Which medication classification increases aqueous fluid outflow in the client with glaucoma?

Which action should the nurse recommend to a client with blepharitis?

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Which of the following categories of medications increases aqueous fluid outflow in the patient with glaucoma?
Which of the following medications is used for refraction during an eye exam?
Which of the following is the overall aim of glaucoma treatment?
Which of the following eye disorders is caused by an elevated intraocular pressure IOP )?

a. Soak the area in warm water
b. Sleep with the face parallel to the floor
c. Incision and drainage
d. Keep lid margins clean

d. Keep lid margins clean

Explanation:
Instructions on lid hygiene (to keep the lid margins clean and free of exudates) are given to the client. Treatment of a stye includes warm soaks of the area and incision and drainage. The client is not required to sleep with the face parallel to the floor.

To avoid the side effects of corticosteroids, which medication classification is used as an alternative to treat inflammatory conditions of the eyes?

a. Miotics
b. Mydriatics
c. Cycloplegics
d. NSAIDs

d. NSAIDs

Explanation:
NSAIDs are used as an alternative in controlling inflammatory eye conditions and postoperatively to reduce inflammation. Miotics are used to cause the pupil to constrict. Mydriatics cause the pupil to dilate. Cycloplegics cause paralysis of the iris sphincter.

A client asks the nurse what they can do to improve her vision after having a cataract removed. What is the nurse's best response?

a. "There is nothing you can do to improve your vision."
b. "To improve your vision, you need to eat more beta carotene."
c. "Having an intraocular lens implanted at the time of surgery is the best thing you can do."
d. "To improve your vision, you need to rest more."

c. "Having an intraocular lens implanted at the time of surgery is the best thing you can do."

Explanation:
Insertion of an IOL at the time of cataract surgery is the most often used method for improving vision. Most commonly, IOLs are inserted behind the iris. Ultrasonography is performed before surgery to determine the size and prescription of the IOL. A monofocal (single-vision) or multifocal lens is implanted to correct presbyopia. Eating more beta carotene and resting more will not improve your vision after cataract surgery. Option A is incorrect because it is an untrue statement.

Which of the following eye disorders is caused by an elevated intraocular pressure (IOP)?

a. Glaucoma
b. Myopia
c. Hyperopia
d. Cataracts

a. Glaucoma

Explanation:
In glaucoma, there is an abnormally high IOP. Cataracts occur when there is a clouding of the lens. Hyperopia is farsightedness. Myopia is nearsightedness.

Which of the following is the main refracting surface of the eye?

a. Conjunctiva
b. Iris
c. Cornea
d. Pupil

c. Cornea

Explanation:
The cornea is a transparent, avascular, domelike structure that covers the iris, pupil, and anterior chamber. It is the most anterior portion of the eyeball and is the main refracting surface of the eye. The iris is the colored part of the eye. The pupil is a space that dilates and constricts in response to light. Normal pupils are round and constrict symmetrically when a bright light shines on them. The conjunctiva provides a barrier to the external environment and nourishes the eye.

After a fall at home, a client hits their head on the corner of a table. Shortly after the accident, the client arrives at the ED, unable to see out of their left eye. The client tells the nurse that symptoms began with seeing spots or moving particles in the field of vision but that there was no pain in the eye. The client is very upset that the vision will not return. What is the most likely cause of this client's symptoms?

a. eye trauma
b. angle-closure glaucoma
c. chalazion
d. retinal detachment

d. retinal detachment

Explanation:
A detached retina is associated with a hole or tear in the retina caused by stretching or degenerative changes. Retinal detachment may follow a sudden blow, penetrating injury, or eye surgery.

A nurse is performing an eye examination. Which question would not be included in the examination?

a. Have you experienced blurred, double, or distorted vision?"
b. "What medications are you taking?"
c. "Are you able to raise both eyebrows?"
d. "Do any family members have any eye conditions?"

c. "Are you able to raise both eyebrows?"

Explanation:
Asking to raise both eyebrows is a test for cranial nerve VII, the facial nerve, and would not be included in an eye assessment.

A patient is to have an angiography done using fluorescein as a contrast agent to determine if the patient has macular edema. What laboratory work should the nurse monitor prior to the angiography?

a. Hemoglobin and hematocrit
b. BUN and creatinine
c. Platelet count
d. AST and ALT

b. BUN and creatinine

Explanation:
Angiography is done using fluorescein or indocyanine green as contrast agents. Fluorescein angiography is used to evaluate clinically significant macular edema, document macular capillary nonperfusion, and identify retinal and choroidal neovascularization (growth of abnormal new blood vessels) in age-related macular degeneration. It is an invasive procedure in which fluorescein dye is injected, usually into an antecubital vein. Prior to the angiography, the patient's blood urea nitrogen (BUN) and creatinine should be checked to ensure that the kidneys will excrete the contrast agent (Fischbach & Dunning, 2011).

A nurse conducted a history and physical for a newly admitted patient who states, "My arms are too short. I have to hold my book at a distance to read." The nurse knows that the patient is most likely experiencing:

a. Opacity in the lens.
b. Shrinkage of the vitreous body.
c. Decreased eye muscle tone.
d. Loss of accommodative power in the lens.

d. Loss of accommodative power in the lens.

Explanation:
Presbyopia is a refractive change that occurs with age. The lens of the eye loses accommodative power. Opacity in the lens indicates a cataract.

There are four major types of ophthalmic procedures to complete a glaucoma examination. If the health care provider wants to inspect the optic nerve, the nurse would prepare the patient for:

a. Gonioscopy.
b. Perimetry.
c. Tonometry.
d. Ophthalmoscopy.

d. Ophthalmoscopy.

Explanation:
Four major types of examinations are used in glaucoma evaluation, diagnosis, and management: tonometry to measure the IOP, ophthalmoscopy to inspect the optic nerve, gonioscopy to examine the filtration angle of the anterior chamber, and perimetry to assess the visual fields.

A client accidentally splashes chemicals into one eye. The nurse knows that eye irrigation with plain tap water should begin immediately and continue for 15 to 20 minutes. What is the primary purpose of this first aid treatment?

a. To eliminate the need for medical care
b. To hasten formation of scar tissue
c. To serve as a stopgap measure until help arrives
d. To prevent vision loss

d. To prevent vision loss

Explanation:
Prolonged eye irrigation after a chemical burn is the most effective way to prevent formation of permanent scar tissue and thus help prevent vision loss. After a potentially serious eye injury, the victim should always seek medical care. Eye irrigation isn't considered a stopgap measure.

The nurse is providing care to a client who has been admitted to the hospital for treatment of an infection. The client is visually impaired. Which of the following would be most appropriate for the nurse to do when interacting with the client?

a. Face the client when speaking directly to him.
b. Avoid using the terms "see" or "look."
c. Talk to the client in a loud tone of voice.
d. Touch the client before identifying himself or herself.

a. Face the client when speaking directly to him.

Explanation:
When interacting with a client with a visual impairment, the nurse should face the client and speak directly to the client using a normal tone of voice. It is not necessary to raise the voice unless the client asks the nurse to do so and it is not necessary to avoid the terms, "see" or "look" when interacting with the client. The nurse should identify himself or herself when approaching the client and before making any physical contact.

After surgery for removal of cataract, a client is being discharged, and the nurse has completed discharge instruction. Which client statement indicates that the outcome of the teaching plan has been met?

a. "Dots or flashing lights in my vision are to be expected for the first few days."
b. "I should avoid pulling or pushing any object that weighs more than 15 lbs."
c. "I need to keep the eye patch on for about a week after surgery."
d. "I need to wear sunglasses for the first 3 to 4 days even when I'm inside."

b. "I should avoid pulling or pushing any object that weighs more than 15 lbs."

Explanation:
After cataract surgery, the client needs to avoid lifting, pulling, or pushing any object that weighs more than 15 pounds to prevent putting excessive pressure on the surgical site. Sunglasses should be worn when outdoors during the day because the eye is sensitive to light. Dots, flashing lights, a decrease in vision, pain, and increased redness need to be reported to the physician immediately. The eye patch is worn for 24 hours after surgery, followed by eyeglasses worn during the day and a metal shield worn at night for 1 to 4 weeks.

