Glaucoma & Cataracts Questions
A 44-year-old client with diabetes asks how often a visit to the eye care practitioner is recommended. What is the appropriate nursing response? a. "Annually." b. "Every six months." c. "Only if you have vision problems." d. "No examinations are necessary until you are 50 years old."
ANS: A To provide the earliest detection of concerns such as macular degeneration, retinal detachment, or glaucoma, an annual visit to the eye care practitioner should be recommended.
Which foods will the nurse recommend to a client who wishes to enhance eye health? (Select all that apply.) a. Kale b. Bananas c. Carrots d. Ground Beef e. Shellfish f. Spinach
ANS: A, B, C, F Foods richest in lutein include fruits like bananas; vegetables like carrots; and especially leafy, dark green vegetables like kale and spinach.
A client is being discharged after surgery to correct a retinal detachment. Which symptoms will the nurse teach the client to immediately report to the eye care provider? (Select all that apply.) a. Purulent discharge in the affected eye b. Fever of 102 degrees Fahrenheit (38.9 degrees Centigrade) c. Pupil that constricts in response to light d. Improved visual acuity e. Pain in the eye
ANS: A, B, E Purulent discharge can be a sign of infection. Fever of 102F (38.9C) can be a sign of infection. Pain in the eye should be reported to the eye care provider since this is not a normal side effect of surgery to repair a detached retina. Pupils that constrict in response to light and improved visual acuity are favorable findings.
The nurse is teaching a client who must instill multiple types of eye drops before cataract surgery. Which client statement requires further teaching? a. "I will make a schedule for inserting the eye drops." b. "Touching the dropper to my eye could cause contamination and infection." c. "If I can't remember when to take which drops, I'll just take them all at once." d. "If I have trouble instilling the drops, I will have my spouse put them in for me."
ANS: C Multiple eye drops that are prescribed prior to cataract surgery must be taken on a specific schedule. They should not be mixed together for convenience of administration.
The nurse is caring for four clients. Which has the highest risk for development of macular degeneration? a. 25 year old, 70 inches tall, with fracture of the right femur b. 38 year old, 71 inches tall, who has just given birth to a healthy baby c. 45 year old, 67 inches tall, who is a vegetarian d. 57 year old, 60 inches tall, with hypertension
ANS: D Dry AMD is more common and progresses at a faster rate among smokers than among nonsmokers. Other risk factors include hypertension, female gender, short stature, family history, and a long-term diet poor in carotene and vitamin E. The client in choice D is of short status and has a hypertension, increasing the risk for AMD.
Which precaution is most important for the nurse to teach a 62-year-old client newly diagnosed with early-stage dry age-related macular degeneration? A. Quit smoking B. Quit drinking alcoholic beverages C. Eat more dark green, red, and yellow vegetables D. Wear dark glasses whenever he or she is outside or in bright interior lighting environments
Answer: A Rationale: Dry AMD is more common and progresses at a faster rate among smokers than among nonsmokers. Thus, quitting smoking can slow the rate of AMD progression. Avoiding alcohol and bright light (even ultraviolet light) is not related to AMD development or progression. Although increasing long-term dietary intake of antioxidants, vitamin B12, and the carotenoids lutein and zeaxanthin that are found in green, red, and yellow vegetables is thought to help slow the progression of AMD, the effects are not as profound as quitting smoking.
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
Answer: A, D, E Rationale: 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
Answer: B Rationale: 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.
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."
Answer: B Rationale: 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.
The client who had cataract surgery with a lens implant 1 week ago says that after his daughter left to go to her home in another state, he combined all of his eyedrops together in one container. What is the nurse's best response? A. "This is not a good idea - not all of the drugs are on the same schedule." B. "Call your surgeon immediately - get new prescriptions because these drugs cannot be mixed together." C. "Get new prescriptions because together these drugs can lower your blood pressure."
Answer: B Rationale: These drugs are not to be mixed together. Not only is the chance for contamination high, but the drug concentrations and effectiveness are also reduced when mixed together. Even when the drugs are administered separately, they should be given 5 to 10 minutes apart.
