Chap 13 Eye assessment
A client comes into the emergency department because of "spots" floating in the line of vision. What should the nurse respond to the client about this symptom? "This is a normal change in the eye associated with aging." "A cataract is forming and cannot be treated until it ripens." "You have a detached retina and need to lie down immediately." "This means you have glaucoma and need to have your eye pressure checked."
"This is a normal change in the eye associated with aging." Reference: Jensen, S, Nursing Health Assessment, 3rd ed., Philadelphia, Wolters Kluwer, 2019, Chapter 13: Eye Assessment for Advanced and Specialty Practice, pp. 321-322-339.
You are assessing visual fields on a client newly admitted for eye surgery. The client's left eye repeatedly does not see your fingers until they have crossed the line of gaze. You would document that the client has what? A left temporal hemianopsia A homonymous hemianopsia A bitemporal hemianopsia A quadrantic defect
A left temporal hemianopsia Explanation: When the client's left eye repeatedly does not see your fingers until they have crossed the line of gaze, a left temporal hemianopsia is present.
What would the nurse expect to assess when examining the eyes of a client who reports a history of severe allergies? Generalized redness Pinguecula Areas of dryness Nodular appearance
Areas of dryness Explanation: Severe allergies are characterized by areas of dryness in the eyes, often due to medications used to counter the effects of the allergies. Generalized redness suggests conjunctivitis. Pinguecula are yellowish nodules on the bulbar conjunctiva commonly found in older adults.
A nurse assesses a client's pupils for the reaction to light and observes that the pupils are of unequal size. What should the nurse do next in relation to this finding? Report this to the health care provider Ask the client about previous trauma to the eyes Document this finding in the client's record Continue with the examination
Ask the client about previous trauma to the eyes Explanation: Unequal pupil size is termed anisocoria. Often it is a normal finding but it can indicate trauma to the parasympathetic nerve supply to the iris. The nurse should ask the client about previous trauma to the eye to determine whether this is a new finding or new onset. All other options the nurse can do after this is determined.
The thin mucous membrane that lines the inner eyelid and covers the sclera is known as what? Conjunctiva Limbus Lacrimal apparatus Eyelid
Conjunctiva Explanation: The conjunctiva is a thin mucous membrane that lines the inner eyelid (palpebral conjunctivae) and also covers the sclera (bulbar conjunctivae). The border between the cornea and the sclera is the limbus. The lacrimal apparatus protects and lubricates the cornea and the conjunctiva by producing and draining tears. The eyelid is a loose fold of skin that covers and protects the eye.
A nurse shines a light into one of the client's eyes during an ocular exam and the pupil of the other eye constricts. The nurse interprets this as which of the following? Direct reflex Optic chiasm Consensual response Accommodation
Consensual response Explanation: When a light is shone in one eye, that eye will constrict and the opposite (consensual) eye will also constrict. Shining a light in one eye with the resulting constriction of that eye demonstrates the direct reflex. The optic chiasm is the point where the optic nerves from each eyeball cross. Accommodation occurs when the client moves the focus of vision from a distant point to a near object, causing the pupils to constrict.
A client asks a nurse if any foods promote eye health. What food would the nurse include as a response? Deep-water fish Low-fat meat Foods that contain lots of water Multigrain foods
Deep-water fish Explanation: Foods that promote eye health include deep-water fish, fruits, and vegetables (e.g., carrots, spinach).
Why is it important to ask the client regarding discharge or drainage from the eyes? Discharge is associated with inflammation or infection Discharge is associated with glaucoma Discharge is associated with presbyopia Discharge is associated with a detached retina
Discharge is associated with inflammation or infection Explanation: Discharge is associated with inflammation or infection. Glaucoma is a disease of the optic nerve that involves loss of retinal ganglion cells. With aging, the ability of the lens to accommodate decreases. Near vision is subsequently impaired, and thus older adults need reading glasses. This is presbyopia. Discharge is not an indication of a detached retina.
esotropia oscillating
Esotropia is a form of strabismus (eye misalignment) characterized by an inwards turn of one or both eyes [See figure 1]. It may be intermittent or constant and may occur with near fixation, distance fixation, or both. The crossing may occur mostly with one eye or may alternate between eyes. esotropia is swing back and forth at a regular speed.
