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Question 1

Which information will the nurse include when teaching a patient about routine glaucoma testing?

a. The test involves reading a Snellen chart at a distance of 20 feet.
b. Application of a Tono-pen to the surface of the eye will be needed.
c. The examination includes checking the pupil’s reaction to a bright light.
d. Medications to dilate the pupil will be used before testing for glaucoma.

Answer 1

b. Application of a Tono-pen to the surface of the eye will be needed.

Question 2

Which assessment information obtained by the nurse when performing an eye examination for a 78-year-old patient indicates that more extensive examination of the eyes is needed?

a. The patient’s sclerae are light yellow in color.
b. The patient complains of persistent photophobia.
c. The pupil recovers slowly after being stimulated by a penlight.
d. There is a whitish gray ring encircling the periphery of the iris.

Answer 2

b. The patient complains of persistent photophobia.

Question 3

When performing an eye examination, the nurse will assess for accommodation by

a. covering one eye for 1 minute and noting the pupil reaction when the cover is removed.
b. shining a light into the patient’s eye and watching the pupil response in the opposite eye.
c. observing the pupils when the patient focuses on a close object and then on a distant object.
d. touching the patient’s pupil with a small piece of sterile cotton and watching for a blink reaction.

Answer 3

c. observing the pupils when the patient focuses on a close object and then on a distant object.

Question 4

The nurse at the eye clinic advises all patients to wear sunglasses that protect the eyes from ultraviolet light because ultraviolet sunlight exposure is associated with the development of

a. cataracts.
b. glaucoma.
c. anisocoria.
d. exophthalmos.

Answer 4

a. cataracts.

Question 5

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 40 feet and the right eye can see at 20 feet what a person with normal vision can see at 50 feet. The nurse records which of the following findings as visual acuity?

a. OS 20/40; OD 20/50
b. OU 20/40; OS 50/20
c. OD 20/40; OS 20/50
d. OU 40/20; OD 50/20

Answer 5

a. OS 20/40; OD 20/50

Question 6

Which nursing action is included when assessing a patient’s visual field?

a. Position the patient 20 feet from the Snellen chart.
b. Have the patient cover one eye while facing the nurse.
c. Instruct the patient to follow a moving object using only the eyes.
d. Shine a light into one pupil and observe the response for both pupils.

Answer 6

b. Have the patient cover one eye while facing the nurse.

Question 7

The nurse is observing a student who is preparing to perform an ear examination of a 24-year-old patient. The nurse will need to intervene if the student

a. chooses a speculum smaller than the ear canal.
b. pulls the auricle of the ear down and backward.
c. stabilizes the hand holding the otoscope on the patient’s head.
d. stops inserting the otoscope after observing impacted cerumen.

Answer 7

b. pulls the auricle of the ear down and backward.

Question 8

When obtaining a health history from a 52-year-old patient, which patient statement is most important to communicate to the health care provider?

a. “My vision seems blurry now when I read.”
b. “I have noticed that my eyes are drier now.”
c. “It is hard for me to see when I drive at night.”
d. “The peripheral part of my vision is decreased.”

Answer 8

d. “The peripheral part of my vision is decreased.”

Question 9

The nurse is obtaining a health history for a 64-year-old patient with glaucoma who is a new patient at the eye clinic. Which information given by the patient will have the most implications for the patient’s treatment?

a. “I use aspirin when I have a sinus headache.”
b. “I have had frequent episodes of conjunctivitis.”
c. “I take metoprolol (Lopressor) daily for angina.”
d. “I have not had an eye examination for 10 years.”

Answer 9

c. “I take metoprolol (Lopressor) daily for angina.”

Question 10

In order to assess the visual acuity for a patient in the outpatient clinic, the nurse will need to obtain a (an)

a. penlight.
b. Amsler grid.
c. Snellen chart.
d. ophthalmoscope.

