Chapter 14: Eyes

Question 1

When examining the eye, the nurse is aware that the bulbar conjunctiva:

a. overlies the sclera.
b. covers the iris and pupil.
c. is visible at the inner canthus of the eye.
d. is a thin mucous membrane that lines the lids.

Answer 1

a.

Question 2

During ocular examinations, the nurse keeps in mind that movement of the extraocular muscles is:

a. decreased in the older adult.
b. impaired in a patient with cataracts.
c. stimulated by cranial nerves I and II.
d. stimulated by cranial nerves III, IV, and VI.

Answer 2

d.

Question 3

Which of the following statements about 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 (CN V) and the trochlear (CN IV) nerves 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.

Answer 3

a.

Question 4

When examining a patient’s eyes, the nurse recalls that stimulation of the sympathetic branch of the autonomic nervous system:

a. causes pupillary constriction.
b. adjusts the eye for near vision.
c. elevates the eyelid and dilates the pupil.
d. causes contraction of the ciliary body.

Answer 4

c.

Question 5

Intraocular pressure is determined by the:

a. thickness or bulging of the lens.
b. posterior chamber as it accommodates an increase in fluid.
c. contraction of the ciliary body in response to the aqueous humor within the eye.
d. amount of aqueous humor produced and resistance to its outflow at the angle of the anterior chamber.

Answer 5

d.

Question 6

Which of the following statements regarding visual pathways and visual fields is true?

a. The right side of the brain interprets vision for the right eye.
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. The light impulses are conducted through the optic nerve to the temporal lobes of the brain.

Answer 6

b.

Question 7

The nurse is testing a patient’s visual accommodation, which refers to:

a. pupillary constriction when looking at a near object.
b. pupillary dilation when looking at a far object.
c. changes in peripheral vision in response to light.
d. involuntary blinking in the presence of bright light.

Answer 7

a.

Question 8

A patient has a normal pupillary light reflex. The nurse recognizes this to indicate that:

a. vision in both eyes converges to focus on the light.
b. light is reflected at the same spot in both eyes.
c. the eye focuses the image at the centre of the pupil.
d. constriction of both pupils occurs in response to bright light.

Answer 8

d.

Question 9

The mother of a newborn asks the nurse when her baby’s eyesight will be fully developed. The nurse should say:

a. “Vision is not totally developed until 2 years of age.”
b. “Infants develop the ability to focus on an object around 8 months.”
c. “By about 3 months, infants develop more co-ordinated eye movements and can fixate on an object.”
d. “Most infants have uncoordinated eye movements in the first year of life.”

Answer 9

c.

Question 10

Which of the following physiological changes is responsible for presbyopia?

a. Degeneration of the cornea
b. Loss of lens elasticity
c. Decreased adaptation to darkness
d. Decreased distance vision abilities

Answer 10

b.

Question 11

Which of the following would the nurse expect to find when examining the eyes of a patient of African descent?

a. Increased night vision
b. A dark retinal background
c. Increased photosensitivity
d. Narrowed palpebral fissures

Answer 11

b.

Question 12

A 52-year-old patient complains of seeing occasional “floaters or spots” in front of his eyes. The nurse should:

a. examine the retina to determine the number of floaters.
b. presume the patient has glaucoma and refer him for further testing.
c. consider this an abnormal finding and refer him to an ophthalmologist.
d. know that “floaters” are usually not significant and are caused by condensed vitreous fibres.

Answer 12

d.

Question 13

The nurse is preparing to assess the visual acuity of a 16-year-old patient. How would the nurse proceed?

a. Perform the confrontation test.
b. Ask the patient to read the print on a hand-held Jaeger card.
c. Use the Snellen chart positioned 6.1 m (20 feet) away from the patient.
d. Determine the patient’s ability to read newsprint at a distance of 30 to 35 cm (12 to 14 inches).

Answer 13

c.

Question 14

A patient’s vision is recorded as 20/30 when the Snellen eye chart is used. The nurse recognizes that these results indicate that:

a. at 9.1 m (30 feet) the patient can read the entire chart.
b. the patient can read at 6.1 m (20 feet) what a person with normal vision can read at 9.1 m (30 feet).
c. the patient can read the chart from 6.1 m (20 feet) with the left eye and 9.1 m (30 feet) with the right eye.
d. the patient can read from 9.1 m (30 feet) what a person with normal vision can read from 6.1 m (20 feet).

Answer 14

b.

Question 15

A patient is unable to read the 20/100 line on the Snellen chart. The nurse would:

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 and ask him or her to read the smallest line of print possible.

Answer 15

a.

Question 16

A patient’s vision is recorded as 20/80 in each eye. The nurse recognizes that this finding indicates:

a. poor vision.
b. acute vision.
c. normal vision.
d. presbyopia.

Answer 16

a.

Question 17

When performing the corneal light reflex assessment, the nurse notes that the light is reflected at the 2 o’clock position in each eye. The nurse would:

a. consider this a normal finding.
b. refer the individual for further evaluation.
c. document this as an asymmetric light reflex.
d. perform the confrontation test to validate the findings.

Answer 17

a.

Question 18

Which of the following is an expected normal finding in the diagnostic positions test?

a. Convergence of vision in both eyes
b. Parallel movement of both eyes
c. Nystagmus in extreme superior gaze
d. A slight amount of lid lag when moving the eyes from a superior position to an inferior position

Answer 18

b.

Question 19

In assessing the sclera of a patient of African descent, which of the following would be an expected finding?

a. Yellow fatty deposits over the cornea
b. Pallor near the outer canthus of the lower lid
c. Yellow colour of the sclera that extends up to the iris
d. The presence of small brown macules on the sclera

Answer 19

d.

