Chapter 15: Eyes
Jarvis: Physical Examination and Health Assessment, 8th Edition
MULTIPLE CHOICE
1. When examining the eye, the nurse notices that the patient’s eyelid margins approximate
completely. What does the nurse understand about this assessment finding?
a.
It is expected.
b.
It may result in problems with tearing.
c.
It indicates increased intraocular pressure.
d.
It may indicate a problem with extraocular muscles.
2. During ocular examinations, what should the nurse keep in mind regarding the movement of
the extraocular muscles?
a.
Is decreased in the older adult.
b.
Is stimulated by CNs III, IV, and VI.
c.
Is impaired in a patient with cataracts.
d.
Is stimulated by cranial nerves (CNs) I and II.
3. The nurse is performing an external eye examination. Which statement regarding the outer
layer of the eye is true?
a.
The outer layer of the eye is very sensitive to touch.
b.
The outer layer of the eye is darkly pigmented to prevent light from reflecting
internally.
c.
The trigeminal nerve (CN V) and the trochlear nerve (CN IV) are stimulated when
the outer surface of the eye is stimulated.
d.
The visual receptive layer of the eye in which light waves are changed into nerve
impulses is located in the outer layer of the eye.
4. When examining a patient’s eyes, what should the nurse be aware that stimulation of the
sympathetic branch of the autonomic nervous system causes?
a.
Pupillary constriction
b.
Adjusts the eye for near vision
c.
Causes contraction of the ciliary body
d.
Elevates the eyelid and dilates the pupil
5. The nurse is reviewing causes of increased intraocular pressure. Which of these factors
determines intraocular pressure?
a.
Thickness or bulging of the lens
b.
Posterior chamber as it accommodates increased fluid
c.
Contraction of the ciliary body in response to the aqueous within the eye
d.
Amount of aqueous produced and resistance to its outflow at the angle of the
anterior chamber
6. The nurse is conducting a visual examination. Which of these statements regarding visual
pathways and visual fields is true?
a.
The right side of the brain interprets the vision for the O.D.
b.
The image formed on the retina is upside down and reversed from its actual
appearance in the outside world.
c.
Light rays are refracted through the transparent media of the eye before striking the
pupil.
d.
Light impulses are conducted through the optic nerve to the temporal lobes of the
brain.
7. The nurse is testing a patient’s visual accommodation. How is accommodation assessed?
a.
Pupillary dilation when looking at a distant object
b.
Involuntary blinking in the presence of bright light
c.
Pupillary constriction when looking at a near object
d.
Changes in peripheral vision in response to bright light
8. A mother asks when her newborn infant’s eyesight will be developed. What is the best
response by the nurse?
a.
“Vision is not totally developed until 2 years of age.”
b.
“Infants develop the ability to focus on an object at approximately 8 months of
age.”
c.
“By approximately 3 months of age, infants develop more coordinated eye
movements and can fixate on an object.”
d.
“Most infants have uncoordinated eye movements for the first year of life.”
9. The nurse is reviewing the age-related changes in the eye for a class. Which of these
physiologic changes is responsible for presbyopia?
a.
Loss of lens elasticity
b.
Degeneration of the cornea
c.
Decreased adaptation to darkness
d.
Decreased distance vision abilities
10. Which of these assessment findings would the nurse expect to see when examining the eyes of
a black patient?
a.
Increased night vision
b.
Dark retinal background
c.
Increased photosensitivity
d.
Narrowed palpebral fissures
11. A 52-year-old patient describes the presence of occasional floaters or spots moving in front of
his eyes. How should the nurse proceed?
a.
Examine the retina to determine the number of floaters.
b.
Presume the patient has glaucoma and refer him for further testing.
c.
Consider these to be abnormal findings, and refer him to an ophthalmologist.
d.
Understand that floaters are usually insignificant and are caused by condensed
vitreous fibers.
12. The nurse is preparing to assess the visual acuity of a 16-year-old patient. How should the
nurse proceed?
a.
Perform the confrontation test.
b.
Ask the patient to read the print on a handheld Jaeger card.
c.
Use the Snellen chart positioned 20 feet away from the patient.
d.
Determine the patient’s ability to read newsprint at a distance of 12 to 14 inches.
13. A patient’s vision is recorded as 20/30 when the Snellen eye chart is used. How should the
nurse interpret these results?
a.
At 30 feet the patient can read the entire chart.
b.
The patient can read at 20 feet what a person with normal vision can read at 30
feet.
c.
The patient can read the chart from 20 feet in the O.S. and 30 feet in the O.D.
d.
