Chapter 19, Drugs for Eye and Ear Problems: Drug Therapy for Eye Problems-Sherpath

Question 1 of 21

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Label the structures of the eye.

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Correct Answers:

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Submitted Answers:

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1 Vitreous humor

Correct

2 Iris

Correct

3 Cornea

Correct

4 Anterior segment

Correct

5 Posterior segment

Correct

6 Optic nerve

Correct

7 Retina

Correct

8 Ciliary body

Correct

9 Aqueous humor

Correct

10 Lens

Question 2 of 21

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Match the structure of the eye to its function.

• Cornea
• Iris
• Retina
• Optic nerve

Question 3 of 21

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A child with which risk factor is at risk of developing glaucoma? Select all that apply. One, some, or all responses may be correct.

• • Family history of glaucomaHaving a family history of glaucoma increases the risk of an adult developing glaucoma but is not associated with an increased risk of glaucoma in childhood.
• Correct
  • Recent eye traumaA child with a recent eye trauma is at higher risk for developing glaucoma.
• • White raceBeing of white rate is not a risk factor for a child to develop glaucoma. A child who has had recent eye trauma, regardless of their race, is at higher risk for developing the disease.
• • Green eye colorA particular eye color is not associated with an increased risk in glaucoma in either adults or children.

Question 4 of 21

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Which response by the nurse is correct after a patient taking bimatoprost for glaucoma mentions that their eye color is changing?

• • “These eye color changes you are experiencing are only temporary.”Eye color changes with prostaglandin agonists are typically permanent, not temporary.
• Correct
  • “Yes, the color usually becomes darker with this drug.”Patients who take bimatoprost (Lumigan) may develop changes in the color of the iris as it usually becomes darker. Prostaglandins increase the production of a brown pigment called melanin.
• • “You should place the drops in both eyes so that your eyes remain the same color.”Patients who take bimatoprost (Lumigan) should only place the drops into the affected eye, even if the eyes become different colors.
• • “The drug you are taking can cause a rapid onset of different color changes.”Patients who take bimatoprost (Lumigan) may gradually notice a darker color on the eyelid. This is due to the increase in production of a brown pigment called melanin caused by the drops.

Question 5 of 21

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Which side effect is expected when latanoprost is first applied to the eye? Select all that apply. One, some, or all responses may be correct.

• Correct
  • RednessRedness is an expected side effect when prostaglandin agonists are first applied to the eye.
• Correct
  • ItchingItching is an expected side effect when prostaglandin agonists are first applied to the eye.
• Correct
  • Foreign body sensationForeign body sensation is an expected side effect when prostaglandin agonists are first applied to the eye.
• • SwellingPatients who are taking prostaglandin agonists can experience rare adverse reactions such as an infection. Eye swelling may be a sign of infection and is not expected.
• • Green drainagePatients who are taking prostaglandin agonists can experience rare adverse reactions such as an infection. Green drainage noted from the eye is a sign of infection and is not expected.

Question 6 of 21

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Which assessment would the nurse perform prior to administering travoprost?

• • Measure heart rateTravoprost is a prostaglandin agonist. The nurse should check the heart rate every 4–8 hours while the patient is receiving a beta-adrenergic antagonist to assess for any decreases in heart rate.
• • Check blood pressureTravoprost is a prostaglandin agonist. The nurse should check the blood pressure every 4–8 hours while the patient is receiving a beta-adrenergic antagonist to assess for any decreases in blood pressure.
• Correct
  • Check the eye for scratchesThe nurse should check the eye carefully for any scratches or signs of trauma. If any breaks in the tissue are found, the nurse should withhold the drug and contact the healthcare provider because these drugs could cause further injury or irritation.
• • Observe length of eyelashesWith prostaglandin agonists, eyelashes on the affected eye may grow longer and thicker. However, it is not necessary to check the eyelash length prior to administering travoprost.

Question 7 of 21

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Which adverse reaction may occur with systemic absorption in patients receiving beta-adrenergic antagonists? Select all that apply. One, some, or all responses may be correct.

