Glaucoma Practice Questions

A client is prescribed an eye drop and an eye ointment for the right eye. How should the nurse best administer the medications? 1. Administer the eye drop first, followed by the eye ointment. 2. Administer the eye ointment first, followed by the eye drop. 3. Administer the eye drop, wait 15 minutes, and administer the eye ointment. 4. Administer the eye ointment, wait 15 minutes, and administer the eye drop.

1. Administer the eye drop first, followed by the eye ointment.

Betaxolol eye drops have been prescribed for a client with glaucoma. The home health nurse preparing to visit the client develops a plan of care that includes monitoring for the side/adverse effects of this medication by taking which assessment action? 1. Monitoring body weight 2. Assessing the glucose level 3. Assessing peripheral pulses 4. Monitoring body temperature

1. Monitoring body weight

Pilocarpine hydrochloride is prescribed for a client with glaucoma. The nurse checks the medication supply room to ensure that atropine sulfate is available for administration in the event that systemic toxicity occurs from the use of pilocarpine hydrochloride. The nurse also monitors for which sign of systemic toxicity? 1. Anorexia 2. Bradycardia 3. Tachycardia 4. Hypertension

2. Bradycardia

A client has been prescribed betaxolol eye drops for the treatment of glaucoma. The ambulatory care nurse determines that the client understands proper medication use if the client states the need to return to the office for monitoring of what item(s)? 1. Hearing acuity 2. Blood glucose level 3. Presence of calf pain 4. Blood pressure and apical pulse

4. Blood pressure and apical pulse

When teaching a client with glaucoma about the effects of a miotic medication, the nurse should tell the client that the medication will produce which effect? 1. Reshape the lens to eliminate blurred vision 2. Dilate the pupil to reduce intraocular pressure 3. Interrupt the drainage of aqueous humor from the eye 4. Lower intraocular pressure and improve blood flow to the retina

4. Lower intraocular pressure and improve blood flow to the retina

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. A. If solution is discolored, do not use it. B. Wash hands thoroughly before placing drops in eye. C. Use enough drops so that the eye tears up. D. Do not touch tip of dropper, bottle, or tube. E. Use the medication for seven days.

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

The nurse is giving discharge instructions to a client who will be using eye medications and counsels the client to keep the eye medications under what condition? A. Refrigerated B. Sterile C. Clean D. In a warm environment

B. Sterile Eye medications should be kept sterile, to avoid infection.

A patient is scheduled for cataract surgery. What anesthetic agent should the nurse prepare to administer? A) Acetazolamide (Diamox) B) Pilocarpine (Pilocar) C) Dipivefrin (Propine) D) Lidocaine

Injectable local anesthetics are administered by ophthalmologists, usually for eye surgery. Lidocaine is commonly used; it has a rapid onset and lasts 1 to 2 hours.

Which of the following is an example of a beta-adrenergic blocking ophthalmic drop? A. Betaxolol (Betoptic) B. Ketorolac (Acular) C. Nedocromil (Alocril) D. Dexamethasone (Maxidex)

A. Betaxolol (Betoptic)

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."

C. "Be sure to place the drop in the conjuctival sac of the lower lid." 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.

A patient's medication administration record include daily timolol maleate eye drops. The nurse should identify what goal of therapy when planning this patient's care? A) Decrease intraocular pressure. B) Constrict pupils. C) Promote lacrimation. D) Improve visual acuity.

A) Decrease intraocular pressure. The purpose of the administration of beta-blocking drugs such as timolol is to decrease the IOP. Beta-blockers are not used to promote lacrimation, improve vision, or constrict the pupils.

The nurse is aware that brimonidine is used to produce what physiologic effect in clients with ocular hypertension? A) Reduce aqueous humor production B) Decrease uveoscleral outflow C) Increase IOP D) Decrease blood pressure

A) Reduce aqueous humor production Brimonidine is an alpha2-adrenergic agonist that is used to treat open-angle glaucoma and ocular hypertension. It reduces aqueous humor production.