A client diagnosed with a cataract comes into the clinic. What assessments should the nurse observe in this client?

a. A swollen lacrimal caruncle
b. A burning sensation and the sensation of an object in the eye
c. Inability to produce sufficient tears
d. Blurred or cloudy visual image

d. Blurred or cloudy visual image

Explanation:
When a cataract forms, the light is blocked from reaching the macula and the visual image becomes blurred or cloudy. The client does not experience any burning or the sensation of an object in the eye, an inability to produce sufficient tears, or a swollen lacrimal caruncle.

An aging client is brought to the eye clinic by the son. The son states he has seen his parent holding reading materials at an increasing distance to focus properly. What age-related changes does this indicate?

a. Cataract
b. Macular degeneration
c. Myopia
d. Presbyopia

d. Presbyopia

Explanation:
Refractive changes, such as presbyopia, occur in older adults where the lens cannot readily accommodate aging. In such cases, the client is observed holding reading materials at an increasing distance to focus properly. In case of a cataract, the client should report increased glare, decreased vision, and changes in color perception. Macular degeneration affects the central vision. Myopia is the inability to see things at a distance clearly.

A client has been referred to an ophthalmologist for suspected macular degeneration. The nurse knows to prepare what test for the physician to give the client?

a. Visual field
b. Amsler grid
c. Slit lamp
d. Ishihara polychromatic plates

b. Amsler grid

Explanation:
Clients with macular problems are tested with an Amsler grid. It is made up of a geometric grid of identical squares with a central fixation point. The examiner instructs the client to stare at the central fixation spot on the grid and report if they see any distortion of the squares. Clients with macular problems may say some of the squares are faded or wavy.

An Ishihara polychromatic plate, visual field, or slit lamp test will not diagnose macular degeneration.

A client has noticed recently having clearer vision at a distance than up close. What is the term used to describe this client's visual condition?

a. astigmatism
b. hyperopia
c. myopia
d. emmetropia

b. hyperopia

Explanation:
Hyperopia is farsightedness. People who are hyperopic see objects that are far away better than objects that are close.

A client who is blind is awaiting elective surgery. What should the nurse do to promote this client's control over their hospital environment?

a. Keep personal care items where the nurse knows their location.
b. Arrange the meal tray in a way that is easiest for the nurse to assist the client.
c. Ask the client where to store his or her self-care items.
d. Open all containers without prompting to be helpful.

c. Ask the client where to store his or her self-care items.

Explanation:
Ask the client's preference for where to store hygiene articles and other objects needed for self-care. Involving the client promotes his or her control over the environment. Personal care items should be kept in the same location at all times to provide the client with the ability to locate toiletries easily. At mealtime, describe where food is on the plate using the positions on the face of a clock. This measure assists the client to identify the location of food. Allow the client to open containers and offer help if needed. Having a choice facilitates independence.

A client with multiple sclerosis is being seen by a neuroophthalmologist for a routine eye exam. The nurse explains to the client that during the examination, the client will be asked to maintain a fixed gaze on a stationary point while an object is moved from a point on the side, where it can't be seen, toward the center. The client will indicate when the object becomes visible The nurse further explains that the test being performed is called a:

a. slit-lamp examination
b. retinal angiography
c. color vision test
d. perimetry test

d. perimetry test

Explanation:
A visual field test or perimetry test measures peripheral vision and detects gaps in the visual field.

The nurse is caring for a client ordered for multiple eye screening. Following which procedure will the nurse instruct the client on a yellow coloring to the skin and urine as being normal?

a. Ultrasonography
b. Retinal Angiography
c. Retinal Imaging
d. Retinoscopy

b. Retinal Angiography

Explanation:
The nurse is most correct to instruct the client that his skin and urine may turn yellow following a retinal angiography. Sodium fluorescein is a water-soluble dye that is injected into a vein. The dye then travels to the retinal arteries and capillaries, where pictures are obtained of the vascular supply. The other options do not include a dye injection.

A 52-year-old comes to the clinic for a follow-up examination after being diagnosed with glaucoma. The client states, "I'm hoping that I don't have to use these drops for very long." Which response by the nurse would be most appropriate?

a. "You'll need to use the drops for the rest of your life to control the glaucoma."
b. "These drops are just the first step to make sure that your vision doesn't get worse."
c. "Most clients need to use the drops for only about a few months."
d. "If the drops don't work, surgery may be needed to cure your condition."

a. "You'll need to use the drops for the rest of your life to control the glaucoma."

Explanation:
The client is demonstrating a lack of understanding about the condition and its treatment. The nurse needs to provide additional information to the client that the condition can be controlled but not cured. The statement about lifelong therapy would be most appropriate. Eye medications would most likely be needed for the long term, not just a few months. Surgery may be used in conjunction with medication therapy; however, neither method cures the condition. The goal of therapy is to reduce the intraocular pressure to prevent optic nerve damage. In some clients, medication may be all that is needed. In other cases, additional or combintation treatment with surgery or laser procedures may be necessary.

Which of the following occurs when there is deviation from perfect ocular alignment?

a. Strabismus
b. Chemosis
c. Nystagmus
d. Ptosis

a. Strabismus

Explanation:
Strabismus is a condition in which there is deviation from perfect ocular alignment. Ptosis is a drooping eyelids. Chemosis is edema of the conjunctiva. Nystagmus is an involuntary oscillation of the eyeball.

Which category of drugs is contraindicated in clients with glaucoma?

a. prostaglandins
b. NSAIDs
c. mydriatics
d. beta-blockers

c. mydriatics

Explanation:
Dilation of the pupil can further obstruct drainage of aqueous fluid, raise IOP, and damage whatever vision remains. Atropine is contraindicated in clients with glaucoma.

A client is having a routine eye examination. The procedure being performed is done by using an instrument to indent or flatten the surface of the eye. This is known as ________ and it is routinely done to test for ________.

a. retinoscopy; cataracts
b. tonometry; intraocular pressure
c. retinoscopy; detached retina
d. tonometry; macular degeneration

b. tonometry; intraocular pressure

Explanation:
The procedure being performed is known as tonometry and it measures intraocular pressure.

A client with chronic open-angle glaucoma is now presenting with eye pain and intraocular pressure of 50 mm Hg. An immediate iridotomy is scheduled. Which of the following describes the desired effects of this procedure?

a. Reverse optic nerve damage
b. Improve outflow drainage
c. To relieve pain
d. Restore vision

b. Improve outflow drainage

Explanation:
Laser iridotomy or standard iridotomy is a surgical procedure that provides additional outlet drainage of aqueous humor. This is done to lower the IOP as quickly as possible since permanent vision loss can occur in 1 to 2 days. Once optic nerve damage occurs, it cannot be reversed, and vision is not restored. Pain that occurs with rising IOP will be controlled once pressure is lowered through improved outflow drainage.

The nurse at the eye clinic is caring for a patient with suspected glaucoma. What complaint would be significant for a diagnosis of glaucoma?

a. A significant loss of central vision
b. Diminished acuity
c. The presence of halos around lights
d. Pain associated with a purulent discharge

c. The presence of halos around lights

Explanation:
Glaucoma is often called the "silent thief of sight" because most patients are unaware that they have the disease until they have experienced visual changes and vision loss. The patient may not seek health care until he or she experiences blurred vision or "halos" around lights, difficulty focusing, difficulty adjusting eyes in low lighting, loss of peripheral vision, aching or discomfort around the eyes, and headache.

What type of medication would the nurse use in combination with mydriatics to dilate the patient's pupil?

a. NSAIDs
b. Cycloplegics
c. Anti-infectives
d. Corticosteroids

b. Cycloplegics

Explanation:
Mydriasis, or pupil dilation, is the main objective of the administration of mydriatics and cycloplegics (Table 63-3). These two types of medications function differently and are used in combination to achieve the maximal dilation that is needed during surgery and fundus examinations to give the ophthalmologist a better view of the internal eye structures.

An ophthalmologist tells a patient that he has a cataract. The nurse explains to the patient that this means there is:

a. Distortion and loss of central vision.
b. A tendency for the retina to tear.
c. Interference with focusing of a sharp image.
d. Increased corneal exposure.

c. Interference with focusing of a sharp image.

Explanation:
Refer to Table 48-1 in the text for the distinguishing functional changes associated with a cataract.

When conducting an eye exam, the nurse practitioner is aware that a diagnostic clinical manifestation of glaucoma is:

a. The presence of halos around lights.
b. Pain associated with a purulent discharge.
c. Diminished acuity.
d. A significant loss of central vision.

a. The presence of halos around lights.

Explanation:
Most patients are unaware that they have glaucoma until they experience visual changes and vision loss. Usually the patient notices blurred vision and the presence of "halos" around lights.

