Prep U Unit 8: Eyes

A client has been prescribed multiple eye medications. Which of the following instructions would be important for the nurse to explain to the client?

"Place one of the medications into the eye and then wait 5-15 minutes before administering the next medication."

A client asks the nurse if the eye drops (a beta-adrenergic blocking drug used to treat his open-angle glaucoma) just prescribed will cause any effect on his asthma. What would be an appropriate response from the nurse?

"They might. Let's talk to the care provider and pharmacist about asthma and these eye drops."

A male client is prescribed a topical ophthalmic medication. The nurse teaches the client that the medication should be discarded at what point? (Select all that apply.)

- After the expiration date -If it becomes cloudy -If the color changes

The nurse should caution the patient about potential common adverse effects of ophthalmic medications. Which of the following are examples? Select all that apply.

-blurred vision -Stinging or burning

A patient with glaucoma asks the nurse why it is necessary to use drops every day. The nurse responds that the drops help lower intraocular pressure (IOP) and that if IOP remains high, which of the following complications can develop? (Select all that apply.)

-optic nerve damage -visual loss -blindness

What tasks does the role of the home care nurse caring for clients with acute or chronic eye disorders include? (Select all that apply.)

-teaching clients and caregivers reasons for use of drugs -assessing therapeutic and adverse drug reactions -teaching accurate administration technique of drugs

To ensure drops stay in the eye and avoid systemic absorption of the medication, the nurse should instruct the client to do which of the following after instilling eyedrops?

Apply finger pressure over the lacrimal sac for 1 to 2 minutes after instillation.

When proparacaine is used, how long will the topical anesthetic action be effective?

10-15

A female client wears soft contact lenses. She uses eye drops containing benzalkonium. The nurse teaches the client that the medication should be instilled under what condition?

15 minutes or longer before inserting soft contacts

A nurse is preparing a patient for discharge after an eye examination in which atropine sulfate was used to dilate the pupil. The nurse knows to caution the patient to use sunglasses until the effects of the atropine wear off. For how long should the patient be cautious?

7 to 14 days

A patient has been prescribed acetazolamide (Diamox) for a new diagnosis of glaucoma. The nurse recognizes this drug is contraindicated in patients with which of the following diseases?

Addison's disease

A patient is scheduled for a complete ophthalmic examination. The nurse anticipates the medication to be used to dilate the pupil will belong to which class of drugs?

Anticholinergic

The patient is treated for chronic open-angle glaucoma. The nurse recognizes that which category of drugs is considered the first-line category of drugs to treat this?

Beta blockers

Which of the following is an example of a beta-adrenergic blocking ophthalmic drop? (Choose one)

Betazolol (Betaptic)

What is the major disadvantage of ophthalmologic ointments?

Blurred vision

Which of the following is an example of an alpha2 adrenergic agonist ophthalmic drop? (Choose one)

Brimonidine (Alphagan)

Which of the following is an example of a carbonic anhydrase inhibitor ophthalmic drop? (Choose one)

Brinzolamide (Azopt)

The nurse on the med-surg floor is reviewing discharge instructions with a patient who has a history of glaucoma. Which classification of drugs on the patient's discharge instructions is used to treat the patient's glaucoma?

Cholinergics

A nurse is teaching a patient with glaucoma how to administer eyedrops to achieve maximum absorption. Where should the nurse teach the patient to instill the eyedrops?

Conjunctival sac

Which of the components of the eyeball is without blood vessels?

Cornea

The nurse is aware that as a general rule practitioners prefer to use which of the following in pediatric patients to dilate the eye for an examination?

Cyclopentolate

The eyeball can exhibit refractory errors, which impair vision by interfering with the eye's ability to focus light rays on the retina. How are ophthalmic drugs used in these instances?

Diagnostically

The nurse is preparing a client for discharge after cataract surgery. The client is instructed to use anti-inflammatory eyedrops after the surgery for 2 weeks. Which of the following medications will the client be using?

Diclofenac (Voltaren)

The nurse is teaching the parents of a child about brimonidine. The nurse informs the parents that which of the following can be an adverse effect?

