Chapter 46, Assessment of the Eye and Vision

The nurse is preparing a patient for a fluorescein angiography. What does the nurse instruct the patient about this procedure? -'The stain is eliminated through sweat.' -'The skin may appear yellow for an hour after the test.' -'Mydriatic eyedrops are instilled 30 minutes before the test.' -'A digital camera photographs retinal and choroidal blood vessels.'

-'A digital camera photographs retinal and choroidal blood vessels.'

A patient has a left eye infection. What does the nurse teach to prevent the spread of infection to the right eye? -'Wash the left eye first followed by the right eye.' -'Avoid touching the eyedrop bottle to any part of the eye.' -'Apply an eyedrop first to the left eye, then to the right eye.' -'Clean the tip of the eyedrop bottle before sharing it with others.'

-'Avoid touching the eyedrop bottle to any part of the eye.'

The nurse is caring for a patient scheduled for a fluorescein angiography. What does the nurse remind the patient about this test after it is over? -'Drink plenty of fluids.' -'Urine will be bright red for 24 hours.' -'Skin will be stained yellow-green for 24 hours.' -'Avoid going out until skin color is back to normal.'

-'Drink plenty of fluids.'

The nurse is teaching a patient who is scheduled for an ultrasonography of the eye. Which statement by the patient indicates a need for further instruction? -'I will be awake during this test.' -'I won't hear the high-frequency sound waves.' -'I'll have to wear a bandage over my eye after the test.' -'This test will help determine whether my retina is detached.'

-'I'll have to wear a bandage over my eye after the test.'

The nurse is teaching a group of adults about the importance of washing hands before touching the eye. Which statement made by a patient indicates a correct understanding of why eye infections can occur? -'The surface of the eye is sterile.' -'The surface of the eye is very delicate.' -'Immunities in the blood do not reach the cornea.' -'The sclera and cornea have a separate blood supply.'

-'Immunities in the blood do not reach the cornea.'

The nurse is teaching a patient about visual changes that occur with age. Which statement does the nurse include? -'Most visual changes occur before age 40.' -'It may take your eyes longer to adjust in a darkened room.' -'You probably will have to move reading materials closer to your eyes.' -'When the sclera starts to turn yellow, this means you might have problems with your liver.'

-'It may take your eyes longer to adjust in a darkened room.'

An older adult patient expresses concern about the ability to instill over-the-counter eyedrops, saying, 'My vision is getting so bad, I can't even see my own eyes.' What is the nurse's best response? -'Getting old isn't fun, is it?' -'Don't worry about the eyedrops.' -'Can your daughter help you do it?' -'Let's find a way that will work for you.'

-'Let's find a way that will work for you.'

What does the nurse teach an older adult patient who is diagnosed with presbyopia? -'Increase the humidity in your home.' -'Use saline eyedrops on a regular schedule.' -'Use more light to distinguish between colors.' -'Place reading material farther away from your eyes.'

-'Place reading material farther away from your eyes.'

What does the nurse teach an older adult patient who reports an inability to maintain an upward gaze? -'Use saline eyedrops.' -'Wear corrective lenses.' -'Refocus your gaze frequently.' -'Ensure that you have good lighting.'

-'Refocus your gaze frequently.'

When performing an eye or vision assessment, which comment by the patient alerts the nurse that immediate care by an ophthalmologist is needed? -'My eyes are red and itchy.' -'One eye is green and the other eye is blue.' -'My vision has been getting worse gradually.' -'Something hit my eye while I was cutting grass.'

-'Something hit my eye while I was cutting grass.'

A patient with trauma to the cornea due to a contact lens is prescribed a corneal staining test. What does the nurse inform the patient about this test? Select all that apply. -'The eye is viewed through a blue filter.' -'It magnifies the anterior structures of the eye.' -'A topical dye is placed into the conjunctival sac.' -'It locates abnormalities in the anterior vitreous humor.' -'Non-intact areas of the eye will stain a bright green color.'

-'The eye is viewed through a blue filter.' -'A topical dye is placed into the conjunctival sac.' -'Non-intact areas of the eye will stain a bright green color.'

A patient has been prescribed eyeglasses with biconcave lenses to correct the patient's vision. What does the nurse tell the patient about the need for this correction? -'The vision beyond 20 feet is normal, but near vision is poor.' -'The eye is unable to refract enough light and the images fall behind the retina.' -'The eye overbends the light and the images converge in front of the retina.' -'There is a refractive error caused by unevenly curved surfaces on the cornea.'

-'The eye overbends the light and the images converge in front of the retina.'

