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Chapter 63: Assessment and Management of Patients with Eye andVision Disorders The registered nurse taking shift report learns that an assigned patient is blind. How best communicate with this patient? should the nurse A) Provide instructions in simple, clear terms. B) Introduce herself in a firm, l...

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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter63:AssessmentandManagementofPatientswithEyeand VisionDisorders  1.

Theregisterednursetakingshiftreportlearnsthatanassignedpatientisblind.Howshouldthenurse bestcommunicatewiththispatient?

A)

Provideinstructionsinsimple,clearterms.

B)

Introduceherselfinafirm,loudvoiceatthedoorwayoftheroom.

C)

Lightlytouchthepatientsarmandthenintroduceherself.

D)

Statehernameandroleimmediatelyafterenteringthepatientsroom.

Ans:

D Feedback: Thereareseveralguidelinestoconsiderwheninteractingwithapersonwhoisblindorhaslowvision. Identifyyourselfbystatingyournameandrole,beforetouchingormakingphysicalcontactwiththe patient.Whentalkingtotheperson,speakdirectlyathimorherusinganormaltoneofvoice.Thereis noneedtoraiseyourvoiceunlessthepersonasksyoutodosoandthereisnoparticularneedtosimplify verbalinstructions.

2.

Thenursehastakenshiftreportonherpatientsandhasbeentoldthatonepatienthasanocularcondition thathasprimarilyaffectedtherodsinhiseyes.Consideringthisinformation,whatshouldthenursedo whilecaringforthepatient?

A)

Ensureadequatelightinginthepatientsroom.

B)

Provideadimlylitroomtoaidvisionbylimitingcontrast.

C)

Carefullypointoutcolordifferencesforthepatient.

D)

Carefullypointoutfinedetailsforthepatient.

Ans:

A Feedback: Thenurseshouldprovideadequatelightinginthepatientsroom,astherodsaremainlyresponsiblefor nightvisionorvisioninlowlight.Ifthepatientsrodsareimpaired,thepatientwillhavedifficultyseeing indimlight.Theconesintheeyesprovidebestvisionforbrightlight,colorvision,andfinedetail.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

3.

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Apatientwhopresentsforaneyeexaminationisdiagnosedashavingavisualacuityof20/40.The patientasksthenursewhatthesenumbersspecificallymean.Whatisacorrectresponsebythenurse?

A)

Apersonwhosevisionis20/40canseeanobjectfrom40feetawaythatapersonwith20/20vision canseefrom20feetaway.

B)

Apersonwhosevisionis20/40canseeanobjectfrom20feetawaythatapersonwith20/20vision canseefrom40feetaway.

C)

Apersonwhosevisionis20/40canseeanobjectfrom40inchesawaythatapersonwith20/20 visioncanseefrom20inchesaway.

D)

Apersonwhosevisionis20/40canseeanobjectfrom20inchesawaythatapersonwith20/20 visioncanseefrom40inchesaway.

Ans:

B Feedback: TheSnellenchartisatoolusedtomeasurevisualacuity.Itiscomposedofaseriesofprogressively smallerrowsoflettersandisusedtotestdistancevision.Thefraction20/20isconsideredthestandard ofnormalvision.Mostpeoplecanseethelettersonthelinedesignatedas20/20fromadistanceof20 feet.Apersonwhosevisionis20/40canseeanobjectfrom20feetawaythatapersonwith20/20vision canseefrom40feetaway.

4.

Duringdischargeteachingthenurserealizesthatthepatientisnotabletoreadmedicationbottles accuratelyandhasnotbeentakinghermedicationsconsistentlyathome.Howshouldthenurse intervenemostappropriatelyinthissituation?

A)

Askthesocialworkertoinvestigatealternativehousingarrangements.

B)

Askthesocialworkertoinvestigatecommunitysupportagencies.

C)

Encouragethepatienttoexploresurgicalcorrectionsforthevisionproblem.

D)

Arrangeforreferraltoarehabilitationfacilityforvisiontraining.

Ans:

B Feedback: Managinglowvisioninvolvesmagnificationandimageenhancementthroughtheuseoflow-visionaids andstrategiesandreferralstosocialservicesandcommunityagenciesservingthosewithvisual impairment.Communityagenciesofferservicestopatientswithlowvision,whichincludetrainingin independentlivingskillsandavarietyofassistivedevicesforvisionenhancement,orientation,and mobility,preventingpatientsfromneedingtoenteranursingfacility.Arehabilitationfacilityis generallynotneededbythepatientstolearntousetheassistivedevicesortogainagreaterdegreeof

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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independence.Surgicaloptionsmayormaynotbeavailabletothepatient. 5.