Answer 10

c. Snellen chart

Question 11

A patient being admitted to the hospital has an eye patch in place and tells the nurse “I had a recent eye injury, so I need to wear this patch for a few weeks.” Which nursing diagnosis will the nurse include in the plan of care?

a. Risk for falls related to current decrease in stereoscopic vision
b. Ineffective health maintenance related to inability to see surroundings
c. Disturbed body image related to eye trauma and need to wear eye patch
d. Ineffective denial related to inability to admit the impact of the eye injury

Answer 11

a. Risk for falls related to current decrease in stereoscopic vision

Question 12

A patient in the eye clinic is scheduled for refractometry. Which information will the nurse include in patient teaching?

a. “You will need to wear sunglasses for a few hours after the exam.”
b. “The surface of your eye will be numb while the doctor does the exam.”
c. “You should not take any of your eye medicines before the examination.”
d. “The doctor will shine a bright light into your eye during the examination.”

Answer 12

a. “You will need to wear sunglasses for a few hours after the exam.”

Question 13

The nurse is assessing a 48-year-old patient for presbyopia. Which equipment will the nurse need to obtain before the examination?

a. Penlight
b. Tono-pen
c. Jaeger chart
d. Snellen chart

Answer 13

c. Jaeger chart

Question 14

A patient arrives in the emergency department complaining of eye itching and pain caused by sleeping with contact lenses in place. To facilitate further examination of the eye, the nurse will anticipate the need for

a. a tonometer.
b. eye patching.
c. a refractometer.
d. fluorescein dye.

Answer 14

d. fluorescein dye.

Question 15

During the nursing history, a patient complains of dizziness when bending over and of nausea and dizziness associated with physical activities. The nurse will plan to teach the patient about

a. tympanometry.
b. rotary chair testing.
c. pure-tone audiometry.
d. bone-conduction testing.

Answer 15

b. rotary chair testing.

Question 16

When the nurse is taking a health history of a new patient at the ear clinic, the patient states, “I always sleep with the radio on.” Which follow-up question is most appropriate to obtain more information about possible hearing problems?

a. “Do you grind your teeth at night?”
b. “What time do you usually fall asleep?”
c. “Have you noticed any ringing in your ears?”
d. “Are you ever dizzy when you are lying down?”

Answer 16

c. “Have you noticed any ringing in your ears?”

Question 17

Which finding by the nurse during the admission assessment for a patient may indicate that the patient is at risk for falls while hospitalized?

a. Lateralization with Weber test
b. Positive result for Rinne testing
c. Inability to hear a low-pitched whisper
d. Nystagmus when head is turned rapidly

Answer 17

d. Nystagmus when head is turned rapidly

Question 18

When taking a health history from a new patient in the outpatient clinic, which information may indicate the need to perform a focused hearing assessment?

a. The patient uses albuterol (Proventil) for acute asthma.
b. The patient takes atenolol (Tenormin) to prevent angina.
c. The patient uses acetaminophen (Tylenol) frequently for headaches.
d. The patient has taken ibuprofen (Advil) for 20 years to treat arthritis.

Answer 18

d. The patient has taken ibuprofen (Advil) for 20 years to treat arthritis.

Question 19

Which action will the nurse include in the plan of care for a patient who has vestibular disease?

a. Check Rinne and Weber tests.
b. Face the patient when speaking.
c. Enunciate clearly when speaking.
d. Monitor the patient’s ability to ambulate safely.

Answer 19

d. Monitor the patient’s ability to ambulate safely.

Question 20

The nurse in the eye clinic is examining a 65-year-old patient who says “I see small spots that move around in front of my eyes.” Which action will the nurse take first?

a. Immediately have the ophthalmologist evaluate the patient.
b. Explain that spots and “floaters” are a normal part of aging.
c. Inform the patient that these spots may indicate damage to the retina.
d. Use an ophthalmoscope to examine the posterior chamber of the eyes.

Answer 20

d. Use an ophthalmoscope to examine the posterior chamber of the eyes.

Question 21

Which observation by the nurse when examining a patient’s auditory canal and tympanic membrane is a priority to report to the health care provider?

a. There is a cone of light visible.
b. The tympanum is bluish-tinged.
c. Cerumen is present in the auditory canal.
d. The skin in the ear canal is dry and scaly.

Answer 21

b. The tympanum is bluish-tinged.