Test Bank - Lewis's Medical Surgical Nursing (11th Edition by Harding) 196
Chapter 20: Assessment and Management: Visual
Problems
Test Bank MULTIPLE CHOICE
1. The nurse is providing health promotion teaching to a group of older adults. Which information will the nurse
include when teaching about routine glaucoma testing?
a. A Tono-pen will be applied to the surface of the eye.
b. The test involves reading a Snellen chart from 20 feet.
c. Medications will be used to dilate the pupils for the test.
d. The examination involves checking the pupils reaction to light.
ANS: A
Glaucoma is caused by an increase in intraocular pressure, which would be measured using the Tono-pen. The
other techniques are used in testing for other eye disorders.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
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 patients sclerae are light yellow.
b. The patient reports persistent photophobia.
c. The pupil recovers slowly after responding to a bright light.
d. There is a whitish gray ring encircling the periphery of the iris.
ANS: B
Photophobia is not a normally occurring change with aging, and would require further assessment. The other
assessment data are common gerontologic differences and would not be unusual in a 76-year-old patient.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
3. The nurse performing an eye examination will document normal findings for accommodation when
a. shining a light into the patients eye causes pupil constriction in the opposite eye.
b. a blink reaction follows touching the patients pupil with a piece of sterile cotton.
,Test Bank - Lewis's Medical Surgical Nursing (11th Edition by Harding) 197
c. covering one eye for 1 minute and noting pupil constriction as the cover is removed.
d. the pupils constrict while fixating on an object being moved closer to the patients eyes.
ANS: D
Accommodation is defined as the ability of the lens to adjust to various distances. The pupils constrict while
fixating on an object being moved far away to near the eyes. The other responses may also be elicited as part o
the eye examination, but they do not indicate accommodation.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
4. Which assessment finding alerts the nurse to provide patient teaching about cataract development?
a. History of hyperthyroidism
b. Unequal pupil size and shape
c. Blurred vision and light sensitivity
d. Loss of peripheral vision in both eyes
ANS: C
Classic signs of cataracts include blurred vision and light sensitivity. Thyroid problems are a major cause of
exophthalmos. Unequal pupil is indicative of anisocoria, not cataracts. Loss of peripheral vision is a sign of
glaucoma.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
5. Assessment of a patients 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. OU 20/40; OS 50/20
c. OD 20/40; OS 20/50
d. OU 40/20; OD 50/20
ANS: A
When documenting visual acuity, the first number indicates the standard (for normal vision) of 20 feet and the
second number indicates the line that the patient is able to read when standing 20 feet from the Snellen chart. OS
, Test Bank - Lewis's Medical Surgical Nursing (11th Edition by Harding) 198
is the abbreviation for left eye and OD is the abbreviation for right eye. The remaining three answers do no
correctly describe the patients visual acuity.
DIF: Cognitive Level: Understand (comprehension)
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
6. When assessing a patients consensual pupil response, the nurse should
a. have the patient cover one eye while facing the nurse.
b. observe for a light reflection in the center of both corneas.
c. instruct the patient to follow a moving object using only the eyes.
d. shine a light into one pupil and observe the response of both pupils.
ANS: D
The consensual pupil response is tested by shining a light into one pupil and observing for both pupils to
constrict. Observe the corneal light reflex to evaluate for weakness or imbalance of the extraocular muscles. In a
darkened room, ask the patient to look straight ahead while a penlight is shone directly on the cornea. The light
reflection should be located in the center of both corneas as the patient faces the light source. To perform
confrontation visual field testing, the patient faces the examiner and covers one eye, then counts the number of
fingers that the examiner brings into the visual field. Instructing the patient to follow a moving object only with
the eyes is testing for visual fields and extraocular movements.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
7. When obtaining a health history from a 49-year-old patient, which patient statement is most important to
communicate to the primary health care provider?
a. My eyes are dry now.
b. It is hard for me to see at night.
c. My vision is blurry when I read.
d. I cant see as far over to the side.
ANS: D
The decrease in peripheral vision may indicate glaucoma, which is not a normal visual change associated with
aging and requires rapid treatment. The other patient statements indicate visual problems (presbyopia, dryness,
and lens opacity) that are considered a normal part of aging.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
8. A 65-year-old patient is being evaluated for glaucoma. Which information given by the patient has
implications for the patients treatment?
