lights, and eye pain
c. a gradual loss of vision with abnormal color perception and glare
d. light flashes, floaters comma and a "cobweb" in the field of vision with loss of central or peripheral vision

c.
The lens opacity of cataracts causes a decrease in vision, abnormal color perception, and glare. blurred vision, Halos around lights, an eye pain or characteristic of glaucoma. light flashes, floaters, and cobwebs or hairnets in the field of vision followed by a painless, sudden loss of vision or characteristic of detached retina

1. a patient with bilateral cataracts is scheduled for an extra scapular cataract extraction with an intraocular lens implantation of one eye. what should be done by the nurse preoperatively?

a. assess the visual acuity in the unoperated eye to plan the need for postoperative assistance
b. informed the patient that the operative I will need to be patched for three to four days postoperatively
c. assure the patient that vision in the operative eye will be improved to near normal on the first postoperative day
d. teach the patient to continue coughing and deep breathing techniques to use postoperatively to prevent respiratory complications

a.
assessment of the visual acuity in the patients on operative I enables the nurse to determine how visually compromise the patient may be while the operative eye is patched in healing and to plan for assistance until vision improves. the Patch on the operative eye is usually removed within 24 hours and although vision in the eye may be good it is not unusual for visual acuity to be reduced immediately after surgery. activities that are thought to increase intraocular pressure, such as bending, coughing, and lifting, are frequently restricted post operatively

1. for the patient with a retinal break, what extraocular techniques may be used with sclera buckling to seal the break by creating an inflammatory reaction that causes a chorioretinal adhesion or scar (select all that apply)

a. cryopexy
b. vitrectomy
c. pneumatic retinopexy
d. laser photocoagulation
e. penetrating keratoplasty

a, d.
cryopexy (Freezing the retinal brake) and laser photocoagulation (creating an inflammatory reaction) are extraocular procedures used of scleral buckling to seal or retinal break. Vitrectomy is an intraocular procedure that removes vitreous to relieve tension on the retina. pneumatic retinopexy is an intraocular procedure injecting gas to form a temporary bubble with photocoagulation or cryotherapy to close a retinal break. penetrating keratoplasty is used for corneal scars or opacities and removes the cornea

1. following a pneumatic retinopexy, what does the nurse need to know about the post operative care for the patient?

a. specific positioning and activity restrictions are likely to be required for days or weeks
b. the patient is frequently hospitalised for Seven to 10 days on bed rest until healing is complete
c. patients experience little or no pain, and development of pain indicates hemorrhage or infection
d. reattachment of the retina completely fails, and patients can be expected to grieve for loss of vision

a.
post operatively the patient must position the head so that the bubble is in contact with the retinal break in may have to maintain its position for up to 16 hours a day for at least five days. the patient may go home within a few hours of surgery or may remain in the hospital for several days. no matter what type of repair, reattachment is successful in 90% of retinal detachment. if postoperative pain occurs, it is treated with analgesics

1. what nursing action is the most important for the patient with age related dry macular degeneration (AMD)?

a. teach the patient how to use topical eyedrops for treatment of AMD
b. emphasize the use of vision enhancement techniques to improve what vision is present
c. encourage the patient to undergo laser treatment to slow the deposit of extracellular debris
d. explain that nothing can be done to save the patients vision because there is no treatment for AMD

b.
the patient with dry AMD can benefit from low vision aids despite increasing loss of vision, and it is important to promote a positive outlook by not giving patients the impression that "nothing can be done" for them. approach magnification can help and vision enhancing devices include desktop video magnification/closed circuit units, electronic handheld magnifiers, text to speech scanners, e-readers and computer tablets of magnification, brighter screens, voice recognition and verbal response. The American foundation for the blind can help as well. limited treatment options include vitreal injections of selective inhibitors of endothelial growth factor slow vision loss in wet AMD. photodynamic therapy is indicated for neovascularization in a small percentage of patients with the wet AMD, but there is no treatment for the increasing deposit of extracellular debris in the retinal pigment epithelium. mineral and vitamin supplements may also be ordered

1. a patient with a wet AMD is treated with photodynamic therapy. what is the nurse instruct the patient to do after the procedure?