What is a characteristic symptom of Graves hyperthyroidism? Pterygium Exophthalmos Pinguecula Episcleritis
Exophthalmos Explanation: In exophthalmos the eyeball protrudes forward. When bilateral, it suggests the infiltrative ophthalmopathy of Graves hyperthyroidism.
When testing for consensual pupillary constriction, which technique would be most appropriate? Hold a pencil about 12 inches from the tip of the nose Use an ophthalmoscope to inspect the inner eye Shine a light directly into one eye of the client Place a barrier between the client's eyes
Place a barrier between the client's eyes Explanation: When testing for consensual response, the nurse should place a hand or another barrier to light between the client's eyes to avoid an inaccurate finding. Holding a pencil 12 inches from the tip of the nose is appropriate when testing for accommodation. The nurse should shine a light obliquely onto the eye when testing direct papillary response.
The nurse observes a middle-aged colleague fully extending her arm to read the label on a vial of medication. Which of the following age-related changes is the nurse likely to have observed? Presbyopia Cataract formation Loss of convergence Macular degeneration
Presbyopia Explanation: Presbyopia denotes an age-related deficit in close vision. It is less likely that cataracts, macular degeneration, or loss of convergence underlie the colleague's visual changes.
What is vital in maintaining vision and a healthy outlook for clients? Health education Monthly eye exams Emotional support Physical exercise
Health education Explanation: Nursing education is vital in maintaining vision and a healthy outlook for clients.
When performing a client's ophthalmoscopic exam, the nurse observes a round shape with distinct margins. How would the nurse document this finding? Physiologic cup Optic disc Retinal vessels Fovea
Optic disc Explanation: The optic disc is round to oval with sharp, well-defined borders. The physiologic cup appears on the optic disc as slightly depressed and a lighter color than the disc. Arteriole retinal vessels appear bright red, and venules appear darker red and larger, with both progressively narrowing as they move away from the optic disc. The fovea is a small area of the retina that provides acute vision.
What is the primary purpose of the health history in relation to the eyes? To identify a family history of ocular disease To identify if problems are unilateral or bilateral To test the acuity of central vision To identify changes
To identify changes Explanation: The purpose of the health history is to identify changes in the eyes.
An adult client tells the nurse that his eyes are painful because he left his contact lenses in too long the day before yesterday. The nurse should instruct the client that prolonged wearing of contact lenses can lead to retinal damage. cataracts. myopia. corneal damage.
corneal damage. Explanation: Improper cleaning or prolonged wearing of contact lenses can lead to infection and corneal damage.
The nurse has tested the near visual acuity of a 45-year-old client. The nurse explains to the client that the client has impaired near vision and discusses a possible reason for the condition. The nurse determines that the client has understood the instructions when the client says that presbyopia is usually due to congenital cataracts. decreased accommodation. muscle weakness. constant misalignment of the eyes.
decreased accommodation. Explanation: Presbyopia (impaired near vision) is indicated when the client moves the chart away from the eyes to focus on the print. It is caused by decreased accommodation.
While assessing the eye of an adult client, the nurse observes an inward turning of the client's left eye. The nurse should document the client's esotropia. strabismus. phoria. exotropia.
esotropia. Explanation: Esotropia is an inward turn of the eye. Esotropia is a form of strabismus (eye misalignment) characterized by an inwards turn of one or both eyes [See figure 1]. It may be intermittent or constant and may occur with near fixation, distance fixation, or both. The crossing may occur mostly with one eye or may alternate between eyes.
The optic nerves from each eyeball cross at the optic chiasma. vitreous humor. optic disc. visual cortex.
optic chiasma. Explanation: At the point where the optic nerves from each eyeball cross—the optic chiasma—the nerve fibers from the nasal quadrant of each retina (from both temporal visual fields) cross over to the opposite side.
