Download Advanced Health Assessment Exam: Ophthalmology Questions and Answers and more Exams Nursing in PDF only on Docsity!
2025 - 2026 ADVANCED HEALTH ASSESSMENT
EXAM|ACTUAL 220 QUESTIONS AND
ANSWERS|A+GRADE
What is lipemia retinalis?ANS:->>>it is a creamy white appearance of the retinal vessels that occurs with excessively high serum triglyceride levels Pathophysiology of lipemia retinalis?ANS:->>>it occurs when the serum triglyceride level exceeds 2000 mg/dl and seen in most hyperlipidemic states Subjective data of lipemia retinalis ?ANS:->>> reports of elevated serum triglycerides and no vision symptoms Objective data of lipemia retinalis?ANS:->>>during the early stages the peripheral fundus is salmon pink in color but as the triglyceride levels rise they turn white colored. What is retinitis pigmentosa?ANS:->>>it is an autosomal recessive disorder in which the genetic defects cause cell death in the rod photoreceptors Pathophysiology of retinitis pigmentosa?ANS:->>>it is caused by a genetic defect that causes apoptosis of the photoreceptors. Associated conditions include deafness, paralysis of one or more of the extraocular
muscles, dysphagia, ataxia, intellectual delay, peripheral neuropathy, acanthotic (spiked) RBC's, absence of VLDL Subjective data of retinitis pigmentosa?ANS:->>>reports of night blindness as the earliest symptom, tunnel vision, bumping into furniture, loss of vision is painless and progressive over years to decades Objective data of retinitis pigmentosa?ANS:->>>the exam is normal in the early stages. In later stages waxy pallor, narrowing of the arterioles, and peripheral bone spicule pigmentation are seen in the mid periphery with retinal atrophy What is glaucoma?ANS:->>>it is a disease of the optic nerve where the nerve cells die, usually due to excessively high intraocular pressure Pathophysiology of glaucoma?ANS:->>>acute angle may occur acutely with dramatically elevated intraocular pressure if the iris blocks the exit of aqueous humor from the anterior chamber. Open angle is caused by decreasing aqueous humor absorption that leads to increased resistance and painless build up of pressure in the eye. This may also be congenital as a result of improper development of the eye's aqueous outflow system. Subjective data of glaucoma?ANS:->>>with chronic disease the symptoms may be asymptomatic with the exception of a gradual loss of peripheral vision over a
What are visual field defects?ANS:->>>it is defective vision or blindness Pathophysiology of visual field defects?ANS:->>>it may be a consequence of degenerative changes within the eye such as a cataract or from a lesion of the optic nerve. The most common cause is interruption of the vascular supply to the optic nerve. Bitemporal hemianopia is caused by a lesion most commonly a pituitary tumor and homonymous hemianopia can be caused by lesions of the optic nerve radiation on either side of the brain occurring after the optic chiasm. Subjective data of visual field defects?ANS:->>>reports of defective vision or blindness Objective data of visual field defects?ANS:->>>visual field defects found on exam What is a retinoblastoma?ANS:->>>it is an embryonic malignant tumor arising from the retina Pathophysiology of retinoblastoma?ANS:->>>it usually develops in the first 2 years of life and is transmitted by autosomal dominant or a chromosomal mutation and is the most common retinal tumor in children Subjective data of retinoblastoma?ANS:->>>family history of it and reports of a white reflex on photographs
Objective data of retinoblastoma?ANS:->>>the initial sign that can be seen is leukocoria, and then an ill defined mass arising from the retina on fundoscopic exam and chalky white areas of calcification can be seen What is macular degeneration?ANS:->>>it is age related and is caused when part of the retina deteriorates Pathophysiology of macular degeneration?ANS:->>>There are two types. The dry type is atrophic and occurs from the gradual breakdown of cells in the macula which results in gradual blurring of central vision. The wet (exudative) type is when new abnormal blood vessels grow under the center of the retina then leak and scar the retina which distorts or destroys central vision and may be rapid. It is the leading cause of legal blindness Subjective data of macular degeneration?ANS:->>>reports of blurred or decreased central vision, blind spots or scotomas, straight lines looking irregular or bent, objects appearing a different color or shape in each eye, or objects appearing smaller in one eye (micropsia) Objective data of macular degeneration?ANS:->>>with the dry form, Drusen bodies (multiple spots in the macular region) can be seen with thinning and loss of the retina and choroid. The wet form can cause exudates, blood, scarring, and new blood vessels membranes below the retina that can be seen
and flexible Explain boundaries Be honest What is the primary objective when developing a relationship with the patient?ANS:->>>To discover the details about a patient's concern, explore expectations, display interest, and partnership What does establishing a positive relationship with the patient depend on?ANS:->>>Communication built on courtesy, comfort, connection, and confirmation. What are effective communication strategies when obtaining a health history?ANS:->>>Using open-ended questions, direct questions, rarely leading questions. Facilitate by encouraging patient to say more. Reflect by repeating what you heard. Clarify. Empathize by showing understanding and acceptance. Confront by discussing disturbing behavior. Interpret by repeating what you heard to confirm. What are open-ended questions?ANS:->>>Those that give the patient discretion about the extent of the answer. Such as "How have you been feeling?" or "What brings you in today?" What are direct questions?ANS:->>>Those that seek specific information. Such as "How long ago did that happen?" or "Where does it hurt?"