A patient visits a clinic for an eye examination. He describes his visual changes and mentions a specific diagnostic clinical sign of glaucoma. What is that clinical sign?

a. Pain associated with a purulent discharge
b. The presence of halos around lights
c. A significant loss of central vision
d. Diminished acuity

b. The presence of halos around lights

Explanation:
Colored halos around lights is a classic symptom of acute-closure glaucoma.

Which is the most common cause of visual loss in people older than 60 years of age?

a. Macular degeneration
b. Glaucoma
c. Cataracts
d. Retinal detachment

a. Macular degeneration

Explanation:
Macular degeneration is the most common cause of visual loss in people older than 60 years of age.

The nures is assessing a client using an Amsler Grid. The nurse is assessing for which of the following?

a. Visual field
b. Macular problems
c. Visual acuity
d. Intraocular pressure

b. Macular problems

Explanation:
The Amsler grid is a test used to assess clients for macular problems. Visual acuity is tested using the Snellen chart. Intraocular pressure is measured using tonometry. Perimetry testing evaluates the field of vision.

Which nursing intervention should be included during the assessment of a client with an eye disorder?

a. Instruct the client to stare at the central fixation spot on an Amsler grid and report if he or she sees any distortion of the squares.
b. Examine the retina with a direct ophthalmoscope.
c. Use a tonometer to indent or flatten the surface of the eye.
d. Check the extraocular muscles by instructing the client to keep his or her head still when following an object.

d. Check the extraocular muscles by instructing the client to keep his or her head still when following an object.

Explanation:
When assessing a client with an eye disorder, the nurse should check the extraocular muscles by instructing the client to keep his or her head still when following an object. A qualified examiner, not the nurse, should assess the client by examining the retina with a direct ophthalmoscope, using a tonometer, or an Amsler grid.

The nurse admits a client to the emergency department who has been referred by the eye clinic. Which condition is an emergency where the nurse should refer the client for medical treatment immediately?

a. Blepharitis
b. Chalazion
c. Hordeolum
d. Acute angle-closure glaucoma

d. Acute angle-closure glaucoma

Explanation:
Acute angle-closure glaucoma is an emergency where the nurse should refer the client for medical treatment immediately because vision may be permanently lost in 1 to 2 days. Treatment of a chalazion is not necessary if the cyst is small and does not interfere with vision. Occurrence of a hordeolum or blepharitis is not an emergency and may be treated with warm soaks or frequent washing of the eye.

Which part of the retina is responsible for central vision?

a. Optic disk
b. Macula
c. Sclera
d. Fundus

b. Macula

Explanation:
The macula is the area of the retina responsible for central vision. The optic disk is the point of entrance of the optic nerve into the retina. The sclera helps maintain the shape of the eyeball and protects the intraocular contents from trauma. The fundus is the largest chamber of the eye and contains the vitreous humor.

Which of the following medication classifications increases aqueous fluid outflow in the patient with glaucoma?

a. Alpha-adrenergic agonists
b. Cholinergics
c. Beta blockers
d. Carbonic anhydrase inhibitors

b. Cholinergics

Explanation:
Cholinergics increase aqueous fluid outflow by contracting the ciliary muscle, causing miosis and opening the trabecular meshwork. Beta blockers decrease aqueous humor production. Alpha-adrenergic agonists decrease aqueous humor production. Carbonic anhydrase inhibitors decrease aqueous humor production.

A nurse is obtaining a history from a new client with glaucoma. The client indicates having read about the diagnosis and understanding that this type of glaucoma is due to the degeneration and obstruction of the trabecular meshwork, whose original function is to absorb the aqueous humor. The loss of absorption will lead to an increased resistance, and thus a chronic, painless buildup of pressure in the eye. Which type of glaucoma has the client described?

a. congenital
b. secondary
c. open angle
d. angle closure

c. open angle

Explanation:
The client described open-angle glaucoma. This type of glaucoma develops painlessly, and visual changes occur slowly. As the IOP rises, it causes edema of the cornea, atrophy of nerve fibers in the peripheral areas of the retina, and degeneration of the optic nerve.

The nurse is obtaining a history on a client stating the inability to read the newspaper and even seeing detail when looking at an image. Which assessment test would add additional data for a diagnosis?

a. Assess vision on the Snellen chart.
b. Assess peripheral vision.
c. Assess color vision.
d. Assess if the pupils are equal and reactive to light.

b. Assess peripheral vision.

Explanation:
The client states symptoms of the inability to discriminate letters, words, and details of an image, indicating the degeneration of the macula. If the macula is damaged, the client will only have the ability to see movement and gross objects in the peripheral fields. Assessing the peripheral vision will add essential information. The other visual tests are not as important at this time.

During assessment of a patient with a hearing loss, the nurse notes a defect in the tympanic membrane. The nurse documents this disturbance as a loss known as:

a. Sensorineural.
b. Functional.
c. Mixed.
d. Conductive.

d. Conductive.

Explanation:
A defect in the tympanic membrane or interruption of the ossicular chain disrupts normal air conduction, which results in a conductive hearing loss.

An ophthalmologist diagnoses a patient with myopia. The nurse explains that this type of impaired vision is a refractive error characterized by:

a. Farsightedness.
b. Blurred distance vision.
c. A shorter depth to the eyeball.
d. Eyes that are shallow.

b. Blurred distance vision

Explanation:
People who have myopia are said to be nearsighted. They have deeper eyeballs; thus, the distant visual image focuses in front of, or short of, the retina. Myopic people experience blurred distance vision.

A client has just been diagnosed with early glaucoma. During a teaching session, the nurse should:

a. provide instructions on eye patching.
b. assess the client's visual acuity.
c. demonstrate eyedrop instillation.
d. teach about intraocular lens cleaning.

c. demonstrate eyedrop instillation.

Explanation:
Eyedrop instillation is a critical component of self-care for a client with glaucoma. After demonstrating eyedrop instillation to the client and family, the nurse should verify their ability to perform this measure properly. An eye patch isn't necessary unless the client has undergone surgery. Visual acuity assessment isn't necessary before discharge. Intraocular lenses aren't implanted in clients with glaucoma.

Which term refers to the absence of the natural lens?

a. Aphakia
b. Scotoma
c. Keratoconus
d. Hyphema

a. Aphakia

Explanation:
When a cataract is extracted and an intraocular lens implant is not used, the client demonstrates aphakia. Scotoma refers to a blind or partially blind area in the visual field. Keratoconus refers to a cone-shaped deformity of the cornea. Hyphema refers to blood in the anterior chamber of the eye.

When the client tells the nurse that his vision is 20/200 and then asks what that means, the nurse informs the client that a person with 20/200 vision

a. sees an object from 200 feet away that a person with normal vision sees from 20 feet away.
b. sees an object from 20 feet away just like a person with normal vision.
c. sees an object from 200 feet away just like a person with normal vision.
d. sees an object from 20 feet away that a person with normal vision sees from 200 feet away.

d. sees an object from 20 feet away that a person with normal vision sees from 200 feet away (must be 20 ft away, rather than 200, to see)

Explanation:
The fraction 20/20 is considered the standard of normal vision. Most people can see the letters on an eye chart designated as 20/20 from a distance of 20 feet.

A nurse instructs a client to refrain from blinking after administering eye drops based on which rationale?

a. Blinking keeps substances from entering the eye.
b. Blinking causes the eye drop to be expelled from the conjunctival sac.
c. Blinking limits the size of the conjunctival sac for the needed amount of eye drop.
d. Blinking slows absorption of the instilled eye drops.

b. Blinking causes the eye drop to be expelled from the conjunctival sac.

Explanation:
Blinking expels an instilled eye drop from the conjunctival sac, which interferes wtih the efficacy of the medication. Blood-ocular barriers keep foreign substances from entering the eye. The size of the conjunctival sac does change with blinking. It can hold only 50 uL.

The nurse is giving a visual field examination to a 55-year-old male client. The client asks what this test is for. What would be the nurse's best answer?

a. "This test measures visual acuity."
b. "This test measures how well your eyes move."
c. "This test is to see how well your eyes are aging."
d. "This test measures peripheral vision and detects gaps in the visual field."

d. "This test measures peripheral vision and detects gaps in the visual field."

Explanation:
A visual field examination or perimetry test measures peripheral vision and detects gaps in the visual field.

