Deck 18: Ophthalmic Surgery

Question 1

The refractive apparatus of the eye directs (refracts)the light rays to strike the:

A) retina.
B) optic nerve.
C) vitreous body.
D) lateral geniculate body.

Answer 1

A
Light rays emanate from an object in the field of vision and transmit to the eye.These light rays pass through the clear cornea,travel through the clear vitreous fluid,and land directly on the macula,the central part of the retina and the area of highest sensitivity for details.The nerve endings of the retina pass the images as nerve impulses through the optic nerve to the brain,where the occipital area interprets the images.

Question 2

Miotics and mydriatics produce opposite effects on the pupil of the eye.Select the most appropriate statement about miotic and/or mydriatic drugs.

A) Miotic drugs are anticholinergic drugs useful in lowering intraocular pressure.
B) Mydriatic drugs, such as phenylephrine, dilate the pupil.
C) Miotic drugs dilate the pupil for posterior chamber access after lens removal.
D) Mydriatic drugs are often referred to as cycloplegics.

Answer 2

B
Mydriatics: Phenylephrine 2.5%,and 10% (Neo-Synephrine,Mydfrin)promotes mydriasis (dilates pupil but permits focusing); cause vasoconstriction of conjunctiva and anterior vessels,used for objective examination of the retina,testing of refraction,easier removal of lens; and are used alone or with a cycloplegic.Miotics: (1)Carbachol 0.01% (Miostat)is a potent cholinergic (constricts pupil)used intracamerally during anterior segment surgery.(2)Acetylcholine chloride 1% (Miochol-E)is a cholinergic that rapidly constricts the pupil and is used intraocularly during anterior segment surgery to constrict a dilated pupil.(3)Pilocarpine hydrochloride 1% and 4% is a cholinergic (constricts pupil)used topically for lowering intraocular pressure in glaucoma.

Question 3

When preparing for pars plana vitrectomy in the posterior segment,the perioperative nurse must be aware that a combined scleral buckling procedure may be necessary.Other important information the perioperative nurse should know before preparing the OR for the procedure includes the location of the ocular problem,the surgeon's plan to address the problem,and the instrumentation and biomedical equipment and devices to be used.Technologic advances in ophthalmic surgery require that perioperative nurses be familiar with complex biomedical equipment.A best practice,stated below,relevant to the safe use of complex equipment would be to:

A) determine the presence and appropriate date (not expired) of the biomedical monitoring label.
B) confirm competence through inservice education and training specific to new equipment.
C) schedule the manufacturer's representative to be present to provide technical support.
D) schedule the biomedical clinical engineer to check all equipment before each procedure.

Answer 3

B
A wide range of equipment is used in ophthalmic surgery.The perioperative team's knowledge of proper functioning and troubleshooting should be confirmed through inservice education and training specific to new equipment.

Question 4

Review the list below,and select the option that describes an action that occurs during vitrectomy.

A) Excision of fibrotic membranes
B) Resolution of vitrous opacities
C) Replacement of the lens
D) Placement of a CO₂ bubble

Question 5

Select the true statement about dacryocystorhinostomy (DCR).

A) A DCR is performed for chronic or recurrent dacryocystitis, which is also called epiphora.
B) A Weis procedure is attempted if the DCR is unsuccessful.
C) DCR establishes a new passageway for tear drainage into the nasal cavity.
D) The passageway is usually restored with the use of ultrasonic lacrimal probes.

Question 6

A cataract is defined as any opacification of the lens.Cataracts may be congenital,posttraumatic,or induced by medications but are most commonly the result of age-related changes.Which of the following statements about cataracts best describes its presentation or etiology (cause)?

A) A cataract can be compared to a window that is foggy or yellowed.
B) Cataracts can be classified as brittle or pliable, based on collagen matrix fibers in the capsule.
C) Cataracts are an early sign of type 1 diabetes.
D) The cloudiness is caused by clumping of lipoproteins in the lens capsule.

