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NC Optometry Jurisprudence study materials
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NC Optometry Jurisprudence practice questions

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Question 1Licensure, Registration, and Board Administration

In North Carolina, which entity is vested with the authority to examine applicants and issue licenses to practice optometry?

  1. The North Carolina Board of Examiners in Optometry Correct answer.
  2. The North Carolina Optometric Society
  3. The North Carolina Medical Board
  4. The North Carolina Department of Health and Human Services

Explanation

The North Carolina Board of Examiners in Optometry is the statutory licensing body for optometry in the state. It examines applicants, issues licenses, and administers discipline. The Optometric Society is a voluntary professional association, while the Medical Board and DHHS license other providers or administer other programs.

Question 2Licensure, Registration, and Board Administration

A person applies for an initial North Carolina optometry license. Which requirement is imposed by the licensure statute rather than by a professional society?

  1. Purchase of professional liability insurance
  2. Graduation from an accredited optometry school Correct answer.
  3. Completion of a residency in ocular disease
  4. Membership in the North Carolina Optometric Society

Explanation

Initial licensure in North Carolina requires graduation from an accredited optometry school or college, along with other statutory requirements such as examination. Membership in a professional society, liability insurance, and residency training are not statutory prerequisites for licensure. The Board verifies education as part of the application process.

Question 3Licensure, Registration, and Board Administration

Which document does the North Carolina Board of Examiners in Optometry maintain as the official record of persons authorized to practice optometry in the state?

  1. The hospital staff privileging list
  2. The federal DEA registration list
  3. The membership roster maintained by the professional society
  4. The Board's register of licensed optometrists Correct answer.

Explanation

The Board maintains the official register of licensed optometrists, which records who is authorized to practice in North Carolina. Society rosters, hospital privileging lists, and DEA registrations serve different purposes and do not confer or record state optometry licensure. The register is a core administrative function of the Board.

Question 4Licensure, Registration, and Board Administration

An optometrist licensed in another state applies for a North Carolina license without taking the standard examination. The Board may grant that request only if the applicant:

  1. has practiced for at least twenty years in any jurisdiction
  2. belongs to the American Optometric Association
  3. agrees to limit practice to a rural county
  4. satisfies the Board's licensure-by-endorsement requirements Correct answer.

Explanation

North Carolina law allows the Board to license qualified optometrists from other jurisdictions through endorsement or reciprocity rather than the standard examination. The applicant must satisfy the Board's requirements, which generally include equivalent education, examination history, and good standing. Length of practice alone, association membership, or a practice-location promise does not substitute for those requirements.

Question 5Licensure, Registration, and Board Administration

The Board adopts a rule specifying continuing education hours that licensees must complete for renewal. The Board's authority to adopt the rule comes chiefly from:

  1. the bylaws of the North Carolina Optometric Society
  2. the federal Medicare Conditions of Participation
  3. its statutory rulemaking power under the optometry act Correct answer.
  4. a vote of the state's licensed optometrists

Explanation

The Board's rulemaking authority is granted by the optometry licensing statute and is exercised under the state Administrative Procedure Act. Professional society bylaws bind members only, a referendum of licensees is not a source of law, and federal Medicare conditions do not authorize state board rules. Continuing education rules are therefore adopted through the Board's statutory power.

Question 6Licensure, Registration, and Board Administration

Which circumstance most directly supports Board discipline against a licensee?

  1. Declining membership in a professional association
  2. Referring a patient to an ophthalmologist for surgery
  3. Obtaining the license through a false application Correct answer.
  4. Charging fees higher than those of a nearby practice

Explanation

Fraud or deception in obtaining a license is a classic ground for board discipline because it undermines the integrity of the licensure process. Fee differences, voluntary association membership, and appropriate referrals to physicians are not, by themselves, grounds for discipline. The Board's focus is on statutory violations and public protection.

Question 7Licensure, Registration, and Board Administration

Before the Board may revoke a license in a contested case, the licensee must be afforded:

  1. a criminal conviction before any board action
  2. notice and a hearing under the Administrative Procedure Act Correct answer.
  3. a closed session conducted without a record or a response
  4. a county-wide vote of licensed optometrists

Explanation

A license revocation in a contested case must comply with due process and the North Carolina Administrative Procedure Act. The licensee is entitled to notice of the charges and an opportunity for an administrative hearing. A closed session without a record, a licensee vote, or a prior criminal conviction is not the required procedure.

