Cataracts, Glaucoma, Retinal Detachment

Disorders of the Eye: Cataracts, Glaucoma, Retinal Detachment, Intraocular Pressure, Diplopia, Miotics, Mydriatics, Snellen Chart 1. The clinic nurse is preparing to test the visual acuity of a client using a Snellen chart. Which of the following identifies the accurate procedure for this visual acuity test? 1. Both eyes are assessed together, followed by the assessment of the r. and then the l.eye. 2. The right eye is tested followed by the left eye, and then both eyes are tested. 3. The client is asked to stand at a distance of 40ft. from the chart and is asked to read the largest line on the chart. 4. The client is asked to stand at a distance of 40ft from the chart and to read the line than can be read 200 ft away by an individual with unimpaired vision. 2. The clinic nurse notes that the following several eye examinations, the physician has documented a diagnosis of legal blindness in the client’s chart. The nurse reviews the results of the Snellen’s chart test expecting to note which of the following? 1. 20/20 vision 2. 20/40 vision 3. 20/60 vision 4. 20/200 vision 3. The client’s vision is tested with a Snellen’s chart. The results of the tests are documented as 20/60. The nurse interprets this as: 1. The client can read at a distance of 60 feet what a client with normal vision can read at 20 feet. 2. The client is legally blind. 3. The client’s vision is normal 4. The client can read only at a distance of 20 feet what a client with normal vision can read at 60 feet. 4. Tonometry is performed on the client with a suspected diagnosis of glaucoma. The nurse analyzes the test results as documented in the client’s chart and understands that normal intraocular pressure is: 1. 2-7 mmHg 2. 10-21 mmHg 3. 22-30 mmHg 4. 31-35 mmHg 5. The nurse is developing a plan of care for the client scheduled for cataract surgery. The nurse documents which more appropriate nursing diagnosis in the plan of care? 1. Self-care deficit 2. Imbalanced nutrition 3. Disturbed sensory perception 4. Anxiety 6. The nurse is performing an assessment in a client with a suspected diagnosis of cataract. The chief clinical manifestation that the nurse would expect to note in the early stages of cataract formation is: 1. Eye pain 2. Floating spots 3. Blurred vision 4. Diplopia 7. In preparation for cataract surgery, the nurse is to administer prescribed eye drops. The nurse reviews the physicians orders, expecting which type of eye drops to be instilled? 1. An osmotic diuretic 2. A miotic agent 3. A mydriatic medication 4. A thiazide diuretic 8. During the early postoperative period, the client who had a cataract extraction complains of nausea and severe eye pain over the operative site. The initial nursing action is to: 1. Call the physician 2. Administer the ordered main medication and antiemetic 3. Reassure the client that this is normal. 4. Turn the client on his or her operative side 9. The client is being discharged from the ambulatory care unit following cataract removal. The nurse provides instructions regarding home care. Which of the following, if stated by the client, indicates an understanding of the instructions? 1. “I will take Aspirin if I have any discomfort.” 2. “I will sleep on the side that I was operated on.” 3. “I will wear my eye shield at night and my glasses during the day.” 4. “I will not lift anything if it weighs more that 10 pounds.” 10. The client with glaucoma asks the nurse is complete vision will return. The most appropriate response is: 1. “Although some vision as been lost and cannot be restored, further loss may be prevented by adhering to the treatment plan.” 2. “Your vision will return as soon as the medications begin to work.” 3. “Your vision will never return to normal.” 4. “Your vision loss is temporary and will return in about 3-4 weeks.” 11. The nurse is developing a teaching plan for the client with glaucoma. Which of the following instructions would the nurse include in the plan of care? 1. Decrease fluid intake to control the intraocular pressure 2. Avoid overuse of the eyes 3. Decrease the amount of salt in the diet 4. Eye medications will need to be administered lifelong. 12. The nurse is performing an admission assessment on a client with a diagnosis of detached retina. Which of the following is associated with this eye disorder? 1. Pain in the affected eye 2. Total loss of vision 3. A sense of a curtain falling across the field of vision 4. A yellow discoloration of the sclera. 13. The nurse is caring for a client with a diagnosis of detached retina. Which assessment sign would indicate that bleeding has occurred as a result of the retinal detachment? 1. Complaints of a burst of black spots or floaters 2. A sudden sharp pain in the eye 3. Total loss of vision 4. A reddened conjunctiva 14. The client sustains a contusion of the eyeball following a traumatic injury with a blunt object. Which intervention is initiated immediately? 1. Notify the physician 2. Irrigate the eye with cold water 3. Apply ice to the affected eye 4. Accompany the client to the emergency room 15. The client arrives in the emergency room with a penetrating eye injury from wood chips while cutting wood. The nurse assesses the eye and notes a piece of wood protruding from the eye, what is the initial nursing action? 1. Remove the piece of wood using a sterile eye clamp 2. Apply an eye patch 3. Perform visual acuity tests 4. Irrigate the eye with sterile saline. 16. The client arrives in the emergency room after sustaining a chemical eye injury from a splash of battery acid. The initial nursing action is to: 1. Begin visual acuity testing 2. Irrigate the eye with sterile normal saline 3. Swab the eye with antibiotic ointment 4. Cover the eye with a pressure patch. 