Chapter 16 Eyes

A 52-year-old patient 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. "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 emergency department right away. This sounds very serious." D. "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'."

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? "In children, this problem is usually caused by an increase in pressure within the eye." "I'll prescribe some analgesics because your son is likely to have quite severe pain while his eye heals." "Antibiotics will clear this up, but you need to make sure he gets them as ordered to avoid vision damage." "This might have been the result of an allergy, but most likely it was caused by a bacteria or virus."

"This might have been the result of an allergy, but most likely it was caused by a bacteria or virus."

A patient 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

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.

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

You are assessing visual fields on a patient newly admitted for eye surgery. The patient's left eye repeatedly does not see your fingers until they have crossed the line of gaze. You would document that the patient has what? A. A left temporal hemianopsia B. A homonymous hemianopsia C. A bitemporal hemianopsia D. A quadrantic defect

A left temporal hemianopsia

What do retinal abnormalities include? Age-related macular degeneration Mydriasis Argyll Robertson syndrome Horner's syndrome

Age-related macular degeneration

Which of the following statements most accurately describes the maintenance of normal intraocular pressure? A. The lacrimal gland produces increased fluid when intraocular pressure is low and ceases production when pressure is high. B. The eye is a closed system whose contents of aqueous humour provide consistent internal pressure. C. The muscles of the ciliary body adjust the volume of the eye in response to increased or decreased pressure. D. Aqueous humour is continuously circulating through the eye with production equalling drainage.

Aqueous humour is continuously circulating through the eye with production equalling drainage.

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

Arcus senilis

A client performs the test for distant visual acuity and scores 20/50. How should the nurse most accurately interpret this finding? A. Client did not wear his glasses for this test and therefore it is not accurate. B. When 50 feet from the chart, the client can see better than a person standing at 20 feet. C. Client can read the 20/50 line correctly and two other letters on the line above. D. 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.

A diabetes educator is teaching a group of adults about the risks to vision that result from poorly controlled blood glucose levels. Which of the following pathophysiologic processes underlies the vision loss associated with diabetes mellitus? A. Diabetes contributes to increased intraocular pressure. B. Increased blood glucose levels cause osmotic changes in the aqueous humour. C. Blood vessels supplying the retina become weak and bleeding occurs. D. Diabetes is associated with recurrent corneal infections and consequent scarring.

Blood vessels supplying the retina become weak and bleeding occurs.

A client presents to a primary care office with a complaint of double vision (diplopia). On questioning, the client claims to have not suffered any head injuries. Which of the following underlying conditions should the nurse most suspect in this client? A. Vitamin A deficiency B. Brain tumor C. Allergies D. Viral infection

Brain tumor

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

Corrective lenses

A patient asks a nurse if any foods promote eye health. What food would the nurse A. Deep-water fish B. Low-fat meat C. Foods that contain lots of water D. Multigrain foods

Deep-water fish

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

What is a characteristic symptom of Graves hyperthyroidism? A. Pterygium B. Exophthalmos C. Pinguecula D. Episcleritis

Exophthalmos

What muscles control the eye movement and hold the eye in place in the socket? A. Extraocular B. Oculomotor C. Trochlear D. Abducens

Extraocular

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

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

Focused on the bridge of the nose

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

Have the client hold the Jaeger card 14 inches from the face and read with one eye at a time

A client presents to the emergency department after being hit in the head with a baseball bat during a game. The nurse should assess for which condition? Hyphema Blepharitis Chalazion Iris nevus

Hyphema

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

Lacrimal apparatus

When examining the eye with an ophthalmoscope, where would the nurse look to visualize Medially toward the nose Laterally toward the ear Upward toward the forehead Downward toward the chin

Medially toward the nose

A client presents to the clinic complaining of sudden visual loss in the left eye. What is the nurse's priority action? A. Assess cranial nerve function. B. Notify the healthcare provider immediately. C. Ask the client if protective eyewear was worn. D. Perform the Allen test and report the findings urgently.

