Vocab
dark pigmentation to prevent light from reflecting internally and is heavily vascularized
Choroid
Located on temporal side of fundus, receives and transduces light from center of visual field
Macula
This painful, red lump on the eyelid margin is caused by infection of an eyelash follicle or sebaceous gland.
horedeolum (stye)
When examining the eye, the nurse notices that the patients eyelid margins approximate completely. The nurse recognizes that this assessment finding:
a. Is expected.
b. May indicate a problem with extraocular muscles.
c. May result in problems with tearing.
d. Indicates increased intraocular pressure.
ANS: A
The palpebral fissure is the elliptical open space between the eyelids, and, when closed, the lid margins approximate completely, which is a normal finding.
A 52-year-old patient describes the presence of occasional floaters or spots moving 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 these to be abnormal findings, and refer him to an ophthalmologist.
d. Know that floaters are usually insignificant and are caused by condensed vitreous fibers.
ANS: D
Floaters are a common sensation with myopia or after middle age and are attributable to condensed vitreous fibers. Floaters or spots are not usually significant, but the acute onset of floaters may occur with retinal detachment.
Functions as a diaphragm, varying opening at its center
Iris
Increased intraocular pressure leading to optic nerve compression
Glaucoma
To prevent spreading this highly contagious eye infection, nurses should emphasize hand hygiene, avoiding shared towels, and not touching or rubbing the eyes.
Conjunctivitis
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 (CNs) I and II.
d. Stimulated by CNs III, IV, and VI.
ANS: D
Movement of the extraocular muscles is stimulated by three CNs: III, IV, and VI.
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 patients ability to read newsprint at a distance of 12 to 14 inches.
ANS: C
The Snellen alphabet chart is the most commonly used and most accurate measure of visual acuity. The confrontation test is a gross measure of peripheral vision. The Jaeger card or newspaper tests are used to test near vision.
Round and regular, size determined by PNS and SNS
Pupil
Lens opacity, resulting from a clumping of proteins in lens
Cataract formation
Patients with this chronic eye condition should be taught the importance of taking prescribed eye drops consistently to prevent optic nerve damage and vision loss.
Glaucoma
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.
ANS: A
The cornea and the sclera make up the outer layer of the eye. The cornea is very sensitive to touch. The middle layer, the choroid, has dark pigmentation to prevent light from reflecting internally. The trigeminal nerve (CN V) and the facial nerve (CN VII) are stimulated when the outer surface of the eye is stimulated. The retina, in the inner layer of the eye, is where light waves are changed into nerve impulses.
A patients vision is recorded as 20/30 when the Snellen eye chart is used. The nurse interprets these results to indicate that:
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 left eye and 30 feet in the right eye.
d. The patient can read from 30 feet what a person with normal vision can read from 20 feet.
ANS: B
The top number indicates the distance the person is standing from the chart; the denominator gives the distance at which a normal eye can see.
Biconvex disc located posterior to pupil
Lens
Condition where Esotropia and exotropia are seen
Strabismus (lazy eye)
If a patient’s pupils are unequal or nonreactive to light, the nurse should recognize this as a possible sign of what type of serious issue?
increased intracranial pressure or neurological damage?
The nurse is testing a patients visual accommodation, which refers to which action?
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
ANS: A
The muscle fibers of the iris contract the pupil in bright light and accommodate for near vision, which also results in pupil constriction. The other responses are not correct.
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 individuals near vision.
c. Observe the distance between the palpebral fissures.
d. Perform the corneal light test, and look for symmetry of the light reflex.
ANS: C
Ptosis is a drooping of the upper eyelid that would be apparent by observing the distance between the upper and lower eyelids. The confrontation test measures peripheral vision. Measuring near vision or the corneal light test does not check for ptosis.
Visual receptive layer of eye where light waves change into nerve impulses
Retina
Age related, eyes have a hard time focusing on near objects because of lens loss of elasticity
Presbyopia
A patient reports blurred vision and sees halos around lights. On examination, the lens appears cloudy rather than clear.
Cataracts
The nurse is reviewing in age-related changes in the eye for a class. Which of these physiologic 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
ANS: B
The lens loses elasticity and decreases its ability to change shape to accommodate for near vision. This condition is called presbyopia.
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.
ANS: C
To test the pupillary light reflex, the nurse should advance a light in from the side and note the direct and consensual pupillary constriction.