Photoreceptors of the eye are located in the eye's ciliary body. lens. retina. pupil.
retina. Explanation: The innermost layer, the retina, extends only to the ciliary body anteriorly. It receives visual stimuli and sends it to the brain. The retina consists of numerous layers of nerve cells, including the cells commonly called rods and cones. These specialized nerve cells are often referred to as "photoreceptors" because they are responsive to light
A nurse in the emergency department assesses a client's pupillary reaction and observes pinpoint pupils. The nurse interprets this finding as suggesting which of the following? Recent eye trauma Narcotic use Macular degeneration Recent peripheral nervous system injury
Narcotic use Explanation: Pinpoint pupils suggest narcotic use or brain damage. Hyphema would suggest recent eye trauma. Dilated and fixed pupils typically result from central nervous system injury, circulatory collapse, or deep anesthesia.
When testing the near reaction, an expected finding includes which of the following? Pupillary dilation on near gaze; dilation on distant gaze Pupillary dilation on near gaze; constriction on distant gaze Pupillary constriction on near gaze; dilation on distant gaze Pupillary constriction on near gaze; constriction on distant gaze
Pupillary constriction on near gaze; dilation on distant gaze Explanation: During accommodation, pupils constrict with near gaze and dilate with far gaze.
While assessing the eye of an adult client, the nurse observes an inward turning of the client's left eye. The nurse should document the client's esotropia. strabismus. phoria. exotropia.
esotropia. Explanation: Esotropia is an inward turn of the eye.
The nurse tests the distant visual acuity of several clients and records the findings. Which finding indicates that the client with the poorest vision? 20/30 20/40 20/50 20/60
20/60 Explanation: The higher the second number, the poorer the client's vision is. The top number is always 20, indicating the distance from the client to the chart.
A 52-year-old client with myopia calls the ophthalmology clinic very upset. She tells the nurse, "I keep seeing semi-clear spots floating across my vision. What is wrong with me?" What would be the most appropriate response by the nurse? "It is not an uncommon finding in people older than 40 years for this to happen. They are called 'floaters'." "Please come into the clinic right away so we can see what is wrong." "Because it is almost 5 o'clock, please go to the emergency department right away. This sounds very serious." "I have an opening tomorrow at 2 in the afternoon. Can you come in then?"
"It is not an uncommon finding in people older than 40 years for this to happen. They are called 'floaters'." Explanation: Floaters (translucent specks that drift across the visual field) are common in people older than 40 years of age and nearsighted clients; no additional follow-up is needed. Jensen, S, Nursing Health Assessment, 3rd ed., Philadelphia, Wolters Kluwer, 2019, Chapter 13: Eye Assessment for Advanced and Specialty Practice, p. 321.
The nurse is preparing to assess a client's visual fields to evaluate her gross peripheral vision. Which test would the nurse perform? Cover test Corneal light reflex test Confrontation test Eye position test
Confrontation test Explanation: The confrontation test evaluates peripheral vision. The cover test, corneal light reflex test, and eye position test would be used to evaluate extraocular muscle function.
A nurse examines a client's retina during the ophthalmic examination and notices light-colored spots on the retinal background. The nurse should ask the client about a history of what disease process? Anemia Renal insufficiency Diabetes Retinal detachment
Diabetes Explanation: Exudates appear as light-colored spots on the retinal background and occur in individuals with diabetes or hypertension. Anemia, renal insufficiency, and retinal detachment do not cause this appearance on the retina.
The nurse selects the chart shown here (Snellen E chart) to assess a client's vision. Which client characteristic caused the nurse to select this chart? Does not speak English Being treated for glaucoma Has blue-green color blindness Recovering from cataract surgery
Does not speak English Explanation: The Snellen E chart can be used for clients who do not speak English. This chart is not used for clients being treated for glaucoma, color blindness, or recovering from cataract surgery.
