Professional Documents
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Eye and Vision 7th Edition
Eye and Vision 7th Edition
Test Bank
MULTIPLE CHOICE
ANS: A
The optic nerve enters the eyeball at this point and contains no photoreceptors. The
other responses are incorrect.
2. During assessment of an older adult, which finding does the nurse immediately
report to the health care provider?
ANS: D
In an older client, it is normal for the sclera to turn yellow or blue with aging. It is also
common for the older adult to have problems discriminating between the colors of
green, blue, and violet. Arcus senilis, an opaque, bluish-white ring on the edge of the
cornea, is a common occurrence in the older adult. This does not cause vision loss.
Pupil constriction as a reaction to light should occur in less than 1 second. If pupil
constriction takes longer, then the reaction is considered sluggish and should be
reported to the provider.
3. Which teaching is essential for a client who is going to have intraocular pressure
measurement with a slit lamp?
ANS: B
The IOP test done with a slit lamp must have direct eye contact, which could cause
discomfort, so a local anesthetic is used. The test is quick but does not cause
temporary blindness.
TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)
MSC: Integrated Process: Teaching/Learning
ANS: A
The voluntary muscles of the orbit rotate the eye and coordinate eye movements to
ensure that the retina of each eye receives an image at the same time, so that only a
single image is perceived. If the client has reported double vision, this would indicate
a problem with this coordination. The other answers are not related to extraocular eye
movements.
TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)
5. A client has paralysis of the right medial rectus muscle of the right eye. Which
assessment finding assists the nurse in validating this diagnosis?
ANS: A
Contraction of the medial rectus muscle turns the eye toward the nose. The superior
oblique muscle pulls the eye downward, and the inferior oblique muscle pulls the eye
upward. The ocular muscles do not lift the upper eyelid.
6. The nurse is assessing extraocular eye movements (EOMs) in an older adult client
and finds that the client is unable to sustain an upward gaze for longer than 2 seconds.
What does the nurse do next?
a. Repeat the test while holding the clients head in a fixed position.
b. Perform a cover-uncover eye test.
c. Document the finding and continue assessing.
d. Assess for additional signs of impending brain attack.
ANS: C
In the older adult, decreased muscle tone impairs the ability to maintain an upward
gaze and to sustain convergence. Therefore, this finding is normal for an older adult
client. The nurse would not repeat the test or hold the clients head in a fixed position.
The nurse would document the finding and continue to assess. This would not be a
cause for concern, nor would it be a symptom of impending brain attack. The cover-
uncover test is used for determining the degree of peripheral vision.
TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for
Alterations in Body Systems) MSC: Integrated Process: Nursing Process (Assessment)
7. The nurse is assessing an older adult client whose irises no longer fully dilate. What
is the best intervention for the nurse to suggest?
a. Wear dark glasses whenever you are outside.
b. Use eyedrops on a regular basis to prevent dryness.
c. Avoid rubbing your eyes to prevent corneal abrasions.
d. Turn up room lights when reading or doing close work.
ANS: D
With increasing age, the iris has less ability to dilate and clients have difficulty
adapting to a darker environment. Older adult clients may need additional light for
reading. Wearing dark glasses will not assist the client, and no indication suggests that
the clients eyes are dry. Rubbing the eyes should not cause corneal abrasions.
TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for
Alterations in Body Systems) MSC: Integrated Process: Teaching/Learning
8. The nurse is performing vision screenings. Which client is at greatest risk for
developing vision problems?
ANS: B
TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)
9. A client relates that the vision in the left eye is greatly decreased from the day
before. What does the nurse do first?
ANS: D
A client with a sudden or persistent loss of vision needs to undergo a complete history
and assessment first to identify the possible cause. Information such as current
medications must be available before the ophthalmologist is called. The nurse cannot
patch the left eye without completing an interview first.
10. During assessment, the nurse notes that a clients right pupil is 2 mm larger than the
left pupil. Which is the nurses first action?
a. Ask the client how long this condition has been present.
b. Attempt to elicit a red reflex in both eyes.
c. Document the finding as the only action.
d. Identify the medications that the client is taking.
ANS: A
Although both pupils are normally the same size and a difference in size can indicate
various pathologies, approximately 5% of people have a noticeable difference in the
size of their pupils. The nurse should first determine whether this condition represents
a change or has been present for a long time.
TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)
11. The nurse is assessing the blink reflex in a client who is blind. Which is the best
technique to use?
a. Ask the client to blink first with one eye and then with the other.
b. Expel a syringe of air toward the clients eyes.
c. Shine a bright light at the clients pupils one at a time.
d. Suddenly bring a finger toward the clients face.
