Chapter 51: Eye and Vision Disorders: Multiple Choice

Chapter 51: Eye and Vision Disorders
MULTIPLE CHOICE
1. The 60-year-old patient who has had an enucleation asks when he can get his prosthesis
fitted. The nurse responds that the prosthesis will be fitted by an optician in approximately:
1. 2 weeks.
2. 4 weeks.
3. 8 weeks.
4. 12 weeks.
ANS: 2
After an enucleation, the patient is fitted with a prosthesis in 1 month.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 1185

OBJ: 4 TOP: Enucleation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
2. The patient who has been taking opioid medication for postoperative pain exhibits pinpoint
pupils. The anatomic portion of the eye that has been affected by the medication is the:
1. sclera.
2. retina.
3. choroid.
4. bulbar conjunctiva.
ANS: 3
The choroid of the eye contains the pupil and iris.
PTS: 1 DIF: Cognitive Level: Knowledge REF: 1158

OBJ: 1 TOP: Anatomy and Physiology of the Eye: The Eyeball
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
3. The nurse explains that the portion of your eye that will make it possible for you to see in a
darkened environment is the:
1. macula.
2. rods.
3. cones.
4. optic nerve.
ANS: 2
The eye uses rods to accommodate to dim light. Cones are the color receptors. The optic
nerve transmits to the brain all sensory input from the eye.
PTS: 1 DIF: Cognitive Level: Analysis REF: 1158

OBJ: 5 TOP: Anatomy and Physiology: The Eyeball
4. When being interviewed, a 50-year-old patient says that he cannot see the newspaper as well
as he used to. You know that vision changes from near to far because:
1. the ciliary muscle changes the pupil size.
2. the lens of the eye changes shape as a muscle contracts and relaxes.
3. of nearsightedness.
4. of clouding of the vitreous humor.
ANS: 2
Accommodation or adjustment of the lens by contraction and expansion of the ciliary
muscle allows us to see far or near.
PTS: 1 DIF: Cognitive Level: Application REF: 1159

OBJ: 1 TOP: Lens Adjustment
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance
5. During the initial assessment of a very thin patient at the eye clinic, the nurse notes that the
patient has very prominent eyes. The nurse should inquire about a history of:
1. diabetes.
2. glomerulonephritis.
3. Graves’ disease.
4. hypertension.
ANS: 3
The appearance of the patient and the prominence of the eye (exophthalmos) would lead the
nurse to inquire about a thyroid disorder, most likely Graves’ disease or hyperthyroidism.

OBJ: 1 TOP: Past Medical History
6. When you ask your patient about his vision, he says that the last time he had it tested, it was
recorded as 20/50. This means that:
1. the patient can read at 20 feet what a person with normal vision can read at 50 feet.
2. the patient can read at 50 feet what a person with normal vision can read at 20 feet.
3. the patient needs to be 50 feet from objects to see them.
4. the patient’s best vision is between 20 feet and 50 feet from objects.
ANS: 1
The Snellen eye chart is read at 20 feet. The last line the patient can read with no more than
two errors is recorded. In this case, the patient was able to read the 50-foot line at 20 feet.
This means that he is reading at 20 feet what a person with normal vision can read at 50 feet.

OBJ: 1 TOP: Physical Examination: Eyes
7. The nurse recognizes that the patient who is being evaluated for a visual impairment does
not have glaucoma because the tonometry reveals an intraocular pressure of:
1. 18 mm Hg.
2. 28 mm Hg.
3. 45 mm Hg.
4. 52 mm Hg.
ANS: 1
The normal intraocular pressure is between 12 and 21 mm Hg. If the patient had glaucoma,
the intraocular pressure would be abnormally high.
PTS: 1 DIF: Cognitive Level: Analysis REF: 1162-1163

OBJ: 4 TOP: Tonometry KEY: Nursing Process Step: Assessment
8. The nurse explains to the patient who is to have a pneumotonometry study of the eye that
this procedure requires that:
1. his eye may be anesthetized
2. a pneumotonometer will be placed into his eye.
3. there will be a puff of air directed at the surface of the eye.
4. an applanation be done with a slit-lamp microscope.
ANS: 1
A pneumotonometer directs a puff of air at the surface of the eye, measuring intraocular
pressure by measuring the resistance to the air. The eye is anesthetized prior to the
evaluation.
PTS: 1 DIF: Cognitive Level: Application REF: 1162-1163

OBJ: 2 TOP: Tonometry KEY: Nursing Process Step: Implementation
9. The nurse performing the eye irrigation would:

1. have the patient tip her head up and run the irrigation fluid over the open eye.
2. direct the irrigating fluid from the inner to the outer canthus.
3. not allow the patient to blink.
4. place the irrigating syringe directly onto the corner of the eye and allow the fluid to
move across the eye.
ANS: 2
The direction of the flow should be from the inner to the outer canthus.

