parm chapter 57 exam 1
Which medication decreases the production of aqueous humor and increases its outflow? 1Timolol 2Betaxolol 3Metipranolol 4Levobetaxolol
1Timolol Timolol is a beta-adrenergic blocker class of drug used for treating disorders like open-angle glaucoma. Timolol is the only beta blocker that reduces the intraocular pressure by decreasing the production of aqueous humor and increasing its outflow. It is available in formulations that are devoid of benzalkonium chloride (preservative) to prevent allergic reactions in patients sensitive to this preservative. Betaxolol, metipranolol, and levobetaxolol do not have an effect on the outflow of aqueous humor. These medications also contain benzalkonium chloride as a preservative. Therefore to avoid hypersensitive reactions, these medications cannot be prescribed for the patient.
Which medication is an example of an ocular sympathomimetic drug? 1Latanoprost 2Dorzolamide 3Apraclonidine 4Levobetaxolol
3Apraclonidine Apraclonidine is a direct-acting ocular sympathomimetic drug. It is used as short-term adjunctive therapy for glaucoma. Latanoprost is a prostaglandin agonist. Dorzolamide is a carbonic anhydrase inhibitor. Levobetaxolol is an ophthalmic beta-blocking drug.
Which eye component is the jelly-like fluid in the large chamber behind the lens of the eye? 1Uvea 2Lysozyme 3Vitreous body 4Aqueous humor
3Vitreous body The vitreous body is the jelly-like fluid that fills the large chamber behind the lens of the eye. The uvea is a structure in the eye consisting of the iris, ciliary body, and choroid. Lysozyme is an enzyme that destroys foreign organisms; it is present in the tears, saliva, sweat, and breast milk. Aqueous humor is a clear, watery fluid produced by the ciliary body. It circulates in the anterior and posterior chambers of the eye.
Which information would the nurse teach the patient prior to receiving atropine sulfate drops for an ophthalmic exam? 1Wait 72 hours to wear contacts. 2A common side effect is dry eyes. 3Wear sunglasses when you leave the exam room. 4Your pupils will appear small after you receive the drops.
3Wear sunglasses when you leave the exam room.
The nurse identifies which description as the method of action of pilocarpine in treating glaucoma? a) producing miosis, increasing outflow of aqueous humor b) decreasing the production and formation of aqueous humor c) vasoconstriction thereby inhibiting the flow of aqueous humor d) producing cyclopegia, decreasing pupillary response
A) pilocarpine (pilocar) is a direct acting cholinergic drug that is used as a miotic in the treatment of glaucoma.
The nurse prepares to administer daily medications to a female patient who takes furosemide (Lasix) for heart failure and uses brinzolamide (Azopt) ophthalmic drops for glaucoma. The nurse notes that the patient's serum potassium level is 3.0 mEq/L. What should the nurse do next? A. Assess the patient's cardiac rhythm B. Withhold the brinzolamide C. Withhold the furosemide D. Administer the medications
A. Assess the patient's cardiac rhythm Before administering or withholding the medications, the nurse should assess the patient for clinical indicators of hypokalemia, including the cardiac rhythm, because hypokalemia increases the risk of ventricular dysrhythmias. Once the assessment is complete, the nurse can determine if medication should be administered or withheld.
Jonathan has blue eyes; Julie has brown eyes. Why would the drug effects of the miotics on the iris be less pronounced in Julie?
Drug induced miotic effects may be less pronounced in individuals with dark eyes than in those with lighter eyes because the pigment of the iris absorbs the drug (which reduces its therapeutic effects)
During an ophthalmic procedure, the patient receives ophthalmic acetylcholine. The nurse is aware that which effect is the purpose of administering this drug? a. To produce mydriasis for ophthalmic examination b. To produce immediate miosis during ophthalmic surgery c. To cause cycloplegia to allow for measurement of intraocular pressure d. To provide topical anesthesia during ophthalmic surgery
b. To produce immediate miosis during ophthalmic surgery
The nurse is preparing to administer ketorolac (Acular) eyedrops. The patient asks, "Why am i getting these eyedrops?" What is the nurses correct response? a) these drops will reduce the pressure inside your eye as part of treatment for glaucoma. b) these drops are for bacterial eye infection. c) these drops will relieve your dry eyes. d) these drops work to reduce the inflammation in your eyes.
d) these drops work to reduce the inflammation in your eyes.
The nurse is administering antibiotic eyedrops to a patient for the first time. After the first drop is given, the patient states, "That eyedrop is making my eye sting! Is that normal?" Which is the best response by the nurse? a. "That's unusual. Let me rinse the medication from your eye." b. "Sometimes these eyedrops may cause burning and stinging, but it should go away soon." c. "These may be serious side effects, so I will notify your doctor before the next dose is due." d. "Let's wait and see if these effects happen the next time you receive these drops."
ANS: B Ocular antibiotics may cause local inflammation, burning, stinging, urticaria, and dermatitis. These effects are transient. The other options are incorrect.
