Med Surg TB Chapter 20 Flashcards


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1

The nurse is performing an eye exam on a 76-year-old patient. Which finding indicates that the nurse should refer the patient for a more extensive assessment?

A) The patient's sclerae are light yellow.

B) The patient reports persistent photophobia.

C) The pupil recovers slowly after responding to a bright light.

D) There is a whitish gray ring encircling the periphery of the iris.

Answer: B

2

Which finding by the nurse performing an eye examination indicates that the patient has normal accommodation?

A) After covering one eye for 1 minute, the pupil constricts as the cover is removed.

B) Shining a light into the patient's eye causes pupil constriction in the opposite eye.

C) A blink reaction occurs after touching the patient's pupil with a piece of sterile cotton.

D) The pupils constrict while fixating on an object being moved toward the patient's eyes.

Answer: D

3

Which assessment finding alerts the nurse to provide patient teaching about cataract development?

A) Unequal pupil size

B) Sensitivity to light

C) Loss of peripheral vision

D) History of hyperthyroidism

Answer: B

4

Assessment of a patient's visual acuity reveals that the left eye can see at 20 feet what a person with normal vision can see at 50 feet and the right eye can see at 20 feet what a person with normal vision can see at 40 feet. Which finding should the nurse record?

A) OS 20/50; OD 20/40

B) OU 20/40; OS 50/20

C) OD 20/40; OS 20/50

D) OU 40/20; OD 50/20

Answer: A

5

A 65-year-old patient is being evaluated for glaucoma. Which information given by the patient has implications for the patient's treatment plan?

A) "I take metoprolol (Lopressor) for angina."

B) "I take aspirin when I have a sinus headache."

C) "I have had frequent episodes of conjunctivitis."

D) "I have not had an eye examination for 10 years."

Answer: A

6

The nurse is testing the visual acuity of a patient in the outpatient clinic. Which instructions should the nurse give for this test?

A) "Stand 20 feet away from the wall chart."

B) "Look at an object far away and then near to you."

C) "Follow the examiner's finger with your eyes only."

D) "Look straight ahead while I check your eyes with a light."

Answer: A

7

A patient who underwent eye surgery must wear an eye patch until the scheduled postoperative clinic visit. Which patient problem will the nurse address in the plan of care?

A) Risk for falls

B) Difficulty coping

C) Disturbed body image

D) Inability to care for home

Answer: A

8

Which information will the nurse provide to the patient scheduled for refractometry?

A) "You should not take any of your eye medicines before the examination."

B) "You will need to wear sunglasses for a few hours after the examination."

C) "The doctor will shine a bright light into your eye during the examination."

D) "The surface of your eye will be numb while the doctor does the examination."

Answer: B

9

The nurse is assessing a 65-year-old patient for presbyopia. Which instruction will the nurse give the patient before the test?

A) "Hold this card and read the print out loud."

B) "Cover one eye while reading the wall chart."

C) "You'll feel a short burst of air directed at your eyeball."

D) "A light will be used to look for a ahcnage in your pupils."

Answer: A

10

What should the nurse teach the patient before fluorescein angiography?

A) Hold a card and fixate on the center dot.

B) Report any burning or pain at the IV site.

C) Remain still while the cornea is anesthetized.

D) Let the examiner know when images shown appear clear.

Answer: B

11

The nurse in the eye clinic is examining a 67-year-old patient who says, "I see small spots that move around in front of my eyes." Which action will the nurse take first?

A) Immediately have the ophthalmologist evaluate the patient.

B) Explain that spots and "floaters" are a normal part of aging.

C) Warn the patient that these spots may indicate retinal damage.

D) Use an ophthalmoscope to examine the posterior eye chambers.

Answer: D

12

Which action can the nurse working in the emergency department delegate to an experienced unlicensed assistive personnel (UAP)?

A) Ask a patient with decreased visual acuity about medications taken at home.

B) Perform Snellen testing of visual acuity for a patient with a history of cataracts.

C) Obtain information from a patient about any history of childhood ear infections.

D) Inspect a patient's external ear for redness, swelling, or presence of skin lesions.

Answer: B

13

The nurse working in the clinic receives telephone calls from several patients who want appointments as soon as possible. Which patient should be seen first?

A) 71-year-old who has noticed increasing loss of peripheral vision

B) 74-year-old who has difficulty seeing well enough to drive at night

C) 60-year-old who is reporting dry eyes with decreased tear formation

D) 74-year-old who states that it is becoming difficult to read news print

Answer: A

14

What should the nurse assess to evaluate the effectiveness of treatment for the patient's myopia and presbyopia?

A) Strength of the eye muscles.

B) Both near and distant vision.

C) Cloudiness in the eye lenses.

D) Intraocular pressure changes.