Thenurseisprovidinghealtheducationtoapatientnewlydiagnosedwithglaucoma.Thenurseteaches thepatientthatthisdiseasehasafamilialtendency.Thenurseshouldencouragethepatientsimmediate familymemberstoundergoclinicalexaminationshowoften?

A)

Atleastmonthly

B)

Atleastonceevery2years

C)

Atleastonceevery5years

D)

Atleastonceevery10years

Ans:

B Feedback: Glaucomahasafamilytendencyandfamilymembersshouldbeencouragedtoundergoexaminationsat leastonceevery2yearstodetectglaucomaearly.Testingonamonthlybasisisnotnecessaryand excessive.

6.

Apatientisexploringtreatmentoptionsafterbeingdiagnosedwithage-relatedcataractsthataffecther vision.Whattreatmentismostlikelytobeusedinthispatientscare?

A)

Antioxidantsupplements,vitaminCandE,beta-carotene,andselenium

B)

Eyeglassesormagnifyinglenses

C)

Corticosteroideyedrops

D)

Surgicalintervention

Ans:

D Feedback: Surgeryisthetreatmentoptionofchoicewhenthepatientsfunctionalandvisualstatusiscompromised. Nononsurgical(medications,eyedrops,eyeglasses)treatmentcurescataractsorpreventsage-related cataracts.Studiesrecentlyhavefoundnobenefitfromantioxidantsupplements,vitaminsCandE,betacarotene,orselenium.Corticosteroideyedropsareprescribedforuseaftercataractsurgery;however, theyincreasetheriskforcataractsifusedlong-termorinhighdoses.Eyeglassesandmagnificationmay improvevisioninthepatientwithearlystagesofcataracts,buthavelimitationsforthepatientwith impairedfunctioning.

7.

ApatientpresentsattheEDafterreceivingachemicalburntotheeye.Whatwouldbethenursesinitial

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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interventionforthispatient? A)

Generouslyflushtheaffectedeyewithadiluteantibioticsolution.

B)

Generouslyflushtheaffectedeyewithnormalsalineorwater.

C)

Applyapatchtotheaffectedeye.

D)

Applydirectpressuretotheaffectedeye.

Ans:

B Feedback: Chemicalburnsoftheeyeshouldbeimmediatelyirrigatedwithwaterornormalsalinetoflushthe chemicalfromtheeye.Antibioticsolutions,lubricantdrops,andotherprescriptiondropsmaybe prescribedatalatertime.Applicationofdirectpressuremayextendthedamagetotheeyetissueand shouldbeavoided.Patchingwillbeincorporatedintothetreatmentplanatalatertimetoassistwiththe processofre-epithelialization,butatthispointinthecareofthepatient,patchingwillpreventirrigation oftheeye.

8.

Thenurseisadministeringeyedropstoapatientwithglaucoma.Afterinstillingthepatientsfirst medication,howlongshouldthenursewaitbeforeinstillingthepatientssecondmedicationintothe sameeye?

A)

30seconds

B)

1minute

C)

3minutes

D)

5minutes

Ans:

D Feedback: A5-minuteintervalbetweensuccessiveeyedropadministrationsallowsforadequatedrugretentionand absorption.Anytimeframelessthan5minuteswillnotallowadequateabsorption.

9.

Apatientisbeingdischargedhomefromtheambulatorysurgicalcenteraftercataractsurgery.In reviewingthedischargeinstructionswiththepatient,thenurseinstructsthepatienttoimmediatelycall theofficeifthepatientexperienceswhat?

A)

Slightmorningdischargefromtheeye

B)

Anyappearanceofrednessoftheeye

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

C)

Ascratchyfeelingintheeye

D)

Anewfloaterinvision

Ans:

D

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Feedback: Cataractsurgeryincreasestheriskofretinaldetachmentandthepatientmustbeinstructedtonotifythe surgeonofnewfloatersinvision,flashinglights,decreaseinvision,pain,orincreaseinredness.Slight morningdischarge,someredness,andascratchyfeelingmaybeexpectedforafewdaysaftersurgery. 10. Apatientcomestotheophthalmologyclinicforaneyeexamination.Thepatienttellsthenursethathe oftenseesfloatersinhisvision.Howshouldthenursebestinterpretthissubjectiveassessmentfinding? A)

Thisisanormalagingprocessoftheeye.

