1. The clinic nurse is preparing to test the visual acuity of a client using a Snellen chart.

Which of the following identifies the accurate procedure for this visual acuity test?

1. Both eyes are assessed together, followed by the assessment of the right and then the left eye.
2. The right eye is tested followed by the left eye, and then both eyes are tested.
3. The client is asked to stand at a distance of 40ft. from the chart and is asked to read the largest
line on the chart.
4. The client is asked to stand at a distance of 40ft from the chart and to read the line than can be
read 200 ft away by an individual with unimpaired vision.

2. The clinic nurse notes that the following several eye examinations, the physician has
documented a diagnosis of legal blindness in the client’s chart. The nurse reviews the
results of the Snellen’s chart test expecting to note which of the following?

1. 20/20 vision
2. 20/40 vision
3. 20/60 vision
4. 20/200 vision

3. The client’s vision is tested with a Snellen’s chart. The results of the tests are
documented as 20/60. The nurse interprets this as:

1. The client can read at a distance of 60 feet what a client with normal vision can read at 20 feet.
2. The client is legally blind.
3. The client’s vision is normal
4. The client can read only at a distance of 20 feet what a client with normal vision can read at 60
feet.

4. Tonometry is performed on the client with a suspected diagnosis of glaucoma. The nurse
analyzes the test results as documented in the client’s chart and understands that normal
intraocular pressure is:

1. 2-7 mmHg
2. 10-21 mmHg
3. 22-30 mmHg
4. 31-35 mmHg

5. The nurse is developing a plan of care for the client scheduled for cataract surgery. The
nurse documents which more appropriate nursing diagnosis in the plan of care?

1. Self-care deficit
2. Imbalanced nutrition
3. Disturbed sensory perception
4. Anxiety

6. The nurse is performing an assessment in a client with a suspected diagnosis of cataract.

The chief clinical manifestation that the nurse would expect to note in the early stages of
cataract formation is:

1. Eye pain
2. Floating spots
3. Blurred vision
4. Diplopia

7. In preparation for cataract surgery, the nurse is to administer prescribed eye drops. The
nurse reviews the physicians orders, expecting which type of eye drops to be instilled?

1. An osmotic diuretic
2. A miotic agent
3. A mydriatic medication
4. A thiazide diuretic

8. During the early postoperative period, the client who had a cataract extraction
complains of nausea and severe eye pain over the operative site. The initial nursing action
is to:

1. Call the physician

2. Administer the ordered main medication and antiemetic
3. Reassure the client that this is normal.
4. Turn the client on his or her operative side

9. The client is being discharged from the ambulatory care unit following cataract removal.
The nurse provides instructions regarding home care. Which of the following, if stated by
the client, indicates an understanding of the instructions?

1. “I will take Aspirin if I have any discomfort.”

2. “I will sleep on the side that I was operated on.”
3. “I will wear my eye shield at night and my glasses during the day.”
4. “I will not lift anything if it weighs more that 10 pounds.”

10. The client with glaucoma asks the nurse is complete vision will return. The most
appropriate response is:
1. “Although some vision as been lost and cannot be restored, further loss may be prevented by
adhering to the treatment plan.”
2. “Your vision will return as soon as the medications begin to work.”
3. “Your vision will never return to normal.”
4. “Your vision loss is temporary and will return in about 3-4 weeks.”

11. The nurse is developing a teaching plan for the client with glaucoma. Which of the
following instructions would the nurse include in the plan of care?

1. Decrease fluid intake to control the intraocular pressure

2. Avoid overuse of the eyes
3. Decrease the amount of salt in the diet
4. Eye medications will need to be administered lifelong.

12. The nurse is performing an admission assessment on a client with a diagnosis of

detached retina. Which of the following is associated with this eye disorder?

1. Pain in the affected eye

2. Total loss of vision
3. A sense of a curtain falling across the field of vision
4. A yellow discoloration of the sclera.

13. The nurse is caring for a client with a diagnosis of detached retina. Which assessment
sign would indicate that bleeding has occurred as a result of the retinal detachment?

1. Complaints of a burst of black spots or floaters

2. A sudden sharp pain in the eye
3. Total loss of vision
4. A reddened conjunctiva

14. The client sustains a contusion of the eyeball following a traumatic injury with a blunt
object. Which intervention is initiated immediately?

1. Notify the physician

2. Irrigate the eye with cold water
3. Apply ice to the affected eye
4. Accompany the client to the emergency room

15. The client arrives in the emergency room with a penetrating eye injury from wood
chips while cutting wood. The nurse assesses the eye and notes a piece of wood protruding
from the eye, what is the initial nursing action?
1. Remove the piece of wood using a sterile eye clamp
2. Apply an eye patch
3. Perform visual acuity tests
4. Irrigate the eye with sterile saline.

16. The client arrives in the emergency room after sustaining a chemical eye injury from a
splash of battery acid. The initial nursing action is to:

1. Begin visual acuity testing

2. Irrigate the eye with sterile normal saline
3. Swab the eye with antibiotic ointment
4. Cover the eye with a pressure patch.

17. The nurse is caring for a client following enucleation. The nurse notes the presence of
bright red blood drainage on the dressing. Which nursing action is appropriate?

1. Notify the physician

2. Continue to monitor the drainage
3. Document the finding
4. Mark the drainage on the dressing and monitor for any increase in bleeding.

18. When using a Snellen alphabet chart, the nurse records the client’s vision as 20/40.
Which of the following statements best describes 20/40 vision?

1. The client has alterations in near vision and is legally blind.

2. The client can see at 20 feet what the person with normal vision can see at 40 feet.
3. The client can see at 40 feet what the person with normal vision sees at 20 feet.
4. The client has a 20% decrease in acuity in one eye, and a 40% decrease in the other eye.

19. Which of the following instruments is used to record intraocular pressure?

1. Goniometer
2. Ophthalmoscope
3. Slit lamp
4. Tonometer

20. After the nurse instills atropine drops into both eyes for a client undergoing ophthalmic
examination, which of the following instructions would be given to the client?

1. “Be careful because the blink reflex is paralyzed.”

2. “Avoid wearing your regular glasses when driving.”
3. “Be aware that the pupils may be unusually small.”
4. “Wear dark glasses in bright light because the pupils are dilated.”

21. Which of the following procedures or assessments must the nurse perform when
preparing a client for eye surgery?

1. Clipping the client’s eyelashes

2. Verifying the affected eye has been patched 24 hours before surgery
3. Verifying the client has been NPO since midnight, or at least 8 hours before surgery.
4. Obtaining informed consent with the client’s signature and placing the forms on the chart.

22. Cataract surgery results in aphakia. Which of the following statements best describes
this term?

1. Absence of the crystalline lens

2. A “keyhole” pupil
3. Loss of accommodation
4. Retinal detachment

23. When developing a teaching session on glaucoma for the community, which of the
following statements would the nurse stress?

1. Glaucoma is easily corrected with eyeglasses

2. White and Asian individuals are at the highest risk for glaucoma.
3. Yearly screening for people ages 20-40 years is recommended.
4. Glaucoma can be painless and vision may be lost before the person is aware of a problem.

24. For a client having an episode of acute narrow-angle glaucoma, a nurse expects to give
which of the following medications?

1. Acetazolamide (Diamox)
2. Atropine
3. Furosemide (Lasix)
4. Urokinase (Abbokinase)

25. Which of the following symptoms would occur in a client with a detached retina?

1. Flashing lights and floaters

2. Homonymous hemianopia
3. Loss of central vision
4. Ptosis
26. A male client has just had a cataract operation without a lens implant. In discharge
teaching, the nurse will instruct the client’s wife to:

1. Feed him soft foods for several days to prevent facial movement
2. Keep the eye dressing on for one week
3. Have her husband remain in bed for 3 days
4. Allow him to walk upstairs only with assistance.

Answers and Rationale

1. Answer: 2. The right eye is tested followed by the left eye, and then both eyes are tested.

Visual acuity is assessed in one eye at a time, and then in both eyes together with the client
comfortably standing or sitting. The right eye is tested with the left eye covered; then the left eye
is tested with the right eye covered. Both eyes then are tested together. Visual acuity is measured
with or without corrective lenses and the client stands at a distance of 20ft. from the chart.

2. Answer: 4. 20/200 vision

Legal blindness is defined as 20/200 or less with corrected vision (glasses or contact lenses) or
visual acuity of less than 20 degrees of the visual field in the better eye.

3. Answer: 4. The client can read only at a distance of 20 feet what a client with normal
vision can read at 60 feet.

Vision that is 20/20 is normal, that is, the client is able to read from 20 feet what a person with
normal vision can read from 20 feet. A client with a visual acuity of 20/60 only can read at a
distance of 20 feet of what a person with normal vision can read at 60 feet.

4. Answer: 2. 10-21 mmHg

Tonometry is the method of measuring intraocular fluid pressure using a calibrated instrument
that indents or flattens the corneal apex. Pressures between 10 and 21 mmHg are considered
within normal range.

