adams4e tif ch49

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/EChapter 49Question 1Type: MCMA

The client asks the nurse how glaucoma develops. What is the best response by the nurse?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. "Having diabetes is a risk factor in the development of glaucoma."

2. "Glaucoma exists when the pressure in your eye is high enough to cause optic nerve damage."

3. "High blood pressure can certainly lead to the development of glaucoma."

4. "Having blue eyes is a risk factor in the development of glaucoma."

5. "Drugs like antihistamines and antidepressants can contribute to glaucoma."

Correct Answer: 1,2,3,5

Rationale 1: Having diabetes mellitus is a risk factor for glaucoma.

Rationale 2: Glaucoma occurs when the pressure in the eye is high enough to cause optic nerve damage.

Rationale 3: High blood pressure can lead to the development of glaucoma.

Rationale 4: . Blue eyes are not a risk factor for the development of glaucoma.

Rationale 5: Medications like antihistamines and antidepressants can cause glaucoma.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 49-1

Question 2Type: MCMA

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Which statements would the nurse interpret as indicating that the client understands the diagnosis of open-angle glaucoma?



1. "My eye cannot drain the fluid that it produces."

2. "One of the first signs of this is pain behind my eyes."

3. "My type of glaucoma is a medical emergency."

4. "This is a gradual process; it may take years to develop."

5. "This is the most common kind of glaucoma."

Correct Answer: 1,4,5

Rationale 1: In cases of open-angle glaucoma, the cause for the high pressure is an imbalance in the production and drainage of fluid in the eye (aqueous humor).

Rationale 2: With open-angle glaucoma the person will have no warning sign, or hint that anything is wrong.

Rationale 3: Closed-angle glaucoma, not open-angle glaucoma, is a medical emergency.

Rationale 4: Open-angle glaucoma often takes years to develop.

Rationale 5: Open-angle glaucoma is the most common type of glaucoma.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 49-2

Question 3Type: MCSA

The client is scheduled for an eye exam. Prior to the exam the physician will put a cycloplegic drug, atropine sulfate (Isopto Atropine) eyedrops in the client's eyes. What will the nurse teach the client about these eyedrops?

1. The drugs will dilate the pupil and lubricate the eye to provide additional comfort during the examination.


2. The drops will paralyze the muscles that move the eye so that examination can take place.

3. The drops will dilate the pupil so that the physician can better visualize the retina during examination.

4. The drops dilate the pupil and paralyze the ciliary muscle to prevent the lens from moving during examination.

Correct Answer: 4

Rationale 1: Cycloplegic eyedrops dilate the pupil and paralyze the ciliary muscle; they do not lubricate the eye.

Rationale 2: The drops do not prevent eye movement.

Rationale 3: This is only a partial explanation of the effects of these drops.

Rationale 4: Cycloplegic eyedrops dilate the pupil and paralyze the ciliary muscle. This allows visualization during the exam and also keeps the lens from moving.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 49-5


The client tells the nurse that when he uses his timolol (Timoptic) eyedrops, they sting his eyes. What is the best response by the nurse?

1. "Hold the next dose and contact your physician."

2. "This is a normal and expected effect of the drops."

3. "Your eyedrops may have expired; check the date."

4. "You should wash your eyes immediately with saline."

Correct Answer: 2

Rationale 1: The physician does not need to be contacted; stinging is a normal effect of the eyedrops.

Rationale 2: It is normal for eyedrops to cause stinging when used.

Rationale 3: The drops should cause stinging; it means they have not expired.


Rationale 4: Washing the eye with saline will dilute the eyedrops; this is not recommended.

Global Rationale:



The client tells the nurse that he experiences frequent eye irritation even after using over-the-counter (OTC) medications. What is the best recommendation by the nurse?

1. Increase your fluid intake; you are probably dehydrated.

2. See your eye doctor for further evaluation.

3. This sounds like an allergic response; try an antihistamine.

4. Use normal saline rinses instead of over-the-counter (OTC) preparations.

Correct Answer: 2

Rationale 1: The client should follow up with his physician; not increase fluid intake.

Rationale 2: The client should follow up with his physician if over-the-counter (OTC) remedies are ineffective for eye irritation.

Rationale 3: The client should follow up with his physician; not try an antihistamine.

Rationale 4: The client should follow up with his physician; not use normal saline rinses.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 49-7



The client receives latanoprost (Xalatan) and another eyedrop. The nurse has completed medication education and evaluates that learning has occurred when the client makes which statement?

1. "I will give two drops of one medication, wait one minute, and then give two drops of the other medication."

