NURSING 16954 (C47) CHAPTER 47: CARE OF PATIENTS WITH EYE AND VISION PROBLEMS IGNATAVICIUS: MEDICAL-SURGICAL NURSING, 8TH EDITION MULTIPLE CHOICE

NURSING 16954 (C47) CHAPTER 47: CARE OF PATIENTS WITH EYE AND VISION PROBLEMS IGNATAVICIUS: MEDICAL-SURGICAL NURSING, 8TH EDITION MULTIPLE CHOICE 1. A client has a corneal ulcer. What information provided by the client most indicates a potential barrier to home care? a. Chronic use of sleeping pills b. Impaired near vision c. Slightly shaking hands d. Use of contact lenses ANS: A Antibiotic eyedrops are often needed every hour for the first 24 hours for corneal ulceration. The client who uses sleeping pills may not wake up each hour or may awaken unable to perform this task. This client might need someone else to instill the eyedrops hourly. Impaired near vision and shaking hands can both make administration of eyedrops more difficult but are not the most likely barriers. Contact lenses should be discarded. DIF: Analyzing/Analysis REF: 980 KEY: Visual system| visual disorders| medication administration MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance 2. An older client has decided to give up driving due to cataracts. What assessment information is most important to collect? a. Family history of visual problems b. Feelings related to loss of driving c. Knowledge about surgical options d. Presence of family support ANS: B Loss of driving is often associated with loss of independence, as is decreasing vision. The nurse should assess how the client feels about this decision and what its impact will be. Family history and knowledge about surgical options are not related as the client has made a decision to decline surgery. Family support is also useful information, but it is most important to get the client’s perspective on this change. DIF: Applying/Application REF: 983 KEY: Visual system| visual disorders| cataracts| older adult| coping| psychosocial response MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Psychosocial Integrity 3. A client is in the preoperative holding area waiting for cataract surgery. The client says “Oh, yeah, I forgot to tell you that I take clopidogrel, or Plavix.” What action by the nurse is most important? a. Ask the client when the last dose was. b. Check results of the prothrombin time (PT) and international normalized ratio (INR). c. Document the information in the chart. d. Notify the surgeon immediately. ANS: D Clopidogrel is an antiplatelet aggregate and could increase bleeding. The surgeon should be notified immediately. The nurse should find out when the last dose of the drug was, but the priority is to notify the provider. This drug is not monitored with PT and INR. Documentation should occur but is not the priority. DIF: Applying/Application REF: 983 KEY: Visual system| visual disorders| cataracts| preoperative nursing| communication MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 4. A client does not understand why vision loss due to glaucoma is irreversible. What explanation by the nurse is best? a. “Because eye pressure was too high, the tissue died.” b. “Glaucoma always leads to permanent blindness.” c. “The traumatic damage to your eye was too great.” d. “The infection occurs so quickly it can’t be treated.” ANS: A Glaucoma is caused when the intraocular pressure becomes too high and stays high long enough to cause tissue ischemia and death. At that point, vision loss is permanent. Glaucoma does not have to cause blindness. Trauma can cause glaucoma but is not the most common cause. Glaucoma is not an infection. DIF: Understanding/Comprehension REF: 985 KEY: Visual system| visual disorders| glaucoma| patient education| pathophysiology MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 5. A client’s intraocular pressure (IOP) is 28 mm Hg. What action by the nurse is best? a. Educate the client on corneal transplantation. b. Facilitate scheduling the eye surgery. c. Plan to teach about drugs for glaucoma. d. Refer the client to local Braille classes. ANS: C This increased IOP indicates glaucoma. The nurse’s main responsibility is teaching the client about drug therapy. Corneal transplantation is not used in glaucoma. Eye surgery is not indicated at this time. Braille classes are also not indicated at this time. DIF: Applying/Application REF: 985 KEY: Visual system| visual disorders| glaucoma| patient education MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 6. A client had a retinal detachment and has undergone surgical correction. What discharge instruction is most important?