# A nurse is assessing a 45-year-old client who reports difficulty reading small print and holding reading materials at arm's length to see clearly. Which assessment finding would the nurse expect to document for this client? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541549 > language: ko > subject: Adult Health ## 문제 A nurse is assessing a 45-year-old client who reports difficulty reading small print and holding reading materials at arm's length to see clearly. Which assessment finding would the nurse expect to document for this client? ## 보기 1. Myopia (nearsightedness) 2. Astigmatism 3. Presbyopia **✔ 정답** 4. Hyperopia (farsightedness) **정답: 3** ## 해설 The client's symptoms of difficulty reading small print and holding materials at arm's length are classic for presbyopia, an age-related refractive error starting in the mid-40s. Other options represent refractive errors not typically presenting with these specific age-related symptoms. ## 심화 해설 Understanding the Client's Presentation The client's report of difficulty reading small print and the compensatory behavior of holding reading materials at arm's length is a classic clinical presentation. This action increases the distance between the object and the eye, which reduces the accommodative demand on the lens, allowing the image to be focused more clearly on the retina. This specific behavior is the hallmark of a condition where the eye's ability to focus on near objects is diminished due to a loss of lens flexibility. Analysis of the Correct Answer: Presbyopia The correct assessment finding to document is Presbyopia. This is not a refractive error of the eye's shape but an age-related, progressive decline in ocular accommodation. The underlying mechanism is a gradual stiffening of the crystalline lens, which reduces its ability to change shape and increase its optical power for near vision [2]. This physiological change is a universal part of the aging process, strongly dependent on age and progressing throughout life [3]. The clinical consequence is impaired near vision, which significantly impacts daily activities like reading [2]. Why Other Options Are Incorrect - Myopia (Option 1): Nearsightedness is a refractive error where the eye's axial length is too long or the cornea is too curved, causing light rays to focus in front of the retina. A person with myopia sees near objects clearly but has difficulty with distance vision. The client's complaint is specifically about near vision, making this option inconsistent with the assessment. - Astigmatism (Option 2): This condition is caused by an irregular curvature of the cornea or lens, leading to blurred or distorted vision at all distances. While it can affect near vision, it does not specifically explain the age-related loss of accommodation and the characteristic behavior of moving objects farther away to see them clearly. - Hyperopia (Option 4): Farsightedness is a refractive error where the eye's axial length is too short, causing light to focus behind the retina. Young individuals with hyperopia can often compensate by using their accommodation to focus on near objects. However, the client is 45 years old and is experiencing a new difficulty with near vision, which points to a loss of accommodative ability (presbyopia) rather than a pre-existing refractive state. While presbyopia and hyperopia can be confused, the specific age of onset and the mechanism of lens stiffening confirm the diagnosis of presbyopia [1,2]. Clinical Assessment and Pathophysiology During an eye examination, the expected clinical finding for this client would be an increased need for plus-power lenses (reading glasses) to see near objects clearly. The near add power, which quantifies the degree of presbyopia, is measured during a refractive assessment [3]. The pathophysiology extends beyond just the lens; evidence suggests presbyopia is associated with both lens stiffening and neuroretinal changes . This condition affects a vast global population, with estimates of approximately 1.8 billion individuals, a number projected to rise to 2.1 billion by 2030 [2]. Management strategies are diverse, ranging from corrective spectacles and contact lenses to pharmacologic agents like pilocarpine or newer dual-agent drops such as carbachol and brimonidine tartrate, and surgical interventions like LASIK nonlinear aspheric micro-monovision [2,4].References (research sources) - [2]Yuvezzi™ (carbachol and brimonidine tartrate) dual-agent eyedrops: a new option for presbyopia.Research articleAbid MA, Abid MH, Afzal MD. (2026) · DOI: 10.1097/ms9.0000000000004984 - [3]Drinking Habit Could Exacerbate the Progression of Presbyopia in Men.Research articleAyaki M, Hanyuda A, Negishi K. (2026) · DOI: 10.2147/opto.s603879 ## 임상 시나리오 Assessing Age-Related Near Vision LossKey Clinical Indicators of Presbyopia The classic symptom of presbyopia is difficulty reading small print or doing near work, with the client instinctively holding materials at arm's length to see clearly. This compensatory action increases the focal distance, reducing the accommodative demand on the stiffening lens. Presbyopia is a universal, age-related change beginning around age 40-45. It is caused by a progressive loss of lens elasticity, not a refractive error of the eye's shape. Document the client's report of this specific behavior as a hallmark finding. CautionDo not confuse presbyopia with hyperopia (farsightedness). While both affect near vision, hyperopia is a lifelong refractive error due to a short eyeball, whereas presbyopia is an acquired, age-related loss of accommodation. The arm's length compensatory behavior is the key differentiator. ## 핵심 개념 - **Presbyopia** — Age-related, progressive loss of the eye's ability to focus on near objects due to decreased lens elasticity, typically beginning after age 40. - **Accommodation** — The process by which the eye's lens changes shape to focus on near objects, which diminishes with age as the lens stiffens. - **Myopia** — Nearsightedness; a refractive error where light focuses in front of the retina, causing clear near vision but blurry distance vision. - **Hyperopia** — Farsightedness; a refractive error where light focuses behind the retina, causing better distance vision than near vision, though severe cases blur both. - **Astigmatism** — A refractive error caused by an irregularly shaped cornea or lens, resulting in blurred or distorted vision at all distances. ## 같은 주제 문제 - [A nurse is assessing a 45-year-old client who reports difficulty reading small print and n…](https://mymerci.kr/pages/nclex_q.php?qn_id=541550) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._