The patient can read from 30 feet what a person with normal vision can read from
20 feet.
14. A patient is unable to read even the largest letters on the Snellen chart. The nurse should take
which action next?
a.
Refer the patient to an ophthalmologist or optometrist for further evaluation.
b.
Assess whether the patient can count the nurse’s fingers when they are placed in
front of his or her eyes.
c.
Ask the patient to put on his or her reading glasses and attempt to read the Snellen
chart again.
d.
Shorten the distance between the patient and the chart until the letters are seen, and
record that distance.
15. A patient’s vision is recorded as 20/80 in each eye. How does the nurse interpret this finding?
a.
Patient has presbyopia.
b.
Patient as poor vision.
c.
Patient has acute vision.
d.
Patient has normal vision.
16. When performing the corneal light reflex assessment, the nurse notes that the light is reflected
at 2 o’clock in each eye. What should the nurse do regarding this finding?
a.
Record this as a normal finding.
b.
Refer the individual for further evaluation.
c.
Document this finding as an asymmetric light reflex.
d.
Perform the confrontation test to validate the findings.
17. The nurse is performing the diagnostic positions test. Which result is a normal finding?
a.
Convergence of the eyes
b.
Parallel movement of both eyes
c.
Nystagmus in extreme superior gaze
d.
Slight amount of lid lag when moving the eyes from a superior to an inferior
position
18. During an assessment of the sclera of a black patient, the nurse would consider which of these
an expected finding?
a.
Yellow fatty deposits over the cornea
b.
Presence of small brown macules on the sclera
c.
Pallor near the outer canthus of the lower lid
d.
Yellow color of the sclera that extends up to the iris
19. A 60-year-old man is at the clinic for an eye examination. The nurse suspects that he has
ptosis of one eye. How should the nurse check for this?
a.
Perform the confrontation test.
b.
Assess the individual’s near vision.
c.
Observe the distance between the palpebral fissures.
d.
Perform the corneal light test, and look for symmetry of the light reflex.
20. During an examination of the eye, the nurse would expect what normal finding when
assessing the lacrimal apparatus?
a.
Presence of tears along the inner canthus
b.
Blocked nasolacrimal duct in a newborn infant
c.
Absence of drainage from the puncta when pressing against the inner orbital rim
d.
Slight swelling over the upper lid and along the bony orbit if the individual has a
cold
21. When assessing the pupillary light reflex, the nurse should use which technique?
a.
Shine a penlight from directly in front of the patient, and inspect for pupillary
constriction.
b.
Ask the patient to follow the penlight in eight directions, and observe for bilateral
pupil constriction.
c.
Shine a light across the pupil from the side, and observe for direct and consensual
pupillary constriction.
d.
Ask the patient to focus on a distant object. Then ask the patient to follow the
penlight to approximately 7 cm from the nose.
22. The nurse is assessing a patient’s eyes for the accommodation response and would expect to
see which normal finding?
a.
Dilation of the pupils
b.
Consensual light reflex
c.
Disconjugate movement of the eyes
d.
Convergence of the axes of the eyes
23. In using the ophthalmoscope to assess a patient’s eyes, the nurse notices a red glow in the
patient’s pupils. Based on this finding, what should the nurse do?
a.
Suspect that an opacity is present in the lens or cornea.
b.
Check the light source of the ophthalmoscope to verify that it is functioning.
c.
Consider the red glow a normal reflection of the ophthalmoscope light off the inner
retina.
d.
Continue with the ophthalmoscopic examination, and refer the patient for further
evaluation.
24. The nurse is examining a patient’s retina with an ophthalmoscope. Which finding is
considered normal?
a.
Optic disc that is a yellow-orange color.
b.
Presence of pigmented crescents in the macular area.
c.
Optic disc margins that are blurred around the edges.
d.
Presence of the macula located on the nasal side of the retina.
25. A 2-week-old infant can fixate on an object but cannot follow a light or bright toy. What
should the nurse do?
a.
Consider this a normal finding.
b.
Continue with the examination, and assess visual fields.
c.
Assess the pupillary light reflex for possible blindness.
d.
Expect that a 2-week-old infant should be able to fixate and follow an object.
26. The nurse is assessing color vision of a male child. Which statement is correct?
a.
Color vision should be checked annually until the age of 18 years.
b.
Color vision screening should begin at the child’s 2-year checkup.
c.
The nurse should ask the child to identify the color of his or her clothing.
d.
Testing for color vision should be done once between the ages of 4 and 8 years.
27. The nurse is performing an eye-screening clinic at a daycare center. When examining a
2-year-old child, the nurse suspects that the child has a “lazy eye”. What should the nurse do
next?
a.
