Chapter 13: Eye Assessment for Advanced and Specialty Practice

A nurse is completing a comprehensive health history of a 69-year-old woman who is a new client of the clinic. Which of the nurse's interview questions most directly addresses the client's risk for developing cataracts?

"Have you ever been tested for diabetes?"

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?

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

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?

"You will need to see the doctor to have your eye checked."

The nurse is caring for a healthy adult client with no history of vision problems. The nurse should tell the client that a thorough eye examination is recommended every

2 years.

Which vision acuity reading indicates blindness?

20/200

When visual acuity is tested using the Snellen eye chart, which result suggests better distance vision?

30/20

Which of the following statements most accurately describes the maintenance of normal intraocular pressure?

Aqueous humor is continuously circulating through the eye with production equaling 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?

Arcus senilis

A factory worker has presented to the occupational health nurse with a small wood splinter in his left eye. The nurse has assessed the affected eye and irrigated with warm tap water, but the splinter remains in place. What should the nurse do next?

Arrange for worker to be promptly assessed by an eye specialist.

A nurse assesses a client's pupils for the reaction to light and observes that the pupils are of unequal size. What should the nurse do next in relation to this finding?

Ask the client about previous trauma to the eyes

A nurse is preparing to assess the distant visual acuity of a client who wears reading glasses. Which of the following would be most appropriate?

Ask the client to remove the glasses before testing.

Which technique by the nurse demonstrates proper use of the ophthalmoscope?

Asks the client to fix the gaze upon an object and look straight ahead

A client complains of excessive tearing of the eyes. Which assessment would the nurse do next?

Assess the nasolacrimal sac

The nurse is assessing a client's eye muscle strength and cranial nerve function. Which test would be most appropriate for the nurse to perform?

Cardinal fields of gaze test

A woman who is 5 months pregnant is being assessed at a routine visit. She has increased pigmentation around the eyes. This is known as what?

Chloasma

A nurse is examining the eyes of a client who has complained of having a feeling of a foreign body in his eye. The nurse examines the thin, transparent, continuous membrane that lines the inside of the eyelids and covers most of the anterior eye. The nurse recognizes this membrane as which of the following?

Conjunctiva

The thin mucous membrane that lines the inner eyelid and covers the sclera is known as what?

Conjunctiva

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?

Consensual reaction

A nurse performs the cover test to assess for proper alignment of the eyes. When uncovering the previously covered eye, the nurse should observe for which response to indicate a normal finding?

Covered eye remains fixed straight ahead

A client asks a nurse if any foods promote eye health. What food would the nurse include as a response?

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?

Diabetes

The nurse selects the chart shown here to assess a client's vision. Which client characteristic caused the nurse to select this chart?

Does not speak English

A nurse is inspecting a client's eyelids and eyelashes. Which of the findings would the nurse document as abnormal?

Drooping of the upper lid

A client is diagnosed with glaucoma. When performing the ophthalmic exam, what changes should the nurse anticipate finding?

Enlarged physiologic cup that occupies more than half of disc's diameter

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?

Exophthalmos

What is a characteristic symptom of Graves hyperthyroidism?

Exophthalmos

A client's history suggests a need to assess eye muscle strength and cranial nerve function. What assessment should the nurse consequently perform?

Eye positions tesEye positions test

The nurse is preparing to test a client's eyes for accommodation. The nurse would have the client focus on an object in which sequence for this test?

Far, then near

The muscles of the ciliary body control the thickness of the lens, allowing the eye to:

Focus on near or distant objects

A client has sought care because she states that she has begun to see halos around headlights and streetlights when she is out at night. The nurse should recognize the need to refer the client for further assessment related to what health problem?

Glaucoma

A nurse begins the eye examination on a client who presents to the health care clinic for a routine examination. What is the correct action by the nurse to perform the test for near visual acuity?

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

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

What features would most likely be noted on fundoscopic examination of someone with glaucoma?

Increased cup-to-disc ratio

A client is diagnosed with an obstruction of the canal of Schlemm affecting the left eye. What assessment data concerning the left eye noted in the client's medical record supports this diagnosis?

