NCLEX RN Practice Question 458

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Glaucoma Disorders


  • A group of ocular diseases resulting in increased intraocular pressure
  • Intraocular pressure is the fluid (aqueous humor) pressure within the eye (normal intraocular pressure is 10 to 21 mm Hg).
  • Increased intraocular pressure results from inadequate drainage of aqueous humor from the canal of Schlemm or overproduction of aqueous humor.
  • The condition damages the optic nerve and can result in blindness.
  • The gradual loss of visual fields may go unnoticed because central vision is unaffected.


  • Primary open-angle glaucoma (POAG) results from obstruction to outflow of aqueous humor and is the most common type.
  • Primary angle-closure glaucoma (PACG) results from blocking the outflow of aqueous humor into the trabecular meshwork; causes include lens or pupil dilation from medications or sympathetic stimulation.


  • Early signs include diminished accommodation and increased intraocular pressure.
  • Primary open-angle glaucoma (POAG): Painless, and vision changes are slow; results in “tunnel” vision.
  • Primary angle-closure glaucoma (PACG): Blurred vision, halos around lights, and ocular erythema.

Interventions for acute angle-closure glaucoma

  • Acute angle-closure glaucoma is a medical emergency that causes sudden eye pain and possible nausea and vomiting.
  • Treat acute angle-closure glaucoma as a medical emergency.
  • Administer medications as prescribed to lower intraocular pressure.
  • Prepare the client for peripheral iridectomy, which allows aqueous humor to flow from the posterior to the anterior chamber.

Interventions for the client with glaucoma

  • Instruct the client on the importance of medications to constrict the pupils (miotics), to decrease the production of aqueous humor (carbonic anhydrase inhibitors), and to decrease the production of aqueous humor and intraocular pressure (b-blockers).
  • Instruct the client of the need for lifelong medication use.
  • Instruct the client to wear a Medic-Alert bracelet.
  • Instruct the client to avoid anticholinergic medications.
  • Instruct the client to report eye pain, halos around the eyes, and changes in vision to the physician.
  • Instruct the client that when maximal medical therapy has failed to halt the progression of visual field loss and optic nerve damage, surgery will be recommended.

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