A patient is unable to read even the largest letters on the Snellen chart. The nurse should take which action next?

A) Refer the patient to an ophthalmologist or optometrist for further evaluation.
B) Assess whether the patient can count the nurse's fingers when they are placed in front of his or her eyes.
C) Ask the patient to put on his or her reading glasses and attempt to read the Snellen chart again.
D) Shorten the distance between the patient and the chart until the letters are seen, and record that distance.

If the person is unable to see even the largest letters when standing 20 feet from the chart, then the nurse should shorten the distance to the chart until the letters are seen, and record that distance (e.g., "10/200"). If visual acuity is even lower, then the nurse should assess whether the person can count fingers when they are spread in front of the eyes or can distinguish light perception from a penlight. If vision is poorer than 20/30, then a referral to an ophthalmologist or optometrist is necessary, but the nurse must first assess the visual acuity. The nurse should assess whether the person can count fingers when they are spread in front of the eyes or can distinguish light perception from a penlight only if unable to see the letters on the Snellen chart when the distance is shortened. Applying reading glasses will not help with reading the Snellen chart as that is assessing far vision, not near vision.