Ch 16 - Assessing Eyes

A nurse is providing discharge teaching on preventative measures that can be used to reduce risk to a client who is at high risk for eye disorders. What should the nurse include in the discharge teaching? Select all that apply. A. "Eat a well-balanced diet that includes green leafy vegetables." B. "Wear sunglasses when you are exposed to sunlight." C. "Have a thorough eye exam at least every 5 years." D. "Have tonometry testing annually." E. "Avoid smoking tobacco."

A, B, D, and E: "Eat a well-balanced diet that includes green leafy vegetables," "Wear sunglasses when you are exposed to sunlight," "Have tonometry testing annually," and "Avoid smoking tobacco." All clients at risk for eye problems should be examined annually or as recommended by their primary care provider. A thorough eye examination is recommended every 2 years for healthy clients ages 18 through 64 without risk factors, and annually for those ages 65 and older. Clients who are exposed to UV radiation are at high risk for the development of cataracts. Sunglasses, if worn consistently, will reduce the client's risk of cataracts. The risk of age-related macular degeneration (AMD) can be reduced with a well-balanced diet, which should include green leafy vegetables, eggs, and other foods that contain lutein and zeaxanthin. Smoking tobacco increases the risk fo eye disorders such as cataracts and AMD.

A 52-year-old client with myopia calls the ophthalmology clinic very upset. She tells the nurse, "I keep seeing semi-clear spots across my vision. What is wrong with me?" What would be the most appropriate response by the nurse? A. "It is not an uncommon finding in people older than 40 years for this to happen. They are called 'floaters'." B. "Please come into the clinic right away so we can see what is wrong." C. "Because it is almost 5 o'clock, please go to the ED right away. This sounds very serious." D. "I have an opening tomorrow at 2 in the afternoon. Can you come in then?"

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

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. Arcus senilis B. Presbyopia C. Ectropion D. Myopia

A. Arcus senilis 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.

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. Blunt-force trauma often results in fracture of the orbit B. High-velocity injuries are typically non-penetrating C. The client could have optic atrophy D. This could be a sign of strabismus

A. Blunt-force trauma often results in fracture of the orbit 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.

The thin mucous membrane that lines the inner eyelid and covers the sclera is known as what? A. Conjunctiva B. Limbus C. Lacrimal apparatus D. Eyelid

A. Conjunctiva 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.

The nurse selects the Snellen-E chart to assess a client's vision. Which client characteristic caused the nurse to select this chart? A. Does not speak English B. Being treated for glaucoma C. Has blue-green color blindness D. Recovering from cataract surgery

A. Does not speak English The Snellen-E chart can be used for clients who do not speak English. The 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? A. Exotropia B. Esotropia C. Strabismus D. Presbyopia

A. Exotropia 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.

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? A. Focused on the bridge of the nose B. Directly on the eye being examined C. Pointed at a fixed object on the wall D. Shined on the forehead

A. Focused on the bridge of the nose 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 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. Have the client hold the Jaeger card 14 inches from the face and read with one eye at a time B. Sit the client in front of the examiner, extend one arm, and slowly move one finger upward C. Tell the client to remove glasses, if present, and read the Snellen card using both eyes D. Place the client 20 feet from the Snellen chart and record the smallest line the client can read

A. Have the client hold the Jaeger card 14 inches from the face and read with one eye at a time 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 recording the smallest line the client can read is the test for distant acuity.

A nurse has completed the assessment of a client's direct pupillary response and is now assessing consensual response. This aspect of assessment should include which action? A. Observing the eye's reaction when a light is shone into the opposite eye B. Shining a light into one eye while covering the other eye with an opaque card C. Have the client state when they see the nurse's finger enter their peripheral vision field D. Comparing the difference between the client's dilated pupil and a constricted pupil

A. Observing the eye's reaction when a light is shone into the opposite eye The nurse assesses consensual response at the same time as direct response by shining a light obliquely into one eye and observing the pupillary reaction in the opposite eye. This does not involve a comparison between maximum and minimum pupil size, however. Neither eye is covered, and peripheral vision is not relevant to this assessment.

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? A. Presbyopia B. Cataract formation C. Loss of convergence D. Macular degeneration

A. Presbyopia 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.

Which of the following is a symptom of the eye? A. Scotomas B. Tinnitus C. Dysphagia D. Rhinorrhea

A. Scotomas Scotomas are specks in the vision or areas where the client cannot see; therefore, this is a common and concerning symptom of the eye. Tinnitus is a ringing in the ears, dysphagia is difficulty swallowing, and rhinorrhea is a "runny nose."