The nurse is caring for a patient who will undergo a fluorescein angiography to get a detailed image of retinal circulation. What does the nurse tell the patient about this test? -'The patient will have to sign an informed consent form.' -'The patient will receive 10 mL of a 5% solution of fluorescein by IV.' -'Mydriatic eyedrops will be instilled in the eye half an hour before the test.' -'Retinal and choroidal blood vessels are photographed after the dye passes through them.'

-'The patient will have to sign an informed consent form.'

The nurse educator is teaching a group of nursing students about normal changes that occur with the eyes and vision with aging. Which student statement indicates the need for further education? -'The sclera becomes yellow with age.' '-A reduction in tear production increases the risk of corneal damage.' -'The lens in the eye hardens, compacts, and forms a cataract on aging.' -'The eyes become sunken; however, this should not be used to assess hydration status.'

-'The sclera becomes yellow with age.'

The nurse provides preprocedure teaching to a patient who is scheduled for an electroretinography. The patient asks the nurse why this test is necessary. Which response by the nurse is appropriate? -'This test will detect whether you are experiencing optic nerve changes.' -'This test will detect whether you are experiencing blood vessel changes.' -'This test is used to differentiate open-angle from closed-angle glaucoma.' -'This test will determine whether you are experiencing a disturbance in your peripheral vision.'

-'This test will detect whether you are experiencing blood vessel changes.'

The nurse is teaching an older adult patient about the prevention of cataracts. What instructions does the nurse include? Select all that apply. -'Avoid rubbing your eyes.' -'Use sunglasses whenever you go outdoors.' -'Wash your hands before touching your eyes.' -'Be sure to wear eye and head protection gear.' -'Use ultraviolet (UV) protection in tanning salons.'

-'Use sunglasses whenever you go outdoors.' -'Be sure to wear eye and head protection gear.' -'Use ultraviolet (UV) protection in tanning salons.'

A patient has been prescribed eye drops to be used for both eyes, although the patient has infection only in one eye. What does the nurse tell the patient's caregiver about the appropriate method of using eye drops? -'Stand in front of the patient and tilt the patient's head back.' -'Hold the upper eyelid to prevent the eyedrops from falling out.' -'Use two separate bottles labeled 'left' and ''right' for each eye.' -'Have the patient squeeze the eye after the eyedrops are instilled.'

-'Use two separate bottles labeled 'left' and ''right' for each eye.'

The nurse is providing care to a school-age patient with myopia. The patient's family asks the nurse what the patient's diagnosis means. How should the nurse respond? -'Your child is color blind.' -'Your child has perfect vision.' -'Your child is nearsighted and will require glasses.' -'Your child is farsighted and will require glasses for reading.'

-'Your child is nearsighted and will require glasses.'

What actions should the nurse take for a patient who is undergoing radioisotope scanning? Select all that apply. -Instill anesthetic drops in the lower eyelid. -Administer a tracer dose of radioactive isotope. -Ask the patient to first sign the informed consent form. -Ask the patient to breathe normally during the procedure. -Ask the patient to sit upright with the chin in the chin rest.

-Administer a tracer dose of radioactive isotope. -Ask the patient to first sign the informed consent form. -Ask the patient to breathe normally during the procedure.

What action does the nurse take to assess the blink reflex of a patient? -Shines a penlight into the eye -Decreases the light in the room -Moves a finger toward the patient's nose -Brings a fist quickly toward the patient's face

-Brings a fist quickly toward the patient's face

Which finding does the nurse consider abnormal while assessing a patient's pupils? -Pupils are round in shape. -Difference in size of the pupils. -Diameter of each pupil is 3.5 mm. -Pupils constrict with increased light.

-Difference in size of the pupils.

The nurse is assessing the blink reflex of a patient. What actions does the nurse take? Select all that apply. -Shines a penlight into the eye -Moves a finger toward the nose slowly -Observes how the pupils respond to light -Expels a syringe full of air toward the eyes -Brings a fist quickly toward the patient's face

-Expels a syringe full of air toward the eyes -Brings a fist quickly toward the patient's face

A patient has a history of hypertension and diabetes. What does the nurse include in this patient's teaching plan regarding eye examinations? -Check for refractive errors every year. -Follow up yearly with an ophthalmologist. -Use eye and head protection gear outdoors. -Have an eye examination every 3 to 5 years.

-Follow up yearly with an ophthalmologist.

The nurse is preparing a patient for an ultrasound examination of the eye. The patient was prescribed anesthetic eye drops before the test. Which action should the nurse take when administering the eye drops? -Have the patient stand up. -Ask the patient to tilt the head forward. -Clean the tip of the eye drop bottle with a cotton swab. -Gently press and hold the corner of the eye nearest the nose.

-Gently press and hold the corner of the eye nearest the nose.

Which explanation best describes emmetropia? -Near vision is poor. -Distance vision is poor. -Inverted images fall on the retina. -Images converge behind the retina.