A patient is about to undergo ocular surgery. The preoperative nurse anticipates that which drug will be used for local anesthesia? a. Oral glycerin b. Proparacaine (Alcaine) c. Timolol (Timoptic) d. Dipivefrin (Propine)
ANS: B Proparacaine (Alcaine) and tetracaine are used as a local anesthetic for ocular surgery or other procedures. The other drugs are used for glaucoma.
The nurse is reviewing the use of ophthalmic preparations. Indications for the direct- and indirect-acting miotics include which condition? a. Cataracts b. Removal of foreign bodies c. Open-angle glaucoma d. Ocular infections
ANS: C Indications for the direct- and indirect-acting miotics include open-angle glaucoma, angle-closure glaucoma, ocular surgery, and convergent strabismus.
A patient is receiving ocular cyclosporine (Restasis) and also has an order for an artificial tears product. The nurse includes which instructions in the teaching plan for these medications? a. "These two eye drugs cannot be given together. Let's check with your prescriber." b. "You may take these two drugs together at the same time." c. "First take the artificial tears, and then take the Restasis after 5 minutes." d. "Take the Restasis first, and then wait 15 minutes before taking the artificial tears."
ANS: D Restasis can be used together with artificial tears if the drugs are given 15 minutes apart. The other options are incorrect.
The nurse identifies which description as the method of action of betaxolol in treating glaucoma? a) producing miosis, increasing outflow of aqueous humor b) decreasing the production and formation of aqueous humor c) vasodilation, increasing blood flow to the optic nerve d) producing clyclopegia, decreasing pupillary response
B Opthalmic beta blockers reduce intraocular pressure by reducing aqueous humor formation.
Which medication used as maintenance therapy in the treatment of glaucoma works by providing another exit route of aqueous humor besides the trabecular network? A. Isosorbide (Ismotic) B. Latanoprost (Xalatan) C. Dorzolamide (Trusopt) D. Levobetaxolol (Betagan)
B. Latanoprost (Xalatan) Lantanoprost is a prostaglandin agonist that relieves intraocular pressure (IOP) by increasing the outflow of aqueous humor between the uvea and the sclera in addition to the trabecular network. Isosorbide is an osmotic diuretic that reduces IOP by drawing water from the aqueous humor by means of osmotic pressure. Dorzolamide is a carbonic anhydrase inhibitor, and levobetaxolol is a beta-adrenergic blocker that reduces the formation of aqueous humor.
During the assessment of a glaucoma patient who has newly prescribed carbonic anhydrase inhibitor eyedrops, the nurse would report a history of which condition? a) allergy to sulfa drugs b) decreased renal function c) diabetes mellitus d) hypertension
a) allergy to sulfa drugs
A patient has undergone an eye procedure during which opthalmic mydriatics and anesthetic drops were used. The nurse gives which instructions to the patient prior to discharge (select all that apply) a) do not rub or touch the numb eye. b) you may reinsert your contact lenses before you leave. c) be sure to wear sunglasses when you go outside. d) your pupils will appear very tiny until the medication wears off. e) report any increase in eye pain or drainage to the opthalmologist immediately.
a, c, e
When the nurse is providing teaching about eye medications for glaucoma, the nurse tells the patient that miotics help glaucoma by which mechanism of action (select all that apply) a) decreasing intracranial pressure b) decreasing intraocular pressure c) enhancing aqueous humor drainage d) increasing tear production e) causing pupillary dilation
b) decreasing intraocular pressure c) enhancing aqueous humor drainage
When assessing a patient who is receiving a direct-acting cholinergic eyedrop as part of treatment for glaucoma, the nurse anticipates that the drug affects the pupil in which way? a) It causes mydriasis, or pupil dilation. b) it causes miosis, or pupil constriction c) it changes the color of the pupil d) it causes no change in pupil size.
b) it causes miosis, or pupil constriction
The nurse is administering sympathomimetic opthalmic drops. Which therapeutic drug effect will these drops have on the patients eyes? a) Miosis b) reduced intraocular pressure c) reduced inflammation d) increased lubrication
b) reduced intraocular pressure
When giving latanoprost (Xalatan) eyedrops, the nurse will advise the patient of which possible ad- verse effects? a. Temporary eye color changes, from light eyecolors to brown b. Permanent eye color changes, from light eyecolors to brown c. Photosensitivity d. Bradycardia and hypotension
b. Permanent eye color changes, from light eyecolors to brown
A patient has come to the emergency department with an eye injury. After fluorescein (AK-Fluor) is applied, the physician sees an area with a green halo. This indicates which condition? a. A corneal defect b. A conjunctival lesion c. The presence of a hard contact lens d. A foreign object
d. A foreign object
Which structure causes mydriasis? 1Ciliary muscle 2Dilator muscle 3Lacrimal caruncle 4Sphincter papillae
2Dilator muscle The pupil is opened (called mydriasis) by a radial smooth muscle called the dilator muscle. It is composed of radiating fibers, like spokes of a wheel, which converge from the circumference of the iris toward its center. Sympathetic nervous system impulses control this muscle. Ciliary muscles are the circular muscles between the anterior and the posterior chambers of the eye behind the iris. They control the curvature of the lens. Lacrimal caruncle is a small, red, rounded elevation covered by modified skin at the medial angle of the eye. The sphincter papillae muscle is a smooth muscle controlled by the parasympathetic nervous system. It constricts the diameter of the pupil.
