NURS634 /NURS 634 EXAM 2025
QUESTIONS AND ANSWERS
Subjective History Components - ANS chief complaint, HPI, PMH, family history, social
history, & review of systems: what patient tells you.
Objective History Components - ANS General survey, vitals, physical exam, diagnostic results,
what you observe or see.
Presbyopia - ANS age-related near-vision loss. Can see far away better.
Examples of sudden, painful unilateral vision loss - ANS corneal ulcer, acute closed angle
glaucoma, uveitis, or traumatic hyphema.
Examples of sudden, PAINLESS unilateral vision loss - ANS retinal detachment, macular
degeneration, or retinal vein occlusion.
Olfactory (CN 1) - ANS smell, occlude each nostril
Optic (CN 2) - ANS Vision-Snellen chart, an enlarged blind spot affects optic nerve
caused by glaucoma, optic neuritis, and papilledema.
1
Page
@COPYRIGHT @THEBRIGHT 2025/2026
, Oculomotor Nerve (CN III) - ANS Test PERRLA, Paralysis if the pupil is dilated, fixed to light
and near accommodation with ptosis, lateral deviation of the eye. Impaired ability to look up,
down, or inward. (A conjugate gauze is a normal gaze=both eyes move in same direction at
same time). ptosis=CNIII problem.
Trochlear Nerve (CN IV) - ANS controls superior oblique muscle-moves eye down towards
nose, damage from head trauma or central lesions=diplopia. Diplopia is also seen in cataracts,
astigmatism, or CN III, IV, or VI neuropathy, or myasthenia gravis, trauma, or lesions in
brainstem or cerebellum.
Trigeminal (CN V): - ANS Facial sensation, nasal and buccal mucosa, & teeth, mastication
muscles. Test corneal reflex, have pt clench teeth/palpate masseter/temporal muscles,
sharp/dull sensations on cheek/forehead.
Abducens (CNVI) - ANS Movement of lateral rectus muscle, moves eye laterally.
Facial (CN VII) - ANS Facial muscles, taste anterior 2/3rd of tongue. Have pt smile, show
teeth, raise eyebrows, frown, close eyes tight, puff out cheeks. Bell's Palsy.
Vestibulocochlear (CN VIII) - ANS Sensation to pharynx, posterior 1/3rd of tongue, and
tympanic membrane. Test gag reflex.
Vagus Nerve (CN X) - ANS Supplies parasympathetic nerve fibers to viscera of chest,
abdomen, motor fibers to pharynx, larynx. *A deviated uvula without swelling indicates vagus
nerve lesion.
Spinal Accessory (CN XI): - ANS Supplies motor fibers to sternocleidomastoid & trapezius
muscle, ask pt to shrug shoulders against your hands.
Hypoglossal (CN XII): - ANS Tongue muscles, ask pt to move tongue all around.
2
Page
@COPYRIGHT @THEBRIGHT 2025/2026
, Glaucoma - ANS gradual loss of peripheral vision, optic nerve damage. Open
Angle=asymptomatic, bilateral, gradual increased cup-to-disk ratio from increased intraocular
pressure=notching of optic cup. Acute Closed Angle rapid onset of sudden vision loss, unilateral,
deep eye pain, dilated and fixed pupil with cloudy cornea=emergency if increased intraocular
pressure.
Macular Degeneration - ANS gradual loss of central vision d/t damaged retina.
Cataracts: - ANS gradual cloudiness/opacification of the lens from DM, overexposure to sun,
long-term steroid use, diuretics, poor diet, smoking, ETOH, age, trauma, lead exposures=NO red
reflex, Leukoria-white reflex present, blurred/cloudy vision, halo around lights, diminished night
vision, diplopia, fall risk.
Normal Retina: - ANS present red reflex, veins pulsate, arteries narrower. Normal Cup/Disk
ratio is 1/3, fovea is in middle of macula.
AV Tapering - ANS vein "winds" or tapers down on either side of artery.
AV Nicking - ANS vein stops abruptly on either side of artery, arteries indent and displace
veins, caused by HTN
AV Banking - ANS vein is twisted on distal side of artery
Subconjuncival Hemorrhage: - ANS red painless eye.
Red & Painful eye - ANS Hyphema (blood in anterior chamber of eye), episcleritis
(inflammation of episcleral vessels in RA or herpes), acute angle closer glaucoma, or uveitis.
3
Page
@COPYRIGHT @THEBRIGHT 2025/2026
, Amblyopia - ANS Reduction in vision causing loss of binocular vision from cataracts or
untreated strabismus (cross-eyed detected with cover-uncover test or Hirschberg Test- will
show asymmetric light reflex, pt c/o diplopia).
Esotropia: - ANS eye drifts in
Exotropia - ANS eye drifts out
Hypertropia: - ANS eye drifts up
Hypotropia - ANS eye drifts down
Retinoblastoma - ANS rapidly developing cancer of the retina w/ absent red reflex.
Corneal Scar - ANS superficial grayish-white opacity in cornea.
Tonic Pupil (Adele's Pupil): - ANS Pupil is large, regular, slow reaction to light unilateral.
Normal Optic Disk: - ANS yellowish-orange to creamy pink with sharp margins.
Optic Atrophy - ANS death of optic nerve fibers=loss of disc vessels=white appearance.
Glaucomatous Cupping: - ANS the optic disk is pale with a backward depression caused by
increased IOP.
Papilledema - ANS the optic disk is pink and hyperemic.