-Inverted images fall on the retina.

The nurse is assessing an older patient who is worried about the formation of an opaque bluish-white ring within the outer edge of the cornea. What does the nurse tell the patient about this development? Select all that apply. -It affects night visibility. -It does not affect vision. -It is caused by fat deposits. -It is an age-related disorder. -It leads to dry-eye symptoms.

-It does not affect vision. -It is caused by fat deposits. -It is an age-related disorder.

What is the main cause of cataract formation? -Collapse of the eyeball -Loss of transparency of the lens -Necrosis and death of photoreceptors -Compression of nerve fibers in the eye

-Loss of transparency of the lens

The nurse examines the vision of an older adult patient with ectropion. What is the nurse's probable assessment? -Protrusion of the eye -Sunken appearance of the eye -Eyelashes point away and outward from the eye -Lower eyelid relaxes and falls away from the eye

-Lower eyelid relaxes and falls away from the eye

Which proper technique does the nurse use for eyedrop instillation? -Touching the bottle tip to the eyeball -Instilling the drops into the inner canthus -Placing the eyedrop in the lower lid pocket -Opening the eye by raising the upper eyelid

-Placing the eyedrop in the lower lid pocket

The nurse is evaluating the pupils of a patient for reaction speed. What does the nurse document if the response is sluggish? -Pupil does not constrict. -Pupil constricts immediately. -Pupil constricts within 1 second. -Pupil constricts after 1.5 seconds.

-Pupil constricts after 1.5 seconds.

A patient says, 'I have problems reading the signs when I am driving.' Which test does the nurse use to assess this patient's problem? -Ishihara chart -Snellen chart -Confrontation test -Rosenbaum Pocket Vision Screener or a Jaeger card

-Snellen chart

The nurse performing an ophthalmoscopy for a patient notes an absent red reflex. What does this indicate? -The cornea is thicker than normal. -The surface of the cornea is uneven. -The lens is opaque or the vitreous is cloudy. -There are fat deposits within the outer edge of the cornea.

-The lens is opaque or the vitreous is cloudy.

During the eye assessment of an African-American patient, what does the nurse document as an abnormal finding? -Upper eyelid covers a small portion of the iris. -The sclera appears yellow with pigmented dots. -The cornea is transparent, smooth, shiny, and bright. -The lower eyelid is relaxed and falls away from the eye.

-The lower eyelid is relaxed and falls away from the eye.

What visual physiological change can happen as a result of uncontrolled hypertension? -The lens loses its transparency. -The eye does not refract enough light. -The patient is at risk for loss of vision. -The lens loses its ability to transmit light.

-The patient is at risk for loss of vision.

Which statements best explain the functions of the cones in the eye? Select all that apply. -They provide color vision. -They work at low light levels. -They provide peripheral vision. -They are sensory photoreceptors. -They transmit impulses to the optic nerve.

-They provide color vision. -They are sensory photoreceptors. -They transmit impulses to the optic nerve.

A patient is scheduled for an electroretinography. What is the purpose of this assessment? -To screen the peripheral visual field -To assess thickness and contours of the optic nerve -To detect blood vessel changes from drugs or disease -To assess retina changes due to high intraocular pressure (IOP)

-To detect blood vessel changes from drugs or disease

Which statement regarding tonometry is correct? -The tonometer applies pressure to the inside of the eye. -Tonometry measures intraocular pressure using a tonometer. -A person with a thicker cornea will have low tonometer reading. -Readings are more accurate in the morning because intraocular pressure (IOP) is lower.

-Tonometry measures intraocular pressure using a tonometer.

The nurse is assisting a patient scheduled for a gonioscopy test. What does this test determine? -Presence of infection -Trauma to the cornea -Type of glaucoma present -Presence of refractive errors

-Type of glaucoma present

Which assessment finding warrants further investigation by the nurse in the ophthalmology clinic? -When assessing the cornea, the nurse notes cloudiness and the patient reports pain when the ophthalmoscope light shines into the pupil. -Snellen eye examination result is 20/50 for a patient who normally wears corrective lenses, but does not have them at the time of the examination. -When six cardinal positions of gaze of the left eye are assessed, the patient exhibits nystagmus when looking to the left lower and upper fields. -The pupil exhibits miosis when exposed to light from the ophthalmoscope during examination and mydriasis when the light is removed from the pupil.

-When assessing the cornea, the nurse notes cloudiness and the patient reports pain when the ophthalmoscope light shines into the pupil.