When preparing to examine a client's sclera and conjunctiva during an eye examination, the nurse should instruct the client to move both eyes to look in which direction? A. Up B. Down C. To the right D. To the left

A. Up The correct technique to use when examining a client's sclera and conjunctiva during an eye examination is to instruct the client to look up. Having the client look down, to the right, or to the left will not provide visualization of the sclera or conjunctiva during the examination.

A teenager is brought to the clinic for a sports physical examination. The client states she plans to play goalie on the community soccer team. What is the most important teaching opportunity presented for this client? A. Use of safety equipment B. Prevention of knee injuries C. Prevention of head injuries D. Use of correct foot gear

A. Use of safety equipment The nurse should assess with each client the use of safety equipment when playing sports. Proper eye protection can prevent many sports-related eye injuries. All options are points for client teaching for this client; however, the most important opportunity involves the use of safety equipment.

The nurse should make it a priority to assess which client for papilledema? A. a 45-year-old suspected of experiencing a subarachnoid hemorrhage B. an 80-year-old diagnosed with chronic open-angle glaucoma C. a 12-year-old demonstrating a deviated left eye D. a 56-year-old reporting double vision

A. a 45-year-old suspected of experiencing a subarachnoid hemorrhage Papilledema describes swelling of the optic disc and anterior bulging of the physiologic cup. Increased intracranial pressure is transmitted to the optic nerve, causing edema of the optic nerve. Papilledema often signals serious disorders of the brain, such as meningitis, subarachnoid hemorrhage, trauma, and mass lesions. An enlarged physiological cup suggests chronic open-angle glaucoma. If cranial nerve IV is paralyzed, the left eye will deviate from its normal position in that direction of gaze, and the eyes will no longer appear conjugate, or parallel. Diplopia in adults may arise from a lesion in the brainstem or cerebellum, or from weakness or paralysis of one or more extraocular muscles, as in horizontal diplopia from palsy of cranial nerve (CN) III or VI, or vertical diplopia from palsy of CN III or IV.

The meibomian glands secrete A. an oily substance to lubricate the eyes. B. sweat. C. hormones. D. clear liquid tears.

A. an oily substance to lubricate the eyes. Meibomian glands secrete an oily substance that lubricates the eyelid.

The middle layer of the eye is known as the A. choroid layer. B. scleral layer. C. retinal layer. D. optic layer.

A. choroid layer. The middle layer contains both an anterior portion, which includes the iris and the ciliary body, and a posterior layer, which includes the choroid.

A nurse is performing a focused visual assessment on a client. The nurse assesses the pupillary response with a pen light. Both of the client's pupils immediately constrict when the light is shone into the right pupil. How should the nurse document this finding? A. consensual reflexes observed B. negative for nystagmus C. equal accommodation D. positive corneal reflex

A. consensual reflexes observed When exposed either directly or indirectly to light, pupils will constrict; the term consensual means that constriction occurs in both eyes when light is only shown into one eye. Oscillating or shaking of an eye is referred to as nystagmus. Accommodation is tested by having the client focus their vision on something distant and then a near object, which causes the pupils to constrict. A wisp of cotton is used to test corneal reflex, which stimulates a blink in both eyes when the cotton touches the eye.

The nurse observes an inward turning of the lower lid in a 77-year-old client. The nurse documents A. entropion B. ectropion C. ptosis D. exophthalmos

A. entropion N/A explanation.

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 A. esotropia B. strabismus C. phoria D. exotropia

A. esotropia Esotropia is an inward turn of the eye.

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 A. glaucoma. B. increased intracranial pressure. C. bacterial infection. D. migraine headaches.

A. glaucoma. A scotoma is a blind spot that is surrounded by either normal or slightly diminished peripheral vision. It may be from glaucoma.

The nurse is using the ophthalmoscope to examine the client's eyes. The nurse holds the scope A. in the right hand for the right eye and in the left hand for the left eye B. in the left hand for the right eye and in the right hand for the left eye C. in the right hand for both eyes D. in the left hand for both eyes

A. in the right hand for the right eye and in the left hand for the left eye N/A explanation.

A client complains of feeling like he is slowly losing his central vision. The nurse knows this symptom could represent A. macular degeneration B. open-angle glaucoma C. hemianopsia D. retinal detachment

A. macular degeneration Macular degeneration causes deterioration in the center of the retina, which leads to a gradual loss of central vision.

