Glaucoma (open-angle and angle-closure) NCLEX questions for nursing students!
Glaucoma develops from high intraocular pressure which damages the optic nerve. This can lead to vision loss and blindness. The nurse should be aware of the pathophysiology, types of glaucoma, nursing implications, signs/symptoms, and medication administration etc.
Glaucoma NCLEX Questions Quiz
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Glaucoma (Open-angle and Closed-Angle) NCLEX Questions
1. 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.
2. 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?
The answer is B. A tonometer is used to assessment IOP.
3. The production and drainage rate of aqueous humor is not equal in patients with glaucoma. Select below the correct sequence for how aqueous humor should flow through the eye:
A. The ciliary body produces aqueous humor -> then it flows through the anterior chamber (area of the eye between the iris and cornea) -> pupil opening -> posterior chamber (area of the eye between lens and iris) ->drainage angle ->trabecular meshwork -> schlemm’s canal -> episcleral veins
B. The lens produces aqueous humor -> then it flows through the pupil opening -> the anterior chamber (area of the eye between the iris and cornea) -> posterior chamber (area of the eye between lens and iris) -> drainage angle ->trabecular meshwork -> schlemm’s canal -> episcleral veins
C. The ciliary body produces aqueous humor -> then it flows through the posterior chamber (area of the eye between the lens and iris) -> pupil opening -> anterior chamber (area of the eye between iris and cornea) -> drainage angle ->trabecular meshwork -> schlemm’s canal -> episcleral veins
D. The lens produces aqueous humor -> then it flows through the posterior chamber (area of the eye between the iris and cornea) -> pupil opening -> anterior chamber (area of the eye between lens and iris) -> drainage angle ->trabecular meshwork -> schlemm’s canal -> episcleral veins
The answer is C. This is the correct sequence for how aqueous humor flows through the eye: The ciliary body produces aqueous humor -> then it flows through the posterior chamber (area of the eye between the lens and iris) -> pupil opening -> anterior chamber (area of the eye between iris and cornea) -> drainage angle ->trabecular meshwork -> schlemm’s canal -> episcleral veins
4. You’re providing an educational seminar to a group of senior citizens about glaucoma. You explain to the participants about the differences between open-angle and angle-closure glaucoma in relation to the drainage angle of the eye. A participant asks what type of examination can be performed to assess the drainage angle of the eye. Your response is?
The answer is D. A gonioscopy is used to assess the drainage angle of the eye. The drainage angle is the area in which an angle is formed at the front of the eyes where the iris and cornea meet. This is where aqueous humor drains out into the trabecular meshwork.
5. 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.
6. Your patient is being treated for open-angle glaucoma. What assessment finding is NOT typically present with this type of glaucoma?
A. Tunnel vision
B. Cloudy vision
C. Optic disc cupping
D. High intraocular pressure
The answer is B. Cloudy vision is associated with cataracts, while tunnel vision is associated with glaucoma due to the loss of peripheral vision.
7. Your patient has a history of angle-closure glaucoma. What type of medications should this patient avoid?
C. Beta blockers
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.
8. 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?
B. Selective Laser Trabeculoplasty (SLT)
C. Laser iridotomy
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.
9. 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 eyes are frequently tearing up.
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.
10. A patient is experiencing a severe case of acute angle-closure glaucoma. The patient is not a candidate for laser intervention. The nurse would anticipate the physician would order the nurse to prep the patient for what procedure?
The answer is C. Iridectomy is where the surgeon removes part of the iris which will help drain off aqueous humor and decrease the IOP. Options A and B are procedures to help treat open-angle glaucoma. Option C is used to treat angle-closure glaucoma and is more invasive than the laser procedure called a laser iridotomy (it’s where a small hole is created in the iris with a laser to drain the increased aqueous humor). We are told in the scenario the patient is not a candidate for this procedure.
11. 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 eye via the cornea.
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.
12. 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 drop directly on the eye via the cornea.
D. The nurse encourages the patient to blink after each eye drop administration.
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.
13. 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.
14. 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?
The answer is A. Bimatoprost is a prostaglandin analog and can cause these signs and symptoms.
15. 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 another type of glaucoma medication.
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.
16. 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).
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