a. maintain the head in an upright position for 24 hours
b. avoid blowing the nose or causing jerking movements of the head
c. completely cover all the skin to avoid a thermal burn from sunlight
d. expected experience blind spots where the laser has caused retinal damage

c.
verteporfin, The dye used in photodynamic therapy to destroy abnormal blood cells, is a photosynthesizing drug that can be activated by exposure to sunlight or other high intensity light. patients must cover all of their skin to avoid chemical burns when exposed to sunlight until the drug has cleared the body. blind spots occur with wet AMD. head movement and position or not of concern following this procedure

1. what is an important health promotion nursing intervention for a middle aged adult related to glaucoma?

a. teach individuals at risk about early signs and symptoms of the disease
b. prepare patients with glaucoma for lifestyle changes necessary to adapt to eventual blindness
c. promote measurements of intraocular pressure every 2 to 4 years for early detection and treatment of glaucoma
d. inform patients that glaucoma is curable if I medications are administered before visual impairment has occurred

c.
because glaucoma developed slowly and without symptoms it is important that intraocular pressure be evaluated every two to four years in persons between the ages of 40 and 64 and every one to two years in those over 65 years old. more frequent measurement of intraocular pressure should be done in a patient with family history of glaucoma, African American patients, in patients with diabetes or cardiovascular disease. the disease is chronic, the vision impairment is preventable in most cases with treatments

1. when teaching the patient about the new diagnosis, which characteristics of glaucoma are included related to only primary open angle glaucoma (POAG)(select all that apply)?

a. gradual loss of peripheral vision
b. treated with iridotomy or iridectomy
c. causes loss of central vision with corneal edema
d. may be caused by increased production of aqueous humor
e. Treated with cholinergic agents such as pilocarpine (pilocar)
f. resistance to aqueous outflow through trabecular meshwork

a, d, f.
POAG is associated with gradual loss of peripheral vision, increased production of aqueous humor, and resistance to aqueous outflow via trabecular meshwork. treatment with iridotomy or iridectomy and cholinergic agents to facilitate aqueous humor outflow, as well as central vision loss of corneal edema, are associated with primary angle closure glaucoma .

1. which characteristics of glaucoma associated with only primary angle closure Glaucoma (PACG)(select all that apply)?

a. caused by lens blocking papillary opening
b. treated with trabeculoplasty or trabeculectomy
c. causes loss of central vision with corneal edema
d. treated with beta adrenergic blockers such as betaxolol (Betoptic)
e. causes sudden, severe eye pain associated with nausea and vomiting
f. treated with hyperosmotic oral and IV fluid still lower intraocular pressure

a, c, e, f.
acute PACG is caused by the lens blocking the papillary opening, which causes loss of central vision with corneal edema. sudden severe eye pain and nausea and vomiting occur, and it is initially treated with hyperosmotic oral and IV fluids. treatment with trabeculoplasty or trabeculectomy or beta adrenergic blockers are associated with POAG

1. What is one of the nurses roles in preservation of hearing?

a. advise patients to keep ears clear of wax with cotton tipped applicators
b. monitor patients at risk for drug induced auto toxicity for tinnitus and Vertigo
c. promote the use of ear protection in work an recreational activity with noise levels above 75 dB
d. advocate for MMR immunization insusceptible woman as soon as pregnancy is confirmed

b.
patients receiving auto toxic drugs should be monitored for tinnitus, hearing loss, and vertigo to prevent further damage caused by the drugs. ear should not be cleaned with anything but a washcloth, an finger an ear protection should be used in any environment with consistent noise levels above 85 dB. exposure to the rubella virus during the first eight weeks of pregnancy may cause fetal deafness, and the vaccine should never be given during pregnancy

1. number the following high noise environments from one for the greatest risk for ear injury to six for the lowest risk for ear injury

a. gas lawn mower for 10 hours
b. heavy factory noise for 8 hours
c. using a chainsaw continuously for two hours
d. working in a quiet Home Office for 8 hours
e. guiding jet planes to and from airport gates
f. sitting in front of amplifiers at a rock concert

a. 5;
b. 4;
c. 3;
d. 6;
e. 1;
f. 2.
The highest risk is determined by the highest dB level per time

1. a 74 year old man has moderate presbycusis and heart disease. he takes one aspirin a day as an antiplatelet agent and uses quinidine, furosemide, and enalapril for his heart condition. what risk factors are present for hearing loss and ototoxicity in this situation?

