Eye Prep-U
Stye Explanation: A hordeolum or stye is a painful, tender, erythematous infection in a gland at the margin of the eyelid.
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? Stye Dacryocystitis Xanthelasma Chalazion
Exophthalmos Explanation: 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 tumour and inflammation in the orbit.
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? Ptosis Epicanthus Exophthalmos Ectropion
Assess the nasolacrimal sac Explanation: Excessive tearing is caused by exposure to irritants or obstruction of the lacrimal apparatus. Therefore the nurse should assess the nasolacrimal sac. Inspecting the palpebral conjunctiva would be done if the client complains of pain or a feeling of something in the eye. The client is not exhibiting signs of problems with muscle strength such as drooping, so performing the eye position test, which assesses eye muscle strength and cranial nerve function, is not necessary. Testing the pupillary reaction to light evaluates pupillary response and function of the oculomotor nerve.
A client complains of excessive tearing of the eyes. Which assessment would the nurse do next? Test pupillary reaction to light Inspect the palpebral conjunctiva Assess the nasolacrimal sac Perform the eye positions test
Lacrimal apparatus Explanation: 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 client frequently experiences dry, irritated eyes. These findings are consistent with a problem in what part of the eye? Lacrimal apparatus Vitreous chamber Sinus Aqueous chamber
Corrective lenses Explanation: 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.
A client has been diagnosed with astigmatism. The nurse should be prepared to teach the client about which treatment for this condition? Surgery No night driving Corrective lenses Daily use of eye drops
She can see at 20 feet what a normal person could see at 100 feet. Explanation: 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 client is assigned a visual acuity of 20/100 in her left eye. Which of the following is true? She can accurately name 20% of the letters at 20 feet. She obtains a 20% correct score at 100 feet. 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.
conjunctivitis Explanation: Pink-colored sclera with tearing is associated with conjunctivitis which can be caused by allergies, or bacterial or viral infections. Hyphema is blood in the anterior chamber of the eye which is usually caused by blunt trauma. Anisocoria is a term used to describe pupils of unequal size. Exophthalmos is protrusion of the eye ball usually caused by a problem with the thyroid gland.
A client is concerned because the sclera of the right eye has been pink in color for several days and tearing. What should the nurse suspect is occurring with this client? hyphema anisocoria conjunctivitis exophthalmos
At 20 feet from the chart, the client sees what a person with good vision can see at 50 feet Explanation: 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.
A client performs the test for distant visual acuity and scores 20/50. How should the nurse most accurately interpret this finding? Client can read the 20/50 line correctly and two other letters on the line above When 50 feet from the chart, the client can see better than a person standing at 20 feet Client did not wear his glasses for this test and therefore it is not accurate At 20 feet from the chart, the client sees what a person with good vision can see at 50 feet
Risk for Injury Explanation: The only nursing diagnosis that can be confirmed with these data is Risk for Injury. The client is aware of the dangers of driving due to changes in his vision. There is not enough data to support the other diagnoses.
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? Self-Care Deficit Ineffective Individual Coping Risk for Injury Disturbed Self Concept
Assess the nasolacrimal sac. Explanation: Excessive tearing is caused by exposure to irritants or obstruction of the lacrimal apparatus. Therefore the nurse should assess the nasolacrimal sac. Inspecting the palpebral conjunctiva would be done if the client complains of pain or a feeling of something in the eye. The client is not exhibiting signs of problems with muscle strength, such as drooping, so performing the eye position test, which assesses eye muscle strength and cranial nerve function, is not necessary. Testing the pupillary reaction to light evaluates pupillary response and function of the oculomotor nerve.
A client tells the clinic nurse that she has sought care because she has been experiencing excessive tearing of her eyes. Which assessment should the nurse next perform? Perform the eye positions test. Assess the nasolacrimal sac. Inspect the palpebral conjunctiva. Test pupillary reaction to light.
Arrange for worker to be promptly assessed by an eye specialist. Explanation: The nurse should refer the client to an eye doctor immediately if a foreign body cannot be removed with gentle washing. Optometrists are specialists in primary vision care and do not normally treat eye trauma. Irrigation with hydrogen peroxide or attempted removal using instruments would be contraindicated and potentially dangerous.
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? Irrigate the eye with dilute hydrogen peroxide. Attempt to remove the splinter using sterile forceps. Arrange for worker to be promptly assessed by an eye specialist. Encourage the worker to see an optometrist as soon as possible.
Consensual reaction Explanation: 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.
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? Accommodation Direct reaction Near reaction Consensual reaction
Instruct the client hold the chart 14 inches from the eyes Explanation: 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.
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? Place the chart 20 feet away from the client on the wall Place the chart on a table 17 inches away from the client Instruct the client hold the chart 14 inches from the eyes Instruct the client to hold the chart away from the body at arm's length
Focused on the bridge of the nose Explanation: 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 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? Pointed at a fixed object on the wall Shined on the forehead Directly on the eye being examined Focused on the bridge of the nose
Black spokes pointing inward Explanation: When seen through an ophthalmoscope, cataracts appear as black spokes that point inward against the red reflex. A white arc around the limbus is a normal finding in older adults seen when inspecting the cornea and lens. Thickened bulbar conjunctiva would be noted on inspection of the external eye, not during an ophthalmoscopic exam. A red spot on the retina suggests hemorrhages and microaneurysms.
