Fundamental Concepts in Nursing (NUR 352)|Chapter 11: Assessing the Eyes

Fundamental Concepts in Nursing (NUR 352)Chapter 11: Assessing the Eyes1. Which of the following cranial nerves are responsible for the activity of the eye? Select all that apply. 1. Cranial nerve III 2. Cranial nerve IV 3. Cranial nerve I 4. Cranial nerve VI 5. Cranial nerve X 2. The nursing instructor is teaching a group of students about the Healthy People 2020 goals related to improving vision health. Which objectives should the nursing student be prepared to include in future patient education? Select all that apply. 1. Have routine eye examinations performed. 2. Rest your eyes. 3. Wear protective eyewear. 4. Increase protein in diet. 5. Take B12 vitamins daily. 3. The extraocular structures of the eye include which of the following? Select all that apply. 1. Sclera 2. Conjunctiva 3. Optic nerve 4. Lacrimal glands 5. Iris 4. A patient is diagnosed with glaucoma. The nurse reviews the patient’s medical record, expecting to note which of the following? Select all that apply. 1. Medications for intraocular pressure 2. Decreased visual acuity 3. Loss of peripheral vision 4. Redness of the conjunctiva 5. Swelling of the eyes Downloaded by DANIEL NDAMBIRI () lOMoARcPSD| A++ 5. An older patient is diagnosed with macular degeneration and asks the nurse to explain this condition. The nurse includes which information in her response to the patient? Select all that apply. 1. “It may be an age-related problem.” 2. “It is a breakdown of cells in the macula of the retina.” 3. “It is caused by a gradual blockage of the arteries and veins in your eye.” 4. “It is a result of deterioration of the area that controls peripheral vision.” 5. “Treatment aims to help maximize remaining vision.” 6. You are assessing a patient’s eyes. You start by inspecting the anterior eye structures. Normal findings would include which of the following? Select all that apply. 1. Eyelashes equally distributed 2. Yellow drainage from lacrimal ducts 3. Eyes symmetrical 4. Cornea with white opacities 5. Sclera white 6. No abnormal involuntary movement 7. You are assessing a patient’s eye using the Confrontation Test for Visual Field Testing. At what angles should the field of vision be assessed? Select all that apply. 1. Temporal 2. Nasal 3. Posteriorly 4. Superiorly 5. Inferiorly 8. You are performing an eye assessment on a patient in the intensive care unit who suffered a head injury. Which of the following are normal findings? Select all that apply. 1. The left pupil measures 7 mm and the right pupil measures 6 mm. 2. The eyes are symmetrical. 3. There is a drooping eyelid and constricted right pupil. 4. The pupils dilate in response to light. 9. You are assessing the internal structures of the eye. Normal findings of the optic disc include which of the following? Select all that apply. Downloaded by DANIEL NDAMBIRI () lOMoARcPSD| A++ 1. Color is red or dark orange 2. Shape is round or oval 3. Disc outline is sharp or cloudy 4. Central physiologic cup (if present) is a dark gray color 10. You are assessing for color blindness. What are the most common colors affected when you have color blindness? Select all that apply. 1. White 2. Red 3. Blue 4. Brown 5. Green 11. A patient has fallen off a small cliff and hit his head. He reports blurry vision. What is the purpose of inspecting this patient’s pupil size and consensual pupil response? Select all that apply. 1. To assess the integrity of the optic pathways 2. To assess the accommodation reflex 3. To assess the pupillary light reflex 4. To assess the functioning of the ocular muscles 12. You are assessing a patient’s eyes and note that the left eyelid is drooping. What assessment should you perform next? 1. Assess the nasolacrimal folds. 2. Assess the conjunctiva for drainage. 3. Assess the palpebral fissures. 4. Assess the pupil reaction. 13. The nurse is preparing a patient for a dilated eye examination using mydriatic eye drops. Which areas of the eye will be examined? 1. Eyebrows, conjunctiva, and optic disc 2. Conjunctiva, optic disc, and eyelids 3. Pupils, sclera, and lacrimal glands 4. Fundus, macula, and optic disc Downloaded by DANIEL NDAMBIRI () lOMoARcPSD| A++ 14. The nurse is preparing a patient for a dilated eye examination using mydriatic eye drops. What post-procedure education should be provided to the patient? 1. “You should not drive for 1 to 2 hours.” 2. “You will need to remain on bedrest today.” 3. “You should follow up with the doctor in a week.” 4. “You may feel a numbing sensation for several hours.” 15. An elderly African American man reports that he has been diagnosed with open-angle glaucoma. He has a past medical history of being a type 2 diabetic and states that he takes pills for his diabetes. He does not know what he did wrong to have this eye condition and asks if you can help him to understand why he has glaucoma. How should the nurse respond? 1. “Open-angle glaucoma is more common in diabetics and African Americans.” 2. “You should not have glaucoma at your age, but sometimes it just develops.” 3. “Open-angle glaucoma occurs more often when you do not get regular eye examinations.” 4. “Open-angle glaucoma occurs most often among all family members.”