OBJ: 4 TOP: Eye Irrigation
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment
10. The nurse would include in the information given to a patient who is using topical eye
medications to:
1. look upward and drop medication into the inner canthus.
2. pull the lower lid down and drop the medication into the conjunctival sac.
3. hold both lids open and drop medication onto the sclera.
4. tilt the head to the side and drop the medication into the outer canthus.
ANS: 2
The eye drops should be dropped into the lower lid and the nurse should press the tear duct
to slow absorption.
OBJ: 4 TOP: Topical Medications
MSC: NCLEX: Physiological Integrity
11. When the patient asks what electroretinography is supposed to measure, the nurse responds
that:
1. a fluorescein dye is injected by IV and the retina is observed as the dye circulates.
2. electrodes are placed on the scalp, each eye is stimulated, and retinal activity is
assessed.
3. a small plunger is used to apply pressure on the sclera while the retinal vessels are
evaluated.
4. a contact lens is placed on the eye and exposed to flashes of light to evaluate the
retinal response.
ANS: 4
A contact lens is placed on the eye and retinal activity is assessed as lights are flashed into
the eye. The other three options describe fluorescein angiography, visual evoked response,
and opthodynamometry, respectively.

OBJ: 4 TOP: Electroretinography
12. When doing patient education about protecting vision, you should tell the patient that:
1. after 40 years of age, eye examinations should be done every 2 years.
2. crusted lids on awakening are caused by decreased tear production.
3. floaters are a sign of eye infection.
4. blurred vision without pain is temporary eye strain.
ANS: 1
Eye examinations every 2 years are recommended for persons over 40. All the other options
are indications that the person should consult a physician for an eye disorder.

OBJ: 3 TOP: Protection of the Eye and Vision
KEY: Nursing Process Step: Implementation MSC: NCLEX: Health
13. The nurse instructs a family member how to guide a visually impaired person when
ambulating by:
1. holding the visually impaired person by his or her nondominant arm and walking
side by side.
2. holding the nondominant hand, wrapping the arm around his or her waist, and
walking side by side.
3. allowing the visually impaired person to hold the helper’s arm, with the helper
slightly ahead.
4. allowing the visually impaired person to hold the shoulder of the helper and walk
slightly behind the helper.
ANS: 3
Allowing the visually impaired person to walk slightly behind the helper and holding the
helper’s arm is the most effective way to guide someone who is visually impaired.

OBJ: 4 TOP: Assisting Ambulation with the Visually Impaired
14. The newly diagnosed patient with macular degeneration flings her book at the TV set and
furiously says, “I can’t read this blasted book and I can’t see what is on the stupid TV!” The
nurse recognizes this behavior as:
1. the anger stage of grieving.
2. poor impulse control.
3. ineffective management of therapeutic regimen.
4. psychotic reaction to loss.
ANS: 1
There is frequently a grieving process that accompanies the realization that there will be
deteriorating vision and ultimate blindness.

OBJ: 6 TOP: Impact of Visual Impairment
KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity
15. The nurse explains that the correct term to use for a patient with a vision disorder is:
1. blind.
2. handicapped.
3. partially blind.
4. visually impaired.
ANS: 4
The term visual impairment is a medically accepted term to use for patients with a vision
loss.

OBJ: 6 TOP: Nursing Care of the Visually Handicapped Patient
KEY: Nursing Process Step: N/A MSC: NCLEX: Psychosocial Integrity
16. A nursing diagnosis for a visually impaired patient might include all of the following except:
1. Impaired sensory perception.
2. Risk for delayed development.
3. Self-care deficit.
4. Ineffective coping.
ANS: 2
Patients with a visual impairment are not at risk for delayed development. They will have a
nursing diagnosis of Impaired sensory perception, Ineffective coping, and Self-care deficit.
PTS: 1 DIF: Cognitive Level: Application REF: 1169-1170