When performing the cover test, a nurse notices that the client's left eye turns outward. How should the nurse document this finding in the client's record? Exotropia Esotropia Strabismus Presbyopia
Exotropia Explanation: With the cover test, the eyes of the client should remain fixed straight ahead. If the covered eye moves when uncovered to reestablish focus, it is abnormal. If the eye turns outward it is called exotropia. If the uncovered eye turns inward, it is called esotropia. Strabismus is constant malalignment of the eyes. Presbyopia is impaired near vision.
Which of the following would a nurse expect to assess in a client with esotropia? Eye turning outward Eye malalignment Eye turning inward Eye oscillating
Eye turning inward Explanation: Esotropia is a term used to describe eyes that turn inward. Exotropia refers to an outward turning of the eyes. Strabismus refers to a constant malalignment of the eyes. Nystagmus refers to oscillating or shaking movement of the eye
The nurse is preparing to test a client's eyes for accommodation. The nurse would have the client focus on an object in which sequence for this test? Far, then near Lateral, then near Near, then far Lateral, then far
Far, then near Explanation: When testing accommodation, the nurse would ask the client to focus on a distant object such as a finger or pencil and to remain focused on that object as the nurse moves it closer to the eyes.
A nurse assesses the parallel alignment of a client's eyes by testing the corneal light reflex. Where should the nurse shine the penlight to obtain an accurate result? Focused on the bridge of the nose Directly on the eye being examined Pointed at a fixed object on the wall Shined on the forehead
Focused on the bridge of the nose Explanation: When testing the corneal light reflex, the nurse should shine the light toward the bridge of the nose. At the same time, the client is instructed to stare straight ahead. This facilitates a parallel image on the cornea. The eye response upon shining the light toward the eye may interfere with the assessment. The light should not be shined toward the forehead or on an object on the wall.
A nurse is presenting a class to a local community group about vision and eye health. As part of the presentation, the nurse explains how visual perception occurs. What would the nurse include in the explanation? It refers to a client's subjective appraisal of his or her vision. It begins with light rays striking the retina. It primarily involves the lens of the eye. It allows the eyes to focus on near objects.
It begins with light rays striking the retina. Explanation: Visual perception occurs as light rays strike the retina, where they are transformed into nerve impulses, conducted to the brain through the optic nerve, and interpreted. The lens does not contribute directly to visual perception. Accommodation is the process that allows the eyes to focus on near objects.
During adolescence, what vision change is common? Nearsightedness Color blindness Amblyopia Presbyopia
Nearsightedness Explanation: Vision changes, such as nearsightedness, are common in adolescents. Amblyopia is also known as "lazy eye". This is more common in young children. Presbyopia is the decreased ability for one to focus on near objects and is more common in the adult as they age. Color blindness is a genetic condition and not impacted by the age of the client.
On a health history, a client reports no visual disturbances, last eye exam two years ago, and does not wear glasses. The nurse notices that the client squints when signing the consent for treatment form and holds the paper close to the face. What should the nurse do next? Document the findings in the client's record Perform both the distant and near visual acuity tests Test the pupils for direct and consensual reaction to light Obtain a referral to the ophthalmologist for a complete eye exam
Perform both the distant and near visual acuity tests Explanation: The first thing the nurse should do is perform both the distant and near visual acuity exams to assess for loss of far and near vision. Testing the pupil is important to assess reaction to light. The findings must be documented in the client's record. If abnormalities are found upon assessment, the client should be referred for a complete eye examination.
A client presents to the health care clinic and reports pain in the eyes when working on the computer for long periods of time. Client states he almost ran into a parked car yesterday because he misjudged the distance from the bumper of his own car. He works for a computer software company and has noticed he is experiencing difficulty reading the manuals that accompany the software he installs for companies. What nursing diagnosis can the nurse confirm based on this data? Ineffective Individual Coping Disturbed Self-Concept Self-Care Deficit Risk for Injury
Risk for Injury Explanation: The only nursing diagnosis that can be confirmed with this data is Risk for Injury. The client is aware of the dangers of driving due to changes in his vision. There is not enough data to support the other diagnosis. Reference: Jensen, S, Nursing Health Assessment, 3rd ed., Philadelphia, Wolters Kluwer, 2019, Chapter 13: Eye Assessment for Advanced and Specialty Practice, p. 337.
