NURS 6512 - Advanced Health Assessment
Exam 1 Study Guide-Graded A (Walden
University)
What are the components of a cultural response to a patient? ------- Correct
Answers ----
---- the response should include modes of communication to include speech,
space, and body language, awareness of the the patients health beliefs, diet
and nutritional practice, and the nature of relationships with their family
How do you measure visual acuity and test CN II ------- Correct Answers by
measuring distance, near vision , and peripheral vision
What is CN II? ------- Correct Answers - - -optic nerve
How do you measure distance vision for visual acuity? ------- Correct Answers
--------------------------------------------------------------------------------------------------------by
using a snellen chart and having the patient cover one eye and read the
lowest line that he can see clearly and then alternate eyes
How do you document distance vision? ------- Correct Answers the numerator is
20 and the denominator is the distance at which the average eye can read the
line.
How do you measure near vision? ------- Correct Answers by using a
rosenbaum
pocket screener and have the patient hold it about 14 inches from eyes and
read the smallest line possible with one eye and then the other
How do you measure peripheral vision? ------- Correct Answers by using the
confrontation test. Have the patient sit directly across from you and look
directly at you. Have them cover their left eye and your cover your right
eye. Then test nasal, temporal, superior, and inferior fields. Have the patient
tell you as soon as they see your finger in each of those fields.
What may be some causes of abnormal results from the confrontation
test? -------Correct Answers stroke, retinal detachment, optic
neuropathy, pituitary tumor,
central retinal vascular occlusion
How would you perform an external examination of the eyes? ------- Correct
Answers ---
,-----Systematically beginning with appendages and move inward
eyebrows
orbits/periorbital
area eyelids
,What is being assessed when looking at the patient's eyebrows? Correct
Answers
--------size, extension beyond temporal canthus, texture of hair
If the eyebrows do not extend beyond the temporal canthus or are course
what may be the cause? ------- Correct Answers hypothyroidism
What is being assessed when looking at the patient's orbits/periorbital
area? -------Correct Answers edema, puffiness, sagging tissue below
orbit
What can cause periorbital edema? ------- Correct Answers thyroid disease,
allergies, or nephrotic syndrome (children)
What are xanthelasma? ------- Correct Answers - yellowish deposits on the
periorbital tissue most often on the nasal side that represents a lipid
metabolism disorder
What is being assessed with looking at the patient's eyelids? ------- Correct
Answers -----
--- have the patient close lids lightly to look for
tremors inspect ability of eyelids to close completely
and open wide check for flakiness, crusting, redness,
or swelling
check eyelashes to make sure that they curve away from the eye
when eye is open the superior eyelid should cover a portion of the iris but
not cover pupil
What can be a cause of fasciculations of the eyelid when a patient lightly closes
eye? ---
---- Correct Answers -----hyperthyroidism
What is ptosis? ------- Correct Answers - -when the upper eyelid covers more
than
the top of the iris or pupil and indicates congenital weakness of levator
muscle or paresis of a branch of CN III
What is CN III ------- Correct Answers ---oculomotor nerve
How do you document a finding of ptosis? ------- Correct Answers by
recording
the difference between the two eyelids in millimeters (the average lid is 2 mm
below the border of the cornea and sclera. average lower lid is at the lower
limbus)
What is ectropion? ------- Correct Answers --it is when the lower eyelid turns
away
from the eye and may result in excessive tearing because the tear collecting
system can't collect the secretions
, What is entropion? ------- Correct Answers --it is when the eyelid turns toward
the
globe which can cause corneal and conjunctival irritation and risk for
secondary infection
Exam 1 Study Guide-Graded A (Walden
University)
What are the components of a cultural response to a patient? ------- Correct
Answers ----
---- the response should include modes of communication to include speech,
space, and body language, awareness of the the patients health beliefs, diet
and nutritional practice, and the nature of relationships with their family
How do you measure visual acuity and test CN II ------- Correct Answers by
measuring distance, near vision , and peripheral vision
What is CN II? ------- Correct Answers - - -optic nerve
How do you measure distance vision for visual acuity? ------- Correct Answers
--------------------------------------------------------------------------------------------------------by
using a snellen chart and having the patient cover one eye and read the
lowest line that he can see clearly and then alternate eyes
How do you document distance vision? ------- Correct Answers the numerator is
20 and the denominator is the distance at which the average eye can read the
line.
How do you measure near vision? ------- Correct Answers by using a
rosenbaum
pocket screener and have the patient hold it about 14 inches from eyes and
read the smallest line possible with one eye and then the other
How do you measure peripheral vision? ------- Correct Answers by using the
confrontation test. Have the patient sit directly across from you and look
directly at you. Have them cover their left eye and your cover your right
eye. Then test nasal, temporal, superior, and inferior fields. Have the patient
tell you as soon as they see your finger in each of those fields.
What may be some causes of abnormal results from the confrontation
test? -------Correct Answers stroke, retinal detachment, optic
neuropathy, pituitary tumor,
central retinal vascular occlusion
How would you perform an external examination of the eyes? ------- Correct
Answers ---
,-----Systematically beginning with appendages and move inward
eyebrows
orbits/periorbital
area eyelids
,What is being assessed when looking at the patient's eyebrows? Correct
Answers
--------size, extension beyond temporal canthus, texture of hair
If the eyebrows do not extend beyond the temporal canthus or are course
what may be the cause? ------- Correct Answers hypothyroidism
What is being assessed when looking at the patient's orbits/periorbital
area? -------Correct Answers edema, puffiness, sagging tissue below
orbit
What can cause periorbital edema? ------- Correct Answers thyroid disease,
allergies, or nephrotic syndrome (children)
What are xanthelasma? ------- Correct Answers - yellowish deposits on the
periorbital tissue most often on the nasal side that represents a lipid
metabolism disorder
What is being assessed with looking at the patient's eyelids? ------- Correct
Answers -----
--- have the patient close lids lightly to look for
tremors inspect ability of eyelids to close completely
and open wide check for flakiness, crusting, redness,
or swelling
check eyelashes to make sure that they curve away from the eye
when eye is open the superior eyelid should cover a portion of the iris but
not cover pupil
What can be a cause of fasciculations of the eyelid when a patient lightly closes
eye? ---
---- Correct Answers -----hyperthyroidism
What is ptosis? ------- Correct Answers - -when the upper eyelid covers more
than
the top of the iris or pupil and indicates congenital weakness of levator
muscle or paresis of a branch of CN III
What is CN III ------- Correct Answers ---oculomotor nerve
How do you document a finding of ptosis? ------- Correct Answers by
recording
the difference between the two eyelids in millimeters (the average lid is 2 mm
below the border of the cornea and sclera. average lower lid is at the lower
limbus)
What is ectropion? ------- Correct Answers --it is when the lower eyelid turns
away
from the eye and may result in excessive tearing because the tear collecting
system can't collect the secretions
, What is entropion? ------- Correct Answers --it is when the eyelid turns toward
the
globe which can cause corneal and conjunctival irritation and risk for
secondary infection