OBJ: 6 TOP: Nursing Diagnosis, Goals, Outcomes
KEY: Nursing Process Step: Planning MSC: NCLEX: Psychological Integrity
17. Implementations that are appropriate in the care plan for a visually impaired person include:
1. leaving the bed in the highest position.
2. keeping the door closed.
3. announcing your presence when you enter and leave the room.
4. leaving the radio on all the time to help the patient know the time of day.
ANS: 3
The nurse should announce her or his presence in the room and address the patient before
touching him or her. The bed should be in the lowest position and the door should be open to
avoid social isolation.
PTS: 1 DIF: Cognitive Level: Synthesis REF: 1170

OBJ: 6 TOP: Implementations
MSC: NCLEX: Safe, Effective Care Environment
18. The patient with glaucoma who is using a beta-adrenergic blocking agent, timolol
(Timoptic) should be monitored for:
1. wheezing.
2. hypertension.
3. sudden eye pain.
4. blurred vision.
ANS: 1
Beta-adrenergic blocking agents cause bronchospasm and tachycardia.
PTS: 1 DIF: Cognitive Level: Application

REF: 1180, Drug Therapy table OBJ: 4
TOP: Beta-Adrenergic Blocking Agents KEY: Nursing Process Step: Assessment
19. The patient tells you that he has to hold his paper farther and farther away from his face to
read it. It has become a joke in his family about how far away he needs to hold reading
material. You tell the patient:
1. “You have myopia. Glasses will help you read.”
2. “You may have astigmatism, and your eyes will get used to the problem.”
3. “You have presbyopia, which is a normal age-related change. Reading glasses will
help you.”
4. “You may have an eye infection that is affecting your vision. You will need an
antibiotic ointment to instill into your eyes.”
ANS: 3
Presbyopia is a normal age-related change. It is caused by changes in the ciliary muscles.
Corrective lenses such as bifocals are used to correct this visual change.

OBJ: 5 TOP: Error of Refraction
20. The nurse explains that LASIK surgery and PRK are new methods to correct refractive
errors surgically. These procedures are used to reshape the:
1. cornea.
2. lens.
3. iris.
4. pupil.
ANS: 1
Both surgical procedures are used to reshape the cornea. The test taker will need to
determine which structure of the eye will need surgery to correct vision.

OBJ: 5 TOP: Surgical Treatment for Refractive Errors
21. The patient reports to the home health nurse that she is having cloudy vision and seeing
spots and halos around lights. Based on these complaints, the nurse makes arrangement to
have a medical evaluation for:
1. cataracts.
2. glaucoma.
3. detached retina.
4. macular degeneration.
ANS: 1
Cataracts are the cause of cloudy vision and seeing spots or halos.

OBJ: 5 TOP: Internal Eye Disorders
22. The nurse explains that the difference between open-angle and closed-angle glaucoma is
that, with closed-angle glaucoma:
1. the onset is acute.
2. trabeculectomy is the initial treatment.
3. can be treated conservatively.
4. intraocular pressure drops suddenly.
ANS: 1
Closed-angle glaucoma has an acute onset with eye pain and other systemic symptoms, such
as nausea and vomiting. It is an ocular emergency to get the intraocular pressure reduced.

OBJ: 4 TOP: Open-Angle versus Closed-Angle Glaucoma
23. The nurse considers in planning care for a patient with glaucoma that this disorder is caused
by:
1. cloudiness in the lens.
2. an increase in intraocular pressure.
3. failed eye surgery.
4. retinal tears.
ANS: 2
Glaucoma is caused by an increase in intraocular pressure.

OBJ: 6 TOP: Glaucoma KEY: Nursing Process Step: Planning
24. A patient presents in the emergency room complaining of severe pain in his eye, and is
seeing halos around lights and feeling nauseous. You suspect that he may be experiencing:
1. open-angle glaucoma.
2. angle-closure glaucoma.
3. cataracts.
4. retinal detachment.
ANS: 2
Sudden onset of acute eye pain with nausea and vomiting and halos around lights are all
symptoms of angle-closure glaucoma. The acute pain is caused by sudden blockage of the
fluid channels in the eye.

OBJ: 5 TOP: Glaucoma KEY: Nursing Process Step: Assessment
25. The nurse explains to a patient with retinal detachment that the surgical implementation that
is most effective is:
1. removing the lens.
2. macular bonding.
3. LASIK surgery.
4. scleral buckling.
ANS: 4
Scleral buckling is used to hold the retinal repair in place. The band is left in place to keep
the layers of the eye tissue together.