An adult client tells the nurse that her peripheral vision is not what it used to be and she has a blind spot in her left eye. The nurse should refer the client for evaluation of possible glaucoma. increased intracranial pressure. bacterial infection. migraine headaches.
glaucoma. Explanation: A scotoma is a blind spot that is surrounded by either normal or slightly diminished peripheral vision. It may be from glaucoma. Glaucoma is a group of eye conditions that damage the optic nerve, the health of which is vital for good vision. This damage is often caused by an abnormally high pressure in your eye. Glaucoma is one of the leading causes of blindness for people over the age of 60
A client has conjunctivitis. The nurses understand that conjunctivitis differs from conjunctival hemorrhage in that conjunctivitis has a watery, mucoid discharge. usually follows trauma. is not painful. can result from a cough.
has a watery, mucoid discharge. Reference: Jensen, S, Nursing Health Assessment, 3rd ed., Philadelphia, Wolters Kluwer, 2019, Chapter 13: Eye Assessment for Advanced and Specialty Practice, p. 330
A client notices that the newspaper print is not as clear to read as it used to be. What health problem should the nurse consider is occurring with this client? myopia hyperopia amblyopia strabismus
hyperopia Explanation: A change in seeing things close to the eyes is considered hyperopia or farsightedness. Myopia is difficulty with seeing distances or nearsightedness. Amblyopia is considered a lazy eye where one eye is working harder than the other. Strabismus is constant misalignment of the eyes.
An older client asks why vision is not as sharp as it used to be when the eyes are focused forward. What should the nurse realize this client is describing? cataracts glaucoma detached retina macular degeneration
macular degeneration Explanation: Macular degeneration causes a loss of central vision. Risk factors for macular degeneration are age, smoking history, obesity, family history, and female gender. Cataracts are characterized by cloudiness of the eye lenses. Glaucoma is an increase in intraocular pressure that places pressure on eye structures and affecting vision. A detached retina is the sudden loss of vision in one eye. This health problem may be precipitated by the appearance of blind spots.
When using the ophthalmoscope, which of the following would the nurse do? Use the small round beam of white light Use the right eye to examine the client's left eye Move the ophthalmoscope around to get the best view Approach the client at a 15-degree angle to the client's side
Approach the client at a 15-degree angle to the client's side Explanation: The nurse should begin about 10 to 15 inches from the client at a 15-degree angle to the client's side, and select the aperture with the large round beam of white light. The small round beam is used if the client has smaller pupils. The nurse should not use his or her right eye to examine the client's left eye, or his or her left eye to examine the client's right eye. The nurse should not move the ophthalmoscope around.
A factory worker has presented to the occupational health nurse with a small wood splinter in his left eye. The nurse has assessed the affected eye and irrigated with warm tap water, but the splinter remains in place. What should the nurse do next? Attempt to remove the splinter using sterile forceps. Irrigate the eye with dilute hydrogen peroxide. Arrange for worker to be promptly assessed by an eye specialist. Encourage the worker to see an optometrist as soon as possible.
Arrange for worker to be promptly assessed by an eye specialist. Explanation: The nurse should refer the client to an eye doctor immediately if a foreign body cannot be removed with gentle washing. Optometrists are specialists in primary vision care and do not normally treat eye trauma. Irrigation with hydrogen peroxide or attempted removal using instruments would be contraindicated and potentially dangerous.
A client reports, "There is something in my left eye that is causing me considerable discomfort." What initial step should the nurse take when everting the client's upper eyelid in order to search for the foreign body? Place a tongue blade at least 1 cm above the right lid margin. Raise the upper eyelid slightly to cause the eyelashes to protrude. Grasp the upper eyelashes, and gently pull down and forward. Ask the client to look down toward the left cheek.