Question 8Licensure, Registration, and Board Administration

A licensee does not complete the continuing education required for renewal by the deadline. What is the Board's typical administrative response?

  1. Renewal is withheld until the CE requirement is satisfied Correct answer.
  2. Referral of the matter to the professional society for membership discipline
  3. Automatic issuance of a license in another state
  4. Permanent revocation of the license without any further procedure

Explanation

Continuing education is a condition of license renewal, so the Board may withhold renewal or condition it until the required hours are completed. Permanent revocation without procedure, automatic licensure elsewhere, or referral to a voluntary society are not the standard administrative consequences. The Board applies its CE rules and may provide limited make-up options.

Question 9Licensure, Registration, and Board Administration

Which principle best explains the Board's authority to discipline a licensee for conduct that occurs outside the examining room?

  1. The Board owns the licensee's patient records
  2. Professional societies may delegate discipline to the Board
  3. Only malpractice insurers may regulate off-duty conduct
  4. Licensure is a privilege conditioned on statutory compliance Correct answer.

Explanation

The state regulates optometry under its police power to protect the public, and a license is a privilege conditioned on compliance with statutes and Board rules. That authority can reach conduct outside the office when it bears on fitness or public protection. Patient-record ownership, society delegation, and insurer control do not supply the legal basis.

Question 10Licensure, Registration, and Board Administration

An optometrist allows her North Carolina license to lapse for failure to renew. To lawfully resume practice, she generally must:

  1. ask the professional society to certify her automatically
  2. rely on her inactive federal DEA registration
  3. resume seeing patients while paying the overdue fee
  4. apply for reinstatement under Board rules Correct answer.

Explanation

A lapsed license does not authorize continued practice. The former licensee must apply for reinstatement and satisfy the Board's current requirements, which may include fees, continuing education, and other conditions. Paying a late fee while practicing, relying on a DEA registration, or obtaining society certification does not restore the license.

Question 11Licensure, Registration, and Board Administration

The Governor appoints a public member to the North Carolina Board of Examiners in Optometry. Which characteristic is required of that appointee?

  1. The appointee is employed by the North Carolina Department of Health and Human Services.
  2. The appointee is a licensed optometrist in active clinical practice.
  3. The appointee has no financial interest in the practice of optometry. Correct answer.
  4. The appointee teaches full time at an accredited optometry school.

Explanation

The Board includes a public member who is not an optometrist and has no financial interest in optometry. The public member represents the public's interest in regulation rather than the profession's interest.

Question 12Licensure, Registration, and Board Administration

An active North Carolina optometry license must be renewed annually by which date?

  1. June 30
  2. March 1
  3. September 30
  4. December 31 Correct answer.

Explanation

Under the licensure statute, an active optometry license is renewed annually on or before December 31. A late renewal may be allowed with a penalty, but practicing after expiration is unlicensed practice.

Question 13Licensure, Registration, and Board Administration

During an investigation, the Board needs testimony from a person who refuses to appear voluntarily. Which power does the Board have?

  1. Direct the Governor to indict the person for obstruction.
  2. Suspend the person's driver's license until the person cooperates.
  3. Issue a subpoena compelling attendance and production of documents. Correct answer.
  4. Order the person jailed for contempt without court involvement.

Explanation

The Board may administer oaths, subpoena witnesses, and require production of records in connection with its investigations and hearings. If a subpoena is ignored, the Board must seek enforcement through the courts.

Question 14Licensure, Registration, and Board Administration

A retiring optometrist sells her practice, including equipment and patient records, to another licensed optometrist. What is the status of the seller's North Carolina license?

  1. It converts to a facility license held by the practice.
  2. It is personal to the seller and cannot be transferred. Correct answer.
  3. It automatically transfers to the buyer for the remainder of the renewal year.
  4. It may be assigned to the buyer if the Board approves the sale.

Explanation

An optometry license is a personal privilege granted to an individual based on that person's qualifications. It is not property that can be sold, assigned, or transferred with a practice; the buyer must hold a separate license.

Question 15Licensure, Registration, and Board Administration

The Board receives credible evidence that an unlicensed person is examining patients and dispensing contact lenses. Which civil remedy may the Board pursue?

  1. Seek an injunction in superior court to stop the unlicensed practice. Correct answer.
  2. Issue a license retroactively to cure the violation.
  3. Order the person to forfeit equipment to the Board without a court order.
  4. File a criminal information directly in the Court of Appeals.