5. Answer: 3. Disturbed sensory perception

The most appropriate nursing diagnosis for the client scheduled for cataract surgery is Disturbed
sensory perception (visual) related to lens extraction and replacement. Although the other
options identify nursing diagnoses that may be appropriate, they are not related specifically to
cataract surgery.
6. Answer: 3. Blurred vision

A gradual, painless blurring of central vision is the chief clinical manifestation of a cataract.
Early symptoms include slightly blurred vision and a decrease in color perception.

7. Answer: 3. A mydriatic medication

A mydriatic medication produces mydriasis or dilation of the pupil. Mydriatic medications are
used preoperatively in the cataract client. These medication act by dilating the pupils. They also
constrict blood vessels. An osmotic diuretic may be used to decrease intraocular pressure. A
miotic medication constricts the pupil. A thiazide diuretic is not likely to be prescribed for a
client with a cataract.

8. Answer: 1. Call the physician

Severe pain or pain accompanied by nausea is an indicator of increased intraocular pressure and
should be reported to the physician immediately. The other options are inappropriate.

9. Answer: 3. “I will wear my eye shield at night and my glasses during the day.”

The client is instructed to wear a metal or plastic shield to protect the eye from accidental and is
instructed not to rub the eye. Glasses may be worn during the day. Aspirin or medications
containing aspirin are not to be administered or taken by the client and the client is instructed to
take acetaminophen as needed for pain. The client is instructed not to sleep on the side of the
body on which the operation occurred. The client is not to lift more than 5 pounds.

10. Answer: 1. “Although some vision as been lost and cannot be restored, further loss may
be prevented by adhering to the treatment plan.”

Vision loss to glaucoma is irreparable. The client should be reassured that although some vision
has been lost and cannot be restored, further loss may be prevented by adhering to the treatment
plan. Option C does not provide reassurance to the client.

11. Answer: 4. Eye medications will need to be administered lifelong.

The administration of eye drops is a critical component of the treatment plan for the client with
glaucoma. The client needs to be instructed that medications will need to be taken for the rest of
his or her life.

12. Answer: 3. A sense of a curtain falling across the field of vision

A characteristic manifestation of retinal detachment described by the client is the feeling that a
shadow or curtain is falling across the field of vision. No pain is associated with detachment of
the retina. Options B and D are not characteristics of this disorder. A retinal detachment is an
ophthalmic emergency and even more so if visual acuity is still normal.

13. Answer: 1. Complaints of a burst of black spots or floaters

Complaints of a sudden burst of black spots or floaters indicate that bleeding has occurred as a
result of the detachment.

14. Answer: 3. Apply ice to the affected eye

Treatment for contusion begins at the time of injury. Ice is applied immediately. The client then
should be seen by a physician and receive a thorough eye examination to rule out the presence of
other eye injuries.

15. Answer: 3. Perform visual acuity tests

If the laceration is the result of a penetrating injury, an object may be noted protruding from the
eye. This object must never be removed except by the ophthalmologist because it may be holding
ocular structures in place. Application of an eye patch or irrigation of the eye may disrupt the
foreign body and cause further tearing of the sclera. (The only option that will prevent further
disruption is to assess visual acuity.)

16. Answer: 2. Irrigate the eye with sterile normal saline

Emergency care following a chemical burn to the eye includes irrigating the eye immediately
with sterile normal saline or ocular irrigating solution. In the emergency department, the
irrigation should be maintained for at least 10 minutes. Following this emergency treatment,
visual acuity is assessed.

17. Answer: 1. Notify the physician

If the nurse notes the presence of bright red drainage on the dressing, it must be reported to the
physician because this indicated hemorrhage.

18. Answer: 2. The client can see at 20 feet what the person with normal vision can see at 40
feet.

The numerator refers to the client’s vision while comparing the normal vision in the
denominator.
19. Answer: 4. Tonometer

A tonometer is a device used in glaucoma screening to record intraocular pressure. A goniometer

measures joint movement and angles. An ophthalmoscope examines the interior of the eye,
especially the retina. A slit lamp evaluates structures in the anterior chamber in the eye.

20. Answer: 4. “Wear dark glasses in bright light because the pupils are dilated.”

Atropine, an anticholinergic drug, has mydriatic effects causing pupil dilation. This allows more
light onto the retina and may cause photophobia and blurred vision. Atropine doesn’t paralyze
the blink reflex or cause miosis (pupil constriction). Driving may be contraindicated to blurred
vision.

21. Answer: 3. Verifying the client has been NPO since midnight, or at least 8 hours before
surgery.

Maintaining NPO status for at least 8 hours before surgical procedures

prevents vomiting and aspiration. There is no need to patch an eye before most surgeries or to
clip the eyelashes unless specifically ordered by the physician. The physician is responsible for
obtaining informed consent; the nurse validates that the consent is obtained.

22. Answer: 1. Absence of the crystalline lens

Aphakia means without lens, a keyhole pupil results from iridectomy. Loss of accommodation is
a normal response to aging. A retinal detachment is usually associated with retinal holes created
by vitreous traction.

23. Answer: 4. Glaucoma can be painless and vision may be lost before the person is aware
of a problem.

Open-angle glaucoma causes a painless increase in intraocular pressure (IOP) with loss of
peripheral vision. A variety of miotics and agents to decrease IOP and occasional surgery are
used to treat glaucoma. Blacks have a threefold greater chance of developing with an increased
chance of blindness than other groups. Individuals older than 40 should be screened.

24. Answer: 1. Acetazolamide (Diamox)

Acetazolamide, a carbonic anhydrase inhibitor, decreases intraocular pressure (IOP) by

decreasing the secretion of aqueous humor. Atropine dilates the pupil and decreases outflow of
aqueous humor, causing further increase in IOP. Lasix is a loop diuretic, and Urokinase is a
thrombolytic agent; they aren’t used for the treatment of glaucoma.
25. Answer: 1. Flashing lights and floaters

Signs and symptoms of retinal detachment include abrupt flashing lights, floaters, loss of
peripheral vision, or a sudden shadow or curtain in the vision. Occasionally visual loss is
gradual.

26. Answer: 4. Allow him to walk upstairs only with assistance.

Without a lens, the eye cannot accommodate. It is difficult to judge distance and climb stairs
when the eyes cannot accommodate. Therefore, the client should walk up and down stairs only
with assistance.

1. The nurse is performing a voice test to assess hearing. Which of the following describes
the accurate procedure for performing this test?

1. Stand 4 feet away from the client to ensure that the client can hear at this distance.
2. Whisper a statement and ask the client to repeat it.
3. Whisper a statement with the examiners back facing the client
4. Whisper a statement while the client blocks both ears.

2. During a hearing assessment, the nurse notes that the sound lateralizes to the clients left
ear with the Weber test. The nurse analyzes this result as:

1. A normal finding
2. A conductive hearing loss in the right ear
3. A sensorineural or conductive loss
4. The presence of nystagmus

3. The nurse is caring for a client that is hearing impaired. Which of the following
approaches will facilitate communication?

1. Speak frequently
2. Speak loudly
3. Speak directly into the impaired ear
4. Speak in a normal tone
4. The nurse has conducted discharge teaching for a client who had a fenestration
procedure for the treatment of otosclerosis. Which of the following, if stated by the client,
would indicate that teaching was effective?

1. “I should drink liquids through a straw for the next 2-3 weeks.”
2. “It’s ok to take a shower and wash my hair.”
3. “I will take stool softeners as prescribed by my doctor.”
4. “I can resume my tennis lessons starting next week.”

5. A client arrives at the emergency room with a foreign body in the left ear that has been
determined to be an insect. Which intervention would the nurse anticipate to be prescribed
initially?

1. Irrigation of the ear

2. Instillation of diluted alcohol
3. Instillation of antibiotic ear drops
4. Instillation of corticosteroids ear drops

6. The nurse has notes that the physician has a diagnosis of presbycusis on the client’s
chart. The nurse plans care knowing the condition is:

1. A sensorineural hearing loss that occurs with aging

2. A conductive hearing loss that occurs with aging.
3. Tinnitus that occurs with aging
4. Nystagmus that occurs with aging

7. A client with Meniere’s disease is experiencing severe vertigo. Which instruction would
the nurse give to the client to assist in controlling the vertigo?

1. Increase fluid intake to 3000 ml a day

2. Avoid sudden head movements
3. Lie still and watch the television
4. Increase sodium in the diet

8. The nurse is reviewing the physician’s orders for a client with Meniere’s disease. Which
diet will most likely be prescribed?

1. Low-cholesterol diet
2. Low-sodium diet
3. Low-carbohydrate diet
4. Low-fat diet
9. A client is diagnosed with a disorder involving the inner ear. Which of the following is
the most common client complaint associated with a disorder in this part of the ear?

