Final N110

A patient with open-angle glaucoma has developed thicker and longer eyelashes and reports a darkening of their eye color. You assess the patient's medication list. What glaucoma medication on the patient's medication list can cause this side effect? A. Bimatoprost B. Pilocarpine C. Acetazolamide D: Timolol

The answer is A. Bimatoprost is a prostaglandin analog and can cause these signs and symptoms.

Your patient is being treated for open-angle glaucoma. What assessment finding is NOT typically present with this type of glaucoma? A. Tunnel vision B. Cloudy vision C. Optic disc cupping D. High intraocular pressure

The answer is B. Cloudy vision is associated with cataracts, while tunnel vision is associated with glaucoma due to the loss of peripheral vision.

Pt on pilocarpine (Isopto Carpine) for TX of glaucoma. Which symptom is attributed to systemic absorption? 1. diaphoresis 2. constipation 3. tachycardia 4. hypertension

1. diaphoresis Symptoms of systemic absorption of pilocarpine include: Diaphoresis diarrhea bradycardia HYPOtension

Which statement by the pt indicates to the nurse that the pt has an understanding regarding pilocarpine (Isopto Carpine)? 1. I will see better at night 2. I may have trouble adjusting to darkness 3. It should not be difficult adjusting to changes from light to dark 4. I will not use the medication if I plan to drive

2. I may have trouble adjusting to darkness Difficulty in adjusting quickly to changes in illumination occurs as a result of miosis, (PUPIL CONSTRICTION), an effect of pilocarpine. The pt will have DIFFICULTLY SEEING AT NIGHT Driving is not contraindicated; however night time drive might not be possible because of the MIOSIS

Parasympathomimetic ophthalmic drugs such as pilocarpine (Pilocar) reduce intraocular pressure in the treatment of glaucoma by which mechanism of action? A. Miosis B. Mydriasis C. Cause the pupils to get larger D. Decrease in drainage of aqueous humor

A. Miosis

A client has recently had cataract surgery. About which symptom does the nurse instruct the client to notify the health care provider?A. Increased tearing B. Itching of the eye C. Reduction in vision D. Swollen eyelid

Answer: C Rationale: A reduction in vision after cataract surgery indicates a problem, and the client should notify the provider immediately. Increased tearing, itching of the eye, and a swollen eyelid all are expected after cataract surgery.

The client is prescribed timolol (Timoptic) for treatment of glaucoma. The nurse assesses for which of the following medical disorders during the history and physical, which may be a contraindication to the use of this drug? (Select all that apply.) 1. Heart block 2. Heart failure 3. Liver disease 4. COPD 5. Renal disease

Answer: 1, 2, 4 1. Heart block 2. Heart failure 4. COPDRationale: The nurse needs to notify the health care provider if the client has a history of heart block, bradycardia , cardiac failure, HF, or COPD because timolol may be contraindicated for clients with these conditions. If the drug is absorbed systemically, it will worsen these conditions. Proper administration lessens the danger that the drug will be absorbed systemically. Options 3 and 5 are incorrect. The renal and hepatic systems are not affected by timolol.

The nurse is providing discharge instructions to a client with glaucoma. Which activities does the nurse instruct the client to avoid? (Select all that apply.) A. Bending over to tie shoes B. Sitting with legs elevated C. Sleeping on more than two pillows D. Blowing the nose frequently E. Lifting objects weighing more than 10 pounds

Answer: A, D, E Rationale: Any action that would increase pressure in the eye should be avoided, such as bending over, excessive blowing of the nose, and lifting heavy objects. Sitting with the legs elevated or sleeping on more than two pillows is not contraindicated in clients with glaucoma.

What is the action of miotics in the client with glaucoma? A. Decrease the inflammatory process B. Enhance aqueous outflow C. Increase the production of vitreous humor D. Vasoconstrict the blood vessels in the eye

Answer: B Rationale: Miotics are used to improve the flow of fluid (aqueous humor) and decrease intraocular pressure in clients with glaucoma. Steroid drops, not miotics, decrease the inflammatory process. Vitreous humor fills the space between the lens and the retina, is stagnant, and is not replenished as the aqueous humor is. Miotics make the pupil smaller, which creates more room between the iris and the lens.