A client having an eye exam asks the nurse what she can do to help prevent cataracts. What dietary recommendations should a nurse give to a client to prevent cataracts?

a. Calcium with vitamin D
b. Foods rich in purine
c. Fat-free foods
d. Vitamins A and C

d. Vitamins A and C

Explanation:
Studies have shown that vitamins A and C are essential for preventing cataracts. Calcium with vitamin D, foods rich in purine, and fat-free foods have no implications on prevention of cataracts.

The nurse is teaching a parent how to instill drops in their 12-year-old son's eyes. Which action would the nurse teach is accomplished first?

a. Close the eye gently.
b. Tilt the head slightly backward.
c. Instill the prescribed number of drops into the conjunctival pocket.
d. Do not allow the tip of the container to touch the eye.

b. Tilt the head slightly backward.

Explanation:
To instill eye drops: Tilt the head slightly backward and toward the eye in which the medication is to be instilled; Do not allow the tip of the container to touch the eye; Instill the prescribed number of drops into the conjunctival pocket, or apply a thin ribbon of ointment directly into the conjunctival pocket, beginning at the inner corner and moving outward; Close the eye gently. Options A, C, and D are not the first action in instilling eye drops.

When the patient tells the nurse that his vision is 20/200, and asks what that means, the nurse informs the patient that a person with 20/200 vision:

a. Sees an object from 200 feet away that a person with normal vision sees from 20 feet away.
b. Sees an object from 20 feet away that a person with normal vision sees from 200 feet away.
c. Sees an object from 20 feet away that a person with normal vision sees from 20 feet away.
d. Sees an object from 200 feet away that a person with normal vision sees from 200 feet away.

b. Sees an object from 20 feet away that a person with normal vision sees from 200 feet away.

Which type of benign tumor of the eyelids is characterized by superficial, vascular capillary lesions that are strawberry-red in color?

a. Hemangioma
b. Nevi
c. Milia
d. Xanthelasma

a. Hemangioma

Explanation:
Hemangiomas are vascular capillary tumors that may be bright, superficial, strawberry-red lesions or bluish and purplish deeper lesions. Milia are small, white, slightly elevated cysts of the eyelid that may occur in multiples. Xanthelasma are yellowish, lipoid deposits on both lids near the inner angle of the eye; these commonly appear as a result of the aging of the skin or a lipid disorder. Nevi are freckles.

A young client is being seen by a pediatric ophthalmologist due to a recent skateboarding accident that resulted in trauma to the right cornea, and is now at risk of developing an infection. Which nursing intervention would be contraindicated for a client at risk for infection?

a. To ensure correct application of antibiotic ointment, gently drag tip of tube along lower lid while squeezing ointment on to lid.
b. Avoid using a container of ophthalmic medication for anyone other than the client.
c. Change gauze eye bandages using aseptic technique.
d. Wash hands before examining the eyes or performing any procedure about the face.

a. To ensure correct application of antibiotic ointment, gently drag tip of tube along lower lid while squeezing ointment on to lid.

Explanation:
Avoid contaminating the medication dropper or tube by holding the tip above the eye and adjacent tissue. Using a separate container of ophthalmic medication for each client prevents cross-contamination. Maintaining asepsis prevents the introduction and transmission of infection. Handwashing prevents infection.

A client who is blind is awaiting elective surgery. What should the nurse do to promote this client's control over their hospital environment?

a. Ask the client where to store his or her self-care items.
b. Keep personal care items where the nurse knows their location.
c. Arrange the meal tray in a way that is easiest for the nurse to assist the client.
d. Open all containers without prompting to be helpful.

a. Ask the client where to store his or her self-care items.

Which medication is used to treat glaucoma by pulling the iris away from the drainage channels so that aqueous fluid can escape?

a. carbachol
b. latanoprost
c. bimatoprost
d. timolol

a. carbachol

Explanation:
Miotics constrict the pupil, pulling the iris away from the drainage channels so that aqueous fluid can escape. Prostaglandins increase the outflow of the fluid in the eye and reduce IOP. Beta-blockers decrease the flow rate of aqueous humor into the eye.

A client has developed diabetic retinopathy and is seeing the physician regularly to prevent further loss of sight. From where do the nerve cells of the retina extend?

a. optic nerve
b. oculomotor nerve
c. trochlear nerve
d. trigeminal nerve

a. optic nerve

Explanation:
The nerve cells of the retina extend from the optic nerve.

A client has undergone enucleation. What complication of enucleation should be addressed by the nurse?

a. Hypotension
b. Nausea and vomiting
c. Hemorrhage
d. Pneumonia

c. Hemorrhage

Explanation:
The nurse should take measures to prevent hemorrhage, a complication of enucleation, by applying a pressure dressing. Nausea and vomiting may be common side effects of surgery. Enucleation does not increase risk of developing hypotension or pneumonia.

A client's vision is assessed at 20/200. The client asks what that means. Which is the most appropriate response by the nurse?

a. "You see an object from 200 feet away that a person with normal vision sees from 20 feet away."
b. "You see an object from 20 feet away just like a person with normal vision."
c. "You see an object from 200 feet away just like a person with normal vision."
d. "You see an object from 20 feet away that a person with normal vision sees from 200 feet away."

d. "You see an object from 20 feet away that a person with normal vision sees from 200 feet away."

A client has been prescribed eye drops for the treatment of glaucoma. At the yearly follow-up appointment, the client tells the nurse that she has stopped using the medication because her vision did not improve. Which action by the nurse is appropriate?

a. Explain the therapeutic effect and expected outcome of the medication.
b. Talk with the doctor about switching to a different glaucoma medication.
c. Administer the medication immediately.
d. Refer the patient to the emergency department.

a. Explain the therapeutic effect and expected outcome of the medication.

Explanation:
The nurse needs to explain the therapeutic effect and expected outcome of the medication. The medication is not a cure for glaucoma, but can slow the progression. The client will not see improvements in vision with the use of the medication but should experience little to no deterioration of vision. The doctor may choose to switch the medication, but not because the vision is not improving; it would be based on not obtaining the set intraocular pressure. Administering the medication immediately or referring the client to the emergency department is not appropriate because this is not an emergent situation.

A patient has had cataract extractions and the nurse is providing discharge instructions. What should the nurse encourage the patient to do at home?

a. Maintain bed rest for 1 week.
b. Lie on the stomach while sleeping.
c. Avoid bending the head below the waist.
d. Lift weights to increase muscle strength.

c. Avoid bending the head below the waist.

Explanation:
The nurse should encourage the patient to avoid bending or stooping for an extended period. Keep activity light. Avoid lying on the side of the affected eye the night after surgery. Avoid lifting, pushing, or pulling objects heavier than 15 pounds.

On ocular examination, the health care provider notes severely elevated IOP, corneal edema, and a pupil that is fixed in a semi-dilated position. The nurse knows that these clinical signs are diagnostic of the type of glaucoma known as:

a. Chronic open-angle.
b. Normal tension.
c. Acute angle-closure.
d. Chronic angle-closure.

c. Acute angle-closure.

Explanation:
Acute angle-closure glaucoma is characterized by the symptoms listed, as well as by being rapidly progressive and accompanied by pain.

During an intial assessment, the nurse notes a symptom of a mild case of bacterial conjunctivitis and documents in the electronic medical record that the client is displaying which of the following?

a. Blurred vision
b. Elevated intraocular pressure
c. Mucopurulent ocular discharge
d. Severe pain

c. Mucopurulent ocular discharge

Explanation:
Bacterial conjunctivitis manifests with an acute onset of redness, burning, and discharge. Purulent discharge occurs in severe acute bacterial infections, whereas mucopurulent discharge appears in mild cases.

A client is color blind. The nurse understands that this client has a problem with:

a. rods.
b. cones.
c. lens.
d. aqueous humor.

b. cones.

Explanation:
Cones provide daylight color vision, and their stimulation is interpreted as color. If one or more types of cones are absent or defective, color blindness occurs. Rods are sensitive to low levels of illumination but can't discriminate color. The lens is responsible for focusing images. Aqueous humor is a clear watery fluid and isn't involved with color perception.

The nurse should monitor for which manifestation in a client who has undergone LASIK?

a. Excessive tearing
b. Cataract formation
c. Halos and glare
d. Stye formation

c. Halos and glare

Explanation:
Symptoms of central islands and decentered ablations can occur after LASIK surgery; these include monocular diplopia or ghost images, halos, glare, and decreased visual acuity. These procedures do not cause excessive tearing or result in cataract or stye formation.

