Nokea
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.
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The nurse is caring for a client with open-angle glaucoma. What does the nurse know that this disease causes? Select all that apply.
- A. Atrophy of nerve fibers in the central area of the retina
- B. Edema of the lens
- C. Degeneration of the optic nerve
- D. Edema of the cornea
- E. Atrophy of nerve fibers in the peripheral areas of the retina
Correct Answer: C,D,E
Rationale: Open-angle glaucoma occurs when structures in the drainage system (i.e., trabecular meshwork and canal of Schlemm) degenerate, and the exit channels for aqueous fluid become blocked. As the intraocular pressure (IOP) rises, it causes edema of the cornea, atrophy of nerve fibers in the peripheral areas of the retina, and degeneration of the optic nerve. This makes the other options incorrect.
A nurse is caring for a client who has just been diagnosed with glaucoma. What teaching should the nurse include with this client?
- A. How long it will be necessary to wear dark glasses
- B. The importance of regular bowel habits
- C. What vegetables to eat
- D. When it will be possible to read again
Correct Answer: B
Rationale: Instructions for the client with glaucoma include the following: Obtain assistance from a family member, relative, or friend if having trouble instilling eye drops. Avoid all drugs that contain atropine. Check with physician or pharmacist before using any nonprescription drug. preparations for cold or allergy symptoms may contain an atropine-like drug. Maintain regular bowel habits; straining at stool can raise intraocular pressure (IOP). Avoid heavy lifting and emotional upsets (especially crying) because they increase IOP. Patients do not have to wear dark glasses. Vegetable consumption is not restricted. Reading does not increase IOP.
An eighth-grade client visits the school nurse and reports having been to an eye doctor who identified an astigmatism and described it as a condition in which the eyeball is not shaped correctly. The client asks the nurse why both eyes look alike in the mirror if this is the case. What is the nurse's best response?
- A. Astigmatism means that the very front part of the eye is shaped differently than the very front part in most eyes.
- B. Astigmatism means that the overall shape of the eye resembles an olive more than most eyes.
- C. Astigmatism means that the inside of the eye is shaped differently than the inside of most eyes.
- D. Astigmatism means that the overall shape of your eye is shorter than most eyes.
Correct Answer: A
Rationale: Astigmatism is visual distortion caused by an irregularly shaped cornea. When the overall shape of the eye is like an olive, or more oblong, it results in myopia, not astigmatism, although both conditions may be present at once. The inside of the eye is not shaped differently in the client with an astigmatism. The overall shape of the eye being shorter results in hyperopia, not astigmatism.
The client with chronic open-angle glaucoma is receiving timolol eye drops. Which evaluation finding would indicate to the nurse the treatment is working?
- A. Intraocular pressure 15 mm Hg
- B. Reduced peripheral vision
- C. Halos around lights
- D. Decrease in nausea and vomiting
Correct Answer: A
Rationale: Timolol is a beta-blocker that is used topically to decrease the flow rate of aqueous humor in the eye. As flow rate decreases, the intraocular pressure decreases. IOP of 12 to 21 mm Hg is within normal range. Reduced peripheral vision, halos around lights, and blurred vision are all symptoms of open-angle glaucoma. Nausea and vomiting are more likely to occur with acute angle-closure glaucoma.
A client is diagnosed with blepharitis. What symptoms should a nurse monitor in this client?
- A. Patchy flakes clinging to the eyelashes
- B. A red pustule in the internal tissue of the eyelid
- C. Redness surrounding the conjunctival sac
- D. A halo around the pupil
Correct Answer: A
Rationale: Blepharitis is an inflammation of the lid margins. The nurse monitors visible patchy flakes clinging to the eyelashes and about the lids. The condition does not cause redness or a halo around the pupil. In case of a sty, the nurse would observe a red pustule in the internal tissue of the eyelid.