NURS 3131 Exam 3 Ch 16

a) Instruct the client hold the chart 14 inches from the eyes Pg. 316 To test near visual acuity, the nurse should have the client hold the chart 14 inches from the eyes. The Snellen chart should be kept at eye level, 20 feet away on the wall when testing for distant vision. An arms length is an arbitrary length depending on the size of the client and is not an accurate method for testing. The chart should not be placed on a table 17 inches away from the client.

14. A middle-aged client reports difficulty in reading. Which action by the nurse is appropriate to test near visual acuity using a Jaeger reading card? a) Instruct the client hold the chart 14 inches from the eyes b) Place the chart on a table 17 inches away from the client c) Place the chart 20 feet away from the client on the wall d) Instruct the client to hold the chart away from the body at arm's length

d) Touch the cornea with a wisp of cotton Pg. 305 The nurse should assess the corneal reflex by lightly touching the corneal surface with a wisp of cotton. Shining a penlight may help to test the pupillary response and accommodation. A Snellen chart tests the visual vision acuity. An ophthalmoscope is used to assess the internal structures of the eye.

1. Which action by the nurse demonstrates correct assessment of the corneal reflex of a client during an eye examination? a) Test the cornea of the eye with an ophthalmoscope b) Ask the client to read the Snellen chart c) Shine a penlight on the eye in a darkened room d) Touch the cornea with a wisp of cotton

b) Blunt-force trauma often results in fracture of the orbit Pg. 304 High-velocity injuries are typically penetrating. Blunt-force trauma often results in fracture of the orbit. Optic atrophy is atrophy of the optic nerve. Strabismus is the medical term for cross-eye.

10. A client is being assessed following a motor vehicle accident. The client's right eye is swollen shut and very painful. Why does this require further assessment? a) The client could have optic atrophy b) Blunt-force trauma often results in fracture of the orbit c) This could be a sign of strabismus d) High-velocity injuries are typically non-penetrating

a) Consensual reaction Pg. 307 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.

11. 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? a) Consensual reaction b) Myopia c) Presbyopia d) Direct reaction

b) Stye Pg. 320 A hordeolum or stye is a painful, tender, erythematous infection in a gland at the margin of the eyelid.

12. A 12-year-old presents to the clinic with his father for evaluation of a painful lump in the left eye. It started this morning. The client denies any trauma or injury. There is no visual disturbance. Upon physical examination, there is a red raised area at the margin of the eyelid that is tender to palpation; no tearing occurs with palpation of the lesion. Based on this description, what is the most likely diagnosis? a) Dacryocystitis b) Stye c) Chalazion d) Xanthelasma

a) A client's extraocular movements are asymmetrical and she complains of diplopia Pg. 319 Deficits in cranial nerves III, IV, and VI can manifest as impaired extraocular movements or diplopia. Flashes of light are associated with retinal detachment, while intraocular bleeding and cataracts do not have a neurological etiology.

13. Which of the following assessment findings suggests a problem with the client's cranial nerves? a) A client's extraocular movements are asymmetrical and she complains of diplopia b) A client states that he has recently begun seeing lights flashing in his field of vision c) Fundoscopic examination reveals intraocular bleeding d) A client's lens appears cloudy and she claims that her visual acuity has recently declined

c) At 20 feet from the chart, the client sees what a person with good vision can see at 50 feet Pg. 317 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.

15. A client performs the test for distant visual acuity and scores 20/50. How should the nurse most accurately interpret this finding? a) When 50 feet from the chart, the client can see better than a person standing at 20 feet b) Client did not wear his glasses for this test and therefore it is not accurate c) At 20 feet from the chart, the client sees what a person with good vision can see at 50 feet d) Client can read the 20/50 line correctly and two other letters on the line above

a) Corneal damage Pg. 309 Improper cleaning or prolonged wearing of contact lenses can lead to infection and corneal damage.