When undergoing testing of visual acuity with a Snellen chart, the client can read the line labeled 20/50 but misses three letters on the line. The nurse documents this finding as which of the following?

a. 20/20 + 30
b. 20/20/50
c. 20/50-3
d. 20/50

c. 20/50-3

Explanation:
The nurse would document the finding as 20/50-3, indicating that the client missed three of the letters on the line 20/50.

Which client statement would lead the nurse to suspect that the client is experiencing bacterial conjunctivitis?

a. "My eyes feel like they are on fire."
b. "My eyelids were stuck together this morning."
c. "It feels like there is something stuck in my eye."
d. "My eyes hurt when I'm in the bright sunlight."

b. "My eyelids were stuck together this morning."

Explanation:
Burning, a sensation of a foreign body, and pain in bright light (photophobia) are signs and symptoms associated with any type of conjunctivitis. The drainage related to bacterial conjunctivitis is usually present in the morning, and the eyes may be difficult to open becacuse of adhesions caused by the exudate.

Which of the following medications needs to be withheld for 5 to 7 days prior to cataract surgery?

a. Coumadin
b. Prednisone
c. Lasix
d. Glucophage

a. Coumadin

Explanation:
It has been common practice to withhold any anticoagulant therapy such as Coumadin to reduce the risk for retrobulbar hemorrhage (after retrobulbar injection) for 5 to 7 days before surgery.

A patient has been brought to the emergency room after being hit in the head with a baseball. The nurse should be alert to which of the following clinical manifestations of a detached retina? Select all that apply.

a. Bright flashing lights
b. Sudden onset of floaters
c. Cobwebs
d. Sensation of a curtain coming across vision of one
eye
e. Pain

a. Bright flashing lights
b. Sudden onset of floaters
c. Cobwebs
d. Sensation of a curtain coming across vision of
one eye

Explanation:
Patients may report the sensation of a shade or curtain coming across the vision of one eye, cobwebs, bright flashing lights, or the sudden onset of a great number of floaters. Patients do not complain of pain.

A client suffered trauma to the sclera and is being treated for a subsequent infection. During client education, the nurse indicates where the sclera is attached. Which structure would not be included?

a. eyelids
b. cornea
c. iris
d. pupil

a. eyelids

Explanation:
The sclera does not attach to the eyelids. The sclera protects structures in the eye, and connects directly to the cornea, anterior chamber, iris, and pupil.

Following cataract removal, discharge instructions will be provided to the client. Which of the following instructions is most important?

a. Apply protective patch to both eyes at bedtime.
b. Only sleep on back.
c. Avoid washing face and eyes for first 24 hours.
d. Avoid any activity that can increase intraocular
pressure.

d. Avoid any activity that can increase intraocular
pressure.

Explanation:
For approximately 1 week, the client should avoid any activity that can cause an increase in intraocular pressure. Clients may sleep on back or unaffected side. Clients may use a clean damp cloth to remove eye discharge and wash face. An eye shield is often ordered for the first 24 hours and during the night to prevent rubbing or trauma to the operative eye.

Which surgical procedure involves flattening the anterior curvature of the cornea by removing a stromal lamella layer?

a. Photorefractive keratectomy (PRK)
b. Laser-assisted stromal in situ keratomileusis (LASIK) c. Keratoconus
d. Keratoplasty

b. Laser-assisted stromal in situ keratomileusis
(LASIK)

Explanation:
LASIK involves flattening the anterior curvature of the cornea by removing a stromal lamella or layer. PRK is used to treat myopia and hyperopia with or without astigmatism. Keratoconus is a cone-shaped deformity of the cornea. Keratoplasty involves replacing abnormal host tissue with healthy donor (cadaver) corneal tissue.

Which term refers to swelling of the optic disc due to increased intracranial pressure?

a. Ptosis
b. Chemosis
c. Papilledema
d. Photophobia

c. Papilledema

Explanation:
Papilledema is swelling of the optic disc due to increased intracranial pressure. Chemosis is edema of the conjunctiva. Ptosis is a drooping eyelid. Photophobia is ocular pain on exposure to light.

To avoid the side effects of corticosteroids, which medication classification is used as an alternative in treating inflammatory conditions of the eyes?

a. Miotics
b. Nonsteroidal anti-inflammatory drugs (NSAIDs)
c. Mydriatics
d. Cycloplegics

b. Nonsteroidal anti-inflammatory drugs (NSAIDs)

The nurse is administering an ophthalmic ointment to a patient with conjunctivitis. What disadvantage of the application of an ointment does the nurse explain to the patient?

a. It does not work as rapidly as eye drops do.
b. Blurred vision results after application.
c. It has a lower concentration than eye drops.
d. It has more side effects than eye drops.

b. Blurred vision results after application.

Explanation:
Ophthalmic ointments have extended retention time in the conjunctival sac and provide a higher concentration than eye drops. The major disadvantage of ointments is the blurred vision that results after application. In general, eyelids and eyelid margins are best treated with ointments.

Chemical burns of the eye are immediately treated by:

a. Administering local anesthetics and antibacterial
drops for 24 to 36 hours.
b. Applying hot compresses at 15-minute intervals.
c. Flushing the lids, conjunctiva, and cornea with tap
water or normal saline.
d. Cleansing the conjunctiva with a small cotton-tipped
applicator.

c. Flushing the lids, conjunctiva, and cornea with
tap water or normal saline.

Explanation:
The immediate response is to always flush the affected eyelid and eye with normal saline or tap water to dilute the effectiveness of the agent that is causing the burn.

A nurse practitioner examines a patient and documents a best corrected visual acuity (BCVA) ratio in his better eye that qualifies him for government financial assistance based on the definition of legal blindness. What is that ratio?

a. 20/120
b. 20/140
c. 20/160
d. 20/200

d. 20/200

Explanation:
Legal blindness is a condition of impaired vision in which a person has a BCVA that does not exceed 20/200 in the better eye or whose widest visual field diameter is 20 degrees or less.

A major role for nursing in the management of glaucoma is health education. Which of the following is the most important teaching point that the nurse should advise the patient of?

a. Keep all follow-up appointments.
b. Keep a record of eye pressure measurements.
c. Adhere to the medication regimen.
d. Participate in the decision-making process.

c. Adhere to the medication regimen.

Explanation:
All of the teaching points are important but the most important is emphasizing the strict adherence to the medication regimen because glaucoma cannot be cured but its progression can be slowed.

Which of the following is the leading cause of blindness in the United States?

a. Glaucoma
b. Cataracts
c. Retinal detachment
d. Macular degeneration

a. Glaucoma

Explanation:
Glaucoma is one of the leading causes of irreversible blindness in the world and is the leading cause of blindness among adults in the United States.

The nurse is demonstrating how to perform punctal occlusion. Which activities does the nurse perform?

a. Applies gentle pressure bilaterally on the bridge of
the nose to the inner canthus of each eye
b. Holds down the lower lid of the eye by applying
pressure on the eyeball and the cheekbone
c. Applies gentle pressure to the upper eyelid to keep
the lid open while telling the client to gaze upward
d. Applies firm pressure to the upper and lower eyelids
at the outer edges to keep eyelids in approximation

a. Applies gentle pressure bilaterally on the bridge
of the nose to the inner canthus of each eye

Explanation:
Punctal occlusion is done by applying gentle pressure to the inner canthus of each eye for 1 to 2 minutes immediately after eye drops are instilled. The nurse does not apply pressure to the eyeball when administering medications. The lower eyelid is held down to expose the conjunctival sac. The other action described will not aid in the retention or absorption of medication.

During a routine eye examination, a patient complains that she is unable to read road signs at a distance when driving her car. What should the patient be assessed for?

a. Astigmatism
b. Anisometropia
c. Myopia
d. Presbyopia

c. Myopia

Explanation:
Some people have deeper eyeballs, in which case the distant visual image focuses in front of, or short of, the retina; those with myopia Impaired Vision are said to be nearsighted and have blurred distance vision.

Prior to an eye exam for possible macular degeneration, the nurse completes a history of symptoms. The nurse is aware that a diagnostic sign of age-related dry macular degeneration is:

a. The abrupt onset of symptoms.
b. Reporting that a straight line appears crooked.
c. The appearance of tiny, yellow spots in the field of
vision.
d. Reporting that letters in words appear broken.

c. The appearance of tiny, yellow spots in the field
of vision.

Explanation:
Drusen are tiny yellow spots that patients who have dry AMD report.