The nurse is providing health promotion teaching to a group of older adults. Which information will the nurse include when teaching about routine glaucoma testing? A. A tonometer will be applied to the surface of the eye. B. The test involves reading a Snellen chart from 20 feet. C. Medications will be used to dilate the pupils for the test. D. The examination involves checking the pupils reaction to light.

A. A tonometer will be applied to the surface of the eye. Glaucoma is caused by an increase in intraocular pressure, which would be measured using the Tono-pen. The other techniques are used in testing for other eye disorder

Which classifications of ophthalmic solutions are used to decrease intraocular pressure (IOP) for the management of open angle glaucoma? Select all that apply. A. Alpha adrenergic agonists B. Beta adrenergic antagonists C. Prostaglandins D. Carbonic anhydrase inhibitors E. Anticholinergics

A. Alpha adrenergic agonists B. Beta adrenergic antagonists C. Prostaglandins D. Carbonic anhydrase inhibitors

A client 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 complications can develop? (Select all that apply.) A. optic nerve damage B. visual loss C. diabetes D. blindness E. hypertension

A. optic nerve damage B. visual loss D. blindness

To determine whether treatment is effective for a patient with primary open-angle glaucoma (POAG), the nurse can evaluate the patient for improvement by a. questioning the patient about blurred vision. b. noting any changes in the patients visual field. c. asking the patient to rate the pain using a 0 to 10 scale. d. assessing the patients depth perception when climbing stair

b. noting any changes in the patients visual field. POAG develops slowly and without symptoms except for a gradual loss of visual fields. Acute closed-angle glaucoma may present with excruciating pain, colored halos, and blurred vision. Problems with depth perception are not associated with POAG

Patients with permanent visual impairment a. feel most comfortable with other visually impaired people. b. may feel threatened when others make eye contact during a conversation. c. usually need others to speak louder so they can communicate appropriately. d. may experience the same grieving process that is associated with other losses.

d. may experience the same grieving process that is associated with other losses. When the patient has lost visual function or even the entire eye, he or she will grieve the loss. The nurse should help the patient through the grieving process.

In reviewing a 55-year-old patients medical record, the nurse notes that the last eye examination revealed an intraocular pressure of 28 mm Hg. The nurse will plan to assess a. visual acuity. b. pupil reaction. c. color perception. d. peripheral vision

d. peripheral vision The patients increased intraocular pressure indicates glaucoma, which decreases peripheral vision. Because central visual acuity is unchanged by glaucoma, assessment of visual acuity could be normal even if the patient has worsening glaucoma. Color perception and pupil reaction to light are not affected by glaucoma

A nurse is administering eye drops of two different drugs to a patient. How long should the nurse wait between the instillation of the first medication and the second medication? A) At least 1 minute B) At least 5 minutes C) At least 15 minutes D) At least 20 minutes

B) At least 5 minutes When multiple eye drops are required, there should be an interval of 5 to 10 minutes between drops. The drops should not be as close as 1 minute. The drops will not need to be separated by 15 to 20 minutes.

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? A) Increased visual acuity B) Systemic effects C) Local effects D) Exacerbation of her glaucoma

B) Systemic effects

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? A) Topical ACE inhibitors B) Topical beta-blockers C) Antibacterials D) Mydriatics

B) Topical beta-blockers

A nurse is completing admission paperwork for a client with pneumonia. The client's medication history shows only brimonidine 1 mL in both eyes three times a day. The nurse knows that this client has which preexisting condition? A) cataracts B) glaucoma C) myopia D) hyperopia

B) glaucoma

Which medication for glaucoma should the nurse question? A. Betaxolol B. Atropine Sulfate C. Pilocarpine Hydrochloride D. Pilocarpine

B. Atropine Sulfate Atropine is a mydriatic which dilates the pupil and can increase intraoccular pressure in the eye

A patient is prescribed ophthalmic corticosteroids. What eye disorder may result from long-term use of ophthalmic corticosteroids? A) Conjunctivitis B) Hordeolum C) Glaucoma D) Blepharitis

C) Glaucoma Long-term use of corticosteroid ophthalmic agents may result increased IOP, optic nerve damage, defects in visual acuity, and fields of vision, cataracts, and secondary ocular infections.

