The advanced practice nurse is conducting a comprehensive eye ...

[piesebel]

The advanced practice nurse is conducting a comprehensive eye examination on an 80-year-old African American woman. Which of the following findings requires the nurse to contact the patient's physician for further examination?
 
  a. A thin white ring along the margin of the iris
  b. A black pupil
  c. Dilated pupils
  d. A black fundus of the eye

Question 2

The patient presents to the clinic with dysuria and hematuria. How does the nurse proceed to assess for kidney inflammation?
 
  a. Lightly palpates each abdominal quadrant
  b. Inspects abdomen for abnormal movement or shadows using indirect lighting
  c. Uses deep palpation posteriorly
  d. Percusses posteriorly the costovertebral angle at the scapular line

[Cheesycrackers]

Answer to Question 1

ANS: C
Dilated pupils result from glaucoma, trauma, neurological disorders, eye medication, or withdrawal from opioids. Shining a beam of light through the pupil and onto the retina stimulates the third cranial nerve and causes the muscles of the iris to constrict. Any abnormality along the nerve pathways from the retina to the iris alters the ability of the pupils to react to light. A thin white ring along the margin of the iris, called an arcus senilis, is common with aging but is abnormal in anyone younger than age 40. The pupils are normally black, round, regular, and equal in size. The fundus of African American patients can be black.

Answer to Question 2

ANS: D
With the patient sitting or standing erect, use direct or indirect percussion to assess for kidney inflammation. With the ulnar surface of the partially closed fist, percuss posteriorly the costovertebral angle at the scapular line. If the kidneys are inflamed, the patient feels tenderness during percussion. Use a systematic palpation approach for each quadrant of the abdomen to assess for muscular resistance, distention, abdominal tenderness, and superficial organs or masses. Light palpation would not detect kidney tenderness because the kidneys sit deep within the abdominal cavity. Posteriorly, the lower ribs and heavy back muscles protect the kidneys, so they cannot be palpated. Kidney inflammation will not cause abdominal movement. However, to inspect the abdomen for abnormal movement or shadows, the nurse should stand on the patient's right side and inspect from above the abdomen using direct light over the abdomen.