1. Hearing loss
2. Pruritus
3. Tinnitus
4. Burning of the ear

10. A nurse would question an order to irrigate the ear canal in which of the following
circumstances?

1. Ear pain
2. Hearing loss
3. Otitis externa
4. Perforated tympanic membrane

11. Which of the following interventions is essential when instilling Cortisporin suspension,
2 gtt right ear?

1. Verifying the proper client and route

2. Warming the solution to prevent dizziness
3. Holding an emesis basin under the client’s ear
4. Positioning the client in the semi-fowlers position

12. When teaching the client about Meniere’s disease, which of the following instructions
would a nurse give about vertigo?

1. Report dizziness at once

2. Drive in daylight hours only
3. Get up slowly, turning the entire body
4. Change your position using the logroll method

13. The part of the ear that contains the receptors for hearing is the:

1. Utricle
2. Cochlea
3. Middle ear
4. Tympanic cavity

14. The ear bones that transmit vibrations to the oval window of the cochlea are found in
the:
1. Inner ear
2. Outer ear
3. Middle ear
4. Eustachian tube

15. Nerve deafness would most likely result from an injury or infection that damaged the:

1. Vagus nerve
2. Cochlear nerve
3. Vestibular nerve
4. Trigeminal nerve

16. A labyrinthectomy can be performed to treat Meniere’s syndrome. This procedure

results in:

1. Anosmia
2. Absence of pain
3. Reduction in cerumen
4. Permanent irreversible deafness

17. Otosclerosis is a common cause of conductive hearing loss. Which such a partial
hearing loss:

1. Stapedectomy is the procedure of choice

2. Hearing aids usually restore some hearing
3. The client is usually unable to hear bass tones
4. Air conduction is more effective than bone conduction

18. A client who is complaining of tinnitus is describing a symptom that is:

1. Objective
2. Subjective
3. Functional
4. Prodromal

19. Physiologically, the middle ear, containing the three ossicles, serves primarily to:

1. Maintain balance
2. Translate sound waves into nerve impulses
3. Amplify the energy of sound waves entering the ear
4. Communicate with the throat via the Eustachian tube.
Answers and Rationale
1. Answer: 2. Whisper a statement and ask the client to repeat it.

The examiner stands 1-2 feet away from the client and asks the client to block one external ear
canal. The nurse whispers a statement and asks the client to repeat it. Each ear is tested
separately.

2. Answer: 3. A sensorineural or conductive loss.

In the Weber tuning fork test the nurse places the vibrating tuning fork in the middle of the
client’s head, at the midline of the forehead, or above the upper lip over the teeth. Normally, the
sound is heard in equally in both ears by bone conduction. If the client has a sensorineural
hearing loss in one ear, the sound is heard in the other ear. If the client has a conductive hearing
loss in one ear, the sound is heard in that ear.

3. Answer: 4. Speak in a normal tone.

Speaking in a normal tone to the client with impaired hearing and not shouting are important.
The nurse should talk directly to the client while facing the client and speak clearly. If the client
does not seem to understand what is said, the nurse should express it differently. Moving closer
to the client and toward the better ear may facilitate communication, but the nurse should avoid
talking directly into the impaired ear.

4. Answer: 3. “I will take stool softeners as prescribed by my doctor.”

Following ear surgery, the client needs to avoid straining while having a bowel movement. The
client needs to be instructed to avoid drinking through a straw for 2-3 weeks, air travel, and
coughing excessively. The client needs to avoid getting his or her hair wet, washing hair,
showering for 1 week, and rapidly moving the head, bouncing, and bending over for 3 weeks.

5. Answer: 2. Instillation of diluted alcohol.

Insects are killed before removal unless they can be coaxed out by a flashlight or a humming
noise. Mineral oil or diluted alcohol is instilled into the ear to suffocate the insect, which then is
removed by using forceps. When the foreign object is vegetable matter, irrigation is not used
because this material expands with hydration and the impaction becomes worse.

6. Answer: 1. A sensorineural hearing loss that occurs with aging.

Presbycusis is a type of hearing loss that occurs with aging. Presbycusis is a gradual
sensorineural loss caused by nerve degeneration in the inner ear or auditory nerve.

7. Answer: 2. Avoid sudden head movements.

The nurse instructs the client to make slow head movements to prevent worsening of the vertigo.
Dietary changes such as salt and fluid restrictions that reduce the amount of endolymphatic fluid
sometimes are prescribed. Lying still and watching television will not control vertigo.

8. Answer: 2. Low-sodium diet.

Dietary changes such as salt and fluid restrictions that reduce the amount of endolymphatic fluid
sometimes are prescribed.

9. Answer: 3. Tinnitus.

Tinnitus is the most common complaint of clients with otological disorders, especially disorders
involving the inner ear. Symptoms of tinnitus range from mild ringing in the ear, which can go
unnoticed during the day, to a loud roaring in the ear, which can interfere with the client’s
thinking process and attention span.

10. Answer: 4. Perforated tympanic membrane.

Irrigation of the ear canal is contraindicated with perforation of the tympanic membrane because
the solution entering the inner ear may cause dizziness, nausea, vomiting, and infection.

11. Answer: 1. Verifying the proper client and route.

When giving medications, a nurse follows the five R’s of medication administration. The drops
may be warmed to prevent pain or dizziness, but this action is not essential. An emesis basin
would be used for irrigation of the ear. Put the client in the lateral position to prevent the drops
from draining out for 5 minutes, not semi-fowlers position.

12. Answer: 3. Get up slowly, turning the entire body.

Turning the entire body, not the head, will prevent vertigo. Dizziness is expected but can be
prevented. The client shouldn’t drive as he may reflexively turn the wheel to correct vertigo.
Turning the client in bed slowly and smoothly will be helpful; logrolling isn’t needed.

13. Answer: 2. Cochlea.

The dendrites of the cochlear nerve terminate on the hair cells of the organ of Corti in the
cochlea.

14. Answer: 3. Middle ear.

The bones in the middle ear transmit and amplify air pressure waves from the tympanic
membrane to the oval window of the cochlea, which is the inner ear. The tympanic membrane
separates the other from the middle ear.

15. Answer: 2. Cochlear nerve.

Because the organ of hearing is the organ of Corti, located in the cochlea, nerve deafness would
most likely accompany damage to the cochlear nerve.

16. Answer: 4. Permanent irreversible deafness.

The labyrinth is the inner ear and consists of the vestibule, cochlea, semicircular canals, utricle,
saccule, cochlear duct, and membranous semicircular canals. A labyrinthectomy is performed to
alleviate the symptoms of vertigo but results in deafness, because the organ of Corti and cochlear
nerve are located in the inner ear.

17. Answer: 2. Hearing aids usually restore some hearing.

With a partial hearing loss that auditory ossicles have not yet become fixed; as long as vibrations
occur, a hearing aid may be beneficial.

18. Answer: 2. Subjective.

A subjective symptom such as ringing in the ears can be felt only by the client.

19. Answer: 3. Amplify the energy of sound waves entering the ear.

The middle ear contains the three ossicles—malleus, incus, and stapes—which, along with the
tympanic membrane and oval window, form an amplifying system.
The client who had cataract surgery with a lens implant 1 week ago remarks to the
home care nurse that after his daughter left to go to her home in another state
yesterday, he combined all of his prescribed eyedrops together in one container so he
had fewer drops to administer. What is the nurse's best response?
A. "This is not a good idea because not all of the drugs are on the same schedule."
B. "That is a good idea; just remember to not touch the dropper to your eye when giving
yourself the drops."
C. "Call your surgeon immediately and get new prescriptions because together these
drugs can lower your blood pressure."
D. "Call your surgeon immediately and get new prescriptions to use one at a time
because these drugs cannot be mixed together."
Answer: D

Rationale: These drugs are not to be mixed together. Not only is the chance for
contamination high, but the drug concentrations and effectiveness are also reduced
when mixed together. Even when the drugs are administered separately, they should be
given 5 to 10 minutes apart.
Which assessment is most important for the nurse to perform before instilling travoprost
(Travatan) into the client's eye?
A. Measuring the client's blood pressure
B. Measuring the client's intraocular pressure
C. Checking the cornea for abrasions or open areas
D. Assessing heart rate and rhythm for 1 full minute
Answer: C

Rationale: Travoprost is a prostaglandins agonist. Drugs from this class should not be
applied unless the cornea is completely intact. Measuring intraocular pressure is not
necessary when a diagnosis of glaucoma has been established. Prostaglandins
agonists, even if systemically absorbed, do not affect body blood pressure or heart rate
and rhythm.
Which precaution is most important for the nurse to teach a 62-year-old client newly
diagnosed with early-stage dry age-related macular degeneration?
A. Quit smoking
B. Quit drinking alcoholic beverages
C. Eat more dark green, red, and yellow vegetables
D. Wear dark glasses whenever he or she is outside or in bright interior lighting
environments
Answer: A

Rationale: Dry AMD is more common and progresses at a faster rate among smokers
than among nonsmokers. Thus, quitting smoking can slow the rate of AMD progression.
Avoiding alcohol and bright light (even ultraviolet light) is not related to AMD
development or progression. Although increasing long-term dietary intake of
antioxidants, vitamin B12, and the carotenoids lutein and zeaxanthin that are found in
green, red, and yellow vegetables is thought to help slow the progression of AMD, the
effects are not as profound as quitting smoking.
A client with glaucoma is being assessed for new symptoms. Which symptom indicates
a high priority need for reassessment of intraocular pressure?
A. Burning in the eye
B. Inability to differentiate colors
C. Increased sensitivity to light
D. Gradual vision changes
Answer: D

Rationale: Gradual vision changes are an indication of increased intraocular pressure. A

burning sensation in the eye usually indicates inflammation and/or infection. An inability
to differentiate colors is an early sign of cataracts. An increased sensitivity to light might
be a sign of a corneal abrasion.
A client has recently had cataract surgery. About which symptom does the nurse
instruct the client to notify the health care provider?