Ask the client to look down toward the left cheek. Explanation: Adequate examination of the eye in search of a foreign body requires eversion of the upper eyelid. The nurse should follow these steps: Instruct the client to look down; get the client to relax the eyes (by reassurance and by gentle, assured, and deliberate movements); raise the upper eyelid slightly so that the eyelashes protrude, and then grasp the upper eyelashes and pull them gently down and forward; place a small stick such as an applicator or a tongue blade at least 1 cm above the lid margin (and therefore at the upper border of the tarsal plate); push down on the stick as you raise the edge of the lid, thus everting the eyelid or turning it "inside out." Do not press on the eyeball itself.
Which technique by the nurse demonstrates proper use of the ophthalmoscope? Uses right eye to examine the client's left eye Moves the scope around so the entire optic disk may be seen Approaches the client directly in front of the pupil Asks the client to fix the gaze upon an object and look straight ahead
Asks the client to fix the gaze upon an object and look straight ahead Explanation: After turning on the ophthalmoscope, the nurse should ask the client to gaze straight ahead and slightly upward. Ask the client to remove glasses but keep contact lens in place. The nurse should use the right eye to examine the right eye & left eye to examine the client's left eye. This allows the nurse to get as close as possible to the client's eye. Begin about 10-15 inches from the client at a 15 degree angle. The nurse should keep the ophthalmoscope still & ask the client to look into the light to view the fovea and macula.
A client tells the clinic nurse that she has sought care because she has been experiencing excessive tearing of her eyes. Which assessment should the nurse next perform? Inspect the palpebral conjunctiva. Assess the nasolacrimal sac. Perform the eye positions test. Test pupillary reaction to light.
Assess the nasolacrimal sac. Explanation: Excessive tearing is caused by exposure to irritants or obstruction of the lacrimal apparatus. Therefore the nurse should assess the nasolacrimal sac. Inspecting the palpebral conjunctiva would be done if the client complains of pain or a feeling of something in the eye. The client is not exhibiting signs of problems with muscle strength, such as drooping, so performing the eye position test, which assesses eye muscle strength and cranial nerve function, is not necessary. Testing the pupillary reaction to light evaluates pupillary response and function of the oculomotor nerve.
A client performs the test for distant visual acuity and scores 20/50. How should the nurse most accurately interpret this finding? Client did not wear his glasses for this test and therefore it is not accurate. When 50 feet from the chart, the client can see better than a person standing at 20 feet. Client can read the 20/50 line correctly and two other letters on the line above. At 20 feet from the chart, the client sees what a person with good vision can see at 50 feet.
At 20 feet from the chart, the client sees what a person with good vision can see at 50 feet. Explanation: The Snellen chart tests distant visual acuity by seeing how far the client can read the letters standing 20 feet from the chart. The top number is how far the client is from the chart and the bottom number refers to the last line the client can read. A reading of 20/50 means the client sees at 20 feet what a person with normal vision can see at 50 feet. The minus number is the number of letters missed on the last line the client can distinguish.
A nurse is collecting subjective data during a client's eye and vision assessment. When asking the question, "Do you wear sunglasses during exposure to the sun?" the nurse is addressing a known risk factor for what health problem? Presbyopia Cataracts Nystagmus Glaucoma
Cataracts Explanation: Sun exposure is a risk factor for cataracts but is not noted to influence the development of presbyopia, nystagmus, or glaucoma. Glaucoma is a group of eye conditions that damage the optic nerve, the health of which is vital for good vision. This damage is often caused by an abnormally high pressure in your eye. Glaucoma is one of the leading causes of blindness for people over the age of 60 Nystagmus is a vision condition in which the eyes make repetitive, uncontrolled movements. These movements often result in reduced vision and depth perception and can affect balance and coordination. These involuntary eye movements can occur from side to side, up and down, or in a circular pattern.