Examine the external structures of the eye.
b.
Assess visual acuity with the Snellen eye chart.
c.
Assess the child’s visual fields with the confrontation test.
d.
Test for strabismus by performing the corneal light reflex test.
28. The nurse is performing an eye assessment on an 80-year-old patient. Which of these findings
is considered abnormal?
a.
Decrease in tear production
b.
Unequal pupillary constriction in response to light
c.
Presence of arcus senilis observed around the cornea
d.
Loss of the outer hair on the eyebrows attributable to a decrease in hair follicles
29. The nurse notices the presence of periorbital edema when performing an eye assessment on a
70-year-old patient. What should the nurse do next?
a.
Check for the presence of exophthalmos.
b.
Suspect that the patient has hyperthyroidism.
c.
Ask the patient if he or she has a history of heart failure.
d.
Assess for blepharitis, which is often associated with periorbital edema.
30. What is the nurse assessing for when he or she directs a light across the iris of a patient’s eye
from the temporal side?
a.
Drainage from dacryocystitis
b.
Presence of conjunctivitis over the iris
c.
Presence of shadows, which may indicate glaucoma
d.
Scattered light reflex, which may be indicative of cataracts
31. In a patient who has anisocoria, what would the nurse expect to observe?
a.
Dilated pupils
b.
Excessive tearing
c.
Pupils of unequal size
d.
Uneven curvature of the lens
32. A patient comes to the emergency department after a boxing match, and his O.S. is almost
swollen shut. He has bruises on his face and neck. He says he is worried because he “can’t see
well” from his O.S. The physician suspects retinal detachment. What finding would support
this suspicion?
a.
Loss of central vision
b.
Loss of peripheral vision
c.
Sudden loss of pupillary constriction and accommodation
d.
Shadow or diminished vision in one quadrant or one half of the visual field
33. A patient comes into the clinic reporting pain in her O.D. On examination, the nurse sees a
pustule at the lid margin that is painful to touch, red, and swollen. What is the correct term for
this finding?
a.
Chalazion
b.
Hordeolum
c.
Blepharitis
d.
Dacryocystitis
34. A 68-year-old woman is in the eye clinic for a checkup. She tells the nurse that she has been
having trouble reading the paper, sewing, and even seeing the faces of her grandchildren. On
examination, the nurse notes that she has some loss of central vision but her peripheral vision
is normal. What do these findings suggest?
a.
Macular degeneration
b.
Vision that is normal for someone her age
c.
The beginning stages of cataract formation
d.
Increased intraocular pressure or glaucoma
35. A patient comes into the emergency department after an accident at work. A machine blew
dust into his eyes, and he was not wearing safety glasses. The nurse examines his corneas by
shining a light from the side across the cornea. What findings would suggest that he has
suffered a corneal abrasion?
a.
Smooth and clear corneas
b.
Opacity of the lens behind the cornea
c.
Bleeding from the areas across the cornea
d.
Shattered look to the light rays reflecting off the cornea
36. An ophthalmic examination reveals papilledema. What does this finding indicate?
a.
Retinal detachment
b.
Diabetic retinopathy
c.
Acute-angle glaucoma
d.
Increased intracranial pressure
37. During a physical education class, a student is hit in the eye with the end of a baseball bat.
When examined in the emergency department, the nurse notices the presence of blood in the
anterior chamber of the eye. What does this finding indicate?
a.
Hypopyon
b.
Hyphema
c.
Pterygium
d.
A corneal abrasion
38. During an assessment, the nurse notices that an older adult patient has tears rolling down his
face from his O.S. Closer examination shows that the lower lid is loose and rolling outward.
The patient complains of his eye feeling “dry and itchy.” Which action by the nurse is
correct?
a.
Documenting the finding as ptosis
b.
Assessing for other signs of ectropion
c.
Assessing the eye for a possible foreign body
d.
Contacting the prescriber; these are signs of basal cell carcinoma
MULTIPLE RESPONSE
1. During an examination, a patient states that she was diagnosed with open-angle glaucoma 2
years ago. The nurse assesses for characteristics of open-angle glaucoma. Which of these are
characteristics of open-angle glaucoma? (Select all that apply.)
a.
Immediate treatment is needed.
b.
Virtually no symptoms are exhibited.
c.
Vision loss begins with peripheral vision.
d.
Patient may experience sensitivity to light, nausea, and halos around lights.
e.
Patient experiences tunnel vision in the late stages.
f.
Open-angle glaucoma causes sudden attacks of increased pressure that cause
blurred vision.