Which drug will decrease postoperative intraocular hypertension? 1Dipivefrin 2Pilocarpine 3Acetylcholine 4Brimonidine
2Pilocarpine Pilocarpine is a direct-acting cholinergic drug used to treat postoperative intraocular hypertension. Dipivefrin is used to treat chronic open-angle glaucoma. Acetylcholine is used for surgical miosis. Brimonidine is used primarily for glaucoma.
Which effects are expected from therapy with direct- and indirect-acting miotics? Select all that apply. 1Mydriasis 2Eye numbness 3Pupillary dilation 4Enhanced aqueous humor drainage 5Ciliary muscle contraction
4 Enhanced aqueous humor drainage 5 Ciliary muscle contraction Both direct- and indirect-acting miotics have effects similar to those of acetylcholine, but their actions are more prolonged. The direct-acting miotics can directly stimulate ocular cholinergic receptors and mimic acetylcholine. Indirect-acting miotics work by binding to and inactivating the cholinesterases acetylcholinesterase and pseudocholinesterase, the enzymes that break down acetylcholine. As a result, acetylcholine accumulates and acts longer at the cholinergic receptor sites. This leads to drug effects that include miosis, enhanced aqueous humor drainage, ciliary muscle contraction, and reduced intraocular pressure by an average of 20% to 30%. Drug-induced miotic effects may be less pronounced in individuals with dark eyes (e.g., brown or hazel). Miotics are not used to numb the eye.
A patient is started on olopatadine drops. What assessment finding indicates the medication is having a therapeutic effect? 1Dilated pupils 2Absence of pain 3Increased tearing 4Absence of itching
4Absence of itching Olopatadine is an ocular antihistamine used to treat symptoms of allergic conjunctivitis (hay fever), which can be seasonal or nonseasonal. It works by competing at the receptor sites for histamine. Histamine normally produces ocular symptoms such as itching and tearing. Olopatadine is not used to dilate pupils or reduce pain.
Which drug is used to treat accommodative esotropia? 1Carbachol 2Pilocarpine 3Acetylcholine 4Echothiophate
4Echothiophate Echothiophate is used to treat accommodative esotropia. Carbachol is used to treat open-angle glaucoma. Pilocarpine is used to treat secondary glaucoma after iridectomy. Acetylcholine is used for rapid miosis after cataract lens extraction.
A female patient who has glaucoma and has used dipivefrin (Propine) ophthalmic drops for 6 months tells the nurse that she is experiencing palpitations. Which action should the nurse implement? A. Checking for over-the-counter medication B. Telling the patient to visit her health care provider C. Asking the patient about excessive caffeine intake D. Assessing the patient for signs of cardiac stimulation
D. Assessing the patient for signs of cardiac stimulation With prolonged use or excessive dosing, a sympathomimetic agent such as dipivefrin can cause systemic effects, including extrasystoles, hypertension, and tachycardia; although this is uncommon, the nurse assesses the patient for clinical indicators of sympathetic stimulation.
information about which adverse effects would the nurse include in the teaching about indirect-acting miotic eyedrops? Select all that apply. 1Blurred vision 2Farsightedness 3Paralysis of eyelids 4Stinging on instillation 5Decreased night time vision
1Blurred vision 4Stinging on instillation 5Decreased night time vision Adverse effects are more likely to occur with indirect-acting miotics because they have longer-lasting effects. Adverse effects include blurred vision, temporary stinging upon drug instillation, reduced night time or low-light vision, drug-induced myopia (near sightedness), and accommodative spasms. Such effects are secondary to contraction of the ciliary muscle. Miotic drugs also cause vasodilation of blood vessels supplying the conjunctiva, iris, and ciliary body, which may lead to vascular congestion and ocular inflammation. Other undesirable effects include conjunctivitis, lacrimation (tearing), twitching of the eyelids (blepharospasm), and eye or brow pain. Prolonged use can result in iris cysts, lens opacities, and, rarely, retinal detachment.
Which type of glaucoma occurs in infants? 1Congenital glaucoma 2Pigmentary glaucoma 3Open-angle glaucoma 4Angle-closure glaucoma
1Congenital glaucoma An infant may be born with congenital glaucoma. Infants do not typically have pigmentary, open-angle, or angle-closure glaucoma.