A client comes to the eye clinic for a routine check-up. The client tells the nurse he thinks he is color blind. What screening test does the nurse know will be performed on this client to assess for color blindness?

a. Rosenbaum
b. Jaeger
c. Ishihara
d. Snellen

c. Ishihara

Explanation:
Color vision is assessed with Ishihara polychromatic plates. The client receives a series of cards on which the pattern of a number is embedded in a circle of colored dots. The numbers are in colors that color-blind persons commonly cannot see. Clients with normal vision readily identify the numbers. The Jaeger and the Rosenbaum test near vision while the Snellen tests far vision.

A client with glaucoma has been given a prescription for a mydriatic drug. What is a priority action of the nurse?

a. Tell the physician.
b. Nothing.
c. Have the client fill the prescription.
d. Have the client ask the physician for another drug.

a. Tell the physician.

Explanation:
Mydriatics (drugs that dilate the pupil) must never be administered to clients with glaucoma. The nurse should tell the physician right away. The client should not fill the prescription. The client should not ask the physician for another prescription.

A client has just been diagnosed with glaucoma. What teaching should the nurse include with this client?

a. How long they have to wear dark glasses.
b. Maintain regular bowel habits.
c. What vegetables to eat.
d. When they can read again.

b. Maintain regular bowel habits.

Explanation:
Instructions for the client with glaucoma include the following: Obtain assistance from a family member, relative, or friend if you have trouble instilling eyedrops; Avoid all drugs that contain atropine; Check with physician or pharmacist before using any nonprescription drug; preparations for cold or allergy symptoms may contain an atropine-like drug; Maintain regular bowel habits; straining at stool can raise IOP; Avoid heavy lifting and emotional upsets (especially crying) because they increase IOP.

A client comes to the eye clinic for an examination. The client tells the nurse that his vision is like a target with the bull's eye area of the image missing. What would the nurse suspect?

a. Retinal detachment
b. Fractured orbit
c. Conjunctivitis
d. Macular degeneration

d. Macular degeneration

Explanation:
When the macula becomes irreparably damaged, clients compare their vision to a target in which the bull's-eye area of the image is absent. Retinal detachment, a fractured orbit, and conjunctivitis do not present with vision likened to a target with the bull's eye portion missing.

The upper eyelid normally covers the uppermost portion of the iris and is innervated by which cranial nerve?

a. III
b. I
c. IV
d. II

a. III

Explanation:
The upper lid is innervated by the oculomotor nerve (CN III). Cranial nerve I is the olfactory nerve, cranial nerve II is the optic nerve, and cranial nerve IV is the trochlear nerve.

Viewed through the pupil, the landmarks of the retina are which of the following? Select all that apply.

a. Optic disk
b. Retinal vessels
c. Macula
d. Pupil
e. Iris

a. Optic disk
b. Retinal vessels
c. Macula

Explanation:
Viewed through the pupil, the landmarks of the retina are the optic disk, the retinal vessels, and the macula. The pupil and iris are not landmarks of the retina.

Which of the following is the role of the nurse toward a patient who is to undergo eye examinations and tests?

a. Ensuring that the patient receives eye care to
preserve his or her eye function and prevent further
visual loss
b. Conducting various tests to determine the function
and the structure of the eyes
c. Determining if further action is warranted
d. Advising the patient on the diet and exercise
regimen to be followed

a. Ensuring that the patient receives eye care to
preserve his or her eye function and prevent
further visual loss

Explanation:
Although nurses may not be directly involved in caring for patients who are undergoing eye examinations and tests, it is essential that they ensure that patients receive eye care to preserve their eye function and/or prevent further visual loss. The nurse is not involved in conducting the various tests to determine the status of the eyes and in determining if further action is warranted. Patients who are to undergo eye examinations and tests are not required to modify their diet and exercise regimen.

The nurse should monitor for which manifestation in a client who has had LASIK surgery?

a. Excessive tearing
b. Cataract formation
c. Halos and glare
d. Stye formation

c. Halos and glare

Explanation:
After LASIK surgery, symptoms of central islands and decentered ablations can occur that include monocular diplopia or ghost images, halos, glare, and decreased visual acuity. These procedures do not cause excessive tearing or result in cataract or stye formation.

A client is diagnosed with a corneal abrasion and the nurse has administered proparacaine hydrochloride per orders to assess visual acuity. The client requests a prescription for this medication because it completely took away the pain. What is the best response by the nurse?

a. "I will let the doctor know."
b. "Prescriptions of this medication are generally not
given because it can cause corneal problems."
c. "It is standard for the doctor to write a prescription
for this medication."
d. "Usually we will send you home with this bottle and
written instructions for administering the
medication."

b. "Prescriptions of this medication are generally
not given because it can cause corneal
problems."

Explanation:
Proparacaine hydrochloride can cause corneal softening and other complications if overused. Clients with corneal abrasions or other painful eye disorders have a tendency to overuse the medication, thus leading to the complications. It would not be appropriate to give the bottle with written instructions, and it is not a standard prescription for eye disorders because of the complications from overuse. Telling the client that you will let the doctor know does not provide the education needed about this medication.

During a routine physical examination, the nurse practitioner notes that a 72-year-old patient has a significant loss of ability to discriminate words. The patient also states that he has noticed that he has trouble hearing high-frequency sounds. The nurse suspects that the patient has an age-related change in his ears known as:

a. Cerumen hardening.
b. Alterations in the vestibulospinal reflex.
c. Thickening of the eardrum.
d. Degeneration of the organ of Corti.

d. Degeneration of the organ of Corti.

Explanation:
Degeneration of the organ of Corti causes a decreased ability to discriminate high frequencies or to interpret consonant sounds. Refer to Table 48-2 in the text. Alterations in the vestibulospinal reflex affect balance and gait.

A client with an inflammatory ophthalmic disorder has been receiving repeated courses of a corticosteroid ointment, one-half inch in the lower conjunctival sac four times a day as directed. The client reports a headache and blurred vision. The nurse suspects that these symptoms represent:

a. expected drug effects that should diminish over time.
b. common adverse reactions to corticosteroid therapy.
c. incorrect ointment application.
d. increased intraocular pressure (IOP).

d. increased intraocular pressure (IOP).

Explanation:
Headache and blurred vision are symptoms of increased IOP, such as from glaucoma. Ophthalmic corticosteroids may trigger an episode of acute glaucoma in susceptible clients. Although the effects of some drugs may diminish with continued use, this doesn't happen with ophthalmic corticosteroids. Incorrect ointment application doesn't cause headache or blurred vision.

Which statement is accurate regarding refractive surgery?

a. Refractive surgery is an elective, cosmetic surgery performed to reshape the cornea.
b. Refractive surgery may be performed on all clients, even if they have underlying health conditions.
c. Refractive surgery will alter the normal aging of the eye.
d. Refractive surgery may be performed on clients with an abnormal corneal structure as long as they have a stable refractive error.

a. Refractive surgery is an elective, cosmetic surgery performed to reshape the cornea.

Explanation:
Refractive surgery is an elective procedure and is considered a cosmetic procedure (to achieve clear vision without the aid of prosthetic devices). It is performed to reshape the cornea for the purpose of correcting all refractive errors. Refractive surgery will not alter the normal aging process of the eye. Clients with conditions that are likely to adversely affect corneal wound healing (corticosteroid use, immunosuppression, elevated intraocular pressure) are not good candidates for the procedure. The corneal structure must be normal and refractive error stable.

Which feature should a nurse observe during an ophthalmic assessment?

a. Appearance of the external eye
b. Internal eye function
c. Visual acuity
d. Intraocular pressure

a. Appearance of the external eye

Explanation:
During an ophthalmic assessment, the nurse should examine the appearance of the external eye and the pupil responses in the client. A qualified examiner determines internal eye function, visual acuity, and intraocular pressure.

Which are accurate clinical manifestations of a retinal detachment?

a. Cobwebs
b. Pain
c. Sudden onset of a greater number of floaters
d. Bright flashing lights

c. Sudden onset of a greater number of floaters

Explanation:
Clients may report the sensation of a shade or curtain coming across the vision of one eye, cobwebs, bright flashing lights, or the sudden onset of a great number of floaters. Clients with retinal detachment do not complain of pain.

A client comes to the clinic for a routine examination. After obtaining the ocular history, which of the following would the nurse do next?

a. Test the client's visual acuity.
b. Prepare the client for a slit-lamp examination.
c. Perform direct ophthalmoscopy.
d. Examine the external eye.

a. Test the client's visual acuity.

