7th_Ed Test Bank Nursing for Wellness in Older Adults by Carol A.Miller
Origin: Chapter 17- Vision, 1
1. A nurse develops a plan of care for an older adult recently diagnosed with Lewy body dementia. Which functional consequence would be most important to monitor in this older adult?
A) Development of visual hallucinations
B) A visual acuity score of 20/30
C) Improved visual acuity after medications for dementia
D) Growth of cataracts
Persons with Lewy body dementia are at risk for visual hallucinations. Low vision is 20/70 visual acuity to 20/200 visual acuity. Visual acuity will not improve with dementia medications, as anticholinergics also impair vision. Cataracts are unrelated to Lewy body dementia, although they are common in all older adults.
Origin: Chapter 17- Vision, 2
2. A nurse is providing an educational program about age-related macular degeneration (AMD) to a group of older adults. Which of the following statements by an older adult indicates the need for further teaching?
A) “Smoking is a risk factor for AMD.”
B) “Macular degeneration causes a loss of central vision.”
C) “People with macular degeneration should have any sudden changes evaluated.”
D) “The dry type of macular degeneration occurs rapidly.”
The dry type of AMD progresses slowly and does not cause total blindness. The wet type of macular degeneration develops rapidly and causes visual loss. Smoking is a risk factor for macular degeneration. As AMD progresses, it affects central vision. People with AMD should have any sudden changes evaluated.
Origin: Chapter 17- Vision, 3
3. Which of the following methods can be used to informally assess an older adult’s visual skills? (Select all that apply.)
A) Ask the person to look out a window and describe certain details.
B) Perform a standard confrontation test to assess central vision.
C) Place good illumination and ask the person to read printed material with various type sizes.
D) Perform a standard vision test, testing each eye separately and allowing the person to cover the other eye with a hand.
Ans: A, C
Nurses informally assess vision by asking the older adult to read printed material with various type sizes and describing details of a scene at a distance. A standard confrontation test is a gross measurement of peripheral vision fields. With standard vision tests, each eye is tested separately, and one should avoid using the hand as a cover.
Origin: Chapter 17- Vision, 4
4. Which of the following are crucial when assessing visual function in an older adult? (Select all that apply.)
A) Asking the older adult to read the fine print on a medicine bottle without a magnifying aid
B) Asking the older adult whether he or she can drive without difficulties at night
C) Observing the older adult functioning in his or her normal environment
D) Observing the older adult while he or she is reading a newspaper without glasses
Ans: B, C
The nurse should observe the older adult’s usual pattern of activities. These observations are best made in the person’s usual environment and address the person’s ability to carry out activities. Older adults who report difficulty driving at night may have cataracts or other visual impairments.
Origin: Chapter 17- Vision, 5
5. A nurse knows teaching has been effective when the client states the following:
A) “If my sensitivity to glare decreases and my contrast sensitivity increases, I will be evaluated for cataracts.”
B) “I wear sunglasses and a wide-brimmed hat when I am in the sun to protect my eyes and prevent the development of cataracts.”
C) “Having Alzheimer disease increases one’s risk of developing macular degeneration.”
D) “If I take ototoxic medications, this will increase my risk for developing cataracts.”
Protecting one’s eyes from sunlight is a health promotion intervention for preventing cataracts. Cataract symptoms include increased sensitivity to glare and decreased contrast sensitivity. Individuals with Alzheimer disease may have impaired contrast sensitivity and other visual impairments, but not an increased risk of developing macular degeneration. Ototoxic drugs will damage the auditory nerve; they do not affect the optic nerve or vision.
Origin: Chapter 17- Vision, 6
6. A nurse has noted that most of the residents who live at the long-term care facility require corrective lenses of some type. Which of the following age-related changes contributes to the loss of visual acuity?
A) Decreased size and density of the lens
B) Increased intraocular pressure
C) Presence of floaters in the vitreous
D) Decreased responsiveness of the ciliary body
Because of age-related changes, the ciliary body gradually becomes smaller, stiffer, and less functional. Although floaters may occur, they do not affect visual acuity. Increased intraocular pressure is a pathologic process in individuals of any age. The lenses increase, not decrease, in mass.
