EYE DISORDERS Immature cataracts are not completely opaque and
thus allow some light to pass providing the patient with
Situation: Mang Tomas is a 60 year old man who has just had
cataract surgery performed on his right eye.
1. The physician has prescribed Cyclogel preoperatively to:
a) prevent dryness of the cornea and conjunctiva
b) reduce the inflammation of the iris and choroids
c) paralyze the ciliary muscle
d) promote drainage of aqueous humor from the
chamber of the eye
Another preoperative eye drop that is usually
prescribed to patient awaiting cataract surgery is
tropicamide (mydriacyl) which is a dilating agent.
2. After discharge, Mang Tomas attends the eye clinic for
follow-up visits. When he receives his cataract glasses, it
is important that the nurse advise him that:
a) his peripheral vision will be increased
b) objects will appear closer than they really are
c) magnification by the lens is only about 10%
d) daily eye drops are required with these lenses
Cataract surgery is performed to remove the
opacified lens. After surgery, a new artificial lens will be
inserted at the posterior chamber or the client will be left
without a lens. Aphakia or the absence of lens can be
corrected to restore normal vision by eye glasses, contact
lenses or intraocular lenses.
Eye glasses are the safest and least expensive
alternative. The nurse should inform the patient that the
eyeglasses will be thick and will cause objects to appear
closer than they really are and vertical lines will also
appear curved.
Contact lenses provide better visual correction than
eye glasses but the patient must learn how to insert,
clean and replace the lenses correctly. This can be
difficult for elderly clients afflicted with arthritis,
Parkinson's disease and Alzheimer's.
Intraocular lenses are implants that provide the best
visual correction. However, it is associated with more
postoperative complications.
3. The nurse should instruct a client preparing for eye
surgery that which of these activities will be restricted
post-operatively?
a) bending with the knees flexed
b) bending from the waist
c) keeping the head in a neutral position
d) lying flat
During the postoperative period of eye surgery,
activities that increase intraocular pressure should be
avoided:
• instruct patient to avoid bending over
• avoid vomiting - give antiemetics
• avoid coughing - give antitussives, avoid conditions
that stimulate coughing
• avoid sneezing - avoid allergens that stimulate
sneezing such as powders, dusts etc.
• avoid straining - use stool softener
• avoid lifting heavy objects
4. Nursing care for Mang Tomas during the first 48 hours
after surgery will include:
a) maintain bed rest
b) changing the dressing daily
c) encouraging coughing and deep breathing
d) lie on the unoperated side
Cataract is clouding or opacity of the lens which
prevents light rays from reaching the retina. Cataract is
not due to trauma tends to occur bilaterally but they do
not mature at the same time.
some useful vision.
Mature cataract occurs when the lenses are
completely opaque and vision is greatly reduced or
absent.
Intumescent cataract occurs when the lens absorbs
water and increases in size resulting in glaucoma.
Hypermature cataract occurs when the lens protein
breaks down into short chain polypeptides and leak
through the lens capsules. The proteins are engulfed by
macrophages and may lead to phacolytic glaucoma.
The cause are:
• congenital cataract - heredity
• traumatic cataract - exposure heat
• senile cataract - aging, most common cause
• secondary cataract - caused by another disease
It is manifested by:
• blurred vision
• photophobia - client complains to glare
• progressive loss of vision
• opaque or cloudy white pupil
• difficulty to identify colors
• indirect opthalmoscpe - red reflex is distorted or
absent
• patient does not experience pain
Instructions after Cataract Surgery include:
• leave ocular dressing/eye patch in place, it is
usually removed after 24 hours
• limit activity for 24 hours
• avoid reading
• avoid rubbing eyes
• wear eye glasses for protection during the day
• avoid lifting more than five pounds
• avoid straining and any activity that increase IOP
• lie on unoperated side
• avoid aspirin or any drug containing aspirin
• use eye shield to protect eyes
• pain and itching after surgery is normal and can be
relieved with acetaminophen. Report persistent and
unrelieved pain.
