FNP Eye and Vision Practice Questions

When a caregiver for a patient with severe Alzheimer's disease is profoundly exhausted and frequently tearful, the priority is providing structured respite. Adult day care services offer safe patient supervision while giving the caregiver a necessary break. Option A is financially unrealistic for most families and not the standard initial recommendation. Option B ignores the root cause of caregiver burden, which requires practical support first. Option D is impractical without first establishing alternative care arrangements for the patient.

The patient's presentation of sudden metamorphopsia and hemorrhage strongly suggests wet macular degeneration, which is a vision-threatening emergency. You should arrange an urgent ophthalmology referral because timely anti-VEGF therapy can preserve vision. Option B is incorrect because while the Amsler grid monitors progression, it delays necessary immediate treatment for acute changes. Option C is wrong since antioxidant vitamins are indicated to slow dry macular degeneration, not to treat acute wet disease. Option D is inappropriate because a routine four-week follow-up would likely result in irreversible central vision loss due to the rapid progression of neovascularization.

Using a sitter or family member provides necessary supervision and reorientation without the negative effects of physical or chemical restraints. Option B and D act as physical restraints, which increase agitation and the risk of severe injury if the patient attempts to climb over them. Option C uses an anticholinergic medication, which is highly likely to worsen delirium and increase fall risk in older adults.

Older adults wearing multifocal lenses, such as progressive bifocals, have a significantly higher risk of tripping on stairs and curbs because these lenses impair depth perception and lower-field contrast sensitivity. Advising the patient to switch to single-vision distance glasses when navigating outdoors directly mitigates this specific environmental risk. Referring immediately for bilateral cataract extraction surgery is an overreaction to a single tripping incident, as cataract surgery requires comprehensive ophthalmologic evaluation and scheduling. Recommending a quad cane for outdoor ambulation is overly restrictive and inappropriate for a patient who does not have a documented gait or balance deficit requiring an assistive device. Prescribing a daily lubricating eye drop therapy is a treatment for dry eyes and will not improve the visual spatial deficits caused by multifocal lenses.

Migraine with typical aura features visual symptoms like scintillating scotomas that gradually expand over several minutes before the headache phase begins. Transient ischemic attacks typically present with sudden, negative visual symptoms like vision loss rather than gradual, positive visual phenomena. Retinal migraines cause strictly monocular visual disturbances, not binocular scotomas. Occipital seizures cause very brief visual flashes lasting only seconds, rather than expanding over 20 minutes.

The most appropriate referral is occupational therapy because they excel at environmental hazard mitigation, such as removing throw rugs and optimizing home lighting for patients with visual impairments. While optometry is important, macular degeneration is progressive and cannot always be immediately corrected with lenses, making environmental adaptation crucial. Physical therapy is highly effective for lower extremity strengthening and Parkinson's gait training, but it does not directly alter the physical hazards in the home environment. A home health aide provides supervision and assistance but lacks the specialized training to formally evaluate and modify the home for long-term safety.

GLP-1 receptor agonists are an excellent choice for weight management, but they carry an absolute contraindication for patients with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2. Because of this risk, option B is the best choice; you should select an alternative weight loss medication. Options A, C, and D are incorrect because initiating any GLP-1 or GIP/GLP-1 agonist, even at a low dose or with close monitoring and ultrasound imaging, violates this strict safety contraindication and places the patient at unnecessary risk.

A chronic follicular conjunctivitis with preauricular adenopathy in a sexually active adult strongly suggests chlamydial inclusion conjunctivitis. Because this is a systemic infection presenting with ocular symptoms, it requires systemic treatment with oral azithromycin or doxycycline. Topical antibiotics like erythromycin or gatifloxacin will not eradicate the underlying chlamydial reservoir and are insufficient. Oral acyclovir is indicated for herpetic viral infections, which typically present with vesicular lesions or dendritic ulcers, not purulent follicular conjunctivitis.

Infants between 6 and 23 months of age with bilateral acute otitis media require immediate antibiotic therapy regardless of symptom severity, making watchful waiting inappropriate. Because this infant has not had amoxicillin in the past 30 days and lacks concurrent purulent conjunctivitis, high-dose amoxicillin at 80 to 90 mg/kg/day is the guideline-directed first-line therapy. Standard-dose amoxicillin is insufficient to overcome potential intermediate-resistant Streptococcus pneumoniae. Amoxicillin-clavulanate is unnecessarily broad for a first-line approach and is reserved for patients who have received amoxicillin recently or have a history of recurrent infections unresponsive to amoxicillin.

Migraine without aura is characterized by unilateral throbbing pain that is worsened by routine physical activity and is often accompanied by nausea or photophobia. Tension headaches are bilateral, non-throbbing, and are not worsened by routine physical activity. Secondary headaches usually present with red flags, such as an abnormal neurologic exam or sudden onset. Cluster headaches feature severe orbital pain with prominent autonomic signs, lacking prominent nausea as a primary symptom.