Explanation

The Board may ask a superior court for an injunction against a person who practices optometry without a license. Unlicensed practice may also lead to criminal prosecution, but the Board's civil remedy is injunctive relief.

Question 16Licensure, Registration, and Board Administration

After a final Board order suspending a license, the licensee seeks judicial review under the North Carolina Administrative Procedure Act. In which court may the petition be filed?

  1. The Superior Court of Wake County or the superior court in the county where the licensee resides. Correct answer.
  2. The District Court of the county where the alleged violation occurred.
  3. The North Carolina Court of Appeals in all cases.
  4. The Supreme Court of North Carolina by direct appeal.

Explanation

The APA sets venue for judicial review of a final agency decision in the Superior Court of Wake County or the superior court of the county where the petitioner resides. The Court of Appeals generally hears appeals from the superior court, not directly from the Board.

Question 17Licensure, Registration, and Board Administration

A Board member's spouse is a partner in an optical company that is the subject of a Board complaint. What is the appropriate action for the Board member?

  1. Recuse from the investigation and adjudication of the matter. Correct answer.
  2. Participate but disclose the relationship after the vote.
  3. Serve as the sole hearing officer to avoid a quorum problem.
  4. Refer the complaint to the spouse for a written response.

Explanation

A licensee facing discipline is entitled to an impartial decision-maker. A Board member with a close family financial interest in a party should recuse from both the investigation and the adjudication to avoid a due process challenge.

Question 18Licensure, Registration, and Board Administration

The Board adopts a rule that allows licensees to renew without paying the fee set by statute. A licensee relies on the rule. What is the legal effect?

  1. The rule becomes valid if the Board publishes it in the Bulletin.
  2. The rule is invalid to the extent it conflicts with the statute. Correct answer.
  3. The rule controls because the Board has exclusive authority over optometry.
  4. The rule is valid only for licensees who renewed before its adoption.

Explanation

An administrative agency may adopt rules to implement a statute but cannot adopt a rule that contradicts the statute. A conflicting rule is invalid, and the statutory fee requirement controls.

Question 19Licensure, Registration, and Board Administration

A licensee wants to challenge the Board's denial of a license renewal in court before requesting a Board hearing. What doctrine likely bars immediate judicial relief?

  1. Sovereign immunity
  2. Res judicata
  3. Collateral estoppel
  4. Exhaustion of administrative remedies Correct answer.

Explanation

A party generally must pursue the administrative review process, including a contested case hearing, before seeking judicial review of an agency action. Immediate court review is barred until available administrative remedies are exhausted.

Question 20Licensure, Registration, and Board Administration

In a contested case disciplinary hearing before the Board, what standard of proof applies to the Board's findings?

  1. Beyond a reasonable doubt
  2. Substantial evidence
  3. Clear and convincing evidence
  4. Preponderance of the evidence Correct answer.

Explanation

In North Carolina administrative contested cases, the agency decides disputed facts by a preponderance of the evidence. Substantial evidence is the standard a court uses when reviewing the agency's findings, not the hearing standard.

Question 21Licensure, Registration, and Board Administration

A member of the North Carolina Board of Examiners in Optometry resigns before the end of the member's term. How is the resulting vacancy filled under the state's optometry board statutes?

  1. The North Carolina Optometric Society appoints a temporary successor.
  2. The Governor appoints a replacement for the unexpired term. Correct answer.
  3. The seat stays vacant until the next general election.
  4. The remaining Board members elect a licensed optometrist to serve.

Explanation

The optometry board statutes place appointment power with the Governor, and a mid-term vacancy is filled for only the unexpired portion of the term. The Board itself and the professional society do not elect or appoint voting members, and the seat is not left open for a general election.

Question 22Licensure, Registration, and Board Administration

Which source principally defines the North Carolina Board of Examiners in Optometry's licensing and disciplinary powers?

  1. Rules published by the American Optometric Association
  2. The North Carolina Optometry Practice Act in Chapter 90 Correct answer.
  3. The North Carolina Administrative Procedure Act alone
  4. Local county ordinances where the optometrist practices

Explanation

The North Carolina Optometry Practice Act, codified in Chapter 90, creates the Board and supplies its licensing and disciplinary authority. The APA supplies procedural rules, but it is not the source of the Board's substantive optometry powers.