• report redness around the eye, nausea and
vomiting
• avoid touching and rubbing of eyes
• avoid closing of eyes tightly
After surgery, instruct client to return for follow-up
care. If the surgery is out-patient, first clinic visit is after
24 hours, then after one week and then after one month.
Situation: Mang Ben is diagnosed with glaucoma and is
scheduled for surgery.
5. Which symptoms are associated with acute closed-angle
glaucoma?
a) diplopia and photophobia
b) episodic blindness and no pain
c) blurred vision and colored rings around lights
d) sensation of curtain drawn across the visual field
Glaucoma is due to increased ocular pressure
(normal is 10-20 mm/Hg) from accumulation of aqueous
humor in the eye that damages the optic nerve resulting
in irreversible blindness. Aqueous humor is produced by
the ciliary body, nourishes the cornea and lens and flows
out of the eye through the trabecular meshwork via the
canal of Schlemm.
Two kinds of Glaucoma:
1. Close Angle/Narrow/Acute - caused by narrowing of
the anterior chamber or blockage that occurs
between cornea and iris. This type of glaucoma can
develop only in one eye and occurs suddenly. It is
common in people of Asian ancestry and associated
with aging.
Symptoms include:
 • intermittent episodic attacks characterized
by severe eye pain, headache, face pain and
abrupt decrease of visual acuity that occur when
pupils dilate such as during emotional upset and
when patient is adjusting vision in darkness
• blurred vision to loss of vision
• rainbow halos around lights
• nausea and vomiting
• rapid rise of intraocular pressure
• cloudy cornea
• reddened conjunctiva
2. Open angle/chronic/simple - caused by blockage in
the trabecular meshwork and the canal of Schlemm.
this type of glaucoma is usually bilateral, with
insidious onset, and often hereditary. it is the most
common type of glaucoma in adults.
Symptoms include:
• appearance early in the disease of scotoma
or blind spots
• gradual loss of peripheral vision
• gradual increase of intraocular pressure
especially upon awakening and when lying flat
• halos around lights
• mild headaches
• difficulty focusing on near objects and
adapting in the dark
• affects both eyes but progression of the
disease is not the same
• vague symptoms so that it is often called
"thief of the night" glaucoma because patient is
unaware until visual acuity is greatly reduced.
6. Which order for Mang Ben before surgery will the nurse
question:
a) demerol (meperidine) 50 mg IM
b) atropine sulfate 0.4 mg IM
c) valium (diazepam) 2 mg IM
d) phenergan (promethazine) 25 mg IM
Drugs which cause pupils to dilate should be avoided
by persons having angle closure glaucoma as they
increase flow of fluid, and thus, the intraocular pressure.
This includes:
• atropine
• anticholinergics
• patient should also avoid caffeine
Drugs used in Glaucoma are:
1. Betablockers: Timolol/Betaxolol
• action: decreases production of aqueous
humor
• side effects: bradycardia, hypotension
• contraindication: asthma, heart block, COPD
2. Carbonic Anhydrase: Acetazolamide/Mannitol
• action: decreases production of aqueous
humor
• side effects: allergy (do not give if with sulfa
allergy), weight loss, electrolyte imbalance,
depression, impotence
3. Cholinergics: Pilocarpine/Carbachol
• action: increases outflow of aqueous humor
• side effects: pain, blurry vision, diminished
vision at dark
4. Adrenergics: Epinephrine/Dipivefrin
• action: decreases production of aqueous
humor
• side effects: tremors, headache, redness
and itching
7. A physician prescribes "patching" for a child with
strabismus of the right eye. A nurse instructs the mother
regarding this procedure. Which of the following
statements when made by the mother indicates that she
understands the instruction?
a) I will place the patch on the right eye
b) I will place the patch on both eyes
c) I will place the patch on the left eye
d) I will alternate the patch from right to left eye hourly
In strabismus, patch the good eye. This will train the
affected eye.
8. The client comments, "I frequently change my eye
glasses, none of which is satisfactory and I have difficulty
focusing on my work." Which of the following disorders
may the client be experiencing?
a) cataract
b) glaucoma
c) detached retina
d) myopia
Glaucoma is an eye disorder that causes damage to
the retina and optic nerve that may lead to blindness. Eye
glasses does not improve the vision, so the client
frequently changes them.