Answer: B

15

What should the nurse teach a patient with recurring staphylococcal and seborrheic blepharitis to do?

A) Irrigate the eyes with saline solution.

B) Schedule an appointment for eye surgery.

C) Use a gentle baby shampoo to clean the eyelids.

D) Apply cool compresses to the eyes three times daily.

Answer: C

16

What is the safest technique for the nurse to use when assisting a blind patient to ambulate to the bathroom?

A) Lead the patient slowly to the bathroom, holding on to the patient by the arm.

B) Stay beside the patient and describe any obstacles on the path to the bathroom.

C) Walk slightly ahead of the patient, allowing the patient to hold the nurse's elbow.

D) Have the patient place a hand on the nurse's shoulder and guide the patient forward.

Answer: C

17

What should the nurse teach a patient with repeated hordeolum about how to prevent further infection?

A) Apply cold compresses.

B) Discard all used eye cosmetics.

C) Wash the elbows with an antiseborrheic shampoo.

D) Be examined for secually transmitted infections (STIs).

Answer: B

18

Which instruction should the nurse include in a teaching plan for a patient with herpes simplex keratitis?

A) Wash hands frequently and avoid touching the eyes.

B) Apply antibiotic drops to the eye several times daily.

C) Apply new occlusive dressing to the affected eye at bedtime.

D) Use corticosteroid ophthalmic ointment to decrease inflammation.

Answer: A

19

Which teaching point should the nurse plan to include when caring for a patient whose vision is corrected to 20/200?

A) How to access audio books?

B) How to use a white cane safely?

C) Where Braille instruction is available?

D) Where to obtain hand-held magnifiers?

Answer: D

20

The nurse is caring for a patient diagnosed with adult inclusion conjunctivitis (AIC) caused by C. trachomatis. Which action should be included in the plan of care?

A) Apply topical corticosteroids to decrease inflammation

B) Discussing the need for sexually transmitted infection testing

C) Educating about the use of antiviral eyedrops to treat the infection

D) Assisting with applying for community visual rehabilitation sevices

Answer: B

21

Which topic will the nurse teach after a patient has had out[atient cataract surgery and lens implantation?

A) Use of oral opioids for pain control

B) Administration of corticosteroid drops

C) Need for bed rest for 1 to 2 days after the surgery

D) Importance of coughing and deep breathing exercises

Answer: B

22

In reviewing a patient's medical record, the nurse notes that the last eye examination revealed an intraocular pressure of 28 mm Hg. What should the nurse plan to assess?

A) Visual acuity

B) Pupil reaction

C) Color perception

D) Peripheral vision

Answer: D

23

A patient with right retinal detachment had a pneumatic retinopexy procedure. Which information will the nurse include in the discharge teaching plan?

A) The use of eye patches to reduce movement of the operative eye

B) The need to wear dark glasses to protect the eyes from bright light

C) The purpose of maintaining the head resting in a prescribed position

D) The procedure for dressing changes when the eye dressing is saturated

Answer: C

24

A patient with age-related macular degeneration (AMD) has just had photodynamic therapy. Which statement by the patient indicates that the discharge teaching has been effective?

A) "I will use drops to keep my pupils dilated until my next appointment."

B) "I will need to use brighter lights to read for at least the next week."

C) "I will not use facial lotions near my eyes during the recovery period."

D) "I will cover up with long-sleeved shirts and pants for the next 5 days."

Answer: D

25

How should the nurse evaluate a patient for improvement after treatment of primary open-angle glaucoma (POAG)?

A) Question the patient about blurred vision.

B) Note any changes in the patient's visual field.

C) Ask the patient to rate the pain using a 0 to 10 scale.

D) Assess the patient's depth perception when climbing stairs.

Answer: B

26

A patient with glaucoma who has been using timolol (Timoptic) drops for several days tells the nurse that the eyedrops cause eye burning and visual blurriness after administration. The best response to the patient's statement is

A) "Those symptoms may indicate a need for a change in dosage of the eyedrops."

B) "The drops are uncomfortable, but it is important to use them to retain your vision."

C) "These are normal side effects of the drug, which should be less noticeable with time."

D) "Notify your healthcare provider so that different eyedrops can be prescribed for you."

Answer: B

27

Which statement by a patient with bacterial conjunctivitis indicates a need for further teaching?

A) "I will wash my hands often during the day."

B) "I will remove my contact lenses at bedtime."

C) "I will not share towels with my friends or family."

D) "I will monitor my family for eye redness or drainage."

Answer: B

28

The nurse at the outpatient surgery obtains the following information about a patient who is scheduled for cataract extraction and implantation of an intraocular lens. Which information is important to report to the health care provider before the procedure?

A) The patient has had blurred vision for 3 years.

B) The patient has not eaten anything for 8 hours.