ANS: B
A blind client cannot respond with a blink reflex to visually threatening movements
such as bright light or bringing a finger toward the client. Air blowing suddenly at the
eye should elicit the blink reflex as a protective response. Asking the client to blink
first with one eye and then with the other will not elicit the blink reflex.
12. The nurse is performing an eye assessment on a client. Which finding confirms
normal accommodation during visual assessment?
ANS: C
Normal accommodation is seen when the clients eyes converge. The pupils constrict
when the client focuses on an object that is being moved from about 18 cm from the
clients nose in closer toward the nose. Consensual response occurs when both pupils
constrict after a light is shined at one eye. The blink reflex occurs in response to a
sudden movement. Extraocular muscle function is tested when the client is asked to
hold an upward gaze while keeping the head still.
TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)
13. The nurse is assessing a client for the possibility of a lens opacity. Which
assessment finding confirms this problem?
ANS: B
The red reflex is elicited with an ophthalmoscope and represents reflection of the
ophthalmoscopic light through the lens onto the vascular retina. The absence of a red
reflex strongly indicates a lens opacity that does not allow light to penetrate through to
the retina. The other answers are not related to a lens opacity. Increased intraocular
pressure is measured by tonometry and could indicate glaucoma. Decreased central
vision is measured by a Snellen chart and a Jaeger card and indicates decreased visual
acuity. Positive corneal staining with topical dye could indicate corneal abrasion.
14. A client is scheduled for electroretinography. Which statement indicates that the
client understands the teaching about this procedure?
ANS: C
A local anesthetic agent is used for this procedure because an electrode is placed on
the cornea. The client could inadvertently scratch or harm the eye by touching or
rubbing it while the anesthetic effect is present. No eye pain should be noted with this
procedure, no dye is used, and restricting driving for 24 hours is not necessary.
15. The nurse is evaluating a clients technique for instilling eyedrops. Which behavior
indicates that the client needs more teaching?
ANS: B
Touching the eye with the tip of the dropper contaminates the dropper and the
medication. If the client has an infection in the eye that is touched, the dropper cannot
even be used on the clients other eye. The other answers indicate correct technique.
16. The nurse is educating a client about the instillation of eyedrops. Which client
statement indicates the need for additional teaching?
a. Squeezing my eye tightly after I put the drops in may force the drops out
of my eye too quickly.
b. If the drops are kept in the refrigerator, I will be able to tell when they
are in my eye because they will feel cold.
c. My sister has the same prescription, so we can use the same bottle of
eyedrops.
d. I will wash my hands before I use these eyedrops.
ANS: C
Eyedrops or eye ointment should never be shared because of the risk of spreading
infection. The other answers indicate correct technique.
ANS: C
Presbyopia is caused by stiffening of the lens as a result of water loss as the lens ages.
Consequently, the lens does not refract as well and light waves converge behind the
retinaa condition similar to farsightedness (hyperopia). The condition makes near
vision blurry. Corrective lenses for presbyopia increase light wave refraction and are
used for reading or close work. Therefore the other answers are incorrect. Presbyopia
can be helped with corrective lenses but only for near vision, not for distance vision.
TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for
Alterations in Body Systems)
18. A teenager is admitted to the emergency department with a possible fracture of the
left orbit after getting hit in the face with a baseball. All tests are negative and the
client is being discharged. Which is important for the nurse to teach the client?
ANS: B
If all tests are negative, restrictions on heavy lifting are not needed. An eye patch does
not have to be worn. Acetaminophen (Tylenol) would be a better choice for a
headache because aspirin promotes bleeding. The client and the family should be
taught about protective equipment while playing sports (helmet and goggles).
19. An anxious adult client asks why she needs to have intraocular pressure tested
every year. What is the best response from the nurse?
ANS: D
Although all responses are somewhat correct, explaining the outcome of abnormal
pressure is to the point and is done at the clients level of understanding, especially if
she is anxious about the test.
20. A client is told that he has 20/10 vision when tested on the Snellen chart. How
does the nurse explain this finding to the client?
ANS: B
The 20 is the point at which the client can see from the chart, and the 10 is the point at
which a healthy eye can see from the chart. Normal vision is 20/20.
21. The nurse is assessing a clients eyes. Which is the first step for the nurse in this
procedure?
ANS: B
Before examining a clients eyes, the examiner should wash his or her hands. This is
done to prevent contamination of the eye and structures. The nurse could then proceed
to explain any procedure, assess infection, or assess visual acuity using the Snellen
chart.
TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection
ControlStandard Precautions/Transmission-Based Precautions/Surgical Asepsis)
ANS: D
A client with abrupt onset of eye pain should be the priority because of possible
underlying pathology causing the symptom. An IOP of 15 is within the normal range
(10 to 21); therefore the client does not need to be seen by an eye doctor. If a client is
confused, the ophthalmoscopic examination must be rescheduled because it would not
be safe to perform the examination at this time. Drainage from an eye indicates
possible infection, but this would not be the first client to be seen.
TOP: Client Needs Category: Safe and Effective Care Environment (Management of
CareEstablishing Priorities)
MULTIPLE RESPONSE
1. The nurse is assessing the eye changes in an older adult. Which changes lead the
nurse to consult with the health care provider? (Select all that apply.)
ANS: B, C, D
Increasing redness, acute pain, and sudden changes in acuity represent manifestations
that might be indicative of a more serious complication and need the providers
evaluation. Delay could cause harm. The other signs are associated with the aging
process and do not require immediate evaluation.
TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)
OTHER
1. The nurse is administering ophthalmic drops to a client with an eye infection. Put
the following nursing interventions in order, from first to last. (Separate letters by a
comma and space as follows: a, b, c, d.)
b. Put on gloves.
e. Pull the lower eyelid downward and instill the medication into the conjunctival sac.
f. Instruct the client to close the eyes gently without squeezing the eyelids together.
ANS:
d, b, a, c, e, f
Medication checking of the five Rs the first time is always the first step, followed by
handwashing and gloving because of the risk for secretions. Rechecking the five Rs
right before giving the medication, which is actually the third time that the five Rs are
checked, is critical for maintaining safety. The nurse has the client tilt the head back,
prepare the eye, give the drug, and have the client gently close the eye.
ANS:
c, b, a, e, d, f
Before the invasive procedure is started, an informed consent form must be signed.
The mydriatic drops are then instilled 1 hour before the procedure. An IV is inserted
and the fluorescein dye injected. A series of photographs are taken. After the
procedure, the client is instructed to drink plenty of fluids to aid with excretion of the
dye through the urine. The client is taught to wear dark glasses to prevent pain caused
by the bright light until the mydriatic action of the drops has worn off.
Test Bank
MULTIPLE CHOICE
ANS: C
Nasal punctal occlusion during eyedrop instillation keeps the drug in contact with the
eye structures longer and decreases systemic absorption and side effects. Systemic
distribution of the drug is what may cause orthostatic hypotension. The other answers
will not help prevent orthostatic hypotension.
ANS: A
3. An older adult client who has a mature cataract in the right eye states, Now I have
lost the sight in my right eye because I waited too long for treatment. How does the
nurse best respond to the client?
ANS: D
Although sight is increasingly impaired as a cataract matures, no other damage is done
to the eye by waiting. Removal of the cataract will result in improved vision,
regardless of how long the cataract has been present. No indication suggests that the
client will develop a cataract in the other eye. The other statements are inaccurate.
4. Which statement indicates that the client understands teaching about the use of
aspirin postcataract surgery?
ANS: B
Aspirin disrupts platelet aggregation and increases the risk for bleeding after surgery.
Aspirin may decrease inflammation but would not mask symptoms of infection.
Aspirin does not cause increased intraocular pressure, nor does it typically cause
nausea and vomiting. Aspirin should not mask signs of infection.
5. Which assessment alerts the nurse to the possible presence of a cataract in a client?
a. Loss of central vision
b. Loss of peripheral vision
c. Dull aching in the eye and brow areas
d. Blurred vision and reduced color perception
ANS: D
As the lens becomes opaque and less able to refract light appropriately, the client
experiences blurred vision and a reduced ability to distinguish among different colors.
The development of a cataract does not typically cause loss of peripheral or central
vision, nor does it result in aching in the brow area.
TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)
a. Tobramycin (Tobrex)
b. Apraclonidine (Iopidine)
c. Gentamicin (Genoptic)
d. Ciprofloxacin (Ciloxan)
ANS: B
7. Which statement indicates that a client understands why his cataract surgery is
being done first on the eye with the poorest vision?
ANS: D
The eye with the better sight is left alone until the outcome of the first surgery is
known to reduce the chance that the client will lose sight in both eyes if complications
arise from the surgery.
TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for
Complications from Surgical Procedures and Health Alterations)
8. The nurse is teaching a client about home care after cataract surgery. Which
statement indicates that the client requires further teaching?
ANS: D
TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for
Complications from Surgical Procedures and Health Alterations)
9. A client has been educated about activities that can increase intraocular pressure.
Which statement indicates that the client requires further teaching?
ANS: D
Arm position does not influence intraocular pressure. All other activities listed
decrease the incidence of increased intraocular pressure.
TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for
Complications from Surgical Procedures and Health Alterations)
ANS: B
White, dry, crusty drainage on the eyelid and lashes is expected after cataract surgery.
Because the drainage is white and no other symptoms of infection are noted, a culture
does not need to be done and an antibiotic will not be needed. Urgency is not an issue
because this is an expected effect from the trauma of surgery. The physician does not
need to be called.
TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for
Complications from Surgical Procedures and Health Alterations)
11. The nurse is assessing a client who wishes to be considered as a potential donor for
corneal transplantation. Which medical diagnosis at the time of death excludes the
client from consideration?
ANS: A
Clients of any age may donate corneas as long as the corneas are clear and the client is
free from infectious disease or cancer at the time of death. The other problems would
not keep a client from donating corneas.
TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for
Complications from Surgical Procedures and Health Alterations)
12. The nurse assesses several clients. Which one is most likely to have secondary
open-angle glaucoma?
ANS: B
Secondary open-angle glaucoma results from another condition that interferes with
drainage of the aqueous humor such as recent eye surgery. Cataracts usually start with
a slow onset of blurred vision but do not lead to secondary open-angle glaucoma. A
late manifestation of primary open-angle glaucoma is seeing halos around lights; this
is not considered secondary open-angle glaucoma. The client with reactive pupils and
clear sclera has normal assessment findings, not related to secondary open-angle
glaucoma.
ANS: C
Aqueous humor can leak from the incision site if wound closure is incomplete. Any
fluid coming from the eye in the early postoperative period needs to be checked by the
provider.
TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for
Complications from Surgical Procedures and Health Alterations)
14. Which clinical manifestation alerts the nurse to the possibility of a vitreous humor
hemorrhage?
ANS: C
Mild seepage of blood into the vitreous humor causes the clients vision to have an
overall red haze or floaters. With a vitreous humor hemorrhage, the red reflex is
reduced. Reddened whites of the eye and swelling of the eyelids would indicate
irritation and infection of the eye.
DIF: Cognitive Level: Comprehension/Understanding REF: p. 1067
TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)
15. The nurse is providing discharge teaching for a client with posterior uveitis. Which
is the most important precaution for the nurse to teach the client?
ANS: A
Treatment of posterior uveitis is symptomatic, with eyedrops used to dilate the pupil
and decrease the inflammatory response. The client may have to instill eyedrops as
frequently as every hour. This condition consists of inflammation of the retinanot a
hemorrhage. Opioids are not prescribed to lessen the pain, but cool or warm
compresses may be used for ocular pain.
16. A client with macular degeneration would like to watch television. Where does the
nurse place the television for best visualization of the screen?
Macular degeneration decreases central vision but usually does not affect peripheral
vision. Clients looking straight ahead can see people and objects off to the side.
Therefore the television should be placed on either side of the client. The other
options would not help the client with macular degeneration to see the screen.
17. In the emergency department, the nurse is caring for a client diagnosed with a
hyphema. Which statement by the client indicates a need for further teaching?
a. When I get home, I can lie flat in bed and turn from side to side.
b. For a few days, I cannot even read a book or watch television.
c. I will need to protect the eye with a patch and shield.
d. I need to stay on bedrest and will try not to make any sudden movement.
ANS: A
A hyphema is a hemorrhage in the anterior chamber of the eye due to blunt force such
as a motor vehicle accident. For management of this condition, the client must be on
bedrest but must remain in a semi-Fowlers position to prevent accumulation of blood
around the optical center of the cornea. The client cannot lie flat in bed and rotate
from side to side. The client cannot read a book or watch television and must protect
the eye if paralytic eyedrops were used. The client needs to be as still as possible to
prevent further bleeding.
TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection
ControlHome Safety) MSC: Integrated Process: Teaching/Learning
18. A client has just returned from having surgery, and sulfahexafluoride gas was used
intraocularly. How does the nurse position the client?
ANS: D
Sulfahexafluoride gas has a lower specific gravity than the vitreous humor. It will
float to the highest position. The client should be positioned so that the gas will float
up and against the newly reattached retina. The other positions are incorrect after this
procedure.
TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for
Complications from Surgical Procedures and Health Alterations)
19. A client comes to the emergency department with periorbital ecchymosis of the
right eye. Which is the nurses priority action?
ANS: A
Ice will cause capillary vasoconstriction, thereby decreasing swelling and capillary
oozing. Treatment with ice begins at the time of injury. Whenever the eye or
surrounding tissue is injured, visual acuity is assessed next.