9. An 85-year old woman complains of pain in her operated
eye after cataract removal surgery. The nurse knows that
this symptoms is
a) expected, and she should offer analgesic
b) unexpected and may signify a detached retina
c) unexpected and may indicate hemorrhage
d) expected and she should advise the client to be on
bed rest
Pressure or pain in the eye postop indicates
hemorrhage. This should be reported to the physician.
10. The client had just undergone repair of detached retina.
Which of the following should be included in the nursing
care plan of the client?
a) encourage self-care activities
b) limit movement of his eyes
c) restrict excessive talking
d) limit fluid intake
Limiting eye movement after retinal surgery is done
by application of pressure dressing. This is to prevent
increase in intraocular pressure.
11. Which of the following is an effective technique of
communicating with a hearing impaired client?
a) speak slowly in a low tone of voice
b) speak slowly in a loud voice
c) speak slowly and try to overemphasize words
d) speak slowly and directly in front of the client
Speaking slowly allows the client to understand the
message. And speaking in fron of the client allows him to
read the lip movement of the speaker. Avoid using loud
voice pitch. High-pitched voice is more difficult to be
understood by hearing-impaired client.
12. Which of the following client statements indicates the
need to postpone cataract surgery in the morning?
a) this seasonal allergy should no be a problem
b) the medications instilled into my eyes make my
vision blurred
c) feel nervous with my operation tomorrow
d) I have allergy to certain medications
Seasonal allergy is characterized by sneezing and
coughing. These may cause increase in intraocular
pressure (IOP) and bleeding after eye surgery.
13. Which of the following is done when performing Weber
test?
a) place vibrating tuning fork in front of the opening of
the ear
b) place the vibrating tuning fork in the middle of
the head
c) place the vibrating tuning fork behind the ear
 d) irrigate the ear with cold water and observe
movement of the eyes
Describes weber test, which confirms presence of
sensorineural hearing loss like Meniere's disease.
14. The client has been diagnosed to have Meniere's disease.
Which of the following should be included when giving
health teachings?
a) limit carbohydrates and proteins in the diet
b) limit salt intake
c) limit fats in the diet
d) drink a lot of fluids
Meniere's disease is a disorder caused by increased
endolymphatic pressure in the inner ear; characterized by
vertigo, tinnitus, gradual hearing loss. Low sodium diet is
indicated to prevent further accumulation of
endolymphatic fluids.
15. The nurse plans care for a client with acute glaucoma
who reports severe pain in the eyes and rainbow colors
(halos) around lights. Which action should the nurse take
first?
a) administer pain medication
b) explain to the client that with reduction in intraocular
pressure, pain and other symptoms will subside
c) provide preoperative teachings to the client
d) assess the client's visual status
Pain is the priority problem in a client with glaucoma.
Loss of vision in glaucoma is irreversible.
16. A nurse is providing instructions to a client and the family
regarding home care after right eye cataract removal.
Which statement by the client would indicate an
understanding of the instructions?
a) I will not sleep on my left side
b) I will not sleep on my right side
c) I will not sleep with my head elevated
d) I will not wear my glasses until my physician says it
is okay
After cataract surgery, the client should not sleep on
the side of the body that was operated on. The client also
should be placed in a semi-fowler's position to assist in
minimizing edema and intraocular pressure. During the
day, the client may wear glasses or a protective shield; at
night, the protective shield alone is sufficient.
17. A day care nurse is observing a 2-year old child and
suspects that the child may have strabismus. Which
observation made by the nurse might indicate this
condition?
a) the child has difficulty
b) the child consistently tills the head to see
c) the child consistently turns the head to see
d) the child does not respond when spoken to
Strabismus is a condition in which the eyes are not
aligned because of lack of coordination of the extraocular
muscles. The nurse may suspect strabismus in a child
when the child complains of frequent headaches, squints,
or tilts the head to see. Options A, C, and D are not
indicative of this condition.