Which extraocular muscle, when contracted alone, turns the eye toward the side of the head? 1 2 3 4

3 Rational: Label 3 indicates the lateral rectus musclelateral rectus muscle, which, when contracted alone, turns the eye toward the side of the head. Label 1 indicates the superior rectus muscle, which moves the eye diagonally upward toward the middle of the head when contracted along with the medial rectus muscles. Label 2 indicates the superior oblique muscle, which, when contracted alone, pulls the eye downward. Label 4 indicates the inferior rectus muscles, which, when contracted together with the lateral rectus muscle, move the eye diagonally downward toward the side of the head.

What eye function allows a patient to focus sharply on near and distant images? Miosis Mydriasis Convergence Accommodation

Accommodation

The nurse observes unevenly curved surfaces of the cornea during the eye exam of an older patient. How does the nurse report this finding? Myopia Hyperopia Astigmatism Emmetropia

Astigmatism

The nurse is conducting an eye assessment. The nurse brings a fist quickly towards the patient's face and then asks the patient to look straight ahead while beaming a penlight directly at the right eye. What is the nurse assessing? Select all that apply. Blink reflex Signs of ptosis Pupillary reaction Signs of anisocoria Symmetry in the appearance of the eyes

Blink reflex Pupillary reaction

The nurse is conducting vision assessments for patients at a senior citizen center. What visual changes does the nurse assess for in older patients? Select all that apply. Pruritus Cataracts Glaucoma Presbyopia Retinal detachment

Cataracts Glaucoma Presbyopia

Which assessment finding describes ptosis? Drooping eyelids Nonreactive pupils Protrusion of the eye Sunken appearance of the eye

Drooping eyelids

The occupational nurse is educating a group of machine operators about ophthalmic risk factors. What points does the nurse plan to cover in the teaching? Eye injury Eye strain Cataracts Photophobia

Eye injury

Which eye procedure requires informed consent from the patient? Snellen test Ophthalmoscopy Eyedrop instillation Fluorescein angiography

Fluorescein angiography

The nurse is developing a plan of care for a patient with visual problems. What foods that are good for eye health does the nurse recommend to the patient? Select all that apply. Fruits Milk and eggs Dark green vegetables Vitamin D supplements Lutein and beta carotene

Fruits Dark green vegetables Lutein and beta carotene

Patients with a family history of which eye disorder may have problems with increased intraocular pressure (IOP), requiring additional assessment? Cataracts Anisocoria Glaucoma Diabetic retinopathy

Glaucoma

Which equipment does the nurse use to test the color vision of a patient? Slit-lamp Jaeger card Snellen chart Ishihara chart

Ishihara chart

The nurse providing education on eye protection suggests the special need for protective eyewear for which patients? Lifeguard Cab driver College student Registered nurse Racquetball player

Lifeguard Racquetball player

The nurse providing education on eye protection suggests the special need for protective eyewear for which patients? Select all that apply. Lifeguard Cab driver College student Registered nurse Racquetball player

Lifeguard Racquetball player

The patient is seen in the emergency department with eye pain following a welding accident. He suspects he has a shard of metal in his eye. Which diagnostic test ordered by the provider should the nurse question? Corneal staining Opthalmoscopy Slit-lamp examination Magnetic resonance imaging (MRI)

Magnetic resonance imaging (MRI)

While reading a patient's optical chart, the nurse notices that the patient has emmetropia. Which corrective equipment does the nurse expect to see this patient wearing? Contact lenses Reading glasses Bilateral eye patches Nothing; this is normal

Nothing; this is normal

Which test is used to view the internal and external structure of a patient's eyes? Perimetry Gonioscopy Ophthalmoscopy Electroretinography

Ophthalmoscopy

What physical changes does the nurse expect to see in the eyes of an older patient during an assessment? Increased pupil size Presence of arcus senilis Increased production of tears The cornea forming an external bump

Presence of arcus senilis

The nurse educator is teaching a group of nursing students about the functions of the ocular muscles. The educator asks the group, 'Which type of muscle contracts and pulls the eye downward?' Which response is correct? Inferior rectus muscle Inferior oblique muscle Superior rectus muscle Superior oblique muscle

Superior oblique muscle

The nurse is providing care to a patient with cataracts that will require surgical treatment. The nurse anticipates that which diagnostic test will be performed before the surgery is scheduled? Ultrasonography Radioisotope scanning Computed tomography Magnetic resonance imaging

Ultrasonography

The eyelids are able to open and close by the work of which cranial nerve (CN)? II V III VII

VII

The nurse instructs a patient with diabetes and hypertension about the importance of controlling blood sugar and blood pressure. What is the potential effect of these systemic conditions on the eye and vision? Vision loss Presbyopia Arcus senilis Relaxation of the lower eyelids

Vision loss

A patient reports 'something scratching on the inside of my eyelid.' Before examining the eyelid, what should the nurse do first? Wash the hands. Wear sterile gloves. Administer a Snellen test. Obtain an informed consent.

Wash the hands.