During ocular examinations, what should the nurse keep in mind regarding the movement of the extraocular muscles?

Is impaired in a patient with cataracts.

Is always decreased in the older adult.

Is stimulated by cranial nerves (CNS) I and II.

Is stimulated by CNS III, IV, and VI.

Answer and Explanation

The Correct Answer is D

A. Is impaired in a patient with cataracts: Cataracts primarily cause lens opacity, leading to blurry vision and reduced acuity. They do not directly affect extraocular muscle function, which is controlled by cranial nerves rather than the lens.

B. Is always decreased in the older adult: Aging can cause minor changes in eye movement speed and coordination, but significant impairment is not inevitable. Extraocular muscle function remains intact unless affected by neurological conditions such as cranial nerve palsy.

C. Is stimulated by cranial nerves (CNS) I and II: Cranial nerve I (olfactory) is responsible for smell, and cranial nerve II (optic) transmits visual signals to the brain. Neither nerve controls eye movement, which is instead governed by different cranial nerves.

D. Is stimulated by cranial nerves III, IV, and VI: The oculomotor (III), trochlear (IV), and abducens (VI) nerves control extraocular muscle movement. They coordinate eye positioning, alignment, and smooth tracking, ensuring proper function of the visual system.

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Correct Answer is A

Explanation

A. Anteroposterior-to-transverse diameter ratio of 1:1: In COPD, chronic air trapping leads to hyperinflation of the lungs, causing a "barrel chest" appearance where the anteroposterior (AP) diameter approaches or equals the transverse diameter (1:1 ratio). This is a hallmark physical finding in advanced stages of the disease.

B. Unequal chest expansion: COPD causes diffuse rather than localized lung pathology, leading to generally reduced but symmetrical chest expansion. Unequal expansion is more characteristic of conditions like pneumothorax, pleural effusion, or unilateral lung consolidation.

C. Atrophied neck and trapezius muscles: Patients with COPD often develop hypertrophy of the neck and accessory muscles due to chronic respiratory effort, not atrophy. These muscles become more prominent as they assist with breathing, especially during exacerbations.

D. Increased tactile fremitus: Fremitus is the vibration felt on the chest wall when a patient speaks. In COPD, hyperinflation and air trapping decrease lung density, leading to reduced tactile fremitus. Increased fremitus is typically found in conditions with lung consolidation, such as pneumonia.

A. Bronchophony B. Wheezes C. Bronchial sounds D. Whispered pectoriloquy

Correct Answer is B

Explanation

A. Bronchophony: Bronchophony is an increase in clarity of spoken sounds when auscultating the lungs, typically indicating lung consolidation or pathology. It is not an adventitious sound associated with airflow through narrowed bronchioles.

B. Wheezes: Wheezes are high-pitched, musical sounds that occur when air passes through narrowed or obstructed airways, such as in cases of severe asthma. They are often heard during expiration and indicate bronchoconstriction or inflammation in the airways. This is the correct answer for the scenario presented.

C. Bronchial sounds: Bronchial sounds are normal breath sounds typically heard over the trachea and major bronchi. They are characterized by a higher pitch and a hollow quality. They are not classified as adventitious sounds and are not indicative of asthma.

D. Whispered pectoriloquy: Whispered pectoriloquy is a clinical finding where whispered sounds are heard more clearly over areas of lung consolidation. Like bronchophony, it does not represent an adventitious sound caused by airflow through narrowed bronchioles and is more indicative of lung pathology.

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During ocular examinations, what should the nurse keep in mind regarding the movement of the extraocular muscles?

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