Prep U ch 16 eye
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 Renal insufficiency Anemia Retinal detachment
Diabetes Exudates appear as light-colored spots on the retinal background and occur in individuals with diabetes or hypertension. Anemia, renal insufficiency, and retinal detachment do not cause this appearance on the retina.
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 Strabismus Presbyopia
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.
When examining the eye with an ophthalmoscope, where would the nurse look to visualize the optic disc? Medially toward the nose Laterally toward the ear Upward toward the forehead Downward toward the chin
Medially toward the nose Follow the blood vessels as they get wider. Follow the vessels medially toward the nose and look for the round yellowish orange structure which is the optic disc.
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
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.
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? -Controls the amount of light entering the eye -Permits the entrance of light to the eye -Transforms light rays into nerve impulses that are conducted to the brain -Refracts light rays onto the posterior surface of the eye
Transforms light rays into nerve impulses that are conducted to the brain Visual perception occurs as light rays strike the retina, where they are transformed into nerve impulses, conducted to the brain through the optic nerve, and interpreted. The lens functions to refract (bend) light rays onto the retina. Muscles in the iris adjust to control the pupils size, which controls the amount of light entering the eye. The cornea permits the entrance of light, which passes through the lens to the retina.
The conjunctiva of the eye is divided into the palpebral portion and the canthus portion. intraocular portion. nasolacrimal portion. bulbar portion.
bulbar portion. 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 middle layer of the eye is known as the optic layer. choroid layer. retinal layer. scleral layer
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.
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 -examine the client for other signs of glaucoma. -refer the client for further evaluation. -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.
A client frequently experiences dry, irritated eyes. These findings are consistent with a problem in what part of the eye? Vitreous chamber Aqueous chamber Lacrimal apparatus Sinus
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 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? Dacryocystitis Chalazion Stye Xanthelasma
stye A hordeolum or stye is a painful, tender, erythematous infection in a gland at the margin of the eyelid.
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? "It is not an uncommon finding in people older than 40 years for this to happen. They are called 'floaters'." "Please come into the clinic right away so we can see what is wrong." "Because it is almost 5 o'clock, please go to the emergency department right away. This sounds very serious." "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'." Floaters (translucent specks that drift across the visual field) are common in people older than 40 years of age and nearsighted patients; no additional follow-up is needed.
Which of the following assessment findings suggests a problem with the client's cranial nerves? -A client states that he has recently begun seeing lights flashing in his field of vision. -A client's extraocular movements are asymmetrical and she complains of diplopia. -Fundoscopic examination reveals intraocular bleeding. -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. 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 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? Brain tumor Vitamin A deficiency Viral infection Allergies
Brain tumor Double vision (diplopia) may indicate increased intracranial pressure due to injury or a tumor. Vitamin A deficiency is a cause of night blindness. Allergies are usually indicated by burning or itching pain in the eye. Viral infection is usually indicated by redness or swelling of the eye.
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? Cornea Conjunctiva Retina Sclera
Conjunctiva 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 innermost layer, the retina, extends only to the ciliary body anteriorly. It receives visual stimuli and sends them to the brain. The sclera is a dense, protective, white covering that physically supports the internal structures of the eye. The transparent cornea permits the entrance of light, which passes through the lens to the retina.
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? -Increased blood glucose levels cause osmotic changes in the aqueous humour. -Blood vessels supplying the retina become weak and bleeding occurs. -Diabetes is associated with recurrent corneal infections and consequent scarring. -Diabetes contributes to increased intraocular pressure.
Blood vessels supplying the retina become weak and bleeding occurs. In diabetic retinopathy, the vessels that feed the retina change and weaken. Eventually, they may become blocked and cause bleeding into the eye, which blocks vision. Diabetes does not directly cause an increase in pressure in the eye, osmotic changes in the aqueous humor or corneal infection.
A patient has been found to have abnormal vision. What would be the nurse's next step? -facilitate a referral to an ophthalmologist. -Refer the patient to social services to get money for glasses. -Refer the patient to a community-based support group. -Encourage the patient to adopt a healthier diet.
-facilitate a referral to an ophthalmologist.
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? 20/400 or less 20/100 or less 20/200 or less 20/300 or less
20/200 or less In the United States, a person is usually considered legally blind when vision in the better eye, corrected by glasses, is 20/200 or less.
A client visits the health care clinic with reports of itchy and watery eyes for three days. The nurse observes a generalized redness to the conjunctiva. The nurse recognizes this as what condition? Conjunctivitis Chalazion Blepharitis Hordeolum
Conjunctivitis Redness of the conjunctiva is called conjunctivitis and can be due to n allergic reaction, and viral or bacterial infection. Blepharitis is an infection of the eyelid by the staphylococcus bacteria. A hordeolum is also called a stye and is caused by infection in the lower eyelashes. A chalazion is an infected meibomian gland in the lower lid.
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 viral infection. double vision. allergic reactions. lacrimal obstruction.
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.
A client recently diagnosed with Grave's diseases exhibits protruded eyeballs. Which eye care instruction should the nurse discuss with this client? "Clean the eyes from the outer to inner canthus once a day." "Wear ultraviolet blocking glasses to slow the development of this condition." "Use sympathomimetic eye drops twice daily." "Wear an eyepatch and use moisturizing eye drops."
"Wear an eyepatch and use moisturizing eye drops." Exopthalmos, or protruding eyeballs, is commonly caused by Grave's disease. Untreated exopthalmos can impair the ability of the eye to close properly and can increased dryness. The client should have regular eye exams and can wear an eyepatch and use moisturizing eye drops for dryness. Eyes should be cleaned from the inner to outer canthus as needed. Wearing UV blocking glasses does not affect the progression of this condition, but does help with cataracts. Sympathomimetic eye drops are used to dilate pupils for eye exams. These drops are not commonly prescribed for exopthalmos.
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 Presbyopia Ectropion Myopia
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 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 Focused on the bridge of the nose Directly on the eye being examined
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.
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? Esotropia Strabismus Presbyopia Exotropia
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.
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 glaucoma. increased intracranial pressure. bacterial infection. migraine headaches.
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 preparing to examine an adult client's eyes, using a Snellen chart. The nurse should position the client 609.6 cm (20 ft) away from the chart. ask the client to remove his glasses. ask the client to read each line with both eyes open. instruct the client to begin reading from the bottom of the chart.
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 on a wall or door at eye level in a well-lighted area. -The client stands 20 feet from the chart and covers one eye with an opaque card (which prevents the client from peeking through the fingers). - Then the client reads each line of letters until he or she can no longer distinguish them.
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. 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.
A client is diagnosed with a scotoma. What question is appropriate for the nurse to ask to obtain more data about this condition? "Do you see floaters in front of your eyes?" "Are the blind spots constant or intermittent? " "How often do you have redness or tearing?" "Is night blindness a problem for you?"
"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 person over the age of 40 years and are a sign of normal aging. Redness or tearing is associated with allergies or inflammation of the eye. Night blindness is associated with optic nerve atrophy, glaucoma, or vitamin A deficiency.