The nurse is performing preop teaching for an older adult client who will be having a cataract removed. Which will the nurse include? SATA A. "You'll need to wear a patch on your eye for several weeks after the surgery." B. "Several types of eyedrops are requested after surgery, and they have to be taken several times a day for up to 4 weeks." C. "You will receive a medication to help you relax and then some different eyedrops to dilate your pupils and paralyze the lens." D. "Bring sunglasses wi
Answer: B, C, D Rationale: The client will have multiple eyedrops to use after surgery and should be made aware of this before the procedure to understand the importance. Providing information on what to expect, such as telling the client about the medication that will be administered and the eyedrops that will dilate and paralyze the lens, helps the client prepare for the day of surgery. The client will need to have sun protection after the procedure. A patch is required after surgery only if a risk for injury is present.
A client has recently had cataract surgery. About which symptom does the nurse instruct the client to notify the health care provider? A. Increased tearing B. Itching of the eye C. Reduction in vision D. Swollen eyelid
Answer: C Rationale: A reduction in vision after cataract surgery indicates a problem, and the client should notify the provider immediately. Increased tearing, itching of the eye, and a swollen eyelid all are expected after cataract surgery.
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."
Answer: C Rationale: 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.
Which assessment is most important for the nurse to perform before instilling travoprost (Travatan) into the client's eye? A. Measuring the client's blood pressure B. Measuring the client's intraocular pressure C. Checking the cornea for abrasions or open areas D. Assessing heart rate and rhythm for 1 full minute
Answer: C Rationale: Travoprost is a prostaglandins agonist. Drugs from this class should not be applied unless the cornea is completely intact. Measuring intraocular pressure is not necessary when a diagnosis of glaucoma has been established. Prostaglandins agonists, even if systemically absorbed, do not affect body blood pressure or heart rate and rhythm.
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
Answer: D Rationale: 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.
Your patient has a history of angle-closure glaucoma. What type of medications should this patient avoid? A. Anticholinergics B. Cholinergics C. Beta blockers D. Alpha-agonists
The answer is A. Angle-closure glaucoma occurs when the drainage angle of the eye becomes too narrow or closed to allow aqueous humor to drain out of the eye. This fluid stays in the eye and increases intraocular pressure, which can damage the optic nerve. Dilation of the pupils can push the iris forward and block off the drainage angle. Therefore, this patient should avoid anticholinergics. Remember anticholinergics cause dilation of the pupils...therefore, patients with angle-closure glaucoma should avoid these medications unless otherwise approved by their doctor.
A patient with open-angle glaucoma has developed thicker and longer eyelashes and reports a darkening of their eye color. You assess the patient's medication list. What glaucoma medication on the patient's medication list can cause this side effect? A. Bimatoprost B. Pilocarpine C. Acetazolamide D. Timolol
The answer is A. Bimatoprost is a prostaglandin analog and can cause these signs and symptoms.
You're providing care to a patient who just had glaucoma surgery. The patient is alert and oriented. Vital signs are: heart rate 82 bpm, blood pressure 110/80, oxygen saturation 97% on room air, respiratory rate 18, and pain rating of 2 on 1-10 scale. Which patient finding below requires you to notify the physician? A. The patient reports blurred vision. B. The patient is having difficulty passing stool and reports constipation. C. The patient reports that the eyes feel itchy. D. The patient's e
The answer is B. Option A, C, and D are NORMAL findings that can occur after glaucoma surgery. The patient should avoid activities that can increase intraocular pressure like bending, straining (especially during bowel movements), or lifting heavy objects. Therefore, the nurse would need to notify the doctor to obtain an order for a laxative or stool softener so the patient won't strain during a bowel movement.
Your patient is ordered to take Acetazolamide for treatment of glaucoma. What in the patient's history would require you to hold the medication and obtain an order clarification from the physician? A. The patient has open-angle glaucoma. B. The patient is allergic to sulfonamides. C. The patient reports tunnel vision. D. The patient's IOP is 25 mmHg.
The answer is B. Patients who have a sulfonamide allergy should NOT take carbonic anhydrase inhibitors (hence Acetazolamide).
A patient with glaucoma is ordered eye medication for the right eye in the form of an ointment and eye drop. The nurse will administer which type of medication first? A. Ointment and then the eye drops B. Eye drops and then the ointment
The answer is B. The nurse will administer eye drops FIRST and then the ointment.
