Correct answer—C. Rationales: Bacterial conjunctivitis has an acute onset, moderate pain, copious purulent discharge, and preauricular adenopathy. Viral conjunctivitis has an acute or a subacute onset, mild to moderate pain, and moderate and seropurulent discharge; preauricular adenopathy is common. Allergic conjunctivitis has a recurrent onset, no pain, moderate clear discharge, and no preauricular adenopathy. Irritant conjunctivitis has acute onset, no pain to mild pain, minimal clear discharge, and rarely, preauricular adenopathy.

Nursing process step: Assessment

Correct answer—D. Rationales: A client who now has bilateral involvement needs further therapy. After effective treatment for conjunctivitis, eye pain should be relieved, the preauricular adenopathy should be decreased or resolved, and purulent discharge should be absent. Client education on disease transmission and method for cleaning the eye is needed.

Nursing process step: Evaluation

Correct answer—B. Rationales: Iritis is treated with prednisolone to reduce inflammation (five times daily) and tropicamide to reduce ciliary muscle spasm (1 to 2 drops, repeated in 5 minutes if necessary). Topical decongestants and antibiotics are used in the treatment of bacterial conjunctivitis. Referral to an ophthalmologist generally isn’t necessary in the treatment of iritis.

Nursing process step: Intervention

Correct answer—A. Rationales: Central retinal artery occlusion presents with a sudden, painless unilateral loss of vision. Light perception is all that remains in the affected eye. The pupil is dilated and nonreactive. Glaucoma occurs with sudden onset of severe pain, diminished vision, semidilated and nonreactive pupils, and increased intraocular pressure.

Nursing process step: Assessment

Correct answer—D. Rationales: Central retinal artery occlusion results from a sudden painless blindness, usually in one eye. The vision loss may be transient in nature. Orbital cellulitis is an infection of the orbital septum and may cause vision loss but doesn’t cause sudden blindness. Glaucoma causes gradual loss of vision, not sudden blindness. Retinal detachment causes a sudden flash of light in one or both eyes or a shadow or curtain over a portion of the visual field but doesn’t cause sudden blindness.

Nursing process step: Analysis

Correct answer—C. Rationales: The most appropriate intervention is to instill NSAID drops. The client may require instillation of ophthalmic antibiotic ointment; however, the ointment shouldn’t contain a corticosteroid, which would increase the risk of infection. Topical anesthetics may lead to irreversible corneal damage and should never be administered. Studies show that eye patching doesn’t speed healing or reduce pain. It may actually increase client discomfort and has been found to interfere with the client’s ability to participate in routine activities.

Nursing process step: Intervention

Correct answer—B. Rationales: Severe corneal abrasions present with corneal surface irregularity and loss of luster. Tearing is common; however, vision is only blurred, not lost. Redness without purulent discharge is also a common finding. The pupils are of normal size and reactivity, unless eyedrops are used for examination and relief of severe pain.

Nursing process step: Assessment

Correct answer—A. Rationales: A client with a lidocaine allergy may be allergic to the medications administered to anesthetize the eye. Many medications have cross-reactivity with drugs commonly used for the examination and treatment of eye injuries. Atropine is also commonly used for eye examination and can worsen glaucoma, not diabetes insipitus. Both a medical and surgical history are necessary, but obtaining information on allergies takes priority.

Nursing process step: Assessment