A. Increased tearing
B. Itching of the eye
C. Reduction in vision
D. Swollen eyelid
Answer: C

Rationale: A reduction in vision after cataract surgery indicates a problem, and the client
should notify the provider immediately. Increased tearing, itching of the eye, and a
swollen eyelid all are expected after cataract surgery.
The nurse is teaching a client about open-angle glaucoma management. Which
statement by the client indicates a need for further instruction?
A. "I must wait 10 to 15 minutes between different eyedrop medications."
B. "I must press on the inside of my eye to prevent washout."
C. "It is important to not skip a dose."
D. "These eyedrops will not cure my glaucoma."
Answer: B

Rationale: Pressing on the inside of the eye after instillation of eye medication prevents
systemic absorption of the drug. To avoid washout, the client should wait 10 to 15
minutes between eyedrop medications. Skipping a dose will not exacerbate the client's
glaucoma. Medication will not cure glaucoma, but it will control its progression.
What is the action of miotics in the client with glaucoma?

A. Decrease the inflammatory process

B. Enhance aqueous outflow
C. Increase the production of vitreous humor
D. Vasoconstrict the blood vessels in the eye
Answer: B

Rationale: Miotics are used to improve the flow of fluid (aqueous humor) and decrease
intraocular pressure in clients with glaucoma. Steroid drops, not miotics, decrease the
inflammatory process. Vitreous humor fills the space between the lens and the retina, is
stagnant, and is not replenished as the aqueous humor is. Miotics make the pupil
smaller, which creates more room between the iris and the lens.
The nurse is performing preoperative teaching for an older adult client who will be
having a cataract removed. Which instructions does the nurse include? (Select all that
apply.)

A. "You will need to wear a patch on your eye for several weeks after the surgery."
B. "Several different types of eyedrops are requested after surgery, and they have to be
taken several times a day for up to 4 weeks."
C. "You will receive a medication to help you relax. Then you will receive some different
eyedrops to dilate your pupils and paralyze the lens."
D. "Bring sunglasses with you on the day of your procedure."
E. "You might experience a lot of bruising and swelling around the eye."
Answer: B, C, D

Rationale: The client will have multiple eyedrops to use after surgery and should be
made aware of this before the procedure to understand the importance. Providing
information on what to expect, such as telling the client about the medication that will be
administered and the eyedrops that will dilate and paralyze the lens, helps the client
prepare for the day of surgery. The client will need to have sun protection after the
procedure. A patch is required after surgery only if a risk for injury is present. Cataract
surgery does not cause bruising and swelling post-surgery.
The nurse is providing discharge instructions to a client with glaucoma. Which activities
does the nurse instruct the client to avoid? (Select all that apply.)

A. Bending over to tie shoes

B. Sitting with legs elevated
C. Sleeping on more than two pillows
D. Blowing the nose frequently
E. Lifting objects weighing more than 10 pounds
Answer: A, D, E

Rationale: Any action that would increase pressure in the eye should be avoided, such
as bending over, excessive blowing of the nose, and lifting heavy objects. Sitting with
the legs elevated or sleeping on more than two pillows is not contraindicated in clients
with glaucoma.
During patient teaching regarding self-administration of ophthalmic drops, with
statement by the nurse is correct?

A. "Hold the eyedrops over the cornea, and squeeze out the drop."
B. "Apply pressure to the lacrimal duct area for 5 minutes after administration."
C. "Be sure to place the drop in the conjuctival sac of the lower lid."
D. "Squeeze your eyelid closed tightly after placing the drop into your eye."
Answer: C

Rationale: Because the cornea is sensitive, most eye medications are placed inside the
lower lid. For systemic osmotic drugs, pressure only needs to be applied to lacrimal duct
for 60 seconds.

1. Which statement below is CORRECT about glaucoma?

A. “The vision loss that occurs with glaucoma is reversible with eye drop medications.”

B. “Glaucoma occurs due to decreased intraocular pressure, which damages the optic
nerve.”

C. “Surgery can cure glaucoma.”

D. “A normal intraocular pressure is about 10-21 mmHg and is elevated in most patients
with glaucoma.”

The answer is D. This option is the only correct statement about glaucoma. Vision loss is
NOT reversible when it occurs in glaucoma but it’s permanent…eye drops can prevent
further progression. Glaucoma occurs due to INCREASED intraocular pressure (NOT
decreased), and there is NO cure for glaucoma.

2. A patient asks you to explain how the intraocular pressure is measured to help detect
glaucoma. You state that IOP (intraocular pressure) is measured by what instrument
below?

A. Goniscope

B. Tonometry

C. Ophthalmoscope

D. Phoroptor

The answer is B. A tonometer is used to assessment IOP.

3. The production and drainage rate of aqueous humor is not equal in patients with
glaucoma. Select below the correct sequence for how aqueous humor should flow through
the eye:

A. The ciliary body produces aqueous humor -> then it flows through the anterior
chamber (area of the eye between the iris and cornea) -> pupil opening -> posterior
chamber (area of the eye between lens and iris) ->drainage angle ->trabecular meshwork -
> schlemm’s canal -> episcleral veins
B. The lens produces aqueous humor -> then it flows through the pupil opening -> the
anterior chamber (area of the eye between the iris and cornea) -> posterior chamber (area
of the eye between lens and iris) -> drainage angle ->trabecular meshwork -> schlemm’s
canal -> episcleral veins

C. The ciliary body produces aqueous humor -> then it flows through the posterior
chamber (area of the eye between the lens and iris) -> pupil opening -> anterior chamber
(area of the eye between iris and cornea) -> drainage angle ->trabecular meshwork ->
schlemm’s canal -> episcleral veins

D. The lens produces aqueous humor -> then it flows through the posterior chamber (area
of the eye between the iris and cornea) -> pupil opening -> anterior chamber (area of the
eye between lens and iris) -> drainage angle ->trabecular meshwork -> schlemm’s canal ->
episcleral veins

The answer is C. This is the correct sequence for how aqueous humor flows through the
eye: The ciliary body produces aqueous humor -> then it flows through the posterior
chamber (area of the eye between the lens and iris) -> pupil opening -> anterior chamber
(area of the eye between iris and cornea) -> drainage angle ->trabecular meshwork ->
schlemm’s canal -> episcleral veins

4. You’re providing an educational seminar to a group of senior citizens about glaucoma.

You explain to the participants about the differences between open-angle and angle-
closure glaucoma in relation to the drainage angle of the eye. A participant asks what type
of examination can be performed to assess the drainage angle of the eye. Your response
is?

A. Tonometry

B. Ophthalmoscopy

C. Retinoscopy

D. Gonioscopy

The answer is D. A gonioscopy is used to assess the drainage angle of the eye. The
drainage angle is the area in which an angle is formed at the front of the eyes where the
iris and cornea meet. This is where aqueous humor drains out into the trabecular
meshwork.

5. What signs and symptoms are present with angle-closure glaucoma? Select all that
apply:

A. Patients are mainly asymptomatic

B. Gradual loss of peripheral vision

C. Sudden vision changes (halos around lights or blurred vision)

D. Severe eye pain

E. Corneal edema

F. Nausea and vomiting

G. Red eyes

H. No pain

I. IOP <10 mmHg

The answers are: C, D, E, F, G. Angle-closure glaucoma is SUDDEN and SEVERE. The

patient will NOT be asymptomatic like in open-angle glaucoma. They will have SUDDEN
vision changes, severe pain (eyes or head), corneal edema, nausea/vomiting, red eyes, and
IOP >50 mmHg. It is a medical emergency.

6. Your patient is being treated for open-angle glaucoma. What assessment finding is NOT
typically present with this type of glaucoma?

A. Tunnel vision

B. Cloudy vision

C. Optic disc cupping

D. High intraocular pressure

The answer is B. Cloudy vision is associated with cataracts, while tunnel vision is
associated with glaucoma due to the loss of peripheral vision.

7. Your patient has a history of angle-closure glaucoma. What type of medications should
this patient avoid?

A. Anticholinergics

B. Cholinergics

C. Beta blockers

D. Alpha-agonists
The answer is A. Angle-closure glaucoma occurs when the drainage angle of the eye
becomes too narrow or closed to allow aqueous humor to drain out of the eye. This fluid
stays in the eye and increases intraocular pressure, which can damage the optic nerve.
Dilation of the pupils can push the iris forward and block off the drainage angle.
Therefore, this patient should avoid anticholinergics. Remember anticholinergics cause
dilation of the pupils…therefore, patients with angle-closure glaucoma should avoid these
medications unless otherwise approved by their doctor.