Diminished alertness

A nurse is completing admission paperwork for a patient with pneumonia. The patient's medication history shows only brimonidine 1 gtt in both eyes three times a day. The nurse deducts that this patient suffers from which of the following diseases?

Glaucoma

A patient has arrived at the clinic. Assessment findings indicate an acute attack of glaucoma. The nurse anticipates which of the following drugs will be ordered?

Glycerin

A client is taking an oral beta-adrenergic blocker for his congestive heart failure. He has just been diagnosed with glaucoma and prescribed carteolol, an ophthalmic beta blocker. What potentially dangerous adverse reaction should the nurse warn the client about?

Hypotension

Glaucoma is an optical disorder characterized by increased intraocular pressure (IOP). What causes increased IOP?

Impaired drainage of aqueous humor

Your patient, an 11-year-old boy has an extensive history of blepharitis and hordeolum. Why would you expect an oral antimicrobial to be ineffective?

Inability to achieve therapeutic levels

The nurse is aware that some medications have additional actions besides treating glaucoma. Which of the following medications can also be used to increase eyelash growth?

Latisse

A client is seen in the clinic due to seasonal allergies. His major complaint is his itchy eyes. The nurse knows that what type of medication could be used to treat his itchy eyes?

Mast cell stabilizer

A client has just been diagnosed with a fungal infection in his eye. Which of the following medications is used to treat fungal infections?

Natamycin

A male client presents to the physician's office with symptoms of an eye infection. He is diagnosed with a fungal infection. The nurse expects the physician to order which medication for this client?

Natamycin

A female client has both heart and eye disease. The nurse will administer the eye medications in what way to prevent exacerbation of her cardiac symptoms?

Occlude the nasolacrimal duct in the inner canthus of the eye

The physician prescribes medication for a client's eye disorder. The physician's concern is that the client requires high concentrations of the drug. The nurse knows that the physician will order the medication in what type of formulation?

Ointment

The nurse is reviewing the medication history with a new client. During the assessment the nurse notes this patient should be screened for glaucoma. Which of the following is a basic guideline to screen for glaucoma?

Older than 40 years of age

A client is diagnosed with blepharitis. What symptoms should a nurse monitor in this client?

Patchy flakes clinging to the eyelashes

A nurse in the free clinic is assessing a patient diagnosed with conjunctivitis who has presented for a follow-up examination. What finding would lead the nurse to conclude that the treatment for conjunctivitis was effective?

Perauricular adenopathy is decreased

A female client is diagnosed with cardiac disease. She is also prescribed local eye medications. The nurse cautions Mrs. Young that local eye medications may cause what effect?

Systemic effects

A patient taking medications to treat glaucoma tells the nurse that she has not experienced any side effects that the nurse listed during teaching. The patient, however, informs the nurse of problem with fatigue, drowsiness, and palpitations since starting the medications. What should the nurse expect as the cause of the patient's symptoms?

Systemic effects

A client with glaucoma has been given a prescription for a mydriatic drug. What is a priority action of the nurse?

Tell the physician

The nurse is preparing an 8-year-old boy for an ophthalmic procedure that requires the use of an anesthetic. Which of the following should the nurse question, if there is an order for it on the patient chart?

Tetracaine

A female client complains that she must administer her eye drops several times because she blinks. How might this influence the therapeutic effects of the drops?

Therapeutic effects depend on accurate administration

You are teaching a parent how instill drops in their 12 year-old sons' eyes. Which action would you teach the parent is accomplished first?

Tilt the head slightly backward

The nurse recognizes that the first drug developed in the beta-blocker class to treat open-angle glaucoma is which of the following?

Timolol maleate (Timoptic)

When caring for a client with chronic glaucoma, the nurse sets the goal of drug therapy to slow disease progression by reducing IOP. What are the first-line drugs used to treat glaucoma?

Topical beta-blockers

Topical medications are the ocular "drug of choice." How are these medications distributed?

Via tear film

A client has been diagnosed with keratoconjunctivitis related to an exacerbation of herpes simplex virus. The nurse anticipates this client will need teaching regarding which of the following medications?

Viroptic

The nurse is taking an ocular history. What question would be most important for the nurse to ask the client?