16. 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 a) Corneal damage b) Myopia c) Cataracts d) Retinal damage

d) "It is not an uncommon finding in people older than 40 years for this to happen. They are called 'floaters'" Pg. 308 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.

17. 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? a) "Please come into the clinic right away so we can see what is wrong" b) "I have an opening tomorrow at 2 in the afternoon. Can you come in then?" c) "Because it is almost 5 o'clock, please go to the emergency department right away. This sounds very serious" d) "It is not an uncommon finding in people older than 40 years for this to happen. They are called 'floaters'"

c) 20/200 Pg. 307 The reading of 20/200 on a vision acuity test indicates blindness. The reading of 20/20 is considered normal vision. This means that the client being tested can distinguish what a person with normal vision can distinguish from 20 feet away. The top or first number is always 20, indicating the distance from the client to the chart. The bottom or second number refers to the last full line the client could read. The higher the second number, the poorer the vision. 20/40 and 20/100 also denote poor vision.

18. Which vision acuity reading indicates blindness? a) 20/20 b) 20/40 c) 20/200 d) 20/100

c) Position the client 609.6 cm (20 ft) away from the chart Pg. 316 Used to test distant visual acuity, the Snellen chart consists of lines of different letters stacked one above the other. The letters are large at the top and decrease in size from top to bottom. The chart is placed on a wall or door at eye level in a well-lighted area. The client stands 20 feet from the chart and covers one eye with an opaque card (which prevents the client from peeking through the fingers). Then the client reads each line of letters until he or she can no longer distinguish them.

19. The nurse is preparing to examine an adult client's eyes, using a Snellen chart. The nurse should a) Instruct the client to begin reading from the bottom of the chart b) Ask the client to read each line with both eyes open c) Position the client 609.6 cm (20 ft) away from the chart d) Ask the client to remove his glasses

a) Consensual reaction Pg. 307 The constriction of the contralateral pupil is called the consensual reaction. The response of the ipsilateral eye is the direct response. The dilation of the pupil when focusing on a close object is the near reaction. Accommodation is the changing of the shape of the lens to sharply focus on an object.

2. A light is pointed at a client's pupil, which then contracts. It is also noted that the other pupil contracts as well, though it is not exposed to bright light. Which of the following terms describes this latter phenomenon? a) Consensual reaction b) Near reaction c) Direct reaction d) Accommodation

c) Have the client hold the Jaeger card 14 inches from the face and read with one eye at a time Pg. 318 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.

20. 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? a) Sit the client in front of the examiner, extend one arm, and slowly move one finger upward b) Place the client 20 feet from the Snellen chart and record the smallest line the client can read c) Have the client hold the Jaeger card 14 inches from the face and read with one eye at a time d) Tell the client to remove glasses, if present, and read the Snellen card using both eyes

d) "Are the blind spots constant or intermittent?" Pg. 308 A scotoma is the presence of blind spots that can be constant or intermittent. If they are constant it may indicate retinal detachment. Intermittent blind spots may be due to vascular spasm or pressure on the optic nerve. Floaters are a common finding in individuals with myopia or in person over the age of 40 years and are a sign of normal aging. Redness or tearing is associated with allergies or inflammation of the eye. Night blindness is associated with optic nerve atrophy, glaucoma, or vitamin A deficiency.

21. A client is diagnosed with a scotoma. What question is appropriate for the nurse to ask to obtain more data about this condition? a) "Is night blindness a problem for you?" b) "Do you see floaters in front of your eyes?" c) "How often do you have redness or tearing?" d) "Are the blind spots constant or intermittent?"

a) Iris Pg. 305 The iris is a circular disc of muscle containing pigments that determine eye color. The central aperture of the iris is called the pupil. Muscles in the iris adjust to control the pupils size, which controls the amount of light entering the eye. The lens is a biconvex, transparent, avascular, encapsulated structure located immediately posterior to the iris that refracts (bends) light rays onto the retina. The optic disc is a cream-colored, circular area located on the retina toward the medial or nasal side of the eye where the optic nerve enters the eyeball. The innermost layer, the retina, extends only to the ciliary body anteriorly. It receives visual stimuli and sends it to the brain.