The nurse is teaching a client about open-angle glaucoma management. Which statement by the client indicates a need for further instruction? A. "I must wait 10 to 15 minutes between different eyedrop medications." B. "I must press on the inside of my eye to prevent washout." C. "It is important to not skip a dose." D. "These eyedrops will not cure my glaucoma."

Answer: B Rationale: Pressing on the inside of the eye after instillation of eye medication prevents systemic absorption of the drug. To avoid washout, the client should wait 10 to 15 minutes between eyedrop medications. Skipping a dose will not exacerbate the client's glaucoma. Medication will not cure glaucoma, but it will control its progression.

The nurse is performing preoperative teaching for an older adult client who will be having a cataract removed. Which instructions does the nurse include? (Select all that apply.)A. "You will need to wear a patch on your eye for several weeks after the surgery."B. "Several different types of eyedrops are requested after surgery, and they have to be taken several times a day for up to 4 weeks."C. "You will receive a medication to help you relax. Then you will receive some different eyedrops to dilate your pupils and paralyze the lens."D. "Bring sunglasses with you on the day of your procedure."E. "You might experience a lot of bruising and swelling around the eye."

Answer: B, C, D Rationale: The client will have multiple eyedrops to use after surgery and should be made aware of this before the procedure to understand the importance. Providing information on what to expect, such as telling the client about the medication that will be administered and the eyedrops that will dilate and paralyze the lens, helps the client prepare for the day of surgery. The client will need to have sun protection after the procedure. A patch is required after surgery only if a risk for injury is present. Cataract surgery does not cause bruising and swelling post-surgery.

Which assessment is most important for the nurse to perform before instilling travoprost (Travatan) into the client's eye? A. Measuring the client's blood pressure B. Measuring the client's intraocular pressure C. Checking the cornea for abrasions or open areas D. Assessing heart rate and rhythm for 1 full minute

Answer: C Rationale: Travoprost is a prostaglandins agonist. Drugs from this class should not be applied unless the cornea is completely intact. Measuring intraocular pressure is not necessary when a diagnosis of glaucoma has been established. Prostaglandins agonists, even if systemically absorbed, do not affect body blood pressure or heart rate and rhythm.

During patient teaching regarding self-administration of ophthalmic drops, with statement by the nurse is correct? A. "Hold the eyedrops over the cornea, and squeeze out the drop." B. "Apply pressure to the lacrimal duct area for 5 minutes after administration." C. "Be sure to place the drop in the conjuctival sac of the lower lid." D. "Squeeze your eyelid closed tightly after placing the drop into your eye."

Answer: C Rationale: Because the cornea is sensitive, most eye medications are placed inside the lower lid. For systemic osmotic drugs, pressure only needs to be applied to lacrimal duct for 60 seconds.

The client who had cataract surgery with a lens implant 1 week ago remarks to the home care nurse that after his daughter left to go to her home in another state yesterday, he combined all of his prescribed eyedrops together in one container so he had fewer drops to administer. What is the nurse's best response? A. "This is not a good idea because not all of the drugs are on the same schedule." B. "That is a good idea; just remember to not touch the dropper to your eye when giving yourself the drops." C. "Call your surgeon immediately and get new prescriptions because together these drugs can lower your blood pressure." D. "Call your surgeon immediately and get new prescriptions to use one at a time because these drugs cannot be mixed together."

Answer: D Rationale: These drugs are not to be mixed together. Not only is the chance for contamination high, but the drug concentrations and effectiveness are also reduced when mixed together. Even when the drugs are administered separately, they should be given 5 to 10 minutes apart.

