# A nurse is providing discharge teaching to a 72-year-old client diagnosed with age-related macular degeneration (AMD). Which safety instruction is most important for the nurse to emphasize?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541581  
> language: ko  
> subject: Adult Health

## 문제

A nurse is providing discharge teaching to a 72-year-old client diagnosed with age-related macular degeneration (AMD). Which safety instruction is most important for the nurse to emphasize?

## 보기

1. Avoid reading in dim lighting conditions
2. Use magnifying glasses for all close-up activities
3. Schedule regular ophthalmologic examinations every 6 months
4. Remove throw rugs and ensure adequate lighting throughout the home **✔ 정답**

**정답: 4**

## 해설

Safety modifications like removing throw rugs and ensuring adequate lighting are critical to prevent falls in clients with macular degeneration, as central vision loss increases fall risk. Other options are important but not the highest safety priority.

## 심화 해설

Understanding the Priority: Safety in AMD

Age-related macular degeneration (AMD) leads to a progressive loss of central vision, which severely impacts a client's ability to navigate their environment safely. While all the listed options are relevant to managing the condition, the NCLEX-RN prioritization framework requires you to first address the intervention that prevents the most immediate and significant physical harm. For a client with a visual impairment, the greatest risk in a home setting is injury from falls. Research underscores this, showing that 70% of individuals with visual impairments experience falls annually, with navigation and spatial awareness being major challenges [1].

Analyzing the Options Through a Safety Lens

The core of this question is distinguishing between interventions that support visual function and the one that directly mitigates a high-risk safety hazard.

-   Option 1 (Avoid reading in dim lighting): This is a comfort and visual efficiency strategy. While it reduces eye strain, it does not address the primary environmental dangers that cause traumatic injury. It is a helpful recommendation but not the highest safety priority.

-   Option 2 (Use magnifying glasses): This is a compensatory strategy for impaired near vision, aiding with activities like reading or medication administration. It is an important tool for independence but does not protect the client from environmental hazards when they are mobile.

-   Option 3 (Schedule regular examinations): This focuses on disease monitoring and medical management, which is crucial for long-term care but does not provide immediate protection against a fall that could happen today. The question asks for the most important *safety instruction* at discharge, shifting the focus from disease treatment to immediate environmental risk reduction.

-   Option 4 (Remove throw rugs and ensure adequate lighting): This is the correct answer because it directly modifies the home environment to prevent falls. Throw rugs are a notorious tripping hazard, and for someone with impaired depth perception and contrast sensitivity from AMD, they become exceptionally dangerous. Adequate lighting maximizes the use of remaining peripheral vision, improving spatial awareness and obstacle detection. This intervention aligns directly with the principles of barrier-free design, which aims to create predictable, safe spaces that compensate for sensory loss and reduce cognitive load during navigation [1].

Connecting to Pathophysiology and Clinical Practice

AMD damages the macula, the central part of the retina responsible for sharp, detailed vision. This pathophysiology explains why a client struggles to see fine details, recognize faces, or read. More critically for safety, the loss of central vision destroys depth perception and the ability to see small, low-contrast objects on the floor—like the edge of a throw rug or a cord. A client will not see these hazards to avoid them. The instruction to remove throw rugs and improve lighting is a direct clinical application of this pathophysiological understanding. It is a primary prevention strategy that modifies the client's environment to match their functional ability, a cornerstone of rehabilitation nursing. While anti-VEGF therapies like ranibizumab, aflibercept, and faricimab are central to treating the neovascular form of AMD, their efficacy in improving visual acuity and retinal anatomy does not instantly restore functional vision or eliminate the immediate risk of falling in a home that has not been assessed for safety . The nurse’s discharge teaching must therefore prioritize environmental modification as the most immediate and impactful safety measure.References (research sources)

- [1]Designing accessible and independent living spaces for visually impaired individuals: a barrier-free approach to interior design.Research articlePatil A, Raghani S. (2025) · DOI: 10.1186/s12939-025-02503-5

## 임상 시나리오

Home Safety for Low VisionFall prevention strategies for clients with AMD
The primary safety risk with central vision loss is falls. Over 70% of visually impaired individuals fall annually. The first step in discharge planning is environmental modification.

Instruct the client to remove throw rugs, secure loose cords, and ensure adequate lighting in hallways and stairwells. Use contrasting colors on step edges to improve depth perception.

CautionDo not prioritize visual aids like magnifiers over immediate physical safety. A home safety evaluation by occupational therapy should be ordered to identify hazards the client may not perceive.

## 핵심 개념

- **Age-related Macular Degeneration (AMD)** — A progressive eye condition that damages the macula, leading to loss of central vision, which is crucial for reading, driving, and recognizing faces.
- **Central Vision Loss** — The inability to see objects directly in front of you, severely impacting depth perception and the ability to navigate obstacles, increasing fall risk.
- **Fall Risk** — The increased susceptibility to falling, often due to environmental hazards combined with intrinsic factors like visual impairment, leading to significant injury.
- **Safety Priority** — In nursing prioritization, the intervention that mitigates the most immediate threat to physical well-being, such as preventing traumatic injury, is addressed first.
- **Environmental Modification** — Altering the home setting by removing hazards like throw rugs and improving lighting to create a safer space for individuals with mobility or sensory deficits.

## 같은 주제 문제

- [A nurse is assessing a 72-year-old client with suspected age-related macular degeneration …](https://mymerci.kr/pages/nclex_q.php?qn_id=541578)
- [A nurse is assessing a 72-year-old client with suspected age-related macular degeneration …](https://mymerci.kr/pages/nclex_q.php?qn_id=541579)
- [A nurse is providing education to a 68-year-old client newly diagnosed with age-related ma…](https://mymerci.kr/pages/nclex_q.php?qn_id=541580)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._