Question 1

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?

Accepted Answer

The condition described is known as ectropion, and it occurs in older adults and is attributable to atrophy of the elastic and fibrous tissues. The lower lid does not approximate to the eyeball, and, as a result, the puncta cannot effectively siphon tears; excessive tearing results. Ptosis is a drooping of the upper eyelid. These signs do not suggest the presence of a foreign body in the eye or basal cell carcinoma.

Question 2

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?

Accepted Answer

Hyphema is the term for blood in the anterior chamber and is a serious result of blunt trauma (a fist or a baseball) or spontaneous hemorrhage and may indicate scleral rupture or major intraocular trauma. Hypopyon is the term for lager of white blood cells in the anterior chamber and often cause pain, red eye, and possibly decreased vision. Pterygium is the term for a triangular opaque wing of bulbar conjunctive overgrows toward the center of the cornea. It looks membranous, translucent, and yellow to white. A corneal abrasion is the term for damage or removal of the top layer of corneal epithelium, usually a result of scratches or poorly fitting or overworn contact lenses. The person with a corneal abrasion usually feels intense pain; a foreign body sensation; and lacrimation, redness, and photophobia. The presence of blood in the anterior chamber that this patient has is hyphema.

Question 3

The nurse is examining a patient's retina with an ophthalmoscope. Which finding is considered normal?

Accepted Answer

The optic disc is located on the nasal side of the retina. Its color is a creamy yellow-orange to a pink, and the edges are distinct and sharply demarcated, not blurred. A pigmented crescent is black and is due to the accumulation of pigment in the choroid. Presence of pigmented crescents in the macular area is an abnormal finding. A pigmented crescent is black and is due to the accumulation of pigment in the choroid. The optic dish margins are normally distinct and sharply demarcated, not blurred around the edges. The macula is located on the temporal side of the fundus of the eye, not on the nasal side of the retina. The correct answer of a normal finding is that the optic disc is a yellow-orange color.

Question 4

An ophthalmic examination reveals papilledema. What does this finding indicate?

Accepted Answer

Papilledema, or choked disk, is a serious sign of increased intracranial pressure, which is caused by a space-occupying mass such as a brain tumor or hematoma. This pressure causes venous stasis in the globe, showing redness, congestion, and elevation of the optic disc, blurred margins, hemorrhages, and absent venous pulsations. Papilledema is not associated with the conditions in the other responses. Papilledema is not associated with retinal detachment, diabetic retinopathy, or acute-angle glaucoma.

Question 5

The nurse is assessing color vision of a male child. Which statement is correct?

Accepted Answer

Boys should be tested only once for color vision between the ages of 4 and 8 years. Color vision is not tested in girls because it is rare in girls. Testing is performed with the Ishihara test, which is a series of polychromatic cards.

Question 6

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?

Accepted Answer

The presence of shadows in the anterior chamber may be a sign of acute angle-closure glaucoma. The normal iris is flat and creates no shadows. This technique (directing a light across the iris of a patient's eye from the temporal side) is not the technique to assess for dacryocystitis, conjunctivitis, or cataracts.

Question 7

A 2-week-old infant can fixate on an object but cannot follow a light or bright toy. What should the nurse do?

Accepted Answer

This is a normal finding. By 2 to 4 weeks an infant can fixate on an object. By the age of 1 month, the infant should fixate and follow a bright light or toy. This is a normal finding. The nurse cannot assess visual fields as the infant cannot follow instructions; assessing the pupillary light reflex does not assess for blindness; and the nurse should not expect the infant to be able follow an object. An infant can fixate on an object by 2 to 4 weeks and by the age of 1 month, should be able to fixate and follow a bright light or toy.

Question 8

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?

Accepted Answer

Periorbital edema occurs with local infections, crying, and systemic conditions such as heart failure, renal failure, allergy, and hypothyroidism. Periorbital edema is not associated with blepharitis. Exophthalmos is associated with hyperthyroidism or thyrotoxicosis and hyperthyroidism is not associated with periorbital edema (although hypothyroidism is). Periorbital edema is not associated with blepharitis, either. Thus, the nurse should ask about these conditions.

Question 9

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?