2. ”I should lay the dropper against my eyelid for stability when putting in drops.”

3. “I will remove my contact lens before instilling these eyedrops.”

4. ”I may notice that my eyelashes get thinner while I am using this medication.”

Correct Answer: 3

Rationale 1: One minute is not sufficient time to wait between administrations.

Rationale 2: The client should avoid touching the eye or eyelid/lashes with any part of the eyedropper to avoid cross-contamination.

Rationale 3: The client should remove contact lenses before instilling drops and should wait 15 minutes before reinserting them.

Rationale 4: Lashes may grow thicker and darker.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 49-4


The client has excess cerumen in his ears. What will the best plan by the nurse include as to the safe removal of the cerumen?

1. Use a sterile Q-tip to remove cerumen.

2. Instill 2% acetic acid in each ear.

3. Take hot showers to facilitate drainage.

4. Use warm water and a bulb syringe.

Correct Answer: 4


Rationale 1: A Q-tip is dangerous as it can pack the cerumen into the ear canal.

Rationale 2: Acetic acid is not the best method for cerumen removal.

Rationale 3: Hot showers will not facilitate drainage of cerumen.

Rationale 4: Warm water and a bulb syringe is the best method for cerumen removal.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 49-6


The nurse has taught the client about open-angle glaucoma. The nurse evaluates learning has occurred when the client makes which statement?

1. "The eyedrops only need to be used when my eyes hurt."

2. "I will need to continually increase the dose of my eyedrops."

3. "I can stop the eyedrops when the glaucoma has resolved."

4. "I must use my eyedrops as prescribed for the rest of my life."

Correct Answer: 4

Rationale 1: Eyedrops must be used continuously; most clients with glaucoma do not experience eye pain.

Rationale 2: Increasing the dosage of eyedrops is only necessary if the ocular pressure is not controlled; this must be determined by the physician, not the client.

Rationale 3: Glaucoma can be controlled, but it will not resolve: the client cannot stop using the eyedrops.

Rationale 4: Glaucoma can be controlled, but not cured; the client must use eyedrops for the rest of his life.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral Therapies


Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 49-2


The client has glaucoma. Which assessment finding indicates to the nurse that a client's medical regimen could have contributed to onset of glaucoma?

1. Taking a beta blocker to treat hypertension

2. Occasional use of antihistamines for allergies

3. Taking glucocorticoids to treat arthritis

4. Regular use of an antidepressant drug

Correct Answer: 4

Rationale 1: Hypertension can be a factor, but beta blockers may be used to treat glaucoma.

Rationale 2: Occasional use of antihistamines for allergies should not be a factor.

Rationale 3: Glucocorticoids can contribute to the development of cataracts, but not glaucoma.

Rationale 4: Some antidepressant drugs are associated with development of glaucoma.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 49-2


The client is to receive eyedrops for glaucoma. What is the correct method of administration?

1. Place the drop in the center of the eye.

2. Place the drop so it falls on the white part of the eye.

3. Place the drop in the conjunctival sac below the eye.


4. Turn the head to the side so that the drop flows to the outer corner.

Correct Answer: 3

Rationale 1: The eyedrop should be placed in the conjunctival sac below the eye, not in the center of the eye.

Rationale 2: The eyedrop should be placed in the conjunctival sac below the eye, not on the sclera.

Rationale 3: The correct method for administering eyedrops is to place the drop in the conjunctival sac below the eye.

Rationale 4: The head should not be turned to the side when administering eyedrops.

Global Rationale:



The client receives timolol (Timoptic) eyedrops for glaucoma. The nurse has completed medication education and evaluates learning has occurred when the client makes which statement?

1. "I will discuss use of over-the-counter (OTC) medications with my physician."

2. "I will store my drops in the refrigerator to keep them fresh."

3. "I will restrict my caffeine to one cup of coffee per day."

4. "I will discontinue the drops if my eye looks red."

Correct Answer: 1

Rationale 1: Timolol (Timoptic) eyedrops may be absorbed systemically, so the client should discuss use of and OTC preparation with the physician prior to use.

Rationale 2: Refrigeration is not necessary for timolol (Timoptic) eyedrops.

Rationale 3: There is no need to reduce caffeine when a client uses timolol (Timoptic) eyedrops.

Rationale 4: Timolol (Timoptic) must be continued to prevent loss of vision; the client should not discontinue them.


Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 49-4


The client wears contact lenses and has been prescribed eyedrops for glaucoma. What will the best education by the nurse include with regard to contact lenses?