8. Your patient, who has open-angle glaucoma, is scheduled for a procedure that will
remove some of the trabecular meshwork and create an opening to allow aqueous humor
to collect in an area of the conjunctiva. This procedure will allow aqueous humor to be
reabsorbed and help decrease IOP. As the nurse you know that you will need to provide
pre-op and post-op patient education about what procedure below?

A. Iridectomy

B. Selective Laser Trabeculoplasty (SLT)

C. Laser iridotomy

D. Trabeculectomy

The answer is D: Trabeculectomy This procedure can help decrease IOP pressure in the
eyes, and is used when eye drops or other procedures are not working.

9. You’re providing care to a patient who just had glaucoma surgery. The patient is alert
and oriented. Vital signs are: heart rate 82 bpm, blood pressure 110/80, oxygen
saturation 97% on room air, respiratory rate 18, and pain rating of 2 on 1-10 scale. Which
patient finding below requires you to notify the physician?

A. The patient reports blurred vision.

B. The patient is having difficulty passing stool and reports constipation.

C. The patient reports that the eyes feel itchy.

D. The patient’s eyes are frequently tearing up.

The answer is B. Option A, C, and D are NORMAL findings that can occur after glaucoma
surgery. The patient should avoid activities that can increase intraocular pressure like
bending, straining (especially during bowel movements), or lifting heavy objects.
Therefore, the nurse would need to notify the doctor to obtain an order for a laxative or
stool softener so the patient won’t strain during a bowel movement.
10. A patient is experiencing a severe case of acute angle-closure glaucoma. The patient is
not a candidate for laser intervention. The nurse would anticipate the physician would
order the nurse to prep the patient for what procedure?

A. Trabeculoplasty

B. Trabeculectomy

C. Iridectomy

D. Blepharoplasty

The answer is C. Iridectomy is where the surgeon removes part of the iris which will help
drain off aqueous humor and decrease the IOP. Options A and B are procedures to help
treat open-angle glaucoma. Option C is used to treat angle-closure glaucoma and is more
invasive than the laser procedure called a laser iridotomy (it’s where a small hole is
created in the iris with a laser to drain the increased aqueous humor). We are told in the
scenario the patient is not a candidate for this procedure.

11. You’re observing a patient self-administer eye drops for the treatment of glaucoma.
Which finding below requires you to re-educate the patient on how to administer eye
drops correctly?

A. The patient refrains from blinking after instilling the eye drops.

B. The patient washes hands before and after administering the eye drops.

C. The patient uses a tissue to catch any medication that drips out of the eye after
administration of the drops.

D. The patient places the drops of medication directly on the eye via the cornea.

The answer is D. Eye drops are placed in the lower sac of the eye (conjunctival sac) NOT
directly on the eye via the cornea. It’s important that the nurse observes the patient using
the drops and re-educate if they are using them incorrectly.

12. A patient is scheduled to take Brimonidine and Latanoprost eye drops for
management of glaucoma at 1000. What correct action below will the nurse take when
administering these eye drops?

A. The nurse assists the patient with using the index finger to gently place pressure at the
side of the nose bridge for about 30 seconds after administering each eye drop
medication.
B. The nurse waits at least 3-5 minutes before administering the second eye drop
medication.

C. The nurse administers each eye drop directly on the eye via the cornea.

D. The nurse encourages the patient to blink after each eye drop administration.

The answer is B. This is the only correct action by the nurse. The nurse should wait at least
3-5 minutes before administering the second medication. This is so that the first
medication can be used by the eye and not washed out by the second medication.

13. A patient with glaucoma is ordered eye medication for the right eye in the form of an
ointment and eye drop. The nurse will administer which type of medication first?

A. Ointment and then the eye drops

B. Eye drops and then the ointment

The answer is B. The nurse will administer eye drops FIRST and then the ointment.

14. A patient with open-angle glaucoma has developed thicker and longer eyelashes and
reports a darkening of their eye color. You assess the patient’s medication list. What
glaucoma medication on the patient’s medication list can cause this side effect?

A. Bimatoprost

B. Pilocarpine

C. Acetazolamide

D: Timolol

The answer is A. Bimatoprost is a prostaglandin analog and can cause these signs and
symptoms.

15. The patient is ordered to take Timolol for the treatment of glaucoma. Before
administration the nurse will educate the patient about this new medication. Which of the
following information is the MOST pertinent the nurse to include?

A. Measuring the heart rate because this medication can cause tachycardia

B. Performing punctal occlusion after instilling the eye drops

C. Avoid taking this medication with any other glaucoma medications.

D. Always administer this medication 1 minute before another type of glaucoma
medication.

The answer is B. Timolol is a beta blocker, and it is administered via eye drops for the
treatment of glaucoma. It is very important the patient perform punctal occlusion after
instilling the eye drop to prevent systemic effects of the medication. The medication
needs to stay in the eye rather than enter the blood stream. Punctal occlusion is where the
tear duct is blocked with the index finger for about 2-3 minutes. This will prevent the
medication from draining down into the nasolacrimal duct.

16. Your patient is ordered to take Acetazolamide for treatment of glaucoma. What in the
patient’s history would require you to hold the medication and obtain an order
clarification from the physician?

A. The patient has open-angle glaucoma.

B. The patient is allergic to sulfonamides.
C. The patient reports tunnel vision.
D. The patient’s IOP is 25 mmHg.

The answer is B. Patients who have a sulfonamide allergy should NOT take carbonic
anhydrase inhibitors (hence Acetazolamide).

The client is diagnosed with glaucoma. Which symptom should the nurse expect the
client to report?
a. Loss of peripheral vision
b. Floating spots in the vision
c. A yellow haze around everything
d. A curtain coming across vision
a. Loss of peripheral vision

Rationale: In glaucoma, the client is often unaware he or she has the disease until the
client experiences blurred vision, halos around lights, difficulty focusing, or loss of
peripheral vision. Glaucoma is often called the "silent thief".
2. The client is scheduled for right-eye cataract removal surgery in 5 days. Which prep
instruction should be discussed with the client?
a. Administer dilating drops to both eyes for 72 hours prior to surgery.
b. Prior to surgery do not lift or push any objects heavier than 15 pounds.
c. Make arrangements for being in the hospital for at least 3 days.
d. Avoid taking any type of medication which may cause bleeding, such as aspirin.
d. Avoid taking any type of medication which may cause bleeding, such as aspirin.

Rationale: To reduce retrobulbar hemorrhage, any anticoagulant therapy is withheld,

including aspirin, NSAIDs, and warfarin (Coumadin).
3. The client is post op retinal detachment surgery, and gas tamponade was used to
flatten the retina. Which intervention should the nurse implement first?
a. Teach the signs of increased intraocular pressure.
b. Position the client as prescribed by the surgeon.
c. Assess the eye for signs or symptoms of complications
d. Explain the importance of follow-ups visits
c. Assess the eye for signs or symptoms of complications

Rationale: The nurse's priority must be assessment of complications, which include

increased intraocular pressure, endophthalmitis, development of another retinal
detachment, or loss of turgor in the eye.
4. The 65 yr old client is diagnosed with macular degeneration. Which statement by the
client indicates the client needs more discharge teaching?
a. "I should use magnification devices as much as possible".
b. "I will look at my Amsler grid at least twice a week".
c. "I need to use low-watt light bulbs in my house".
d. I am going to contact a low-vision center to evaluate my home".
c. "I need to use low-watt light bulbs in my house".

Rationale: Macular degeneration is the most common cause of visual loss in people
older than age 60 years. Any intervention which helps increase vision should be
included in the teaching, such as bright lightning, not decreased lightning.
The nurse who is at a local park sees a young man on the ground who has fallen and
has a stick lodged in his eye. Which intervention should the nurse implement at the
scene?
a. Carefully remove the stick from the eye.
b. Stabilize the stick as best as possible.
c. Flush the eye with water if available.
d. Place the young man in a high-Fowler's position
b. Stabilize the stick as best as possible.

Rationale: The foreign object should be stabilized to prevent further movement which
could cause more damage to the eye
The employee health nurse is teaching a class on "Preventing Eye Injury". Which info.
should be discussed in the class?
a. Read instructions thoroughly before using tools and working with chemicals.
b. Wear some type of glasses when working around flying fragments.
c. Always wear a protective helmet with eye shield around dust particles
d. Pay close attention to the surrounding so eye injuries will be prevented.
a. Read instructions thoroughly before using tools and working with chemicals.