advanced age, use of three potentially ototoxic drugs

1. which nursing action should be included in the management of the patient with external otitis?

a. irrigate the ear canal with body temperature Saline at several hours after instilling lubricating ear drops
b. insert an earwig deep into the ear before each application of ear drops to this burst of medication
c. teach the patient to prevent further infections by instilling antibiotic drops into the ear canal before swimming
d. administer ear drops without touching the dropper to the Oracle and position the ear upward for two minutes afterward

d.
Antibiotic ear drops for external otitis should be applied without touching the Oracle to avoid contaminating the dropper and solution and the patient should hold the ear upward for several minutes to allow the drops to run down the canal. an earwig may be placed in the external canal and remains in the ear for at least several days to deliver treatment. the use of irrigation or lubricating ear drops is performed for impacted cerumen. "swimmers ear" is best prevented by avoiding swimming in contaminated waters ; prophylactic antibiotics are not used

1. what knowledge is needed by the nurse to best care for a patient with chronic otitis media (select all that apply)?

a. a culture and sensitivity of drainage determines treatment
b. it is an infection of the inner ear that may lead to headaches
c. full feeling in the ear, popping, and decreased hearing initiate effusion
d. formation of an acoustic neuroma may destroy the structures of the middle ear or invade the dura of the brain
e. the patient who has had tympanoplasty should protect the ear from infection and sudden pressure changes in the ear

a, c, e.
Antibiotics are used to treat bacteria identified with culture and sensitivity test. if antibiotic resistant, frequent evacuation of drainage and debris or surgery is needed. affusion causes of full feeling and popping may decrease hearing. infection or sudden pressure changes disrupt the surgical repair during healing or cause facial nerve paralysis post tympanoplasty. both acute and chronic ototis media occur in the middle ear.

1. while caring for a patient with otosclerosis, the nurse would expect which finding in the patient's history and physical?

a. a strong family history of the disease
b. symptoms of sensorineural hearing loss
c. a positive rinne test and lateralisation to the better ear on Webber testing
d. an immediate and consistent improvement in hearing at the time of surgical treatment

a.
otosclerosis is an autosomal dominant hereditary disease that causes fixation of the footplate of the stapes, Leading to conductive hearing loss. tuning fork testing in conductive hearing loss would result in a negative rinne test an lateralisation to the ear with greater hearing loss upon Webber testing. during a stapdectomy, the patient often reports an immediate improvement in hearing but the hearing level decreases temporarily postoperatively

1. what makes up the triad of symptoms that occur with inner ear problems (select all that apply)?

a. Vertigo
b. nausea
c. tinnitis
d. sensorineural hearing loss
e. inflammation of the ear canal

a, c, d.
vertical tonight isn't since your neural hearing laws or that ride of symptoms that occur with inner ear problems. now he may occur with Vertigo but is not part of the triad of symptoms. inflammation of the ear canal occurs with external otitis

1. an appropriate nursing intervention for the patient during an acute attack of menieres disease includes providing

a. frequent repositioning
b. a quiet darkened room
c. a television for diversion
d. padded side rails on the bed

b.
nursing care should minimize Vertigo by keeping the patient in a quiet dark environment. movement aggravates the whirling and roaring sensations, and the patient should be moved only for a central care. fluorescent lights or television flickering may also increase Vertigo and should be avoided. side rails should be raised to assist with safe movement when the patient is in bed, but padding is not indicated

1. what characteristics of hearing loss are associated with conductive loss (select all that apply)?

a. Presbycusis
b. speak softly
c. related to otitis media
d. results from ototoxic drugs
e. hears best in noisy environment
f. may be caused by impacted cerumen

b, c, e, f.
remaining answers are characteristics of sensorineural hearing loss

1. when teaching a patient to use hearing aid, where does the nurse encourage the patient to initially use the aid?

a. outdoors were sounds or distinct
b. at social functions where simultaneous conversations take place
c. in a quiet controlled environment to experiment with tone and volume
d. in the public areas such as malls or stores where others will not notice its use

c.
initial adjustment to hearing aids should include voices in household sounds and experimenting with volume in a quiet environment. the next recommended exposure is small parties the outdoors and finally uncontrolled areas

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