The nursing instructor is teaching the Level 1 nursing students the proper way to instill eye drops in a patient's eye. How long would the instructor teach the students to wait between successive eye drops in the same eye to achieve adequate eye drop drug retention and absorption? A) 30 seconds B) 1 minute C) 3 minutes D) 5 minutes

D) 5 minutes A 5-minute interval between successive eye drop administration allows for adequate drug retention and absorption. Any timeframe less than 5 minutes will not allow adequate absorption.

What is the major disadvantage of ophthalmologic ointments? A) Hard to administer B) Patients don't like them C) They ooze out of the eye D) Blurred vision

D) Blurred vision

When performing teaching with a patient with glaucoma while administering a scheduled dose of pilocarpine, the nurse would include which statement? A. "Prolonged eye irritation is an expected adverse effect of this medication." B. "This medication will help to raise intraocular pressure to a near normal level." C. "This medication needs to be continued for at least 5 years after your initial diagnosis." D. "It is important not to do activities requiring visual acuity immediately after administration."

D. "It is important not to do activities requiring visual acuity immediately after administration." Pilocarpine causes blurred vision and difficulty in focusing, so it is important not to engage in any activities requiring visual acuity until the vision clears.

The nurse working in the vision and hearing clinic receives telephone calls from several patients who want appointments in the clinic as soon as possible. Which patient should be seen first? a. 71-year-old who has noticed increasing loss of peripheral vision b. 74-year-old who has difficulty seeing well enough to drive at night c. 60-year-old who has difficulty hearing clearly in a noisy environment d. 64-year-old who has decreased hearing and ear stuffiness without pai

a. 71-year-old who has noticed increasing loss of peripheral vision

Which prescribed medication should the nurse give first to a patient who has just been admitted to a hospital with acute angle-closure glaucoma? a. Morphine sulfate 4 mg IV b. Mannitol (Osmitrol) 100 mg IV c. Betaxolol (Betoptic) 1 drop in each eye d. Acetazolamide (Diamox) 250 mg orall

b. Mannitol (Osmitrol) 100 mg IV The most immediate concern for the patient is to lower intraocular pressure, which will occur most rapidly with IV administration of a hyperosmolar diuretic such as mannitol. The other medications are also appropriate for a patient with glaucoma but would not be the first medication administered

A patient with glaucoma who has been using timolol (Timoptic) drops for several days tells the nurse that the eye drops cause eye burning and visual blurriness for a short time after administration. The best response to the patients statement is a. Those symptoms may indicate a need for an increased dosage of the eye drops. b. The drops are uncomfortable, but it is important to use them to retain your vision. c. These are normal side effects of the drug, which should be less noticeable with time. d. Notify your health care provider so that different eye drops can be prescribed for yo

b. The drops are uncomfortable, but it is important to use them to retain your vision.

A client being discharged to home with a prescription for eye drops to be given in the left eye has received instructions regarding self-administration of the drops. The nurse determines that the client needs further instruction if, on return demonstration, the client takes which action? 1. Lies supine, pulls up on the upper lid, and puts the drop in the upper lid 2. Lies supine, pulls down on the lower lid, and puts the drop in the lower lid 3. Tilts the head back, pulls down on the lower lid, and puts the drop in the lower lid 4. Lies with head to the right, puts the drop in the inner canthus, and slowly turns to the left while blinking

1. Lies supine, pulls up on the upper lid, and puts the drop in the upper lid

A client with chronic glaucoma is being started on medication therapy with acetazolamide. The nurse teaches the client that which can occur early with the use of this medication? 1. Fatigue 2. Diuresis 3. Headache 4. Loss of libido

2. Diuresis

Betaxolol eye drops have been prescribed for a client with glaucoma. The nurse monitoring this client for side/adverse effects of the medication would place highest priority on which assessment? 1. Pulse rate 2. Blood glucose 3. Respiratory rate 4. Oxygen saturation

1. Pulse rate

The nursing student is assigned to care for a client with glaucoma for whom pilocarpine hydrochloride eye drops have been prescribed. The nursing instructor asks the student to describe the action of the eye medication. Which statement by the student indicates an understanding of the purpose of this medication? 1. "The medication prevents blurred vision by relaxing the muscles of the eyes." 2. "The medication dilates the eye to prevent increased pressure from occurring." 3. "The medication increases the blood flow to the retina and also will lower the pressure in the eye." 4. "The medication blocks responses that are sent to the brain that direct the actions of the muscles in the eye."