1. Remove lenses before instilling eyedrops; do not reinsert lenses for 15 minutes.

2. Instill the drops with the contacts in as long as they are the hard kind of contacts.

3. Eyeglasses must be worn for as long as the client must have the eyedrops.

4. Instill the drops with the contacts in as long as they are the soft kind of contacts.

Correct Answer: 1

Rationale 1: The client should remove lenses before instilling eyedrops and not reinsert them for 15 minutes.

Rationale 2: Drops should not be instilled while the client is wearing contact lenses, regardless of the kind of lens.

Rationale 3: Eyeglasses do not need to be worn for as long as the client must have eyedrops..

Rationale 4: Drops should not be instilled while the client is wearing contact lenses, regardless of the kind of lens.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 49-7



The client receives eyedrops as treatment for glaucoma. The client calls the clinic one day and tells the nurse that his eye color is changing. What is the best response by the nurse?

1. "This is an expected side effect of the medication."

2. "This is unusual; please come in for an evaluation."

3. "Are you sure that your eyes have changed color?"

4. "What do you mean that your eyes have changed color?"

Correct Answer: 1

Rationale 1: The iris may change color with the medication; this is expected.

Rationale 2: It is not unusual for the eyes to change color; this is an expected reaction.

Rationale 3: The client has said his eye color is changing; it is condescending to ask him if he is sure.

Rationale 4: Asking the client what he means by saying his eyes have changed color does not make sense; he means his eyes have changed color.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 49-4


The nurse is counseling a client with glaucoma. The nurse explains that, if left untreated, the condition can lead to

1. myopia.

2. nearsightedness.

3. diabetes mellitus.

4. blindness.

Correct Answer: 4

Rationale 1: Myopia is the same as nearsightedness, which is a risk factor for glaucoma.


Rationale 2: Nearsightedness is a risk factor for glaucoma.

Rationale 3: Diabetes mellitus is a risk factor leading to glaucoma.

Rationale 4: Glaucoma can lead to optic nerve damage and blindness.

Global Rationale:

Cognitive Level: UnderstandingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 49-2


Which of the following best describes open-angle glaucoma?

1. It is bilateral with a slow onset.

2. It is less common than closed-angle glaucoma.

3. It is accompanied by eye pain.

4. It is unilateral with a rapid onset.

Correct Answer: 1

Rationale 1: Open-angle glaucoma is bilateral, and has a slow onset over several years.

Rationale 2: Open-angle glaucoma is more common.

Rationale 3: Open-angle glaucoma, in contrast to closed-angle glaucoma, has no symptoms.

Rationale 4: Closed-angle glaucoma is unilateral with rapid onset.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 49-2

Question 16


Type: MCSA

Which of the following is an adverse effect of prostaglandins, such as latanoprost (Xaltan)?

1. Hypotension

2. Nausea

3. Tachycardia

4. Eye pain

Correct Answer: 4

Rationale 1: Hypotension is an adverse effect of beta-adrenergic blockers.

Rationale 2: Nausea is not an adverse effect.

Rationale 3: Tachycardia is an adverse effect of carbonic anhydrase inhibitors.

Rationale 4: Eye pain, burning, and dry eyes are adverse effects of prostaglandins.

Global Rationale:

Cognitive Level: UnderstandingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 49-4


The primary mechanism of action of beta-adrenergic blockers in the treatment of open-angle glaucoma is to

1. increase the outflow of aqueous humor.

2. constrict the pupil.

3. dilate the pupil to increase outflow.

4. reduce production of aqueous humor.

Correct Answer: 4

Rationale 1: Prostaglandins increase the outflow of aqueous humor.


Rationale 2: Cholinergic agonists constrict the pupil to allow for more room for outflow.

Rationale 3: Carbonic anhydrase inhibitors dilate the pupil to increase outflow.

Rationale 4: Beta-adrenergic blockers decrease the production of aqueous humor.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 49-3


The client is preparing for an eye examination. Which of the following classification of drugs will be used?

1. Mydriatics

2. Vasoconstrictors

3. Prostaglandins

4. Beta-adrenergic blockers

Correct Answer: 1

Rationale 1: Mydriatics dilate the pupil for better visualization.

Rationale 2: Vasoconstrictors are used for irritation and dryness of the eye.

Rationale 3: Prostaglandins are used for open-angle glaucoma.

Rationale 4: Beta-adrenergic blockers are used for glaucoma.

Global Rationale:

Cognitive Level: UnderstandingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 49-5

Question 19


Type: MCSA

The drug most likely to be used to soften or eliminate cerumen is

1. a steroid.

2. a wax softener.

3. an antifungal agent.

4. a local analgesic.

Correct Answer: 2

Rationale 1: Steroids would not be used for cerumen, but for inflammation.