While the nurse examines a client's pupillary response to light in the right eye, the pupil in the left eye is constricted. What does this finding suggest to the nurse? Myopia Presbyopia Direct reaction Consensual reaction
Consensual reaction Explanation: The consensual reaction is when the pupil constricts in the opposite eye. Myopia is impaired far vision. Presbyopia is impaired near vision often seen in middle-aged and older clients. The direct reaction is when the pupil constricts in the same eye.
A nurse is inspecting a client's eyelids and eyelashes. Which of the findings would the nurse document as abnormal? Raised yellow plaques near inner canthus Upright lower eyelid Drooping of the upper lid White sclera absent above iris
Drooping of the upper lid Explanation: Drooping of the upper lid is ptosis and may be attributed to oculomotor nerve damage, myasthenia gravis, weakened muscle or tissue, or a congenital disorder. It is an abnormal finding. Raised yellow plaques near the inner canthus are a normal variation associated with increasing age and high lipid levels. An upright lower eyelid and white sclera that is not visible above or below the iris are normal findings.
A nurse begins the eye examination on a client who presents to the health care clinic for a routine examination. What is the correct action by the nurse to perform the test for near visual acuity? Have the client hold the Jaeger card 14 inches from the face and read with one eye at a time Sit the client in front of the examiner, extend one arm, and slowly move one finger upward Tell the client to remove glasses, if present, and read the Snellen card using both eyes Place the client 20 feet from the Snellen chart and record the smallest line the client can read
Have the client hold the Jaeger card 14 inches from the face and read with one eye at a time Explanation: Near vision is tested with a Jaeger card, Snellen card, or comparable card), held 14 inches from the face. Have the client cover one eye with an opaque card before reading from top to bottom. Sitting the client in front of the examiner, extending one arm, and slowly move one finger upward until it is seen by both the client and the examiner is a test for gross peripheral vision. If the client wears glasses, they should be left on for the test. Placing the client 20 feet from the chart and record the smallest line the client can read is the test for distant acuity.
What is vital in maintaining vision and a healthy outlook for clients? Health education Monthly eye exams Emotional support Physical exercise
Health education Explanation: Nursing education is vital in maintaining vision and a healthy outlook for clients. Reference: Jensen, S, Nursing Health Assessment, 3rd ed., Philadelphia, Wolters Kluwer, 2019, Chapter 13: Eye Assessment for Advanced and Specialty Practice, p. 337.
A client is diagnosed with an obstruction of the canal of Schlemm affecting the left eye. What assessment data concerning the left noted in the client's medical record supports this diagnosis? Increased intraocular pressure Sluggish pupillary reaction Displaced optic nerve Opaque lens
Increased intraocular pressure Explanation: Aqueous humor is produced by the ciliary body, circulates from the posterior chamber through the pupil into the anterior chamber, and drains out through the canal of Schlemm. This system controls the pressure within the eye. If there is an obstruction of the canal of Schlemm, aqueous humor will not drain, increasing pressure within the eye. An obstruction of the canal of Schlemm will not displace the optic nerve because the optic nerve is located within the posterior portion of the eye. An opaque lens is a cataract, which is not caused by an obstruction of the canal of Schlemm. Pupil reaction is a neurological function not affected by intraocular pressure.
Cataracts vs Glaucoma vs Macular degeneration
Most cataracts develop slowly over the course of years. The main symptom is blurry vision. Having cataracts can be like looking through a cloudy window. When a cataract interferes with someone's usual activities, the cloudy lens can be replaced with a clear, artificial lens. This is generally a safe, outpatient procedure. A group of eye conditions that can cause blindness. With all types of glaucoma, the nerve connecting the eye to the brain is damaged, usually due to high eye pressure. The most common type of glaucoma (open-angle glaucoma) often has no symptoms other than slow vision loss An eye disease that causes vision loss. Macular degeneration causes loss in the center of the field of vision. In dry macular degeneration, the center of the retina deteriorates. With wet macular degeneration, leaky blood vessels grow under the retina. Blurred vision is a key symptom.