What are leading questions?ANS:->>>Those that are prompting the patient toward the desired answer and these are the most risky. What is a patient centered question?ANS:->>>One that respects and responds to a patient's wants, needs, preferences so that they can make choices in their care that best fit their individual circumstances. Such as "How would you like to be addressed?", "What would you like us to do today?", "How are you coping with your illness?". What are potential barriers of patient and provider communication?ANS:-
When the patient is curious about you, anxiety, silence, depression, crying/compassionate moments, physical & emotional intimacy, seduction, anger, avoiding the full story, financial considerations. What is the structure and components of the patient history?ANS:->>>Patient identifiers, chief complaint, history of present illness, past medical history, family history, personal/social history, review of systems What kind of patient information is obtained in the patient identifier component of the patient history?ANS:->>>name, age, gender, race, occupation, date, time, and referral source What kind of patient information is obtained in the chief complaint component of the patient history?ANS:->>>a brief statement about why the patient is seeking care while probing for underlying concerns.
where was the patient raised education position in family marital status life satisfaction hobbies/interests source of stress habits (nutrition, sleep, drugs, etoh, ADL's, and smoking) self- care (self breast exams, exercise, home remedies) sexual history environmental (travel, exposure to diseases) religious and cultural preferences access to care What information is necessary when obtaining sexual health information?ANS:->>>number of partners, concerns, birth control, protection from STI's What kind of information is obtained for the ROS component of the patient history?ANS:->>>those that identify presence or absence of health related issues in each body system What is subjective data?ANS:->>>it is information collected during the patient interview with the patient or significant other. it is their words. It can include symptoms, sensations, feelings, perceptions, desires, preferences, beliefs, ideas, values, personal information, ROS, complete health history What is objective data?ANS:->>>it is the information that can be physically seen
by the provider and tested against. It can include the physical exam, lab analysis, x rays, and professional consults. How do you approach sensitive issues when interviewing a patient? ANS:-
Provide privacy, be direct and firm, don't ask leading questions, use open- ended questions, don't apologize for asking questions, don't preach, avoid confrontation, use understandable language, watch medical jargon, document carefully using the patient's words. What does it mean to be culturally aware?ANS:->>>It is the deliberate self- examination and in depth exploration of one's own biases, stereotypes, prejudices, assumptions that one holds about people different than them. What does it mean to be culturally competent?ANS:->>>It requires the provider to be sensitive to a patient's heritage, sexual orientation, socioeconomic situation, ethnicity, and cultural background What are examples of questions that explore the patient's culture? ANS:->>>"what do you call your problem?" "What do you think caused it?" "What does your sickness do to you?" "Why do you think it started when it did?" "What should be done to get rid of it?" "Who else or what else might help you get better?"