Chapter 20: Assessment and Management: Visual
Problems
Test Bank MULTIPLE CHOICE
1. The nurse is providing health promotion teaching to a group of older adults. Which information will the nurse
include when teaching about routine glaucoma testing?
a. A Tono-pen will be applied to the surface of the eye.
b. The test involves reading a Snellen chart from 20 feet.
c. Medications will be used to dilate the pupils for the test.
d. The examination involves checking the pupils reaction to light.
ANS: A
Glaucoma is caused by an increase in intraocular pressure, which would be measured using the Tono-pen. The
other techniques are used in testing for other eye disorders.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
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 patients sclerae are light yellow.
b. The patient reports persistent photophobia.
c. The pupil recovers slowly after responding to a bright light.
d. There is a whitish gray ring encircling the periphery of the iris.
ANS: B
Photophobia is not a normally occurring change with aging, and would require further assessment. The other
assessment data are common gerontologic differences and would not be unusual in a 76-year-old patient.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
3. The nurse performing an eye examination will document normal findings for accommodation when
a. shining a light into the patients eye causes pupil constriction in the opposite eye.
b. a blink reaction follows touching the patients pupil with a piece of sterile cotton.
,Test Bank - Lewis's Medical Surgical Nursing (11th Edition by Harding) 197
c. covering one eye for 1 minute and noting pupil constriction as the cover is removed.
d. the pupils constrict while fixating on an object being moved closer to the patients eyes.
ANS: D
Accommodation is defined as the ability of the lens to adjust to various distances. The pupils constrict while
fixating on an object being moved far away to near the eyes. The other responses may also be elicited as part o
the eye examination, but they do not indicate accommodation.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
4. Which assessment finding alerts the nurse to provide patient teaching about cataract development?
a. History of hyperthyroidism
b. Unequal pupil size and shape
c. Blurred vision and light sensitivity
d. Loss of peripheral vision in both eyes
ANS: C
Classic signs of cataracts include blurred vision and light sensitivity. Thyroid problems are a major cause of
exophthalmos. Unequal pupil is indicative of anisocoria, not cataracts. Loss of peripheral vision is a sign of
glaucoma.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
5. Assessment of a patients 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. OU 20/40; OS 50/20
c. OD 20/40; OS 20/50
d. OU 40/20; OD 50/20
ANS: A
When documenting visual acuity, the first number indicates the standard (for normal vision) of 20 feet and the
second number indicates the line that the patient is able to read when standing 20 feet from the Snellen chart. OS
, Test Bank - Lewis's Medical Surgical Nursing (11th Edition by Harding) 198
is the abbreviation for left eye and OD is the abbreviation for right eye. The remaining three answers do no
correctly describe the patients visual acuity.
DIF: Cognitive Level: Understand (comprehension)
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
6. When assessing a patients consensual pupil response, the nurse should
a. have the patient cover one eye while facing the nurse.
b. observe for a light reflection in the center of both corneas.
c. instruct the patient to follow a moving object using only the eyes.
d. shine a light into one pupil and observe the response of both pupils.
ANS: D
The consensual pupil response is tested by shining a light into one pupil and observing for both pupils to
constrict. Observe the corneal light reflex to evaluate for weakness or imbalance of the extraocular muscles. In a
darkened room, ask the patient to look straight ahead while a penlight is shone directly on the cornea. The light
reflection should be located in the center of both corneas as the patient faces the light source. To perform
confrontation visual field testing, the patient faces the examiner and covers one eye, then counts the number of
fingers that the examiner brings into the visual field. Instructing the patient to follow a moving object only with
the eyes is testing for visual fields and extraocular movements.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
7. When obtaining a health history from a 49-year-old patient, which patient statement is most important to
communicate to the primary health care provider?
a. My eyes are dry now.
b. It is hard for me to see at night.
c. My vision is blurry when I read.
d. I cant see as far over to the side.
ANS: D
The decrease in peripheral vision may indicate glaucoma, which is not a normal visual change associated with
aging and requires rapid treatment. The other patient statements indicate visual problems (presbyopia, dryness,
and lens opacity) that are considered a normal part of aging.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
8. A 65-year-old patient is being evaluated for glaucoma. Which information given by the patient has
implications for the patients treatment?