The nurse is preparing to examine an adult client's eyes, using a Snellen chart. The nurse should A. position the client 609.6 cm (20 ft) away from the chart. B. ask the client to remove his glasses. C. ask the client to read each line with both eyes open. D. instruct the client to begin reading from the bottom of the chart.

A. position the client 609.6 cm (20 ft) away from the chart. 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 at eye level in a well-lighted area. The client stands 20 feet from the chart and covers one eye with an opaque card. Then the client reads each line of letters until he or she can no longer distinguish them.

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

B. "Are the blind spots constant or intermittent?" 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 persons 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.

Which vision acuity reading indicates blindness? A. 20/20 B. 20/200 C. 20/40 D. 20/100

B. 20/200 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.

A client in the clinic where you work is considered legally blind. The nurse knows that this means the vision in his better eye, corrected by glasses, is what? A. 20/100 or less B. 20/200 or less C. 20/300 or less D. 20/400 or less

B. 20/200 or less In the U.S., a person is usually considered legally blind when vision in the better eye, corrected by glasses, is 20/200 or less.

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

B. A client's extraocular movements are asymmetrical and she complains of diplopia. 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.

A 29-year-old physical therapist presents for evaluation of an eyelid problem. On observation, the right eyeball appears to be protruding forward. Based on this description, what is the most likely diagnosis? A. Ptosis B. Exophthalmos C. Ectropion D. Epicanthus

B. Exophthalmos In exophthalmos, the eyeball protrudes forward. If it is bilateral, it suggests the presence of Graves' disease, although unilateral exophthalmos could still be caused by Graves' disease. Alternative causes include a tumor and inflammation in the orbit.

On a health history, a client reports no visual disturbances, last eye exam being 2 years ago, and not wearing 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? A. Document the findings in the client's record B. Perform both the distant and near visual acuity tests C. Test the pupils for direct and consensual reaction to light D. Obtain a referral to the ophthalmologist for a complete eye exam

B. Perform both the distant and near visual acuity tests 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.

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. Snellen E C. Ishihara D. PERRLA

B. Snellen E The Snellen E chart can be used for people who cannot read or speak English.

How can a nurse accurately assess the distant visual acuity of a client who is non-English speaking? A. Move an object through the six cardinal positions of gaze B. Use a Snellen E chart to perform the examination C. Have the client read from a Jaeger reading card D. Perform the confrontation test

B. Use a Snellen E chart to perform the examination If a client does not speak English, is unable to read, or has a verbal communication problem, the Snellen E chart can be used to test the client's distant visual acuity. With this test, the client is asked to indicate by pointing which way the E is open on the chart. the six cardinal positions of gaze test eye muscle function and cranial nerve function. The Jaeger chart tests near visual acuity. Confrontation test is used to test visual fields for peripheral vision.

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 A. congenital cataracts B. decreased accommodation C. muscle weakness D. constant misalignment of the eyes

B. decreased accommodation 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.

An adult client visits the clinic and tells the nurse that he has been experiencing double vision for the past few days. The nurse refers the client to a physician for evaluation of possible A. glaucoma. B. increased intracranial pressure. C. hypertension. D. ophthalmic migraine.

B. increased intracranial pressure. Double vision (diplopia) may indicate increased intracranial pressure due to injury or a tumor.

A client comes to the clinic, reporting that he woke up this morning with a painful right eye. What would be the most appropriate response from the nurse? A. "It is probably just allergies. If it still hurts in the morning call me." B. "A painful eye happens sometimes with allergies. Do you have allergies?" C. "You will need to see the doctor to have your eye checked." D. "Did you do anything different yesterday? You may have eye strain."

C. "You will need to see the doctor to have your eye checked." Pain in the eye is never normal and should always be further explored.

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. Place the chart 20 feet away from the client on the wall B. Instruct the client to hold the chart away from the body at arm's length C. Instruct the client to hold the chart 14 inches from the eyes D. Place the chart on a table 17 inches away from the client

C. Instruct the client to hold the chart 14 inches from the eyes To test near vision 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 arm's 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.

A client frequently experiences dry, irritated eyes. These findings are consistent with a problem in what part of the eye? A. Vitreous chamber B. Aqueous chamber C. Lacrimal apparatus D. Sinus

C. Lacrimal apparatus The lacrimal apparatus (which consists of the lacrimal gland, punctum, lacrimal sac, and nasolacrimal duct) protects and lubricates the cornea and conjunctiva by producing and draining tears.