A client with glaucoma is being assessed for new symptoms. Which symptom indicates a high priority need for reassessment of intraocular pressure? A. Burning in the eye B. Inability to differentiate colors C. Increased sensitivity to light D. Gradual vision changes

Answer: D Rationale: Gradual vision changes are an indication of increased intraocular pressure. A burning sensation in the eye usually indicates inflammation and/or infection. An inability to differentiate colors is an early sign of cataracts. An increased sensitivity to light might be a sign of a corneal abrasion.

A patient is prescribed timolol (Timoptic) for treatment of glaucoma. Which medical disorders, if discovered during the history and physical, could be a contraindication to the use of this drug? a. Heart block b. Renal disease c. Liver disease d. Hyperthyroidism

Answer: a. Heart blockRationale: Consult with the physician and pharmacist if the client has second- or third-degree heart block, bradycardia, cardiac failure, CHF, or COPD, as timolol might be contraindicated for patients with these conditions. If the drug is absorbed systemically, it will worsen these conditions. Proper administration lessens the danger of the drug being absorbed systemically

Which instruction should the nurse include in the teaching plan for the client who is receiving timolol (Betimol, Timoptic, others) for the treatment of glaucoma? a. Monitor your weight daily and report gain of over 2 lb per week. b. Monitor your body temperature for late afternoon onset of fever. c. Assess your blood pressure once weekly and report any reading less than 90/60. d. Monitor your breathing for any periods of shortness of breath.

Assess your blood pressure once weekly and report any reading less than 90/60.Rationale: Systemic side effects of beta-adrenergic agents may include bronchoconstriction, dysrhythmias, and hypotension. Because of the potential for systemic side effects, these drugs should be used with caution in clients with asthma, bradycardia, or heart failure. Clients and their families should be taught to monitor their pulse and blood pressure. Option 1, 2, and 4 are incorrect. Daily weight, temperature, and potential for shortness of breath would not need to be stressed in the teaching plan.

The patient is ordered to take Timolol for the treatment of glaucoma. Before administration the nurse will educate the patient about this new medication. Which of the following information is the MOST pertinent the nurse to include? A. Measuring the heart rate because this medication can cause tachycardia. B. Performing punctal occlusion after instilling the eye drops. Timolol is a beta blocker, and it is administered via eye drops for the treatment of glaucoma. C. Avoid taking this medication with any other glaucoma medications. D. Always administer this medication 1 minute before another type of glaucoma medication.

B. Performing punctal occlusion after instilling the eye drops. Timolol is a beta blocker, and it is administered via eye drops for the treatment of glaucoma. It is very important the patient perform punctal occlusion after instilling the eye drop to prevent systemic effects of the medication. The medication needs to stay in the eye rather than enter the blood stream. Punctal occlusion is where the tear duct is blocked with the index finger for about 2-3 minutes. This will prevent the medication from draining down into the nasolacrimal duct.

A patient asks you to explain how the intraocular pressure is measured to help detect glaucoma. You state that IOP (intraocular pressure) is measured by what instrument below? A. Goniscope B. Tonometry C. Ophthalmoscope D. Phoroptor

B. Tonometry The answer is B. Tonometry is used to assessment IOP.

The production and drainage rate of aqueous humor is not equal in patients with glaucoma. Select below the correct sequence for how aqueous humor should flow through the eye: A. The ciliary body produces aqueous humor -> then it flows through the anterior chamber (area of the eye between the iris and cornea) -> pupil opening -> posterior chamber (area of the eye between lens and iris) ->drainage angle ->trabecular meshwork -> schlemm's canal -> episcleral veins B. The lens produces aqueous humor -> then it flows through the pupil opening -> the anterior chamber (area of the eye between the iris and cornea) -> posterior chamber (area of the eye between lens and iris) -> drainage angle ->trabecular meshwork -> schlemm's canal -> episcleral veins C. The ciliary body produces aqueous humor -> then it flows through the posterior chamber (area of the eye between the lens and iris) -> pupil opening -> anterior chamber (area of the eye between iris and cornea) -> drainage angle ->trabecular meshwork -> schlemm's canal -> episcleral veins D. The lens produces aqueous humor -> then it flows through the posterior chamber (area of the eye between the iris and cornea) -> pupil opening -> anterior chamber (area of the eye between lens and iris) -> drainage angle ->trabecular meshwork -> schlemm's canal -> episcleral veins

