Chapter 26: Drugs for Glaucoma Nursing School Test Banks

Workman: Understanding Pharmacology

Chapter 26: Drugs for Glaucoma

Test Bank

MULTIPLE CHOICE

1. How does untreated elevated intraocular pressure eventually lead to visual impairment?
a. It compresses blood vessels and causes hypoxia of the photoreceptors.
b. It clouds the lens and prevents light from striking the photoreceptors.
c. It constricts the pupil and prevents light from entering the posterior chamber.
d. It pushes the cornea forward and distorts the placement of the image on the retina.
ANS: A
The photoreceptors of the retina are the part of the sensory nerve that respond to light and enable vision. These receptors require a constant supply of oxygen. Higher than normal intraocular pressure compresses retinal vessels and limits or prevents blood flow to these receptors. As a result of this lack of oxygen, the receptors die and are not replaced. Loss of any photoreceptors reduces vision. Loss of them all causes total blindness.

PTS: 0 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 468 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

2. Which statement regarding primary open-angle glaucoma (POAG) is true?
a. It is most common in children.
b. The major cause is trauma to the eye.
c. The problem usually affects both eyes.
d. The first symptom is chronic eye pain.
ANS: C
POAG is the most common form of glaucoma and is much more common in older adults. It does not occur as a result of trauma and usually affects both eyes, although one eye may be affected to a greater degree than the other.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 468 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

3. Which precaution is most important for the nurse to teach a patient who is prescribed any type of eye drug administered as eye drops?
a. Apply only the number of drops prescribed.
b. Stop the drug immediately if eye redness occurs.
c. Wear dark glasses for 1 hour after placing the eye drops.
d. Apply pressure to the corner of the eye after the drug has been placed.
ANS: A
Not only can eye drops enter the circulatory system and have systemic effects, excessive drops for some types of drugs for glaucoma can reduce intraocular pressure to dangerously low levels. Many patients do not consider any topical drug, including eye drops, to be real medication and believe that more drug is better. Patients must be taught to use all eye drugs exactly as prescribed, and not use more drug than is prescribed.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

4. Which safety precaution does the nurse teach a patient who is prescribed eye drops or eye ointment?
a. Wash your hands before and after applying the drug.
b. Do not share your eye medications with anyone else.
c. Avoid drinking alcoholic beverages while taking this drug.
d. Do not drive or use heavy equipment while your vision is blurred.
ANS: D
Both eye drops and eye ointments can blur vision immediately after instillation. Vision may remain blurry with eye ointments until the ointment is removed. Patients must not drive, operate heavy equipment, or perform any skill requiring precision (e.g., drawing up an insulin dose) until vision is clear.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

5. Which assessment is most important for the nurse to perform before instilling latanoprost (Xalatan) into a patients eyes?
a. Measure the patients temperature.
b. Measure the patients intraocular pressure.
c. Check the cornea for abrasions or open areas.
d. Assess heart rate and rhythm for 1 full minute.
ANS: C
Latanoprost is a prostaglandin agonist. These drugs should not be applied unless the cornea is completely intact. Measuring intraocular pressure is not necessary when a diagnosis of glaucoma has been established. Prostaglandin agonists, even if systemically absorbed, do not affect body temperature, or heart rate and rhythm.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Safe and Effective Care Environment

6. A patient has been taking bimatoprost (Lumigan) for the last 2 months. Which statement by the patient indicates to the nurse a correct understanding of this drug therapy?
a. When my eyes are red or itchy, I should wait until the next day to use my glaucoma medicine.
b. Even though my intraocular pressure is now normal, I will continue to take the drug once daily.
c. One indication that I have used too much of this drug is when my vision becomes blurry or fuzzy.
d. If I forget to take the eye drops one day, I should apply them as soon as I remember them the next day and also take the regular dose for that day.
ANS: B
Primary open angle glaucoma is not cured by drugs and the eye drops must be used as prescribed continually for control of intraocular pressure. Prostaglandin agonists are applied just once daily. If one days dose is forgotten, the patient should not take it along with the next days dose. Overusing drugs from this class reduces their effectiveness. Eye redness and itchiness are expected as temporary local responses to eye drugs. They are not a reason to withhold the drug.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

7. A patient who has been using travoprost (Travatan) eye drops for glaucoma reports that the eye lashes seem longer and thicker. What is the nurses best action?
a. Teach the patient that the drug is absorbed by the blood vessels of the eye and has no effect on other eye or lid structures.
b. Instruct the patient to apply only the number of drops prescribed and to blot the area with cotton balls after each dose.
c. Remind the patient that eye drops are liquid and that wet lashes appear both longer and thicker.
d. Reassure the patient that this is an expected response to the drug and no action is needed.
ANS: D
An expected side effect of prostaglandin agonists is longer and thicker eyelashes on the side in which eye drops are applied. In fact, there is now a special formulation of the drug to be applied just to the lashes to increase length and thickness. In addition, the lashes, iris, and lid may become darker. Other than reassurance, no action is needed.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Psychosocial Integrity