18. The mother of a 6-year old child arrives at a clinic
because the child has been experiencing scratchy, red,
and swollen eyes. The nurse notes a discharge from the
eyes and sends a culture to the laboratory for analysis.
Chlamydial conjunctivitis is diagnosed. Based on this
diagnosis, the nurse determines that which of the
following requires further investigation?
a) possible trauma
b) possible sexual abuse
c) presence of an allergy
d) presence of a respiratory infection
Conjunctivitis is an inflammation of the conjunctiva.
A diagnosis of chlamydial conjunctivitis in a child who is
not sexually active should signal the health care provider
to assess the child for possible sexual abuse. Allergy,
infection, and trauma can cause conjunctivitis, but the
causative organism is not likely to be chlamydia.
19. A nurse prepares a teaching plan for a mother of a child
diagnosed with bacterial conjunctivitis. Which of the
following, if stated by the mother, indicates a need for
further teaching?
a) I need to wash my hands frequently
b) I need to clean the eye as prescribed
c) it is okay to share towels and washcloths
d) I need to give the eye drops as prescribed
Conjunctivitis is an inflammation of the conjunctiva.
Bacterial conjunctivitis is highly contagious, and the
nurse should teach infection control measures. These
include good hand washing and not sharing towels and
washcloths. Options A, B, and D are correct treatment
measures.
20. A nurse provides discharge instructions to the mother of
a child after myringotomy with insertion of
tympanostomy tubes. The nurse determines that the
mother needs additional instructions if the mother states
that:
a) swimming in deep water is prohibited
b) swimming in lake water needs to be avoided
c) she will place earplugs in the child's ears during
baths and showers
d) she will be sure to give her child soft tissues to
blow his nose
A myringotomy is the insertion of tympanoplasty
tubes into the middle ear to equalize pressure and keep
the ear aerated. Parents need to be instructed that the
child should not blow his or her nose for 7 to 10 days.
Bath and lake water are potential sources of bacterial
contamination. Diving and swimming in deep water are
prohibited. The child’s ears need to be kept dry. Options
A, B, and C are appropriate instructions.17) B
21. Shortly after a neonate is delivered, erythromycin is
instilled into the neonate’s eyes. This drug is given to
prevent:
a) Ophthalmia neonatorum
b) Retrolental fibroplasias
c) Corneal keratitis
d) Acute uveitis
Erythromycin is an antibiotic used to prevent
Ophthalmia neonatorum (ocular gonorrheal infection. It
doesn’t prevent other eye disorders.
22. An older female client confides to the visiting nurse that
she is afraid she will fall while going to the bathroom at
night. Which suggestion, if made by the nurse, indicates
that the nurse understands the visual changes affecting
the older client?
a) limit your fluid intake during the day
b) use a commode in your bedroom at night
c) keep a red light on the bathroom at night
d) use a bell to call your daughter if you need to get up
Because it takes longer to adapt to changes from
dark to light and vice versa, older persons are at a
greater risk of falls and injuries. Wherever a sudden
change from dark to light or from light to dark occurs can
be dangerous. Getting up during the night is a hazardous
situation for an older client. Eyes adapt to the dark by
using the rod receptors, which are sensitive to short blue-
green wavelengths. Red wavelengths are longer and are
perceived by the cones. Thus, a red light in the bathroom
at night will allow for vision to function in the dark
adequately without the need for adaptation.

23. The nurse is developing a plan of care for the client
scheduled for cataract surgery. The nurse documents
which most appropriate nursing diagnosis in the plan of
care?
a) anxiety
b) self-care deficit
c) nutrition, imbalanced
d) sensory perception, disturbed
The most appropriate nursing diagnosis for the client
scheduled for cataract surgery is Sensory perception,
disturbed (visual) related to lens extraction and
replacement. Although options A, B, and C identify
nursing diagnoses that may be appropriate, they are not
related specifically to cataract surgery.
24. The nurse is performing an assessment on 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:
a) diplopia
b) eye pain
c) floating spots
d) 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. Options A, B, and C are not signs of a
cataract.