Rationale: Instructions provide precautions and steps to take if eye injuries occur
secondary to the use of tools or chemicals.
The 65 yr old male client who is complaining of blurred vision reports he thinks his
glasses need to be cleaned all the time, and he denies any type of eye pain. Which eye
disorder should the nurse suspect the client has?
a. Corneal dystrophy
b. Conjunctivitis
c. Diabetic retinopathy
d. Cataracts
d. Cataracts

Rationale: A cataract is a lens opacity or cloudiness, resulting in the s/s discussed in the
stem of the question
The nurse is administer eyedrops to the client. Which guidelines should the nurse
adhere to when instilling the drops into the eye? SATA
a. Do not touch the tip of the medication container to the eye.
b. Apply gently pressure on the outer cants of the eye.
c. Apply sterile gloves prior to instilling eyedrops
d. Hold the lower lid down and instill drops into the conjunctiva
e. Gently pat the skin to absorb excess eyedrops on the cheek
a. Do not touch the tip of the medication container to the eye.
Rationale: Touching the tip of the container to the eye may cause eye injury or an eye
infection

d. Hold the lower lid down and instill drops into the conjunctiva
Rationale: Medication should not be placed directly on the eye but in the lower part of
the eyelid

e. Gently pat the skin to absorb excess eyedrops on the cheek

Rationale: Eyedrops are meant to go in the eye, not on the skin, so the nurse should
use a clean tissue to remove excess medication
The client has had an enucleation of the left eye. Which intervention should the nurse
implement?
a. Discuss the need for special eyeglasses
b. Refer the client for an ocular prosthesis
c. Help the client obtain a seeing-eye dog
d. Teach the client how to instill eyedrops
b. Refer the client for an ocular prosthesis

Rationale: An enucleation is the removal of the entire eye and part of the optic nerve.
An ocular prosthesis will help maintain the shape of the eye socket after the enucleation
The client diagnosed with glaucoma is prescribed a biotic cholinergic medication. Which
data indicate the medication has been effective?
a. No redness or irritation of the eyes
b. A decrease in intraocular pressure
c. The pupil reacts briskly to light
d. The client denies any type of floaters
b. A decrease in intraocular pressure

Rationale: Both systemic and topical medications are used to decrease the intraocular
pressure in the eye, which causes glaucoma
The client is scheduled for laser-assisted in situ keratomileusis (LASIK) surgery for
severe myopia. Which instruction should the nurse discuss prior to the client's discharge
from day surgery?
a. Wear bilateral eye patches for 3 days
b. Wear corrective lenses until the follow-up visit
c. Do not read any material for at least one week.
d. Teach the client how to instill corticosteroid ophthalmic drops.
d. Teach the client how to instill corticosteroid ophthalmic drops.

Rationale: LASIK surgery is an effective, safe, predictable surgery performed in day

surgery; there is minimal postoperative care. Instilling topical corticosteroid drops helps
decrease inflammation and edema of the eye
The client comes to the emergency department after splashing chemicals into the eye.
Which intervention should the nurse implement first?
a. Have the client move the eyes in all directions
b. Administer a broad-spectrum antibiotic
c. Irrigate the eyes with normal saline solution
d. Determine when the client had a tetanus shot.
c. Irrigate the eyes with normal saline solution

Rationale: Before any further evaluation or treatment, the eyes must be thoroughly
flushed with sterile normal saline solution
Which statement indicates to the nurse the client is experiencing some hearing loss?
a. "I clean my ears every day after I take a shower".
b. "I keep turning up the sound on my television".
c. "My ears hurt, especially when I yawn"
d. " I get dizzy when I get up from the chair".
b. "I keep turning up the sound on my television".

Rationale: The need to turn up the volume on the television is an early sign of hearing
impairment
Which risk factors should the nurse discuss with the client concerning reasons for
hearing loss? SATA
a. Perforation of the tympanic membrane
b. Chronic exposure to loud noises
c. Recurrent ear infections
d. Use of nephrotoxic medications
e. Multiple piercings in the auricle
a. Perforation of the tympanic membrane
Rationale: The tympanic membrane is the eardrum, and if it is punctured it may lead to
hearing loss

b. Chronic exposure to loud noises

Rationale: Loud persistent noise, such as heavy machinery, engines, and artillery, over
time may cause noise-induced hearing loss

c. Recurrent ear infections

Rationale:Multiple ear infections scar the tympanic membrane, which can lead to
hearing loss
The nurse is caring for a client diagnosed with acute otitis media. Which s/s support this
medical diagnosis?
a. Unilateral pain in the ear
b. Green, foul-smelling drainage
c. Sensation of congestion in the ear
d. Reports of hearing loss
a. Unilateral pain in the ear
Rationale: Otalgia (ear pain) is experienced by clients with otitis media
The client is diagnosed with Meniere's disease. Which statement indicates the client
understands the medical management for this disease?
a."After intravenous antibiotic therapy, I will be cured".
b. "I will have to use a hearing aid for the rest of my life".
c. "I must adhere to a low-sodium diet, 2,000 mg/day".
d. "I should sleep with the head of my bed elevated".
c. "I must adhere to a low-sodium diet, 2,000 mg/day".

Rationale: Sodium regulates the balance of fluid within the body; therefore, a low-
sodium diet is prescribed to help control the symptoms of Meniere's disease
The client diagnosed with chronic otitis media is scheduled for a mastoidectomy. Which
discharge teaching should the nurse discuss with the client?
a. Instruct the client to blow the nose with the mouth closed
b. Explain the client will never be able to hear from the ear
c. Instill ophthalmic drops in both ears and then insert a cotton ball.
d. Do not allow water to enter the ear for 6 weeks.
d. Do not allow water to enter the ear for 6 weeks.

Rationale:Water should be prevented from entering the external auditory canal because
it may irritate the surgical incision and is a medium for bacterial growth
The client is complaining of ringing in the ears. Which data are most appropriate for the
nurse to document in the client's chart?
a. Complaints of vertigo
b. Complaints of otorrhea
c. Complaints of tinnitus
d. Complaints of presbycusis
c. Complaints of tinnitus

Rationale: Tinnitus is "ringing of the ears". It is a subjective perception of sounds with

internal origins
Which statement best describes the scientific rationale for the nurse holding the
otoscope with the hand in a pencil-hold position when examining the client's ear?
a. It is usually the most comfortable position to hold the otoscope
b. This allows the best visualization of the tympanic membrane
c. This prevents inserting the otoscope too far into the external ear
d. It ensures the nurse will not cause pain when examining the ear
c. This prevents inserting the otoscope too far into the external ear

Rationale: Inserting the speculum of the otoscope into the external ear can cause ear
trauma if not done correctly
The nurse is preparing to administer otic drops into an adult client's right ear. Which
intervention should the nurse implement?
a. Grasp the earlobe and pull back and out when putting drops in the ear
b. Insert the teardrops without touching the outside of the ear.
c. Instruct the client to close the mouth and blow prior to instilling drops
d. Pull the auricle down and back prior to instilling drops
d. Pull the auricle down and back prior to instilling drops

Rationale: This will straighten the ear canal so the teardrops will enter the ear canal and
drain toward the tympanic membrane (eardrum)
Which ototoxic medication should the nurse administer cautiously?
a. An oral calcium channel blocker
b. An intravenous amino glycoside antibiotic
c. An intravenous glucocorticoid
d. An oral lood diuretic
b. An intravenous amino glycoside antibiotic

Rationale: Aminoglycoside antibiotics are ototoxic. Overdosage of these medications

can cause the client to go deaf, which is why peak and trough serum levels are drawn
while the client is taking a medication of this type. These antibiotics are also very
nephrotoxic
Which teaching instruction should the nurse discuss with students who are on the high
school swim team when discussing how to prevent external otitis?
a. Do not wear tight-fitting swim caps
b. Avoid using silicone ear plugs while swimming
c. Use a drying agent in the ear after swimming
d. Insert a bulb syringe into each ear to remove excess water
c. Use a drying agent in the ear after swimming

Rationale: A 2% acetic acid solution or 2% boric acid in ethyl alcohol is effective in

drying the canal and restoring its normal acidic environment
The client comes to the clinic and is diagnosed with otitis media. Which intervention
should the clinic nurse include in the discharge teaching?
a. Instruct the client not to take any over-the-counter pain medication
b. Encourage the client to apply cold packs to the affected ear
c. Tell the client to call the HCP if an abrupt relief of ear pain occurs
d. Wear a protective ear plug in the affected ear.
c. Tell the client to call the HCP if an abrupt relief of ear pain occurs

Rationale: Pain subsiding abruptly may indicate spontaneous perforation of the

tympanic membrane within the middle ear and should be reported to the HCP
The client is scheduled for ear surgery. Which statement indicates the client needs
more prep operative teaching concerning the surgery?
a. "If I have to sneeze or blow my nose, I will do it with my mouth open".
b. "I may get dizzy after the surgery, so I must be careful when walking".
c. "I will probably have some hearing loss after surgery, but hearing will return".
D. "I can shampoo my hair the day after surgery as long as I am careful".
D. "I can shampoo my hair the day after surgery as long as I am careful".

