Nokea
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.
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While cleaning gutters, a client reports getting debris in the eyes. On inspection, the nurse notes no obvious foreign object. Which diagnostic evaluation technique would be most beneficial for this client?
- A. Administer fluorescein dye.
- B. Obtain an x-ray for orbital fractures.
- C. Assess intraocular movements.
- D. Assess with tonometer.
Correct Answer: A
Rationale: Fluorescein dye stains the eye and helps to identify minute foreign body or abrasions in the cornea. X-ray of the eye orbit would be done if a blow to the area preceded the visit. Assessment of intraocular movements (cranial nerves III, IV, and VI) would not be indicated. Tonometry is done for assessment of intraocular pressure and would not be indicated.
The nurse is caring for a client who underwent surgery for a retinal detachment. The surgery included the injection of an air bubble to promote contact between the retina and choroids. What position should the nurse keep the client in?
- A. With the face parallel to the floor
- B. With the client's head slightly elevated
- C. With the client lying in a high Fowler's position
- D. With the client in an upright position
Correct Answer: A
Rationale: If an air bubble is instilled to promote contact between the retina and sclera, the client is positioned with the face parallel to the floor so that the bubble floats to the posterior of the eye. The client is asked to be on complete bed rest for several days with the head immobilized and to avoid any physical movements.
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.
At morning report, the nurse learns the assigned client is blind. Which question should the nurse ask the client upon initial assessment?
- A. Have you always been blind?
- B. What caused your vision problem?
- C. Are you dependent with your care?
- D. Can you perceive light and motion?
Correct Answer: D
Rationale: Many people who are considered blind perceive light and motion. Establishing this fact can help in developing a plan of care for this client. Establishing cause and length of time for visual impairment is not required for initial care. Asking the client about dependence is important, but the new environment could provide safety issues (even if independent) if no perception of light is identified.
An older adult client is scheduled for cataract surgery and asks the nurse, 'Will I need to wear thick lenses after surgery?' Which is an appropriate response from the nurse?
- A. An implanted lens has replaced the need for corrective glasses.
- B. Contact lenses are preferred by most clients after this surgery.
- C. They can make corrective lenses much thinner now.
- D. No lens is necessary with cataract surgery.
Correct Answer: A
Rationale: Vision is usually restored after cataract surgery with an intraocular lens implant. Contact lenses can be used but can be burdensome for older adults. Corrective glass lenses can cause a distortion of peripheral vision and only one lens is required (over operative eye). To restore vision after cataract surgery, a lens is required.