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Jarvis Ch. 14 Eyes Exam Questions And 100%
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An ophthalmic exam reveals papilledema. The nurse identifies this condition as characteristic of: 1.retinal detachment. 2.diabetic retinopathy. 3.acute-angle glaucoma. 4.increased intracranial pressure. - ANSWER ANS: 4 The choked disk, or papilledema, results from increased intracranial pressure caused by a space-occupying mass such as a brain tumor or hematoma. This pressure causes venous stasis in the globe, redness and congestion and elevation of the optic disc, blurred margins, hemorrhages, and absent venous pulsations.
During an ophthalmscopic examination of the eye, the examiner notices areas of exudate that appear as "cotton wool" or fluffy gray-white cumulus clouds. This would indicate which of the following possible problem? 1.Diabetes 2.Hyperthyroidism 3.Glaucoma 4.Hypotension - ANSWER ANS: 1 Soft exudates or "cotton wool" areas appear as fluffy gray-white cumulus clouds, They occur with diabetes, hypertension, subacute bacterial endocarditis, lupus, and papilledema of any cause.
A student is playing a game in physical education class and is struck in the eye by the end of a baseball bat. The nurse assesses the patient in the emergency department and blood is present in the anterior chamber of the eye. This would indicate the presence of: 1.hypopyon.
2.hyphema. 3.corneal abrasion. 4.iris. ANSWER ANS: 2 Hyphema is blood in the anterior chamber; a serious result of blunt trauma-a fist or a baseball-or spontaneous hemorrhage and may signal scleral rupture or major intraocular trauma.
A client is seen in the clinic and states she was diagnosed with glaucoma, open-angle 2 years ago. The nurse recalls that glaucoma may present in a variety of forms to include open-angle glaucoma and closed-angle glaucoma. Which statements are correct regarding open-angle glaucoma? Choose all those that apply. 1.The patient may complain of photophobia, nausea, and seeing halos around lights. 2.It is the most common form of glaucoma. 3.Treatment must be initiated immediately. 4.The loss of vision begins in the periphery. 5.It leads to sudden attacks of increased tension, which blur the vision. 6.It has practically no symptoms-ANSWER ANS: 2, 4, 6 The most common form of glaucoma is open-angle glaucoma; there are practically no symptoms. The loss of vision begins in the periphery, to which one frequently adapts unconsciously by turning the head. The other characteristics are those of closed-angle glaucoma.
When examining the eye, the nurse recalls that the bulbar conjunctiva: 1.overlies the sclera. 2.covers the iris and pupil. 3.is visible at the inner canthus of the eye. 4.is a thin mucous membrane that lines the lids. - ANSWER ANS: 1 The bulbar conjunctiva overlies the eyeball with the white sclera showing through.
During ocular exams, the nurse recalls that mobility of the extraocular muscles is:
3.contraction of the ciliary body in response to the aqueous within the eye. 4.amount of aqueous produced and resistance to its outflow at the angle of the anterior chamber. - ANSWER ANS: 4 Intraocular pressure is maintained by a balance between aqueous production and the resistance to aqueous outflow at the anterior chamber angle.
The nurse is performing a physical exam that includes a visual examination. The nurse understands the statement below regarding visual pathways and visual fields to be correct.
The right hemisphere interprets vision for the right eye.
The image formed on the retina is upside down and reversed from its appearance in the outside world.
Light rays are refracted through the transparent media of the eye before striking the pupil.
The light impulses are conducted across the optic nerve to the temporal lobes of the brain. - ANSWER ANS: 2 The image formed on the retina is inverted and reversed from its true appearance in the external environment.
The nurse is examining a patient's visual accommodation, that is best defined as:
Pupillary constriction while viewing a near object
Pupillary dilation while viewing a distant object
Peripheral changes in the visual field in response to light
Involuntary blinking when bright light is present. ANSWER ANS: 1 Contraction of the muscle fibers of the iris mediates pupillary constriction in bright light and accommodation for near vision.
The nurse recognizes that a patient's normal pupillary light reflex indicates which of the following?
