NURS 340 Health Assessment
Exam 2 Study Guide
Exam 2 covers chapters 11-15 in the following text:
Hogan-Quigley, B., Palm, M. L., & Bickley, L. (2017). Bates’ nursing guide to physical examination
and history taking (2nd ed.). Wolters Kluwer.
Although an exam question may come from any part of chapters 11-15, the student should
focus on the following:
Chapter 11
o Anatomy and physiology of the eye
o The cranial nerves affecting the eyes and the function of each
The levator palpebrae, the muscle that raises the upper eyelid, is innervated by
the oculomotor nerve
o The tests used to assess the eyes (name, how it is performed, why it is used)
The Light Reaction. A light beam shining onto one retina causes pupillary
constriction both in that eye, termed the direct reaction to light, and in the
opposite eye, the consensual reaction. The initial sensory pathways are similar
to those described for vision: retina, optic nerve, and optic tract. The pathways
diverge in the midbrain, however, and impulses are transmitted through the
oculomotor nerve, CN III, to the constrictor muscles of the iris of each eye.
The Near Reaction. When a person shifts gaze from a far object to a near one,
the pupils constrict. This response, like the light reaction, is mediated by the
oculomotor nerve (CN III). At the same time as the pupillary constriction, but not
a part of it, are (1) convergence of the eyes, an extraocular movement; and (2)
accommodation, an increased convexity of the lenses caused by contraction of
the ciliary muscles. This change in shape of the lenses brings near objects into
focus but is not visible to the examiner.
Autonomic Nerve Supply to the Eyes. Fibers traveling in the oculomotor nerve
(CN III) and producing pupillary constriction are part of the parasympathetic
nervous system. The iris is also supplied by sympathetic fibers. When these are
stimulated, the pupil dilates, and the upper eyelid rises a little, as if from fear.
The sympathetic pathway starts in the hypothalamus and passes down through
the brainstem and cervical cord into the neck. From there, it follows the carotid
artery or its branches into the orbit. A lesion anywhere along this pathway may
impair sympathetic effects that dilate the pupil.
Extraocular Movements. The coordinated action of six muscles: the four rectus
(superior, lateral, medial, and inferior) and two oblique (inferior and superior),
control the eye. To test the function of each muscle and the nerve that supplies
it, ask the patient to move the eye in the direction controlled by that muscle.
There are six cardinal directions, indicated by the lines on the figure below.
When a person looks down and to the right, for example, the right inferior
rectus (CN III) is principally responsible for moving the right eye, whereas the left
superior oblique (CN IV) is principally responsible for moving the left. If one of
these muscles is paralyzed, the eye will deviate from its normal position in that
direction of gaze and the eyes will no longer appear conjugate, or parallel.
This study source was downloaded by 100000827141222 from CourseHero.com on 01-25-2022 02:51:39 GMT -06:00
https://www.coursehero.com/file/93086766/Exam2StudyGuide-1docx/
Exam 2 Study Guide
Exam 2 covers chapters 11-15 in the following text:
Hogan-Quigley, B., Palm, M. L., & Bickley, L. (2017). Bates’ nursing guide to physical examination
and history taking (2nd ed.). Wolters Kluwer.
Although an exam question may come from any part of chapters 11-15, the student should
focus on the following:
Chapter 11
o Anatomy and physiology of the eye
o The cranial nerves affecting the eyes and the function of each
The levator palpebrae, the muscle that raises the upper eyelid, is innervated by
the oculomotor nerve
o The tests used to assess the eyes (name, how it is performed, why it is used)
The Light Reaction. A light beam shining onto one retina causes pupillary
constriction both in that eye, termed the direct reaction to light, and in the
opposite eye, the consensual reaction. The initial sensory pathways are similar
to those described for vision: retina, optic nerve, and optic tract. The pathways
diverge in the midbrain, however, and impulses are transmitted through the
oculomotor nerve, CN III, to the constrictor muscles of the iris of each eye.
The Near Reaction. When a person shifts gaze from a far object to a near one,
the pupils constrict. This response, like the light reaction, is mediated by the
oculomotor nerve (CN III). At the same time as the pupillary constriction, but not
a part of it, are (1) convergence of the eyes, an extraocular movement; and (2)
accommodation, an increased convexity of the lenses caused by contraction of
the ciliary muscles. This change in shape of the lenses brings near objects into
focus but is not visible to the examiner.
Autonomic Nerve Supply to the Eyes. Fibers traveling in the oculomotor nerve
(CN III) and producing pupillary constriction are part of the parasympathetic
nervous system. The iris is also supplied by sympathetic fibers. When these are
stimulated, the pupil dilates, and the upper eyelid rises a little, as if from fear.
The sympathetic pathway starts in the hypothalamus and passes down through
the brainstem and cervical cord into the neck. From there, it follows the carotid
artery or its branches into the orbit. A lesion anywhere along this pathway may
impair sympathetic effects that dilate the pupil.
Extraocular Movements. The coordinated action of six muscles: the four rectus
(superior, lateral, medial, and inferior) and two oblique (inferior and superior),
control the eye. To test the function of each muscle and the nerve that supplies
it, ask the patient to move the eye in the direction controlled by that muscle.
There are six cardinal directions, indicated by the lines on the figure below.
When a person looks down and to the right, for example, the right inferior
rectus (CN III) is principally responsible for moving the right eye, whereas the left
superior oblique (CN IV) is principally responsible for moving the left. If one of
these muscles is paralyzed, the eye will deviate from its normal position in that
direction of gaze and the eyes will no longer appear conjugate, or parallel.
This study source was downloaded by 100000827141222 from CourseHero.com on 01-25-2022 02:51:39 GMT -06:00
https://www.coursehero.com/file/93086766/Exam2StudyGuide-1docx/