What medications are you taking?

The eyeball is a spherical structure with several components. Which of the following are components of the eyeball?

all of these

The patient with glaucoma has which of the following?

an increase in IOP

The eye has several structures to facilitate sight. Which of the following is the mucous membrane lining of the eyelids?

conjunctiva

A nursing student is studying medical terminology and identifies which of the following correctly to mean constriction of the pupil?

miosis

A patient has been diagnosed with a fungal infection in the right eye. The ophthalmologist plans to order which of the following drugs to treat this infection?

natamycin

The nurse is aware that brimonidine is used to produce what physiologic effect in clients with ocular hypertension?

reduce aqueous humor production

The ophthalmic preparation pilocarpine (Isopto Carpine) should be used cautiously in clients with which of the following? Select all that apply:

• Asthma • Hypertension • Peptic ulcer disease

The nurse is preparing to administer timolol maleate to a client who has just been diagnosed with chronic open-angle glaucoma. The nurse will contact the physician before administering the medication if the client reports a history of which conditions? (Select all that apply.)

• Asthma • Heart failure • Left ventricular dysfunction

A nurse is preparing to teach a patient about timolol, which has been prescribed to treat newly diagnosed glaucoma. When reviewing the patient's current medication list, the nurse notes some medications that can increase the effect of timolol. Which of the following medications should not be used with timolol? Select all that apply.

• Calcium-channel blockers • Antihypertensives • Monoamine oxidase (MAO) inhibitors

Several topical antimicrobials are utilized to treat bacterial, viral, and fungal infections of the external portions of the eye. Which of the following are bacterial infections of the eye? Select all that apply.

• Corneal ulcers • Keratitis • Blepharitis

A nurse is reviewing a medication list with a client who confirms use of timolol maleate (Timoptic) as ordered. He also casually mentions that his wife has been doing research online and giving him various herbs to help improve overall health. Which of the following herbs would the nurse recognize as enhancing the effects of timolol? Select all that apply.

• Garlic • Ginger • Ginseng

A nurse is talking to a client who has just been prescribed an ophthalmic medication. Which of the following teaching points would be important for the nurse to teach the client? Select all that apply.

• If solution is discolored, do not use it. • Wash hands thoroughly before placing drops in eye. • Do not touch tip of dropper, bottle, or tube.

Which of the following adverse effects of ophthalmic medications should a nurse educate her client on? Select all that apply.

• Irritation • Blurred vision • Redness

Left untreated, increased intraocular pressure caused by glaucoma can lead to which of the following? Select all that apply:

• Nerve damage • Blindness • Visual loss

The nurse is preparing to administer acetazolamide and knows that it may be prescribed to be administered in what ways? (Select all that apply.)

• Orally • Intravenously

The nurse is preparing a client for an eye examination and administers atropine sulfate (ophthalmic). The nurse instructs the client that this medication has what effects on the eye? (Select all that apply.)

• Produces pupillary dilation • Produces mydriasis

Brimonidine, used to treat open-angle glaucoma, has which of the following actions? (Select all that apply.)

• Reduce the production of aqueous humor • Increase the outflow of aqueous humor

A nurse is writing a care plan for a client who is being treated for glaucoma. Which of the following nursing diagnoses would be appropriate for this client? Select all that apply.

• Risk for Injury Related to Blurred Vision • Risk for Body Image Disturbance related to eye discoloration • Risk for Acute Pain related to increased intraocular pressure

The post-anesthesia care unit (PACU) nurse who routinely administers nonsteroidal anti-inflammatory drugs (NSAIDs) to patients who have undergone eye surgery knows that this classification of drugs is given to do which of the following? (Select all that apply.)

• Treat pain • Treat inflammation after surgery • Relieve itching of the eyes caused by allergies • Prevent miosis during surgery

A nursing instructor is teaching a pharmacology class and informs the students that various preparations are used to treat ophthalmic disorders such as glaucoma. The instructor also states that other conditions of the eyes require treatment, including which of the following? (Select all that apply.)

• bacterial infections • viral infections • inflammatory conditions • symptoms of allergies related to the eyes