C) The patient takes antihypertensive medications.

D) The patient gets nauseated with general anesthesia.

Answer: C

29

The nurse learns that a newly admitted patient has functional blindness and that the spouse has cared for the patient for many years. What is the nurse’s most important action during the initial assessment?

A)Obtain more information about the cause of the patient’s vision loss.
B) Obtain information from the spouse about the patient’s special needs.
C) Make eye contact with the patient and ask about any need for assistance.
D) Perform an evaluation of the patient’s visual acuity using a Snellen chart.

Answer: C

30

Which action could the registered nurse (RN) who is working in the clinic delegate to a licensed practical/vocational nurse (LPN/VN)?

A) Evaluate a patient’s ability to administer eyedrops.

B) Check a patient’s visual acuity using a Snellen chart.

C) Inspect a patient’s external ear for signs of irritation caused by a hearing aid.

D) Teach a patient with otosclerosis about use of sodium fluoride and vitamin D.

Answer: B

31

The occupational health nurse is caring for an employee who reporting bilateral eye pain after a cleaning solution splashed into the employee’s eyes. Which action will the nurse take?

A) Apply cool compresses.

B) Flush the eyes with saline.

C) Apply antiseptic ophthalmic ointment to the eyes.

D) Cover the eyes with dry sterile patches and shields.

Answer: B

32

The nurse at the eye clinic made a follow-up telephone call to a patient who underwent cataract extraction and intraocular lens implantation the previous day. Which information is the priority to communicate to the health care provider?

A) The patient reports that the vision has not improved.

B) The patient requests a prescription refill for next week.

C) The patient feels uncomfortable wearing an eye patch.

D) The patient reports eye pain rated 5 (on a 0 to 10 scale).

Answer: D

33

A patient in the emergency department reports being struck in the right eye with a fist. Which finding is a priority for the nurse to communicate to the health care provider?

A) The patient reports a right-sided headache.

B) The sclera on the right eye has broken blood vessels.

C) The patient reports "a curtain" over part of the visual field.

D) The area around the right eye is bruised and tender to the touch.

Answer: C

34

The charge nurse observes a newly hired nurse performing all the following interventions for a patient who has just undergone right cataract removal and an intraocular lens implant. Which action requires that the charge nurse intervene?

A) The nurse leaves the eye shield in place.

B) The nurse encourages the patient to cough.

C) The nurse elevates the patient's head 45 degrees.

D) The nurse applies corticosteroid drops to the right eye.

Answer: B

35

Which nursing activity is appropriate for the registered nurse (RN) working in the eye clinic to delegate to experienced unlicensed assistive personnel (UAP)?

A) Instilling antiviral drops for a patient with a corneal ulcer

B) Application of a warm compress to a patient's hordeolum

C) Instruction about hand washing for a patient with herpes keratitis

D) Checking for eye irritation in a patient with possible conjunctivitis

Answer: B

36

A patient with a head injury after a motorcycle crash arrives in the emergency department (ED) reporting shortness of breath and severe eye pain. Which action will the nurse take first?

A) Assess cranial nerve functions.

B) Administer the prescribed analgesic.

C) Check the patient's oxygen saturation.

D) Examine the eye for evidence of trauma.

Answer: C

37

Which prescribed medication should the nurse give first to a patient who has just been admitted to a hospital with acute angle-closure glaucoma?

A) Morphine sulfate 4 mg IV

B) Mannitol (Osmitrol) 100 mg IV

C) Betaxolol (Betoptic) 1 drop in each eye

D) Acetazolamide (Diamox) 250 mg orally

Answer: B

38

A 75-yr-old patient who lives alone at home tells the nurse, "I am afraid of losing my independence because my eyes don't work as well as they used to." Which action should the nurse take first?

A) Discuss the increased risk for falls that is associated with impaired vision.

B) Ask the patient about what type of vision problems are being experienced.

C) Explain that there are many ways to compensate for decreases in visual acuity.

D) Suggest ways of improving the patient's safety, such as using brighter lighting.

Answer: B

39

A patient who received a corneal transplant 2 weeks ago calls the ophthalmology clinic to report that his vision has not improved with the transplant. Which action should the nurse take?

A) Suggest the patient arrange a ride to the clinic immediately.

B) Ask about the presence of "floaters" in the patient's visual field.

C) Remind the patient it may take months to restore vision after transplant.

D) Teach the patient to continue using prescribed pupil-dilating medications.

Answer: C

40

Which patient arriving at the urgent care center will the nurse assess first?

A) Patient who is reporting that the left eyelid has just started to droop

B) Patient with acute right eye pain that began while using power tools

C) Patient with purulent left eye discharge and conjunctival inflammation

D) Patient who has redness, crusting, and swelling along the lower right lid margin

Answer: B