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4. When examining a patient’s eyes, the nurse recalls that stimulation of the sympathetic branch
of the autonomic nervous system:
a. Causes pupillary constriction.
b. Adjusts the eye for near vision.
c. Elevates the eyelid and dilates the pupil.
d. Causes contraction of the ciliary body.
ANS: C
Stimulation of the sympathetic branch of the autonomic nervous system dilates the pupil and
elevates the eyelid. Parasympathetic nervous system stimulation causes the pupil to constrict.
The muscle fibers of the iris contract the pupil in bright light to accommodate for near vision.
The ciliary body controls the thickness of the lens.
5. The nurse is reviewing causes of increased intraocular pressure. Which of these factors
determines intraocular pressure?
a. Thickness or bulging of the lens
b. Posterior chamber as it accommodates increased fluid
c. Contraction of the ciliary body in response to the aqueous within the eye
d. Amount of aqueous produced and resistance to its outflow at the angle of the
anterior chamber
ANS: D
Intraocular pressure is determined by a balance between the amount of aqueous produced and
the resistance to its outflow at the angle of the anterior chamber. The other responses are
incorrect.
6. The nurse is conducting a visual examination. Which of these statements regarding visual
pathways and visual fields is true?
a. The right side of the brain interprets the vision for the right eye.
b. The image formed on the retina is upside down and reversed from its actual
appearance in the outside world.
c. Light rays are refracted through the transparent media of the eye before striking the
pupil.
d. Light impulses are conducted through the optic nerve to the temporal lobes of the
brain.
ANS: B
The image formed on the retina is upside down and reversed from its actual appearance in the
outside world. The light rays are refracted through the transparent media of the eye before
striking the retina, and the nerve impulses are conducted through the optic nerve tract to the
visual cortex of the occipital lobe of the brain. The left side of the brain interprets vision for
the right eye.
7. The nurse is testing a patient’s visual accommodation, which refers to which action?
a. Pupillary constriction when looking at a near object
b. Pupillary dilation when looking at a far object
c. Changes in peripheral vision in response to light
d. Involuntary blinking in the presence of bright light
ANS: A
The muscle fibers of the iris contract the pupil in bright light and accommodate for near
vision, which also results in pupil constriction. The other responses are not correct.
8. A patient has a normal pupillary light reflex. The nurse recognizes that this reflex indicates
that:
a. The eyes converge to focus on the light.
b. Light is reflected at the same spot in both eyes.
c. The eye focuses the image in the center of the pupil.
d. Constriction of both pupils occurs in response to bright light.
ANS: D
The pupillary light reflex is the normal constriction of the pupils when bright light shines on
the retina. The other responses are not correct.
9. A mother asks when her newborn infant’s eyesight will be developed. The nurse should reply:
a. “Vision is not totally developed until 2 years of age.”
b. “Infants develop the ability to focus on an object at approximately 8 months of
age.”
c. “By approximately 3 months of age, infants develop more coordinated eye
movements and can fixate on an object.”
d. “Most infants have uncoordinated eye movements for the first year of life.”
ANS: C
Eye movements may be poorly coordinated at birth, but by 3 to 4 months of age, the infant
should establish binocularity and should be able to fixate simultaneously on a single image
with both eyes.
11. Which of these assessment findings would the nurse expect to see when examining the eyes of
a black patient?
a. Increased night vision
b. Dark retinal background
c. Increased photosensitivity
d. Narrowed palpebral fissures
ANS: B
An ethnically based variability in the color of the iris and in retinal pigmentation exists, with
darker irides having darker retinas behind them.
12. A 52-year-old patient describes the presence of occasional floaters or spots moving in front of
his eyes. The nurse should:
a. Examine the retina to determine the number of floaters.
b. Presume the patient has glaucoma and refer him for further testing.
c. Consider these to be abnormal findings, and refer him to an ophthalmologist.
d. Know that floaters are usually insignificant and are caused by condensed vitreous
fibers.
ANS: D
Floaters are a common sensation with myopia or after middle age and are attributable to
condensed vitreous fibers. Floaters or spots are not usually significant, but the acute onset of
floaters may occur with retinal detachment.