25. In preparation for cataract surgery, the nurse is to
administer prescribed eye drops. The nurse reviews the
physician's orders, expecting which type of eye drops to
be prescribed?
a) a miotic agent
b) a thiazide diuretic
c) an osmotic diuretic
d) an mydriatic medication
A mydriatic medication produces mydriasis or
dilation of the pupil. Mydriatic medications are used
preoperatively in the cataract client. These medications
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.
26. During the early postoperative period, the client who has
had a cataract extraction complains of nausea and severe
eye pain over the operative site. The initial nursing action
is to:
a) call the physician
b) reassure the client that this is normal
c) turn the client on his or her operative side
d) administer the ordered pain medication and anti-
emetic
Severe pain or pain accompanied by nausea is an
indicator of increased intraocular pressure and should be
reported to the physician immediately. Options B, C, and
D are inappropriate actions.
27. 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?
a) I will take aspirin if I have any discomfort
b) I will sleep on the side that I was operated on
c) I will not lift anything if weighs more than 10 pounds
d) 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 injury 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 (Tylenol) 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 lb.
28. The client with glaucoma asks the nurse if complete
vision will return. The most appropriate response is:
a) your vision will never return to normal
b) your vision will return soon as the medication begins
to work
c) your vision loss is temporary and will return in about
3 to 4 weeks
d) although some vision has 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 A
does not provide reassurance to the client.
29. 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?
a) avoid overuse of the eyes
b) decrease the amount of salt in the diet
c) eye medications will need to be administered
for the client's entire life
d) decrease fluid intake to control the intraocular
pressure
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. Options A, B, and D are not accurate instructions.
30. The nurse is preforming an admission assessment on a
client with a diagnosis of detached retina. Which of the
following is associated with this eye disorder?
a) total loss of vision'
b) pain in the affected eye
c) a yellow discoloration of hte sclera
d) 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 A and
C are not characteristics of this disorder. A retinal
detachment is an ophthalmic emergency and even more
so if visual acuity is still normal.
31. 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?
a) total loss of vision
b) a reddened conjunctiva
c) a sudden sharp pain in the eye
d) complaints of a burst of black spots or floaters
Complaints of a sudden burst of black spots or
floaters indicates that bleeding has occurred as a result
of the detachment. Options A, B, and C are not signs of
bleeding.
32. The client arrives in the emergency room following an
automobile accident. The client's forehead hit the
 steering wheel and a hyphema is diagnosed. The nurse
places the client in which position?
a) flat on bed rest
b) semi-fowler's on bed rest
c) lateral on the affected side
d) lateral on the unaffected side
A hyphema is the presence of blood in the anterior
chamber. Hyphema is produced when a force is sufficient
to break the integrity of the blood vessels in the eye and
can be caused by direct injury, such as a penetrating
injury from a BB or pellet, or indirectly, such as from
striking the forehead on a steering wheel during an
accident. The client is treated by bed rest in a semi-
Fowler’s position to assist gravity in keeping the hyphema
away from the optical center of the cornea.
33. The client sustains a contusion of the eyeball following a
traumatic injury with a blunt object. Which intervention is
initiated immediately?
a) notify the physician
b) apply ice to the affected eye
c) irrigate the eye with cool water
d) accompany the client to the emergency room
Treatment for a 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.
34. The client arrives in the emergency room with a
penetrating eye injury from wood chips that occurred
while cutting wood. The nurse assesses the eye and notes
a piece of wood protruding form the eye. What is the
initial nursing action?
a) apply an eye patch
b) perform visual acuity tests
c) irrigate the eye with sterile saline
d) remove the piece of wood using a sterile eye clamp
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 cornea.
35. 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:
a) begin visual acuity testing
b) cover the eye with a pressure patch
c) swab the eye with antibiotic ointment
d) 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. Options
B and C are not a component of initial care.