Increased intraocular pressure

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?

Instruct the client hold the chart 14 inches from the eyes

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?

Iris

A client frequently experiences dry, irritated eyes. These findings are consistent with a problem in what part of the eye?

Lacrimal apparatus

A client reports an area of distortion when looking at the Amsler chart. What does this finding indicate to the nurse?

Macular degeneration

When examining the eye with an ophthalmoscope, where would the nurse look to visualize the optic disc?

Medially toward the nose

The nurse observes a young client holding a newspaper up close to read. Which condition does the nurse suspect this client suffers from?

Myopia

The nurse asks the client to perform the action pictured. What is the nurse assessing?

Near vision

The nurse is performing a cardinal fields of gaze test on a client who has an inner ear infection. What would be an expected finding?

Nystagmus

The nurse performs the action shown when assessing a client's eyes. What is the nurse assessing?

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?

Perform both the distant and near visual acuity tests

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?

Place an opaque card in between the eyes of the client

In order to effectively examine a client's eyes with an ophthalmoscope, the nurse should follow which procedure related to this piece of equipment?

Place the ophthalmoscope in the right hand and look through the right eye.

A nurse has taught a group of older adults about the high incidence and prevalence of macular degeneration. What health promotion and prevention activity should the nurse encourage these clients to perform?

Post an Amsler grid in their home and perform the test on a regular basis

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?

Presbyopia

During a health history, a 48-year-old client states, "I've noticed that I need to hold my newspaper farther away so that I can read it." Which of the following would the nurse suspect?

Presbyopia

On visual confrontation testing, a client with a recent stroke cannot see the examiner's fingers on the entire right side with either eye covered. Which of the terms would describe this finding?

Right homonymous hemianopsia

A client is being assessed for indications of a possible obstructed nasolacrimal duct in the right eye. Under what circumstances should the nurse avoid compressing the lacrimal sac?

The area around the sac is inflamed.

A client has a nursing diagnosis of disturbed visual sensory perception. Which of the following is the most appropriate outcome for this client's care planning?

The client will remain free from harm resulting from a loss of vision.

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?

The larger the bottom number, the worse the visual acuity.

A client has an abnormal consensual pupillary reaction to light. A nurse understands that what reaction occurs in the client's eyes?

There is no reaction in the opposite pupil to light.

What is the primary purpose of the health history in relation to the eyes?

To identify changes

How can a nurse accurately assess the distant visual acuity of a client who is non-English speaking?

Use a Snellen E chart to perform the examination

A nurse cares for a client with optic atrophy. The nurse recognizes that an ophthalmoscopic examination of the eye should reveal which characteristic finding in the optic disc?

White-colored

The functional reflex that allows the eyes to focus on near objects is termed

accommodation

The conjunctiva of the eye is divided into the palpebral portion and the

bulbar portion

The chambers of the eye contain aqueous humor, which helps to maintain intraocular pressure and

cleanse the cornea and the lens.

ectropion

ectropion

While assessing the eye of an adult client, the nurse observes an inward turning of the client's left eye. The nurse should document the client's

esotropia.

The nurse is using the ophthalmoscope to examine the client's eyes. The nurse holds the scope

in the right hand for the right eye and in the left hand for the left eye

A client complains of feeling like he is slowly losing his central vision. The nurse knows this symptom could represent

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?

macular degeneration

The optic nerves from each eyeball cross at the

optic chiasma.

Straight movements of the eye are controlled by the

rectus muscles

A client visits the local clinic after experiencing head trauma. The client tells the nurse that he has a consistent blind spot in his right eye. The nurse should

refer the client to an ophthalmologist.

The nurse is examining an adult client's eyes. The nurse has explained the positions test to the client. The nurse determines that the client needs further instructions when the client says that the positions test

requires the covering of each eye separately.

Photoreceptors of the eye are located in the eye's

retina

When assessing the eye, the nurse recognizes which physical structure(s) of the face that can limit the normal visual field of a client?

the brow the medial aspect of the nose the cheek

A client tells the nurse that she has difficulty seeing while driving at night. The nurse should explain to the client that night blindness is often associated with

vitamin A deficiency.