LEWIS 12e Chapter 22: Assessment and Management: Visual Problems

1. The nurse is performing an eye examination on a 76-yr-old patient. Which finding indicates that the nurse would refer the patient for a more extensive assessment?

a. The patient's sclerae are light yellow.

b. The patient reports persistent photophobia.

c. The pupil recovers slowly after responding to a bright light.

d. There is a whitish gray ring encircling the periphery of the iris.

b. The patient reports persistent photophobia.

2. Which finding by the nurse performing an eye examination indicates that the patient has normal accommodation?

a. After covering one eye for 1 minute, the pupil constricts as the cover is removed.

b. Shining a light into the patient's eye causes pupil constriction in the opposite eye.

c. A blink reaction occurs after touching the patient's pupil with a piece of sterile cotton.

d. The pupils constrict while fixating on an object being moved toward the patient's eyes.

d. The pupils constrict while fixating on an object being moved toward the patient's eyes.

3. Which assessment finding alerts the nurse to provide patient teaching about cataract development?

a. Unequal pupil size

b. Glare at night

c. Loss of peripheral vision

d. History of hyperthyroidism

a. Unequal pupil size

4. Assessment of a patient's visual acuity reveals that the left eye can see at 20 feet what a person with normal vision can see at 50 feet and the right eye can see at 20 feet what a person with normal vision can see at 40 feet. Which finding would the nurse record?

a. Left eye 20/50; Right eye 20/40

b. Both eyes 20/40; Left eye 50/20

c. Right eye 20/40; Left eye 20/50

d. Both eyes 40/20; Right eye 50/20

a. Left eye 20/50; Right eye 20/40

5. A 65-yr-old patient is being evaluated for glaucoma. Which information from the patient has implications for the patient's interprofessional treatment plan?

a. ―I take metoprolol (Lopressor) for angina.‖

b. ―I take aspirin when I have a sinus headache.‖

c. ―I have had frequent episodes of conjunctivitis.‖

d. ―I have not had an eye examination for 10 years.‖

a. ―I take metoprolol (Lopressor) for angina.‖

6. The nurse is testing the visual acuity of a patient in the outpatient clinic. Which instructions would the nurse give for this test?

a. ―Stand 20 feet away from the wall chart.‖

b. ―Look at an object far away and then near to you.‖

c. ―Follow theexaminer's finger with your eyes only.‖

d. ―Look straight ahead while I check your eyes with a light.‖

a. ―Stand 20 feet away from the wall chart.‖

7. A patient who underwent eye surgery must wear an eye patch until the scheduled postoperative clinic visit. Which patient problem will the nurse address in the plan of care?

a. Risk for injury

b. Difficulty coping

c. Negative self-image

d. Health maintenance alteration

a. Risk for injury .

8. Which information would the nurse provide to the patient scheduled for refractometry?

a. ―You should not take any of your eye medicines before the examination.‖

b. ―It will be difficult to focus your vision for a few hours after the examination.‖

c. ―The doctor will shine a bright light into your eye during the examination.‖

d. ―The surface of your eye will be numb while the doctor does the examination.‖

b. ―It will be difficult to focus your vision for a few hours after the examination.‖

9. The nurse is assessing a 65-yr-old patient for presbyopia. Which instruction would the nurse give the patient before the test?

a. ―Hold this card and read the print out loud.‖

b. ―Cover one eye while reading the wall chart.‖

c. ―You'll feel a short burst of air directed at your eyeball.‖

d. ―A light will be used to look for a change in your pupils.‖

a. ―Hold this card and read the print out loud.‖

10. Which instruction would the nurse give the patient before fluorescein angiography?

a. Hold a card and fixate on the center dot.

b. Report any burning or pain at theIV site.

c. Remain still while the cornea is anesthetized.

d. Let the examiner know when images appear clear.

b. Report any burning or pain at theIV site.