A nurse is observing the red reflex in a client during an eye assessment. During this component of the assessment, the client states, "I hope you can see it because I have cataracts." What finding should the nurse expect? White arc around the limbus Thickened bulbar conjunctiva Black spokes pointing inward A red spot on the retina
Presbyopia Explanation: 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 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.
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? Strabismus Exotropia Presbyopia Esotropia
true
A parent is very upset because she is told her child has a refractive error. The nurse reassures the parent that refractive errors are the most common visual change in children. False True
glaucoma. Explanation: A scotoma is a blind spot that is surrounded by either normal or slightly diminished peripheral vision. It may be from glaucoma.
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 increased intracranial pressure. migraine headaches. glaucoma. bacterial infection.
corneal damage. Explanation: Improper cleaning or prolonged wearing of contact lenses can lead to infection and corneal damage.
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 corneal damage. retinal damage. cataracts. myopia.
lacrimal obstruction. Explanation: 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 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 lacrimal obstruction. allergic reactions. viral infection. double vision.
Presbyopia Explanation: Presbyopia is indicated when the client moves an object away from the eyes to focus. It is a common condition in clients over age 45. Myopia is impaired far vision. Cataracts typically are associated with painless blurring, light sensitivity, poor night vision, and a need for a brighter light to read. Tropia refers to a misalignment of the eyes
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? Cataracts Presbyopia Tropia Myopia
Use a Snellen E chart to perform the examination Explanation: 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.
How can a nurse accurately assess the distant visual acuity of a client who is non-English speaking? Perform the confrontation test Have the client read from a Jaeger reading card Use a Snellen E chart to perform the examination Move an object through the six cardinal positions of gaze
Perform both the distant and near visual acuity tests Explanation: 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.
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? Test the pupils for direct and consensual reaction to light Document the findings in the client's record Perform both the distant and near visual acuity tests Obtain a referral to the ophthalmologist for a complete eye exam
retina. Explanation: 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
Photoreceptors of the eye are located in the eye's lens. ciliary body. retina. pupil.
bulbar portion. Explanation: The conjunctiva is a thin, transparent, continuous membrane that is divided into two portions: a palpebral 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.
The conjunctiva of the eye is divided into the palpebral portion and the intraocular portion. nasolacrimal portion. bulbar portion. canthus portion.
choroid layer. Explanation: The middle layer contains both an anterior portion, which includes the iris and the ciliary body, and a posterior layer, which includes the choroid.
The middle layer of the eye is known as the choroid layer. scleral layer. optic layer. retinal layer.
Follow my finger with only your eyes." Explanation: Testing cranial nerves III, IV, and VI also tests the movement of the eye muscles by asking the client to move the eyes in different directions. Turning the head assesses neck range of motion and mobility. Shrugging shoulder against resistance assesses a different cranial nerve. Asking the client to stand still with the eyes closed is known as the Romberg's test to test balance.
The nurse is assessing cranial nerves III, IV, and VI. Which instructions should the nurse provide to the client in order to perform this assessment? "Follow my finger with only your eyes." "Stand very still with your eyes closed." "Shrug your shoulders as I push down on them." "Rotate your head from side to side."
have the client read newspaper print held 14 inches from the eyes Explanation: 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.
The nurse is planning to assess a client's near vision. Which technique should be used? have the client read newspaper print held 14 inches from the eyes shine a light on the bridge of the nose 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
Presbyopia Explanation: Prebyopia 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.
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? Macular degeneration Presbyopia Cataract formation Loss of convergence
Exophthalmos Explanation: In exophthalmos the eyeball protrudes forward. When bilateral, it suggests the infiltrative ophthalmopathy of Graves hyperthyroidism
What is a characteristic symptom of Graves hyperthyroidism? Exophthalmos Pinguecula Pterygium Episcleritis
Retina Explanation: The retina, which is the innermost layer of the eye, receives and transmits visual stimuli to the brain for processing. The posterior and vitreous chambers of the eye contain aqueous and vitreous humor of the eye. The optic disc, a well-defined round or oval area, is the opening for the optic nerve head.
What part of the eye receives and transmits visual stimuli to the brain for processing? Retina Vitreous chamber Optic disc Posterior chamber
Exotropia Explanation: 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.
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? Exotropia Esotropia Presbyopia Strabismus
esotropia. Explanation: Esotropia is an inward turn of the eye.
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 strabismus. phoria. exotropia. esotropia.
Consensual reaction Explanation: 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 patients. The direct reaction is when the pupil constricts in the same eye.
While the nurse examines a patient'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 Direct reaction Presbyopia Myopia
A left temporal hemianopsia Explanation: When the patient's left eye repeatedly does not see your fingers until they have crossed the line of gaze, a left temporal hemianopsia is present.
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 left temporal hemianopsia A quadrantic defect A homonymous hemianopsia A bitemporal hemianopsia
