CATARACT

1.The client who had cataract surgery with a lens implant 1 week ago remarks to the home care nurse
that after his daughter left to go to her home in another state yesterday, he combined all of his
prescribed eyedrops together in one container so he had fewer drops to administer. What is the nurse's
best response?
A. "This is not a good idea because not all of the drugs are on the same schedule."
B. "That is a good idea; just remember to not touch the dropper to your eye when giving yourself the
drops."
C. "Call your surgeon immediately and get new prescriptions because together these drugs can lower
your blood pressure."
D. "Call your surgeon immediately and get new prescriptions to use one at a time because these drugs
cannot be mixed together."

Answer: D
Rationale: These drugs are not to be mixed together. Not only is the chance for contamination high, but
the drug concentrations and effectiveness are also reduced when mixed together. Even when the drugs
are administered separately, they should be given 5 to 10 minutes apart.

2.Which assessment is most important for the nurse to perform before instilling travoprost (Travatan)
into the client's eye?
A. Measuring the client's blood pressure
B. Measuring the client's intraocular pressure
C. Checking the cornea for abrasions or open areas
D. Assessing heart rate and rhythm for 1 full minute

Answer: C
Rationale: Travoprost is a prostaglandins agonist. Drugs from this class should not be applied unless the
cornea is completely intact. Measuring intraocular pressure is not necessary when a diagnosis of
glaucoma has been established. Prostaglandins agonists, even if systemically absorbed, do not affect
body blood pressure or heart rate and rhythm.

3.Which precaution is most important for the nurse to teach a 62-year-old client newly diagnosed with
early-stage dry age-related macular degeneration?
A. Quit smoking
B. Quit drinking alcoholic beverages
C. Eat more dark green, red, and yellow vegetables
D. Wear dark glasses whenever he or she is outside or in bright interior lighting environments

Answer: A
Rationale: Dry AMD is more common and progresses at a faster rate among smokers than among
nonsmokers. Thus, quitting smoking can slow the rate of AMD progression. Avoiding alcohol and bright
light (even ultraviolet light) is not related to AMD development or progression. Although increasing
long-term dietary intake of antioxidants, vitamin B12, and the carotenoids lutein and zeaxanthin that are
found in green, red, and yellow vegetables is thought to help slow the progression of AMD, the effects
are not as profound as quitting smoking.

4.A client with glaucoma is being assessed for new symptoms. Which symptom indicates a high priority
need for reassessment of intraocular pressure?
A. Burning in the eye
B. Inability to differentiate colors
C. Increased sensitivity to light
D. Gradual vision changes

Answer: D
Rationale: Gradual vision changes are an indication of increased intraocular pressure. A burning
sensation in the eye usually indicates inflammation and/or infection. An inability to differentiate colors
is an early sign of cataracts. An increased sensitivity to light might be a sign of a corneal abrasion.

5.A client has recently had cataract surgery. About which symptom does the nurse instruct the client to
notify the health care provider?
A. Increased tearing
B. Itching of the eye
C. Reduction in vision
D. Swollen eyelid

Answer: C
Rationale: A reduction in vision after cataract surgery indicates a problem, and the client should notify
the provider immediately. Increased tearing, itching of the eye, and a swollen eyelid all are expected
after cataract surgery.

6.The nurse is teaching a client about open-angle glaucoma management. Which statement by the client
indicates a need for further instruction?
A. "I must wait 10 to 15 minutes between different eyedrop medications."
B. "I must press on the inside of my eye to prevent washout."
C. "It is important to not skip a dose."
D. "These eyedrops will not cure my glaucoma."

Answer: B
Rationale: Pressing on the inside of the eye after instillation of eye medication prevents systemic
absorption of the drug. To avoid washout, the client should wait 10 to 15 minutes between eyedrop
medications. Skipping a dose will not exacerbate the client's glaucoma. Medication will not cure
glaucoma, but it will control its progression.
7.What is the action of miotics in the client with glaucoma?
A. Decrease the inflammatory process
B. Enhance aqueous outflow
C. Increase the production of vitreous humor
D. Vasoconstrict the blood vessels in the eye

Answer: B
Rationale: Miotics are used to improve the flow of fluid (aqueous humor) and decrease intraocular
pressure in clients with glaucoma. Steroid drops, not miotics, decrease the inflammatory process.
Vitreous humor fills the space between the lens and the retina, is stagnant, and is not replenished as the
aqueous humor is. Miotics make the pupil smaller, which creates more room between the iris and the
lens.

8.The nurse is performing preoperative teaching for an older adult client who will be having a cataract
removed. Which instructions does the nurse include? (Select all that apply.)
A. "You will need to wear a patch on your eye for several weeks after the surgery."
B. "Several different types of eyedrops are requested after surgery, and they have to be taken several
times a day for up to 4 weeks."
C. "You will receive a medication to help you relax. Then you will receive some different eyedrops to
dilate your pupils and paralyze the lens."
D. "Bring sunglasses with you on the day of your procedure."
E. "You might experience a lot of bruising and swelling around the eye."

Answer: B, C, D
Rationale: The client will have multiple eyedrops to use after surgery and should be made aware of this
before the procedure to understand the importance. Providing information on what to expect, such as
telling the client about the medication that will be administered and the eyedrops that will dilate and
paralyze the lens, helps the client prepare for the day of surgery. The client will need to have sun
protection after the procedure. A patch is required after surgery only if a risk for injury is present.
Cataract surgery does not cause bruising and swelling post-surgery.

9.The nurse is providing discharge instructions to a client with glaucoma. Which activities does the nurse
instruct the client to avoid? (Select all that apply.)
A. Bending over to tie shoes
B. Sitting with legs elevated
C. Sleeping on more than two pillows
D. Blowing the nose frequently
E. Lifting objects weighing more than 10 pounds

Answer: A, D, E
Rationale: Any action that would increase pressure in the eye should be avoided, such as bending over,
excessive blowing of the nose, and lifting heavy objects. Sitting with the legs elevated or sleeping on
more than two pillows is not contraindicated in clients with glaucoma.
10.During patient teaching regarding self-administration of ophthalmic drops, with statement by the
nurse is correct?

A. "Hold the eyedrops over the cornea, and squeeze out the drop."
B. "Apply pressure to the lacrimal duct area for 5 minutes after administration."
C. "Be sure to place the drop in the conjuctival sac of the lower lid."
D. "Squeeze your eyelid closed tightly after placing the drop into your eye."

Answer: C

Rationale: Because the cornea is sensitive, most eye medications are placed inside the lower lid. For
systemic osmotic drugs, pressure only needs to be applied to lacrimal duct for 60 seconds.