# Situation: A 72-year-old man with type 2 diabetes mellitus and hypertension is scheduled for phacoemulsification with intraocular lens implantation in the right eye under topical anesthesia. Over the past 2 years he has noticed gradually blurred vision and glare when driving at night. Before discharge, which statement by the client shows that he understands his home care?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630342  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 72-year-old man with type 2 diabetes mellitus and hypertension is scheduled for phacoemulsification with intraocular lens implantation in the right eye under topical anesthesia. Over the past 2 years he has noticed gradually blurred vision and glare when driving at night.

Before discharge, which statement by the client shows that he understands his home care?

## 보기

1. "I will avoid rubbing my eye and stop the drops once it looks white."
2. "I will wear the shield at night and sleep on my operated side."
3. "I will wear the shield at night and use all my drops as prescribed." **✔ 정답**
4. "I will use my drops on schedule and bend over to wash my hair."

**정답: 3**

## 해설

After cataract surgery the client wears the eye shield at night, avoids rubbing or pressing on the eye, does not sleep on the operated side, avoids bending with the head below the waist and straining early on, and completes the prescribed drops on schedule.

## 심화 해설

Core answer

The correct statement is 3: “I will wear the shield at night and use all my drops as prescribed.” This response shows understanding of two essential home-care behaviors after cataract surgery: protecting the operated eye during sleep and completing the full prescribed eyedrop regimen.

Why this is the correct understanding

After phacoemulsification with intraocular lens implantation, the corneal incision and anterior chamber are still healing. The eye shield is worn at night to prevent accidental rubbing, pressure from pillows, or trauma during sleep. Completing the prescribed topical drops—typically an antibiotic, a corticosteroid, and sometimes an NSAID—is critical because stopping drops early can allow infection, inflammation, or cystoid macular edema to develop even when the eye “looks fine.” The appearance of the eye does not indicate that healing is complete, so the full drop schedule must be followed.

Why the other options are incorrect

| Option | Correct behavior | Error in the statement |
| --- | --- | --- |
| 1 | Continue drops as prescribed; do not stop based on appearance | “Stop the drops once it looks white” is unsafe because inflammation or infection can persist without visible redness |
| 2 | Sleep on the non-operated side or on the back | Sleeping on the operated side increases pressure on the healing eye and raises the risk of wound distortion or shield displacement |
| 4 | Avoid bending with the head below the waist, especially in the early postoperative period | Bending over to wash hair raises intraocular pressure and can stress the fresh incision |

Clinical reasoning for the licensure exam

Cataract surgery discharge teaching focuses on preventing wound dehiscence, endophthalmitis, and elevated intraocular pressure. The eye shield is a mechanical barrier; the drops are the pharmacological barrier. A patient who says they will wear the shield at night and use all drops as prescribed has demonstrated the two highest-priority self-care behaviors. In contrast, any statement that includes stopping drops early, sleeping on the operated side, or bending over reflects a misunderstanding that requires further teaching before discharge.

Supporting evidence from the literature

Early research on home care after cataract extraction found that patients reported difficulty with instilling eyedrops, applying the eye shield, and managing medications at home [1]. This highlights why a correct verbal statement about using drops and wearing the shield is clinically meaningful—these are exactly the tasks patients struggle with. More recent work on mobile health support after cataract, glaucoma, and corneal surgery also identifies postoperative self-care as a critical determinant of outcomes, reinforcing that discharge teaching must verify the patient can perform and commit to these behaviors [2].

The emphasis on discharge teaching quality is further supported by a study in diabetic retinopathy surgery patients, which found that better discharge teaching was associated with greater readiness for hospital discharge through social support and psychological resilience . Although that study involved retinal surgery rather than cataract surgery alone, the principle applies: a patient who can accurately state the key home-care instructions is more prepared to manage recovery safely. The patient in this scenario has diabetes and hypertension, which increases the importance of strict adherence to the anti-inflammatory drop regimen because diabetes can impair corneal wound healing and increase the risk of postoperative inflammation.

Watch out! A common exam trap is the phrase “once it looks white” or “when the redness is gone.” Key point! The eye can appear quiet while inflammation is still active at the cellular level, so drops are stopped only when the surgeon tapers them, not when the patient decides the eye looks healed.References (research sources)

- [1]Difficulties patients have at home after cataract surgery.Research articleSmith SJ, Drance SM (1984)

- [2]Mobile health and postoperative self-care following glaucoma, cataract, or corneal transplant surgeries.Research articleMoghaddasi H, Rabiei R, Valizadeh Laktarashi H. (2025) · DOI: 10.1186/s12886-025-04513-x

## 임상 시나리오

Post-Cataract Surgery Home CareProtecting the Eye and Completing Drops
Wear the eye shield at night to prevent accidental rubbing, pillow pressure, or trauma during sleep. Sleep on the non-operated side or on the back.

Use all prescribed eyedrops on schedule until completed. Typical regimens include an antibiotic, a corticosteroid, and sometimes an NSAID.

Avoid rubbing or pressing on the operated eye, and avoid bending with the head below the waist or straining during the early healing period.

CautionA white-looking eye does not mean healing is complete. Stopping drops early can allow infection, inflammation, or cystoid macular edema to develop even without visible redness.

## 핵심 개념

- **phacoemulsification** — A modern cataract surgery technique using ultrasound energy to break up and remove the cloudy lens.
- **intraocular lens** — An artificial lens implanted in the eye to replace the natural lens removed during cataract surgery.
- **topical anesthesia** — Local anesthetic applied as drops or gel to numb the eye surface for surgery without injection.
- **eye shield** — A protective cover worn over the operated eye, especially at night, to prevent accidental rubbing or trauma.
- **cystoid macular edema** — Retinal swelling that can occur after eye surgery, often prevented by completing prescribed anti-inflammatory drops.

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