Notify the healthcare provider immediately.

The nurse performs the action shown when assessing a client's eyes. What is the nurse assessing? A. Near vision B. Distance vision C. Ocular alignment D. Color discrimination

Ocular alignment

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

Perform both the distant and near visual acuity tests

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? 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

Perform both the distant and near visual acuity tests

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

Presbyopia

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

When testing the near reaction, an expected finding includes which of 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

Pupillary constriction on near gaze; dilation on distant gaze

What part of the eye receives and transmits visual stimuli to the brain for processing? Retina Optic disc Posterior chamber Vitreous chamber

Retina

A client presents to the health care clinic and reports pain in the eyes when working on the computer for long periods of time. The client states that 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? A. Ineffective Individual Coping B. Disturbed Self Concept C. Self-Care Deficit D. Risk for Injury

Risk for Injury

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.

She can see at 20 feet what a normal person could see at 100 feet.

A client is admitted to the health care facility after sustaining a crushing injury to the right eye. The nurse should anticipate abnormal results for which vision test? A. Accommodation B. Six cardinal positions of gaze C. Pupillary reaction to light D. Position and alignment of the eyeballs

Six cardinal positions of gaze

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 patient's vision? A. Allen B. Snellen E C. Ishihara D. PERRLA

Snellen E

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

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

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.

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

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

Which statement demonstrates the safest way to document assessment findings of drainage noted in both eyes of a client? A. Thick, purulent drainage is noted at inner corner of OD. B. Thick, purulent drainage is noted at inner corner of OS. C. Thick, purulent drainage is noted at inner corner of OU. D. Thick, purulent drainage is noted at inner corner of both eyes.

Thick, purulent drainage is noted at inner corner of both eyes.

Which statement demonstrates the safest way to document assessment findings of drainage noted in both eyes of a client? Thick, purulent drainage is noted at inner corner of OD. Thick, purulent drainage is noted at inner corner of OS. Thick, purulent drainage is noted at inner corner of OU. Thick, purulent drainage is noted at inner corner of both eyes.

Thick, purulent drainage is noted at inner corner of both eyes.

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

Touch the cornea with a wisp of cotton

A nurse is inspecting a client's eyes to assess for the possibility of detached retinas. The nurse is aware that which of the following is the function of the retina? Refracts light rays onto the posterior surface of the eye Controls the amount of light entering the eye Transforms light rays into nerve impulses that are conducted to the brain Permits the entrance of light to the eye

Transforms light rays into nerve impulses that are conducted to the brain

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

Use a Snellen E chart to perform the examination

A teenager is brought to the clinic for a sports physical examination. The client states 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

Use of safety equipment

The functional reflex that allows the eyes to focus on near objects is termed A. pupillary reflex. B. accommodation. C. refraction. D. indirect reflex.

accommodation

The middle layer of the eye is known as the choroid layer. scleral layer. retinal layer. optic layer.

choroid layer.

The chambers of the eye contain aqueous humor, which helps to maintain intraocular pressure and transmit light rays. maintain the retinal vessels. change refractory of the lens. cleanse the cornea and the lens.

cleanse the cornea and the lens.

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

consensual light response present in left eye

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. retinal damage. B. cataracts. C. myopia. D. corneal damage.

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.

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 refer the client for further evaluation. examine the client for other signs of glaucoma. ask the client if there is a genetic history of blindness. document the findings in the client's records.

document the findings in the client's records.

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

entropion

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

have the client read newspaper print held 14 inches from the eyes

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.

increased intracranial pressure.

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 glaucoma. increased intracranial pressure. hypertension. ophthalmic migraine.

increased intracranial pressure.

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.

lacrimal obstruction.

A patient 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

macular degeneration

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

macular degeneration

The optic nerves from each eyeball cross at the A. optic chiasma. B. vitreous humor. C. optic disc. D. visual cortex.

optic chiasma.