Explanation:
After obtaining the client's ocular history, the nurse would test the client's visual acuity. Then the nurse would examine the client's external eye. Direct ophthalmoscopy would follow, and then other examinations, such as a slit-lamp examination, would be done.

A client who had a corneal transplant a few months ago arrives at the emergency department reporting eye discomfort. When assessing the client, which of the following would lead the nurse to suspect graft failure?

a. Reduced tearing
b. Pale conjunctiva
c. Blurred vision
d. Halos around lights

c. Blurred vision

Explanation:
Signs and symptoms of graft failure include eye discomfort, blurred vision, tearing, and redness of the eye. Halos around lights are associated with glaucoma.

A nurse is preparing a presentation for a local senior citizen's group about changes in the eye that accompany aging. Which of the following would the nurse most likely include? Select all that apply.

a. Increased orbital fat
b. Loss of eyelid skin elasticity
c. Development of lens opacities
d. Loss of lens accommodative power
e. Expansion of the vitreous body

b. Loss of eyelid skin elasticity
c. Development of lens opacities
d. Loss of lens accommodative power

Explanation:
Age-related changes in the eye include loss of accommodative power of the lens, development of opacities in the lens, decreased orbital fat, shrinkage of the vitreous body, and loss of skin elasticity.

You are the clinic nurse in an ophthalmic clinic. When assessing clients, which client has an abnormal intraocular pressure (IOP)?

a. A client with an IOP of 21 mm Hg
b. A client with an IOP of 8 mm Hg
c. A client with an IOP of 19 mm Hg
d. A client with an IOP of 15 mm Hg

b. A client with an IOP of 8 mm Hg

Explanation:
The client with an IOP of 8 mm Hg has a low pressure. The normal IOP is 10 to 21 mm Hg.

An 8th grade boy comes to the school nurse and tells the nurse that he had an eye exam the day before. He says the eye doctor told him he had astigmatism and that meant his eyeball wasn't shaped right. The boy is concerned because he says he went home and looked in the mirror and both eyes looked just alike. What is the school nurse's best response?

a. "Astigmatism means that the lens of the eye is more of an oval shape than the lens in most eyes."
b. "Astigmatism means that the cornea of the eye is shaped differently than the cornea in most eyes."
c. "Astigmatism means that the eye is shaped more like an olive than most eyes."
d. "Astigmatism means that the inside of the eye is shaped differently than the inside of most eyes."

b. "Astigmatism means that the cornea of the eye is shaped differently than the cornea in most eyes."

Explanation:
Astigmatism is visual distortion caused by an irregularly shaped cornea. Many people have both astigmatism and myopia or hyperopia. Options B, C, and D are incorrect because they are not the best answer.

Which of the following is the correct advice regarding food for a patient who underwent a cataract surgery?

a. Eat spinach or collard greens two to four times per week.
b. Eat soft, easily chewed foods.
c. Increase intake of vitamins A and C.
d. Eat red meat two to four times per week.

b. Eat soft, easily chewed foods.

Explanation:
The nurse should advise patients recovering from cataract surgery to eat soft, easily chewed foods until healing is complete to avoid tearing from excessive facial movements. Eating spinach or collard greens two to four times per week reduces the risk of macular degeneration and increasing the intake of vitamins A and C is essential for preventing cataracts; however, these have no implications on recovery from cataract surgery.

The nurse is obtaining a visual history from a client who has noted an increase in glare and changes in color perception. Which assessment would the nurse anticipate to confirm a definitive diagnosis?

a. Identification of yellowish aging spot on the retina
b. Identification of redness of the sclera
c. Identification of opacities on the lens
d. Identification of white circle around the cornea

c. Identification of opacities on the lens

Explanation:
The client states an increased glare and changes in color perception, which indicates a cataract. Identification of opacities on the lens confirms that diagnosis. A white circle around the cornea and a yellowish aging spot are also symptoms of aging but with different symptoms. Redness of the sclera indicates irritation.

Which is an accurate statement regarding refractive surgery?

a. Refractive surgery is an elective cosmetic surgery performed to reshape the cornea.
b. Refractive surgery may be performed on all clients, even if they have underlying health conditions.
c. Refractive surgery may be performed on clients with an abnormal corneal structure as long as they have a stable refractive error.
d. Refractive surgery will alter the normal aging of the eye.

a. Refractive surgery is an elective cosmetic surgery performed to reshape the cornea.

Explanation:
Refractive surgery is an elective procedure; it is considered a cosmetic procedure (to achieve clear vision without the aid of prosthetic devices). It is performed to reshape the cornea to correct all refractive errors. Refractive surgery will not alter the normal aging process of the eye. Clients with conditions that are likely to affect corneal wound healing adversely (corticosteroid use, immunosuppression, elevated intraocular pressure) are not good candidates for the procedure. The corneal structure must be normal and the refractive error stable.

Which is be an accurate clinical manifestation of a retinal detachment?

a. Sudden onset of intense pain
b. Colored halos around lights
c. Bright flashing lights
d. Chemosis and redness of the sclera

c. Bright flashing lights

Explanation:
Clients can complain of bright flashing lights as a clinical manifestation of retinal detachment. Clients with retinal detachment do not complain of pain. Colored halos around lights is specific to glaucoma. Chemosis does not usually occur with retinal detachment.

The patient with glaucoma is usually started on the lowest dose of medication. Which of the following is the preferred initial topical medication?

a. Carbonic anhydrase inhibitors
b. Beta-blockers
c. Alpha-agonists
d. Prostaglandins

b. Beta-blockers

Explanation:
Because of their efficacy, minimal dosing (can be used once each day), and low cost, beta-blockers are the preferred initial topical medications. Beta-blockers decrease the production of aqueous humor, with a resultant decrease in IOP.

A client comes to the clinic for an ophthalmologic screening, which will include measurement of intraocular pressure (IOP) with a tonometer. Which statement about this procedure is true?

a. The client will direct the gaze forward while the physician rests the tonometer on the scleral surface.
b. The client should wear dark glasses for several hours after the procedure.
c. A topical anesthetic will be administered after the examination.
d. The tonometer will register the force required to indent or flatten the corneal apex.

d. The tonometer will register the force required to indent or flatten the corneal apex.

Explanation:
The tonometer will register the force required to indent (using Schiotz's tonometer) or flatten (using an applanation tonometer) the corneal apex. This force varies with firmness of the eye, which fluctuates with IOP. Although the client does direct the gaze forward during tonometry, the tonometer rests on the surface of the cornea, not the sclera. Topical anesthetic drops are administered before, not after, the examination. The client should wear dark glasses after pupil dilation, not tonometry, to protect the eyes from light.

Which are included as marker(s) of medication effectiveness in glaucoma control? Select all that apply.

a. Lowering intraocular pressure to target pressure
b. Opacity of the lens
c. Stable appearance of the optic nerve head
d. Visual field

a. Lowering intraocular pressure to target pressure

Explanation:
The main markers of the efficacy of the medication in glaucoma control are lowering the intraocular pressure to the target pressure, stable appearance of the optic nerve head, and the visual field. Opacity of the lens relates to cataract formation.

A nurse practitioner is performing direct ophthalmoscopy and observes the fundus. Which area of the fundus would the nurse examine last?

a. Periphery of the retina
b. Macula
c. Veins
d. Physiologic cup

b. Macula

Explanation:
When performing direct ophthalmoscopy, the last area of the fundus to be examined is the macula, beause this area is the most sensitive to light. When the fundus is examined, the vasculature (veins and arteries) comes into focus first. Next the physiologic cup is examined, followed by the periphery of the retina.

The nurse is precepting a nursing student when a new client comes to the eye clinic. The client explains that she thinks she may have a corneal abrasion. The nurse should explain what to the student nurse?

a. "To detect corneal abrasions, an opthalmoscope is used."
b. "To detect corneal abrasions, ultrasonography is used."
c. "To detect corneal abrasions, retinal angiography is used."
d. "To detect corneal abrasions, a slit lamp is used."

d. "To detect corneal abrasions, a slit lamp is used."

Explanation:
A slit lamp is a binocular microscope that magnifies the surface of the eye. A beam of light, narrowed to a slit, is directed at the cornea, facilitating an examination of structures and fluid in the anterior segment of the eye. This examination is used to identify disorders such as corneal abrasions, iritis, conjunctivitis, and cataracts. Options A, B, and D are not used to detect corneal abrasions.