Rationale: Shampooing, showering, and immersing the head in water are avoided to
prevent contamination of the ear canal; therefore, this comment indicates the client
does not understand the pre

The client reports "something scratching on the inside of my eyelid." Before examining
the eyelid, what does the nurse do first?
A. Administers a Snellen test
B. Obtains informed consent
C. Washes hands.
D. Wears sterile gloves.
C. Washes hands
Always wash hands before touching the external eye structures.
A Snellen test may be done but is not the first thing done by the nurse. An informed
consent is not needed for the nurse to examine the client's eye. Sterile gloves are not
needed to examine the client's eye.
Which is the correct step in the proper technique for eyedrop instillation?
A. Instilling the drops into the inner canthus.
B. Opening the eye by raising the upper eyelid.
C. Placing the eyedrop in the lower lid pocket.
D. Touching the bottle tip to the eyeball.
C. Placing the eyedrop in the lower lid pocket.
The lower lid is gently pulled down against the cheek to form a pocket, and medication
is instilled.
Instilling drops into the inner canthus causes the medication to enter the punctum and
be absorbed systemically. The upper eyelid is larger than the lower eyelid and is used
to protect the eye and keep the cornea moist. It should not be used to create a pocket to
instill medication. Touching the bottle tip to any part of the eye could potentially
contaminate the eye.
Which eye procedure requires informed consent from the client?
A. Eyedrop instillation
B. Fluorescein angiography
C. Ophthalmoscopy
D. Snellen Test
B. Fluorescein angiography
Invasive test that requires informed consent. The others are noninvasive and do not
require informed consent.
A nurse providing education on eye protection should include which of the following as
suggesting high need for protective eyewear? Select all that apply
A. Cab driver
B. College student
C. Lifeguard
D. Racquetball player
E. Registered Nurse
C & E: Lifeguards are in need of eye protection from UV rays; People who play
racquetball need to wear protective eyewear to prevent possible eye injury.
When performing an eye or vision assessment, which comment by the client alerts the
nurse that immediate care by an ophthalmologist is needed?
A. "One eye is green and the other eye is blue."
B. "My eyes are red and itchy."
C. "My vision has been getting worse gradually."
D. "The redness appeared this morning, without any cause."
D. "The redness appeared this morning without any cause."
The client who is experiencing trauma, a foreign body in the eye, sudden ocular pain, or
sudden redness should be seen immediately by an ophthalmologist.
Which systemic disorders may affect the eye and vision and require yearly eye
examination by an ophthalmologist? Select all that apply.
A. Anemia
B. Diabetes mellitus
C. Hepatitis
D. Hypertension
E. Multiple sclerosis
B, D, & E
Clients who are diabetic are at risk for diabetic retinopathy and are in need of annual
eye exams. Clients with elevated blood pressure need to have annual eye exams owing
to the increased risk for retinal damage. Clients with MS need annual eye exams owing
to changes that occur with neurologic effects of MS and that impact visual acuity.
Clients with a family history of which eye disorder may have problems with increased
intraocular pressure, requiring additional assessment?
A. Anisocoria
B. Cataracts
C. Diabetic retinopathy
D. Glaucoma
D. Glaucoma
Glaucoma can be caused by increased IOP, which reduces blood flow to the eyes.
The client is admitted to the ED with metal shards in the right eye. Which test is
contraindicated in this client?
A. MRI
B. Ophthalmoscopy
C. Radioisotope scanning
D. Snellen chart
A. MRI - can't be done because of the metal in the eye.
The nurse is teaching the client about visual changes that occur with age. Which
statement does the nurse include?
A. "It may take your eyes longer to adjust in a darkened room."
B. "Most visual changes occur before age 40."
C. "When the sclera starts to turn yellow, this means you might have problems with your
liver."
D. "You probably will have to move reading materials closer to your eyes."
A. "It may take your eyes longer to adjust in a darkened room."
With increasing age, the iris has less ability to dilate, which leads to difficulty in adapting
to dark environments.
Which of these client assessment findings warrants further investigation by the nurse in
the ophthalmology clinic?
A. Snellen eye exam result is 20/50 for the client who normally wears corrective lenses
but does not have them at the time of the exam.
B. When six cardinal positions of gaze of the left eye are assessed, the client exhibits
nystagmus when looking to the left lower and upper fields.
C. The pupil exhibits miosis when exposed to light from the ophthalmoscope during
exam and mydriasis when the light is removed from the pupil.
D. When assessing the cornea, the nurse notes cloudiness and the client reports pain
when the light shines into the pupil.
D. When assessing the cornea, the nurse notes cloudiness and the client reports pain
when the light shines into the pupil.
This is an abnormal finding that requires further assessment and possible interve

Why is the optic disc considered to be a blind spot?

a. This area does not contain photoreceptors.
b. Light rays are unable to focus on this location.
c. Blood vessels form a meshwork and interfere with vision.
d. This area is heavily pigmented and light rays are absorbed.
ANS: A
The optic nerve enters the eyeball at this point and contains no photoreceptors. The
other responses are incorrect.
During assessment of an older adult, which finding does the nurse immediately report to
the health care provider?
a. Yellowing or bluing of the sclera
b. Lack of discrimination between green and violet
c. An opaque, bluish-white ring within the outer edge of the cornea
d. Pupil constriction in response to light occurring in 2 seconds
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.
Which teaching is essential for a client who is going to have intraocular pressure
measurement with a slit lamp?
a. "The test causes temporary blindness."
b. "The test is quick and a local anesthetic is used."
c. "The test does cause a little pain, but it is over quickly."
d. "The test causes some tearing, but no pain."
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.
The nurse performs an assessment of a client's extraocular movement and notes no
difficulty. Which additional assessment data assist in confirming this finding?
a. No episodes of double vision
b. Synchronized blinking movements
c. No reports of headaches and dizziness
d. Both pupils constricting equally in response to light
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.
A client has paralysis of the right medial rectus muscle of the right eye. Which
assessment finding assists the nurse in validating this diagnosis?
a. Client is unable to turn the eye in toward the nose.
b. Client is unable to lift the upper eyelid.
c. Client cannot look downward.
d. Client cannot look upward.
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.
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 client's 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 client's 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.
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
client's eyes are dry. Rubbing the eyes should not cause corneal abrasions.
The nurse is performing vision screenings. Which client is at greatest risk for developing
vision problems?
a. Postpartum woman with no complications
b. Young client who has diabetes mellitus
c. Middle-aged adult who takes aspirin daily
d. Older client with chronic dry eye syndrome
ANS: B
The hyperglycemia that characterizes diabetes mellitus causes numerous vascular
problems in the eye and damages the nerves. Although good control of blood glucose
levels delays visual problems, it does not eliminate these problems in the diabetic
population. Daily aspirin therapy does not place a client at risk for vision problems. Dry
eyes are a common finding with older clients because tear production is decreased, but
this does not necessarily interfere with the client's vision. Postpartum women should not
be at risk for vision problems.
A client relates that the vision in the left eye is greatly decreased from the day before.
What does the nurse do first?
a. Assess current medications.
b. Patch the left eye.
c. Notify the ophthalmologist.
d. Perform an in-depth interview.
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.
During assessment, the nurse notes that a client's right pupil is 2 mm larger than the left
pupil. Which is the nurse's 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.
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 client's eyes.
c. Shine a bright light at the client's pupils one at a time.
d. Suddenly bring a finger toward the client's 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.
The nurse is performing an eye assessment on a client. Which finding confirms normal
accommodation during visual assessment?
a. Both pupils constrict when a light is shined at one eye.
b. The client blinks in response to a threatening movement.
c. Both pupils constrict when focusing on an object being moved in toward the nose.
d. The client is able to hold an upward gaze without moving the head for 15 seconds.
ANS: C
Normal accommodation is seen when the client's eyes converge. The pupils constrict
when the client focuses on an object that is being moved from about 18 cm from the
client's 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.
The nurse is assessing a client for the possibility of a lens opacity. Which assessment
finding confirms this problem?
a. Increased intraocular pressure
b. Absence of a red reflex
c. Decreased central vision
d. Positive corneal staining
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.
A client is scheduled for electroretinography. Which statement indicates that the client
understands the teaching about this procedure?
a. "I will wear dark glasses in sunlight to prevent eye pain."
b. "I am going to drink at least 3 liters of water to flush the dye out of my system."
c. "I will avoid rubbing my eyes until the anesthetic drops have worn off."
d. "I will not drive for the first 24 hours after the 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.
The nurse is evaluating a client's technique for instilling eyedrops. Which behavior
indicates that the client needs more teaching?
a. Closing they eye after the drops are in
b. Touching the eye with the tip of the dropper
c. Allowing the drops to spread across the eye surface
d. Getting the drops into the conjunctival pocket
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 client's other eye. The other answers indicate correct technique.
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.
A client with presbyopia asks her nurse about corrective lenses. Which is the nurse's
best response?
a. "This type of problem cannot be helped with corrective lenses."
b. "Corrective lenses are needed for both near and distance vision."
c. "Corrective lenses can be used for reading and close work."
d. "Corrective lenses are needed for distance only."
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
retina—a 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.
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?
a. "Keep an eye patch on the eye for 48 hours."
b. "Always wear protective equipment to prevent eye damage."
c. "Take aspirin if a headache should occur."
d. "Do not do any heavy lifting for a week."
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).
An anxious adult client asks why she needs to have intraocular pressure tested every
year. What is the best response from the nurse?
a. "Many changes can occur because of aging."
b. "If the pressure is too low, you will be blind."
c. "If the pressure is too high, blood will not flow through the eye."
d. "Loss of vision can occur if the pressure is too high or too low."
ANS: D
Although all responses are somewhat correct, explaining the outcome of abnormal
pressure is to the point and is done at the client's level of understanding, especially if
she is anxious about the test.
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?
a. "You can read at 10 feet what others can read at 20 feet."
b. "You can read at 20 feet what others can read at 10 feet."
c. "This demonstrates normal vision."
d. "You are considered legally blind."
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.
The nurse is assessing a client's eyes. Which is the first step for the nurse in this
procedure?
a. Explain the procedure.
b. Wash the hands.
c. Assess for infections.
d. Use the Snellen chart.
ANS: B
Before examining a client's 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.
The nurse is triaging clients in the emergency department. Which clients require
immediate attention by an ophthalmologist?
a. Older client with an intraocular pressure (IOP) of 15
b. Confused client in need of an ophthalmoscopic examination
c. Young client with dry drainage from one eye
d. Middle-aged client with recent onset of eye pain
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.
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.)
a. Increasing difficulty perceiving greens, blues, and violets
b. Increasing redness in the eyes
c. Acute pain in the eyes
d. Sudden change in acuity
e. Need for additional lighting for reading
f. Need to hold newspaper farther away to read
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 provider's
evaluation. Delay could cause harm. The other signs are associated with the aging
process and do not require immediate evaluation.
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.)
a. Recheck the five Rs and the expiration date of the drug.
b. Put on gloves.
c. Have the client tilt the head backward.
d. Wash your hands.
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.
A client is scheduled for a fluorescein angiography. Place the nurse's activities in order,
from highest to lowest priority. (Separate letters by a comma and space as follows: a, b,
c, d.)
a. Start an intravenous access.
b. Instill mydriatic eyedrops.
c. Have the consent form signed.
d. Have the client drink fluids.
e. Inject fluorescein dye.
f. Have the client wear dark glasses.
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.
p. 1045 Action Alert - Eye injury
Teach people to see a health care provider immediately when an eye injury occurs or
an eye infection is suspected.
The older adult client asks whether the white ring in the iris of both eyes is a cataract
that can be removed to improve her vision, What is the RNs best response?

