A nurse is collecting data from a client experiencing a change in vision.
Which of the following statements indicates that the client might be developing cataracts?
I can't see objects from the sides of my eyes.
I can't see anything in the middle part of my eyes.
There are dark spots moving around in my eye.
My vision is blurry and objects are hazy.
The Correct Answer is D
Choice A rationale
The inability to see objects from the sides of the eyes describes a loss of peripheral vision, which is a classic clinical manifestation of glaucoma. In glaucoma, increased intraocular pressure causes progressive damage to the optic nerve fibers, typically starting with those responsible for peripheral fields. Cataracts involve the central lens and do not specifically target peripheral vision in this manner; instead, they create a generalized clouding that affects the entire visual field.
Choice B rationale
Difficulty seeing objects in the middle part of the visual field indicates a central scotoma, which is the primary characteristic of macular degeneration. The macula is the central portion of the retina responsible for sharp, detailed vision. When it deteriorates, central vision is lost while peripheral vision remains intact. Cataracts do not cause a localized central void; they cause a diffuse opacification of the lens, leading to an overall reduction in clarity.
Choice C rationale
Dark spots moving around in the visual field are known as floaters, which are often caused by vitreous humor changes or retinal detachment. These occur when shadows are cast on the retina by debris within the vitreous gel. While people with cataracts might see shadows if the opacity is dense, floaters are not a primary diagnostic sign of cataract development. They are more indicative of posterior segment issues rather than lens opacification.
Choice D rationale
Cataracts are characterized by the progressive clouding of the crystalline lens, which scatters light as it enters the eye. This results in blurry, hazy, or dim vision because the light cannot focus sharply on the retina. The denaturation of lens proteins creates an opaque barrier, making it feel as if the client is looking through a frosted window. This generalized blurriness and increased sensitivity to glare are the most common early reports of cataract formation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Meniere's disease is characterized by an accumulation of endolymphatic fluid in the inner ear, but it does not typically cause physical pain or earaches. The pressure felt is usually described as fullness rather than acute or bilateral pain. If a client reports bilateral ear pain, the nurse should investigate other possibilities such as otitis media or external trauma. Pain is not a diagnostic hallmark of the endolymphatic hydrops that defines this chronic inner ear condition.
Choice B rationale
Impacted cerumen is an external ear canal issue that can cause conductive hearing loss, but it is entirely unrelated to the inner ear pathology of Meniere's disease. Meniere's involves the cochlea and vestibular system. While a client with Meniere's could coincidentally have earwax buildup, it is not an expected finding or a symptom of the disease itself. Nurses must distinguish between external obstructions and the internal fluid imbalances that cause the vertigo and tinnitus.
Choice C rationale
Meniere's disease causes progressive sensorineural hearing loss due to repeated episodes of increased endolymphatic pressure damaging the hair cells in the cochlea. Initially, the hearing loss may be fluctuating and involve only low frequencies, but over time, it often becomes permanent and more severe. The typical triad of symptoms includes vertigo, tinnitus, and this gradual decline in auditory acuity. Expecting a decrease in hearing is essential when collecting data for a client with this diagnosis.
Choice D rationale
A retracted eardrum is a sign of Eustachian tube dysfunction or negative pressure in the middle ear, not the inner ear. Meniere's disease occurs deep within the temporal bone in the labyrinthine system, and the tympanic membrane usually appears normal upon otoscopic examination. Finding a retracted or scarred eardrum would point toward a history of middle ear infections or pressure equalization problems rather than the fluid shifts within the endolymphatic sac associated with Meniere's.
Correct Answer is A
Explanation
Choice A rationale
Bending at the knees instead of the waist is a crucial instruction to prevent an increase in intraocular pressure. When a client bends over at the waist, head-down positioning significantly increases venous pressure in the head and eyes. Normal intraocular pressure ranges from 10 to 21 mmHg, and spikes in this pressure can rupture delicate surgical sutures or cause vitreous loss. Maintaining the head in an upright position preserves the integrity of the recent cataract extraction.
Choice B rationale
Aspirin is a salicylate that inhibits platelet aggregation and can increase the risk of intraocular hemorrhage or bleeding at the surgical site. Postoperative pain following cataract surgery should be mild and is typically managed with acetaminophen. Significant pain, especially when described as brow pain, can indicate a dangerous spike in intraocular pressure or acute glaucoma, which is a surgical emergency. The client should report such pain to the surgeon immediately rather than self-medicating with aspirin.
Choice C rationale
Lifting heavy objects, generally defined as anything over 5 to 10 pounds, is strictly prohibited during the initial healing phase after eye surgery. Straining or lifting increases intrathoracic and intracranial pressure, which directly translates to increased intraocular pressure through the Valsalva maneuver. This pressure can cause wound dehiscence or displacement of the newly implanted intraocular lens. Grocery bags weighing 15 pounds exceed the safe weight limit for most patients recovering from a cataract extraction procedure.
Choice D rationale
Lying on the operative side is contraindicated because it puts direct pressure on the surgical eye and can increase localized intraocular pressure. Clients are typically instructed to sleep on their back or on the non-operative side to avoid accidental trauma or pressure to the eye while sleeping. This restriction usually lasts for several weeks, not just 24 hours. Sleeping with an eye shield is also required to prevent the client from rubbing or poking the eye during sleep.
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