A patient with asthma has new orders for eye drops to treat open-angle glaucoma. Which drug order should the nurse question?
Timolol
✓
Latanoprost
Netarsudil
Dorzolamide
Correct Answer
Timolol
Timolol is a nonselective beta blocker, and enough is absorbed through the nasolacrimal duct to block beta-2 receptors in the airways and trigger bronchospasm, so it is used cautiously or avoided in asthma. Latanoprost is a prostaglandin analog with few systemic effects. Netarsudil is a rho kinase inhibitor that acts locally on the trabecular meshwork. Dorzolamide is a carbonic anhydrase inhibitor that does not constrict the airways.
Category: Glaucoma Drugs
Question 2
Which finding in a patient's history is a contraindication to beta blocker eye drops for glaucoma?
Hyperlipidemia
Second- or third-degree heart block
✓
Osteoarthritis
Hypothyroidism
Correct Answer
Second- or third-degree heart block
Systemically absorbed ophthalmic beta blockers can slow conduction through the AV node, so second- or third-degree AV block, sinus bradycardia, cardiogenic shock and decompensated heart failure are contraindications. Hyperlipidemia does not prevent use of these drops. Osteoarthritis is unrelated to beta blockade. Hypothyroidism is not a listed contraindication.
Category: Glaucoma Drugs
Question 3
Which condition calls for caution with latanoprost because the drug can worsen it?
Mild intermittent asthma
Sinus bradycardia
Active uveitis
✓
Sulfonamide allergy
Correct Answer
Active uveitis
Latanoprost labeling advises caution in active intraocular inflammation such as iritis or uveitis, because prostaglandin analogs can aggravate it. Mild intermittent asthma is a concern with nonselective beta blocker drops, not latanoprost. Sinus bradycardia is a contraindication to beta blocker drops. Sulfonamide allergy is relevant to carbonic anhydrase inhibitors such as dorzolamide.
Category: Glaucoma Drugs
Question 4
Before giving dorzolamide, the nurse asks about a history of severe allergy to which drugs?
Penicillin antibiotics
Opioid analgesics
Iodinated contrast dyes
Sulfonamide antibiotics
✓
Correct Answer
Sulfonamide antibiotics
Dorzolamide is a sulfonamide that is absorbed systemically even from the eye, and severe sulfonamide reactions such as Stevens-Johnson syndrome have been reported. Penicillin antibiotics do not share its structure. Opioid analgesics are chemically unrelated. Iodinated contrast dyes are not linked to dorzolamide reactions.
Category: Glaucoma Drugs
Question 5
A patient starting netarsudil asks about redness in the treated eye. What should the nurse explain?
Redness is a common effect and is usually mild
✓
Redness means the drug must be stopped now
Redness signals a rise in eye pressure
Redness shows the drug is not reaching the eye
Correct Answer
Redness is a common effect and is usually mild
Conjunctival redness is the most frequent adverse effect of netarsudil, and it is usually mild, so patients are encouraged to keep using the drug and report swelling or vision changes. Redness means the drug must be stopped now is incorrect; stopping without the provider can let eye pressure rise. Redness signals a rise in eye pressure is false because the redness comes from dilated surface blood vessels. Redness shows the drug is not reaching the eye is wrong; it shows the drug is acting on the eye's vessels.
Category: Glaucoma Drugs
Question 6
A patient using pilocarpine eye drops reports trouble seeing while driving at night. Which drug effect explains this?
A dilated pupil that causes glare
A small pupil that lets in less light
✓
A rise in intraocular pressure
Drying of the corneal surface
Correct Answer
A small pupil that lets in less light
Pilocarpine is a cholinergic agonist that contracts the iris sphincter, and the small pupil admits less light, so vision in dim conditions suffers and night driving needs caution. A dilated pupil that causes glare is the effect of mydriatics, the opposite action. A rise in intraocular pressure is not caused by pilocarpine, which lowers pressure. Drying of the corneal surface is not a typical pilocarpine effect.
Category: Glaucoma Drugs
Question 7
An older adult started on brimonidine reports lightheadedness when standing. Which effect of the drug explains this?
Raised intraocular pressure
Slowed tear drainage
Lowered blood pressure
✓
Widened pupils
Correct Answer
Lowered blood pressure
Brimonidine is an alpha-2 agonist, and absorbed drug can lower blood pressure and cause dizziness, fatigue and drowsiness, which raise fall risk in older adults. Raised intraocular pressure is the opposite of the drug's effect. Slowed tear drainage does not cause lightheadedness. Widened pupils are not an effect of brimonidine and would not explain dizziness on standing.