3. "The medication increases the blood flow to the retina and also will lower the pressure in the eye."

A nurse is teaching a parent how instill drops in the parent's 12-year-old son's eyes. Which action would the nurse teach the parent is accomplished first? A) Close the eye gently. B) Tilt the head slightly backward. C) Instill the prescribed number of drops into the conjunctival pocket. D) Do not allow the tip of the container to touch the eye.

B) Tilt the head slightly backward.

A resident of a long-term care facility was referred to an outpatient ophthalmology clinic for assessment, and the nurse has received the clinical report. The nurse reads that the resident's intraocular pressure was elevated above clinical norms. The nurse should recognize that the resident is at risk of A) cataracts. B) glaucoma. C) myopia. D) conjunctivitis.

B) glaucoma. Glaucoma is characterized by increased IOP, possibly damaging the optic nerve, which transmits images to the brain. If damage to the optic nerve from high IOP continues, glaucoma leads to loss of vision. Cataracts, myopia, and conjunctivitis are not the results of increased IOP.

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."

B. "I must press on the inside of my eye to prevent washout." 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.

A female client reports that she must administer her eye drops several times because she blinks. How might this influence the therapeutic effects of the drops? A. Therapeutic effects depend on administration of the medication on a routine basis. B. Therapeutic effects may vary due to blinking. C. Therapeutic effects may vary due to the medication schedule. D. Therapeutic effects depend on accurate administration.

D. Therapeutic effects depend on accurate administration.

To minimize the risk of systemic absorption of eyedrops the nurse should instruct the pt to do what? A. eat before instilling B. swallow several times after instilling C. blink vigorously to encourage tearing after instilling D. occlude the nasolacrimal duct with a finger after instilling

D. occlude the nasolacrimal duct with a finger after instilling

A client with glaucoma is receiving acetazolamide. The nurse educator provides education to a group of nurses about the indications for and effect of this medication. Which statement by one of the nurses indicates that the teaching has been effective? 1. "This works to prevent hypertension." 2. "This works to prevent hyperthermia." 3. "This works to decrease intraocular pressure." 4. "This works to maintain an adequate blood pressure for cerebral perfusion."

3. "This works to decrease intraocular pressure."

The nurse is providing education to a client newly diagnosed with glaucoma. What explanation could the nurse provide to describe the cause of the disorder? A) "Impaired drainage of aqueous humor results in an increase of intraocular pressure." B) "Impaired tear production causes chronic dryness of the conjunctiva." C) "Retinal inflammation results in the clouding of the lens." D) "An infection of the cornea is caused by impaired lacrimal drainage."

A) "Impaired drainage of aqueous humor results in an increase of intraocular pressure." Normally, production and drainage of aqueous humor are approximately equal, and normal intraocular pressure (IOP) is maintained. Impaired drainage of aqueous humor causes increased IOP that results in glaucoma.

A client has been given an initial diagnosis of glaucoma. What signs or symptoms would the nurse expect to assess that confirm the diagnosis? A) Increased intraocular pressure B) Redness C) Burning sensation D) Periorbital edema

A) Increased intraocular pressure

An adult client has been prescribed pilocarpine eye drops for the treatment of glaucoma. What teaching should the nurse provide before the client begins taking the medication in the home setting? A) Perform hand hygiene immediately before administering the medication. B) Gently touch the dropper to the medial portion of the sclera while administering. C) Rub the eyes gently, with clean hands, after administration. D) Perform a saline eye flush if an extra drop is accidentally instilled.

