Exam 1: Glaucoma Questions

Which drug does a nurse anticipate may be prescribed to produce diuresis and inhibit formation of aqueous humor for a client with glaucoma? 1. chlorothiazide 2. acetazolamide 3. methazolamide 4. aclidinium bromide

2 rationale: Acetazolamide is a carbonic anhydrase inhibitor that decreases inflow of aqueous humor and controls intraocular pressure in acute angle-closure glaucoma attack. Chlorothiazide has no effect on the eye. Methazolamide lowers ocular pressure but does not decrease the inflow of aqueous humor. Aclidinium bromide is a bronchodilator.

A healthcare provider recently made the diagnosis that a client has glaucoma. The nurse is preparing to administer eyedrops to the client. Which ophthalmic solution is contraindicated for this client? 1. timolol 2. atropine 3. pilocarpine 4. epinephrine

2 rationale: Atropine, a mydriatic ophthalmic solution, is contraindicated for clients with glaucoma because it dilates the pupil, increasing intraocular pressure. Timolol, a beta blocker, decreases aqueous humor production; beta blockers are the preferred initial medications given to reduce intraocular pressure. Pilocarpine, a cholinergic, constricts the pupil, thereby increasing aqueous humor outflow. Epinephrine, an adrenergic agent, enhances aqueous humor outflow, thereby reducing intraocular pressure.

A nurse is caring for a client with glaucoma. Which rationale associated with the need for treatment of this condition should the nurse include in a teaching program? 1. total blindness is inevitable 2. lost vision cannot be restored 3. use of both eyes usually is restricted 4. surgery will help the problem only temporarilty

2 rationale: Retinal damage caused by the increased intraocular pressure of glaucoma is progressive and permanent if the disease is not controlled; lost vision cannot be restored. Early treatment may prevent blindness. One eye may be affected, and there is no restriction on the use of either eye. Surgery can open up drainage and permanently reduce pressure.

A client has primary open-angle glaucoma. The nurse expects that the client will receive a prescription for which eyedrops? 1. tetracaine 2. cyclopentolate 3. timolol maleate 4. atropine sulfate

3 rationale: Timolol maleate is a beta-adrenergic antagonist that decreases aqueous humor production and increases outflow, thereby reducing intraocular pressure. Tetracaine is a topical anesthetic; it will not reduce the increased intraocular pressure associated with glaucoma. Cyclopentolate is contraindicated because it dilates the pupil and paralyzes ciliary muscles. Atropine sulfate, a mydriatic, is contraindicated because it dilates the pupil, obstructing drainage, which increases intraocular pressure.

A nurse is assessing a client with a diagnosis of primary open-angle glaucoma. Which ocular symptom should the nurse expect the client to report? 1. attacks of acute pain 2. constant blurred vision 3. decreased peripheral vision 4. complete loss of central vision

3 rationale: With glaucoma, loss of peripheral vision occurs long before central vision is affected. The client also may complain of seeing halos around lights. Primary closed-angle glaucoma causes pain. Blurred vision may be because of a refractive error. Complete loss of central vision occurs with damage to the central retina.

A nurse is teaching a client with a diagnosis of open-angle glaucoma. The nurse explains that the chief aim of treatment is to meet which goal? 1. rest the eye 2. dilate the pupil 3. prevent secondary infections 4. control the intraocular pressure

4 rationale: Individuals with glaucoma have increased intraocular pressure that must be returned to the expected range, or blindness will result. Resting has no effect on this condition because it will not decrease the pressure. Dilation of the pupils may increase the pressure further by obstructing flow; increased pressure reduces the visual field and leads to blindness. Glaucoma does not lead to secondary infections.

A debilitated older client with glaucoma who places great value on independence is being prepared for discharge from the hospital. To promote independence, what should the nurse encourage the client to do? 1. Prevent stressful events that can increase symptoms 2. Conserve eyesight by not reading or watching television 3. Perform household chores and shopping without assistance 4. Self-administer the eye medications using appropriate technique

4 rationale: The responsibility for correctly doing this task will foster independence. Preventing stressful events that increase symptoms is a laudable goal, but it does not relate to independence. Moderate use of the eyes is not contraindicated in clients with glaucoma. Performing household chores and shopping is too ambitious for a debilitated older client.

what does the visual disorder of glaucoma look like

the image shows the visual disorder of glaucoma. rationale: Glaucoma has a halo type effect and damages the optic nerve. There are several varieties. Diabetic retinopathy has areas of blindness caused by hemorrhages, which often occur within 20 years of being diagnosed. Cataracts cause blurring, sensitivity to glare, and decreased perception of light. By understanding changes in vision during the aging process, it is possible to plan nursing care.