A nurse assesses the pupillary reaction to light for a client. Which precaution should the nurse follow to get an accurate result of consensual response? A. Shine a bright light directly into the eye to be tested B. Observe the response in the eye focused with light C. Place an opaque card between the eyes of the client D. Instruct the client to close the eye not focused with light

C. Place an opaque card in between the eyes of the client The nurse should place an opaque card in between the eyes of the client when assessing the client for consensual response to avoid inaccurate results. The light should not be focused directly into the eye to be tested; it should be focused obliquely into one eye, and the response should be checked in the other eye. The client should not be instructed to close the other eye not focused with light because the response is checked in the other eye.

When testing the near reaction, an expected finding includes which fo the following? A. Pupillary dilation on near gaze; dilation on distant gaze. B. Pupillary dilation on near gaze; constriction on distant gaze. C. Pupillary constriction on near gaze; dilation on distant gaze. D. Pupillary constriction on near gaze; constriction on distant gaze.

C. Pupillary constriction on near gaze; dilation on distant gaze. During accommodation, pupils constrict with near gaze and dilate with far gaze.

A client is assigned a visual acuity of 20/100 in her left eye. Which of the following is true? A. She obtains a 20% correct score at 100 feet. B. She can accurately name 20% of the letters at 20 feet. C. She can see at 20 feet what a normal person could see at 100 feet. D. She can see at 100 feet what a normal person could see at 20 feet.

C. She can see at 20 feet what a normal person could see at 100 feet. The denominator of an acuity score represents the line on the chart the client can read. In the example above, the client could read the larger letters corresponding with what a normal person could see at 100 feet.

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. Chalazion C. Stye D. Xanthelasma

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

A nurse assesses the vision of an older adult client with a long history of uncontrolled type 2 diabetes. The nurse determines the client's vision with corrective lenses is 20/200. How should the nurse interpret these findings? A. This is normal vision for a client over 65. B. The client will need a new pair of glasses. C. These findings indicate the client is legally blind. D. The client must have developed macular degeneration.

C. These findings indicate the client is legally blind. A client is considered legally blind when vision in the better eye with corrective lenses is 20/200 or less. In this case the client has to be only 20 feet away from an object to see it when others can see the same object from 200 feet. The Snellen chart is used to test distant visual acuity; the higher the second number the more impaired the vision. Even though vision does decrease as people age, 20/200 is not a normal finding. The client may need a new pair of glasses but this is not the best response. Because the client is an older adult and diabetic, they are at high risk for macular degeneration, but this is not the best option. Macular degeneration causes a loss of central vision; it does not necessarily affect distant visual acuity.

The nurse notes that the pupil of a client's left eye constricts when a light is shined into the right eye. How should the nurse document this finding? A. direct light response present in left eye B. pupils equal and react to accommodation C. consensual light response present in left eye D. consensual light response present in right eye

C. consensual light response present in left eye The consensual light response occurs when one eye is exposed to light and the pupil of the other eye constricts. Since the light was shined in the right eye, the left pupil constricted. The left eye was not exposed to direct light. There is not enough information to determine if the pupils are equal or reacting to accommodation.

Photoreceptors of the eye are located in the eye's A. ciliary body. B. lens C. retina. D. pupil.

C. retina. 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 6-year-old boy has come to the clinic with his mother because of recent eye redness and discharge. The nurse's assessment has suggested a diagnosis of conjunctivitis. What should the nurse tell the mother about her son's eye? A. "In children, this problem is usually caused by an increase in pressure within the eye." B. "I'll prescribe some analgesics because your son is likely to have quite severe pain while his eye heals." C. "Antibiotics will clear this up, but you need to make sure he gets them as ordered to avoid vision damage." D. "This might have been the result of an allergy, but most likely it was caused by a bacteria or virus."

D. "This might have been the result of an allergy, but most likely it was caused by a bacteria or virus." Conjunctivitis usually has an infectious etiology. Severe pain and vision damage are not common consequences.

Which technique by the nurse demonstrates proper use of the ophthalmoscope? A. Uses right eye to examine the client's left eye B. Moves the scope around so the entire optic disk may be seen C. Approaches the client directly in front of the pupil D. Asks the client to fix the gaze upon an object and look straight ahead

D. Asks the client to fix the gaze upon an object and look straight ahead 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 and 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 and ask the client to look into the light to view the fovea and macula.

