Ch 39: Assessment and Concepts of Care for Patients with Eye and Vision Conditions (Evolve Questions)

The nurse is caring for a healthy 54-year-old client presenting for an annual physical. The nurse would recommend that the client have an eye examination how frequently?

A. Once every year

B. Every 2 to 4 years

C. Every 3 to 5 years

D. Only when vision problems occur

B

Per organizations such as Prevent Blindness and the American Academy of Ophthalmology, clients who are 40 to 64 years of age (of any race) should have an eye examination every 2 to 4 years if they have no other eye problems (Choice B). Other choices do not reflect the recommended frequency for eye exams for this patient (Choices A, C, and D).

The nurse is caring for a client who wishes to take supplements to benefit their eye health. Which of the following supplements would the nurse discuss? Select all that apply.

A. Lutein

B. Zeaxanthin

C. Vitamin C

D. Magnesium

E. Saw palmetto

A, B

Lutein (Choice A), zeaxanthin (Choice B), and beta carotene have been shown to benefit eye health. Vitamin C (Choice C), magnesium (Choice D), and saw palmetto (Choice E) are not associated with enhancement of eye health.

Which of the following client statements about instillation of multiple different eyedrops would require the nurse to provide further teaching? Select all that apply.

A. "I bought an eyedrop instillation device."

B. "I can instill all of the prescribed eyedrops at one time."

C. "My spouse is going to make a chart showing when drops need to be used."

D. "To avoid contamination and infection, I will not touch the droppers to my eyes."

E. "Labeling eyedrops by numbers can help me easily distinguish which one is which."

B

The nurse will intervene to provide further teaching when clients say they can instill all prescribed eyedrops at one time (Choice B). Drops cannot be instilled all at one time, as each prescription will have its own dosing schedule. Buying an eyedrop instillation device (Choice A), making a chart showing when drops should be instilled (Choice C), avoiding allowing droppers to touch the eyes (Choice D), and labeling eye drops (Choice E) are appropriate and reflect that teaching has been effective. The nurse does not need to provide further teaching related to those statements.

The nurse is caring for four outpatient clients being seen for an annual physical examination. Which client would the nurse identify as being at highest risk for development of dry age-related macular degeneration (AMD)?

A. 60-year-old client who recently began wearing glasses

B. 63-year-old client who has controlled hypertension

C. 67-year-old client with hypothyroidism

D. 69-year-old client with diabetes mellitus

D

Individuals over the age of 60 who have hypertension, diabetes, or high cholesterol are at the highest risk for development of dry age-related macular degeneration (AMD). The 69-yearold individual is at highest risk, having two risk factors: age and the condition of diabetes (Choice D). The client who is 60 and recently began wearing glasses is at lower risk because this client has just turned 60 and wearing glasses is not associated with AMD (Choice A). The 63-year-old client with controlled hypertension is at lower risk because the hypertensive condition is treated and controlled (Choice B). The 67-year-old individual is at lower risk, as hypothyroidism is not associated with AMD (Choice C).

The telehealth nurse receives a call from a client who had surgery this morning to repair a retinal detachment. When the client reports pain in the affected eye with diminished visual acuity, which nursing response is appropriate?

A. "Take acetaminophen to address the pain."

B. "Contact your ophthalmologist right away."

C. "This is a normal response to the type of surgery you had."

D. "If the symptoms are still present in 24 hours, seek emergency care."

B

Pain, pus, or decreased visual acuity in an eye that recently underwent correction for a retinal detachment must be immediately reported to the eye care provider, as they can indicate a postsurgical complication (Choice B). Taking acetaminophen does not address the problem (Choice A). This is not a normal response to the type of surgery the client had (Choice C). Waiting to see if symptoms are present in 24 hours delays the care that is needed to correct the problem (Choice D).

A client comes to the emergency department reporting the new sensation of something in the eye. Which of the following assessment data would the nurse anticipate that is consistent with a foreign body? Select all that apply.

A. Pain

B. Fever

C. Tearing

D. Photophobia

E. Blurred vision

A, C, D, E

The nurse will anticipate that a client who has a foreign body in the eye will report some level of pain or discomfort (Choice A), tearing (as the foreign body irritates the tissue within the eye) (Choice C), photophobia (as it may be difficult to see if there is the presence of a foreign body and the automatic response is to close the eye) (Choice D), and blurred vision (if the foreign body obstructs the line of sight) (Choice E). Fever is not associated with a foreign body that has been in the eye for such a short amount of time (Choice B); this symptom may be present if infection arose from a foreign body that had been present for a longer period of time

Which condition would the nurse anticipate when a client explains having slow, progressive visual disturbance over the past 2 years?

A. Cataract

B. Retinal hole

C. Corneal abrasion

D. Angle-closure glaucoma

A

A cataract that is growing can cloud vision over a period of time (Choice A). All the other conditions have a more abrupt onset (Choices B, C, and D).

A client reports the sensation of "something scratching on the inside of my eyelid." Before assessing the eyelid, what is the appropriate nursing action?

A. Test the visual field.

B. Obtain informed consent.

C. Wash the hands.

D. Don sterile gloves.

C

Hands must always be washed, and clean gloves donned, before touching the external eye structures to prevent infection. The eye care provider will test the visual field. An informed consent and sterile gloves are not needed for the nurse to assess the client's eye.

Which form of eye assessment requires the nurse to assure that informed consent has been obtained from the client?

