A nurse at an ophthalmology clinic is providing medication teaching to a client who has open-angle glaucoma. Which of the following instructions should the nurse provide?

Apply the medication when you are experiencing eye pain

Use the medication only until the intraocular pressure returns to normal

Use the medication for approximately 10 days, then gradually taper off

Apply the medication on a regular schedule for the rest of your life

Answer and Explanation

The Correct Answer is D

Choice A reason: This is incorrect because applying the medication when you are experiencing eye pain can be ineffective or harmful for treating open-angle glaucoma. Open-angle glaucoma is a chronic condition that causes increased pressure inside the eye and damage to the optic nerve, which can lead to vision loss. Eye pain is not a common symptom of open-angle glaucoma, but rather an indication of acute angle closure glaucoma, which is a medical emergency that requires immediate treatment. The nurse should instruct the client to apply the medication as prescribed, regardless of pain level, and seek medical attention if they experience severe eye pain, headache, nausea, or blurred vision.
Choice B reason: This is incorrect because using the medication only until the intraocular pressure returns to normal can cause recurrence or worsening of open-angle glaucoma. Intraocular pressure is the pressure inside
the eye that can affect eye health and vision. Normal intraocular pressure ranges from 10 to 21 mmHg, but it can vary depending on age, time of day, or other factors. The nurse should instruct the client to monitor their intraocular pressure regularly and report any changes to their provider, but not to stop using
the medication without consulting their provider first.
Choice C reason: This is incorrect because using the medication for approximately 10 days, then gradually tapering off can cause rebound or adverse effects of open-angle glaucoma. The medication for open-angle glaucoma can be either beta-blockers, such as timolol, or cholinergic agents, such as pilocarpine, which work by reducing fluid production or increasing fluid drainage in the eye. The nurse should instruct the client to follow their provider's instructions on how long and how much to use the medication and not to change or discontinue it abruptly without their provider's approval.
Choice D reason: This is correct because applying the medication on a regular schedule for the rest of your life can help control and prevent the progression of open-angle glaucoma. Open-angle glaucoma is a lifelong condition that requires consistent and continuous treatment to maintain normal intraocular pressure and prevent vision loss. The nurse should instruct the client to apply the medication at the same time every day and not to miss or skip any doses. The nurse should also teach the client how to store, handle, and administer the medication properly and safely.

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Correct Answer is B

Explanation

Choice A reason: This is incorrect because a drop in heart rate from 74 to 68/min is not a manifestation that requires immediate reporting to the provider. A mild decrease in heart rate can be normal or due to other factors such as medication, sleep, or relaxation. It does not indicate a worsening of brain injury or increased intracranial pressure.

Choice B reason: This is the correct answer because a change in the Glasgow Coma Scale score from 14 to 10 is a manifestation that requires immediate reporting to the provider. The Glasgow Coma Scale is a tool that measures the level of consciousness based on eye-opening, verbal response, and motor responses. A score of 14 indicates mild impairment, while a score of 10 indicates moderate impairment. A decrease in score can indicate deterioration of neurological status and increased intracranial pressure, which can be life-threatening.

Choice C reason: This is incorrect because the headache is not a manifestation that requires immediate reporting to
the provider. Headache is a common symptom of mild TBI and can be managed with analgesics, rest, and hydration. It does not indicate a worsening of brain injury or increased intracranial pressure unless it is severe, persistent, or accompanied by other signs such as vomiting, confusion, or seizures.

Choice D reason: This is incorrect because diplopia is not a manifestation that requires immediate reporting to
the provider. Diplopia means double vision and can be caused by damage to cranial nerves or eye muscles due to TBI. It can be treated with eye patches, glasses, or surgery. It does not indicate a worsening of brain injury or increased intracranial pressure unless it is associated with other symptoms such as blurred vision, loss of vision, or eye pain.

A. Nystagmus B. Decorticate positioning C. Lack of any response D. Decerebrate positioning

Correct Answer is D

Explanation

Choice A Reason: This is incorrect because nystagmus is not a response to stimuli, but a condition that causes involuntary eye movements. Nystagmus can be caused by various factors, such as inner ear disorders, brain lesions, or drug toxicity, but not necessarily by cervical spine injury.

Choice B Reason: This is incorrect because decorticate positioning is a response to stimuli that indicates damage to the cerebral cortex or the corticospinal tract. Decorticate positioning is characterized by flexion of the arms and extension of the legs. It does not indicate cervical spine injury, which affects the spinal cord below the brainstem.

Choice C Reason: This is incorrect because lack of any response to stimuli can indicate various levels of brain damage or coma, but not specifically cervical spine injury. Lack of any response can also be influenced by other factors, such as sedation, hypothermia, or shock.

Choice D Reason: This is correct because decerebrate positioning is a response to stimuli that indicates damage to the brainstem or the upper cervical spine. Decerebrate positioning is characterized by extension and outward rotation of the arms and legs. It indicates a severe and life-threatening injury that can impair vital functions, such as breathing and blood pressure.

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