Question

When performing a neurologic assessment on a patient, the nurse notes fixed pupils that are unresponsive to a light stimulus. Which causes of fixed pupils should the nurse consider during this assessment? Select all that apply.

a) Previous eye surgery
b) Administration of diuretics
c) Increased intraocular pressure
d) Increased intracranial pressure (ICP)
e) Direct injury to the third cranial nerve (CN III)

Answer 1

When a neurologic assessment reveals fixed pupils unresponsive to light, possible causes include previous eye surgery, increased intraocular pressure, increased intracranial pressure, and direct injury to CN III. Diuretics are not typically associated with fixed pupils.

Step-by-step explanation:

When a nurse observes fixed pupils that are unresponsive to a light stimulus during a neurologic assessment, there are several potential causes to consider. These include:

• Previous eye surgery, which can affect the muscles and nerves controlling pupil dilation and constriction.
• Increased intraocular pressure, which may be indicative of conditions like glaucoma and can affect the function of the optic nerve.
• Increased intracranial pressure (ICP), which can compress the cranial nerves and affect their functioning, including the third cranial nerve (CN III) responsible for pupillary constriction.
• Direct injury to the third cranial nerve (CN III), which can result from trauma or other conditions, impacting the pupillary light reflex. Administration of diuretics is not typically associated with fixed pupils and should not be selected.

The pupillary light reflex involves the afferent pathways through the optic nerve and efferent pathways through the oculomotor nerve. The autonomic control of pupillary size is an important neurological response to assess, as disturbances can indicate significant neurological conditions.