22. A nurse is testing a client's pupillary reaction to light, noting that the pupil constricts when shining light obliquely into it. The nurse understands that muscles in which of the following structures adjust to control the amount of light entering the eye through the aperture of the pupil? a) Iris b) Lens c) Retina d) Optic disc

d) Snellen E Pg. 316 The Snellen E chart can be used for people who cannot read or speak English.

23. The nurse is caring for a 63-year-old client who can neither read nor speak English. What would be the appropriate chart to use to assess this client's vision? a) Allen b) PERRLA c) Ishihara d) Snellen E

d) Arcus senilis Pg. 323 Arcus senilis, a normal condition in older clients, appears as a white arc around the limbus. The condition has no effect on vision. Presbyopia, which is impaired near vision, is caused by decreased accommodation and is a common condition in clients over 45 years of age. Ectropion is when the lower eyelids evert, causing exposure and drying of the conjunctiva. This is a normal finding in the older client. Myopia is impaired far vision.

3. The nurse is inspecting the cornea and lens of an elderly client and notices a white arc around the limbus of the client's eye. The nurse recognizes this condition, common in older adults, as which of the following? a) Myopia b) Presbyopia c) Ectropion d) Arcus senilis

c) Corrective lenses Pg. 309 Astigmatism is corrected with a cylindrical lens that has more focusing power in one access than the other. These corrective lenses can and should be worn while driving at night. Eye drops and surgery are not usual treatments for this condition.

4. A client has been diagnosed with astigmatism. The nurse should be prepared to teach the client about which treatment for this condition? a) Surgery b) Daily use of eye drops c) Corrective lenses d) No night driving

b) A left temporal hemianopsia Pg. 330 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.

5. 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) A quadrantic defect b) A left temporal hemianopsia c) A bitemporal hemianopsia d) A homonymous hemianopsia

c) Accommodation Pg. 307 Accommodation is a functional reflex allowing the eyes to focus on near objects. This is accomplished through movement of the ciliary muscles, causing an increase in the curvature of the lens.

6. The functional reflex that allows the eyes to focus on near objects is termed a) Refraction b) Indirect reflex c) Accommodation d) Pupillary reflex

a) Tell the client that these often occur with aging Pg. 313 Spots or floaters are common among clients with myopia or in clients over age 40. In most cases, they are due to normal physiologic changes in the eye associated with aging and require no intervention.

7. A 45-year-old client tells the nurse that he occasionally sees spots in front of his eyes. The nurse should a) Tell the client that these often occur with aging b) Refer the client to an ophthalmologist c) Re-examine the client in 2 weeks d) Assess the client for signs of diabetes

b) Have the client read newspaper print held 14 inches from the eyes Pg. 316 Near vision is tested by asking the client to read newspaper print held 14 inches from the eyes. Shining a light on the bridge of the nose tests the corneal light reflex. Moving the eyes in the direction of a moving finger tests for extraocular movements. Having the client read letters on a wall chart tests for central and distance vision.

8. The nurse is planning to assess a client's near vision. Which technique should be used? a) Shine a light on the bridge of the nose b) Have the client read newspaper print held 14 inches from the eyes c) Ask the client to move the eyes in the direction of a moving finger d) Have the client stand 20 feet from a wall chart and read the letters after covering one eye

b) Near vision Pg. 318 The client is using the Jaeger chart which is used to assess near vision. The Snellen chart is used to assess distant vision. The nurse would not assess intraocular pressure. Ishihara cards are used to assess color discrimination.

9. The nurse asks the client to perform the action pictured. What is the nurse assessing? a) Distance vision b) Near vision c) Color discrimination d) Intraocular pressure