Which information is essential for the nurse to teach the patient about glaucoma? 1Damages the optic nerve 2Caused by loss of transparency of the lens 3Caused by destruction of cone cells in the eye 4Caused by impaired function of the lacrimal ducts
1Damages the optic nerve Glaucoma is characterized by increased intraocular pressure that damages the optic nerve due to accumulation of aqueous humor. The patient needs to understand that without treatment, the optic nerve is damaged, and blindness can result. The lens, cones, and lacrimal ducts are not involved in glaucoma. Loss of transparency of lenses is caused by cataract. Destruction of cone cells affects central vision and causes color blindness. Lacrimal ducts are the channels arising from lacrimal glands; they drain tears. Impaired functioning of lacrimal ducts does not cause glaucoma.
Which medication is administered intravenously to decrease intraocular pressure prior to surgery when other medications have been unsuccessful? 1Mannitol 2Latanoprost 3Dorzolamide 4Lansoprazole
1Mannitol Mannitol is administered by intravenous infusion to reduce elevated intraocular pressure when the pressure cannot be lowered by other methods. It is effective in lowering intraocular pressure before intraocular surgery. It is also used in treating acute episodes of angle-closure, absolute, or secondary glaucoma. Mannitol does not penetrate the eye and, unlike some of the other osmotic drugs, may be used when irritation is present, such as urea.
Parasympathomimetic ophthalmic drugs such as pilocarpine reduce intraocular pressure in the treatment of glaucoma by which mechanism of action? 1Miosis 2Mydriasis 3Pupillary dilatation 4Decrease in drainage of aqueous humor
1Miosis Pilocarpine is a direct-acting parasympathomimetic drug that is used as a miotic in the treatment of open-angle glaucoma. Miosis causes pupillary constriction, increasing the outflow of aqueous humor.
Which response indicates a therapeutic effect from administering atropine sulfate eyedrops to a patient with uveitis? 1Pupil dilation 2Pupil constriction 3Increased accommodation 4Change in color of the iris
1Pupil dilation Atropine sulfate solution and ointment are used as mydriatic and cycloplegic drugs. The drug dilates the pupil (mydriasis) and paralyzes the ciliary muscle (cycloplegic refraction), which prevents accommodation. It is used to assist with eye examinations or to treat uveal tract inflammatory states. The usual dosage for uveitis (inflammation of the choroid, iris, or ciliary body) in children and adults is 1 to 2 drops of the solution, or 0.3 to 0.5 cm of ointment, two to three times daily. The dosage for eye examination is 1 drop of solution, ideally 1 hour before the procedure. It is classified as a pregnancy category C drug. Atropine sulfate is not used to change the color of the iris.
Which structure covers the exposed anterior surface of the eyeball? 1Pupil 2Sclera 3Conjunctiva 4Lacrimal caruncle
3 Conjunctiva The conjunctiva is the mucous membrane that lines the eyelids and covers the exposed anterior surface of the eyeball. The pupil is a circular opening in the iris of the eye that allows the light to enter the eyeball when the eyelids are open. Sclera is a tough, white coat of fibrous tissue that surrounds the entire eyeball except the cornea. It helps maintain the shape of the eye. Lacrimal caruncle is a small, red, rounded elevation covered by modified skin at the medial angle of the eye.
Which information would be included when teaching a patient about latanoprost? 1This medication is administered orally. 2Eyedrops are to be given three times a day. 3Eye color may darken while on this medication. 4This medication has a very short duration of action.
3Eye color may darken while on this medication. Latanoprost is a prodrug of a naturally occurring prostaglandin known as prostaglandin F2-alpha. When it is administered, it is converted by hydrolysis (with water from ocular fluids) to prostaglandin F2-alpha, which in turn reduces intraocular pressure. About 3% to 10% of patients treated with latanoprost have shown increased iris pigmentation after 3 to 4½ months of treatment. Latanoprost is available only in eyedrop form. The eyedrops are given once a day in the evening. The medication has a long duration of action of 24 hours.
Which information would the nurse teach the patient prescribed glycerin therapy for an ocular problem? 1It will treat eye infections. 2It will cure your eye condition. 3It is instilled into each eye twice a day. 4It will cause you to urinate more frequently.
4 It will cause you to urinate more frequently. Glycerin is an osmotic diuretic given orally to lower intraocular pressure or topically to reduce superficial corneal edema. The patient should be taught that the medication is a diuretic that causes increased urination. Osmotic diuretics include glycerin, mannitol, urea, and isosorbide. These drugs are normally reserved for acute reduction of intraocular pressure during glaucoma crises and perioperative reduction of intraocular pressure in ophthalmic surgery. Another use is before iridectomy in individuals with acute narrow-angle glaucoma. It is also used preoperatively and/or postoperatively in procedures such as treatment of congenital glaucoma, repair of retinal detachment, cataract extraction, and keratoplasty (corneal transplant). It may also be used in the management of secondary glaucoma. It is not an antibiotic and does not cure eye infections. It is administered orally, not by eyedrops.
A patient newly diagnosed with open-angle glaucoma asks about the purpose of epinephrine therapy. Which information would the nurse teach the patient? 1"Epinephrine stops ocular deterioration." 2"Epinephrine decreases spasms in the eye." 3"Epinephrine increases your ability to blink." 4"Epinephrine decreases intraocular pressure."