36. The nurse is caring for a client following enucleation. The
nurse notes the presence of bright red drainage on the
dressing. Which nursing action is appropriate?
a) notify the physician
b) document the finding
c) continue to monitor the drainage
d) mark the drainage on the dressing and monitor for
any increase in bleeding
If the nurse notes the presence of bright red
drainage on the dressing, it must be reported to the
physician, because this indicates hemorrhage. Options B,
C, and D are inappropriate.
37. A 55-year old woman was working in her garden. She
accidentally sprayed insecticide into her right eye. She
calls the emergency room frantic and screaming for help.
The nurse should instruct the woman to take which
immediate action?
a) call the physician
b) irrigate the eyes with water
c) come to the emergency room
d) Irrigate the eyes with diluted hydrogen peroxide
In this type of accident, the client is instructed to
irrigate the eyes immediately with running water for at
least 20 minutes or until the emergency medical service
personnel arrive. In the emergency department, the
cleansing agent of choice is normal saline. Calling the
physician and going to the emergency room delays
necessary intervention. Hydrogen peroxide is never
placed in the eyes.
38. 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?
a) the right eye is tested, followed by the left
eye, and then both eyes are tested
b) both eyes are assessed together, followed by the
assessment of the right and the left eyes
c) the client is asked to stand at a distance of 40 feet
from the chart and asked to read the largest line in
the chart
d) the client is asked to stand at a distance of 40 feet
from the chart and read the line that can be read 200
feet away by an individual with unimpaired vision
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 are then tested together. Visual
acuity is measured with or without corrective lenses and
the client stands at a distance of 20 feet from the chart.
39. The client's vision is tested with a Snellen chart. The
results of the tests are documented as 20/60. The nurse
interprets this as:
a) the client is legally blind
b) the client's vision is normal
c) the client can read at distance of 60 feet what a
client with normal vision can read at 20 feet
d) the client can read only at 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 can only read at a distance of 20 feet what a
person with normal vision can read at 60 feet.
40. The clinic nurse notes that 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 chart test expecting note which
finding?
a) 20/20 vision
b) 20/40 vision
c) 20/60 vision
d) 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.
41. 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 the normal intraocular pressure is:
a) 2 to 7 mm Hg
b) 10 to 21 mm Hg
c) 22 to 30 mm Hg
d) 31 to 35 mm Hg
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 mm Hg are considered within the normal range.
42. The nurse is preparing a teaching plan for a client who is
undergoing cataract extraction with intraocular
implantation. Which home care measures will the nurse
include in the plan? Select all that apply
a) avoid activities that require bending over
b) contact the surgeon if eye scratchiness occurs
c) place an eye shield on the surgical eye at
bedtime
d) episodes of sudden severe pain in the eye are
expected
e) contact the surgeon if a decrease in visual
acuity occurs
f) take acetaminophen (Tylenol) for minor eye
discomfort
Following eye surgery, some scratchiness and mild
eye discomfort may occur in the operative eye and
usually is relieved by mild analgesics. If the eye pain
becomes severe, the client should notify the surgeon
because this may indicate hemorrhage, infection, or
increased intraocular pressure. The nurse also would
instruct the client to notify the surgeon of increased
purulent drainage, increased redness, or any decrease in
visual acuity. The client is instructed to place an eye
shield over the operative eye at bedtime to protect the
eye from injury during sleep and to avoid activities that
increase intraocular pressure, such as bending over.
43. The client is receiving an eye drop and eye ointment to
the right eye. The nurse should:
a) administer the eye drop first, followed by the
eye ointment
b) administer the eye ointment first, followed by the
eye drop
c) administer the eye drop, wait 10 minutes, and
administer the eye ointment
d) administer the eye ointment, wait 10 minutes, and
administer the eye drop
When an eye drop and an eye ointment are
scheduled to be administered at the same time, the eye
drop is administered first. Options B, C, and D are
incorrect.
