PHARM - Eye and Ear

Latanoprost drops are prescribed for the client with glaucoma. The client returns to the health care clinic for evaluation. Which finding noted in the client indicates a side effect associated with the use of these eye drops?

Brown pigmentation of the iris Rationale:Latanoprost is a topical medication used to lower intraocular pressure in clients with open-angle glaucoma and ocular hypertension. The most significant side effect is heightened brown pigmentation of the iris. Other side effects include blurred vision, burning, stinging, conjunctival hyperemia, and punctate keratopathy. The heightened pigmentation stops progressing when the medication is discontinued but does not regress.

The nurse is administering gentamicin sulfate ophthalmic ointment to a client. After instilling the ointment, the nurse reinforces instructions to the client to close the eye and perform which action?

Roll the eyeball in all directions. Rationale:Gentamicin sulfate is an anti-infective of the aminoglycoside type. After the ophthalmic ointment preparation has been applied, the client should close the eye and roll the eyeball in all directions. This helps distribute the medication properly. Options 2 and 3 are of no value. Option 4 is a possibility if systemic absorption is a concern, but this would be done for 1 to 2 minutes, not 10 minutes.

A client has been instructed by the primary health care provider to alternate the use of hydrogen peroxide and glycerin eardrops to loosen an impacted accumulation of earwax. The nurse gives the client which directions to accomplish this daily procedure safely and independently?

"Use the solutions at body temperature for 7 to 14 days." Rationale:The solutions should be used at body temperature for 7 to 14 days. This prevents injury to the ear and allows sufficient time for the material to soften.

A licensed practical nurse (LPN) is reviewing the medication list of the client with a history of glaucoma. The LPN should consult with the registered nurse if which medication is prescribed for the client?

Atropine sulfate Rationale:Pilocarpine and carteolol are examples of miotic agents used in the treatment of glaucoma. Atropine sulfate is a mydriatic and cycloplegic medication that is contraindicated for use in clients with glaucoma. Mydriatic medications dilate the pupil and can cause an increase in intraocular pressure in the eye.

The nurse is reinforcing instructions to a client with glaucoma receiving acetazolamide daily. Which statement by the client indicates an understanding of the adverse effects related to the medication?

"I need to call the doctor if I notice dark urine and stools." Rationale:Acetazolamide is a carbonic anhydrase inhibitor. Nephrotoxicity and hepatotoxicity occur and are manifested by dark urine and stools, pain in the lower back, jaundice, dysuria, crystalluria, renal colic, and calculi. Bone marrow depression also may occur.

A client with chronic glaucoma is being started on medication therapy with acetazolamide. The nurse reinforces instructions to the client that which symptom can occur early but subsides or disappears with continued treatment?

Diuresis Rationale:Diuresis is an early side effect of acetazolamide that usually subsides with continued treatment. This is because the medication is also a weak diuretic, although it is no longer prescribed for that purpose. Fatigue, headache, and loss of libido are common side effects of therapy, but these may not subside spontaneously.

The nurse in the emergency department is preparing to instill fluorescein into the eye of a client with the complaint of eye pain. Fluorescein dye is used to detect which conditions? Select all that apply.

Foreign object, Corneal abrasion Rationale:Fluorescein is a water-soluble dye that produces an intense green color. This agent is applied to the surface of the eye to detect lesions of the corneal epithelium; intact areas of the cornea remain uncolored but abrasions and other defects turn bright green. The dye will also collect around a foreign object

The nurse is caring for a client who has been taking acetazolamide for glaucoma. The nurse reviews the assessment data documented in the client's medical record and determines that an adverse effect of the medication may be occurring if which result is noted?

Jaundice Rationale:Acetazolamide is a carbonic anhydrase inhibitor used in the treatment of open-angle, secondary, or angle-closure glaucoma to reduce the rate of aqueous humor formation and to lower intraocular pressure. Adverse effects relate to nephrotoxicity, hepatotoxicity, and bone marrow depression. A decrease in the level of peripheral vision would indicate a complication of glaucoma. Jaundice is a sign of hepatotoxicity. Pupillary constriction in response to light is a normal response. Tinnitus is unrelated to this medication

A client is being discharged to home with a prescription for eye drops to be given in the left eye. The nurse has shown the client how to self-administer the drops. The nurse determines that the client needs further teaching if the client performs which actions during a return demonstration?