Category: Glaucoma Drugs
Question 8
A patient with open-angle glaucoma stopped his eye drops because his vision seems fine. What should the nurse explain?
The drops are needed only when the eye hurts
Normal vision means the disease is cured
The drops can stop once pressure is normal
Vision lost to optic nerve damage cannot be restored
✓
Correct Answer
Vision lost to optic nerve damage cannot be restored
Open-angle glaucoma usually causes no symptoms until the optic nerve is damaged, and that loss is permanent, so lifelong drops and follow-up visits protect remaining vision. The drops are needed only when the eye hurts is wrong because the disease is usually painless. Normal vision means the disease is cured is false; drugs control pressure but do not cure the disease. The drops can stop once pressure is normal is incorrect because pressure rises again without treatment.
Category: Glaucoma Drugs
Question 9
Which eye drop dilates the pupil without paralyzing the eye's ability to focus?
Phenylephrine
✓
Atropine
Cyclopentolate
Tropicamide
Correct Answer
Phenylephrine
Phenylephrine is an adrenergic agonist that contracts the iris dilator, producing mydriasis without affecting the ciliary muscle, so accommodation is preserved. Atropine is an anticholinergic that both dilates the pupil and paralyzes accommodation. Cyclopentolate is an anticholinergic with the same dual effect. Tropicamide is a short-acting anticholinergic that also causes some cycloplegia.
Category: Mydriatics and Cycloplegics
Question 10
Which mydriatic and cycloplegic drop has the longest-lasting effect?
Tropicamide
Atropine
✓
Cyclopentolate
Homatropine
Correct Answer
Atropine
Atropine produces pupil dilation and cycloplegia that can last far longer than other drops in the class, so it is used for conditions such as uveitis rather than routine exams. Tropicamide has the shortest action of the anticholinergic drops. Cyclopentolate is intermediate and is often used for exams in children. Homatropine lasts longer than tropicamide but not as long as atropine.
Category: Mydriatics and Cycloplegics
Question 11
After cyclopentolate drops, a young child becomes flushed, restless and confused with a fast heart rate. What should the nurse suspect?
An allergic conjunctivitis flare
Low blood glucose
Systemic anticholinergic toxicity
✓
Opioid withdrawal
Correct Answer
Systemic anticholinergic toxicity
Cyclopentolate absorbed through the nasolacrimal system can block muscarinic receptors throughout the body, and children are especially prone to flushing, tachycardia, restlessness and confusion. An allergic conjunctivitis flare causes itching and redness of the eye, not confusion and tachycardia. Low blood glucose causes sweating and pallor rather than flushed, dry skin. Opioid withdrawal is unrelated to an eye drop.
Category: Mydriatics and Cycloplegics
Question 12
Why is a cycloplegic drop prescribed for a patient with uveitis?
To kill the organism causing the inflammation
To increase tear production
To constrict the pupil and open drainage
To ease ciliary spasm pain and prevent iris adhesions
✓
Correct Answer
To ease ciliary spasm pain and prevent iris adhesions
Cycloplegics rest the inflamed ciliary muscle, which relieves painful spasm, and keep the pupil dilated so the iris is less likely to stick to the lens. To kill the organism causing the inflammation is wrong because cycloplegics are not anti-infectives, and most uveitis is noninfectious. To increase tear production is incorrect; anticholinergics reduce secretions. To constrict the pupil and open drainage describes a miotic, the opposite effect.
Category: Mydriatics and Cycloplegics
Question 13
Which teaching fits a patient leaving the clinic after dilating eye drops?
Wear sunglasses and avoid driving until vision clears
✓
Rub the eyes to speed the drug's removal
Apply warm compresses to shrink the pupils
Read in dim light to rest the eyes
Correct Answer
Wear sunglasses and avoid driving until vision clears
Dilated pupils admit too much light and blur vision, so sunglasses and a ride home keep the patient comfortable and safe until the effect fades. Rub the eyes to speed the drug's removal does not shorten the effect and can injure the eye. Apply warm compresses to shrink the pupils is incorrect because compresses do not reverse dilation. Read in dim light to rest the eyes does nothing to speed recovery.