C

Which statement below is CORRECT about glaucoma? A. "The vision loss that occurs with glaucoma is reversible with eye drop medications." B. "Glaucoma occurs due to decreased intraocular pressure, which damages the optic nerve." C. "Surgery can cure glaucoma." D. "A normal intraocular pressure is about 10-21 mmHg and is elevated in most patients with glaucoma."

D. "A normal intraocular pressure is about 10-21 mmHg and is elevated in most patients with glaucoma." The answer is D. This option is the only correct statement about glaucoma. Vision loss is NOT reversible when it occurs in glaucoma but it's permanent...eye drops can prevent further progression. Glaucoma occurs due to INCREASED intraocular pressure (NOT decreased), and there is NO cure for glaucoma.

You're providing an educational seminar to a group of senior citizens about glaucoma. You explain to the participants about the differences between open-angle and angle-closure glaucoma in relation to the drainage angle of the eye. A participant asks what type of examination can be performed to assess the drainage angle of the eye. Your response is? A. Tonometry B. Ophthalmoscopy C. Retinoscopy D. Gonioscopy

D. Gonioscopy The answer is D. A gonioscopy is used to assess the drainage angle of the eye. The drainage angle is the area in which an angle is formed at the front of the eyes where the iris and cornea meet. This is where aqueous humor drains out into the trabecular meshwork

Your patient has a history of angle-closure glaucoma. What type of medications should this patient avoid? A. Anticholinergics B. Cholinergics C. Beta blockers D. Alpha-agonists

The answer is A. Angle-closure glaucoma occurs when the drainage angle of the eye becomes too narrow or closed to allow aqueous humor to drain out of the eye. This fluid stays in the eye and increases intraocular pressure, which can damage the optic nerve. Dilation of the pupils can push the iris forward and block off the drainage angle. Therefore, this patient should avoid anticholinergics. Remember anticholinergics cause dilation of the pupils...therefore, patients with angle-closure glaucoma should avoid these medications unless otherwise approved by their doctor.

You're providing care to a patient who just had glaucoma surgery. The patient is alert and oriented. Vital signs are: heart rate 82 bpm, blood pressure 110/80, oxygen saturation 97% on room air, respiratory rate 18, and pain rating of 2 on 1-10 scale. Which patient finding below requires you to notify the physician? A. The patient reports blurred vision. B. The patient is having difficulty passing stool and reports constipation. C. The patient reports that the eyes feel itchy. D. The patient's eyes are frequently tearing up.

The answer is B. Option A, C, and D are NORMAL findings that can occur after glaucoma surgery. The patient should avoid activities that can increase intraocular pressure like bending, straining (especially during bowel movements), or lifting heavy objects. Therefore, the nurse would need to notify the doctor to obtain an order for a laxative or stool softener so the patient won't strain during a bowel movement.

A patient with glaucoma is ordered eye medication for the right eye in the form of an ointment and eye drop. The nurse will administer which type of medication first? A. Ointment and then the eye drops B. Eye drops and then the ointment

The answer is B. The nurse will administer eye drops FIRST and then the ointment.

A patient is scheduled to take Brimonidine and Latanoprost eye drops for management of glaucoma at 1000. What correct action below will the nurse take when administering these eye drops? A. The nurse assists the patient with using the index finger to gently place pressure at the side of the nose bridge for about 30 seconds after administering each eye drop medication. B. The nurse waits at least 3-5 minutes before administering the second eye drop medication. C. The nurse administers each eye drop directly on the eye via the cornea. D. The nurse encourages the patient to blink after each eye drop administration.