Lies supine, pulls up on the upper lid, and puts the drop in the upper lid Rationale:It is correct procedure for the client to either lie down or sit with the head tilted back. The thumb or finger is used to pull down on the lower lid. The client holds the bottle like a pencil (tip facing downward) and squeezes the bottle so that one drop falls into the sac. The client then gently closes the eye. An alternative method for clients who blink very easily is to place the client in the supine position with the head turned to one side. The eye to be used is uppermost. With the eye closed, the client squeezes the drop onto the inner canthus of the eye. The client turns from this side to the other while blinking. Surface tension and gravity then cause the drop to move into the conjunctival sac.

The nurse is providing instructions to a mother regarding the administration of eardrops for her infant. The nurse observes the mother administer the drops and determines that the mother is performing the procedure correctly if the mother performs what action?

Pulls down and back on the earlobe and directs the solution toward the wall of the canal Rationale:The infant should be turned onto the side, with the affected ear uppermost. With the nondominant hand, the mother pulls down and back on the earlobe while resting the wrist of the dominant hand on the infant's head. The medication is administered by aiming it at the wall of the canal rather than directly onto the eardrum. The infant should be held or positioned with the affected ear uppermost for 10 to 15 minutes to retain the solution. In the adult, the auricle is pulled up and back to straighten the auditory canal.

The nursing student is asked about the medication latanoprost and how this medication helps glaucoma. The student responds correctly by identifying which as the medication's mechanism of action?

To facilitate the outflow of aqueous humor Rationale:Latanoprost, an analogue of prostaglandin F2 alpha, is used to treat glaucoma and is applied topically to lower intraocular pressure (IOP) in clients with open-angle glaucoma and ocular hypertension. Latanoprost lowers IOP by facilitating aqueous humor outflow, in part by relaxing the ciliary muscle. Sympathomimetics and beta-blocker eye medications reduce the production of aqueous humor.

The nurse is caring for a client with glaucoma who is receiving acetazolamide daily. Which sign/symptom indicates to the nurse that the client is experiencing an adverse effect related to the medication?

Low back pain and dysuria Rationale:Acetazolamide is a carbonic anhydrase inhibitor. Nephrotoxicity and hepatotoxicity can occur and are manifested by dark urine and stools, jaundice, pain in the lower back, dysuria, crystalluria, renal colic, and calculi. Bone marrow depression also may occur. The remaining options are not adverse effects of the medication.

The nurse is concerned that a client may experience systemic effects from a beta-blocker ophthalmic solution. The nurse realizes the client is able to self-administer the medication if the client instills the drops in which manner?

Applies digital pressure to the lacrimal sac for 1 to 2 minutes after instillation Rationale:The nurse needs to teach the client methods of administering beta-blocker eye solutions that will prevent systemic absorption. Applying pressure on the lacrimal sac or nasolacrimal duct prevents systemic absorption of the medication.

The nursing student is caring for a client scheduled for cataract surgery. The student reviews the preoperative prescriptions with the nursing instructor and notes that cyclopentolate eye drops are prescribed to be administered preoperatively. The unit nurse performed an admission health assessment on the client before surgery. Which condition contraindicates using cyclopentolate?

Glaucoma Rationale:Cyclopentolate is a rapidly acting mydriatic and cycloplegic medication. It is effective in 25 to 75 minutes, and accommodation returns in 6 to 24 hours. Cyclopentolate is used for preoperative mydriasis to dilate the eye. Mydriatics are contraindicated in glaucoma because they can cause an increase in intraocular pressure.

A pilocarpine ocular system is prescribed for the client with glaucoma. The nurse reinforces instructions to the client regarding the medication. Which statement by the client indicates an understanding of the use of this medication?