8. How do beta-adrenergic blocking agents (antagonists) lower intraocular pressure?
a. They increase the rate that the vitreous humor is reabsorbed.
b. They slow the production of aqueous humor inside the eye.
c. They reduce systemic blood pressure, which results in lower intraocular pressure.
d. They increase the movement of aqueous humor from the posterior chamber into the anterior chamber.
ANS: B
Beta-adrenergic blocking agents, more commonly known as beta blockers, bind to adrenergic receptor sites and act as antagonists. They block the receptor and prevent the naturally occurring adrenalin from binding to the receptor. Selectively blocking beta-adrenergic receptors in the eye causes less aqueous humor to be produced by the ciliary bodies. These drugs also cause the fluid to be absorbed slightly better so that less remains in the eye to contribute to intraocular pressure.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: pp. 473-474 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

9. A patient is prescribed an ophthalmic beta-blocking agent for the treatment of glaucoma. Which precaution does the nurse teach the patient to prevent orthostatic hypotension?
a. Change positions slowly.
b. Take your pulse rate at least four times each day.
c. Be sure to lie down for at least 10 minutes after putting the drops into your eyes.
d. Apply pressure to the inside corner of your eye when putting the drops into the eye.
ANS: D
Beta-blocking agents can cause hypotension if the eye drops are absorbed systemically. Nasal punctal occlusion during eye drop instillation keeps the drug in contact with the eye structures longer and decreases systemic absorption and side effects. The other precautions listed reduce the risk of falling if orthostatic hypotension occurs, but they do not prevent the drop in blood pressure.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

10. A patient who has been prescribed timolol (Timoptic) for the last month reports that his asthma is worse. What is the nurses best response?
a. Check the patients breath sounds and pulse rate.
b. Hold the dose and notify the prescriber immediately.
c. Ask the patient what drugs he takes to control his asthma.
d. Reassure the patient that this is an expected response and requires no action.
ANS: A
Timolol is a nonspecific beta blocker that can have systemic effects. It can cause bronchoconstriction and can make heart failure worse with backing of fluid into the lungs. The first action is to determine whether the patient needs immediate attention for either bronchoconstriction or possible heart failure. This is done by assessing breath sounds with a stethoscope and checking the pulse for rate, strength, and regularity. If a pulse oximeter is available, it should be used to assess the patients degree of oxygen saturation. The results of this assessment along with the patients report are then provided to the prescriber. It is likely that the class of drugs used to control this patients glaucoma will need to be changed.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

11. What is the most important assessment question for the nurse to ask a patient who is newly prescribed apraclonidine (Iopidine) for glaucoma?
a. How long have you had glaucoma?
b. What other medications are you currently taking?
c. Have you had any difficulty with retaining urine?
d. Do you have asthma or any chronic respiratory problem?
ANS: B
Apraclonidine is an adrenergic agonist. It should not be taken with certain types of psychiatric drugs, especially monoamine oxidase (MAO) inhibitors. Before giving the first dose of any drug from this class it is important to know what other prescribed and over-the-counter drugs the patient is taking to avoid serious drug interactions.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Safe and Effective Care Environment

12. Which assessment is most important for the nurse to perform after administering the first dose of dipivefrin (Propine) to a patient with glaucoma?
a. Compare urine output with fluid intake.
b. Listen to breath sounds bilaterally.
c. Assess level of consciousness.
d. Check pupil size.
ANS: C
Dipivefrin is an adrenergic agonist. A common side effect is drowsiness, which increases the patients risk for falls and other injuries. Although drugs from this class cause midriasis (pupillary dilation), this is an expected response and not a change that must be assessed.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity

13. When the nurse shines a penlight into the eyes of a patient who is prescribed brimonidine (Alphagan P), the pupils of both eyes remain equally dilated. What is the nurses best action?
a. Document the response as the only action.
b. Hold the next dose and notify the prescriber.
c. Assess the patients hand grasp strength bilaterally.
d. Remind the patient to wear sunglasses when outdoors.
ANS: D
Brimonidine is an adrenergic agonist. It causes pupils to dilate even when plenty of light is present. This is an expected response, not an adverse reaction, and does not indicate true neurologic changes. However, the patient should protect his or her eyes from excessive light by wearing sunglasses when outdoors or in any brightly lit environment.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Health Promotion and Maintenance

