Chapter 39Visual Dysfunction: Nursing Management My Nursing Test Banks

Chapter 39Visual Dysfunction: Nursing Management

MULTIPLE CHOICE

1.A client is diagnosed with strabismus. Which of the following will the client most likely experience with this disorder?

1.

Nystagmus

2.

Diplopia

3.

Aphakic vision

4.

Ptosis

ANS: 2

Diplopia, or double vision, is the primary symptom of strabismus. Nystagmus is a disorder that causes involuntarily rhythmic movements in the eye. Aphakic vision occurs when the lens of the eye is removed. Ptosis is drooping of the eyelid.

PTS: 1 DIF: Analyze REF: Ocular Movement Disorders: Strabismus

2.A client is experiencing a gradual blurring of vision in both eyes not associated with any pain. The nurse suspects the client is experiencing:

1.

glaucoma.

2.

cataracts.

3.

macular degeneration.

4.

retinal detachment.

ANS: 2

Cataracts occur as the opacity of the lens becomes cloudy, blurring the vision. It occurs in both eyes but is usually worse in one eye. Gradual eye blurring is not associated with glaucoma, macular degeneration, or retinal detachment.

PTS: 1 DIF: Analyze REF: Cataracts: Pathophysiology

3.The nurse should instruct a client, diagnosed with glaucoma, that the purpose of medication is to:

1.

help dry up excess secretions.

2.

lower the intraocular pressure.

3.

strengthen the muscles of the eye.

4.

improve the vision in the eye.

ANS: 2

Glaucoma is a disease that relates to the increase of intraocular pressure. The medication given will decrease this intraocular pressure. Medication for glaucoma is not used to help dry up excess secretions, strengthen the eye muscles, or improve vision.

PTS: 1 DIF: Apply REF: Glaucoma: Pharmacology

4.After surgery to remove a cataract, which of the following should the nurse instruct the client?

1.

Be sure to follow the schedule for the prescribed eyedrop medication.

2.

Sleep on the right side to promote drainage.

3.

It is okay to rub the eye because the surgery was on the inside.

4.

This is an outpatient procedure, and there are no instructions for the patient.

ANS: 1

Client education is extremely important in the aftercare of cataract surgery. There is a need to emphasize the postoperative care of eyedrop instillation. The client should not place any pressure near or on the eye. Postoperative instructions are highly important for the client having an outpatient surgical procedure.

PTS: 1 DIF: Apply REF: Cataracts: Planning and Implementation

5.A tonometry test has been performed with a client and the results are 25 mmHg. The nurse know that:

1.

the reading is low and there is no problem.

2.

the reading is normal and nothing needs to be done at this time.

3.

the results are high and follow-up readings and tests are needed.

4.

the results are high and there is no cure to bring the pressure down.

ANS: 3

Several reading need to be taken throughout the day to establish the highest reading to be the treated pressure. Normal intraocular pressure ranges from 12 to 16 mmHg. The reading of 25 mmHg is not low or normal. Medication can be prescribed to reduce the pressure.

PTS:1DIF:Analyze

REF: Glaucoma: Assessment with Clinical Manifestations and Diagnostic Tests

6.A client has been diagnosed with cataracts. The nurse realizes that the only treatment for this disorder is?

1.

Medical management with eyedrops

2.

Surgical removal of the lens

3.

Cryopexy

4.

Phototherapy

ANS: 2

Surgical treatment for cataracts begins when vision is sufficiently impaired. The lens is removed and the replacement artificial intraocular lens is put in place. Cataracts cannot be treated with medication alone. Cryopexy and phototherapy are not used to treat cataracts.

PTS:1DIF:AnalyzeREF:Cataracts: Surgery

7.Which of the following should the nurse assess in a client diagnosed with open-angle glaucoma?

1.

Degree of lost vision

2.

Severity of headaches

3.

Amount of blurred vision

4.

Date of onset

ANS: 1

Open-angle glaucoma is characterized by a gradual increase in pressure and a gradual loss of vision. Closed-angle glaucoma presents with a sudden onset causing headache, blurred vision, and eye pain.