• • Increased blood pressureSystemic absorption of beta blockers can cause a decrease, not increase, in blood pressure.
• • Increased heart rateSystemic absorption of beta blockers can cause a decrease, not increase, in heart rate.
• Correct
  • Heart failureSystemic absorption of beta blockers may cause heart failure.
• Correct
  • BronchoconstrictionSystemic absorption of beta blockers may cause bronchoconstriction.
• Correct
  • AsthmaSystemic absorption of beta blockers may cause asthma symptoms.

Question 8 of 21

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Which instruction would the nurse include when teaching a patient who is prescribed metipranolol?

• • “Keep your home darkened.”With beta-adrenergic antagonists, the nurse should instruct the patient to use caution in darkened homes because the pupil will not dilate to let more light in. It may be harder to see objects in dim light. The problem can increase the risk of falls.
• • “Please wear sunglasses when you go outside.”It is important for the patient to understand that the pupils will not dilate as easily if sunglasses are worn. This instruction would be more appropriate for a patient receiving alpha-adrenergic agonists.
• • “You may drive at night as long as your headlights are on.”There are no driving restrictions associated with the use of metipranolol.
• Correct
  • “Use a lamp for reading.”The nurse should include use of good lighting for reading because the pupil will not dilate to let in more light.

Question 9 of 21

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Which complication would the nurse monitor for in a patient receiving timolol (Betimol) therapy?

• • HyperkalemiaTimolol is a beta-adrenergic antagonist. There is no concern for hyperkalemia with beta-adrenergic antagonists.
• • HypokalemiaTimolol is a beta-adrenergic antagonist. There is no concern for hypokalemia with beta-adrenergic antagonists.
• • HyperglycemiaTimolol is a beta-adrenergic antagonist. There is a concern for hypoglycemia, not hyperglycemia, as beta-adrenergic antagonists can block the symptoms of hypoglycemia.
• Correct
  • HypoglycemiaTimolol is a beta-adrenergic antagonist. The nurse would monitor the patient with a history of diabetes for hypoglycemia because beta-adrenergic antagonists can mask the symptoms.

Question 10 of 21

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Which statement about the action of alpha-adrenergic agonists is accurate? Select all that apply. One, some, or all responses may be correct.

• Correct
  • They increase the flow of aqueous humor out of the anterior chamber of the eye.Alpha-adrenergic agonists are drugs that bind primarily to alpha-receptors improve the flow of aqueous humor out of the anterior chamber of the eye.
• Correct
  • They diminish the amount of aqueous humor produced in the eye.Alpha-adrenergic agonists are drugs that bind primarily to alpha-receptors reduce the amount of aqueous humor produced in the eye.
• • They bind to prostaglandin receptor sites.Prostaglandin agonists, not alpha-adrenergic agonists, help control glaucoma by binding to prostaglandin receptor sites in the eye and relaxing smooth muscles in blood vessels, which allows the vessels to dilate and absorb aqueous humor.
• • They attach to the beta-adrenergic receptors in the ciliary body of the eye.Beta-adrenergic antagonists, not alpha-adrenergic agonists, reduce the amount of aqueous humor by binding to beta-adrenergic receptors in the ciliary body of the eye.
• Correct
  • They decrease intraocular pressure.Alpha-adrenergic agonists are drugs that bind primarily to alpha-receptors to decrease intraocular pressure.

Question 11 of 21

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After the nurse administers apraclonidine eye drops, the patient states, “it feels like something is in my eye!” Which response would the nurse provide?

• • “Try to keep your eye open for at least 2 minutes.”The nurse should remind the patient to keep the affected eye closed, not open, for about 2 minutes.
• Correct
  • “Please avoid rubbing your eyelid.”The nurse should remind the patient that alpha-adrenergic agonist administration can make it feel like there is a foreign object in the eye and the eyelid should not be rubbed.
• • “It may help to use a wipe by pressing on your eyelid.”The nurse should instruct the patient to gently blot or wipe away any excess drug or tears with a tissue without pressing on the eyelid.
• • “Do not roll your eye under the eyelid.”The nurse should instruct the patient to gently roll the affected eye under the eyelid to spread the drug across the eye.