A client with a history of closed-angle glaucoma is scheduled for abdominal surgery. Because the client is extremely anxious, surgery is to be performed under general anesthesia. What should the nurse teach the client to do to prevent respiratory complications postoperatively? 1. deep breathing techniques 2. performing productive coughing 3. turning from side to side frequently 4. pant breathing while gently closing the eyelids

1 rationale: Deep breathing is an intervention to prevent respiratory complications that does not increase intraocular pressure. Coughing is contraindicated because it increases intraocular pressure. Although turning from side to side is permitted, it is not as effective as deep breathing in preventing respiratory complications. Pant breathing is shallow breathing and will not prevent respiratory complications.

A client asks for information about glaucoma. How should the nurse explain glaucoma to the client? 1. an increase in the pressure within the eyeball 2. an opacity of the crystalline lens or its capsule 3. a curvature of the cornea that becomes unequal 4. a separation of the neural retina from the pigmented retina

1 rationale: An increase in intraocular pressure (IOP) results from a resistance of aqueous humor outflow. Open-angle glaucoma, the most common type of glaucoma, results from increased resistance to aqueous humor outflow. An opacity of the crystalline lens or its capsule is the description of a cataract. A curvature of the cornea that becomes unequal is the description of astigmatism. A separation of the neural retina from the pigmented retina is the description of a detached retina.

Which prostaglandin agonist is used in the treatment of clients with glaucoma? 1. carteolol 2. bimatoprost 3. brinzolamide 4. apraclonidine

2 rationale: Bimatoprost is the prostaglandin agonist used in the treatment of glaucoma. Carteolol is the beta-adrenergic blocker used for treatment of glaucoma. Brinzolamide is the carbonic anhydrate inhibitor used for the treatment of glaucoma. Apraclonidine is the adrenergic agonist used in the treatment of glaucoma.

Which drug worsens uncontrolled angle-closure glaucoma when used for the treatment of generalized anxiety disorder? 1. buspirone 2. duloxetine 3. chlorpromazine 4. lithium carbonate

2 rationale: Duloxetine is an antidepressant drug used in the treatment of generalized anxiety disorder. A contraindication is that it can worsen uncontrolled angle-closure glaucoma. Lithium carbonate is used to treat manic episodes but is contraindicated in clients with renal disease. Buspirone is an antidepressant drug contraindicated in clients with known allergic reactions to this drug. Chlorpromazine is an antipsychotic drug contraindicated in clients with blood dyscrasias.

A client who just has been diagnosed with primary open-angle glaucoma (POAG) refuses therapy. The nurse reinforces that it is important for the client to seek treatment. Which goal is the nurse trying to achieve? 1. prevent cataracts 2. prevent blindness 3. prevent retinal detachment 4. prevent blurred distance vision

2 rationale: POAG progresses gradually without symptoms; if untreated, blindness occurs. Peripheral vision slowly disappears until tunnel vision occurs in which there is only a small center field. Without treatment, eventually all vision is lost. POAG is not related to the development of cataracts, retinal detachment, or blurred distance vision.

Which second-generation antidepressant can worsen uncontrolled angle closure glaucoma? 1. trazodone 2. bupropion 3. duloxetine 4. mirtazapine

3 rationale: Duloxetine can worsen uncontrolled angle-closure glaucoma. Trazodone is contraindicated in clients with a known drug allergy. Bupropion is contraindicated for clients with seizures. Mirtazapine is contraindicated in cases of known drug allergy and concurrent use of monoamine oxidase inhibitors.

A client with glaucoma is receiving a carbonic anhydrase inhibitor. Which statement made by the client will require the nurse to notify the primary healthcare provider? 1. "I have asthma." 2. "I use contact lenses." 3. "I am allergic to sulfonamides." 4. "I have been taking phenelzine medication for three months."

3 rationale: Carbonic anhydrase inhibitors are used for the treatment of glaucoma. These drugs are similar to sulfonamides, and if a client is allergic to the sulfonamides, they may have a chance of developing an allergy. Beta-adrenergic blockers such as betaxolol hydrochloride and carteolol are used for treating glaucoma. These drugs, when absorbed systemically, may lead to constriction of the pulmonary smooth muscles and narrow airway. Clients who wear contact lenses is not an issue with carbonic anhydrase inhibitors; however, if using adrenergic agonists, clients should not use the eyedrops with the contact lenses in place and should wait 15 minutes after using the drug to put in the lenses. Clients taking antidepressants such as phenelzine should not be prescribed adrenergic agonists because it may lead to a hypertension crisis when taken together.

