Nokea
A client asks the nurse why miotic eye solutions were prescribed in the treatment of the client's glaucoma. Which is the best nursing rationale for the use of this medication?
- A. Constricts intraocular vessels
- B. Paralyzes ciliary muscles
- C. Constricts pupil
- D. Dilates the pupil
Correct Answer: C
Rationale: A miotic agent works by constricting the pupil and pulling the iris away from the drainage channels so that the aqueous fluid can escape. These medications increase outflow and decrease intraocular pressure. Cycloplegics paralyze the ciliary muscles of the eye. Mydriatics drugs are used to dilate the pupil and are contraindicated in glaucoma.
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A nurse is caring for a client newly diagnosed with glaucoma. Which would be a priority in the nurse's teaching about maintaining normal pressure range in the eye?
- A. Increase fiber in the diet.
- B. Avoid reading.
- C. Eat small meals.
- D. Treat allergy symptoms promptly.
Correct Answer: A
Rationale: Adding fiber to the diet will increase ease of bowel movements and prevent constipation and straining, which can inadvertently increase intraocular pressure. Eating small meals is insignificant in maintaining intraocular pressure. Avoid over-the-counter treatment of cold and allergy symptoms if contains cholinergic blockers. Reading is not significant in changing intraocular pressure, but eye strain should be avoided.
A nurse is assessing a client for a fracture to the bony orbit. What would the nurse document if the assessment for fracture was positive?
- A. There is excessive tearing.
- B. The client's vision is blurred.
- C. A rust ring is seen around the pupil.
- D. The client has diplopia.
Correct Answer: D
Rationale: If the bony orbit is fractured, the eyes may appear asymmetric, and the client has diplopia or double vision. Excessive tearing, presence of rust rings, or blurry vision do not indicate a fractured bony orbit.
Following cataract removal, the client receives discharge instructions from the nurse. Which of the following instructions is most important?
- A. Apply a protective patch to the affected eye at bedtime.
- B. For the first 48 hours, avoid any activity that could cause particles to lodge in the eye.
- C. Avoid washing face and eyes for the first 24 hours.
- D. Avoid heavy lifting for 1 week.
Correct Answer: D
Rationale: For at least 1 week, the client should avoid strenuous activity and heavy lifting; bending, stooping, or other exercises that potentially increase intraocular pressure; immersing the eyes in water (clients may use a clean damp cloth to remove any eye discharge); and any activity that could cause dust or other particles to lodge in the eye. Clients may sleep on the back or unaffected side. The client should wear a protective eye shield for 24 hours after the procedure and then at night and during naps for about a week. Therefore, it is insufficient for the nurse to instruct the client to wear a protective shield at bedtime.
Which technique would be most beneficial for ambulation of a client who is visually impaired?
- A. Speak before touching the client.
- B. Provide a detailed description of the room and walkway.
- C. Allow client to follow the nurse's lead.
- D. Provide the client with a guide dog.
Correct Answer: C
Rationale: A blind person feels more secure and safe when assisted by someone who is sighted. The nurse should walk slightly ahead while allowing the client to hold onto the nurse's upper arm or elbow. Speaking before touching is an important care action in dealing with clients who have impaired vision but does not assist in ambulation. Providing a detailed description of the room may allow the client an image of the surroundings but is not as helpful in initial ambulation. Finding a perfect fit between guide dog and client is a lengthy process and should be pursued upon request of client.
A nurse is caring for a client diagnosed with keratitis. What advice should the nurse give this client?
- A. Use warm soaks frequently.
- B. Begin using dark glasses.
- C. Wash the face and hair frequently.
- D. Massage the surrounding area.
Correct Answer: B
Rationale: Dark glasses are recommended for a client with keratitis to relieve photophobia. Treatment for keratitis does not require use of warm soaks and massages or washing of the face and hair.