Question 12 of 21

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Which adverse reaction would the nurse monitor for a patient who just received dipivefrin hydrochloride eye drops? Select all that apply. One, some, or all responses may be correct.

• • HeadacheDipivefrin hydrochloride is an alpha-adrenergic agonist. Headache is not an adverse effect associated with this drug class.
• Correct
  • BradycardiaDipivefrin hydrochloride is an alpha-adrenergic agonist. Bradycardia is an adverse reaction associated with alpha-adrenergic agonists as a result of systemic absorption.
• Correct
  • TachycardiaDipivefrin hydrochloride is an alpha-adrenergic agonist. Tachycardia is an adverse reaction associated with alpha-adrenergic agonists as a result of systemic absorption.
• Correct
  • Drop in blood pressureDipivefrin hydrochloride is an alpha-adrenergic agonist. A drop in blood pressure is an adverse reaction associated with alpha-adrenergic agonists as a result of systemic absorption.
• Correct
  • FatigueDipivefrin hydrochloride is an alpha-adrenergic agonist. Fatigue is an adverse reaction associated with alpha-adrenergic agonists.

Question 13 of 21

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Which condition is cause for concern in patients who are prescribed cholinergic drugs? Select all that apply. One, some, or all responses may be correct.

• Correct
  • AsthmaCholinergic drugs should be avoided by people who have asthma because they can cause bronchoconstriction.
• • DiabetesBeta-adrenergic antagonists, not cholinergic drugs, may mask the symptoms of hypoglycemia in patients with diabetes.
• Correct
  • Gallbladder diseaseCholinergic drugs should be avoided by patients with gallbladder because they can be absorbed and cause systemic effects.
• Correct
  • Liver diseaseCholinergic drugs should be avoided by patients with liver disease because they can be absorbed and cause systemic effects.
• • InfluenzaCholinergic drugs are not contraindicated in patients who are suffering from influenza.

Question 14 of 21

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Which information would the nurse provide a patient who has been prescribed a cholinergic eye drop?

• • “Have hard candy available to help with dry mouth.”Increased salivation, not dry mouth, is a side effect associated with cholinergic drugs.
• Correct
  • “Wipe any excess drug if it spills on your skin.”The nurse should inform the patient to remove any excess drug if it spills on skin because it can be absorbed and cause systemic effects.
• • “It is important to move from darker to lighter rooms.”The nurse should instruct the patient to move from lighter to darker rooms. The pupils do not dilate appropriately which makes it difficult to see.
• • “It is okay if you take more drops than prescribed.”The nurse should inform the patient to never take more drops than are prescribed to prevent toxicity.

Question 15 of 21

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The nurse suspects that a patient prescribed carbachol eye drops is developing cholinergic toxicity. Which observation supports this hypothesis? Select all that apply. One, some, or all responses may be correct.

• • Dry mouthIncreased drooling, not dry mouth is a symptom that may indicate cholinergic toxicity from carbachol.
• Correct
  • Trouble breathingSymptoms such as trouble breathing or respiratory failure may indicate cholinergic toxicity from carbachol.
• • Poor urinary outputCarbachol is a cholinergic drug that increases acetylcholine causes increased urination, not poor urinary output.
• Correct
  • SweatingSymptoms such as sweating may indicate cholinergic toxicity from carbachol.
• Correct
  • Severe neuromuscular weaknessCarbachol is a cholinergic drug that increases acetylcholine causing severe neuromuscular weakness which is indicative of cholinergic toxicity.

Question 16 of 21

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Which statement about carbonic anhydrase inhibitors is accurate? Select all that apply. One, some, or all responses may be correct.