A patient is scheduled to take Brimonidine and Latanoprost eye drops for management of glaucoma at 1000. What correct action below will the nurse take when administering these eye drops? A. The nurse assists the patient with using the index finger to gently place pressure at the side of the nose bridge for about 30 seconds after administering each eye drop medication. B. The nurse waits at least 3-5 minutes before administering the second eye drop medication. C. The nurse administers each eye dr
The answer is B. This is the only correct action by the nurse. The nurse should wait at least 3-5 minutes before administering the second medication. This is so that the first medication can be used by the eye and not washed out by the second medication.
The patient is ordered to take Timolol for the treatment of glaucoma. Before administration the nurse will educate the patient about this new medication. Which of the following information is the MOST pertinent the nurse to include? A. Measuring the heart rate because this medication can cause tachycardia. B. Performing punctal occlusion after instilling the eye drops. C. Avoid taking this medication with any other glaucoma medications. D. Always administer this medication 1 minute before anothe
The answer is B. Timolol is a beta blocker, and it is administered via eye drops for the treatment of glaucoma. It is very important the patient perform punctal occlusion after instilling the eye drop to prevent systemic effects of the medication. The medication needs to stay in the eye rather than enter the blood stream. Punctal occlusion is where the tear duct is blocked with the index finger for about 2-3 minutes. This will prevent the medication from draining down into the nasolacrimal duct.
A patient asks you to explain how the intraocular pressure is measured to help detect glaucoma. You state that IOP (intraocular pressure) is measured by what instrument below? A. Goniscope B. Tonometry C. Ophthalmoscope D. Phoroptor
The answer is B. Tonometry is used to assessment IOP.
You're observing a patient self-administer eye drops for the treatment of glaucoma. Which finding below requires you to re-educate the patient on how to administer eye drops correctly? A. The patient refrains from blinking after instilling the eye drops. B. The patient washes hands before and after administering the eye drops. C. The patient uses a tissue to catch any medication that drips out of the eye after administration of the drops. D. The patient places the drops of medication directly on
The answer is D. Eye drops are placed in the lower sac of the eye (conjunctival sac) NOT directly on the eye via the cornea. It's important that the nurse observes the patient using the drops and re-educate if they are using them incorrectly.
Which statement below is CORRECT about glaucoma? A. "The vision loss that occurs with glaucoma is reversible with eye drop medications." B. "Glaucoma occurs due to decreased intraocular pressure, which damages the optic nerve." C. "Surgery can cure glaucoma." D. "A normal intraocular pressure is about 10-21 mmHg and is elevated in most patients with glaucoma."
The answer is D. This option is the only correct statement about glaucoma. Vision loss is NOT reversible when it occurs in glaucoma but it's permanent...eye drops can prevent further progression. Glaucoma occurs due to INCREASED intraocular pressure (NOT decreased), and there is NO cure for glaucoma.
Your patient, who has open-angle glaucoma, is scheduled for a procedure that will remove some of the trabecular meshwork and create an opening to allow aqueous humor to collect in an area of the conjunctiva. This procedure will allow aqueous humor to be reabsorbed and help decrease IOP. As the nurse you know that you will need to provide pre-op and post-op patient education about what procedure below? A. Iridectomy B. Selective Laser Trabeculoplasty (SLT) C. Laser iridotomy D. Trabeculectomy
The answer is D: Trabeculectomy This procedure can help decrease IOP pressure in the eyes, and is used when eye drops or other procedures are not working.
What signs and symptoms are present with angle-closure glaucoma? Select all that apply: A. Patients are mainly asymptomatic B. Gradual loss of peripheral vision C. Sudden vision changes (halos around lights or blurred vision) D. Severe eye pain E. Corneal edema F. Nausea and vomiting G. Red eyes H. No pain I. IOP <10 mmHg
The answers are: C, D, E, F, G. Angle-closure glaucoma is SUDDEN and SEVERE. The patient will NOT be asymptomatic like in open-angle glaucoma. They will have SUDDEN vision changes, severe pain (eyes or head), corneal edema, nausea/vomiting, red eyes, and IOP >50 mmHg. It is a medical emergency.