PTS: 1 DIF: Apply REF: Glaucoma: Pathophysiology

8.A client is experiencing little flashes of lights and things floating in the visual field. The nurse suspects:

1.

cataracts.

2.

glaucoma.

3.

conjunctivitis.

4.

retinal detachment.

ANS: 4

Retinal detachment is clinically manifested by flashes and floaters in the visual field. Flashes of light and floaters are not associated with cataracts, glaucoma, or conjunctivitis.

PTS:1DIF:Analyze

REF:Retinal Detachment: Assessment with Clinical Manifestations

9.A client tells the nurse that she sees a shadow that is slowing getting worse in her left eye. Which of the following should the nurse do?

1.

Instruct the client to return home to rest in bed.

2.

Encourage the client to continue with normal daily activities.

3.

Notify an ophthalmologist.

4.

Encourage fluids and normal saline eyedrops.

ANS: 3

The nurse should notify an ophthalmologist with the clients symptoms. The onset of a shadow in the field of vision that will not dissipate is an indication of a detached retina. Retinal detachments rarely self-repair, and the client will need surgery. The nurse should not instruct the client to return home to rest in bed. The client should not be encouraged to continue with normal daily activities. Fluids and saline eyedrops will not help a detached retina.

PTS:1DIF:Apply

REF:Retinal Detachment: Assessment with Clinical Manifestations

10.A client is experiencing a loss of central vision but not a loss of peripheral vision. The nurse realizes the client should be evaluated for:

1.

detached retina syndrome.

2.

nystagmus.

3.

macular degeneration.

4.

conjunctivitis.

ANS: 3

Macular degeneration is a deterioration of part of the retina, causing loss of central vision but not affecting peripheral vision. The loss of central vision is not typically seen in a detached retina, nystagmus, or conjunctivitis.

PTS: 1 DIF: Analyze REF: Macular Degeneration: Pathophysiology

11.A client is experiencing redness, burning, itching, and pain of the eyes. The nurse suspects the client is experiencing:

1.

blepharitis.

2.

conjunctivitis.

3.

keratitis.

4.

iritis.

ANS: 2

Clinical manifestations of conjunctivitis (pink eye) include watery eyes, redness, itching, and burning pain. Blepharitis is associated with a sticky exudate. Keratitis is associated with photophobia. Iritis is associated with blurred vision and photophobia.

PTS: 1 DIF: Analyze REF: Inflammatory and Infectious Eye Conditions

12.A client has been diagnosed as being legally blind. The nurse realizes this clients vision is:

1.

20/200 or less in the better eye with correction.

2.

20/200 or less in the worse eye without correction.

3.

20/100 or less in the better eye without correction.

4.

20/100 or less in the worse eye with correction.

ANS: 1

Legal blindness is defined as vision of 20/200 or less on a Snellen chart in the better eye with correction. The eye needs to have correction in order to be diagnosed as legally blind; therefore, the choice of 20/200 in the worse eye without correction would be incorrect. The vision measurements of the other choices can be corrected with lenses and would not be categorized as legal blindness.

PTS: 1 DIF: Analyze REF: Low Vision and Blindness

13.The nurse realizes that the best medication treatment for open-angle glaucoma would be:

1.

timolol (Timoptic) eyedrops.

2.

latanoprost (Xalatan) eyedrops.

3.

timolol (Timoptic) and Latanoprost (Xalatan) eyedrops.

4.

metoprolol oral medication.

ANS: 3

For the best effect in the treatment of open-angle glaucoma, timolol (Timoptic) and latanoprost (Xalatan) should be prescribed together. Metoprolol is not prescribed for open-angle glaucoma.

PTS: 1 DIF: Analyze REF: Glaucoma: Pharmacology

MULTIPLE RESPONSE

1.A client tells the nurse that he does not want to develop macular degeneration like his mother. Which of the following should the nurse instruct the client as being risk factors for the development of this disorder? (Select all that apply.)

1.

