NR304 CJE REVIEW
COMPREHENSIVE
STUDY GUIDE
SECTION 1: EYE ASSESSMENT
QUESTION 1
What does visual acuity measured by Snellen 20/40 mean?
ANSWER
The person sees at 20 feet what someone with normal vision sees at 40 feet.
RATIONALE / EXPLANATION
The numerator (20) is the testing distance. The denominator (40) indicates the distance at which
a person with normal vision could read the same line. Higher denominators indicate worse vision.
QUESTION 2
How do you perform the Accommodation test?
ANSWER
• Ask patient to look at a distant object, then shift gaze to a near object
• Observe for pupil constriction and eye convergence
RATIONALE / EXPLANATION
Accommodation tests the ability of the eye to adjust focus. The pupils should constrict and eyes
converge when shifting from far to near vision. Tests CN III (oculomotor).
QUESTION 3
What is Anisocoria?
ANSWER
Unequal pupils, may be accompanied by pain and vision changes.
RATIONALE / EXPLANATION
Page 1 of 22
,Anisocoria can be benign (physiological) or indicate serious conditions like brain herniation,
Horner's syndrome, or CN III palsy. Always assess for accompanying symptoms.
QUESTION 4
What does PERRLA mean and what are normal pupil measurements?
ANSWER
PERRLA: Pupils are Equal, Round, Reactive to Light, and Accommodation
Pupil Gauge:
• Normal: 3-5mm
• Size variation up to 1mm is normal
• Miosis: <2mm or no dilation in dark
• Mydriasis: >6mm or no constriction in light
RATIONALE / EXPLANATION
PERRLA is the standard documentation for normal pupil assessment. Miosis (constricted) and
mydriasis (dilated) are abnormal findings that may indicate neurological issues or medication
effects.
QUESTION 5
How do you test Cardinal fields of gaze and what cranial nerves does it assess?
ANSWER
• Move eyes through 6 positions using H method or wagon wheel
• Tests CN III (oculomotor), IV (trochlear), VI (abducens)
• Watch for nystagmus (involuntary eye movement)
RATIONALE / EXPLANATION
This test assesses extraocular muscle function controlled by three cranial nerves. Nystagmus or
inability to move eyes in certain directions indicates cranial nerve dysfunction.
QUESTION 6
What are the subjective eye exam terms the nurse should know?
ANSWER
• Photophobia: sensitivity to light
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, • Strabismus: misalignment of the eyes
• Diplopia: double vision
• Confrontation test: tests peripheral vision
RATIONALE / EXPLANATION
Understanding these terms helps document and communicate eye findings. Photophobia may
indicate meningitis; strabismus causes amblyopia if untreated; diplopia suggests CN dysfunction.
QUESTION 7
What are common external eye conditions?
ANSWER
• Pingueculae: yellow nodules on sclera due to sun/wind/dust
• Arcus senilis: gray-white arc around cornea from lipid deposits, no impact on
vision
• Xanthelasma: soft yellow plaques near inner canthus
RATIONALE / EXPLANATION
These are generally benign findings. Arcus senilis is normal in elderly. Xanthelasma may indicate
hyperlipidemia. Pingueculae are from UV exposure.
QUESTION 8
What eye diseases are common in aging adults?
ANSWER
• Cataracts: Clouding in the lens due to UV, smoking, diabetes, obesity
• Diabetic Retinopathy: Leading cause of blindness in working age adults -
Macular edema and new nonfunctional blood vessels
• Glaucoma: Increased intraocular pressure leads to optic nerve damage -
Gradual peripheral loss then central vision loss
• Age-related Macular Degeneration (AMD): Central vision loss - Drusen (yellow
deposits) and neovascularization in the macula
RATIONALE / EXPLANATION
These are the major causes of vision loss in older adults. Early detection through screening can
prevent or slow progression. Diabetic retinopathy requires strict glycemic control.