Question 23Licensure, Registration, and Board Administration

The Board wants to consult its attorney in closed session about a pending disciplinary case. Under North Carolina open-meetings law, what must the Board do first?

  1. Obtain the licensee's written consent to close the meeting.
  2. Refer the matter to the Attorney General without a vote.
  3. Post a website notice at least 24 hours before the meeting.
  4. Vote in open session and state the closed-session purpose. Correct answer.

Explanation

North Carolina's Open Meetings Law allows a closed session for attorney-client advice if the public body first makes a motion in open session stating the purpose. Final action must still be taken in open session, and the licensee's consent is not the test.

Question 24Licensure, Registration, and Board Administration

A licensed optometrist files a petition asking the Board to amend its contact-lens dispensing rule. Under the North Carolina Administrative Procedure Act, what must the Board do?

  1. Hold a contested case hearing on the petition within 60 days.
  2. Submit the petition to the Governor for approval before acting.
  3. Deny it in writing or begin rulemaking within 30 days. Correct answer.
  4. Ignore the petition because only the Board may initiate rulemaking.

Explanation

Under G.S. 150B-20, any person may petition an agency to adopt, amend, or repeal a rule. The agency must act within 30 days by denying the petition in writing with reasons or by starting rulemaking.

Question 25Licensure, Registration, and Board Administration

An optometrist asks the Board, before opening a mobile clinic, whether the proposed arrangement would violate the Practice Act. Which APA procedure is designed to resolve that question without a disciplinary hearing?

  1. A petition for judicial review in superior court
  2. A request for an emergency rule
  3. A contested case petition filed by the Board
  4. A petition for a declaratory ruling Correct answer.

Explanation

A declaratory ruling under G.S. 150B-4 tells a petitioner how the agency would apply a statute or rule to specified facts. It is available before enforcement and is not a disciplinary contested case.

Question 26Licensure, Registration, and Board Administration

Which Board record is ordinarily open to public inspection under North Carolina public-records law?

  1. A final license-suspension order Correct answer.
  2. Counsel's confidential legal advice to the Board
  3. An applicant's raw examination score sheet
  4. An unresolved complaint's investigator notes

Explanation

Final disciplinary orders are public records and are commonly published by licensing boards. Investigative records, attorney-client advice, and individual exam materials may be protected by specific exemptions.

Question 27Licensure, Registration, and Board Administration

Board staff and an optometrist sign a proposed consent order resolving a disciplinary complaint. What must happen for the consent order to become the Board's final decision?

  1. The licensee must pay a fine before the order is valid.
  2. The Governor must sign it after reviewing the complaint.
  3. The Board must approve it at a meeting or by lawful written vote. Correct answer.
  4. A superior court judge must ratify it before it takes effect.

Explanation

A consent order is a negotiated settlement that becomes the Board's final disposition only when the Board accepts it and the licensee agrees. Neither the Governor nor a court must ratify the settlement for it to take effect.

Question 28Licensure, Registration, and Board Administration

The Board finds that an optometrist's continued practice poses an imminent risk to patients. Which action may the Board take under the NC APA?

  1. Ask a court to issue the license suspension order.
  2. Revoke the license permanently without any hearing.
  3. Summarily suspend it and provide a prompt hearing. Correct answer.
  4. Suspend the license only after a full contested case hearing.

Explanation

The APA permits summary suspension when the agency finds that public health, safety, or welfare requires emergency action. The licensee must then receive a prompt hearing, while permanent revocation follows the normal contested-case process.

Question 29Licensure, Registration, and Board Administration

An optometrist's Board-issued license certificate is destroyed in an office fire. What is the appropriate administrative step?

  1. Request a replacement certificate from the Board. Correct answer.
  2. Obtain a new license by retaking the licensure examination.
  3. Ask the county clerk to certify that the license existed.
  4. Continue practicing and display a photocopy of the destroyed certificate.

Explanation

The Board keeps the official licensure record and can issue a replacement certificate when the original is lost or destroyed. The underlying license remains valid, so retaking the examination is unnecessary.

Question 30Licensure, Registration, and Board Administration

After the Board adopts a new administrative rule, which step is required for the rule to be codified and enforceable in North Carolina?

  1. Obtain approval from the North Carolina Optometric Society.
  2. File the rule with the Codifier of Rules after required review. Correct answer.
  3. Publish the rule only in the Board's newsletter.
  4. Send the rule to every licensee by certified mail.