14. What is the most important action for the nurse to perform after administering eye drops to a patient who is prescribed pilocarpine (Ocu-Carpine)?
a. Place the patient in the supine position.
b. Wipe the excess drug from the patients skin.
c. Instruct the patient to keep the eyes closed for 2 minutes.
d. Check pupillary responses by shining a penlight into each eye.
ANS: B
Pilocarpine is a cholinergic drug that can be absorbed through the skin and cause many systemic effects, including headache, flushing, increased saliva, and sweating. If excessive amounts are absorbed, the patient can develop more severe problems such as asthma, hypotension, heart block and other rhythm problems, abdominal cramps, diarrhea, urinary incontinence, vomiting, and dizziness. The usual dosage is two drops per eye, which increases the chances that some drug will overflow onto the skin. Wiping any drug that falls on the skin prevents these severe problems.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

15. A patient who has been prescribed echothiophate (Phospholine Iodide) for the last 2 weeks reports all of the following symptoms or conditions. Which symptom or condition does the nurse report to the prescriber immediately?
a. Excessive drooling
b. Pinpoint pupils
c. Cold hands
d. Dry mouth
ANS: A
Echothiophate is a cholinergic drug. A sign of cholinergic toxicity is excessive drooling. If this occurs, other problems, especially slow heart rate, are about to occur also. The patient needs to receive anticholinergic drugs immediately to counteract this toxicity.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

16. What is the most important precaution for the nurse to teach an older patient who is prescribed a glaucoma drug that causes miosis?
a. Wear sunglasses until the drug wears off.
b. Use at least a 30 SPF sunscreen when going outdoors.
c. Avoid driving or operating hazardous machinery until the drug wears off.
d. Increase the light indoors because vision will be decreased in low-light environments.
ANS: D
Miosis is a decrease in pupil size, which lets in less light and reduces visual acuity. Older adults already have a smaller pupil size as a result of the aging process. This problem combined with the drug increases the risk for falls and other injuries. Increasing environmental lighting improves vision and reduces the risk for injury.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

17. Which question is most important for the nurse to ask a patient who is prescribed acetazolamide (Diamox) before administering the first dose?
a. Do you have diabetes?
b. Are you allergic to sulfa drugs?
c. How long have you had glaucoma?
d. Do you eat grapefruit or drink grapefruit juice?
ANS: B
Acetazolamide has a chemical structure similar to sulfa drugs. Patients who have allergies to sulfa drugs often have an allergic reaction to acetazolamide. Although acetazolamide can increase or decrease blood glucose levels, and knowing whether the patient has diabetes is also important, an allergy to sulfa drugs is more likely to result in an adverse reaction.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Safe and Effective Care Environment

18. Why are carbonic anhydrase inhibitors not recommended for use in children with glaucoma?
a. Their use increases the risk for cataracts.
b. Growth is inhibited with use of carbonic anhydrase inhibitors.
c. These drugs could reduce intraocular pressure below normal levels.
d. Carbonic anhydrase inhibitors are known to cause birth defects in animals.
ANS: B
Children have a limited time for normal growth. Once the growth plates in the long bones close, growth in height does not occur. Carbonic anhydrase inhibitors slow childrens growth and contribute to shorter stature in final adult height.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 480 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

MULTIPLE RESPONSE

1. Which nursing actions help prevent infection when placing ointments into a patients eye? (Select all that apply.)
a. Having the patient remove contact lenses
b. Avoiding touching the tip of the applicator
c. Using separate drug tubes for the right and the left eye
d. Applying pressure over the punctum for 1 minute after instilling the drug
e. Waiting 10 minutes between the administration of more than one type of eye drug
f. Squeezing out and discarding a small amount of ointment before instilling the drug
ANS: B, C, F
Not touching the tip of the applicator either with your hand or the patients eye structures prevents contaminating the drug tube and the eye. Using separate drug tubes for the right and left eyes prevents spreading infection from one eye into the other eye. The drug area that is most likely to be contaminated is the first half inch squeezed from the tube. By discarding this portion, the risk for infection is reduced. Removing contact lenses prevents the drug from harming the lens and ensures better distribution of the drug; waiting 10 minutes between drug applications prevents one drug from diluting the next drug and also helps prevent drug interactions; performing punctal occlusion after instilling eye drugs (especially eye drops) helps ensure the drug remains in the eye longer to have a better effectnone of these actions help reduce the risk for infection.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 471 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

ESSAY

1. A patient is prescribed methazolamide (Neptazane) 75 mg orally. The drug available is methazolamide 25 mg per tablet. How many tablets does the nurse administer to the patient?
_____ tablet(s)

ANS:
3 tablets
Want 75 mg in X tablets, Have 25 mg in 1 tablet; 75/25 = 3 1 tablet = 3 tablets.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

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