4"Epinephrine decreases intraocular pressure." Both epinephrine and dipivefrin are used to reduce elevated intraocular pressure in the treatment of chronic open-angle glaucoma, either as initial or long-term therapy. This is the mainstay of therapy for this condition. The medications do not stop ocular deterioration, decrease spasms in the eye, or affect the ability to blink.
Which structure(s) located in the eye play(s) a major role in central vision and enable(s) a person to perceive colors? 1Lens 2Rods 3Pupil 4Cones
4Cones Cones are the photoreceptive cells located in the retina of the eye. These cells play a major role in central vision and enable the perception of colors. The lens is the biconvex transparent crystalline structure of the eye, located directly behind the iris and the pupil. Rods are the photoreceptive cells in the retina and are responsible for light vision. The pupil is a circular opening in the iris of the eye that allows light to enter the eyeball when the eyelids are open.
In a patient admitted with an ocular problem, the nurse performs an assessment of extraocular eye movement. Which purpose does this assessment serve? 1Determines if the patient is in pain 2Determines if the eye is sensitive to stimuli 3Determines if eye movement causes accommodation 4Determines if the patient has the ability to move eyes in all directions
4Determines if the patient has the ability to move eyes in all directions Each eye is held in place and moved by six muscles that are controlled by cranial nerves. These muscles include the rectus and oblique muscles. There are four types of rectus muscles: inferior, superior, medial, and lateral. There are two types of oblique muscles: inferior and superior. The nurse would assess a patient with ocular problems by asking him or her to follow an object as the patient moves the eye. This assessment allows the nurse to determine if the patient has any deficits in muscle movement. This assessment does not show if the patient is in pain or sensitive to stimuli. This assessment is not used to determine if eye movement causes accommodation.
A patient with type 2 diabetes mellitus who takes metformin (Glucophage) daily has excessively high intraocular pressure (IOP). Which medication used in the treatment of increased IOP should the nurse avoid administering to this patient to prevent a serious adverse effect of therapy? A. Mannitol (Osmitrol) B. Betaxolol (Betoptic) C. Latanoprost (Xalatan) D. Brinzolamide (Azopt)
A. Mannitol (Osmitrol) The nurse avoids administering an osmotic diuretic such as mannitol to the patient taking metformin as a means of preventing metabolic acidosis because acidosis is an adverse effect of mannitol and metformin. Betaxolol is indicated in the treatment of chronic glaucoma. Lantanoprost is used in the treatment of open-angle glaucoma and ocular hypertension when other treatments have failed. Brinzolamide is a carbonic anhydrase inhibitor used in the treatment of open-angle and angle-closure glaucoma but not usually for the treatment of acute intraocular hypertension.
Which glaucoma ophthalmic drops reduce increased intraocular pressure without affecting pupil size? A. Timolol (Timoptic) B. Dipivefrin (Propine) C. Pilocarpine (Pilocar) D. Epinephryl (Epinal)
A. Timolol (Timoptic) Beta-adrenergic blockers such as timolol reduce increased intraocular pressure by slowing the formation of aqueous humor. Dipivefrin, pilocarpine, and epinephryl decrease intraocular pressure by means of mydriatic and miotic actions.
A patient with an eye injury requires an ocular examination to detect the presence of a foreign body. The nurse anticipates that which drug will be used for this examination? a. Phenylephrine (Neo-Synephrine) b. Fluorescein sodium (AK-Fluor) c. Atropine sulfate (Isopto Atropine) d. Olopatadine (Patanol)
ANS: B Fluorescein sodium is an ophthalmic diagnostic dye used to identify corneal defects and to locate foreign objects in the eye. Phenylephrine is an ocular decongestant; atropine sulfate has mydriatic and cycloplegic effects, which are useful for examining the inner eye structures; olopatadine is an ophthalmic antihistamine.
The nurse will be giving ophthalmic drugs to a patient with glaucoma. Which drug is given intravenously to reduce intraocular pressure when other medications are not successful? a. Tobramycin (Tobrex) b. Bacitracin (AK-Tracin) c. Mannitol (Osmitrol) d. Ketorolac (Acular)
ANS: C Drugs used to reduce intraocular pressure include osmotic diuretics such as mannitol, which is given intravenously. Tobramycin and bacitracin are antibiotics; ketorolac has anti-inflammatory actions.
A patient has been taking the corticosteroid dexamethasone (Decadron) but has developed bacterial conjunctivitis and has a prescription for gentamicin (Garamycin) ointment. The nurse notes that which interaction is possible if the two drugs are used together? a. The infection may become systemic. b. The gentamicin effects may become more potent. c. The corticosteroid may cause overgrowth of nonsusceptible organisms. d. Immunosuppression may make it more difficult to eliminate the eye infection.
ANS: D Concurrent use of corticosteroids, such as dexamethasone and ophthalmic antimicrobials, may cause immunosuppression that may make it more difficult to eliminate the eye infection.