The eyes converge to focus on the light
Light is reflected at the same spot in both eyes
The eye focuses the image in the center of the pupil
both pupils constrict in response to bright light. - ANSWER ANS: 4 Pupillary light reflex The normal constriction of the pupils when bright light shines on the retina.
A mother asks when her newborn infant's eyesight will be developed. The nurse should reply:
"Vision is not totally developed until 2 years of age."
"Infants develop the ability to focus on an object at around 8 months."
"By about 3 months, infants develop more coordinated eye movements and can fixate on an object."
"Most infants have uncoordinated eye movements for the first year of life." - ANSWER
A 52-year-old client states sometimes he notices "floaters or spots" that dance before his eyes. The nurse should:
count the number of floaters present when viewing the retina.
believe the client has glaucoma and refer him for further testing.
consider this an abnormal finding and refer him to an ophthalmologist.
know that "floaters" are usually not significant and are caused by condensed vitreous fibers. - ANSWER ANS: 4 Floaters are a common sensation with myopia or after middle age owing to condensed vitreous fibers. Usually, they are not significant.
The nurse is going to check the visual acuity of a 16-year-old client. How would the nurse proceed?
Confrontation test
Have the patient read the print on a hand-held Jaeger card.
Position the Snellen chart 20 feet from the patient.
Estimate that the patient can read newsprint at arm's length. -ANSWER ANS: 3 The Snellen alphabet chart is the most valid, reliable measurement for acuity.
A Snellen eye chart measures a patient's vision at 20/30. The nurse recognizes that this measurement indicates that:
The patient can see only the top letter of the chart from a distance of 30 feet.
The patient can only read at 20 feet what the average person can see at 30 feet.
The patient has vision of 20/30 in the left eye and 20/30 in the right eye.
the patient can read from 30 feet what a person with normal vision can read from 20 feet. - ANSWER ANS: 2 The top number reflects the distance that the person is standing from the chart; the denominator provides the distance that the normal eye can see.
A patient is unable to read the 20/100 line on the Snellen chart. The nurse would:
Refer client to an ophthalmologist or optometrist for further examination.
Ask the client whether he or she is able to count the nurse's fingers when they are held in front of the client's eyes.
Ask the client to put on his or her glasses and try to read the Snellen chart again.
move the chart closer to the patient and ask him or her to read the smallest line of print possible. - ANSWER ANS: 1 If acuity is less than 20/30, refer the patient to an ophthalmologist or optometrist.
A patient's vision is 20/80 in both eyes. The nurse understands that this reading demonstrates that the patient:
has poor vision.
A slight amount of lid lag when moving the eyes from a superior to inferior position - ANSWER ANS: 2 A normal response for the diagnostic positions test is parallel tracking of the object with both eyes.
When examining the sclera of a black patient, which of the following would you expect to find?
Yellow fatty deposits over the cornea
Pallor near the outer canthus of the lower lid
Sclera yellow color extending up to the iris
There are small brown macules on the sclera - ANSWER ANS: 4 In dark-skinned people, one normally may see small brown macules in the scle
A 60-year-old male patient presents to the clinic for an ocular examination. The nurse suspects he has a ptosis of one eye. How would the nurse check for this?
Confrontation test is done.
Check client's near vision.
Observe the distance between the palpebral fissures.
Perform the corneal light test and observe symmetry of the light reflex. - ANSWER ANS: 3 Ptosis is drooping of the upper eyelid that would be apparent by observing the distance
between the upper and lower eyelids.
During an eye examination, which normal finding would the nurse expect when examining the lacrimal apparatus?
The presence of tears along the inner canthus
A blocked nasolacrimal duct in a newborn infant
A slight swelling over the upper lid and along the bony orbit if the individual has a cold
The absence of drainage from the puncta when pressing against the inner orbital rim - ANSWER ANS: 4 There should be no swelling, redness, or drainage from the puncta.
Assessing the Pupillary Light Reflex The nurse should do which of the following?
Shine a penlight from directly in front of the patient and observe for constriction of the pupils.
