AVN 2035 MED SURG 3 MIDTERM EXAM
Comprehensive Review Questions with ANSWERs
and Rationales ACTUAL 2026!!
QUESTION 1
The nurse is providing health promotion teaching to a group of older adults. Which information will the
nurse include about routine glaucoma testing?
A) A Snellen chart will be used to assess distance vision
B) A Tono-pen will be applied to the surface of the eye
C) A ophthalmoscope will be used to examine the retina
D) A visual field test will be performed to check peripheral vision
ANSWER: B) A Tono-pen will be applied to the surface of the eye
Rationale: Glaucoma is characterized by increased intraocular pressure (IOP) due to impaired drainage
of aqueous humor. The Tono-pen is a handheld electronic device that measures IOP by making contact
with the corneal surface. Normal IOP ranges from 10-21 mmHg. Elevated pressure can damage the optic
nerve, leading to irreversible vision loss. Routine glaucoma screening is essential for early detection and
treatment. Option A describes visual acuity testing, not glaucoma screening. Option C describes
fundoscopic examination for retinal assessment. Option D describes perimetry testing for visual field
defects, which assesses damage from glaucoma but is not the primary screening tool.
,QUESTION 2
The nurse is performing an eye examination on a 76-year-old patient. The nurse should refer the patient
for a more extensive assessment based on which finding?
A) The patient reports difficulty reading small print
B) The patient reports persistent photophobia
C) The patient reports needing more light to read
D) The patient reports decreased tear production
ANSWER: B) The patient reports persistent photophobia
Rationale: Photophobia (abnormal light sensitivity) is not a normal age-related change and may indicate
underlying pathology such as uveitis, corneal abrasion, meningitis, or migraine. Older adults commonly
experience presbyopia (difficulty reading small print), increased need for lighting, and decreased tear
production as normal age-related changes. These changes occur due to lens stiffening, reduced pupil
size, and decreased lacrimal gland function. Persistent photophobia requires prompt referral for
comprehensive ophthalmologic evaluation to identify and treat the underlying cause.
QUESTION 3
The nurse performing an eye examination will document normal findings for accommodation when:
A) The pupils dilate while fixating on an object being moved closer
B) The pupils constrict while fixating on an object being moved closer
C) The pupils remain unchanged while fixating on an object being moved closer
D) The pupils dilate while fixating on an object being moved farther away
ANSWER: B) The pupils constrict while fixating on an object being moved closer
,Rationale: Accommodation is the ability of the lens to adjust its shape to focus on objects at varying
distances. When an object moves closer to the eyes, three responses occur: pupillary constriction
(miosis), convergence of the eyes, and increased lens convexity. Pupillary constriction increases depth of
field and reduces spherical aberration. The near response is controlled by the parasympathetic nervous
system. Aging causes presbyopia, where the lens loses elasticity, reducing accommodative ability.
Options A and D describe pupillary dilation, which occurs in low light or with sympathetic stimulation.
Option C indicates absent accommodative response.
QUESTION 4
Which assessment finding alerts the nurse to provide patient teaching about cataract development?
A) Floaters and flashes of light
B) Blurred vision and light sensitivity
C) Eye pain and headache
D) Double vision and drooping eyelid
ANSWER: B) Blurred vision and light sensitivity
Rationale: Cataracts develop when proteins in the lens deteriorate and clump together, causing the lens
to thicken and harden, obstructing light passage to the retina. Classic early symptoms include blurred
vision, glare, light sensitivity (photophobia), and decreased night vision. As cataracts progress, patients
may experience halos around lights, frequent prescription changes, and faded color perception. Floaters
and flashes suggest retinal detachment. Eye pain and headache may indicate acute angle-closure
glaucoma. Double vision with drooping eyelid suggests neurological issues such as myasthenia gravis or
cranial nerve palsy.
QUESTION 5
Assessment of a patient's visual acuity reveals that the left eye can see at 20 feet what a person with
normal vision can see at 50 feet and the right eye can see at 20 feet what a person with normal vision
can see at 40 feet. The nurse records which finding?
A) OS 20/50; OD 20/40
, B) OD 20/50; OS 20/40
C) OU 20/50; OS 20/40
D) OS 20/40; OD 20/50
ANSWER: A) OS 20/50; OD 20/40
Rationale: In visual acuity documentation, OS (oculus sinister) refers to the left eye, OD (oculus dexter)
refers to the right eye, and OU (oculus uterque) refers to both eyes. The numerator (20) represents the
standard distance in feet from the Snellen chart. The denominator indicates the distance at which a
person with normal vision could read the same line. Thus, OS 20/50 means the left eye can read at 20
feet what normal vision can read at 50 feet, indicating poorer acuity. OD 20/40 indicates better acuity in
the right eye. Documentation must accurately reflect which eye was tested and the specific visual acuity
measurement.
QUESTION 6
A patient with diabetes mellitus reports sudden onset of floaters and flashes of light in the right eye.
What is the nurse's priority action?
A) Reassure the patient that this is a normal age-related change
B) Instruct the patient to rest the eyes and apply warm compresses
C) Refer the patient for immediate ophthalmologic evaluation
D) Administer prescribed eye drops for dry eyes
ANSWER: C) Refer the patient for immediate ophthalmologic evaluation
Rationale: Sudden onset of floaters and flashes of light are classic warning signs of retinal detachment, a
medical emergency requiring immediate intervention. Patients with diabetes are at increased risk for
retinal detachment due to diabetic retinopathy, vitreous hemorrhage, and traction on the retina.
Without prompt treatment, retinal detachment can lead to permanent vision loss. Normal age-related
changes include gradual onset of floaters, not sudden or accompanied by flashes. Rest and warm
compresses are inappropriate for this emergency. Eye drops for dry eyes would not address the
underlying pathology.