The answer is B. This is the only correct action by the nurse. The nurse should wait at least 3-5 minutes before administering the second medication. This is so that the first medication can be used by the eye and not washed out by the second medication.

A patient is experiencing a severe case of acute angle-closure glaucoma. The patient is not a candidate for laser intervention. The nurse would anticipate the physician would order the nurse to prep the patient for what procedure? A. Trabeculoplasty B. Trabeculectomy C. Iridectomy D. Blepharoplasty

The answer is C. Iridectomy is where the surgeon removes part of the iris which will help drain off aqueous humor and decrease the IOP. Options A and B are procedures to help treat open-angle glaucoma. Option C is used to treat angle-closure glaucoma and is more invasive than the laser procedure called a laser iridotomy (it's where a small hole is created in the iris with a laser to drain the increased aqueous humor). We are told in the scenario the patient is not a candidate for this procedure.

Your patient, who has open-angle glaucoma, is scheduled for a procedure that will remove some of the trabecular meshwork and create an opening to allow aqueous humor to collect in an area of the conjunctiva. This procedure will allow aqueous humor to be reabsorbed and help decrease IOP. As the nurse you know that you will need to provide pre-op and post-op patient education about what procedure below? A. Iridectomy B. Selective Laser Trabeculoplasty (SLT) C. Laser iridotomy D. Trabeculectomy

The answer is D Trabeculectomy This procedure can help decrease IOP pressure in the eyes, and is used when eye drops or other procedures are not working.

You're observing a patient self-administer eye drops for the treatment of glaucoma. Which finding below requires you to re-educate the patient on how to administer eye drops correctly? A. The patient refrains from blinking after instilling the eye drops. B. The patient washes hands before and after administering the eye drops. C. The patient uses a tissue to catch any medication that drips out of the eye after administration of the drops. D. The patient places the drops of medication directly on the eye via the cornea.

The answer is D. Eye drops are placed in the lower sac of the eye (conjunctival sac) NOT directly on the eye via the cornea. It's important that the nurse observes the patient using the drops and re-educate if they are using them incorrectly.

What signs and symptoms are present with angle-closure glaucoma? Select all that apply: A. Patients are mainly asymptomatic B. Gradual loss of peripheral vision C. Sudden vision changes (halos around lights or blurred vision) D. Severe eye pain E. Corneal edema F. Nausea and vomiting G. Red eyes H. No pain I. IOP <10 mmHg

The answers are: C, D, E, F, G. Angle-closure glaucoma is SUDDEN and SEVERE. The patient will NOT be asymptomatic like in open-angle glaucoma. They will have SUDDEN vision changes, severe pain (eyes or head), corneal edema, nausea/vomiting, red eyes, and IOP >50 mmHg. It is a medical emergency.

The nurse is teaching a client about a new eyedrop prescription for timolol (Timoptic) for treatment of open-angle glaucoma. The client has a history of seasonal allergies and hypertension. What is an important administration technique to stress for this client? a. Take any eyedrops for allergies 5 minutes before administering the timolol drops b. Do not use the timolol drops while concurrently taking allergy medication. c. The timolol drops may temporarily worsen seasonal allergies. d. Gently put pressure on the inner canthus (tear duct) for 1 minute after instilling the timolol drop.

d. Gently put pressure on the inner canthus (tear duct) for 1 minute after instilling the timolol drop. Timolol is a beta-adrenergic blocker. To prevent swallowing and systemic absorption, pressure should be applied to the inner canthus of the eye for 1 minute after instilling the drop. Options 1, 2, and 3 are incorrect. No other eyedrops or ointments should be used when taking timolol or other drops for glaucoma without the approval of the provider. Eye solutions for allergies may contain adrenergic drugs that may worsen glaucoma. Timolol is not contraindicated during seasonal allergies. It is not known to worsen seasonal allergies, although it may cause bronchoconstriction in the sensitive individual or if swallowed and systemic effects occur.

Mydriactic meds

dilate the pupils