B)

Glasseswillminimizethisphenomenon.

C)

Thepatientmaybeexhibitingsignsofglaucoma.

D)

Thismaybearesultofweakenedciliarymuscles.

Ans:

A Feedback: Asthebodyages,theperfectgel-likecharacteristicsofthevitreoushumoraregraduallylost,and variouscellsandfiberscastshadowsthatthepatientperceivesasfloaters.Thisisanormalaging process.

11. Apatientsoculartumorhasnecessitatedenucleationandthepatientwillbefittedwithaprosthesis.The nurseshouldaddresswhatnursingdiagnosiswhenplanningthepatientsdischargeeducation? A)

Disturbedbodyimage

B)

Chronicpain

C)

Ineffectiveprotection

D)

Unilateralneglect

Ans:

A

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Feedback: Theuseofanocularprosthesisislikelytohaveasignificantimpactonapatientsbodyimage. Prosthesesarenotassociatedwithchronicpainorineffectiveprotection.Thepatientexperiencesa changeinvision,butisusuallyabletoaccommodatesuchchangesandpreventunilateralneglect. 12. Thenursesassessmentofapatientwithsignificantvisuallossesrevealsthatthepatientcannotcount fingers.Howshouldthenurseproceedwithassessmentofthepatientsvisualacuity? A)

AssessthepatientsvisionusingaSnellenchart.

B)

Determinewhetherthepatientisabletoseethenurseshandmotion.

C)

Performadetailedexaminationofthepatientsexternaleyestructures.

D)

Palpatethepatientsperiocularregions.

Ans:

B Feedback: Ifthepatientcannotcountfingers,theexaminerraisesonehandupanddownormovesitsidetoside andasksinwhichdirectionthehandismoving.Aninabilitytocountfingersprecludestheuseofa Snellenchart.Palpationandexaminationcannotascertainvisualacuity.

13. Thenurseonthemedicalsurgicalunitisreviewingdischargeinstructionswithapatientwhohasa historyofglaucoma.Thenurseshouldanticipatetheuseofwhatmedications? A)

Potassium-sparingdiuretics

B)

Cholinergics

C)

Antibiotics

D)

Loopdiuretics

Ans:

B Feedback: Cholinergicsareusedinthetreatmentofglaucoma.Theactionofthismedicationistoincreaseaqueous fluidoutflowbycontractingtheciliarymuscleandcausingmiosisandopeningthetrabecularmeshwork Diureticsandantibioticsarenotusedinthemanagementofglaucoma.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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14. Anurseisteachingapatientwithglaucomahowtoadministereyedropstoachievemaximum absorption.Thenurseshouldteachthepatienttoperformwhataction? A)

Instillthemedicationintheconjunctivalsac.

B)

Maintainasupinepositionfor10minutesafteradministration.

C)

Keeptheeyesclosedfor1to2minutesafteradministration.

D)

Applythemedicationevenlytothesclera

Ans:

A Feedback: Eyedropsshouldbeinstilledintotheconjunctivalsac,whereabsorptioncanbesttakeplace,ratherthan distributedoverthesclera.Itisunnecessarytokeeptheeyesclosedortomaintainasupinepositionafter administration.

15. Apatientwithchronicopen-angleglaucomaisbeingtaughttoself-administerpilocarpine.Afterthe patientadministersthepilocarpine,thepatientstatesthathervisionisblurred.Whichnursingactionis mostappropriate? A)

Holdingthenextdoseandnotifyingthephysician

B)

Treatingthepatientforanallergicreaction

C)

Suggestingthatthepatientputonherglasses

D)

Explainingthatthisisanexpectedadverseeffect

Ans:

D Feedback: Pilocarpine,amioticdrugusedtotreatglaucoma,achievesitseffectbyconstrictingthepupil.Blurred visionlasting1to2hoursafterinstillingtheeyedropsisanexpectedadverseeffect.Thepatientmay alsonotedifficultyadaptingtothedark.Becauseblurredvisionisanexpectedadverseeffect,thedrug doesnotneedtobewithheld,nordoesthephysicianneedtobenotified.Likewise,thepatientdoesnot needtobetreatedforanallergicreaction.Wearingglasseswillnotalterthistemporaryadverseeffect.