The nurse is teaching patients with glaucoma to self-administer their medications. Which patient teaching should the nurse provide? A. Apply an ointment under the upper eyelid. B. Allow eyedrops to fall on the conjunctival sac. C. Allow all excess medication to be absorbed slowly. D. Wipe the eyes with a warm compress after administering eyedrops.
B. Allow eyedrops to fall on the conjunctival sac. The nurse instructs the patients to allow the medication to fall on the conjunctival sac and not directly on the eye. Ointment is applied under the lower eyelid. Excess medication may be dabbed away with a tissue, provided the patient is careful not to allow the tissue to remove medication from the eye. The nurse avoids instructing patients to wipe the eyes with a warm compress because the heat may affect the absorption of the medication.
A patient's intraocular pressure (IOP) is dangerously high. Which patient assessment data should the nurse use as baseline data before administering treatment for the IOP? A. Gastrointestinal (GI) function B. Breath sounds C. Renal function D. Peripheral edema
B. Breath sounds An osmotic diuretic such as mannitol is indicated in the treatment of acute intraocular hypertension. The nurse assesses the patient's breath sounds before administering mannitol for the acute reduction of IOP because osmotic diuretics are contraindicated in pulmonary edema. Assessments of GI function, renal function, and peripheral edema are reasonable nursing assessments before the administration of an osmotic diuretic but do not reveal contraindications to therapy.
Mrs. N., a 60 year old librarian, has open-angle glaucoma. The opthalmologist prescribes dipivefrin (propine) a) Why might the physician have chosen that drug over epinephrine b) what effects will the nurse tell Mrs. N to expect when first taking dipivefrin? c) Will the nurse expect any serious reactions to the drug? Explain your answer.
a) the chemical alteration account for the main advantage of this drug over epinephrine: It has enhanced lipophilicity (fat solubility) and can better penetrate into the tissues of the anterior chamber of the eye. This also reduces the likelihood of any systemic adverse effects. b) burning, eye pain, lacrimation. Usually temporary and may subside as the patient grows accustomed to the medication. c) No. Systemic effects are rare; they include cardiovascular effects andpossibly headaches and faintness
When applying ophthalmic drugs, the nurse will follow which instructions? (Select all that apply.) a. Apply drops directly onto the cornea. b.Apply drops into the conjunctival sac. c. Apply pressure to the inner canthus for 1 minute after medication administration. d. Apply ointments in a thin layer. e. Avoid touching the eye with the tip of the medication dropper.
b. Apply drops into the conjunctival sac.c. Apply pressure to the inner canthus for 1 minute after medication administration.d. Apply ointments in a thin layer. e. Avoid touching the eye with the tip of the medication dropper.
During patient teaching regarding self-administration of opthalmic drops, which 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 eyelid 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 eyelid
When reviewing the medical record of a patient with a new order for a carbonic anhydrase inhibitor, the nurse knows that which condition would be a potential problem for a patient taking this drug? a. Glaucoma b. Ocular hypertension c. Allergy to sulfa drugs d. Allergy to penicillin
c. Allergy to sulfa drugs
A newborn infant is about to receive medication that prevents gonorrheal eye infection. The nurse will prepare to administer which drug? a. dexamethasone (Maxidex) ointment b. gentamicin (Genoptic) solution c. erythromycin ointment d. sulfacetamide (Cetamide) solution
c. erythromycin ointment
The opthalmologist has given a patient a dose of ocular atropine drops before an eye examination. Which statement by the nurse accurately explains to the patient the reason for these drops? a) these drops will cause the surface of your eye to become numb so that the doctor can do the examination. b) these drops are used to check for any possible foreign bodies or corneal defects that may be in your eye c) these drops will reduce your tear production for the eye examination. d) these drops will cause your pupils to dilate, which makes the eye examination easier.
d) these drops will cause your pupils to dilate, which makes the eye examination easier.
Which sympathomimetic drugs are used in the treatment of glaucoma? Select all that apply. 1Dipivefrin 2Carbachol 3Epinephryl 4Pilocarpine 5Acetylcholine
1Dipivefrin 3Epinephryl Dipivefrin and epinephryl are sympathomimetic drugs used in the treatment of glaucoma. Carbachol and pilocarpine are direct-acting cholinergic drugs used in the treatment of open- and closed-angle glaucoma. Acetylcholine is a direct-acting cholinergic drug used in producing miosis during ophthalmic surgery.
Which assessment finding is expected in a patient admitted with a cataract? Select all that apply. 1Diplopia 2Blurred vision 3Severe eye pain 4Photosensitivity 5Gray-white color within the lens
1Diplopia 2Blurred vision 5Gray-white color within the lens A cataract is a gray-white opacity that can be seen within the lens. If cataracts are untreated, sight may eventually be completely lost. Diplopia, or double vision, may also develop. At the onset of a cataract, vision is blurred and may be further worsened by the glare of bright lights. The patient with a cataract does not typically have severe pain or photosensitivity.