a. "A cataract forms inside the eye, not on the surface. This growth should be assessed
for cancer."
b. "This type of ring in the eye gets worse as intraocular pressure increases, leading to
glaucoma."
c. "The ring is a cataract, and it cannot be removed until it reaches and covers the
pupil."
d. "The ring is just a buildup of deposits, not a cataract, and never interferes with
vision."
d. "The ring is just a buildup of deposits, not a cataract, and never interferes with
vision."
p. 1045
p. 1046 Critical Rescue - Loss of vision
Notify the ophthalmologist immediately for any pt who has a sudden or persistent loss of
vision within the past 48 hours, eye trauma, a foreign body in the eye, or sudden ocular
pain.
Which pt assessment finding does the RN report to the health care provider
immediately?

a. The left pupil is slightly smaller than the right pupil.

b. Both eyes twitch when the pt looks to the far lateral gaze position.
c. The right pupil does not change size when a light is directly shined at it.
d. The lowest line the pt can read clearly at 20 ft. on the Snellen chart is marked 50 feet.
c. The right pupil does not change size when a light is directly shined at it.
p. 1048
p. 1050 Action Alert
Avoid using an ophthalmoscope with a confused patient.
Cranial nerve III
Oculomotor nerve - controls most of the eye's movements, including constriction of the
pupil and maintaining an open eyelid
Cranial Nerve IV
Trochlear nerve - is a motor nerve (a "somatic efferent" nerve) that innervates a single
muscle: the superior oblique muscle of the eye.
Cranial Nerve VI
Abducens nerve - a somatic efferent nerve that, in humans, controls the movement of a
single muscle, the lateral rectus muscle of the eye
Cranial Nerve II
Optic nerve - the nerve of sight, connecting the optic disc to the brain
Cranial Nerve V
Trigeminal nerve - stimulates the blink reflex when the cornea is touched
Cranial Nerve VII
Facial nerve - innervates the lacrimal glands and muscles controlling eyelid closure
p. 1053 Drug Alert - Ophthalmic drugs
Check the route of administration for ophthalmic drugs. Most are administered as eye
instillation route, not the oral route. Administering these drugs orally can cause systemic
side effects in addition to not having a therapeutic effect on the eye.
Which precaution is most important for the RN to teach a pt who is prescribed to use an
ophthalmic ointment?

a. "Keep the tube in the refrigerator to make the ointment easier to control when you
squeeze the tube."
b. "Wear gloves when you apply the ointment to prevent absorbing the drug through
your skin."
c. "Patch your eye at night to prevent ointment from getting on your bedding or in your
hair."
d. "Do not drive with ointment in your eyes."
d. "Do not drive with ointment in your eyes."
(p. 1056)
p. 1056 Action Alert - Antibiotic Eye drops
Teach pts who are prescribed antibiotic eye drops or ointments to complete the entire
course of antibiotics. Stopping antibiotic therapy too soon promotes infection recurrence
and development of antibiotic-resistant bacteria.
Which comment made by a client 1 week after corneal transplant indicates to the nurse
a need to review postoperative care?

a. "I have been feeding my cat on the counter so that I don't have to bend over."
b. "I have been using an icepack on my eye to reduce the redness and swelling."
c. "My daughter has been helping me inspect my eye and place the eye drops."
d. "Instead of reading a book, I now listen to books on tape."
b. "I have been using an icepack on my eye to reduce the redness and swelling."
(p. 1059)
p. 1061 Action Alert - Cataract Surgery
Instruct the pt who has had cataract surgery to immediately report any reduction of
vision after surgery in the eye that had the cartaract removed.
A pt who had cataract removal with placement of an intraocular implant 1 week ago now
calls in and reports that her eye is more bloodshot than it was yesterday and that a
small amount of greenish drainage is present. What is the priority nursing action?

a. Reassure the pt that these symptoms are normal for this stage of recovery after
cataract surgery.
b. Explain how to apply a wet compress to the affected eye for 15 minutes four times
daily.
c. Instruct the pt to come to the office immediately to be seen by the ophthalmologist.
d. Instruct the client to use the antibiotic eye drops four times daily instead of twice
daily.
c. Instruct the pt to come to the office immediately to be seen by the ophthalmologist.
(p. 1062)
p. 1065 Drug Alert - Eye drops glaucoma
Most eye drops used for glaucoma therapy can be absorbed systemically and cause
serious systemic problems. Although punctual occlusion should be used after instilling
any type of eye drop, it is critical to teach pts to use the technique with eye drops for
glaucoma.
Which assessment question is most important for the RN to ask a client with glaucoma
who has just been prescribed the drug apraclonidine (Iopidine)?

a. "Are you allergic to sulfa drugs?"

b. "What other drugs do you currently take?"
c. "Do you have any difficulty passing urine?"
d. "Do you have asthma or any other respiratory problems?"
b. "What other drugs do you currently take?"
(p. 1067)
A client whose sister was just diagnosed with autosomal recessive retinitis pigmentosa
is pregnant with a male fetus. The client's husband has no relatives with the disorder.
She asks what the chances are that er son could be affected. What is the nurse's best
response?

a. "Because it is likely that you are a carrier and your husband does not have any
affected relatives, only your daughters can develop the disease.
b. "Because it is likely that you are a carrier and your husband does not have any
affected relatives, none of your children will have the disease but each child will have a
50% risk for being a carrier."
c. "Because your sister actually has retinitis pigmentosa, the risk for your children
having the disorder is 50% with each pregnancy."
d. "Because you are a woman, your daughters will each have a 50% risk for having the
disease, and all of your sons will be carriers."
b. "Because it is likely that you are a carrier and your husband does not have any
affected relatives, none of your children will have the disease but each child will have a
50% risk for being a carrier."
(p. 1070)
A pt with reduced vision who is 1 day postoperative for a non-vision problem expresses
concern to the nurse that he is afraid if a hospital fire occurred he would not be able to
get out in time. Which nurse response or action is most likely to allay his fears?

a. Demonstrating how to close the door and place wet towels at the bottom edge of the
door.
b. Reminding him that the hospital meets all current fire codes and has never
experienced a major fire.
c. Helping him count the steps to the stairway exit and reminding him that he is on the
second floor.
d. Reassuring him that even if a fire broke out, the nurses and other personnel would
stay on the unit with him.
c. Helping him count the steps to the stairway exit and reminding him that he is on the
second floor.
(p. 1075)