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
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.
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