• • They decrease the availability of acetylcholine.Cholinergic drugs, not carbonic anhydrase inhibitors, increase availability of acetylcholine to activate specific receptors.
• Correct
  • They decrease intraocular pressure.Carbonic anhydrase inhibitors decrease intraocular pressure by reducing aqueous humor in the anterior chamber of the eye.
• Correct
  • They are a type of diuretic.Carbonic anhydrase inhibitors are considered a type of diuretic.
• • They reduce aqueous humor in the posterior chamber of the eye.Carbonic anhydrase inhibitors lower IOP by reducing aqueous humor in the anterior, not the posterior, chamber of the eye.
• Correct
  • They are used to rapidly decrease intraocular pressure.Carbonic anhydrase inhibitors are great for patients who need a rapid decrease in IOP to prevent serious optic nerve damage.

Question 17 of 21

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The use of which drug may cause an allergic reaction in a patient taking a taking carbonic anhydrase inhibitor (CAI)?

• • AspirinAspirin does not cause an allergic reaction in a patient also taking a CAI.
• • Beta blockersBeta blockers do not cause an allergic reaction in a patient also taking a CAI.
• • PenicillinPenicillin does not cause an allergic reaction in a patient also taking a CAI.
• Correct
  • SulfaThere is a risk of an allergic reaction in patients taking CAIs who have an allergy to sulfa.

Question 18 of 21

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Which medical history would the nurse report to the healthcare provider when caring for a patient newly prescribed brinzolmide (Azopt)?

• Correct
  • GoutThe nurse should notify the healthcare provider if the patient has a history of gout since carbonic anhydrase inhibitors increase the uric acid level.
• • OsteoporosisCarbonic anhydrase inhibitors do not negatively affect bone mineral density.
• • HypertensionCarbonic anhydrase inhibitors do not affect blood pressure.
• • BronchitisCarbonic anhydrase inhibitors do not affect the respiratory system.

Question 19 of 21

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Which area of the eye would the nurse use for administering eye drops?

• Correct
  • Conjunctival sacThe nurse should gently pull the lower lid of the affected eye down and place the eye drops or ointment into the conjunctival sac. This allows even distribution of the eye drops.
• • PupilEye drops should never be instilled directly to the pupil.
• • IrisThe nurse should never place eye drops directly onto the iris.
• • CorneaEye drops should never be placed directly onto the cornea of the eye.

Question 20 of 21

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Which information would the nurse include when teaching a patient about the punctal occlusion technique?

• • Teach the patient to apply pressure over the outer portion of the eye 2 minutes.The punctal occlusion technique is used to reduce systemic absorption of eye drops and pressure is applied over the tear duct for at least 3 minutes after administration.
• • Teach the patient to apply pressure over the inner corner for 30 seconds.The punctal occlusion technique is used to reduce systemic absorption of eye drops and pressure is applied over the tear duct for at least 3 minutes after administration.
• Correct
  • Teach the patient to apply pressure over the tear duct for 3 minutes.The nurse should inform the patient to apply pressure over the tear duct for about 3 minutes to reduce systemic absorption of eye drops.
• • Teach patient to apply pressure over the eyelid for about 2 minutes.The punctal occlusion technique is used to reduce systemic absorption of eye drops and pressure is applied over the tear duct for at least 3 minutes after administration.

Question 21 of 21

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Which question is important for the nurse to ask before instilling beta-adrenergic antagonist eye drops to a patient with a history of heart failure?

• • “Do you take any angiotensin-converting enzyme (ACE) inhibitors?”Angiotensin-converting enzyme (ACE) inhibitors are used to treat heart failure. There is no concern giving ACE inhibitors with beta-adrenergic antagonist eye drops.
• Correct
  • “Are you taking any oral beta blockers?”The nurse should ensure the patient is not a taking any oral beta blocker for a heart condition. Ophthalmic beta blockers may increase the risk of expected side effects and adverse effects of the oral beta blocker.
• • “Have you been prescribed any aldosterone antagonists?”Aldosterone antagonists are used to treat heart failure. There is no concern giving aldosterone antagonists with beta-adrenergic antagonist eye drops.
• • “Are you receiving any diuretic drugs?”Diuretic drugs are used to treat heart failure. There is no concern giving diuretics with beta-adrenergic antagonist eye drops.