Which drug is used to identify corneal defects? 1Fluorescein 2Atropine sulfate 3Cromolyn sodium 4Cyclopentolate solution
1Fluorescein Fluorescein is an ophthalmic diagnostic dye used to identify corneal defects. Atropine sulfate is a mydriatic and cycloplegic drug used to assist eye examination and to treat uveal tract inflammation. Cromolyn sodium is an antiallergic drug used in the treatment of vernal (spring time) keratoconjunctivitis. Cyclopentolate solution is used in diagnostics as a mydriatic and cycloplegic drug.
Antiglaucoma beta blockers have which side effects? Select all that apply. 1Keratitis 2Faintness 3Blepharitis 4Photophobia 5Tachycardia
1Keratitis 3Blepharitis4 Photophobia The adverse effects of antiglaucoma beta blockers are primarily limited to ocular effects. The most common ocular effects are transient burning and discomfort. Other effects include keratitis (inflammation of the cornea), blepharitis, photophobia, blurred vision, pain, lacrimation, and decreased corneal sensitivity. Because these drugs are administered topically, few, if any, systemic effects such as faintness or tachycardia are expected.
Which mechanism causes the eye to dilate? 1The iris dilator muscle constricts the iris to cause pupil dilation. 2The sympathetic nervous system causes constriction of the pupil. 3The parasympathetic nervous system causes dilation of the pupil. 4The sphincter pupillae muscle constricts the iris to cause pupil constriction.
1The iris dilator muscle constricts the iris to cause pupil dilation. The pupillary size changes in response to the light due to the constriction and dilation of the pupil. To achieve better vision in low light, the iris dilator muscles constrict the iris and increase the size of the pupil (dilatation). The sympathetic nervous system dilates the pupil by sending impulses to the dilator muscles to contract. This increases the size of the pupil. The parasympathetic nervous system causes constriction of the pupil by sending impulses to the sphincter pupillae muscle. This expands the iris and decreases the pupil size.
The nurse is assessing a patient with angle-closure glaucoma who has been prescribed mydriatics. Which point is essential to include in teaching? 1"Ensure that the tip of the dropper touches the eye." 2"Wear sunglasses after administering your eyedrops." 3"Avoid applying pressure to the inner canthus with a tissue." 4"You can wear contact lenses immediately after administering the eyedrops."
2"Wear sunglasses after administering your eyedrops." Photosensitivity is an expected adverse effect of mydriatics; therefore, when these drugs are administered, encourage the patient to wear sunglasses to help minimize eye discomfort and/or headaches while in sunlight. Touching the eye with the tip of the dropper or container should be avoided to prevent contamination. Pressure should be applied to the inner canthus with a tissue or 2-inch gauze pad for 1 full minute. This helps remove any excess drug and prevents the outflow of the medication from the eye. Contact lenses may cause irritation, so these should be avoided after administering antiglaucoma drugs.
Which drug is prescribed to newborns for preventing ocular infections caused by Neisseria gonorrhoeae? 1Natamycin 2Gentamicin 3Trifluridine 4Erythromycin
4Erythromycin Erythromycin is a macrolide antibiotic. It is used for preventing infections in newborns caused by N. gonorrhoeae. Natamycin is an antifungal drug used in the treatment of blepharitis, conjunctivitis, and keratitis, which are caused by the Candida and Aspergillus species. Gentamicin is an aminoglycoside used in the treatment of Pseudomonas, Proteus, and Klebsiella infections. Trifluridine is an antiviral drug indicated for keratitis and keratoconjunctivitis, which are caused by the herpes simplex virus.
Which ocular infection is characterized by the formation of a single cyst at the follicles of the eyelashes? 1Keratitis 2Blepharitis 3Conjunctivitis 4Hordeolum (sty)
4Hordeolum (sty)Hordeolum (sty) is an acute localized ocular infection that is characterized by the formation of a small cyst at the eyelash follicles. It usually affects the eyelash follicles and glands of the anterior lid. Keratitis is caused by bacterial and viral infections, and its symptoms are intense pain and inflammation of the cornea. Blepharitis is the inflammation of both eyelids where the eyelashes grow. Conjunctivitis is the inflammation of the conjunctiva, the mucous membrane lining the back of the eyelids and the front of the eye except the cornea.
Which assessment finding will the nurse determine is consistent with cycloplegia? 1Pupil dilation 2Pupil constriction 3Absence of lacrimation 4Lack of accommodation
4Lack of accommodation Cycloplegia is paralysis of the ciliary muscles preventing the accommodation of the lens for variations in distance. Cycloplegia is not pupil dilation, constriction, or absence of lacrimation.
