Lewis Chapter 20: Assessment of Visual and Auditory Systems Exam Practice Questions and Answers

Lewis Chapter 20: Assessment of Visual and Auditory Systems Exam Practice Questions and Answers 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 pupil's reaction to light. - Ans:-a. A Tono-Pen will be applied to the surface of the eye 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. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 2/28 The nurse is performing an eye examination on a *76-yr-old* patient. The nurse should refer the patient for a more extensive assessment based on which finding? a. The patient's 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. The patient reports persistent photophobia. *Photophobia* is *not a normally occurring change* with aging and would require further assessment. The other assessment data are common gerontologic differences in assessment and would not be unusual in a 76-yr-old patien The nurse performing an eye examination will document normal findings for accommodation when a. shining a light into the patient's eye causes pupil constriction in the opposite eye. b. a blink reaction follows touching the patient's pupil with a piece of sterile cotton. c. covering one eye for 1 minute and noting pupil constriction as the cover is removed. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 3/28 d. the pupils constrict while fixating on an object being moved toward the patient's eyes. - Ans:-d. the pupils constrict while fixating on an object being moved toward the patient's eyes. 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. Blurred vision and light sensitivity Classic signs of cataracts include blurred vision and light sensitivity. Thyroid problems are a major cause of exophthalmos. Unequal pupil is not indicative of cataracts. Loss of peripheral vision is a sign of glaucoma. Assessment of a patient's 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 ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 4/28 c. OD 20/40; OS 20/50 b. OU 20/40; OS 50/20 d. OU 40/20; OD 50/20 - Ans:-a. OS 20/50; OD 20/40 When assessing a patient's 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 pupils. c. shine a light into one eye and observe responses of both pupils. d. instruct the patient to follow a moving object using only the eyes. - Ans:-c. shine a light into one eye and observe responses of both pupils. The nurse is observing a student who is preparing to perform an ear examination for a 30-yr-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 patient's head. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 5/28 d. stops inserting the otoscope after observing impacted cerumen. - Ans:-b. chooses a speculum larger than the ear canal. When obtaining a health history from a 49-yr-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 can't see as far over to the side." - Ans:-d. "I can't see as far over to the side." The *decrease in peripheral vision* may *indicate glaucoma*, which is not a normal visual change associated with aging and requires rapid treatment. A 65-yr-old patient is being evaluated for glaucoma. Which information given by the patient has implications for the patient's treatment plan? a. "I take metoprolol (Lopressor) for angina." b. "I take aspirin when I have a sinus headache." c. "I have had frequent episodes of conjunctivitis." ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 6/28 d. "I have not had an eye examination for 10 years." - Ans:-a. "I take metoprolol (Lopressor) for angina." It is important to note whether the patient takes any *b-adrenergic blockers* because this classification of medications is *also used to treat glaucoma*, and there may be an *increase in adverse effects*. The use of aspirin does not increase intraocular pressure and is safe for patients with glaucoma. Although older patients should have yearly eye examinations, the treatment for this patient will not be affected by the 10-year gap in eye care. Conjunctivitis does not increase the risk for glaucoma. The nurse is testing the visual acuity of a patient in the outpatient clinic. The nurse's instructions for this test include asking the patient to a. stand 20 feet away from the wall chart. b. follow the examiner's finger with the eyes only. c. look at an object far away and then near to the eyes. d. look straight ahead while a light is shone into the eyes. - Ans:-a. stand 20 feet away from the wall chart. A patient who underwent eye surgery is required to wear an eye patch until the scheduled postoperative clinic visit. Which nursing diagnosis will the nurse include in the plan of care? ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 7/28 a. Disturbed body image related to eye trauma and eye patch b. Risk for falls related to temporary decrease in stereoscopic vision c. Ineffective health maintenance related to inability to see surroundings d. Ineffective coping related to inability to admit the impact of the eye injury - Ans:-b. Risk for falls related to temporary decrease in stereoscopic vision The *loss of stereoscopic vision* created by the *eye patch impairs* the patient's ability to see in three dimensions and to judge distances. It also *increases* the *risk for falls*. Which information will the nurse provide to the patient scheduled for refractometry? a. "You should not take any of your eye medicines before the examination." b. "You will need to wear sunglasses for a few hours after the examination." c. "The doctor will shine a bright light into your eye during the examination." d. "The surface of your eye will be numb while the doctor does the examination." - Ans:-b. "You will need to wear sunglasses for a few hours after the examination." ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 8/28 The *pupils* are *dilated* using *cycloplegic medications* during refractometry. This effect will last several hours and cause photophobia. The nurse is assessing a *65-yr*-old patient for *presbyopia*. Which instruction will the nurse give the patient before the *test*? a. "Hold this card and read the print out loud." b. "Cover one eye while reading the wall chart." c. "You'll feel a short burst of air directed at your eyeball." d. "A light will be used to look for a change in your pupils." - Ans:-a. "Hold this card and read the print out loud." The *Jaeger card* is used to *assess near vision problems* and *presbyopia* in persons *older than 40 years* of age. The card should be held 14 inches away from eyes while the patient reads words in various print sizes. Using a penlight to determine pupil change is testing pupil response. A short burst of air may be used to test intraocular pressure but is not used for testing presbyopia. Covering one eye at a time while reading a wall chart at 20 feet describes the Snellen test. A patient arrives in the emergency department complaining of *eye itching* and *pain* after *sleeping with contact lenses* in place. To facilitate further examination of the eye, *fluorescein angiography* is