Origin: Chapter 17- Vision, 7
7. After a scheduled trip to her optometrist, a 70-year-old has been told that the pressure in her eye is high and she needs to be monitored and treated to prevent damage to the optic nerve. What is this person’s diagnosis?
The term glaucoma refers to a group of eye diseases in which the ganglion cells of the optic nerve are damaged by an abnormal buildup of aqueous humor in the eye. Increased intraocular pressure is not implicated in the development of cataracts, AMD, or presbyopia.
Origin: Chapter 17- Vision, 8
8. A nurse assesses risk factors for vision loss in a 71-year-old client. Which question should the nurse include in this assessment?
A) “Do you have high blood pressure or diabetes?”
B) “Did your parents wear glasses or have cataracts?”
C) “How much red meat do you usually eat?”
D) “Do you have high cholesterol?”
Diabetes and hypertension are significant risk factors for vision loss. Family history, diet, and high cholesterol are not closely associated with vision loss in older adults.
Origin: Chapter 17- Vision, 9
9. A 78-year-old client states, “I often have dry eyes, it is bothersome and irritating.” What intervention should the nurse recommend?
A) Daily rinses with tap water
B) A medication vacation to determine if medications are the cause
C) Use of over-the-counter artificial tears
D) Keeping eyes closed for 3 to 5 minutes each hour
For most older adults with dry eyes, the use of over-the-counter artificial tears or ocular lubricants usually will relieve symptoms. It would be inappropriate for the nurse to independently recommend a cessation of medication. Rinsing with tap water and keeping the eyes closed are not recommended interventions.
Origin: Chapter 17- Vision, 10
10. A resident of a nursing home has experienced a progressive loss of vision over the past several months as a consequence of diabetes. How should the nurse accommodate the resident’s loss of visual acuity?
A) Provide the resident with brightly colored grooming utensils.
B) Replace the resident’s tube television with a flat-screen TV.
C) Remove books from the resident’s room to avoid reminding her of her vision loss.
D) Have the walls in the resident’s room painted a neutral color that matches the color of the flooring.
Brightly colored utensils and grooming supplies can make it easier for an older adult to identify and use them. Replacing the TV is not an effective intervention, and it is not appropriate to remove books simply because they may remind the resident of her vision loss. Contrasting, not monochromatic, color schemes facilitate vision.
Origin: Chapter 17- Vision, 11
11. A nurse assesses an older adult’s color perception. Which of the following colors should the nurse expect the client to have the most difficulty visualizing?
A) Blue and violet hues
B) Yellow tones
C) White and off-white
D) Tan and brown wavelengths
These age-related changes decrease responsiveness of the lens and increase the diffusion of light rays, resulting in fewer rays reaching the retina. The most detrimental effect occurs with the shorter blue and violet wavelengths.
Origin: Chapter 17- Vision, 12
12. A nurse gives a presentation regarding eye health at a wellness clinic. Which of the following interventions should the nurse include in the teaching?
A) Avoid reading under halogen lights
B) Cardiovascular exercise three times a week
C) Get 8 to 10 hours of sleep each night
D) Wearing sunglasses with UV-absorbing lenses
Poor nutrition, cigarette smoking, and exposure to sunlight are associated with the development of eye diseases. Poor lighting and exposure to sunlight are risk factors that can readily be addressed through simple self-care practices.
Origin: Chapter 17- Vision, 13
13. A nurse assesses a 79-year-old adult noting the presence of a white ring around the iris bilaterally. What is the correct term for this?
B) Arcus senilis
Arcus senilis (also called corneal arcus) is evidenced by the development of yellow or gray-white ring around the iris. Glaucoma is related to pressure changes, not changes to the iris. Arthritis is unrelated to eye health. Presbyopia is an age-related visual acuity change.
Origin: Chapter 17- Vision, 14
14. A nurse performs an assessment on a 93-year-old client. Which of the following assessment findings are age-related changes? (Select all that apply.)
Ans: A, B
Enophthalmos is the appearance of sunken eyes and ectropion is when the lower eyelid falls away from conjunctiva, causing decreased lubrication, both of which are age-related changes. Erythematosus refers to the presence of erythema, eschar is the necrotic scab on a wound, and exophthalmos is the protrusion of the eye.
7th_Ed Test Bank Nursing for Wellness in Older Adults by Carol A.Miller