17. The nurse is caring for a client following enucleation. The nurse notes the presence of bright red blood drainage on the dressing. Which nursing action is appropriate? 1. Notify the physician 2. Continue to monitor the drainage 3. Document the finding 4. Mark the drainage on the dressing and monitor for any increase in bleeding. 18. When using a Snellen alphabet chart, the nurse records the client’s vision as 20/40. Which of the following statements best describes 20/40 vision? 1. The client has alterations in near vision and is legally blind. 2. The client can see at 20 feet what the person with normal vision can see at 40 feet. 3. The client can see at 40 feet what the person with normal vision sees at 20 feet. 4. The client has a 20% decrease in acuity in one eye, and a 40% decrease in the other eye. 19. Which of the following instruments is used to record intraocular pressure? 1. Goniometer 2. Ophthalmoscope 3. Slit lamp 4. Tonometer 20. After the nurse instills atropine drops into both eyes for a client undergoing ophthalmic examination, which of the following instructions would be given to the client? 1. “Be careful because the blink reflex is paralyzed.” 2. “Avoid wearing your regular glasses when driving.” 3. “Be aware that the pupils may be unusually small.” 4. “Wear dark glasses in bright light because the pupils are dilated.” 21. Which of the following procedures or assessments must the nurse perform when preparing a client for eye surgery? 1. Clipping the client’s eyelashes 2. Verifying the affected eye has been patched 24 hours before surgery 3. Verifying the client has been NPO since midnight, or at least 8 hours before surgery. 4. Obtaining informed consent with the client’s signature and placing the forms on the chart. 22. Cataract surgery results in aphakia. Which of the following statements best describes this term? 1. Absence of the crystalline lens 2. A “keyhole” pupil 3. Loss of accommodation 4. Retinal detachment 23. When developing a teaching session on glaucoma for the community, which of the following statements would the nurse stress? 1. Glaucoma is easily corrected with eyeglasses 2. White and Asian individuals are at the highest risk for glaucoma. 3. Yearly screening for people ages 20-40 years is recommended. 4. Glaucoma can be painless and vision may be lost before the person is aware of a problem. 24. For a client having an episode of acute narrow-angle glaucoma, a nurse expects to give which of the following medications? 1. Acetazolamide (Diamox) 2. Atropine 3. Furosemide (Lasix) 4. Urokinase (Abbokinase) 25. Which of the following symptoms would occur in a client with a detached retina? 1. Flashing lights and floaters 2. Homonymous hemianopia 3. Loss of central vision 4. Ptosis 26. A male client has just had a cataract operation without a lens implant. In discharge teaching, the nurse will instruct the client’s wife to: 1. Feed him soft foods for several days to prevent facial movement 2. Keep the eye dressing on for one week 3. Have her husband remain in bed for 3 days 4. Allow him to walk upstairs only with assistance. Answers and Rationale 1. Answer: 2. The right eye is tested followed by the left eye, and then both eyes are tested. Visual acuity is assessed in one eye at a time, and then in both eyes together with the client comfortably standing or sitting. The right eye is tested with the left eye covered; then the left eye is tested with the right eye covered. Both eyes then are tested together. Visual acuity is measured with or without corrective lenses and the client stands at a distance of 20ft. from the chart. 2. Answer: 4. 20/200 vision Legal blindness is defined as 20/200 or less with corrected vision (glasses or contact lenses) or visual acuity of less than 20 degrees of the visual field in the better eye. 3. Answer: 4. The client can read only at a distance of 20 feet what a client with normal vision can read at 60 feet. Vision that is 20/20 is normal, that is, the client is able to read from 20 feet what a person with normal vision can read from 20 feet. A client with a visual acuity of 20/60 only can read at a distance of 20 feet of what a person with normal vision can read at 60 feet. 4. Answer: 2. 10-21 mmHg Tonometry is the method of measuring intraocular fluid pressure using a calibrated instrument that indents or flattens the corneal apex. Pressures between 10 and 21 mmHg are considered within normal range. 5. Answer: 3. Disturbed sensory perception The most appropriate nursing diagnosis for the client scheduled for cataract surgery is Disturbed sensory perception (visual) related to lens extraction and replacement. Although the other options identify nursing diagnoses that may be appropriate, they are not related specifically to cataract surgery. 6. Answer: 3. Blurred vision A gradual, painless blurring of central vision is the chief clinical manifestation of a cataract. Early symptoms include slightly blurred vision and a decrease in color perception. 7. Answer: 3. A mydriatic medication A mydriatic medication produces mydriasis or dilation of the pupil. Mydriatic medications are used preoperatively in the cataract client. These medication act by dilating the pupils. They also constrict blood vessels. An osmotic diuretic may be used to decrease intraocular pressure. A miotic medication constricts the pupil. A thiazide diuretic is not likely to be prescribed for a client with a cataract. 8. Answer: 1. Call the physician Severe pain or pain accompanied by nausea is an indicator of increased intraocular pressure and should be reported to the physician immediately. The other options are inappropriate. 