The client is diagnosed with glaucoma. Which symptom should the nurse expect the client to report?
a. Loss of peripheral vision
b. Floating spots in the vision
c. A yellow haze around everything
d. A curtain coming across vision - ANS_a. Loss of peripheral vision
Rationale: In glaucoma, the client is often unaware he or she has the disease until the client experiences
blurred vision, halos around lights, difficulty focusing, or loss of peripheral vision. Glaucoma is often
called the "silent thief".
2. The client is scheduled for right-eye cataract removal surgery in 5 days. Which prep instruction should
be discussed with the client?
a. Administer dilating drops to both eyes for 72 hours prior to surgery.
b. Prior to surgery do not lift or push any objects heavier than 15 pounds.
c. Make arrangements for being in the hospital for at least 3 days.
d. Avoid taking any type of medication which may cause bleeding, such as aspirin. - ANS_d. Avoid taking
any type of medication which may cause bleeding, such as aspirin.
Rationale: To reduce retrobulbar hemorrhage, any anticoagulant therapy is withheld, including aspirin,
NSAIDs, and warfarin (Coumadin).
3. The client is post op retinal detachment surgery, and gas tamponade was used to flatten the retina.
Which intervention should the nurse implement first?
, a. Teach the signs of increased intraocular pressure.
b. Position the client as prescribed by the surgeon.
c. Assess the eye for signs or symptoms of complications
d. Explain the importance of follow-ups visits - ANS_c. Assess the eye for signs or symptoms of
complications
Rationale: The nurse's priority must be assessment of complications, which include increased intraocular
pressure, endophthalmitis, development of another retinal detachment, or loss of turgor in the eye.
4. The 65 yr old client is diagnosed with macular degeneration. Which statement by the client indicates
the client needs more discharge teaching?
a. "I should use magnification devices as much as possible".
b. "I will look at my Amsler grid at least twice a week".
c. "I need to use low-watt light bulbs in my house".
d. I am going to contact a low-vision center to evaluate my home". - ANS_c. "I need to use low-watt light
bulbs in my house".
Rationale: Macular degeneration is the most common cause of visual loss in people older than age 60
years. Any intervention which helps increase vision should be included in the teaching, such as bright
lightning, not decreased lightning.
The nurse who is at a local park sees a young man on the ground who has fallen and has a stick lodged in
his eye. Which intervention should the nurse implement at the scene?
a. Carefully remove the stick from the eye.
b. Stabilize the stick as best as possible.
c. Flush the eye with water if available.
d. Place the young man in a high-Fowler's position - ANS_b. Stabilize the stick as best as possible.
a. Loss of peripheral vision
b. Floating spots in the vision
c. A yellow haze around everything
d. A curtain coming across vision - ANS_a. Loss of peripheral vision
Rationale: In glaucoma, the client is often unaware he or she has the disease until the client experiences
blurred vision, halos around lights, difficulty focusing, or loss of peripheral vision. Glaucoma is often
called the "silent thief".
2. The client is scheduled for right-eye cataract removal surgery in 5 days. Which prep instruction should
be discussed with the client?
a. Administer dilating drops to both eyes for 72 hours prior to surgery.
b. Prior to surgery do not lift or push any objects heavier than 15 pounds.
c. Make arrangements for being in the hospital for at least 3 days.
d. Avoid taking any type of medication which may cause bleeding, such as aspirin. - ANS_d. Avoid taking
any type of medication which may cause bleeding, such as aspirin.
Rationale: To reduce retrobulbar hemorrhage, any anticoagulant therapy is withheld, including aspirin,
NSAIDs, and warfarin (Coumadin).
3. The client is post op retinal detachment surgery, and gas tamponade was used to flatten the retina.
Which intervention should the nurse implement first?
, a. Teach the signs of increased intraocular pressure.
b. Position the client as prescribed by the surgeon.
c. Assess the eye for signs or symptoms of complications
d. Explain the importance of follow-ups visits - ANS_c. Assess the eye for signs or symptoms of
complications
Rationale: The nurse's priority must be assessment of complications, which include increased intraocular
pressure, endophthalmitis, development of another retinal detachment, or loss of turgor in the eye.
4. The 65 yr old client is diagnosed with macular degeneration. Which statement by the client indicates
the client needs more discharge teaching?
a. "I should use magnification devices as much as possible".
b. "I will look at my Amsler grid at least twice a week".
c. "I need to use low-watt light bulbs in my house".
d. I am going to contact a low-vision center to evaluate my home". - ANS_c. "I need to use low-watt light
bulbs in my house".
Rationale: Macular degeneration is the most common cause of visual loss in people older than age 60
years. Any intervention which helps increase vision should be included in the teaching, such as bright
lightning, not decreased lightning.
The nurse who is at a local park sees a young man on the ground who has fallen and has a stick lodged in
his eye. Which intervention should the nurse implement at the scene?
a. Carefully remove the stick from the eye.
b. Stabilize the stick as best as possible.
c. Flush the eye with water if available.
d. Place the young man in a high-Fowler's position - ANS_b. Stabilize the stick as best as possible.