A) Perform hand hygiene immediately before administering the medication. Hand hygiene is a priority when administering eye medications due to the high chance of introducing microorganisms to the eye. The dropper should never touch the eye itself during administration. Clients should be instructed not to rub their eyes after instilling a medication. In most cases, an extra drop of medication does not warrant eye irrigation, since the safety risks posed by an extra drop are low.

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? A. 15 minutes or longer before inserting soft contacts B. While wearing the soft contacts C. 15 minutes after application of the soft contacts D. 5 minutes before inserting soft contacts

A. 15 minutes or longer before inserting soft contacts

Which finding related to primary open-angle glaucoma would the nurse expect to find when reviewing a patient's history and physical examination report? A. Absence of pain or pressure B. Blurred vision in the morning C. Seeing colored halos around lights D. Eye pain accompanied with nausea and vomiting

A. Absence of pain or pressure Primary open-angle glaucoma is typically symptom-free, which explains why patients can have significant vision loss before a diagnosis is made unless regular eye examinations are being performed. Primary angle-closure glaucoma manifestations include sudden, excruciating pain in or around the eye, seeing colored halos around lights, and nausea and vomiting.

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

A. Bending over to tie shoes D. Blowing the nose frequently E. Lifting objects weighing more than 10 pounds 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

B. Enhance aqueous outflow 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.

Betaxolol hydrochloric eyedrops have been ordered for a pt. with glaucoma. Which nursing action is most appropriate relating to monitoring for side.adverse effects of this medication? A. Monitor temp B. monitor bp C. assess peripheral pulses D. assess blood glucose levels

B. monitor bp Hypotension, dizziness, nausea, diaphoresis, HA, fatigue, constipation and or diarrhea are side/adverse reactions to this med.Monitor BP

A nurse is providing health education about the way the normal intraocular pressure (IOP) is maintained. The nurse should explain that normal IOP results from which of the following? A) Consistent production and resorption of tears B) Consistent feedback from baroreceptors located throughout the retina C) A balance between production and drainage of aqueous humor D) Two-way interaction between the medulla oblongata and the eye

C) A balance between production and drainage of aqueous humor Normally, production and drainage of aqueous humor are approximately equal, and the intraocular pressure (IOP) is normal. IOP is not dependent of tear production, baroreceptors in the eye, or stimulation from the medulla.

A nurse has taught the client about acetazolamide. Which statement indicates the client needs further instruction? A. "I can take this medicine with food if needed." B. "I will call my ophthalmologist if I decide to take an herb." C. "I will dissolve the tablet in sterile normal saline and apply it to my eye." D. "I will keep all appointments to see my ophthalmologist."

C. "I will dissolve the tablet in sterile normal saline and apply it to my eye." Acetazolamide is an oral carbonic anhydrase inhibitor used for the management of glaucoma. It decreases the rate of aqueous humor formation and lowers the IOP. The tablet does not need to be dissolved. The client can take the medication with food and should be encouraged to talk to the ophthalmologist about appointments and if considering herbal supplements for the management of glaucoma.

Which statement is most appropriate when teaching a patient about timolol (Timoptic) eye drops in the treatment of glaucoma? A. "You may feel some palpitations after instilling these eye drops." B. "You should withhold this medication if your blood pressure becomes elevated." C. "You may have some temporary blurring of vision after instilling these eye drops." D. "You should keep your eyes closed for 15 minutes after instilling these eye drops."

C. "You may have some temporary blurring of vision after instilling these eye drops." It is common for patients to have a temporary blurring of vision for a few minutes after instilling eye drops. This should not cause concern to the patient. Because timolol is a β-blocker, heart rate may slow, and blood pressure is more likely to decrease if absorbed systemically.

A patient with glaucoma is receiving pilocarpine. What patient teaching does the nurse provide to decrease the possible cardiac adverse effects? A) Administer the medication at bedtime. B) Apply pressure to the lid after application. C) Apply pressure to the lacrimal sac after application. D) Administer the medication every 3 hours.

C. Apply pressure to the lacrimal sac after application. Application of pressure to the lacrimal sac decreases the systemic absorption of the medication thus, assisting in the prevention of cardiac adverse effects.