Category: Mydriatics and Cycloplegics
Question 14
Why are topical ocular anesthetics such as proparacaine not sent home with patients?
They raise intraocular pressure
Repeated use can damage the cornea
✓
They cause permanent pupil dilation
They stain the cornea yellow
Correct Answer
Repeated use can damage the cornea
Repeated use of ocular anesthetics is toxic to the corneal epithelium, delays healing and can cause corneal opacity and vision loss, and a numb eye cannot warn of injury. They raise intraocular pressure is not an effect of these drugs. They cause permanent pupil dilation is incorrect; anesthetics do not act on the iris. They stain the cornea yellow describes fluorescein dye, not an anesthetic.
Category: Anesthetics and Lubricants
Question 15
Prednisolone eye drops are contraindicated in which condition?
Allergic conjunctivitis
Noninfectious uveitis
Herpes simplex keratitis
✓
Inflammation after cataract surgery
Correct Answer
Herpes simplex keratitis
Corticosteroids suppress the local immune response, so they can worsen herpes simplex epithelial keratitis and other viral or fungal eye infections. Allergic conjunctivitis is an indication for ocular corticosteroids. Noninfectious uveitis is a common indication. Inflammation after cataract surgery is also treated with ocular corticosteroids.
Category: Ocular Anti-inflammatories
Question 16
Which medication in a patient's history raises bleeding concern when ocular NSAID drops are prescribed after eye surgery?
Levothyroxine
Metformin
Atorvastatin
Warfarin
✓
Correct Answer
Warfarin
Ocular NSAIDs inhibit prostaglandin synthesis and platelet function in eye tissue, so patients taking anticoagulants such as warfarin have a higher risk of bleeding in the eye after surgery. Levothyroxine does not affect clotting. Metformin has no meaningful effect on bleeding. Atorvastatin is not linked to ocular bleeding with NSAID drops.
Category: Ocular Anti-inflammatories
Question 17
A sedated patient on a ventilator cannot fully close the eyes. Why does the nurse apply an ocular lubricant?
To prevent corneal drying and injury
✓
To lower intraocular pressure
To prevent pupil dilation
To treat a bacterial infection
Correct Answer
To prevent corneal drying and injury
Without blinking and full lid closure, the cornea dries and can ulcerate, so lubricants protect it, and old lubricant is gently removed during eye care to prevent crusting. To lower intraocular pressure is not an action of lubricants. To prevent pupil dilation is incorrect; lubricants do not act on the iris. To treat a bacterial infection would require an antibiotic.
Category: Anesthetics and Lubricants
Question 18
A patient is prescribed an eye drop and an eye ointment for the same eye. Which order should the nurse teach?
Ointment first, then the drops
Drops first, then the ointment after a short wait
✓
Both together, mixed on the eyelid
Either order, one right after the other
Correct Answer
Drops first, then the ointment after a short wait
Drops are instilled first so they can be absorbed, and the ointment is applied after a pause, because an ointment layer would keep drops from reaching the eye. Ointment first, then the drops lets the ointment block the drops. Both together, mixed on the eyelid gives no reliable dose of either. Either order, one right after the other ignores that the second product can wash out or block the first.
Category: Eye Drop Technique
Question 19
Where should eye drops be placed?
Directly onto the center of the cornea
Along the edge of the upper eyelid
Into the pouch made by gently pulling down the lower lid
✓
Onto the closed lid to be rubbed in
Correct Answer
Into the pouch made by gently pulling down the lower lid
The lower conjunctival sac holds the drop and lets it spread over the eye without striking the sensitive cornea. Directly onto the center of the cornea triggers blinking and discomfort and wastes the drop. Along the edge of the upper eyelid does not deliver the drug reliably. Onto the closed lid to be rubbed in leaves most of the dose on the skin.
Category: Eye Drop Technique
Question 20
Why should soft contact lenses be removed before many glaucoma eye drops are instilled?
The drops dissolve the lens material
The lenses change the drug into a toxin
The drops alter the lens prescription
The lenses can absorb the drops' preservative
✓
Correct Answer
The lenses can absorb the drops' preservative
Preservatives such as benzalkonium chloride can be absorbed by soft lenses and irritate the eye, so lenses are removed first and reinserted after a waiting period. The drops dissolve the lens material is incorrect. The lenses change the drug into a toxin does not occur. The drops alter the lens prescription is false; drops do not change a lens's power.
Category: Eye Drop Technique