Page 3 of 22
COMPREHENSIVE
STUDY GUIDE
SECTION 1: EYE ASSESSMENT
QUESTION 1
What does visual acuity measured by Snellen 20/40 mean?
ANSWER
The person sees at 20 feet what someone with normal vision sees at 40 feet.
RATIONALE / EXPLANATION
The numerator (20) is the testing distance. The denominator (40) indicates the distance at which
a person with normal vision could read the same line. Higher denominators indicate worse vision.
QUESTION 2
How do you perform the Accommodation test?
ANSWER
• Ask patient to look at a distant object, then shift gaze to a near object
• Observe for pupil constriction and eye convergence
RATIONALE / EXPLANATION
Accommodation tests the ability of the eye to adjust focus. The pupils should constrict and eyes
converge when shifting from far to near vision. Tests CN III (oculomotor).
QUESTION 3
What is Anisocoria?
ANSWER
Unequal pupils, may be accompanied by pain and vision changes.
RATIONALE / EXPLANATION
Page 1 of 22
,Anisocoria can be benign (physiological) or indicate serious conditions like brain herniation,
Horner's syndrome, or CN III palsy. Always assess for accompanying symptoms.
QUESTION 4
What does PERRLA mean and what are normal pupil measurements?
ANSWER
PERRLA: Pupils are Equal, Round, Reactive to Light, and Accommodation
Pupil Gauge:
• Normal: 3-5mm
• Size variation up to 1mm is normal
• Miosis: <2mm or no dilation in dark
• Mydriasis: >6mm or no constriction in light
RATIONALE / EXPLANATION
PERRLA is the standard documentation for normal pupil assessment. Miosis (constricted) and
mydriasis (dilated) are abnormal findings that may indicate neurological issues or medication
effects.
QUESTION 5
How do you test Cardinal fields of gaze and what cranial nerves does it assess?
ANSWER
• Move eyes through 6 positions using H method or wagon wheel
• Tests CN III (oculomotor), IV (trochlear), VI (abducens)
• Watch for nystagmus (involuntary eye movement)
RATIONALE / EXPLANATION
This test assesses extraocular muscle function controlled by three cranial nerves. Nystagmus or
inability to move eyes in certain directions indicates cranial nerve dysfunction.
QUESTION 6
What are the subjective eye exam terms the nurse should know?
ANSWER
• Photophobia: sensitivity to light
Page 2 of 22
, • Strabismus: misalignment of the eyes
• Diplopia: double vision
• Confrontation test: tests peripheral vision
RATIONALE / EXPLANATION
Understanding these terms helps document and communicate eye findings. Photophobia may
indicate meningitis; strabismus causes amblyopia if untreated; diplopia suggests CN dysfunction.
QUESTION 7
What are common external eye conditions?
ANSWER
• Pingueculae: yellow nodules on sclera due to sun/wind/dust
• Arcus senilis: gray-white arc around cornea from lipid deposits, no impact on
vision
• Xanthelasma: soft yellow plaques near inner canthus
RATIONALE / EXPLANATION
These are generally benign findings. Arcus senilis is normal in elderly. Xanthelasma may indicate
hyperlipidemia. Pingueculae are from UV exposure.
QUESTION 8
What eye diseases are common in aging adults?
ANSWER
• Cataracts: Clouding in the lens due to UV, smoking, diabetes, obesity
• Diabetic Retinopathy: Leading cause of blindness in working age adults -
Macular edema and new nonfunctional blood vessels
• Glaucoma: Increased intraocular pressure leads to optic nerve damage -
Gradual peripheral loss then central vision loss
• Age-related Macular Degeneration (AMD): Central vision loss - Drusen (yellow
deposits) and neovascularization in the macula
RATIONALE / EXPLANATION
These are the major causes of vision loss in older adults. Early detection through screening can
prevent or slow progression. Diabetic retinopathy requires strict glycemic control.
Page 3 of 22