A nurse is assessing a client for a fracture to the bony orbit. What would the nurse document if the assessment for fracture was positive?

a. The client's vision is blurred.
b. There is excessive tearing.
c. A rust ring is seen around the pupil.
d. The client has diplopia.

d. The client has diplopia.

Explanation:
If the bony orbit is fractured, the eyes may appear asymmetric, and the client has diplopia or double vision. Excessive tearing, presence of rust rings, or blurry vision does not indicate a fractured bony orbit.

Pilocarpine (Pilocar) is used in the treatment of glaucoma. What is this drug's mechanism of action?

a. It clears the debris from the Canal of Schlemm.
b. It decreases the edema in the cornea.
c. It pulls the iris away from the drainage channels so that the aqueous fluid can escape.
d. It slows the production of aqueous fluid.

c. It pulls the iris away from the drainage channels so that the aqueous fluid can escape.

Explanation:
Miotics, such as carbachol (Miostat) and pilocarpine (Pilocar), constrict the pupil. These medications pull the iris away from the drainage channels so that the aqueous fluid can escape. A drug that slows the production of aqueous fluid is Diamox. Option B is incorrect as no drug can do this.

Which of the following is an accurate statement regarding refractive surgery?

a. Refractive surgery will alter the normal aging of the eye.
b. Refractive surgery is an elective, cosmetic surgery performed to reshape the cornea.
c. Refractive surgery may be performed on all patients, even if they have underlying health conditions.
d. Refractive surgery may be performed on patients with an abnormal corneal structure as long as they have a stable refractive error.

b. Refractive surgery is an elective, cosmetic surgery performed to reshape the cornea.

Explanation:
Refractive surgery is an elective procedure and is considered a cosmetic procedure (to achieve clear vision without the aid of prosthetic devices). It is performed to reshape the cornea for the purpose of correction of all refractive errors. Refractive surgery will not alter the normal aging process of the eye. Patients with conditions that are likely to adversely affect corneal wound healing (corticosteroid use, immunosuppression, elevated intraocular pressure) are not good candidates for the procedure. The corneal structure must be normal and the refractive error stable.

Which of the following would not be included as a marker of medication effectiveness in glaucoma control?

a. Opacity of the lens
b. Visual field
c. Appearance of optic nerve head
d. Lowering intraocular pressure (IOP) to target pressure

a. Opacity of the lens

Explanation:
Opacity of the lenses relates to cataract formation. The main markers of the efficacy of the medication in glaucoma control are lowering of the IOP to the target pressure, appearance of the optic nerve head, and the visual field.

Which of the following is the overall aim of glaucoma treatment?

a. Reattach the retina
b. Optimize the patient's remaining vision
c. Reverse optic nerve damage
d. Prevent optic nerve damage

d. Prevent optic nerve damage

Explanation:
The aim of all glaucoma treatment is prevention of optic nerve damage. Although treatment cannot reverse optic nerve damage, further damage can be controlled. Reattachment of the retina is not part of glaucoma treatment.

Which type of cataract is caused by central opacity of the lens?

a. Nuclear
b. Subluxated
c. Cortical
d. Posterior subcapsular

a. Nuclear

Explanation:
A nuclear cataract is caused by central opacity in the lens and has a substantial genetic component. Cortical cataracts involve the anterior, posterior, or equatorial cortex of the lens. Vision is worse in very bright light. Posterior subcapsular cataracts occur in front of the posterior capsule. Near vision is diminished, and the eye is increasingly sensitive to glare from bright light. A subluxated cataract requires the entire lens to be removed, as with a partially or completely dislocated lens.

A patient has been diagnosed with hyphema. Which of the following medication classifications stabilizes clot formation at the site of hemorrhage?

a. Diuretics
b. Antiplatelets
c. Antifibrinolytics
d. Corticosteroids

c. Antifibrinolytics

Explanation:
An antifibrinolytic agent, aminocaproic acid (Amicar), stabilizes clot formation at the site of hemorrhage. Corticosteroids, antiplatelets, and diuretics do not have this action. Aspirin is contraindicated.

The nurse realizes that a client understands how to correctly instill ophthalmic medications when the client:

a. allows the tip of the container to touch the eyelid while administering the medication.
b. wipes the lids and lashes prior to instillation in a direction toward the nose with moistened, soft gauze.
c. pulls the tissue near the cheek downward to instill medication.
d. rubs the eye after administering medication.

c. pulls the tissue near the cheek downward to instill medication.

Explanation:
Pull the cheek downward to form a sack in the lower lid. Instill the drops into the conjunctival pocket. The lid and lashes would be wiped in a direction away from the nose to avoid contamination. The tip of the container will be contaminated if it touches eye or eyelid. Do not rub the eye because it may irritate the eye.

Which would be an advanced stage finding in a client with wet macular degeneration?

a. blurred vision when reading or doing close up work
b. distortion of vision
c. inability to see images by looking at them directly
d. diminished perception of color

c. inability to see images by looking at them directly

Explanation:
When the macula becomes irreparably damaged, clients compare their vision to a target in which the bulls-eye area of the image is absent. In clients with dry macular degeneration, blurred vision is the first symptom of disease. Vision distortion is an early finding in clients with wet macular degeneration.

Which features should a nurse observe during an ophthalmic assessment? Select all that apply.

a. external eye appearance
b. pupil responses
c. visual acuity
d. intraocular pressure

a. external eye appearance
b. pupil responses

Explanation:
During an ophthalmic assessment, the nurse should examine the external appearance of the eye and the pupil responses. Intraocular pressure and visual acuity involve a more complex examination and would be performed by a vision specialist.

The nurse is instructing a nursing student when a new client comes to the eye clinic. The client explains that he thinks he has a corneal abrasion. The nurse should explain what to the student nurse?

a. "To detect corneal abrasions, a slit lamp is used."
b. "To detect corneal abrasions, ultrasonography is used."
c. "To detect corneal abrasions, retinal angiography is used."
d. "To detect corneal abrasions, an ophthalmoscope is used."

a. "To detect corneal abrasions, a slit lamp is used."

Explanation:
A slit lamp is a binocular microscope that magnifies the surface of the eye. A beam of light, narrowed to a slit, is directed at the cornea, facilitating an examination of structures and fluid in the anterior segment of the eye. This examination is used to identify disorders such as corneal abrasions, iritis, conjunctivitis, and cataracts. The other options are not used to detect corneal abrasions.

The nurse is caring for geriatric clients who state that they are prescribed reading glasses. Some individuals state needing assistance with seeing writing far away, and others need assistance with closer vision. The nurse is correct to understand that the aging visual changes relate to which of the following?

a. Changes in refraction
b. Changes in accommodation
c. Changes in central vision
d. Changes in the visual field

b. Changes in accommodation

Explanation:
The changes that occur in vision during aging, which include difficulty reading and the need for reading glasses, include changes in accommodation. Accommodation occurs when the ciliary muscles contract or relax to focus an image on the retina.

The nurse is evaluating the client while taking the color vision test. Which response would the nurse anticipate when caring for a client with normal color vision?

a. The nurse would anticipate no differentiation in between colors.
b. The nurse would anticipate a cross-eyed appearance.
c. The nurse would anticipate the client identifying numbers and shapes.
d. The nurse would anticipate responding to the color names in the pictures.

c. The nurse would anticipate the client identifying numbers and shapes.

Explanation:
The nurse is correct to anticipate the client being able to identify numbers and shapes dictated by different color codes. The other options do not test for color vision or indicate an inability to differentiate colors.

An elderly client is scheduled for cataract surgery and asks the nurse, "Will I need to wear pop-bottle lenses after surgery?" Which is the most appropriate response from the nurse?

a. "Contact lenses are preferred by most clients after this surgery."
b. "An implanted lens has replaced the need for corrective glasses."
c. "No lens is necessary with cataract surgery."
d. "They can make corrective lenses much thinner now."

b. "An implanted lens has replaced the need for corrective glasses."

Explanation:
Vision is usually restored after cataract surgery with an intraocular lens implant. Contact lenses can be used but can be burdensome for the elderly. Corrective glass lenses can cause a distortion of peripheral vision and only required one lens (over operative eye). To restore vision after cataract surgery, a lens is required.

Which is the most common cause of visual loss in people older than 65 years of age?

a. Glaucoma
b. Retinal detachment
c. Macular degeneration
d. Cataracts

c. Macular degeneration

Explanation:
Macular degeneration is the most common cause of visual loss in people older than 65 years of age.