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Test Bank for New Ebersole and Hess Toward Healthy Aging 9th Edition by Touhy Sample Chapter 11: Vision MULTIPLE CHOICE You have four rooms to choose from for your older client to be admitted this afternoon Which room would you choose? a A brightly lit, blue room with cozy throw rugs b An orange-carpeted room with soft lighting and yellow walls c A brightly lit, blue room with an EZ-Glide wax floor d A fluorescent-lighted room with green walls and a glossy, tiled floor ANS: B Light colors such as red, orange, and yellow are more easily seen by aging eyes Softer lighting will help reduce some of the glare and is also easier seen by aging eyes Fidelity of color is less accurate with the blues, greens, and violets of the spectrum, and the slowed ability of the pupils to adjust to light makes glare a problem Glare can come from sunlight, but a brightly waxed floor and glossy tile can also cause glare DIF: Cognitive Level: Applying REF: p 138 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance An older adult client shares with the nurse that, “I don’t know what it is but it seems that I need more light for reading or even watching television as I get older.” The nurse explains that aging may cause this change due to the: a slower ability of the pupil to adjust to changes in lighting b impact arcus senilis has on visual acuity c flattening and thinning of the cornea d retinal changes that begin to occur with aging ANS: A A slowed ability of the pupil to accommodate to changes in light accounts for the need of this patient to have more light in order to read Arcus senilis does not affect vision It is true that the cornea becomes flatter and thinner with aging, which results in astigmatism Astigmatism does not account for the need for increased light that this patient is reporting The changes in the retina not account for the need for increased light that this patient is reporting DIF: Cognitive Level: Applying REF: p 131 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance A 77-year-old client being treated for glaucoma asks the nurse what causes glaucoma The nurse’s response is: a the exact etiology of glaucoma is variable and often unknown b spasms of the orbicular muscle c changes to the suspensory ligaments, ciliary muscles, and parasympathetic nerves d bits of broken coalesced vitreous from the peripheral or central part of the retina ANS: A The etiology of glaucoma is variable and often unknown However, when the natural fluids of the eye are blocked by ciliary muscle rigidity and the buildup of pressure, damage to the optic nerve occurs Spasms of the orbicular muscle can cause the lower lid to turn inward If it stays this way, it is called entropion The changes described contribute to decreased accommodation Bits of coalesced vitreous that have broken off from the peripheral or central part of the retina is the definition of floaters DIF: Cognitive Level: Remembering REF: p 134 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance An older man tells a nurse, “The doctor says I have something wrong with my eyes, something called presbyopia Can you explain why I have this? I was always fortunate to have good eyesight.” The nurse formulates a response based on the knowledge that: a the lens of the eye loses elasticity causing a loss of focus for near objects b the cornea of the eye becomes thicker and less curved causing an increase in astigmatism c the lens of the eye increases in opacity causing a decrease in light refraction d the cornea of the eye forms a gray ring at the edges ANS: A Presbyopia is the loss of focus for near objects, caused by a loss of elasticity and hence a loss of accommodation of the lens of the eye All of the other options are normal agerelated changes; however, they are not related to presbyopia DIF: Cognitive Level: Applying REF: p 132, Table 11-1 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance An older resident in a long-term care facility reports to the nurse that she has been noticing changes in her vision, including the appearance of halos around objects and a yellow tint to most objects The nurse knows that these complaints are most often associated with: a cataracts b glaucoma c diabetic retinopathy d age-related macular degeneration ANS: A Signs of cataracts include the appearance of halos around objects as light is diffused, blurring, decreased perception of light and color giving a yellow tint to most objects, and a sensitivity to glare DIF: Cognitive Level: Remembering REF: p 134 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance An older patient reports the following symptoms to a nurse during a routine visit to the geriatric clinic: blurry vision, the need for more light when reading, and blind spots in the middle of his visual field He also states, “Strangely enough my peripheral vision continues to be pretty good.” The nurse suspects that the patient has which of the following? a Glaucoma b Age related macular degeneration c Diabetic retinopathy d Cataracts ANS: B Blurry vision, needing more light, and blind spots in the middle of the visual field (scotomas) are all characteristics of age related macular degeneration The other three eye diseases not present with these symptoms DIF: Cognitive Level: Applying REF: pp 135–136 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE A nurse is providing glaucoma education for a group of older adults in a senior center The nurse knows that the following groups are most likely to develop glaucoma (Select all that apply.) a African Americans b Mexican Americans c Individuals with a family history of glaucoma d Individuals with diabetes e Asian Americans ANS: A, B, C, D African Americans are at risk of developing glaucoma at an earlier age than other racial and ethnic groups Mexican Americans, individuals with a family history of glaucoma, and individuals with diabetes are among the other high-risk groups Asian Americans are more likely to lose eyesight from age-related macular degeneration than other groups DIF: Cognitive Level: Remembering REF: p 133 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance A nurse is performing preoperative teaching for an older adult who is scheduled to have a cataract extraction and lens implant The nurse includes which of the following in the teaching plan? (Select all that apply.) a Avoid lifting heavy objects after the surgery b Avoid bending from the waist after the surgery c Take stool softeners as needed d Maintain strict control of your blood sugar and blood pressure e Maintain a dry sterile dressing over the eye for 10 days ANS: A, B, C Postcataract surgery the individual needs to avoid heavy lifting, straining, and bending from the waist Fall prevention is also very important as is complying with eye drop administration Maintaining strict blood sugar and blood pressure control is most important for diabetic retinopathy, not cataract extraction There usually is not a dressing over the operative site, and not for 10 days DIF: Cognitive Level: Applying REF: pp 134–135 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance An older patient is diagnosed with diabetic retinopathy The patient asks a nurse: “Is there anything that I can to prevent progression of this disease and blindness?” The nurse includes which of the following into the response? (Select all that apply.) a Strict control of blood glucose levels is important in slowing disease progression b Laser photocoagulation treatments can stop progression of the disease c Control of blood pressure and cholesterol levels are important steps slowing disease progression d Wearing sunglasses to protect the eyes from ultraviolet light can stop disease progression e Eating a diet high in beta-carotene can stop disease progression ANS: A, B, C Constant strict control of blood pressure, blood glucose, and cholesterol and laser photocoagulation treatments can halt progression of the disease Laser treatment can reduce vision loss in 50% of patients Neither protecting the eyes from ultraviolet light nor eating a diet high in beta-carotene has been proven to be effective in stopping disease progression DIF: Cognitive Level: Applying REF: p 136 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance A nurse is conducting an assessment of an older patient’s eyes The nurse expects to see which of the following normal age-related changes of the external eye? (Select all that apply.) a The eyelids are less elastic and droopy b The eyes are very dry c The eyelids may not close completely d There is a loss of eyelashes e The lower lid may be turned outward ANS: A, B, C, E Normal age-related changes in the external eye include a loss of elasticity causing drooping Eyes become drier, and the eyelids may not close completely Decreases in orbital muscle strength may result in entropion, the outward turning of the lower lid Loss of eyelashes is not a normal age-related change DIF: Cognitive Level: Remembering REF: p 132, Table 11-1 TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Health Promotion and Maintenance New Ebersole and Hess Toward Healthy Aging: 9th Edition Test Bank – Touhy