4
Page
@COPYRIGHT @THEBRIGHT 2025/2026
QUESTIONS AND ANSWERS
Subjective History Components - ANS chief complaint, HPI, PMH, family history, social
history, & review of systems: what patient tells you.
Objective History Components - ANS General survey, vitals, physical exam, diagnostic results,
what you observe or see.
Presbyopia - ANS age-related near-vision loss. Can see far away better.
Examples of sudden, painful unilateral vision loss - ANS corneal ulcer, acute closed angle
glaucoma, uveitis, or traumatic hyphema.
Examples of sudden, PAINLESS unilateral vision loss - ANS retinal detachment, macular
degeneration, or retinal vein occlusion.
Olfactory (CN 1) - ANS smell, occlude each nostril
Optic (CN 2) - ANS Vision-Snellen chart, an enlarged blind spot affects optic nerve
caused by glaucoma, optic neuritis, and papilledema.
1
Page
@COPYRIGHT @THEBRIGHT 2025/2026
, Oculomotor Nerve (CN III) - ANS Test PERRLA, Paralysis if the pupil is dilated, fixed to light
and near accommodation with ptosis, lateral deviation of the eye. Impaired ability to look up,
down, or inward. (A conjugate gauze is a normal gaze=both eyes move in same direction at
same time). ptosis=CNIII problem.
Trochlear Nerve (CN IV) - ANS controls superior oblique muscle-moves eye down towards
nose, damage from head trauma or central lesions=diplopia. Diplopia is also seen in cataracts,
astigmatism, or CN III, IV, or VI neuropathy, or myasthenia gravis, trauma, or lesions in
brainstem or cerebellum.
Trigeminal (CN V): - ANS Facial sensation, nasal and buccal mucosa, & teeth, mastication
muscles. Test corneal reflex, have pt clench teeth/palpate masseter/temporal muscles,
sharp/dull sensations on cheek/forehead.
Abducens (CNVI) - ANS Movement of lateral rectus muscle, moves eye laterally.
Facial (CN VII) - ANS Facial muscles, taste anterior 2/3rd of tongue. Have pt smile, show
teeth, raise eyebrows, frown, close eyes tight, puff out cheeks. Bell's Palsy.
Vestibulocochlear (CN VIII) - ANS Sensation to pharynx, posterior 1/3rd of tongue, and
tympanic membrane. Test gag reflex.
Vagus Nerve (CN X) - ANS Supplies parasympathetic nerve fibers to viscera of chest,
abdomen, motor fibers to pharynx, larynx. *A deviated uvula without swelling indicates vagus
nerve lesion.
Spinal Accessory (CN XI): - ANS Supplies motor fibers to sternocleidomastoid & trapezius
muscle, ask pt to shrug shoulders against your hands.
Hypoglossal (CN XII): - ANS Tongue muscles, ask pt to move tongue all around.
2
Page
@COPYRIGHT @THEBRIGHT 2025/2026
, Glaucoma - ANS gradual loss of peripheral vision, optic nerve damage. Open
Angle=asymptomatic, bilateral, gradual increased cup-to-disk ratio from increased intraocular
pressure=notching of optic cup. Acute Closed Angle rapid onset of sudden vision loss, unilateral,
deep eye pain, dilated and fixed pupil with cloudy cornea=emergency if increased intraocular
pressure.
Macular Degeneration - ANS gradual loss of central vision d/t damaged retina.
Cataracts: - ANS gradual cloudiness/opacification of the lens from DM, overexposure to sun,
long-term steroid use, diuretics, poor diet, smoking, ETOH, age, trauma, lead exposures=NO red
reflex, Leukoria-white reflex present, blurred/cloudy vision, halo around lights, diminished night
vision, diplopia, fall risk.
Normal Retina: - ANS present red reflex, veins pulsate, arteries narrower. Normal Cup/Disk
ratio is 1/3, fovea is in middle of macula.
AV Tapering - ANS vein "winds" or tapers down on either side of artery.
AV Nicking - ANS vein stops abruptly on either side of artery, arteries indent and displace
veins, caused by HTN
AV Banking - ANS vein is twisted on distal side of artery
Subconjuncival Hemorrhage: - ANS red painless eye.
Red & Painful eye - ANS Hyphema (blood in anterior chamber of eye), episcleritis
(inflammation of episcleral vessels in RA or herpes), acute angle closer glaucoma, or uveitis.
3
Page
@COPYRIGHT @THEBRIGHT 2025/2026
, Amblyopia - ANS Reduction in vision causing loss of binocular vision from cataracts or
untreated strabismus (cross-eyed detected with cover-uncover test or Hirschberg Test- will
show asymmetric light reflex, pt c/o diplopia).
Esotropia: - ANS eye drifts in
Exotropia - ANS eye drifts out
Hypertropia: - ANS eye drifts up
Hypotropia - ANS eye drifts down
Retinoblastoma - ANS rapidly developing cancer of the retina w/ absent red reflex.
Corneal Scar - ANS superficial grayish-white opacity in cornea.
Tonic Pupil (Adele's Pupil): - ANS Pupil is large, regular, slow reaction to light unilateral.
Normal Optic Disk: - ANS yellowish-orange to creamy pink with sharp margins.
Optic Atrophy - ANS death of optic nerve fibers=loss of disc vessels=white appearance.
Glaucomatous Cupping: - ANS the optic disk is pale with a backward depression caused by
increased IOP.
Papilledema - ANS the optic disk is pink and hyperemic.
4
Page
@COPYRIGHT @THEBRIGHT 2025/2026