Rationale 2: Wax softeners are used to soften or eliminate cerumen.

Rationale 3: An antifungal would not be used for cerumen.

Rationale 4: Local analgesics would be used for otitis external.

Global Rationale:



The primary treatment for mastoiditis is

1. topical antibiotics.

2. topical steroids.

3. systemic antibiotics.

4. Systemic steroids.

Correct Answer: 3

Rationale 1: Topical antibiotics are usually used for external ear infections.


Rationale 2: Topical steroids are usually used for external ear infections.

Rationale 3: Systemic antibiotics are used to treat mastoiditis.

Rationale 4: Systemic steroids are not likely to be used in the treatment of mastoiditis since it is frequently very difficult to treat.

Global Rationale:



A client has had several measurements of intraocular pressure. Which measurements would the nurse interpret as indicating need for pharmacologic intervention?



1. A single reading of 14 mmHg

2. A consistent reading trending between 15 and 16 mmHg.

3. A single reading of 19 mmHg.

4. Readings consistently higher than 21 mmHg.

5. A single reading of 32 mmHg.

Correct Answer: 4,5

Rationale 1: This reading is just lower than normal and does not indicate need for intervention.

Rationale 2: The normal range of IOP is between 15 and 156 mmHg.

Rationale 3: Even though this reading is above normal, it is not unusual for a single reading to be this high. The client should be observed.

Rationale 4: Some persons may tolerate IOP at this level, but in most cases, pharmacologic intervention is indicated.


Rationale 5: A single reading above 30 mmHg should be treated to prevent optic nerve damage.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 49.2


A client presents to the emergency department with symptoms of closed-angle glaucoma. Intraocular pressure is measured at 30 mmHg. Which assessment findings would the nurse anticipate?



1. Absence of eye pain

2. Headache

3. Bloodshot eyes

4. Vomiting

5. Bruising around the orbit


Rationale 1: Dull to sharp eye pain is more typical of this condition.

Rationale 2: Headaches are common with acute intraocular pressure increase.

Rationale 3: Bloodshot eyes are a typical assessment finding with IOP.

Rationale 4: Ocular pain may be so severe that it causes vomiting.

Rationale 5: Bruising is not a common finding associated with IOP.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological Integrity


Client Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 49.2


A client is prescribed a beta-adrenergic blocker for treatment of glaucoma. The nurse provides specific information on administration technique to avoid which adverse effects?



1. Bronchoconstriction

2. Cardiac dysrhythmias

3. Low blood pressure

4. Rash

5. Vomiting


Rationale 1: The beta-adrenergic effects may cause bronchoconstriction if the medication is absorbed systemically.

Rationale 2: Systemic absorption may result in cardiac dysrhythmia.

Rationale 3: Hypotension may result if beta-adrenergic eyedrops are systemically absorbed.

Rationale 4: Rash is not an effect of systemic absorption of beta-adrenergic eyedrops.

Rationale 5: Vomiting is not an effect of systemic absorption of beta-adrenergic eyedrops.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 49.3

Question 24


Type: MCMA

A client has been diagnosed with closed-angle glaucoma. Which findings would the nurse interpret as indicating that the pharmacologic treatment regimen has been successful?



1. The client reports being hungry.

2. The client’s last two intraocular pressure readings have been 19 mmHg and 18 mmHg.

3. The client’s eye is not as bloodshot.

4. The client reports a sensation of drainage down the nose.

5. The client’s cough has diminished.

Correct Answer: 2,3

Rationale 1: Anorexia is not associated with closed-angle glaucoma.

Rationale 2: These IOP readings are trending toward normal.

Rationale 3: Resolution of increased IOP will reduce the appearance of being bloodshot.

Rationale 4: The client is not likely to feel this sensation.

Rationale 5: Cough is not a finding associated with glaucoma.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 49.7


A client has been prescribed brinzolamide (Azopt). Which findings would the nurse discuss with the prescriber before administering this drug?




1. The client’s last potassium level was low.

2. The client is a vegetarian.

3. The client is allergic to sulfa.

4. The client has a history of atopic dermatitis.

5. The client’s father had a myocardial infarction at age 35.

Correct Answer: 1,3

Rationale 1: This preparation causes diuresis and may further diminish potassium level.

Rationale 2: Vegetarianism has no bearing on taking this medication.

Rationale 3: This drug contains sulfa.

Rationale 4: Atopic dermatitis is not a contraindication for use of this drug.

Rationale 5: There is no contraindication to use of this drug in a client with a family history of MI.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 49.7


adams4e tif ch49

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