OBJ: 5 TOP: Retinal Detachment
KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity
MULTIPLE RESPONSE
1. The nurse assesses an 80-year-old for age-related changes to the eye, which are (select all
that apply):
1. decreased tear production.
2. eyeball sunk deep in orbit.
3. hyperopia.
4. eye lashes diminished.
5. arcus senilis.
ANS: 1, 2, 3, 5
Eyelash diminution is not a consistent finding in older adults. All the other options are
common eye changes related to advancing age.

OBJ: 1 TOP: Age-Related Changes in the Eye
2. The nurse is aware that the refractive media of the eye is made up of the (select all that
apply):
1. aqueous humor.
2. retina.
3. vitreous humor.
4. cornea.
5. lens.
ANS: 1, 3, 4, 5
The retina is not part of the refractive media. All the other options are components of the
refractive media.
PTS: 1 DIF: Cognitive Level: Knowledge REF: 1158-1159

OBJ: 2 TOP: Refractive Media
3. The nurse assesses the patient’s accommodation by (select all that apply):
1. holding his or her finger approximately 20 inches in front of the patient’s eyes.
2. observing for pupillary constriction.
3. assessing for convergence.
4. noting blinking.
5. moving his or her finger slowly toward the patient’s nose.
ANS: 1, 2, 4, 5
Assessment for blinking is not part of the accommodation assessment. All the others are part
of the accommodation assessment. The nurse holds his or her finger approximately 20
inches in front of the patient’s eyes, slowly moved the finger toward the patient’s nose,
assessing for pupillary constriction and convergence.

OBJ: 2 TOP: Testing for Accommodation
4. The patient who has had surgery this morning for cataracts is now going home. Discharge
instructions include that the patient should (select all that apply):
1. sleep on the operated side.
2. use stool softeners.
3. avoid bending over.
4. not lift anything heavier than 5 pounds.
5. not wear an eye shield at night.
ANS: 2, 3, 4
The postcataract surgery patient should sleep on the unoperated side with the eye shield in
place, avoid heavy lifting, and use stool softeners to prevent straining.

OBJ: 4 TOP: Discharge Instructions for Cataract Surgery

Chapter 51: Eye and Vision Disorders: Multiple Choice

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Chapter 51: Eye and Vision Disorders: Multiple Choice

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Chapter 51: Eye and Vision Disorders

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1185

PTS: 1 DIF: Cognitive Level: Knowledge REF: 1158

PTS: 1 DIF: Cognitive Level: Analysis REF: 1158

PTS: 1 DIF: Cognitive Level: Application REF: 1159

PTS: 1 DIF: Cognitive Level: Analysis REF: 1160

PTS: 1 DIF: Cognitive Level: Application REF: 1161

PTS: 1 DIF: Cognitive Level: Analysis REF: 1162-1163

PTS: 1 DIF: Cognitive Level: Application REF: 1162-1163

9. The nurse performing the eye irrigation would:

PTS: 1 DIF: Cognitive Level: Application REF: 1165

PTS: 1 DIF: Cognitive Level: Analysis REF: 1163

PTS: 1 DIF: Cognitive Level: Application REF: 1168

PTS: 1 DIF: Cognitive Level: Application REF: 1170

PTS: 1 DIF: Cognitive Level: Analysis REF: 1169

PTS: 1 DIF: Cognitive Level: Application REF: 1169

PTS: 1 DIF: Cognitive Level: Application REF: 1169-1170

PTS: 1 DIF: Cognitive Level: Synthesis REF: 1170

PTS: 1 DIF: Cognitive Level: Application

PTS: 1 DIF: Cognitive Level: Analysis REF: 1175

PTS: 1 DIF: Cognitive Level: Application REF: 1175

PTS: 1 DIF: Cognitive Level: Application REF: 1176

PTS: 1 DIF: Cognitive Level: Application REF: 1179

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1179

PTS: 1 DIF: Cognitive Level: Analysis REF: 1179

PTS: 1 DIF: Cognitive Level: Analysis REF: 1183

PTS: 1 DIF: Cognitive Level: Comprehension REF: 1159

PTS: 1 DIF: Cognitive Level: Knowledge REF: 1158-1159

PTS: 1 DIF: Cognitive Level: Application REF: 1161

PTS: 1 DIF: Cognitive Level: Analysis REF: 1177

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