1. A client is using an ophthalmic beta-blocking agent for the treatment of glaucoma. Which instruction does the nurse give to the client to prevent orthostatic hypotension?

a.            “Change positions quickly after administering the drops.”

b.            “Take your pulse at least four times daily.”

c.             “Apply pressure to the inside corner of your eye when administering the drops.”

d.            “Lay down for 10 minutes after administering the drops.”

ANS: C

Nasal punctal occlusion during eyedrop instillation keeps the drug in contact with the eye structures longer and decreases systemic absorption and side effects. Systemic distribution of the drug is what may cause orthostatic hypotension. The other answers will not help prevent orthostatic hypotension.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies—Adverse Effects/Contraindications/Side Effects/Interactions)

MSC: Integrated Process: Nursing Process (Implementation)

2. Which is the most important information for the nurse to teach a client who is receiving cycloplegic drug therapy?

a.            “Do not drive or operate machinery until the drug wears off.”

b.            “Use at least a 30 SPF sunscreen agent when going outdoors.”

c.             “Remain on bedrest for 24 hours in a prone position.”

d.            “Turn up the lights because acuity will be decreased in low-light environments.”

ANS: A

Cycloplegic agents prevent accommodation of the iris, resulting in a widely dilated pupil. The pupil cannot accommodate to bright light, causing eye discomfort and pain. Turning up the lights will not assist the client to see more clearly. Bedrest and sunscreen are not measures needed for this drug.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

3. An older adult client who has a mature cataract in the right eye states, “Now I have lost the sight in my right eye because I waited too long for treatment.” How does the nurse best respond to the client?

a.            “Yes, this type of blindness could have been prevented by earlier treatment.”

b.            “It is fortunate you came for treatment in time to save the sight of your other eye.”

c.             “Nothing you could have done would have made any difference.”

d.            “Surgery can still save the sight in your eye with removal of the cataract.”

ANS: D

Although sight is increasingly impaired as a cataract matures, no other damage is done to the eye by waiting. Removal of the cataract will result in improved vision, regardless of how long the cataract has been present. No indication suggests that the client will develop a cataract in the other eye. The other statements are inaccurate.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Grief and Loss)

MSC: Integrated Process: Nursing Process (Caring)

4. Which statement indicates that the client understands teaching about the use of aspirin post–cataract surgery?

a.            “It may increase intraocular pressure after cataract surgery.”

b.            “It changes the ability of the blood to clot and increases the risk of bleeding.”

c.             “It reduces inflammation and might mask any symptoms of infection.”

d.            “It can cause nausea and vomiting and may increase intraocular pressure.”

ANS: B

Aspirin disrupts platelet aggregation and increases the risk for bleeding after surgery. Aspirin may decrease inflammation but would not mask symptoms of infection. Aspirin does not cause increased intraocular pressure, nor does it typically cause nausea and vomiting. Aspirin should not mask signs of infection.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies—Adverse Effects/Contraindications/Side Effects/Interactions)

MSC: Integrated Process: Nursing Process (Evaluation)

5. Which assessment alerts the nurse to the possible presence of a cataract in a client?

a.            Loss of central vision

b.            Loss of peripheral vision

c.             Dull aching in the eye and brow areas

d.            Blurred vision and reduced color perception

ANS: D

As the lens becomes opaque and less able to refract light appropriately, the client experiences blurred vision and a reduced ability to distinguish among different colors. The development of a cataract does not typically cause loss of peripheral or central vision, nor does it result in aching in the brow area.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1060

TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)

MSC: Integrated Process: Nursing Process (Assessment)

6. A client is recovering from cataract surgery and needs medication to prevent a potential eye infection. Which drug does the nurse question administering to the client?

a.            Tobramycin (Tobrex)

b.            Apraclonidine (Iopidine)

c.             Gentamicin (Genoptic)

d.            Ciprofloxacin (Ciloxan)

ANS: B

Apraclonidine is an adrenergic agonist that binds to eye receptors to reduce the amount of aqueous humor in the eye, resulting in decreased intraocular pressure. This medication usually is administered to clients with glaucoma. Tobramycin, gentamicin, and ciprofloxacin are anti-infectives.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies—Expected Actions/Outcomes)

MSC: Integrated Process: Nursing Process (Implementation)

7. Which statement indicates that a client understands why his cataract surgery is being done first on the eye with the poorest vision?

a.            “Insurance reimbursement dictates the timing of surgeries.”

b.            “The eye with poorer vision is at greater risk for permanent damage.”

c.             “The pressure in the poorer eye could increase, causing permanent damage.”

d.            “If a complication arises in that eye, I will still have some vision in the better eye.”