11. Which action can the nurse working in the emergency department delegate to experienced assistive personnel (AP)?

a. Ask a patient with decreased visual acuity about medications taken at home.

b. Perform Snellen testing of visual acuity for a patient with a history of cataracts.

c. Obtain information from a patient about any history of childhood ear infections.

d. Inspect a patient's external ear for redness, swelling, or presence of skin lesions.

b. Perform Snellen testing of visual acuity for a patient with a history of cataracts.

12. The nurse working in the clinic receives telephone calls from several patients who want appointments as soon as possible. Which patient should be seen first?

a. 71-yr-old who has noticed increasing loss of peripheral vision

b. 74-yr-old who has difficulty seeing well enough to drive at night

c. 60-yr-old who is reporting dry eyes with decreased tear formation

d. 64-yr-old who states that it is becoming difficult to read news print

a. 71-yr-old who has noticed increasing loss of peripheral vision

13. Which assessment would the nurse make to evaluate the effectiveness of treatment for the patient's myopia and presbyopia?

a. Eye muscle strength

b. Near and distant vision

c. Cloudiness in the eye lenses

d. Intraocular pressure changes

b. Near and distant vision

14. Which instruction would the nurse give to a patient with recurrent staphylococcal and seborrheic blepharitis?

a. Irrigate the eyes with saline solution.

b. Schedule an appointment for eye surgery.

c. Use a gentle baby shampoo to clean the eyelids.

d. Apply cool compresses to the eyes three times daily.

c. Use a gentle baby shampoo to clean the eyelids.

15. Which technique is the safest for the nurse to use when assisting a blind patient to ambulate to the bathroom?

a. Lead the patient slowly to the bathroom, holding on to the patient's arm.

b. Stay beside the patient and describe any obstacles on the path to the bathroom.

c. Walk slightly ahead of the patient, allowing the patient to hold the nurse's elbow.

d. Have the patient place a hand on the nurse's shoulder and guide the patient forward.

c. Walk slightly ahead of the patient, allowing the patient to hold the nurse's elbow.

16. Which instruction about preventing further infection would the nurse give to a patient with repeated sty (hordeolum)?

a. Apply cold compresses.

b. Discard all used eye cosmetics.

c. Wash the eyebrows with an antiseborrheic shampoo.

d. Be examined for sexually transmitted infections (STIs).

b. Discard all used eye cosmetics.

17. Which instruction would the nurse include in a teaching plan for a patient with herpes simplex keratitis in one eye?

a. Wash hands frequently and avoid touching the eyes.

b. Apply antibacterial drops to the eye several times daily.

c. Apply a new occlusive dressing to the affected eye at bedtime.

d. Use corticosteroid ophthalmic ointment to decrease inflammation.

a. Wash hands frequently and avoid touching the eyes.

18. Which information would thenurse plan to teach when caring for a patient whose vision is corrected to 20/200?

a. Accessing recorded books

b. Using a white cane safely

c. Finding Braille instruction

d. Obtaining a hand-held magnifier

d. Obtaining a hand-held magnifier

19. The nurse is caring for a patient diagnosed with adult inclusion conjunctivitis (AIC) caused by C. trachomatis. Which action would the nurse include in the plan of care?

a. Applying topical corticosteroids to decrease inflammation

b. Discussing the need for sexually transmitted infection testing

c. Educating about the use of antiviral eyedrops to treat the infection

d. Assisting with applying for community visual rehabilitation services

b. Discussing the need for sexually transmitted infection testing

20. Which topic will the nurse teach after a patient has had outpatient cataract surgery and lens implantation?

a. Use of oral opioids for pain control

b. Administration of corticosteroid drops

c. Need for bed rest for 1 to 2 days after the surgery

d. Importance of coughing and deep breathing exercises

b. Administration of corticosteroid drops

21. In reviewing a patient's medical record, the nurse notes that the last eye examination revealed an intraocular pressure of 28 mm Hg. Which assessment at would the nurse plan to make?

a. Visual acuity

b. Pupil reaction

c. Color perception

d. Peripheral vision

d. Peripheral vision

22. A patient with a retinal detachment had a pneumatic retinopexy procedure. Which information would the nurse include in the discharge teaching plan?