When planning care for a patient with disturbed sensory perception related to increased intraocular pressure caused by primary open-angle glaucoma, what should the nurse focus on? A. Recognizing that eye damage caused by glaucoma can be reversed in the early stages B. Giving anticipatory guidance about the eventual loss of central vision that will occur C. Encouraging compliance with drug therapy for the glaucoma to prevent loss of vision D. Managing the pain experienced by patients with glaucoma that persists until the optic nerve atrophies

C. Encouraging compliance with drug therapy for the glaucoma to prevent loss of vision Drug therapy is necessary to prevent the eventual vision loss that may occur as a consequence of glaucoma. For this reason, encourage the patient to remain compliant with drug therapy.

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

D. Gradual vision changes 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.

Before administrating timolol (Timoptic) eye drops for treatment of glaucoma, the nurse would assess the patient for which contraindication for the use of this medicine? A. Sinusitis B. Migraine headaches C. Chronic urinary tract infection D. Chronic obstructive pulmonary disease

D. Chronic obstructive pulmonary disease Timolol is a nonselective β-adrenergic blocker that could lead to bronchoconstriction and bronchospasm. For this reason, it should not be used in patients with COPD. Timolol may be used to treat migraine headaches, and it does not affect sinusitis or chronic urinary tract infections.

When obtaining a health history from a 49-year-old patient, which patient statement is most important to communicate to the primary health care provider? A. My eyes are dry now. B. It is hard for me to see at night. C. My vision is blurry when I read. D. I cant see as far over to the side

D. I cant see as far over to the side The decrease in peripheral vision may indicate glaucoma, which is not a normal visual change associated with aging and requires rapid treatment. The other patient statements indicate visual problems (presbyopia, dryness, and lens opacity) that are considered a normal part of aging

When administering a scheduled dose of pilocarpine, in which area should the nurse place the drops? A. Inner canthus B. Outer canthus C. Center of the eyeball D. Lower conjunctival sac

D. Lower conjunctival sac Ocular medications such as pilocarpine should be instilled into the lower conjunctival sac. Never apply eye drops directly to the cornea. Applying the drops to the inner canthus will cause them to be distributed systemically.

The home care nurse is reviewing the record of a client newly diagnosed with glaucoma who is scheduled for a home visit. The nurse notes that the health care provider (HCP) has prescribed atropine sulfate and pilocarpine hydrochloride eye drops. The nurse should contact the HCP before the home visit for which reason? 1. Clarify the prescription for the atropine sulfate. 2. Clarify the prescription for the pilocarpine hydrochloride. 3. Determine the date of the scheduled follow-up HCP visit. 4. Determine the extent of the intraocular pressure caused by the glaucoma.

1. Clarify the prescription for the atropine sulfate.

A patient is administering eye drops. What should the patient be taught in order to decrease systemic absorption of eye drops? A) Lie supine for 1 minute after instillation. B) Apply pressure for 2 minutes over the tear duct. C) Apply pressure for 5 minutes over the tear duct. D) Remain still for 10 minutes after instillation

C) Apply pressure for 5 minutes over the tear duct. Systemic absorption of eye drops can be decreased by closing the eye and applying pressure over the tear duct for 3 to 5 minutes after instillation. Pressure should not be applied to the tear duct for less than 3 minutes or greater than 5 minutes. It is unnecessary to remain still or supine after instillation.

After being prescribed medications to treat glaucoma, a client informs the nurse of problem with fatigue, drowsiness, and palpitations since starting the medications. What should the nurse expect as the cause of the client's symptoms? A) local effects B) another disease process C) systemic effects D) other medications the client is taking

C) systemic effects Drugs to treat glaucoma may cause transient local reactions and systemic reactions. Although side effects are usually mild they may include burning and stinging locally in or near the eye, headache, visual blurring, tearing, foreign body sensation, ocular allergic reactions, and ocular itching. Systemic effects include fatigue and drowsiness, palpitations, and nausea.