ANS: D

The eye with the better sight is left alone until the outcome of the first surgery is known to reduce the chance that the client will lose sight in both eyes if complications arise from the surgery.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Evaluation)1. A client is using an ophthalmic beta-blocking agent for the treatment of glaucoma. Which instruction does the nurse give to the client to prevent orthostatic hypotension?

a.            “Change positions quickly after administering the drops.”

b.            “Take your pulse at least four times daily.”

c.             “Apply pressure to the inside corner of your eye when administering the drops.”

d.            “Lay down for 10 minutes after administering the drops.”

ANS: C

Nasal punctal occlusion during eyedrop instillation keeps the drug in contact with the eye structures longer and decreases systemic absorption and side effects. Systemic distribution of the drug is what may cause orthostatic hypotension. The other answers will not help prevent orthostatic hypotension.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies—Adverse Effects/Contraindications/Side Effects/Interactions)

MSC: Integrated Process: Nursing Process (Implementation)

2. Which is the most important information for the nurse to teach a client who is receiving cycloplegic drug therapy?

a.            “Do not drive or operate machinery until the drug wears off.”

b.            “Use at least a 30 SPF sunscreen agent when going outdoors.”

c.             “Remain on bedrest for 24 hours in a prone position.”

d.            “Turn up the lights because acuity will be decreased in low-light environments.”

ANS: A

Cycloplegic agents prevent accommodation of the iris, resulting in a widely dilated pupil. The pupil cannot accommodate to bright light, causing eye discomfort and pain. Turning up the lights will not assist the client to see more clearly. Bedrest and sunscreen are not measures needed for this drug.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

3. An older adult client who has a mature cataract in the right eye states, “Now I have lost the sight in my right eye because I waited too long for treatment.” How does the nurse best respond to the client?

a.            “Yes, this type of blindness could have been prevented by earlier treatment.”

b.            “It is fortunate you came for treatment in time to save the sight of your other eye.”

c.             “Nothing you could have done would have made any difference.”

d.            “Surgery can still save the sight in your eye with removal of the cataract.”

ANS: D

Although sight is increasingly impaired as a cataract matures, no other damage is done to the eye by waiting. Removal of the cataract will result in improved vision, regardless of how long the cataract has been present. No indication suggests that the client will develop a cataract in the other eye. The other statements are inaccurate.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Grief and Loss)

MSC: Integrated Process: Nursing Process (Caring)

4. Which statement indicates that the client understands teaching about the use of aspirin post–cataract surgery?

a.            “It may increase intraocular pressure after cataract surgery.”

b.            “It changes the ability of the blood to clot and increases the risk of bleeding.”

c.             “It reduces inflammation and might mask any symptoms of infection.”

d.            “It can cause nausea and vomiting and may increase intraocular pressure.”

ANS: B

Aspirin disrupts platelet aggregation and increases the risk for bleeding after surgery. Aspirin may decrease inflammation but would not mask symptoms of infection. Aspirin does not cause increased intraocular pressure, nor does it typically cause nausea and vomiting. Aspirin should not mask signs of infection.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies—Adverse Effects/Contraindications/Side Effects/Interactions)

MSC: Integrated Process: Nursing Process (Evaluation)

5. Which assessment alerts the nurse to the possible presence of a cataract in a client?

a.            Loss of central vision

b.            Loss of peripheral vision

c.             Dull aching in the eye and brow areas

d.            Blurred vision and reduced color perception

ANS: D

As the lens becomes opaque and less able to refract light appropriately, the client experiences blurred vision and a reduced ability to distinguish among different colors. The development of a cataract does not typically cause loss of peripheral or central vision, nor does it result in aching in the brow area.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1060

TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)

MSC: Integrated Process: Nursing Process (Assessment)

6. A client is recovering from cataract surgery and needs medication to prevent a potential eye infection. Which drug does the nurse question administering to the client?

a.            Tobramycin (Tobrex)

b.            Apraclonidine (Iopidine)

c.             Gentamicin (Genoptic)

d.            Ciprofloxacin (Ciloxan)

ANS: B

Apraclonidine is an adrenergic agonist that binds to eye receptors to reduce the amount of aqueous humor in the eye, resulting in decreased intraocular pressure. This medication usually is administered to clients with glaucoma. Tobramycin, gentamicin, and ciprofloxacin are anti-infectives.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies—Expected Actions/Outcomes)

MSC: Integrated Process: Nursing Process (Implementation)

7. Which statement indicates that a client understands why his cataract surgery is being done first on the eye with the poorest vision?

a.            “Insurance reimbursement dictates the timing of surgeries.”

b.            “The eye with poorer vision is at greater risk for permanent damage.”

c.             “The pressure in the poorer eye could increase, causing permanent damage.”

d.            “If a complication arises in that eye, I will still have some vision in the better eye.”

ANS: D

The eye with the better sight is left alone until the outcome of the first surgery is known to reduce the chance that the client will lose sight in both eyes if complications arise from the surgery.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Evaluation)