DIF: Cognitive Level: Application/Applying or higher REF: N/A
TOP: Client Needs Category: Safe and Effective Care Environment (Management of
CareEstablishing Priorities)
20. The nurse is teaching a client how to apply eye medication. Which is the correct
technique for applying ointment into the eye?
ANS: B
Ointment should be applied by pulling down the lower lid and forming a pocket.
Application should proceed from the inner canthus toward the outer canthus, with the
client tilting the head backward and looking up at the ceiling.
TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection
ControlStandard Precautions/Transmission-Based Precautions/Surgical Asepsis)
21. A client has conjunctivitis in both eyes and is being treated with topical antibiotics.
Which statement by the client indicates a need for further teaching?
ANS: D
Bacterial conjunctivitis is highly contagious; therefore the client must avoid sharing
anything with others that has the potential to come in contact with the infected eye,
such as washcloths or towels. The client needs to protect from reinfection by washing
hands frequently during application of the antibiotic ointment and must let the eye
doctor know if drainage continues after treatment is begun. Separate tubes of eye
ointment should be used, with one specifically labeled for each eye.
22. A client is having intraocular pressure measured for both eyes. Which response by
the client best indicates that the client understands why this is necessary every year?
ANS: C
Intraocular pressure is the pressure generated by the fluids inside the globe of the eye.
As intraocular pressure increases to above normal, it compresses the blood vessels and
the optic nerves. As the blood vessels are compressed, oxygenation to the internal eye
structures, including the nerves and photoreceptors, is diminished. The nerves and
photoreceptors require a constant supply of oxygen and will die if blood flow is
inadequate, leading to blindness. The other statements are inaccurate.
23. A client just underwent a keratoplasty. Which activity does the nurse suggest that
the client begin possibly 1 week after surgery?
ANS: C
Activities that raise the intraocular pressure (e.g., jogging, dancing, any movement
that can cause jerky head motion) should be discouraged for at least 3 weeks after
surgery. No heavy lifting should be done for 6 to 8 weeks. A sedentary job such as a
receptionist can be tolerated a week after surgery.
MULTIPLE RESPONSE
a. Acetazolamide (Diamox)
b. Pilocarpine (Pilocar)
c. Atropine (Isopto Atropine)
d. Latanoprost (Xalatan)
e. Timolol (Timoptic)
f. Epinephrine
ANS: C, F
Atropine and epinephrine are mydriatics, which decrease the outflow of aqueous
humor, resulting in increased intraocular pressure (IOP). Diamox is a carbonic
anhydrase inhibitor that decreases the formation of aqueous humor. Pilocar is a miotic
that enhances outflow of aqueous humor. Xalatan is a prostaglandin agonist that
improves outflow, and Timoptic is a beta blocker that decreases the formation of
aqueous humor. All these help decrease IOP.
ANS: A, C, D, F
Throw rugs pose a danger of slipping or tripping. The client cannot see if the rug is
flat or elevated. Extension cords should be placed under or behind the furniture to
decrease the possibility of tripping. Furniture should be out of the normal walking
pathway. Low lighting in the hallway may pose a problem when the client has a patch
and shield over the operated eye. Lighting from a window should not be a problem.
When neighbors bring food, the chance of burns occurring while cooking with limited
vision is reduced.
3. A blind client is admitted to the hospital unit. Orientation to the unit includes which
information? (Select all that apply.)
ANS: B, C, E, F
The client needs to know where everything is located to be independent and safe from
falls. Clients need to be shown where things are and how to do things such as turn on
the call light and raise the head of the bed. The client should be introduced to the staff,
not the reverse, and should first be shown how to use the call light.
TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection
ControlAccident/Injury Prevention)
1. A client has an eye prosthesis and needs to have it inserted into the eye socket.
Place the following steps of how to insert an eye prosthesis in the correct order.
(Select in order of priority.)
c. Remove the prosthesis from its container and rinse it with tepid water.
e. Don gloves.
f. Place the prosthesis between the thumb and forefinger of your dominant hand with
the notched end of the prosthesis closest to the clients nose.
g. Insert the prosthesis with the top edge slipping under the upper lid.
i. Retract the lower lid slightly until the bottom edge of the prosthesis slips behind it.
ANS:
b, a, d, e, c, h, f, g, k, i, j
The proper procedure for inserting an eye prosthesis is to explain the procedure, wash
hands, prepare your work area with a cloth or towel, apply gloves, remove the
prosthesis from its container and rinse it, use your nondominant hand to open the
clients upper eyelid, hold the prosthesis properly, insert the prosthesis with the top
edge slipping under the lid, release the lid, retract the lower lid until the prosthesis
slides into place behind the lower lid, and take your hand away slowly.
TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection
ControlAccident/Injury Prevention)