Ask the patient to follow the penlight in eight directions and observe for constriction of both pupils.
Shine a light across the pupil from the side and observe for direct and consensual constriction of the pupils.
Ask the patient to focus on a distant object. Then ask the patient to follow the penlight to about 7 cm from the nose. - ANSWER ANS: 3 To check the pupillary light reflex, bring a light in from the side and observe the direct and consensual constriction of the pupils.
The optic disc is yellow-orange in color
The margins of the optic disc are hazy around the edges
There are pigmented crescents in the macular area
The macula is located on the nasal side of the retina - ANSWER ANS: 1 The optic disc is located on the nasal side of the retina. The color is creamy yellow-orange to pink.
A 2-week-old infant can fixate on an object but not follow a light or bright toy. The nurse would:
Consider this a normal finding.
Examine the pupillary light reflex to rule out blindness.
Proceed with the examination and assess the visual fields.
would expect that a 2-week-old infant should be able to fixate and follow an object. ANSWER ANS: 1 By 2 to 4 weeks an infant can fixate on an object. By 1 month, the infant should fixate and follow a bright light or toy.
To assess color vision on a male child, the nurse would:
test color vision annually until the age of 18 years.
ask the child to identify the colour of his or her clothing.
do a color vision test only once between the ages of 4 to 8.
initiate color vision testing at the child's 2-year visit. - ANSWER ANS: 3 Test only boys for color vision once between the ages of 4 and 8 years.
The nurse is performing an eye-screening clinic at the day care center. When assessing a 2-year-old client, the nurse suspects that the child has "lazy eye" and would:
examine the external structures of the eye.
evaluate the child's visual acuity using the Snellen eye chart.
evaluate the child's visual fields using the confrontation test.
evaluate the child for strabismus using the corneal light reflex test. - ANSWER ANS: 4 Testing for strabismus is done by performing the corneal light reflex test. The light should be reflected at exactly the same spot in both eyes.
The nurse is performing an eye assessment on an 80-year-old patient. Which of the following findings is considered abnormal?
A decrease in tear production
Unequal pupillary constriction in response to light
The presence of arcus senilis seen around the cornea
The presence of shadows within the anterior chamber can be indicative of acute angle- closure glaucoma.
In a patient who has anisocoria, the nurse would expect to see:
dilated pupils
excessive tearing.
pupils of unequal size.
an irregular curvature of the lens. - ANSWER ANS: 3 Anisocoria refers to a condition of unequal pupil size. While anisocoria may be a normal finding in 5% of the population, it may also indicate central nervous system disease.
The patient appears in the emergency department after a boxing match with his left eye swollen almost shut. Bruises are evident to his face and neck. The patient relates he is worried because he "can't see well" from his left eye. The physician is suspicious of an injury to his retina. The nurse recognizes that symptoms of retinal detachment include
Loss of central vision.
Shadow or decreased vision in one quadrant or one half visual field.
loss of peripheral vision.
sudden loss of pupillary constriction and accommodation. - ANSWER ANS: 2 With retinal detachment, the person has shadow or diminished vision in one quadrant or one half visual field.
A patient comes to the clinic complaining of pain in her right eye. On examination, the nurse notices a pustule at the lid margin that is tender to touch, red, and edematous. The nurse identifies that this is
a chalazion.
a hordeolum (stye).
dacryocystitis.
blepharitis. - ANSWER ANS: 3 A hordeolum, or stye, is a painful, red, and swollen pustule at the lid margin.
A 68-year-old female patient is in the eye clinic for a check-up. She states to the nurse that she cannot read the paper, sew, and even watch the face of her grand children. On examination, the nurse identifies that the patient has lost some central vision but her peripheral vision is normal. The following can be identified from the findings:
She might have a macular degeneration.
Her vision is normal for someone of her age.
she has the beginning stages of cataract formation.
she has increased intraocular pressure or glaucoma. - ANSWER ANS: 1 Macular degeneration is the most common cause of blindness. It is characterized by loss of central vision.
