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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.
Correct Answer: B
Rationale: Community support agencies provide low-vision aids and training for medication management. Housing changes or rehabilitation facilities are excessive, and surgical options may not be applicable.
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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.
Correct Answer: B
Rationale: If the patient cannot count fingers, testing hand motion detection is the next step to assess visual acuity. Snellen charts require better vision, and external exams or palpation do not measure acuity.
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
Correct Answer: B
Rationale: Cholinergics, like pilocarpine, increase aqueous outflow in glaucoma treatment. Diuretics and antibiotics are not used for glaucoma management.
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.
Correct Answer: D
Rationale: Isolating affected residents prevents the spread of viral conjunctivitis. Antibiotics, saline flushes, and swabbing unaffected residents are ineffective or unnecessary.
An older adult patient has been diagnosed with macular degeneration and the nurse is assessing him for changes in visual acuity since his last clinic visit. When assessing the patient for recent changes in visual acuity, the patient states that he sees the lines on an Amsler grid as being distorted. What is the nurses most appropriate response?
- A. Ask if the patient has been using OTC vasoconstrictors.
- B. Instruct the patient to repeat the test at different times of the day when at home.
- C. Arrange for the patient to visit his ophthalmologist.
- D. Encourage the patient to adhere to his prescribed drug regimen.
Correct Answer: C
Rationale: Amsler grid distortions in macular degeneration warrant immediate ophthalmologic evaluation. Vasoconstrictors, repeating tests, or drug adherence are not appropriate responses.
A patient is scheduled for enucleation and the nurse is providing anticipatory guidance about postoperative care. What aspects of care should the nurse describe to the patient? Select all that apply.
- A. Application of topical antibiotic ointment
- B. Maintenance of a supine position for the first 48 hours postoperative
- C. Fluid restriction to prevent orbital edema
- D. Administration of loop diuretics to prevent orbital edema
- E. Use of an ocular pressure dressing
Correct Answer: A,E
Rationale: Post-enucleation care includes topical antibiotic ointment and an ocular pressure dressing to prevent infection and support healing. Supine positioning, fluid restriction, and diuretics are not indicated.