A client is diagnosed with glaucoma.
The nurse understands this condition is associated with which pathophysiologic changes?
Impaired aqueous humor drainage.
Separation of the retina from the choroid.
Gradual narrowing of the visual field.
Loss of peripheral vision over time.
Correct Answer : A,C,D,E
Choice A rationale
Impaired aqueous humor drainage is the central pathophysiological mechanism in most forms of glaucoma. In open-angle glaucoma, the trabecular meshwork becomes clogged, while in angle-closure glaucoma, the iris physically blocks the drainage angle. Both scenarios prevent the normal outflow of aqueous humor, which is produced at a constant rate. This obstruction leads to an increase in intraocular pressure, which is the primary modifiable risk factor for the progression of the disease and subsequent visual loss.
Choice B rationale
The separation of the retina from the choroid describes a retinal detachment, which is a medical emergency distinct from glaucoma. In retinal detachment, the sensory layer of the retina is deprived of oxygen and nutrients provided by the underlying vascular choroid. While both conditions can lead to permanent blindness if untreated, the mechanics of retinal detachment involve fluid or traction pulling the tissue away, rather than the chronic pressure-related optic nerve damage that characterizes the progression of glaucoma.
Choice C rationale
Gradual narrowing of the visual field is a hallmark clinical manifestation of glaucoma. As intraocular pressure increases, it causes mechanical compression and ischemic damage to the axons of the retinal ganglion cells. This damage typically begins at the periphery of the retina and moves inward. Patients often do not notice the loss until the disease is advanced because the central vision remains intact while the outer edges of the visual field slowly constrict, creating a tunnel-like effect.
Choice D rationale
Loss of peripheral vision over time is the classic symptom resulting from the progressive destruction of nerve fibers in the optic disc. Because the nerve fibers that serve the peripheral retina are often the most sensitive to early pressure changes, the patient loses their side vision first. This process is usually painless and slow, leading to the nickname of the silent thief of sight. Regular screening is required because the patient may remain asymptomatic until a significant portion of vision is gone.
Choice E rationale
Progressive damage to the optic nerve is the defining anatomical change in glaucoma. The elevated intraocular pressure creates a cupping effect at the optic disc, where the nerve fibers exit the eye. As these fibers die, the optic nerve loses its ability to transmit visual information from the retina to the brain. Regardless of the specific type of glaucoma, the end result of the disease process is the irreversible degeneration of this vital neural pathway.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Infection of the middle ear due to eustachian tube dysfunction describes otitis media, not otitis externa. Otitis media occurs behind the tympanic membrane in the middle ear space. While swimmers can develop middle ear issues if water enters the respiratory tract, otitis externa is specifically localized to the outer ear structures. The pathophysiology involves a breakdown of the skin-canal barrier, which is distinct from the pressure and drainage issues of the eustachian tube.
Choice B rationale
Fluid accumulation behind the tympanic membrane is the hallmark of otitis media with effusion. This condition usually results from chronic eustachian tube obstruction or the aftermath of an acute middle ear infection. It does not involve the external ear canal. In otitis externa, also known as swimmer's ear, the pathology is focused on the skin lining the canal leading up to the eardrum, rather than the air-filled space located behind it.
Choice C rationale
Otitis externa is the inflammation and infection of the external auditory canal. Frequent swimming exposes the canal to moisture, which can alter the acidic pH of the ear and break down protective cerumen. This creates an ideal environment for bacterial or fungal growth, most commonly Pseudomonas aeruginosa. The resulting inflammation causes significant pain, especially with movement of the pinna or tragus, and is confined to the structures lateral to the tympanic membrane.
Choice D rationale
Degeneration of the auditory nerve leading to hearing loss describes sensorineural hearing loss, which is a neurological or sensory issue. Common causes include aging, noise exposure, or ototoxic medications. This process is unrelated to the infectious and inflammatory process of otitis externa. While severe swelling in the external canal during an infection may cause temporary conductive hearing loss, it does not involve the permanent degeneration of the cranial nerve eight. .
Correct Answer is D
Explanation
Choice A rationale
Giving an incompatible blood type never results in increased oxygen delivery to the tissues. Instead, the massive destruction of red blood cells significantly reduces the oxygen-carrying capacity of the blood. The resulting acute hemolytic transfusion reaction causes systemic instability and potential circulatory collapse. Oxygenation is further compromised by the formation of microemboli and the potential for acute lung injury, which are common complications of major ABO incompatibility errors.
Choice B rationale
The administration of incompatible blood triggers a massive, hyperactive immune response rather than suppression. The recipient's pre-existing antibodies immediately identify the foreign antigens on the donor cells, initiating a cascade of complement activation and inflammatory cytokine release. This leads to systemic symptoms such as fever, chills, and hypotension. Suppression of the immune system is generally an intentional therapeutic goal achieved through pharmacology, not a consequence of a mismatched blood transfusion.
Choice C rationale
A reaction is certain when type A blood receives type B blood because the recipient possesses naturally occurring anti-B antibodies. These antibodies are present in the plasma of any individual with type A blood and will recognize the B antigens on the donor erythrocytes. The interaction between the antigen and antibody is immediate and severe, making a "no reaction" scenario biologically impossible in a person with a functioning and healthy immune system.
Choice D rationale
When type B blood enters the circulation of a type A recipient, the anti-B antibodies in the recipient's plasma bind to the B antigens on the donor red blood cells. This causes agglutination, or clumping, of the cells. Following agglutination, the complement system is activated, leading to intravascular hemolysis where the red cells are ruptured. This releases hemoglobin into the plasma, which can cause acute renal failure and disseminated intravascular coagulation.
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