At the time of birth, infants are often treated with erythromycin eye ointment as prophylactic treatment against what possible organism? 1C. albicans 2M. furfur 3A fumigatus 4N. gonorrhoeae
4N. gonorrhoeae Erythromycin eye ointment is indicated for the treatment of neonatal conjunctivitis caused by C. trachomatis and for the prevention of eye infections in newborns that may be caused by N. gonorrhoeae or other susceptible organisms. It is not used for prophylaxis against C. albicans, M. furfur, or A. fumigatus
The nurse is teaching the patient to utilize cromolyn for keratitis. What instruction is correct? 1Put 2 to 4 drops in each eye daily. 2Put 1 to 2 drops in affected eye daily. 3Take 2 tablets daily in the morning. 4Put 1 to 2 drops in affected eye 4 to 6 times daily.
4Put 1 to 2 drops in affected eye 4 to 6 times daily. Cromolyn is utilized as eyedrops to treat keratitis. The correct dose is to put 1 to 2 drops in the affected eye only 4 to 6 times daily. The other administrations are incorrect.
A patient requires dorzolamide (Trusopt) for glaucoma. What is the nurse's priority patient assessment before therapy is begun? A. Medication list B. Fine motor skills C. Eyelid condition D. Systemic illnesses
A. Medication list The nurse's priority is the compilation of a list of the patient's medications to help identify potential drug interactions and the potential for cross-sensitivity to sulfa drugs. The nurse will analyze the medication list for sulfa drugs and sulfonamides and diuretics because these medications have side-effect profiles similar to the hematologic, gastrointestinal, integumentary, and metabolic effects of carbonic anhydrase inhibitors. It is important to assess fine motor skills to determine whether the patient will be able to self-administer the dorzolamide. The condition of the eyelid is a reasonable nursing assessment before the start of any ophthalmic medication regimen. Listing of comorbid illnesses is an important means of identifying conditions that might affect therapy.
When teaching a patient about the proper application of timolol (Timoptic) eyedrops, the nurse will include which instruction? a. "Apply the drops into the conjunctival sac instead of directly onto the eye." b. "Apply the drops directly to the eyeball (cornea) for the best effect." c. "Blot your eye with a tissue immediately after applying the drops." d. "Tilt your head forward before applying the eyedrops."
ANS: A All ophthalmic drugs should be administered in the conjunctival sac. Gently use a tissue to remove excess eye medication—do not blot the eye after giving the medication. Tilt the head back before giving the eyedrops.
A patient has a new prescription for an antiglaucoma eyedrop. The next day, she calls the clinic and states, "The package insert says this medication might make my blue eyes turn brown! Is this true?" The nurse realizes that the patient has a prescription for which eye medication? a. Latanoprost (Xalatan), a prostaglandin agonist b. Dorzolamide (Trusopt), an ocular carbonic anhydrase inhibitor c. Betaxolol (Betoptic), a direct-acting beta blocker d. Pilocarpine (Pilocar), a direct-acting cholinergic
ANS: A There is one unique adverse effect associated with all prostaglandin agonists—in some people with hazel, green, or bluish-brown eye color, eye color will turn permanently brown, even if the medication is discontinued. This adverse effect appears to be cosmetic only, with no known ill effects on the eye. The other medications do not have this effect.
The nurse is administering ophthalmic drops. Place the following administration steps in the correct order. (Select all that apply.) a. Close the eye gently. b. Apply gentle pressure to the inner canthus/lacrimal sac for 1 minute. c. Place drops into the conjunctival sac. d. Clean debris from the eye as needed. e. Have the patient tilt the head back and look up at the ceiling. f. Remove excess medication gently from around the eyes.
ANS: A, B, C, D, E, F Before applying eye medications, clean any debris from the eye, if needed, and have the patient tilt the head back and look up at the ceiling. Drops are placed into the conjunctival sac, and then the eye is closed gently. Pressure may be applied to the inner canthus/lacrimal sac for 1 minute to reduce systemic absorption, and any excess medication can then be removed from around the eyes.
The nurse is reviewing the medical record of a patient and notes an order for ophthalmic dexamethasone (Decadron) solution. The nurse knows that indications for ophthalmic dexamethasone include which conditions? (Select all that apply.) a. Uveitis b. Allergic conditions c. Removal of foreign bodies d. Ocular infections e. Glaucoma f. Conjunctival inflammation
ANS: A, B, C, F Dexamethasone (Decadron) is used to treat inflammation of the eye, eyelids, conjunctiva, and cornea, and it may also be used in the treatment of uveitis, iridocyclitis, allergic conditions, and burns and in the removal of foreign bodies. It is not indicated for infections or glaucoma.
The nurse wants to decrease the risk of secondary infections and complications associated with the use of antimicrobial eyedrops. What is the nurse's priority instruction during teaching of patients who are beginning to use the eyedrops? A. Tilt the head up and open the eye wide. B. Apply gentle pressure to the inner canthus. C. Retract the lower eyelid to instill the eyedrops. D. Avoid touching the medication container to the eye.
D. Avoid touching the medication container to the eye. The nurse stresses the importance of avoiding contact between the medication container and the infected tissue as a means of preventing both contamination of the medication and secondary infections. Tilting the head, applying gentle pressure, and retracting the lower eyelid are reasonable nursing instructions for a patient using eyedrops; however, these measures are unrelated to infection control.
