Physical Examination and Health Assessment 8th Edition 0323510809
Chapter 15: Eyes Jarvis: Physical Examination and Health Assessment, 8th Edition MULTIPLE CHOICE 1. When examining the eye, the nurse notices that the patient’s eyelid margins approximate
completely. What does the nurse understand about this assessment finding? a. It is expected. b. It may result in problems with tearing. c. It indicates increased intraocular pressure. d. It may indicate a problem with extraocular muscles. ANS: A
The palpebral fissure is the elliptical open space between the eyelids, and, when closed, the lid margins approximate completely, which is a normal finding. This is a normal finding and does not result in problems with tearing or indicate problems with increase intraocular pressure or extraocular muscles. DIF: Cognitive Level: Understanding (Comprehension) MSC: Client Needs: Health Promotion and Maintenance 2. During ocular examinations, what should the nurse keep in mind regarding the movement of
the extraocular muscles? a. Is decreased in the older adult. b. Is stimulated by CNs III, IV, and VI. c. Is impaired in a patient with cataracts. d. Is stimulated by cranial nerves (CNs) I and II. ANS: B
Movement of the extraocular muscles is stimulated by three CNs: III, IV, and VI. Aging and cataracts do not affect the extraocular movements. Movement of the extraocular muscles is not stimulated by CNs I and II but by CNs III, IV, and VI. DIF: Cognitive Level: Remembering (Knowledge) MSC: Client Needs: Physiological Integrity: Physiological Adaptation 3. The nurse is performing an external eye examination. Which statement regarding the outer
layer of the eye is true? a. The outer layer of the eye is very sensitive to touch. b. The outer layer of the eye is darkly pigmented to prevent light from reflecting internally. c. The trigeminal nerve (CN V) and the trochlear nerve (CN IV) are stimulated when the outer surface of the eye is stimulated. d. The visual receptive layer of the eye in which light waves are changed into nerve impulses is located in the outer layer of the eye. ANS: A
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