Question 20

A 60-year-old man is at the clinic for an eye examination. The nurse suspects that he has ptosis of one eye. How would 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.

Answer 20

c.

Question 21

What would be a normal finding when assessing the lacrimal apparatus during an eye examination?

a. The presence of tears along the inner canthus
b. A blocked nasolacrimal duct in a newborn infant
c. A slight swelling over the upper lid and along the bony orbit if the patient has a cold
d. The absence of drainage from the puncta the inner orbital rim is pressed

Answer 21

d.

Question 22

When assessing pupillary light reflex, which of the following techniques should the nurse use?

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 about 7 cm from the nose.

Answer 22

c.

Question 23

The nurse is assessing a patient’s eyes for the accommodation response and would expect to see:

a. dilation of the pupils.
b. a consensual light reflex.
c. conjugate movement of the eyes.
d. convergence of the axes of the eyes.

Answer 23

d.

Question 24

In using the ophthalmoscope to assess a patient’s eyes, the nurse notes a red glow in the patient’s pupils. On the basis of this finding, the nurse would:

a. suspect that there is an opacity in the lens or cornea.
b. check the light source of the ophthalmoscope to verify that it is functioning.
c. consider this a normal reflection of the ophthalmoscope light off the inner retina.
d. continue with the ophthalmoscopic examination and refer the patient for further evaluation.

Answer 24

c.

Question 25

When the retina is examined, which of the following is considered a normal finding?

a. An optic disc that is a yellow-orange colour
b. Optic disc margins that are blurred around the edges
c. The presence of pigmented crescents in the macular area
d. The presence of the macula located on the nasal side of the retina

Answer 25

a.

Question 26

A 2-week-old infant can fixate on an object but not follow a light or bright toy. The nurse would:

a. consider this a normal finding.
b. assess the pupillary light reflex for possible blindness.
c. continue with the examination and assess visual fields.
d. expect that a 2-week-old infant should be able to fixate and follow an object.

Answer 26

a.

Question 27

To assess colour vision in a male child, the nurse would:

a. check colour vision annually until the age of 18 years.
b. ask the child to identify the colour of his or her clothing.
c. test for colour vision once between the ages of 4 and 8.
d. begin colour vision screening at the child’s 2-year checkup.

Answer 27

c.

Question 28

The nurse is conducting an eye clinic at the daycare centre. When examining a 2-year-old child, if “lazy eye” is suspected, the nurse would:

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.

Answer 28

d.

Question 29

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

a. A decrease in tear production
b. Unequal pupillary constriction in response to light
c. The presence of arcus senilis seen around the cornea
d. Loss of hair at the outer line of the eyebrows due to a decrease in hair follicles

Answer 29

b.

Question 30

The nurse notes the presence of periorbital edema when performing eye assessment on a 70-year-old patient. The nurse will:

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 because this is often associated with periorbital edema.

Answer 30

c.

Question 31

When a light is directed across the iris of the eye from the temporal side, the examiner is assessing for:

a. drainage from dacryocystitis.
b. the presence of conjunctivitis over the iris.
c. the presence of shadows, which may indicate glaucoma.
d. a scattered light reflex, which may be indicative of cataracts.

Answer 31

c.

Question 32

In a patient with anisocoria, the nurse would expect to observe:

a. dilated pupils.
b. excessive tearing.
c. pupils of unequal size.
d. an uneven curvature of the lens.

Answer 32

c.

Question 33

A man comes to the emergency department after he had participated in a boxing match, and his left eye is swollen almost shut. He has bruises on his face and neck. He says he is worried because he “can’t see well” from his left eye. The physician suspects retinal damage. Signs of retinal detachment include:

a. loss of central vision.
b. shadow or diminished vision in one quadrant or one half of the visual field.
c. loss of peripheral vision.
d. sudden loss of pupillary constriction and accommodation.

Answer 33

b.

Question 34

A patient complains of pain in her right eye. On examination, the nurse sees a pustule at the lid margin that is painful to touch, red, and swollen. The nurse recognizes that this is:

a. a chalazion.
b. a hordeolum (stye).
c. dacryocystitis.
d. blepharitis.

Answer 34

c.

Question 35

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. These findings suggest that:

a. she may have macular degeneration.
b. her vision is normal for someone her age.
c. she has the beginning stages of cataract formation.
d. she has increased intraocular pressure or glaucoma.

Answer 35

a.

Question 36

A patient comes into the emergency department after an accident at work. he had not been wearing safety glasses, and a machine had blown dust into his eyes. The nurse examines his corneas by shining a light from the side across the cornea. What findings would suggest that he has suffered corneal abrasion?

a. Smooth and clear corneas
b. Opacity of the lens behind the cornea
c. Bleeding from the areas across the cornea
d. A shattered look to the light rays reflecting off the cornea

Answer 36

d.

Question 37

An ophthalmic examination reveals papilledema. The nurse is aware that this finding indicates:

a. retinal detachment.
b. diabetic retinopathy.
c. acute-angle glaucoma.
d. increased intracranial pressure.

Answer 37

d.

Question 38

During an ophthalmoscopic examination of a patient, the examiner notes areas of exudate that look like “cotton wool” or fluffy grey-white cumulus clouds. Which of the possible problems below does this finding indicate?

a. Diabetes
b. Hyperthyroidism
c. Glaucoma
d. Hypotension

Answer 38

a.

Question 39

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 notes the presence of blood in the anterior chamber of the eye. This finding indicates the presence of:

a. hypopyon.
b. hyphema.
c. corneal abrasion.
d. iritis.

Answer 39

b.