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. Myopia B. Presbyopia C. Direct reaction D. Consensual reaction

D. Consensual reaction 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 client shares that a first-degree relative has an eye problem, but they are not sure what the diagnosis is. What major eye problem will the nurse suggest screening the client for? A. Retinoblastoma B. Strabismus C. Retinitis pigmentosa D. Glaucoma

D. Glaucoma Glaucoma in a first-degree relative increases the client's risk for the same problem two to three times. Retinoblastoma can be inherited from either parent but does not have increased incidence if a first-degree relative has the disease. Retinitis pigmentosa is also a genetic disease, but a client's risk of the disease is not increased if a first-degree relative is affected. Strabismus is not genetic in nature.

What are the glands that are located on the tarsal plates and open on the lid margins? A. Levator glands B. Chalazion glands C. Pterygium glands D. Meibomian glands

D. Meibomian glands Within the eyelids lie firm strips of connective tissue called tarsal plates. Each plate contains a parallel row of meibomian glands, which open on the lid margin.

A nurse notices a middle-aged client in the waiting room pick up a magazine to read while she waits to be seen. She opens the magazine and then extends her arms to move it further from her eyes. Which condition does the nurse most suspect in this client? A. Exotropia B. Esotropia C. Strabismus D. Presbyopia

D. Presbyopia Presbyopia, which is impaired near vision, is indicated when the client moves a reading chart or other reading material away from the eyes to focus on the print. It is caused by decreased accommodation and is a common condition in clients over 45 years of age. With the cover test, the eyes of the client should remained fixed straight ahead. If the covered eye moves when uncovered to reestablish focus, it is abnormal. If the eye turns outward it is called extropia. If the uncovered eye turns inward, it is esotropia. Strabismus is constant malalignment of the eyes.

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? A. Corneal arcus B. Cataracts C. Corneal scar D. Pterygium

D. Pterygium 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? A. Client's consensual pupil constricts in response to indirect light. B. Eyes converge on an object as it is moved towards the nose. C. Direct light shown into the client's pupils results in constriction. D. The client and the examiner see the examiner's finger at the same time.

D. The client and the examiner see the examiner's finger at the same time. 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.

An adult client visits the outpatient clinic and tells the nurse that he has a throbbing aching pain in his right eye. The nurse should assess the client for A. recent exposure to irritants B. increased intracranial pressure C. excessive tearing D. a foreign body in the eye

D. a foreign body in the eye Throbbing, stabbing, or deep, aching pain suggests a foreign body in the eye or changes within the eye.

The conjunctiva of the eye is divided into the palpebral portion and the A. canthus portion. B. intraocular portion. C. nasolacrimal portion. D. bulbar portion.

D. bulbar portion. The conjunctiva is a thin, transparent, continuous membrane that is divided into two portions: a palpebral portion and a bulbar portion. The palpebral conjunctiva lines the inside of the eyelids, and the bulbar conjunctiva covers most of the anterior eye, merging with the cornea at the limbus.

While assessing the eyes of an adult client, the nurse uses a wisp of cotton to stimulate the client's A. eyelid reflexes. B. refractory mechanism. C. lacrimal reflexes. D. corneal reflexes.

D. corneal reflexes. Contact with a wisp of cotton stimulates a blink in both eyes known as the corneal reflex. This reflex is supported by the trigeminal nerve, which carries the afferent sensation into the brain, and the facial nerve, which carries the efferent message that stimulates the blink.

The nurse has tested an adult client's visual fields and determined that the temporal field is 90 degrees in both eyes. The nurse should A. refer the client for further evaluation B. examine the client for other signs of glaucoma C. ask the client if there is a genetic history of blindness D. document the findings in the client's records

D. document the findings in the client's records Validate the eye assessment data that you have collected. This is necessary to verify that the data are reliable and accurate. Document the assessment data following the heath care facility or agency policy.

An adult client visits the clinic and tells the nurse that he has had excessive tearing in his left eye. The nurse should assess the client's eye for A. viral infection B. double vision C. allergic reactions D. lacrimal obstruction

D. lacrimal obstruction Excessive tearing (epiphora) is caused by exposure to irritants or obstruction of the lacrimal apparatus. Unilateral epiphora is often associated with foreign body or obstruction.

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? A. cataracts B. glaucoma C. detached retina D. macular degeneration

D. macular degeneration 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.

A client has tested 20/40 on the distant visual acuity test using a Snellen chart. The nurse should A. document the results in the client's record. B. ask the client to read a handheld vision chart. C. ask the client to return in 2 weeks for another examination. D. refer the client to an optometrist.

D. refer the client to an optometrist. Myopia (impaired far vision) is present when the second number in the test result is larger than the first (20/40). The higher the second number, the poorer the vision.