Question 7

How does the lacrimal gland differ from the lacrimal sac?

A) The lacrimal gland produces hormones that stimulate the lacrimal sac to secrete tears.
B) The lacrimal sac stores and concentrates the tears secreted by the lacrimal gland.
C) The lacrimal gland and lacrimal sac are the same structure.
D) The lacrimal gland secretes tears that are drained by the lacrimal sac and duct system.

Question 8

Select the true statement about antimetabolite drugs and their indications for use.

A) These cytotoxic/antineoplastic drugs are also useful as thrombolytic agents.
B) Antimetabolites are carbonic anhydrase inhibitors.
C) 5-fluorouracil and mitomycin can both be administered topically to dissolve scars and pterygia.
D) Denuded corneal epithelium responds positively to topical applications of mitomycin.

Question 9

The procedure for cataract extraction with implantation of an intraocular lens (IOL)exposes the patient to risks of infection of the anterior chamber and corruption of the implanted device.Appropriate measures for the circulating nurse and scrub person include managing patient safety needs.Efforts are directed at preventing foreign substances from being introduced intraocularly.Select the nursing actions that may ensure this outcome.

A) Use instruments designed for single use only.
B) Cleanse debris from instruments with a cellulose sponge.
C) Use only latex-free gloves.
D) Soak instruments in sterile water when not being used by the surgeon.

Question 10

Cycloplegic drugs produce a similar effect on the pupil as mydriatic drugs,with one difference.From the options below,select the most appropriate statement about the effects of cycloplegics.

A) Anticholinergics constrict the pupil and inhibit focusing.
B) Epinephrine is added to balanced salt solution (BSS) to constrict sclera vessels and the pupil.
C) Homatropine hydrobromide (Isopto Homatropine) sustains the longest and most potent duration of dilation.
D) Cycloplegics and mydriatics have similar effects on dilating the pupil.

Question 11

The nurse must ensure that the microscope used in ophthalmic surgery is specifically intended for safe use in eye surgery.The perioperative nurse must also be familiar with adjusting the pupillary distance (distance between pupils of the user's eyes)and diopter settings on the oculars (eyepieces)for operator vision correction to work without eyeglasses.How should the oculars be set for a user with astigmatism?

A) Set the oculars to the same diopters as the user's corrective lenses.
B) Set the oculars to the half setting of the diopters of the user's corrective lenses.
C) Set the oculars at zero; users should wear their eyeglasses.
D) Set the oculars to 10´ magnification prior to the surgeon adjusting to the user's preference.

Question 12

Review the list below and select the correct definition for exenteration.

A) Removal of the eye contents with sclera and muscles left intact.
B) Removal of the entire orbital contents, including the periosteum.
C) Removal of the entire globe, severing muscular attachments and optic nerve.
D) Removal of the vitreous, lens, and portion of the sclera.

Question 13

Sutures used in ophthalmic surgery are very fine and range in size from 4-0 to 10-0.Handling and arming these sutures can be a challenge for the scrub person with uncorrected presbyopia.Eye sutures should be handled as little as possible to avoid:

A) weakening and fraying.
B) causing the formation of needle burrs.
C) losing sutures among the drapes or on the floor.
D) causing reaction and discomfort for the patient.

Question 14

Select the appropriate procedure performed for a patient with Fuchs' dystrophy,edema after cataract surgery,or keratoconus (abnormal steepening)of the cornea.

A) Endothelial keratoplasty
B) Photorefractive keratectomy
C) Laser epithelial keratomileusis
D) Laser-assisted in situ keratomileusis

Question 15

Review the list below and select the statement that accurately describes toxic anterior segment syndrome (TASS).

A) TASS is characterized by the introduction of bacteria into the anterior chamber during surgery.
B) Cultures of the vitreous typically show growth of gram-negative bacteria.
C) TASS is characterized by the introduction of nontoxic materials into the anterior chamber during surgery.
D) TASS typically presents within 24 hours after surgery.