9. Answer: 3. “I will wear my eye shield at night and my glasses during the day.” The client is instructed to wear a metal or plastic shield to protect the eye from accidental and is instructed not to rub the eye. Glasses may be worn during the day. Aspirin or medications containing aspirin are not to be administered or taken by the client and the client is instructed to take acetaminophen as needed for pain. The client is instructed not to sleep on the side of the body on which the operation occurred. The client is not to lift more than 5 pounds. 10. Answer: 1. “Although some vision as been lost and cannot be restored, further loss may be prevented by adhering to the treatment plan.” Vision loss to glaucoma is irreparable. The client should be reassured that although some vision has been lost and cannot be restored, further loss may be prevented by adhering to the treatment plan. Option C does not provide reassurance to the client. 11. Answer: 4. Eye medications will need to be administered lifelong. The administration of eye drops is a critical component of the treatment plan for the client with glaucoma. The client needs to be instructed that medications will need to be taken for the rest of his or her life. 12. Answer: 3. A sense of a curtain falling across the field of vision A characteristic manifestation of retinal detachment described by the client is the feeling that a shadow or curtain is falling across the field of vision. No pain is associated with detachment of the retina. Options B and D are not characteristics of this disorder. A retinal detachment is an ophthalmic emergency and even more so if visual acuity is still normal. 13. Answer: 1. Complaints of a burst of black spots or floaters Complaints of a sudden burst of black spots or floaters indicate that bleeding has occurred as a result of the detachment. 14. Answer: 3. Apply ice to the affected eye Treatment for contusion begins at the time of injury. Ice is applied immediately. The client then should be seen by a physician and receive a thorough eye examination to rule out the presence of other eye injuries. 15. Answer: 3. Perform visual acuity tests If the laceration is the result of a penetrating injury, an object may be noted protruding from the eye. This object must never be removed except by the ophthalmologist because it may be holding ocular structures in place. Application of an eye patch or irrigation of the eye may disrupt the foreign body and cause further tearing of the sclera. (The only option that will prevent further disruption is to assess visual acuity.) 16. Answer: 2. Irrigate the eye with sterile normal saline Emergency care following a chemical burn to the eye includes irrigating the eye immediately with sterile normal saline or ocular irrigating solution. In the emergency department, the irrigation should be maintained for at least 10 minutes. Following this emergency treatment, visual acuity is assessed. 17. Answer: 1. Notify the physician If the nurse notes the presence of bright red drainage on the dressing, it must be reported to the physician because this indicated hemorrhage. 18. Answer: 2. The client can see at 20 feet what the person with normal vision can see at 40 feet. The numerator refers to the client’s vision while comparing the normal vision in the denominator. 19. Answer: 4. Tonometer A tonometer is a device used in glaucoma screening to record intraocular pressure. A goniometer measures joint movement and angles. An ophthalmoscope examines the interior of the eye, especially the retina. A slit lamp evaluates structures in the anterior chamber in the eye. 20. Answer: 4. “Wear dark glasses in bright light because the pupils are dilated.” Atropine, an anticholinergic drug, has mydriatic effects causing pupil dilation. This allows more light onto the retina and may cause photophobia and blurred vision. Atropine doesn’t paralyze the blink reflex or cause miosis (pupil constriction). Driving may be contraindicated to blurred vision. 21. Answer: 3. Verifying the client has been NPO since midnight, or at least 8 hours before surgery. Maintaining NPO status for at least 8 hours before surgical procedures prevents vomiting and aspiration. There is no need to patch an eye before most surgeries or to clip the eyelashes unless specifically ordered by the physician. The physician is responsible for obtaining informed consent; the nurse validates that the consent is obtained. 22. Answer: 1. Absence of the crystalline lens Aphakia means without lens, a keyhole pupil results from iridectomy. Loss of accommodation is a normal response to aging. A retinal detachment is usually associated with retinal holes created by vitreous traction. 23. Answer: 4. Glaucoma can be painless and vision may be lost before the person is aware of a problem. Open-angle glaucoma causes a painless increase in intraocular pressure (IOP) with loss of peripheral vision. A variety of miotics and agents to decrease IOP and occasional surgery are used to treat glaucoma. Blacks have a threefold greater chance of developing with an increased chance of blindness than other groups. Individuals older than 40 should be screened. 24. Answer: 1. Acetazolamide (Diamox) Acetazolamide, a carbonic anhydrase inhibitor, decreases intraocular pressure (IOP) by decreasing the secretion of aqueous humor. Atropine dilates the pupil and decreases outflow of aqueous humor, causing further increase in IOP. Lasix is a loop diuretic, and Urokinase is a thrombolytic agent; they aren’t used for the treatment of glaucoma. 25. Answer: 1. Flashing lights and floaters Signs and symptoms of retinal detachment include abrupt flashing lights, floaters, loss of peripheral vision, or a sudden shadow or curtain in the vision. Occasionally visual loss is gradual. 26. Answer: 4. Allow him to walk upstairs only with assistance. Without a lens, the eye cannot accommodate. It is difficult to judge distance and climb stairs when the eyes cannot accommodate. Therefore, the client should walk up and down stairs only with assistance.