Explanation

Rules adopted under the APA must be reviewed as required and filed with the Codifier of Rules for publication in the North Carolina Administrative Code. Newsletter publication, professional-society approval, and mailing to licensees do not satisfy the codification requirement.

Question 31Scope of Practice and Prescriptive Authority

Which entity is responsible for issuing, renewing, and disciplining optometry licenses in North Carolina?

  1. The North Carolina State Board of Examiners in Optometry Correct answer.
  2. The North Carolina Department of Health and Human Services
  3. The North Carolina Optometric Society
  4. The North Carolina Medical Board

Explanation

The North Carolina State Board of Examiners in Optometry is the statutory licensing body for optometrists under the state optometry practice act. It administers licensure, renewal, and disciplinary proceedings for optometric practice. The Medical Board licenses physicians, and the Optometric Society is a professional association rather than a regulator.

Question 32Scope of Practice and Prescriptive Authority

Which activity falls within the statutory scope of practice of a licensed North Carolina optometrist?

  1. Prescribing a topical antibiotic for bacterial conjunctivitis Correct answer.
  2. Managing a patient's hypertension without ocular involvement
  3. Prescribing an oral antibiotic for streptococcal pharyngitis
  4. Performing cataract extraction with phacoemulsification

Explanation

North Carolina optometrists may diagnose and treat ocular conditions with pharmaceutical agents, including topical antibiotics for conditions such as bacterial conjunctivitis. Surgical procedures and treatment of systemic disease unrelated to the eye fall outside optometric scope.

Question 33Scope of Practice and Prescriptive Authority

A patient presents with a corneal foreign body and evidence of intraocular penetration. What is the optometrist's most appropriate action?

  1. Dilate the pupil and observe the patient in the office for two hours
  2. Remove the object at the slit lamp and schedule a follow-up in one week
  3. Prescribe topical antibiotics and reassure the patient
  4. Arrange immediate referral to an ophthalmologist for surgical management Correct answer.

Explanation

A suspected intraocular foreign body requires surgical evaluation and management beyond the optometric scope. The optometrist should protect the eye and arrange urgent ophthalmologic referral rather than attempt removal or delay care.

Question 34Scope of Practice and Prescriptive Authority

In North Carolina, an optometrist's authority to prescribe oral medications is best characterized as:

  1. Unlimited, matching the prescriptive authority of a physician
  2. Limited to pharmaceutical agents for ocular conditions within the optometric scope of practice Correct answer.
  3. Requiring co-signature by an ophthalmologist for every oral prescription
  4. Restricted to topical preparations only

Explanation

North Carolina optometrists may prescribe oral pharmaceutical agents for ocular conditions that fall within the optometric scope of practice. The authority is not equivalent to a physician's unlimited prescriptive authority, and routine ophthalmologist co-signature is not required.

Question 35Scope of Practice and Prescriptive Authority

How many hours of continuing education must a North Carolina-licensed optometrist complete for each annual license renewal?

  1. 30 hours
  2. 24 hours Correct answer.
  3. 18 hours
  4. 12 hours

Explanation

The North Carolina Board of Examiners in Optometry requires 24 hours of continuing education per license year, with certain mandated content categories such as ethics. The other listed totals do not satisfy the annual requirement.

Question 36Scope of Practice and Prescriptive Authority

A patient who has been fitted with contact lenses asks for a copy of the contact lens prescription. The optometrist should:

  1. Send it only to another optometrist or ophthalmologist
  2. Refuse because contact lens prescriptions are the practice's proprietary property
  3. Provide it only if the patient agrees to buy lenses from the practice
  4. Provide the prescription promptly so the patient can obtain lenses elsewhere Correct answer.

Explanation

Contact lens prescriptions must be released to the patient after the fitting is complete so the patient can obtain lenses from the provider of their choice. Release cannot be conditioned on purchasing lenses from the prescribing practice.

Question 37Scope of Practice and Prescriptive Authority

Which task may a North Carolina optometrist delegate to an unlicensed optometric assistant under appropriate supervision?

  1. Finalizing the spectacle prescription without optometrist review
  2. Performing tonometry as directed by the optometrist Correct answer.
  3. Prescribing a topical steroid for anterior uveitis
  4. Interpreting visual field results and diagnosing glaucoma

Explanation

Unlicensed assistants may perform delegated technical tasks such as tonometry under the optometrist's supervision. Diagnosis, interpretation of test results, final prescription determination, and prescribing require the licensed optometrist's judgment and authority.