44. The nurse is caring for a client with glaucoma. Which of
the following medications, if prescribed for the client,
would the nurse question?
a) carbachol (Carboptic)
b) atropine sulfate (Isopto Atropine)
c) pilocarpine (Ocusert Pilo-20, Ocusert Pilo-40)
d) pilocarpine hydrochloride (Isopto Carpine)
45. A miotic medication has been prescribed for the client
with glaucoma. The client asks the nurse about the
purpose of the medication. The nurse tells the client that:
a) the medication will help dilate the eye to prevent
pressure from occurring
b) the medication will relax the muscles of the
eyes and prevent blurred vision
c) the medication causes the pupil to constrict and will
lower the pressure in the eye
d) the medication will help block the responses that are
sent to the muscles in the eye
Options A, C, and D are miotic agents used to treat
glaucoma. Option B is a mydriatic and cycloplegic
medication, and its use is contraindicated in clients with
glaucoma. Mydriatic medications dilate the pupil and can
cause an increase in intraocular pressure in the eye.
46. Pilocarpine hydrochloride (Isopto Carpine) is prescribed
for the client with glaucoma. Which of the following
medications does the nurse plan to have available in case
of systemic toxicity?
a) atropine sulfate
b) pindolol (Visken)
c) protamine sulfate
d) naloxone hydrochloride (Narcan)
Systemic absorption of pilocarpine hydrochloride can
produce toxicity and includes manifestations of vertigo,
bradycardia, tremors, hypotension, syncope, cardiac
dysrhythmias, and seizures. Atropine sulfate must be
available in the event of systemic toxicity. Pindolol is a β
blocker. Naloxone hydrochloride is an opioid antagonist
used to reverse narcotic-induced respiratory depression.
Protamine sulfate is the antidote for heparin.
47. Betaxolol hydrochloride (Betoptic) eye drops have been
prescribed for the client with glaucoma. Which of the
following nursing actions is most appropriate related to
monitoring for the side effects of this medication?
a) monitoring temperature
b) monitoring blood pressure
c) assessing peripheral pulses
d) assessing blood glucose level
Hypotension, dizziness, nausea, diaphoresis,
headache, fatigue, constipation, and diarrhea are
systemic effects of the medication. Nursing interventions
include monitoring the blood pressure for hypotension
and assessing the pulse for strength, weakness, irregular
rate, and bradycardia. Options A, C, and D are not
specifically associated with this medication.
48. In preparation for cataract surgery, the nurse to
administer cyclopentolate (Cyclogyl) eye drops. The
nurse a is to administer the eye drops, knowing that the
purpose of this medication is to:
a) produce miosis of the operative eye
b) dilate the pupil of the operative eye
c) provide lubrication to the operative eye
d) constrict the pupil of the operative eye
Cyclopentolate is a rapidly acting mydriatic and
cycloplegic medication. Cyclopentolate is effective in 25
to 75 minutes, and accommodation returns in 6 to 24
hours. Cyclopentolate is used for preoperative mydriasis.
49. The home health nurse visits a client at home and
instructs the client on the administration of the
prescribed eye drops. Which of the following statements
by the client indicates a need for further education?
a) I can lie down, pull up the upper lid, and place
the drop in the lower lid
b) I can lie down, pull down on the lower lid, and place
the drop in the lower lid
c) I can sit and tilt my head back, pull down on the
lower lid, and place the drop in the lower lid
d) I can lie on my side opposite to the eye I am going to
place the drop, put the drop in the corner of the lid
nearest my nose, and then slowly turn to my other
side while blinking
The client can lie down or sit with the head tilted
back. The lower lid should be pulled downward with the
thumb or fingers. The client holds the bottle like a pencil,
with the tip downward, and squeezes the bottle gently,
allowing one drop to fall into the sac. The client gently
closes the eye. Options B, C, and D identify correct
methods for administering eye drops.
50. The nurse is providing instructions to a client who will be
self-administering eye drops. To minimize the systemic
effects that eye drops can produce, the nurse instructs
the client to:
a) eat before instilling the drops
b) swallow several times after instilling the drops
c) blink vigorously to encourage tearing after instilling
the drops
d) occlude the nasolacrimal duct with a finger
over the inner canthus for 30 to 60 seconds
after instilling the drops

Applying pressure on the nasolacrimal duct prevents

systemic absorption of the medication. Options A, B, and
C will not prevent systemic absorption.