a. The use of eye patches to reduce movement of the operative eye

b. The need to wear dark glasses to protect the eyes from bright light

c. The purpose of maintaining the head resting in a prescribed position

d. The procedure for dressing changes when the eye dressing is saturated

c. The purpose of maintaining the head resting in a prescribed position

23. A patient with age-related macular degeneration (AMD) has just had photodynamic therapy. Which statement by the patient indicates that the discharge teaching has been effective?

a. ―I will use drops to keep my pupils dilated until my appointment.‖

b. ―I will need to use brighter lights to read for at least the next week.‖

c. ―I will not use facial lotions near my eyes during the recovery period.‖

d. ―I will cover up with long-sleeved shirts and pants for the next 5 days.‖

d. ―I will cover up with long-sleeved shirts and pants for the next 5 days.‖

24. How would the nurse evaluate a patient for improvement after treatment of primary open-angle glaucoma (POAG)?

a. Ask the patient about blurred vision.

b. Assess for changes in the patient's visual field.

c. Ask the patient to rate the pain using a 0 to 10 scale.

d. Assess the patient's depth perception when climbing stairs.

b. Assess for changes in the patient's visual field.

25. Which patient arriving at the urgent care center would the nurse assess first?

a. Patient who is reporting that the left eyelid has just started to droop

b. Patient with acute right eye pain that began while using power tools

c. Patient with purulent left eye discharge and conjunctival inflammation

d. Patient who has redness, crusting, and swelling along the lower right lid margin

b. Patient with acute right eye pain that began while using power tools

26. A patient with glaucoma who has been using timolol (Timoptic) drops for several days tells the nurse that the eyedrops cause eye burning and visual blurriness after administration. Which response would the nurse provide?

a. ―Those symptoms may indicate a need for a change in dosage of the eyedrops.‖

b. ―The drops are uncomfortable, but using them can help to retain your vision.‖

c. ―These are normal side effects of thedrug, which will go away over time.‖

d. ―Notify your health care provider so that different eyedrops can be prescribed.‖

b. ―The drops are uncomfortable, but using them can help to retain your vision.‖

27. Which statement by a patient with bacterial conjunctivitis indicates a need for further teaching?

a. ―I will wash my hands often during the day.‖

b. ―I will remove my contact lenses at bedtime.‖

c. ―I will not share towels with my friends or family.‖

d. ―I will monitor my family for eye redness or drainage.‖

b. ―I will remove my contact lenses at bedtime.‖

28. The nurse at the outpatient surgery unit obtains the following information about a patient who is scheduled for cataract extraction and implantation of an intraocular lens. Which information would the nurse report to the health care provider before the procedure?

a. The patient has had blurred vision for 3 years.

b. A family member will drive the patient home.

c. The patient takes antihypertensive medications.

d. The patient reports nausea with general anesthesia.

c. The patient takes antihypertensive medications.

29. The nurse learns that a newly admitted patient has functional blindness and that the spouse has cared for the patient for many years. Which action would the nurse take during the initial assessment?

a. Obtain more information about the cause of the patient's vision loss.

b. Obtain information from the spouse about the patient's special needs.

c. Make eye contact with the patient and ask about any need for assistance.

d. Perform an evaluation of the patient's visual acuity using a Snellen chart.

c. Make eye contact with the patient and ask about any need for assistance.

30. Which action could the registered nurse (RN) who is working in the clinic delegate to a licensed practical/vocational nurse (LPN/VN)?

a. Evaluate a patient's ability to administer eyedrops.

b. Check a patient's visual acuity using a Snellen chart.

c. Inspect a patient's retina with an ophthalmoscope.

d. Teach a patient about medications to treat glaucoma.

b. Check a patient's visual acuity using a Snellen chart.

31. The occupational health nurse is caring for an employee who reports bilateral eye pain after a cleaning solution splashed into the employee's eyes. Which action will the nurse take?

a. Apply cool compresses.

b. Flush the eyes with saline.

c. Apply antiseptic ophthalmic ointment to the eyes.

d. Cover the eyes with dry sterile patches and shields

b. Flush the eyes with saline.