Question 16

A 59-year-old woman with a significant retinal tear close to the macula emerges from anesthesia in the postanesthesia care unit (PACU)after a 4-hour pneumatic retinopexy with scleral buckling,posterior vitrectomy,and injection of a gas bubble to close and support the retinal tear.She will have to maintain a face-down head position for 7 to 10 days,followed by laser surgery or cryotherapy to seal the tear.As the patient prepares for discharge from the PACU,she informs the perioperative nurse that she has reserved a flight to Denver,Colorado in 3 weeks to visit friends and celebrate the end of her ophthalmic surgeries and survival of sustained face-down positioning during recovery.The nurse firmly informs her that she should cancel and delay her trip until the surgeon approves that type of travel.Which statement below justifies the nurse's response to the patient's vacation plans?

A) Facial edema from sustained face-down position will not have resolved within the time frame before her vacation.
B) Airplane cabin pressure and recirculated air are significant risk factors for infection after complex vitreous surgery.
C) The dry air and high elevation of Denver will dehydrate the cornea and sclera, causing the sclera to buckle and the tear to loosen.
D) Airplane cabin pressure and high elevations will cause severe enlargement of the gas bubble and increase intraocular pressure.

Question 17

A wide range of equipment is used in ophthalmic surgery.The perioperative team's knowledge of proper operation should be confirmed through inservice education and training specific to new equipment,plus demonstrated competency.To ensure patient safety and appropriate function and application of surgical devices,which statement best reflects recommended practice when using complex biomedical equipment?

A) Use the device according to the manufacturer's directions and test for proper performance before the patient enters the operating room (OR).
B) Follow the policy and procedure of the facility and/or unit, and request biomedical support.
C) Request assistance and technical support from the appropriate vendor representative, or request biomedical support.
D) Follow the explanation and demonstration as originally provided by the preceptor during orientation.

Question 18

To accommodate near and distant focus,the lens changes shape and focus by relaxation and tightening of the zonular fibers.What physiologic change of the normal aging process is typically corrected with bifocals?

A) Cataracts
B) Presbyopia
C) Glaucoma
D) Astigmatism

Question 19

The perioperative nurse prepares a separate treatment setup for the surgeon to use before the DCR operative procedure is started.Select the statement that describes the justification for this separate treatment setup.

A) The surgeon will cut and mold the nasal splint to size before the nose becomes edematous.
B) The silastic tubing needs to be cut to size and soaked during the procedure.
C) The skin markings, with methylene blue, are done on clean skin before the skin prep.
D) The nasal cavity is anesthetized with cocaine, and a local anesthetic is administered.

Question 20

The extraocular muscles work in yoked pairs,with ocular movements generated by an increase in the tone of one set of muscles and a decrease in the tone of the antagonistic muscles.Of the two muscle types,how many are represented in each eye?

A) Two recti muscles and four oblique muscles
B) Two superior muscles and one lateral muscle
C) Four recti muscles and two oblique muscles
D) Two inferior muscles and two medial muscles

Question 21

Patients presenting for ophthalmic surgery may have endured chronic progressive impairment or recent decrease in visual acuity.Most patients are admitted as outpatients.Select the appropriate nursing actions when admitting the ophthalmic surgery patient.

A) Fully orient the patient to the physical surroundings.
B) Use detailed descriptions and reinforce them.
C) Approach the patient from the unaffected side to avoid startling him or her.
D) Turn the lights down low to foster a calming environment.

Question 22

Most medications prescribed for the eye are administered in the form of eye drops.What techniques should the perioperative nurse use to minimize systemic absorption of eye drops?

A) Use a tissue to dry the inner corners of the patient's eyelid after each drop.
B) Instruct the patient to gently press on the nasolacrimal sac for 1 minute after installation.
C) Instruct the patient to avoid blinking.
D) Instruct the patient to keep the eye closed for 1 minute after installation.
E) Gently massage the patient's eyelids after installation.