While assessing the eyes of a client, a healthcare provider notices there is an obstruction to the outflow of aqueous humor. Which additional finding might be noted to support a diagnosis of glaucoma? 1. blurred central vision 2. increased opacity of the lens 3. elevated intraocular pressure 4. changes in retinal blood vessels

3 rationale: In glaucoma, there is an obstruction of the outflow of aqueous humor due to an intraocular structural damage, which may result from elevated intraocular pressure. Blurred central vision is seen in macular degeneration. Increased opacity of the lens may be seen in cataracts. Retinopathy may result from the changes in retinal blood vessels.

A nurse obtains the nursing history from a client who has open-angle (chronic) glaucoma. The nurse anticipates that the client will report which finding during the history? 1. flashes of light 2. sensitivity to light 3. seeing floating specks 4. loss of peripheral vision

4 rationale: Increased intraocular pressure damages the optic nerve, interfering with peripheral vision. Flashes of light may be associated with a detached retina. There is difficulty in adjusting to darkness, not an intolerance to light. Seeing floating specks is not specific to glaucoma.

Which clinical indicator is the nurse most likely to identify when exploring the history of a client with open-angle glaucoma? 1. constant blurring 2. abrupt attacks of acute pain 3. sudden, complete loss of vision 4. impairment of peripheral vision

4 rationale: Open-angle glaucoma has an insidious onset, with increased intraocular pressure on the retina and blood vessels in the eye. Peripheral vision is decreased as the visual field progressively diminishes. Constant blurring may occur with untreated acute angle-closure glaucoma. Pain occurs in acute angle-closure, not open-angle, glaucoma. Occlusions of the central retinal artery or retinal detachment will cause a sudden loss of vision.

A nurse is providing instructions to a client with glaucoma. Which statements made by the client indicate the nurse needs to intervene? Select all that apply. 1. i should take stool softeners 2. i can wear loose collar shirts 3. i should refrain from sneezing and coughing 4. i can lift objects that weigh more than 10 lbs 5. i should keep my head in a dependent position

4, 5 rationale: Glaucoma is a group of eye disorders that result in increased intraocular pressure. Therefore the nurse should intervene to correct the misconceptions of keeping the head in a dependent position and lifting objects that weigh more than 10 lbs (4.5 kg). All the rest are correct statements and need no follow up. Straining to have a bowel movement leads to increased intraocular pressure. Therefore the client should be instructed to use stool softeners. Wearing tight shirt collars is to be avoided; loose collar shirts are appropriate to wear. Sneezing and coughing also lead to increased intraocular pressure and should be avoided.

Which beta-adrenergic blocker is prescribed to clients with glaucoma? 1. betaxolol 2. carbachol 3. brimonidine 4. methazolamide

1 rationale: Betaxolol is a beta-adrenergic blocker that is prescribed for glaucoma. Carbachol is a cholinergic agent that is used to treat glaucoma. Brimonidine is an alpha-adrenergic agonist that is prescribed in glaucoma. Methazolamide is a carbonic anhydrase inhibitor that is used to treat glaucoma.

The nurse concludes that a client with glaucoma needs education when the client makes which statement? 1. it is dangerous for me to use sedatives 2. lifting heavy objects can worsen my glaucoma 3. i need to be careful to avoid becoming constipated 4. i should not take atropine in any form

1 rationale: Sedatives have no effect on intraocular pressure, so additional teaching is needed if this statement is made. Additional teaching is not necessary if the client acknowledges the dangers associated with lifting heavy objects, becoming constipated, and taking atropine because these will increase intraocular pressure.

A client with glaucoma asks a nurse about future treatment and precautions. Which information should the nurse's explanation include? 1. avoidance of cholinergics 2. surgical replacement of lens 3. continuation of therapy for life 4. prevention of high blood pressure

3 rationale: Therapy must be continued for life to prevent damage to the optic nerve from increased intraocular pressure. Cholinergics are used in the treatment of glaucoma; anticholinergics are contraindicated. The surgical replacement of lens is the treatment for cataracts. There is an increase in intraocular pressure with glaucoma; the blood pressure may be unaffected.