EENT NURS 5433 (MOD 1, UTA: FNP 2) — COMPLETE STUDY
GUIDE: GLAUCOMA MANAGEMENT WITH VERIFIED QUIZ
QUESTIONS AND ANSWERS UNIVERSITY OF TEXAS AT
ARLINGTON | FAMILY NURSE PRACTITIONER PROGRAM
COURSE: EENT NURS 5433 — Module 1
TOPIC: Glaucoma Management
PROGRAM: FNP II
TERMS IN THIS SET: 112
CORE DOMAINS
• Glaucoma Pathophysiology and Classification
• Risk Factors and Prevention
• Screening and Diagnostic Evaluation
• Pharmacological Management
• Patient Education and Adherence
• Referral Criteria and Follow-Up
INTRODUCTION
This comprehensive study guide evaluates the knowledge and clinical reasoning
essential for family nurse practitioners in the assessment, diagnosis, and
management of glaucoma. The guide covers primary open-angle glaucoma
(POAG), acute angle-closure glaucoma, risk stratification, tonometry
interpretation, pharmacological therapy, patient education, and evidence-based
referral criteria. Content is aligned with current American Academy of
Ophthalmology (AAO) guidelines and NICE NG81 recommendations. Multiple-
choice questions with detailed rationales reinforce clinical decision-making for
FNP practice.
,SECTION ONE: GLAUCOMA OVERVIEW AND PATHOPHYSIOLOGY
Question 1
A 62-year-old Black male presents to the FNP clinic for a routine annual
examination. He has no visual complaints. His father was diagnosed with
glaucoma at age 58. The FNP understands that this patient's most significant risk
factor for primary open-angle glaucoma is:
A. Age over 60
B. Male gender
C. Black race and positive family history
D. Absence of visual symptoms
C. Black race and positive family history
RATIONALE: Established risk factors for POAG include elevated intraocular
pressure, older age, family history of glaucoma, Black race, and Latino/Hispanic
ethnicity. While age and male gender are contributing factors, the combination of
Black race and a first-degree relative with glaucoma substantially elevates this
patient's risk profile. The absence of symptoms is expected in early POAG because
open-angle glaucoma is typically asymptomatic until significant optic nerve
damage has occurred.
Question 2
Which statement best describes the pathophysiology of primary open-angle
glaucoma?
A. Acute obstruction of the trabecular meshwork causing rapid IOP elevation
B. Progressive optic neuropathy with characteristic optic nerve head atrophy,
which may or may not be accompanied by elevated IOP
C. Inflammation of the conjunctiva and cornea causing increased aqueous
production
D. Age-related lens thickening causing pupillary block
, B. Progressive optic neuropathy with characteristic optic nerve head atrophy,
which may or may not be accompanied by elevated IOP
RATIONALE: Glaucoma is most accurately defined as an optic neuropathy
involving characteristic atrophy of the optic nerve head, which may or may not be
accompanied by elevated intraocular pressure (IOP). In open-angle glaucoma,
optic nerve damage results in progressive loss of retinal ganglion cell axons,
manifested initially as visual field loss and ultimately as irreversible blindness if
untreated. Option A describes acute angle-closure glaucoma. Options C and D
describe other ocular conditions.
Question 3
A 55-year-old female presents with a 2-hour history of severe right eye pain,
blurred vision, seeing halos around lights, nausea, and vomiting. On examination,
the right pupil is mid-dilated and fixed, and the cornea appears steamy. The FNP
should:
A. Prescribe topical timolol and schedule follow-up in 1 week
B. Refer the patient to the emergency department immediately
C. Prescribe oral acetaminophen and reassure the patient
D. Schedule an appointment with an optometrist within 48 hours
B. Refer the patient to the emergency department immediately
RATIONALE: The presentation is classic for acute angle-closure glaucoma, a
medical emergency requiring same-day referral. Symptoms include severe peri-
ocular pain, red eye, halos, blurred vision, nausea/vomiting, and a steamy cornea.
Acute angle-closure glaucoma is caused by acute obstruction of fluid drainage,
leading to rapid IOP elevation, and requires immediate intervention to prevent
irreversible vision loss. Topical beta-blockers and delayed referral are
inappropriate for this emergency.
SECTION TWO: RISK FACTORS AND PREVENTION
, Question 4
Which of the following is the FIRST-LINE prevention strategy for glaucoma in
primary care?
A. Annual visual acuity testing
B. IOP measurement in yearly eye examinations and avoidance of OTC
vasoconstrictive ocular agents and anticholinergic agents
C. Routine MRI of the optic nerve
D. Prophylactic topical beta-blocker therapy
B. IOP measurement in yearly eye examinations and avoidance of OTC
vasoconstrictive ocular agents and anticholinergic agents
RATIONALE: Glaucoma management prevention first involves IOP
measurement in yearly eye exams and avoiding OTC vasoconstrictive ocular
agents and anticholinergic agents. Vasoconstrictive ocular agents can induce
transient mydriasis, which can precipitate narrow-angle glaucoma. Anticholinergic
agents also cause mydriasis and should be avoided in patients at risk for angle-
closure glaucoma. Visual acuity testing alone does not detect glaucoma. MRI and
prophylactic beta-blockers are not indicated for primary prevention.
Question 5
A 48-year-old Latino male with a BMI of 34 and type 2 diabetes mellitus asks
about his risk for glaucoma. Which statement by the FNP is most accurate?
A. "Your diabetes and ethnicity increase your risk, so you should have regular
comprehensive eye exams."
B. "You have no risk factors for glaucoma."
C. "Only people over 70 develop glaucoma."
D. "Glaucoma only affects people with high blood pressure."
A. "Your diabetes and ethnicity increase your risk, so you should have regular
comprehensive eye exams."
