Page 370 - Saunders Comprehensive Review For NCLEX-RN

the axes of the eyes
b. Client is asked to gaze straight ahead as
the nurse holds a light about 12 inches
(30 cm) from the client.
c. The nurse looks for reflection of the
light on the corneas in exactly the same
spot in each eye.
7. Cover/uncover test
a. Used to check for slight degrees of
deviated alignment
b. Each eye is tested separately.
c. The nurse asks the client to gaze
straight ahead and cover 1 eye.
d. The nurse examines the uncovered eye,
expecting to note a steady, fixed gaze.
8. Diagnostic positions test (6 cardinal positions of gaze)
(Fig. 12-1)
a. The 6 muscles that attach the eyeball to
its orbit and serve to direct the eye to
points of interest are tested.
b. Client holds head still and is asked to
move his or her eyes and follow a
small object.
c. The examiner notes any parallel
movements of the eye or nystagmus,
an involuntary, rhythmic, rapid
twitching of the eyeballs.
d. This assessment tests cranial nerves III,
IV, and VI, oculomotor, trochlear, and
abducens, respectively.
9. Color vision
a. Tests for color vision involve the client
picking numbers or letters out of a
complex and colorful picture using
what is known as the Ishihara chart.
b. The test is sensitive for the diagnosis of
red-green blindness but cannot detect
discrimination of blue.

The first slide on the Ishihara chart is one

that everyone can discriminate; failure to identify
numbers on this slide suggests a problem with
performing the test, not a problem with color vision.

10. Pupils (Box 12-5)

a. The pupils are round and of equal size.
b. Increasing light causes pupillary

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