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.

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.

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.

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 of the eye examination, but they do not indicate accommodation.

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.

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 is the abbreviation for left eye and OD is the abbreviation for right eye. The remaining three answers do not correctly describe the patients visual acuity.

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.

7.            The nurse is observing a student who is preparing to perform an ear examination for a 30-year-old patient. The nurse will need to intervene if the student

a.            pulls the auricle of the ear up and posterior.

b.            chooses a speculum larger than the ear canal.

c.             stabilizes the hand holding the otoscope on the patients head.

d.            stops inserting the otoscope after observing impacted cerumen.

ANS: B

The speculum should be smaller than the ear canal so it can be inserted without damage to the external ear canal. The other actions are appropriate when performing an ear examination.

8.            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.