Question 38Scope of Practice and Prescriptive Authority

An optometrist diagnoses herpes zoster ophthalmicus with corneal involvement. Which action is within the North Carolina optometric scope of practice?

  1. Administering an intravitreal injection of steroid
  2. Prescribing intravenous acyclovir in the office
  3. Prescribing an oral antiviral and providing appropriate follow-up or referral Correct answer.
  4. Performing a penetrating keratoplasty

Explanation

Oral antiviral therapy for ophthalmic herpes zoster is within the therapeutic prescriptive authority of a North Carolina optometrist when consistent with the ocular diagnosis and scope of practice. Surgical corneal procedures, intravitreal injections, and office administration of intravenous drugs are not within optometric scope.

Question 39Scope of Practice and Prescriptive Authority

After removing a superficial corneal foreign body, an optometrist may prescribe which of the following within North Carolina optometric scope?

  1. No medication, because all corneal abrasions require ophthalmology referral
  2. A topical antibiotic and a cycloplegic agent for the corneal abrasion Correct answer.
  3. A systemic antiviral for presumed herpetic keratitis
  4. An oral opioid for pain without further evaluation

Explanation

Removal of a superficial corneal foreign body and treatment of the resulting abrasion with topical antibiotics and cycloplegics are within the optometric scope. Penetrating injuries and conditions requiring surgery must be referred, but uncomplicated superficial injuries may be managed appropriately.

Question 40Scope of Practice and Prescriptive Authority

A patient presents with severe eye pain, halos around lights, a mid-dilated pupil, and an intraocular pressure of 52 mmHg. What is the optometrist's most appropriate response?

  1. Initiate emergency pressure-lowering treatment and refer immediately to an ophthalmologist Correct answer.
  2. Perform careful observation and recheck pressure in one week
  3. Dilate the pupil to relieve the pressure
  4. Prescribe a topical antibiotic and schedule a routine visit

Explanation

These findings suggest acute angle-closure glaucoma, which is an ophthalmic emergency. The optometrist should initiate appropriate pressure-lowering therapy and arrange immediate ophthalmologic care for definitive management.

Question 41Scope of Practice and Prescriptive Authority

In North Carolina, the lawful scope of optometric practice is established primarily by which authority?

  1. The federal Medicare Physician Fee Schedule
  2. The Optometry Practice Act and rules adopted by the Board of Examiners in Optometry Correct answer.
  3. The policy manuals of private vision insurance carriers
  4. The bylaws of the local hospital medical staff

Explanation

The Optometry Practice Act, together with Board of Examiners rules, defines licensed optometric activity in North Carolina. Hospital bylaws, federal fee schedules, and insurer policies do not enlarge or restrict the statutory scope.

Question 42Scope of Practice and Prescriptive Authority

Which diagnostic service may a North Carolina optometrist perform as part of a comprehensive eye examination?

  1. Laser trabeculoplasty
  2. Dilated fundus examination using topical mydriatic agents Correct answer.
  3. Pars plana vitrectomy
  4. Corneal transplant surgery

Explanation

Dilated fundus examination with topical mydriatics is a core diagnostic procedure within optometric practice. Vitrectomy, corneal transplantation, and laser trabeculoplasty are surgical procedures reserved for ophthalmologists.

Question 43Scope of Practice and Prescriptive Authority

A patient with visually significant cataract asks what care the optometrist can provide. Which service is within North Carolina optometric scope?

  1. Performing Nd:YAG laser capsulotomy
  2. Providing postoperative co-management and refraction after cataract surgery Correct answer.
  3. Performing phacoemulsification with intraocular lens implantation
  4. Selecting and inserting the intraocular lens in the operating room

Explanation

Optometrists may evaluate, refract, and co-manage postoperative cataract patients, but they do not perform the surgery or laser capsulotomy. Surgical and laser steps remain outside optometric scope.

Question 44Scope of Practice and Prescriptive Authority

A 68-year-old patient reports sudden monocular vision loss and jaw claudication. The optometrist suspects giant cell arteritis. Which action is most consistent with North Carolina scope of practice?