A 67-year-old lawyer comes to the clinic for an annual examination. He denies any history of eye trauma or recent visual changes. Inspection of his eyes reveals a triangular thickening of the bulbar conjunctiva across the outer surface of the cornea. He has a normal pupillary reaction to light and accommodation. Based on this description, what is the most likely diagnosis? Corneal arcus Cataracts Corneal scar Pterygium
Pterygium Explanation: A pterygium is a triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea, usually from the nasal side. Reddening may occur, and it may interfere with vision as it encroaches on the pupil. Otherwise treatment is unnecessary.
As part of a physical assessment, the nurse performs the confrontation test to assess the client's peripheral vision. Which test result should a nurse recognize as indicating normal peripheral vision for a client using the confrontation test? Client's consensual pupil constricts in response to indirect light. Eyes converge on an object as it is moved towards the nose. Direct light shown into the client's pupils results in constriction. The client and the examiner see the examiner's finger at the same time.
The client and the examiner see the examiner's finger at the same time. Explanation: The observation that the client and examiner see the examiner's finger at the same time indicates normal peripheral vision. The client not seeing the examiner's finger or a delay in seeing it indicates reduced peripheral vision. Client's consensual pupils constricting in response to indirect light as well as direct light shown into the client's pupils resulting in constriction are observed when testing the pupils for reaction to light. Eyes converging on an object as it is moved towards the nose is a normal result for accommodation.
A nurse performs the Snellen test on a client and obtains these results: OD 20/40, OS 20/30. What conclusion can the nurse make in regards to the client's vision based on these results? Vision is worse in the left eye than the right eye. The larger the bottom number, the worse the visual acuity. Client is legally blind in the left eye. Glasses are needed by the client for near vision.
The larger the bottom number, the worse the visual acuity. Explanation: OD = right eye, OS (sai trái) = left eye. Therefore, the client has worse vision in the right eye because the larger the number on the bottom, the worse the visual acuity. A client is considered legally blind when the vision in the better eye with corrective lens is 20/200 or less. Snellen test is to test for distant vision (far) not near vision.
A client has an abnormal consensual pupillary reaction to light. A nurse understands that what reaction occurs in the client's eyes? Pupils dilate in response to a light shone in the eyes. Eyes do not converge to focus on a shining light. There is no reaction in the opposite pupil to light. Light reflection appears at different spots on both ey
There is no reaction in the opposite pupil to light. Explanation: When a light is shone into the eyes, both the pupil that receives direct light and the consensual (opposite) pupil should constrict. An abnormal response to this test is if either or both pupils do not constrict in response to light. Pupils do not dilate in response to light shone into them. Convergence of the eyes is called accommodation and occurs when focus of vision is moved from a far object to a close object. Light reflection appearing at different spots on both eyes is an abnormal result of the corneal light reflex test, not of the consensual pupillary reaction to light test.
A client complains of feeling like he is slowly losing his central vision. The nurse knows this symptom could represent macular degeneration open-angle glaucoma hemianopsia retinal detachment
macular degeneration Explanation: Macular degeneration causes deterioration in the center of the retina, which leads to a gradual loss of central vision. Macular degeneration causes loss in the center of the field of vision. In dry macular degeneration, the center of the retina deteriorates. With wet macular degeneration, leaky blood vessels grow under the retina. Blurred vision is a key symptom. A special combination of vitamins and minerals (AREDS formula) may reduce disease progression. Surgery may also be an option
A client complains of feeling like he is slowly losing his central vision. The nurse knows this symptom could represent macular degeneration open-angle glaucoma hemianopsia retinal detachment
macular degeneration Explanation: Macular degeneration causes deterioration in the center of the retina, which leads to a gradual loss of central vision.
A nurse is completing a comprehensive health history of a 69-year-old woman who is a new client of the clinic. Which of the nurse's interview questions most directly addresses the client's risk for developing cataracts?
"Have you ever been tested for diabetes?" Explanation: Diabetes is a significant risk factor for cataracts, especially those with an early onset. Exercise, use of pain medications, and visual acuity are not closely correlated with the development of cataracts.