1.

During the early postoperative period, a client who has undergone a cataract *1/1
extraction complains of nausea and severe eye pain over the operative site. What
should be the initial nursing action?

Call the physician.

Reassure the client that this is normal.

Turn the client onto his or her operative side.

Administer the prescribed pain medication and antiemetic

2. The nurse is developing a teaching plan for a client with glaucoma. Which *1/1
instruction should the nurse include in the plan of care?

Avoid overuse of the eyes.

Decrease the amount of salt in the diet.

Eye medications will need to be administered for life.

Decrease fluid intake to control the intraocular pressure.

 3. The nurse is performing an admission assessment on a client with a diagnosis *0/1
of detached retina. Which sign or symptom is associated with this eye disorder?

Total loss of vision

Pain in the affected eye

A yellow discoloration of the sclera

A sense of a curtain falling across the field of vision

Tamang sagot

Pain in the affected eye

4. A client is diagnosed with a disorder involving the inner ear. Which is the *1/1
most common client complaint associated with a disorder involving this part of
the ear?

Pruritus

Tinnitus

Hearing loss

Burning in the ear

5. The nurse is performing an assessment on a client with a suspected diagnosis *1/1
of cataract. Which clinical manifestation should the nurse expect to note in the
early stages of cataract formation?

Diplopia

Eye pain

Floating spots

Blurred vision

6. A client with Meniere’s disease is experiencing severe vertigo. Which *1/1

instruction should the nurse give to the client to assist in controlling the vertigo?

Increase sodium in the diet.

Avoid sudden head movements.

Lie still and watch the television.

Increase fluid intake to 3000 mL a day.

 7. A client’s vision is tested with a Snellen chart. The results of the tests are *0/1
documented as 20/60. What action should the nurse implement based on this
finding?

Provide the client with materials on legal blindness.

Instruct the client that he or she may need glasses when driving.

Inform the client of where he or she can purchase a white cane with a red tip.

Inform the client that it is best to sit near the back of the room when attending
lectures.

Tamang sagot

Instruct the client that he or she may need glasses when driving.

8. A nurse speaks with a client who recently learned he has beginning cataracts *1/1
in both eyes. Which statement made by the client should a nurse correct?

“It is important that I have surgery done as soon as possible to prevent permanent
damage to my vision.”

“Cataracts are corrected by surgery, with each eye done at different times.”

“The surgical treatment of a cataract involves the removal of the client’s own lens from
the eye.”

“An intraocular lens is placed in the eye at the time of surgery.

 9. A nurse is discharging a client who underwent outpatient cataract surgery. *1/1
Which intervention should NOT be included in the discharge instructions to the
client and family member?

Wear eye shield at night.

Cough and deep breathe every 2 hours.

Rest in the bed while the head of the elevated at 30 degrees.

Avoid getting water in the client’s eye when washing client’s hair.

10. A nurse working in a long-term care facility suspects a client is experiencing *0/1
detachment of the retina. A nurse should:

Patch both eyes and place the client in a prone position.

flush the eye thoroughly with saline solution and apply a pressure bandage.

apply an eye shield to the affected eye and administer the prescribed oral analgesic
medication.

Notify doctor and have the client transported promptly to a facility for ophthalmologic
referral and treatment.

Tamang sagot

Notify doctor and have the client transported promptly to a facility for ophthalmologic
referral and treatment.
 11. A client is seen in an emergency department and is diagnosed with closed- *0/1
angle glaucoma. In a review of the client’s medical record, which documented
finding should the nurse question?

Eye pain

Nausea and vomiting

Sudden onset of symptoms

Normal intraocular pressure

Tamang sagot

Normal intraocular pressure

12. A nurse, teaching a client with open-angle glaucoma, should instruct the *0/1
client to:

include foods high in omega 3 fatty acids in the diet.

restrict oral intake to lessen the need for glaucoma medications.

remain under the care of and have regular eye examinations by an eye specialist
physician.

administer prescribed eye drop medication when feeling pressure within the eyes.

Tamang sagot

remain under the care of and have regular eye examinations by an eye specialist physician.
13. A client tells a nurse that he has been diagnosed with macular degeneration, *1/1
“wet type.” Based on the nurse’s knowledge of this diagnosis, the nurse,
examining this client’s eyes using an ophthalmoscope, should expect to observe:

clouding of the lens of the eye.

atrophy of structures in the macula.

growth of abnormal blood vessels in the macula.

a thin, grayish-white area on the edge of the cornea.

14. A client diagnosed with macular degeneration is told the condition is *1/1
progressing to an advanced stage. When completing the client’s health
assessment, which findings should the nurse expect the client to report?

Curtain appearance over part of the visual field

Visual distortions in the central vision

Loss of peripheral vision

Clouding of the lens

 15. A client with macular degeneration is scheduled for photodynamic therapy *1/1
with the use of verteporfin. Which of the following items should the client bring
before procedure?

Moisturizer

Reading glass

Cotton underwear

Wide brimmed hat

16. Tonometry is performed on a client with a suspected diagnosis of glaucoma. *0/1

The nurse looks at the documented test results and notes an intraocular pressure
(IOP) value of 23. What would be the nurse’s initial action?

Apply normal saline drops

Note the time of day the test was done

Contact the primary health care provider (PHCP)

Instruct the client to sleep with the head of the bed flat

Tamang sagot

Note the time of day the test was done

17. The nurse notes that the primary health care provider has documented a *1/1
diagnosis of presbycusis on a client’s chart. Based on this information what
action would the nurse take?

Speak loudly but mumble or slur the words

Speak loudly and clearly while facing the client

Speak at normal tone and pitch, slowly and clearly

Speak loudly and directly into the client’s affected ear

18. The nurse is preparing to test the visual acuity of a client, using a Snellen *1/1
chart. Which identifies the accurate procedure for this visual acuity test?

The right eye is tested, followed by the left eye, and then both eyes are tested

Both eyes are assessed together, followed by an assessment of the right eye and then the
left eye.

The client is asked to stand at a distance of 40 feet (12 meters) from the chart and to read
the largest line on the chart.

The client is asked to stand at a distance of 40 feet (12 meters) from the chart and to read
the line that can be read 200 feet (60 meters) away by an individual with unimpaired
vision.
19. The client arrives in the emergency department with a penetrating eye injury *1/1
from wood chips that occurred while cutting wood. The nurse assesses the eyes
and notes a piece of wood protruding from the eye. What is the initial nursing
action?

Apply an eye patch

Perform visual acuity tests.

Irrigate the eye with sterile saline

Remove the piece of wood using a sterile clamp

20. The nurse is caring for a hearing-impaired client. Which approach will *1/1
facilitate communication?

Speak loudly

Speak frequently

Speak at a normal volume

Speak directly into the impaired ear

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