13. The nurse is preparing to assess the visual acuity of a 16-year-old patient. How should the
nurse proceed?
a. Perform the confrontation test.
b. Ask the patient to read the print on a handheld Jaeger card.
c. Use the Snellen chart positioned 20 feet away from the patient.
d. Determine the patient’s ability to read newsprint at a distance of 12 to 14 inches.
ANS: C
The Snellen alphabet chart is the most commonly used and most accurate measure of visual
acuity. The confrontation test is a gross measure of peripheral vision. The Jaeger card or
newspaper tests are used to test near vision.
14. A patient’s vision is recorded as 20/30 when the Snellen eye chart is used. The nurse
interprets these results to indicate that:
a. At 30 feet the patient can read the entire chart.
b. The patient can read at 20 feet what a person with normal vision can read at 30
feet.
c. The patient can read the chart from 20 feet in the left eye and 30 feet in the right
eye.
d. The patient can read from 30 feet what a person with normal vision can read from
20 feet.
ANS: B
The top number indicates the distance the person is standing from the chart; the denominator
gives the distance at which a normal eye can see.
15. A patient is unable to read even the largest letters on the Snellen chart. The nurse should take
which action next?
a. Refer the patient to an ophthalmologist or optometrist for further evaluation.
b. Assess whether the patient can count the nurse’s fingers when they are placed in
front of his or her eyes.
c. Ask the patient to put on his or her reading glasses and attempt to read the Snellen
chart again.
d. Shorten the distance between the patient and the chart until the letters are seen, and
record that distance.
ANS: D
If the person is unable to see even the largest letters when standing 20 feet from the chart, then
the nurse should shorten the distance to the chart until the letters are seen, and record that
distance (e.g., “10/200”). If visual acuity is even lower, then the nurse should assess whether
the person can count fingers when they are spread in front of the eyes or can distinguish light
perception from a penlight. If vision is poorer than 20/30, then a referral to an ophthalmologist
or optometrist is necessary, but the nurse must first assess the visual acuity.
16. A patient’s vision is recorded as 20/80 in each eye. The nurse interprets this finding to mean
that the patient:
a. Has poor vision.
b. Has acute vision.
c. Has normal vision.
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Hän soitti teeman variatioineen, menueton ja synkän juhlallisen
Marcia funebren. Se soi kuin kuolinhymni. Syvä hiljaisuus vallitsi;
kuului vain raskaat akordit, jotka hitaassa kulussa vyöryivät
eteenpäin kuin meren mainingit. Kun se oli lopussa, tuntui kuin olisi
kohtalon käsi raudanraskaana tarttunut minuun; jotain nousi
kurkkuuni, minun täytyi kääntyä pois salatakseni liikutustani.
"Mutta?"
"Mihin sitte?"
*****
"Aa, perh… Aivan niin! Hän oli pikku tyttö silloin. Ja nyt tuollainen
daami! Niin ne nuoret kasvavat."
"Kolme ja keittiö."
"Hullutuksia?"
"Niin, toruit lapsia, kun muka…"
*****
"Arvoisa herra!
Kunnioittaen
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Kirje herätti vilkkaan ajatuksenvaihdon, mutta tulos oli kielteinen —
siitä yksinkertaisesta syystä, että meiltä sattui puuttumaan juuri nuo
viisituhatta markkaa.
"Kiitä Jumalaa, että sinulla on niin järkevä vaimo. Kuulin juuri, että
sama yhtiö on mennyt kumoon, joten niillä osakkeilla ei ole viiden
pennin arvoa", sanoi setä.
"Se on afääriä!"
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1) osakepääoman korottamisesta;
3) hankintatarjouksista ja urakkatöistä;
4) kiinnelainoista;
5) isännöitsijän palkankorotuksesta ja
Johtokunnan puolesta:
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Neitonen kysyi:
"Niin, pääasia on, että ajoissa voi vetäytyä syrjään", lopetti nainen
varoittavasti.
"Se on totta, se. Mutta kun kerran piti viedä panttiin soittokoneeni
kunnallisverojen suoritukseksi, täytyi lopettaa se homma."
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Tirehtööri jatkoi:
"Et suinkaan tullut ilman kuittia! Jos hän tahtoo olla petollinen,
menetämme rahat."