16. Thenurseshouldrecognizethegreatestriskforthedevelopmentofblindnessinwhichofthefollowing patients? A)

A58-year-oldCaucasianwomanwithmaculardegeneration

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

A28-year-oldCaucasianmanwithastigmatism

C)

A58-year-oldAfricanAmericanwomanwithhyperopia

D)

A28-year-oldAfricanAmericanmanwithmyopia

Ans:

A

1193

Feedback: Themostcommoncausesofblindnessandvisualimpairmentamongadults40yearsofageorolderare diabeticretinopathy,maculardegeneration,glaucoma,andcataracts.The58-year-oldCaucasianwoman withmaculardegenerationhasthegreatestriskforthedevelopmentofblindnessrelatedtoherageand thepresenceofmaculardegeneration.Individualswithhyperopia,astigmatism,andmyopiaarenotina riskcategoryforblindness. 17. A6-year-oldchildisbroughttothepediatricclinicfortheassessmentofrednessanddischargefromthe eyeandisdiagnosedwithviralconjunctivitis.Whatisthemostimportantinformationtodiscusswith theparentsandchild? A)

Handwashingcanpreventthespreadofthediseasetoothers.

B)

Theimportanceofcompliancewithantibiotictherapy

C)

Signsandsymptomsofcomplications,suchasmeningitisandsepticemia

D)

Thelikelyneedforsurgerytopreventscarringoftheconjunctiva

Ans:

A Feedback: Thenursemustinformtheparentsandchildthatviralconjunctivitisishighlycontagiousand instructionsshouldemphasizetheimportanceofhandwashingandavoidingsharingtowels,facecloths, andeyedrops.Viralconjunctivitisisnotresponsivetoanytreatment,includingantibiotictherapy. Patientswithgonococcalconjunctivitisareatriskformeningitisandgeneralizedsepticemia;these conditionsdonotapplytoviralconjunctivitis.Surgerytopreventscarringoftheconjunctivaisnot associatedwithviralconjunctivitis.

18. Thenurseisadmittinga55-year-oldmalepatientdiagnosedwitharetinaldetachmentinhislefteye. Whileassessingthispatient,whatcharacteristicsymptomwouldthenurseexpecttofind? A)

Flashinglightsinthevisualfield

B)

Suddeneyepain

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

C)

Lossofcolorvision

D)

Coloredhalosaroundlights

Ans:

A

1194

Feedback: Flashinglightsinthevisualfieldisacommonsymptomofretinaldetachment.Patientsmayalsoreport spotsorfloatersorthesensationofacurtainbeingpulledacrosstheeye.Retinaldetachmentisnot associatedwitheyepain,lossofcolorvision,orcoloredhalosaroundlights. 19. Severalresidentsofalong-termcarefacilityhavedevelopedsignsandsymptomsofviralconjunctivitis. Whatisthemostappropriateactionofthenursewhooverseescareinthefacility? A)

Arrangefortheadministrationofprophylacticantibioticstounaffectedresidents.

B)

Instillnormalsalineintotheeyesofaffectedresidentstwotothreetimesdaily.

C)

Swabtheconjunctivaofunaffectedresidentsforcultureandsensitivitytesting.

D)

Isolateaffectedresidentsfromresidentswhohavenotdevelopedconjunctivitis.

Ans:

D Feedback: Topreventspreadduringoutbreaksofconjunctivitiscausedbyadenovirus,healthcarefacilitiesmustset asidespecifiedareasfortreatingpatientsdiagnosedwithorsuspectedofhavingconjunctivitiscausedby adenovirus.Antibioticsandsalineflushesareineffectiveandnormallynoneedtoperformtestingof individualslackingsymptoms.

20. Apatienthasjustreturnedtothesurgicalfloorafterundergoingaretinaldetachmentrepair.The postoperativeordersspecifythatthepatientshouldbekeptinapronepositionuntilotherwiseordered. Whatshouldthenursedo? A)

Callthephysicianandaskfortheordertobeconfirmed.

B)

Followtheorderbecausethispositionwillhelpkeeptheretinalrepairintact.

C)

Instructthepatienttomaintainthispositiontopreventbleeding.

D)

Repositionthepatientafterthefirstdressingchange.

Ans:

B

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

1195

Feedback: Forpneumaticretinopexy,postoperativepositioningofthepatientiscriticalbecausetheinjectedbubble mustfloatintoapositionoverlyingtheareaofdetachment,providingconsistentpressuretoreattachthe sensoryretina.Thepatientmustmaintainapronepositionthatwouldallowthegasbubbletoactasa tamponadefortheretinalbreak.Patientsandfamilymembersshouldbemadeawareofthesespecial needsbeforehandsothatthepatientcanbemadeascomfortableaspossible.Itwouldbeinap...