A patient has a long history of chronic obstructive pulmonary disease (COPD). During the assessment, the nurse will most likely observe which of these?

A. Macular degeneration: The loss of central vision while maintaining peripheral vision is characteristic of macular degeneration, a common age-related condition that affects the macula, the central part of the retina responsible for sharp and detailed vision. Patients with this condition often struggle with tasks that require fine visual acuity, such as reading or recognizing faces.

B. Increased intraocular pressure or glaucoma: Glaucoma typically causes peripheral vision loss rather than central vision loss. Patients may not notice changes in their vision until the disease has progressed significantly, making this option less likely given the patient's symptoms.

C. Vision that is normal for someone her age: While age-related changes in vision are common, the specific symptoms described—difficulty reading, sewing, and recognizing faces—indicate a significant problem rather than a normal aging process. Conditions like macular degeneration should be considered when central vision loss is present.

D. The beginning stages of cataract formation: Cataracts generally cause blurred vision, glare, and difficulty with night vision. They typically affect overall vision rather than causing specific central vision loss while preserving peripheral vision. Therefore, while cataracts are common in older adults, they do not align with the symptoms described in this case.

A. Loss of the outer hair on the eyebrows attributable to a decrease in hair follicles: It is normal for older adults to experience changes in hair growth, including loss of eyebrow hair due to a decrease in hair follicles. This finding is considered a typical age-related change and not abnormal.

B. Unequal pupillary constriction in response to light: This finding is considered abnormal and may indicate a potential neurological issue or damage to the optic or oculomotor nerves. Normal pupillary response should be equal and reactive to light, so any discrepancy in pupillary constriction warrants further evaluation.

C. Decrease in tear production: A decrease in tear production is common in older adults due to age-related changes in lacrimal gland function. This condition, known as dry eye syndrome, is not considered abnormal for this age group.

D. Presence of arcus senilis observed around the cornea: Arcus senilis is characterized by a gray or white ring around the cornea due to lipid deposits and is commonly seen in older adults. While it may indicate elevated cholesterol levels in younger individuals, its presence in elderly patients is usually not abnormal.