Accepted Answer

A hordeolum, or stye, is a painful, red, and swollen pustule at the lid margin. A chalazion is a nodule protruding on the lid, toward the inside, and is nontender, firm, with discrete swelling. Dacryocystitis is an inflammation of the lacrimal sac. Blepharitis is inflammation of the eyelids. The painful, red, swollen pustule at the lid margin on this patient's eyelid is a hordeolum or stye.

Question 10

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?

Accepted Answer

A corneal abrasion causes irregular ridges in reflected light, which produce a shattered appearance to light rays. No opacities should be observed in the cornea. The other responses are not correct.

Question 11

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?

Accepted Answer

Macular degeneration is characterized by the loss of central vision and is the most common cause of blindness. Cataracts would show lens opacity. Chronic open-angle glaucoma, the most common type of glaucoma, involves a gradual loss of peripheral vision. These findings are not consistent with normal vision at this, or any, age. These findings are not consistent with normal vision at this, or any, age. The increased intraocular pressure of chronic open-angle glaucoma, the most common type of glaucoma, involves a gradual loss of peripheral vision but not central vision. The symptoms this patient has suggest macular degeneration. Macular degeneration is characterized by the loss of central vision and is the most common cause of blindness.

Question 12

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?

Accepted Answer

Testing for strabismus is done by performing the corneal light reflex test and the cover test. The Snellen eye chart and confrontation test are not used to test for strabismus. Examining the external structures of the eye, assessing visual acuity with the Snellen eye chart, and assessing for confrontation are not used to test for strabismus.

Question 13

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?

Accepted Answer

The red glow filling the person's pupil is the red reflex and is a normal finding caused by the reflection of the ophthalmoscope light off the inner retina, so there is no need to check the light source of the ophthalmoscope or referral of the patient, and the interruption or absence, not the presence, of the red reflex would indicate an opacity. The other responses are not correct.

Question 14

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?

Accepted Answer

With retinal detachment, the person has shadows or diminished vision in one quadrant or one half of the visual field. The other responses are not signs of retinal detachment. Loss of central or peripheral vision or sudden loss of pupillary constriction and accommodation are not signs of retinal detachment.

Question 15

In a patient who has anisocoria, what would the nurse expect to observe?

Accepted Answer

Unequal pupil size is termed anisocoria. It normally exists in 5% of the population but may also be indicative of central nervous system disease. Dilated pupils, excessive tearing, and uneven curvature of the lens are not associated with anisocoria. Anisocoria is the term for unequal pupil size. It exists in about 5% of the population but may also be indicative of central nervous system disease.

Question 16

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.)

Accepted Answer

Open-angle glaucoma is the most common type of glaucoma; virtually no symptoms are exhibited. Vision loss begins with the peripheral vision, which often goes unnoticed because individuals learn to compensate intuitively by turning their heads. The other characteristics are those of closed angle glaucoma.

Question 17

When assessing the pupillary light reflex, the nurse should use which technique?

Accepted Answer

To test the pupillary light reflex, the nurse should advance a light in from the side and note the direct and consensual pupillary constriction.

Question 18

The nurse is performing an eye assessment on an 80-year-old patient. Which of these findings is considered abnormal?

Accepted Answer

Pupils are small in the older adult, and the pupillary light reflex may be slowed, but pupillary constriction should be symmetric. The assessment findings in the other responses are considered normal in older people. Decrease in tear production, presence of arcus senilis around the cornea, and loss of outer hair on the eyebrows are normal findings in the aging adult. Although pupils are small in the older adult, and the pupillary light reflex may be slowed, the pupillary constriction should be symmetric. Therefore, unequal pupillary constriction in response to light is an abnormal finding.

Question 19

The nurse is assessing a patient's eyes for the accommodation response and would expect to see which normal finding?

Accepted Answer

The accommodation reaction includes pupillary constriction and convergence of the axes of the eyes. The other responses are not correct. Dilation of the pupil occurs with dimming the lights and having the person look in the distance, not when assessing for accommodation. Consensual light reflex is simultaneous constriction of the pupil opposite the pupil that light is being shined on. Conjugate, not disconjugate, movement of the eye (the axes of both eyes remains parallel while moving) is a normal finding.

Quiz 15: Eyes