There is greater risk as people age.

2.

Women are at greater risk than men.

3.

African Americans are at greater risk than Caucasians.

4.

Family history of macular degeneration increases risk.

5.

Smoking does not increase risk.

6.

Alcohol prevents the onset of this disorder.

ANS: 1, 2, 4

Recent statistics show that macular degeneration is age related and that women are at greater risk than men. Family history and smoking are also significant risk factors. Caucasians are at greater risk than African Americans. Alcohol does not prevent the onset of this disorder.

PTS: 1 DIF: Apply REF: Macular Degeneration

2.A client is receiving tests to diagnose glaucoma. Which of the following diagnostic tests will be used to identify this disorder in the client? (Select all that apply.)

1.

Visual acuity

2.

Visual field test

3.

Tonometry

4.

Weber test

5.

Rinne test

6.

Electroencephalogram

ANS: 1, 2, 3

Glaucoma is determined through a comprehensive eye exam including a visual acuity test, visual fields test, dilated eye exam, and tonometry. The Weber and Rinne tests are used in an ear assessment. An electroencephalogram is not used to diagnose glaucoma.

PTS:1DIF:Analyze

REF: Glaucoma: Assessment with Clinical Manifestations and Diagnostic Tests

3.A client is diagnosed with ocular cancer. The nurse realizes this client could be treated with: (Select all that apply.)

1.

Enucleation

2.

Laser surgery

3.

Plaque brachytherapy

4.

Block incision

5.

Trabeculoplasty

6.

Trabeculectomy

ANS: 1, 3, 4

Surgical options for a client diagnosed with ocular cancer include enucleation, plaque brachytherapy, or block incision. Laser surgery, trabeculoplasty, and trabeculectomy would be used to treat glaucoma.

PTS: 1 DIF: Analyze REF: Ocular Cancer: Surgery

4.A client, diagnosed with keratoconus, asks the nurse what caused the disorder to develop. The nurse should instruct the client on which of the following as risk factors for the development of this disorder? (Select all that apply.)

1.

Sun exposure

2.

Ocular allergies

3.

Wearing rigid contact lenses

4.

Vigorous eye rubbing

5.

Herpes simplex virus

6.

Dry eyes

ANS: 2, 3, 4

Risk factors for the development of keratoconus include ocular allergies, rigid contact lens wear, and vigorous eye rubbing. Sun exposure, herpes simplex virus, and dry eyes are not risk factors for this disorder.

PTS: 1 DIF: Apply REF: Corneal Disorders: Keratoconus

5.The nurse is planning instruction for a client experiencing dry eyes. Which of the following should be included in these instructions? (Select all that apply.)

1.

Drink 8 to 10 glasses of water each day.

2.

Apply petroleum jelly to the eyelids.

3.

Blink more frequently.

4.

Avoid sun exposure.

5.

Avoid rubbing the eyes.

6.

Avoid dry air.

ANS: 1, 3, 5, 6

Interventions to improve dry eyes include drink 8 to 10 glasses of water each day; blink more frequently; avoid rubbing the eyes; and know that dry air makes the condition worse. Petroleum jelly is not a treatment for dry eyes. Avoiding the sun is good advice; however, it is not proven to help with dry eyes.

PTS: 1 DIF: Apply REF: Patient Playbook: Treatment of Dry Eyes

6.Which of the following should the nurse instruct a client diagnosed with type 2 diabetes mellitus regarding vision care? (Select all that apply.)

1.

Maintain good glucose control.

2.

Stop smoking.

3.

Limit exercise.

4.

Reduce reading.

5.

Frequently rest the eyes.

6.

Rub eyes daily.

ANS: 1, 2

To preserve vision and reduce the onset of diabetic retinopathy, the nurse should instruct the client to control blood glucose level, manage other complications, and stop smoking. The client should not be instructed to limit exercise, reduce reading, rest the eyes, or rub the eyes to prevent the onset of diabetic retinopathy.

PTS:1DIF:Apply

REF: Diabetic Retinopathy: Planning and Implementation

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