"I should check my eye each morning to make sure that the medication system is in place." Rationale:The pilocarpine ocular system consists of a bilayered membrane surrounding a reservoir of pilocarpine solution. The tiny unit is placed in the conjunctival sac, after which pilocarpine is slowly released. A replacement unit should be installed once a week. Because the unit may fall out during sleep, clients are advised to check each morning for its presence.

The nurse reinforces instructions to a client who has been prescribed betaxolol eye drops for the treatment of glaucoma. The nurse instructs the client regarding the administration of the medication and about the importance of returning to the clinic for which assessment?

Blood pressure and apical pulse Rationale:Betaxolol is an antiglaucoma medication and a beta-adrenergic blocker. Hypotension manifested as dizziness, nausea, diaphoresis, headache, fatigue, constipation, and diarrhea are systemic effects of the medication. Nursing interventions include monitoring the blood pressure for hypotension and assessing the pulse for strength, weakness, irregular rate, and bradycardia. For the client taking this medication, the nurse also monitors bowel activity and monitors for the evidence of heart failure (HF) as manifested by dizziness, night cough, peripheral edema, and distended neck veins. An increase in weight and a decrease in urine output may also be indicative of HF, so intake and output should also be monitored. Pupil dilation and monitoring temperature are unrelated to the use of this medication. A positive Trousseau's sign indicates a calcium imbalance.

Which finding indicates a side effect associated with the use of latanoprost eye drops?

Brown pigmentation of the iris Rationale:Latanoprost is a medication used to lower intraocular pressure in clients with open-angle glaucoma and ocular hypertension. The most significant side effect is heightened brown pigmentation of the iris. Other side effects include blurred vision, burning, stinging, conjunctival hyperemia, and punctate keratopathy. The heightened pigmentation does not progress once the medication is discontinued, but also it does not regress.

The nurse is teaching a mother how to administer eardrops to an infant. The nurse determines the mother understands instructions if the mother demonstrates pulling the ear in which manner?

Down and back and directing the solution toward the wall of the canal Rationale:The ear is pulled down and straight back in a child younger than 3 years of age. The infant is turned onto the side with the affected ear uppermost. The nurse pulls down and back on the earlobe with the nondominant hand while resting the wrist of the dominant hand on the infant's head. The medication is directed toward the wall of the canal rather than onto the eardrum. The infant should lie with the affected ear uppermost for 10 to 15 minutes to retain the solution. In an adult or a child older than 3 years, the ear is pulled up and back to straighten the auditory canal.

The nurse has reinforced instructions to a client regarding the method for instilling eye drops into the left eye. The nurse determines that the client needs further teaching if the client does which during a return demonstration?

Lies supine, pulls up on the upper lid, and puts the drop in the upper lid Rationale:It is correct procedure for the client to either lie down or sit with the head tilted back. The thumb or finger is used to pull down on the lower lid. The client holds the bottle like a pencil (tip facing downward) and squeezes the bottle so that the drop falls into the sac. The client then gently closes the eye. An alternative method for clients who blink very easily is to place the client in the supine position with the head turned to one side. The eye to be used is uppermost. The client squeezes the drop onto the inner canthus. The client turns from this side to the other while blinking. Surface tension and gravity then cause the drop to move into the conjunctival sac.

A client who has just been diagnosed with glaucoma has been given a prescription for a miotic medication. When reinforcing instructions to the client about medication effects, the nurse plans to tell the client that the medication works in which manner?

Lowers intraocular pressure and enhances blood flow to the retina Rationale:Miotics are used to lower the intraocular pressure, which then increases blood flow to the retina. This in turn decreases retinal damage and loss of vision. Miotics cause a contraction or constriction of the ciliary muscle and widen the trabecular meshwork.

The nurse is preparing to administer eardrops to an infant. How should the nurse administer the eardrops?

Pull down and back on the ear, and direct the solution toward the wall of the canal. Rationale:When administering eardrops to an infant, the nurse pulls the ear down and straight back. In the adult or a child older than 3 years, the ear is pulled up and back to straighten the auditory canal. The medication is administered by aiming it at the wall of the canal rather than directly onto the eardrum.