  1. Prescribe a topical corticosteroid and observe the vision
  2. Perform a temporal artery biopsy in the office
  3. Start long-term oral prednisone and schedule a routine follow-up in one week
  4. Arrange emergency referral for systemic evaluation and treatment Correct answer.

Explanation

Giant cell arteritis is a systemic emergency; the optometrist should recognize it and arrange immediate referral. Temporal artery biopsy and systemic corticosteroid management are medical services outside optometric scope.

Question 45Scope of Practice and Prescriptive Authority

A patient has acute anterior uveitis without hypopyon or posterior involvement. Which prescribing action is within the authority of a TPA-certified North Carolina optometrist?

  1. Administer an intravitreal anti-VEGF injection
  2. Prescribe a topical corticosteroid and a cycloplegic agent Correct answer.
  3. Place a sustained-release intravitreal implant
  4. Perform a surgical peripheral iridotomy

Explanation

TPA certification permits topical medications such as corticosteroids and cycloplegics for ocular inflammation. Intravitreal injections, implants, and laser iridotomy are surgical or specialized procedures outside optometric scope.

Question 46Scope of Practice and Prescriptive Authority

After a corneal abrasion, a patient requests oxycodone for pain. Which statement reflects North Carolina optometric prescriptive authority?

  1. The optometrist may prescribe oxycodone only for patients younger than 18 years
  2. The optometrist may not prescribe Schedule II controlled substances and should arrange other analgesia Correct answer.
  3. The optometrist may prescribe oxycodone only after a telephone consultation with an ophthalmologist
  4. The optometrist may prescribe any Schedule II opioid if the record documents the abrasion

Explanation

North Carolina optometric prescriptive authority extends to certain controlled substances but not Schedule II agents such as oxycodone. The optometrist should manage the ocular condition and direct the patient to an appropriate prescriber for Schedule II analgesia.

Question 47Scope of Practice and Prescriptive Authority

A patient arrives after alkaline fluid splashed into one eye. Which immediate action is within the optometrist's North Carolina scope?

  1. Begin copious ocular irrigation and arrange urgent ophthalmologic evaluation Correct answer.
  2. Perform immediate corneal debridement with a blade in the office
  3. Apply a pressure patch and have the patient return the next day
  4. Prescribe oral antibiotics and schedule a one-week recheck

Explanation

Chemical injury is an emergency; immediate irrigation and urgent referral are appropriate. Pressure patching, delayed recheck, or unauthorized surgical debridement would risk further damage.

Question 48Scope of Practice and Prescriptive Authority

An optometrist is treating bacterial conjunctivitis and notices a spreading cellulitis on the patient's forearm. The patient asks for an oral antibiotic for the arm. What is the appropriate response under North Carolina law?

  1. Prescribe the oral antibiotic only if the patient signs a liability waiver
  2. Treat the ocular condition and refer the forearm cellulitis to an appropriate medical provider Correct answer.
  3. Prescribe an oral antibiotic because TPA certification covers all oral anti-infectives
  4. Ask an unlicensed assistant to transmit the oral antibiotic prescription

Explanation

Optometric prescribing is limited to conditions of the eye and visual system. Spreading cellulitis is a systemic infection requiring evaluation and treatment by a medical provider.

Question 49Scope of Practice and Prescriptive Authority

Which procedure must a North Carolina optometrist refer to an ophthalmologist because it is outside optometric scope?

  1. LASIK refractive surgery Correct answer.
  2. Epilation of misdirected eyelashes
  3. Removal of a superficial corneal foreign body
  4. Punctal plug insertion for dry eye

Explanation

LASIK is laser refractive surgery and is not within optometric scope. Superficial foreign body removal, punctal plug insertion, and epilation are recognized minor optometric procedures when performed within Board rules.

Question 50Scope of Practice and Prescriptive Authority

A patient with proliferative diabetic retinopathy presents with a new vitreous hemorrhage and reduced vision. Which action is most appropriate for the North Carolina optometrist?

  1. Observe without referral because diabetic retinopathy is a chronic condition
  2. Refer urgently for retinal evaluation and continue co-management of ocular findings Correct answer.
  3. Prescribe topical antibiotics and recheck in six months
  4. Perform office-based vitrectomy to clear the hemorrhage

Explanation

Proliferative diabetic retinopathy with vitreous hemorrhage requires urgent retinal specialist evaluation, often for vitrectomy or laser. The optometrist may diagnose and co-manage but does not perform vitrectomy.