A. Eyedrop instillation

B. Fluorescein angiography

C. Ophthalmoscopy

D. Slit lamp

B

Fluorescein angiography is an invasive test and requires informed consent from the client. Assessments that require eyedrop instillation, ophthalmoscopy, or a slip lamp are not invasive procedures and do not require informed consent from the client.

When performing an eye or vision assessment, which comment by the client alerts the nurse that immediate care by an ophthalmologist is needed?

A. “One of my eyes is green and the other is blue.”

B. “My eyes are red and itchy due to allergies.”

C. “My vision has been getting worse gradually.”

D. “Something hit my eye while I was cutting grass.”

D

The client who is experiencing trauma, a foreign body in the eye, sudden ocular pain, or sudden redness should be seen immediately by an ophthalmologist. All other reports will be communicated to the ophthalmologist, but do not require immediate intervention. Heterochromia is an ocular condition, usually genetically inherited, that causes the iris to vary in color. This is not an emergency. Itching and redness can be caused by allergies, irritation, or ocular drug effects but do not require immediate attention. Gradual vision loss could be caused by uncontrolled hypertension and diabetes, or other eye changes, but this does not require immediate care by an ophthalmologist.

A client who is using the same eyedrops in both eyes develops a viral infection in one eye. Which teaching will the nurse provide?

A. "Don't touch the eyes with the dropper, and you can still use the drops in both eyes."

B. "Wash your hands between eyes and put drops in the uninfected eye first."

C. "The other eye has already likely been infected with the virus."

D. "You will need to use a separate bottle of drops for each eye."

D

The client will need a separate bottle of eyedrops for each eye. Because of the risk of transmitting the infection to the uninfected eye, clients would receive two bottles of drops labeled "right" and "left" to use in the correct eyes. There is still a risk of transmitting the infection when the dropper is kept from contacting the eye or when hands are washed. With proper technique, transmission of infection to the other eye can be prevented.

The nurse is caring for four clients with eye concerns. Which client, who has a family history of an eye disorder, does the nurse identify at risk for increased intraocular pressure (IOP)?

A. Client with family history of anisocoria

B. Client with family history of presbyopia

C. Client with family history of diabetic retinopathy

D. Client with family history of glaucoma

D

Glaucoma can be caused by increased IOP, which reduces blood flow to the eyes. Adults with a family history of glaucoma should have their IOP measured once or twice a year. Anisocoria, presbyopia, and glaucoma are not associated with increased IOP.

A client is admitted to the emergency department with metal shards in the right eye. Which diagnostic test ordered by the health care provider does the nurse question?

A. Magnetic resonance imaging (MRI)

B. Ophthalmoscopy

C. Radioisotope scanning

D. Slit lamp

A

Because the client has metal in the eye, MRI is an absolute contraindication. Ophthalmoscopy is used to assess the eye for interior and exterior damage and is not contraindicated for this client. Radioisotope scanning assesses the eye for tumors or lesions and is not contraindicated. Slit lamp examination is not a contraindication.

The nurse is teaching an older adult client about visual changes that occur with age. Which statement does the nurse include?

A. "It may take your eyes longer to adjust in a darkened room."

B. "Most visual changes occur around ages 30-35."

C. "When the sclera turns yellow, you have developed liver problems."

D. "You will have to move reading materials closer to your eyes to focus."

A

The nurse will teach the client that it may take the eyes longer to adjust in a dark room as aging occurs. With increasing age, the iris has less ability to dilate, which leads to difficulty in adapting to dark environments. Adults older than 40 years are at increased risk for both glaucoma and cataract formation. Presbyopia also commonly begins in the 40s. The sclera appears yellow or blue as a process of aging, and this condition should not be used to assess for jaundice in the older adult. The near-point of vision (the closest distance at which the eye can see an object clearly) increases with aging. Near objects (especially reading material) must be placed farther from the eye to be seen clearly.

A client is to undergo gonioscopy. When the client asks what this test is for, how will the nurse respond?

A. "This test creates a three-dimensional view of the back of the eye."

B. "The ophthalmologist uses the test to determine if you have open-angle or closed-angle glaucoma."

C. "This method of testing will determine if you have blood vessel changes due to disease or drugs."

D. "Retinal circulation is evaluated by this test."

B

Gonioscopy is performed for clients with high IOP to determine whether open-angle or closed-angle glaucoma is present. A three-dimensional view of the back of the eye is created by ultrasonic imaging of the retina and optic nerve (called ocular coherence tomography). Electroretinography helps the eye care provider to determine if a client has blood vessel changes resulting from disease or drugs. Retinal circulation is evaluated by fluorescein angiography.

The nurse providing education on eye protection suggests protective eyewear for which client? (Select all that apply.)

A. Cab driver

B. College student

C. Lifeguard

D. Racquetball player

E. Registered nurse

A, B, C, D, E

All clients need eye protection from ultraviolet (UVA) and UVB rays because of exposure to the sun. People who play sports need to wear protective eyewear to prevent possible eye injury. Nurses may need protective eyewear to avoid getting or transmitting infection.

Which systemic disorder may affect vision and require yearly eye examination by an ophthalmologist? (Select all that apply.)

A. Anemia

B. Diabetes mellitus

C. Hepatitis

D. Hypertension

E. Multiple sclerosis (MS)

B, D, E

Clients who have diabetes are at risk for diabetic retinopathy and are in need of annual eye examinations. Clients with elevated blood pressure need to have annual eye examinations because of the increased risk for retinal damage. Clients with MS should have annual examinations because of changes that occur with the neurologic effects of MS that impact visual acuity. Anemia and hepatitis are not disorders that usually affect sight and vision.