When teaching a patient about the pathophysiology related to open-angle glaucoma, which statement is most appropriate? A. "The retinal nerve is damaged by an abnormal increase in the production of aqueous humor." B. "There is decreased draining of aqueous humor in the eye, causing pressure damage to the optic nerve." C. "The lens enlarges with normal aging, pushing the iris forward, which then covers the outflow channels of the eye." D. "There is a decreased flow of aqueous humor into the anterior chamber by the lens of the eye blocking the papillary opening."

B. "There is decreased draining of aqueous humor in the eye, causing pressure damage to the optic nerve." With primary open-angle glaucoma, there is increased intraocular pressure because the aqueous humor cannot drain from the eye. This leads to damage to the optic nerve over time. Primary angle-closure glaucoma is caused by the lens bulging forward and blocking the flow of aqueous humor into the anterior chamber.

A nurse is preparing to apply a client's scheduled dose of bimatoprost. To reduce this client's risk of infection during administration, what action should the nurse take? A) warming the drops prior to instillation B) using sterile gloves when instilling the drug C) preventing the applicator from coming in contact with any surface D) administering antibiotic eye drops immediately after administration of bimatoprost

C) preventing the applicator from coming in contact with any surface The prostaglandin analogs, like bimatoprost, are the most widely prescribed glaucoma drugs. When applying bimatoprost, the nurse takes care to avoid contact between the dropper and the eye, finger, or any other surface. Such contact contaminates the solution and may cause eye infections and serious damage to the eye, with possible loss of vision.

When administering eye drops to a patient with glaucoma, which nursing measure is most appropriate to minimize systemic effects of the medication? A. Apply pressure to each eyeball for a few seconds after administration. B. Have the patient close the eyes and move them back and forth several times. C. Have the patient put pressure on the inner canthus of the eye after administration. D. Have the patient try to blink out excess medication immediately after administration.

C. Have the patient put pressure on the inner canthus of the eye after administration. Systemic absorption can be minimized by applying pressure to the inner canthus of the eye. The other options will not minimize systemic effects of the medication.

A 65-year-old patient is being evaluated for glaucoma. Which information given by the patient has implications for the patients treatment? A. I use aspirin when I have a sinus headache. B. I have had frequent episodes of conjunctivitis. C. I take metoprolol (Lopressor) daily for angina. D. I have not had an eye examination for 10 years

C. I take metoprolol (Lopressor) daily for angina. It is important to note whether the patient takes any b-adrenergic blockers because this classification of medications is also used to treat glaucoma, and there may be an increase in adverse effects. The use of aspirin does not increase intraocular pressure and is safe for patients with glaucoma. Although older patients should have yearly eye examinations, the treatment for this patient will not be affected by the 10-year gap in eye care. Conjunctivitis does not increase the risk for glaucoma.

A miotic medication has been ordered for a pt with glaucoma. The pt asks about this medication, what is an appropriate response? A. The med will help dialate the eye to prevent pressure B. It will relax the muscles of the eye & prevent blurred vision C. It causes pupil to constrict and will lower the pressure in the eye D. will help block responses that are sent to the muscles in the eye

C. It causes pupil to constrict and will lower the pressure in the eye Miotics cause pupillary constriction and are used to tx glaucoma. They lower intraoccular pressure, thereby increasing the blood flow to the retina, decreasing retinal damage and vision loss

The nurse instructs a 66-year-old patient prescribed timolol eye drops to manage chronic open-angle glaucoma. Which statement, if made by the patient to the nurse, indicates that further teaching is needed? A. "The eye drops could cause a fast heart rate and high blood pressure." B. "I will need to take the eye drops twice a day for at least 2 to 3 months." C. "I may experience eye discomfort and redness from the use of these eye drops." D. "I will apply gentle pressure on the inside corner of my eye after each eye drop."

D. "I will apply gentle pressure on the inside corner of my eye after each eye drop." To avoid systemic reactions such as tachycardia and hypertension, the patient should apply punctual occlusion after instillation of the eye drops. Dipivefrin will control chronic open-angle glaucoma but will not cure the disease. Side effects associated with dipivefrin include ocular discomfort and redness, tachycardia, and hypertension.