patient tell you as soon as they see your finger in each of those fields. What may be some causes of abnormal results from the confrontation test?ANS:->>>stroke, retinal detachment, optic neuropathy, pituitary tumor, central retinal vascular occlusion How would you perform an external examination of the eyes?ANS:-
Systematically beginning with appendages and move inward eyebrows orbits/periorbital area eyelids What is being assessed when looking at the patient's eyebrows?ANS:->>>size, extension beyond temporal canthus, texture of hair If the eyebrows do not extend beyond the temporal canthus or are course what may be the cause?ANS:->>>hypothyroidism What is being assessed when looking at the patient's orbits/periorbital area?ANS:->>>edema, puffiness, sagging tissue below orbit What can cause periorbital edema?ANS:->>>thyroid disease, allergies, or nephrotic syndrome (children) What are xanthelasma?ANS:->>>yellowish deposits on the periorbital tissue most
often on the nasal side that represents a lipid metabolism disorder What is being assessed with looking at the patient's eyelids?ANS:->>>have the patient close lids lightly to look for tremors inspect ability of eyelids to close completely and open wide check for flakiness, crusting, redness, or swelling check eyelashes to make sure that they curve away from the eye when eye is open the superior eyelid should cover a portion of the iris but not cover pupil What can be a cause of fasciculations of the eyelid when a patient lightly closes eye?ANS:->>>hyperthyroidism What is ptosis?ANS:->>>when the upper eyelid covers more than the top of the iris or pupil and indicates congenital weakness of levator muscle or paresis of a branch of CN III What is CN IIIANS:->>>oculomotor nerve How do you document a finding of ptosis?ANS:->>>by recording the difference between the two eyelids in millimeters (the average lid is 2 mm below the border of the cornea and sclera. average lower lid is at the lower limbus) What is ectropion?ANS:->>>it is when the lower eyelid turns away from the eye
If the eye is very firm or resists palpation what does this indicate?ANS:->>>it can be a sign of severe glaucoma or retrobulbar tumor How do you inspect the lower conjunctiva?ANS:->>>have the patient look up while you draw the lower eyelid down and note the translucency and vascular pattern, erythema, exudate How do you inspect the upper conjunctiva?ANS:->>>this is only done when there is a foreign object present. Evert the upper lid one a cotton swab What can cause erythema or cobblestone appearance to conjunctiva?ANS:-
allergic or infections conjunctivitis What is a subconjunctival hemorrhage?ANS:->>>it is seen as bright red blood in a sharply defined area that is surrounded by healthy conjunctiva which may occur spontaneously in pregnancy or labor What is a pterygium?ANS:->>>it is the abnormal growth of conjunctiva tissue over the cornea and more common on the nasal side. This is more common in persons exposed to UV light. How do you examine the cornea for clarity?ANS:->>>check for clarity by shining a light tangentially on it. blood vessels should not be present
What is corneal arcus?ANS:->>>it is lipid deposits in the periphery of the cornea and common after age 60. If they present in persons less than 40 it may indicate a lipid disorder How do you check corneal sensitivity (CN V)ANS:->>>by touching a cotton wisp to the cornea which should make the patient blink. This indicates an intact CN V and motor fibers of CN VII (facial nerve) What is CN IV?ANS:->>>trochlear nerve What is decreased corneal sensitivity caused by?ANS:->>> diabetes, herpes simplex, herpes zoster, after trigeminal neuralgia surgery How do you inspect the iris?ANS:->>>check it for visibility and uniform color How do you inspect the pupil?ANS:->>>note irregularities in shape of pupil, they should be round, regular, and equal in size How do you test the pupil?ANS:->>>check the pupils response to light and accomodation How do you test pupil accommodation?ANS:->>>have the patient look at a distant object and then a test object held 10 cm from bridge of nose. Expect the pupils to constrict when eyes focus on the near object
fails to react to light but does respond to convergence. due to destruction of postganglionic nerve innervation to the eye by an infection. What are normal finding when inspecting the lens?ANS:->>> it should be clear and transparent What are normal findings when inspecting the sclera?- ANSWER-it is white and visible above the iris only when eyes are wide open What are some abnormal findings when inspecting the sclera? - ANSWER-pigmentation of yellow or green. Senile hyaline plaque is a dark, slate gray anterior to insertion of medial rectus muscle How do you inspect and palpate the lacrimal apparatus? ANS:->>>inspect it by palpating the lower orbital rim near the inner canthus and the upper temporal orbit. What do you do if the temporal aspect of the upper eyelid feels full?ANS:-
then evert the superior eyelid and inspect the lacrimal gland which is normally non-palpable with no tenderness and no regurgitation of fluid from the nasolacrimal duct What can cause lacrimal gland enlargement?ANS:->>> tumors, lymphoid infiltration, sarcoid disease, sjogrens syndrome
How do you test the extraocular movements of CN II, CN IV, CN VI?ANS:-
hold the patient's chin and ask them to watch your finder as it moves through the 6 cardinal fields of gaze. Then have the patient follow your finger in a vertical plane from ceiling to floor. Movement should be smooth. What are the six cardinal fields of gaze?ANS:->>>*Lateral to the left (left eye lateral rectus, CN IV; right eye medial rectus CNIII) *Left eye looking laterally and then up (left eye uses superior rectus and right eye uses inferior oblique) *Left eye looking laterally and then down (left eye uses inferior rectus and right eye uses superior oblique *Lateral to the right (right eye lateral rectus, CN VI; left eye medial rectus CNIII *right eye looking laterally and then up (right eye uses superior rectus and left eye uses inferior oblique) *right eye looking laterally and then down (right eye uses inferior rectus and left eye uses superior oblique Abnormal findings when testing extraocular movements?- ANSWER-if lid lag occurs or sclera is seen above the iris it may indicate thyroid disease How to test balance of extraocular muscles?ANS:->>>by using the corneal light reflex. direct the light at nasal bridge from 30 cm and ask patient to look at a nearby object. Look for convergence of eyes. if abnormal then do the cover uncover test