GUIDE: GLAUCOMA MANAGEMENT WITH VERIFIED QUIZ
QUESTIONS AND ANSWERS UNIVERSITY OF TEXAS AT
ARLINGTON | FAMILY NURSE PRACTITIONER PROGRAM
COURSE: EENT NURS 5433 — Module 1
TOPIC: Glaucoma Management
PROGRAM: FNP II
TERMS IN THIS SET: 112
CORE DOMAINS
• Glaucoma Pathophysiology and Classification
• Risk Factors and Prevention
• Screening and Diagnostic Evaluation
• Pharmacological Management
• Patient Education and Adherence
• Referral Criteria and Follow-Up
INTRODUCTION
This comprehensive study guide evaluates the knowledge and clinical reasoning
essential for family nurse practitioners in the assessment, diagnosis, and
management of glaucoma. The guide covers primary open-angle glaucoma
(POAG), acute angle-closure glaucoma, risk stratification, tonometry
interpretation, pharmacological therapy, patient education, and evidence-based
referral criteria. Content is aligned with current American Academy of
Ophthalmology (AAO) guidelines and NICE NG81 recommendations. Multiple-
choice questions with detailed rationales reinforce clinical decision-making for
FNP practice.
,SECTION ONE: GLAUCOMA OVERVIEW AND PATHOPHYSIOLOGY
Question 1
A 62-year-old Black male presents to the FNP clinic for a routine annual
examination. He has no visual complaints. His father was diagnosed with
glaucoma at age 58. The FNP understands that this patient's most significant risk
factor for primary open-angle glaucoma is:
A. Age over 60
B. Male gender
C. Black race and positive family history
D. Absence of visual symptoms
C. Black race and positive family history
RATIONALE: Established risk factors for POAG include elevated intraocular
pressure, older age, family history of glaucoma, Black race, and Latino/Hispanic
ethnicity. While age and male gender are contributing factors, the combination of
Black race and a first-degree relative with glaucoma substantially elevates this
patient's risk profile. The absence of symptoms is expected in early POAG because
open-angle glaucoma is typically asymptomatic until significant optic nerve
damage has occurred.
Question 2
Which statement best describes the pathophysiology of primary open-angle
glaucoma?
A. Acute obstruction of the trabecular meshwork causing rapid IOP elevation
B. Progressive optic neuropathy with characteristic optic nerve head atrophy,
which may or may not be accompanied by elevated IOP
C. Inflammation of the conjunctiva and cornea causing increased aqueous
production
D. Age-related lens thickening causing pupillary block
, B. Progressive optic neuropathy with characteristic optic nerve head atrophy,
which may or may not be accompanied by elevated IOP
RATIONALE: Glaucoma is most accurately defined as an optic neuropathy
involving characteristic atrophy of the optic nerve head, which may or may not be
accompanied by elevated intraocular pressure (IOP). In open-angle glaucoma,
optic nerve damage results in progressive loss of retinal ganglion cell axons,
manifested initially as visual field loss and ultimately as irreversible blindness if
untreated. Option A describes acute angle-closure glaucoma. Options C and D
describe other ocular conditions.
Question 3
A 55-year-old female presents with a 2-hour history of severe right eye pain,
blurred vision, seeing halos around lights, nausea, and vomiting. On examination,
the right pupil is mid-dilated and fixed, and the cornea appears steamy. The FNP
should:
A. Prescribe topical timolol and schedule follow-up in 1 week
B. Refer the patient to the emergency department immediately
C. Prescribe oral acetaminophen and reassure the patient
D. Schedule an appointment with an optometrist within 48 hours
B. Refer the patient to the emergency department immediately
RATIONALE: The presentation is classic for acute angle-closure glaucoma, a
medical emergency requiring same-day referral. Symptoms include severe peri-
ocular pain, red eye, halos, blurred vision, nausea/vomiting, and a steamy cornea.
Acute angle-closure glaucoma is caused by acute obstruction of fluid drainage,
leading to rapid IOP elevation, and requires immediate intervention to prevent
irreversible vision loss. Topical beta-blockers and delayed referral are
inappropriate for this emergency.
SECTION TWO: RISK FACTORS AND PREVENTION
, Question 4
Which of the following is the FIRST-LINE prevention strategy for glaucoma in
primary care?
A. Annual visual acuity testing
B. IOP measurement in yearly eye examinations and avoidance of OTC
vasoconstrictive ocular agents and anticholinergic agents
C. Routine MRI of the optic nerve
D. Prophylactic topical beta-blocker therapy
B. IOP measurement in yearly eye examinations and avoidance of OTC
vasoconstrictive ocular agents and anticholinergic agents
RATIONALE: Glaucoma management prevention first involves IOP
measurement in yearly eye exams and avoiding OTC vasoconstrictive ocular
agents and anticholinergic agents. Vasoconstrictive ocular agents can induce
transient mydriasis, which can precipitate narrow-angle glaucoma. Anticholinergic
agents also cause mydriasis and should be avoided in patients at risk for angle-
closure glaucoma. Visual acuity testing alone does not detect glaucoma. MRI and
prophylactic beta-blockers are not indicated for primary prevention.
Question 5
A 48-year-old Latino male with a BMI of 34 and type 2 diabetes mellitus asks
about his risk for glaucoma. Which statement by the FNP is most accurate?
A. "Your diabetes and ethnicity increase your risk, so you should have regular
comprehensive eye exams."
B. "You have no risk factors for glaucoma."
C. "Only people over 70 develop glaucoma."
D. "Glaucoma only affects people with high blood pressure."
A. "Your diabetes and ethnicity increase your risk, so you should have regular
comprehensive eye exams."