Comprehensive Review Questions with ANSWERs
and Rationales ACTUAL 2026!!
QUESTION 1
The nurse is providing health promotion teaching to a group of older adults. Which information will the
nurse include about routine glaucoma testing?
A) A Snellen chart will be used to assess distance vision
B) A Tono-pen will be applied to the surface of the eye
C) A ophthalmoscope will be used to examine the retina
D) A visual field test will be performed to check peripheral vision
ANSWER: B) A Tono-pen will be applied to the surface of the eye
Rationale: Glaucoma is characterized by increased intraocular pressure (IOP) due to impaired drainage
of aqueous humor. The Tono-pen is a handheld electronic device that measures IOP by making contact
with the corneal surface. Normal IOP ranges from 10-21 mmHg. Elevated pressure can damage the optic
nerve, leading to irreversible vision loss. Routine glaucoma screening is essential for early detection and
treatment. Option A describes visual acuity testing, not glaucoma screening. Option C describes
fundoscopic examination for retinal assessment. Option D describes perimetry testing for visual field
defects, which assesses damage from glaucoma but is not the primary screening tool.
,QUESTION 2
The nurse is performing an eye examination on a 76-year-old patient. The nurse should refer the patient
for a more extensive assessment based on which finding?
A) The patient reports difficulty reading small print
B) The patient reports persistent photophobia
C) The patient reports needing more light to read
D) The patient reports decreased tear production
ANSWER: B) The patient reports persistent photophobia
Rationale: Photophobia (abnormal light sensitivity) is not a normal age-related change and may indicate
underlying pathology such as uveitis, corneal abrasion, meningitis, or migraine. Older adults commonly
experience presbyopia (difficulty reading small print), increased need for lighting, and decreased tear
production as normal age-related changes. These changes occur due to lens stiffening, reduced pupil
size, and decreased lacrimal gland function. Persistent photophobia requires prompt referral for
comprehensive ophthalmologic evaluation to identify and treat the underlying cause.
QUESTION 3
The nurse performing an eye examination will document normal findings for accommodation when:
A) The pupils dilate while fixating on an object being moved closer
B) The pupils constrict while fixating on an object being moved closer
C) The pupils remain unchanged while fixating on an object being moved closer
D) The pupils dilate while fixating on an object being moved farther away
ANSWER: B) The pupils constrict while fixating on an object being moved closer
,Rationale: Accommodation is the ability of the lens to adjust its shape to focus on objects at varying
distances. When an object moves closer to the eyes, three responses occur: pupillary constriction
(miosis), convergence of the eyes, and increased lens convexity. Pupillary constriction increases depth of
field and reduces spherical aberration. The near response is controlled by the parasympathetic nervous
system. Aging causes presbyopia, where the lens loses elasticity, reducing accommodative ability.
Options A and D describe pupillary dilation, which occurs in low light or with sympathetic stimulation.
Option C indicates absent accommodative response.
QUESTION 4
Which assessment finding alerts the nurse to provide patient teaching about cataract development?
A) Floaters and flashes of light
B) Blurred vision and light sensitivity
C) Eye pain and headache
D) Double vision and drooping eyelid
ANSWER: B) Blurred vision and light sensitivity
Rationale: Cataracts develop when proteins in the lens deteriorate and clump together, causing the lens
to thicken and harden, obstructing light passage to the retina. Classic early symptoms include blurred
vision, glare, light sensitivity (photophobia), and decreased night vision. As cataracts progress, patients
may experience halos around lights, frequent prescription changes, and faded color perception. Floaters
and flashes suggest retinal detachment. Eye pain and headache may indicate acute angle-closure
glaucoma. Double vision with drooping eyelid suggests neurological issues such as myasthenia gravis or
cranial nerve palsy.
QUESTION 5
Assessment of a patient's visual acuity reveals that the left eye can see at 20 feet what a person with
normal vision can see at 50 feet and the right eye can see at 20 feet what a person with normal vision
can see at 40 feet. The nurse records which finding?
A) OS 20/50; OD 20/40
, B) OD 20/50; OS 20/40
C) OU 20/50; OS 20/40
D) OS 20/40; OD 20/50
ANSWER: A) OS 20/50; OD 20/40
Rationale: In visual acuity documentation, OS (oculus sinister) refers to the left eye, OD (oculus dexter)
refers to the right eye, and OU (oculus uterque) refers to both eyes. The numerator (20) represents the
standard distance in feet from the Snellen chart. The denominator indicates the distance at which a
person with normal vision could read the same line. Thus, OS 20/50 means the left eye can read at 20
feet what normal vision can read at 50 feet, indicating poorer acuity. OD 20/40 indicates better acuity in
the right eye. Documentation must accurately reflect which eye was tested and the specific visual acuity
measurement.
QUESTION 6
A patient with diabetes mellitus reports sudden onset of floaters and flashes of light in the right eye.
What is the nurse's priority action?
A) Reassure the patient that this is a normal age-related change
B) Instruct the patient to rest the eyes and apply warm compresses
C) Refer the patient for immediate ophthalmologic evaluation
D) Administer prescribed eye drops for dry eyes
ANSWER: C) Refer the patient for immediate ophthalmologic evaluation
Rationale: Sudden onset of floaters and flashes of light are classic warning signs of retinal detachment, a
medical emergency requiring immediate intervention. Patients with diabetes are at increased risk for
retinal detachment due to diabetic retinopathy, vitreous hemorrhage, and traction on the retina.
Without prompt treatment, retinal detachment can lead to permanent vision loss. Normal age-related
changes include gradual onset of floaters, not sudden or accompanied by flashes. Rest and warm
compresses are inappropriate for this emergency. Eye drops for dry eyes would not address the
underlying pathology.