32. The nurse at the eye clinic made a follow-up telephone call to a patient who underwent cataract extraction and intraocular lens implantation the previous day. Which information is the priority to communicate to the health care provider?

a. The patient reports that the vision has not improved.

b. The patient requests a prescription refill for next week.

c. The patient feels uncomfortable wearing an eye patch.

d. The patient reports eye pain rated 5 (on a 0 to 10 scale).

d. The patient reports eye pain rated 5 (on a 0 to 10 scale).

33. A patient in the emergency department reports being struck in the right eye with a fist. Which finding is a priority for the nurse to communicate to the health care provider?

a. The patient reports a right-sided headache.

b. The sclera on the right eye has broken blood vessels.

c. The patient reports ―a curtain‖ over part of the visual field.

d. The area around the right eye is bruised and tender to the touch.

c. The patient reports ―a curtain‖ over part of the visual field.

34. The charge nurse observes a newly hired nurse performing all the following interventions for a patient who has just undergone right cataract removal and an intraocular lens implant. Which action requires that the charge nurse intervene?

a. The nurse leaves the eye shield in place.

b. The nurse encourages the patient to cough.

c. The nurse elevates the patient's head to 45 degrees.

d. The nurse applies corticosteroid drops to the right eye.

b. The nurse encourages the patient to cough.

36. A patient with a head injury after a motorcycle crash arrives in the emergency department (ED) reporting shortness of breath and severe eye pain. Which action will the nurse take first?

a. Assess cranial nerve functions.

b. Administer the prescribed analgesic.

c. Check the patient's oxygen saturation.

d. Examine the eye for evidence of trauma.

c. Check the patient's oxygen saturation.

35. Which nursing activity is appropriate for the registered nurse (RN) working in the eye clinic to delegate to experienced assistive personnel (AP)?

a. Instilling antiviral drops for a patient with a corneal ulcer

b. Application of a warm compress to a patient's hordeolum

c. Instruction about hand washing for a patient with herpes keratitis

d. Checking for eye irritation in a patient with possible conjunctivitis

b. Application of a warm compress to a patient's hordeolum .

37. Which prescribed medication would the nurse give first to a patient who has just been admitted to a hospital with acute angle-closure glaucoma?

a. Morphine sulfate 4 mg IV

b. Mannitol (Osmitrol) 100 mg IV

c. Betaxolol (Betoptic) 1 drop in each eye

d. Acetazolamide (Diamox) 250 mg orally

b. Mannitol (Osmitrol) 100 mg IV

38. A 75-yr-old patient who lives alone at home tells the nurse, ―I am afraid of losing my independence because my eyes don't work as well they used to.‖ Which action would the nurse take first?

a. Discuss the increased risk for falls that is associated with impaired vision.

b. Ask the patient about what type of vision problems are being experienced.

c. Explain that there are many ways to compensate for decreases in visual acuity.

d. Suggest ways of improving the patient's safety, such as using brighter lighting.

b. Ask the patient about what type of vision problems are being experienced.

39. A patient who received a corneal transplant 2 weeks ago calls the ophthalmology clinic to report that his vision has not improved with the transplant. Which action would the nurse take?

a. Suggest the patient arrange a ride to the clinic immediately.

b. Ask about the presence of ―floaters‖ in the patient's visual field.

c. Remind the patient it may take months to restore vision after transplant.

d. Teach the patient to continue using prescribed pupil-dilating medications.

c. Remind the patient it may take months to restore vision after transplant.

40. An older adult patient who has been diagnosed with age-related macular degeneration (AMD) asks the nurse what actions could help slow or avoid the potential vision loss. Which recommendations would the nurse plan to make? (Select all that apply.)

a. Maintain a healthy body weight.

b. Do not smoke or use tobacco products.

c. Include whole grains in your daily diet.

d. Avoid eating dark green leafy vegetables.

e. Consider taking an antioxidant supplement.

ANS: A, B, C, E

a. Maintain a healthy body weight.

b. Do not smoke or use tobacco products.

c. Include whole grains in your daily diet.

e. Consider taking an antioxidant supplement.