NSG 5544 PRIMARY CARE FOR ADULTS EXAM 2 REVIEW
COMPLETE PRACTICE TEST BANK WITH DETAILED
RATIONALES
Section 1: Eyes and Glaucoma
1. Acute angle-closure glaucoma involves a sudden severe rise in intraocular pressure. Which
of the following ranges represents normal intraocular pressure?
a. 0 to 7 mm Hg
b. 8 to 21 mm Hg
c. 22 to 40 mm Hg
d. 40 to 80 mm Hg
Correct Answer: b. 8 to 21 mm Hg
Rationale: Normal intraocular pressure (IOP) ranges from 10 to 21 mm Hg. Option a is too low
(indicative of hypotony). Option c represents ocular hypertension or early glaucoma. Option d
represents an acute, severe glaucoma attack requiring immediate intervention.
2. Which of the following medications used in the treatment of glaucoma works by
constricting the pupils to open the angle and allow aqueous fluid to escape?
a. Pilocarpine
b. Timolol
c. Brinzolamide
d. Acetazolamide
Correct Answer: a. Pilocarpine
Rationale: Pilocarpine is a direct-acting cholinergic agonist (miotic) that constricts the pupil,
pulling the iris away from the trabecular meshwork to facilitate aqueous humor outflow. Timolol
is a beta-blocker that decreases aqueous production. Brinzolamide and Acetazolamide are
carbonic anhydrase inhibitors that also decrease aqueous production.
1
,3. A 65-year-old patient presents with severe eye pain, nausea, vomiting, and a fixed mid-
dilated pupil. What is the priority immediate action?
a. Administer oral acetazolamide and refer to ophthalmology emergently.
b. Apply a warm compress and prescribe antibiotic drops.
c. Prescribe pilocarpine drops and schedule a follow-up in one week.
d. Dilate the eye with tropicamide to relieve pressure.
Correct Answer: a. Administer oral acetazolamide and refer to ophthalmology emergently.
Rationale: This is a classic presentation of acute angle-closure glaucoma. Immediate reduction
of IOP is required to prevent permanent optic nerve damage. Acetazolamide (oral or IV) and
topical beta-blockers are used emergently. Warm compresses and antibiotics are for
blepharitis/conjunctivitis. Pilocarpine is used but works slowly; immediate referral is crucial.
Dilation would worsen the condition.
4. Which class of glaucoma medications lowers IOP by increasing uveoscleral outflow?
a. Beta-blockers
b. Prostaglandin analogs
c. Alpha-2 agonists
d. Cholinergic agonists
Correct Answer: b. Prostaglandin analogs
Rationale: Prostaglandin analogs (e.g., latanoprost) increase uveoscleral outflow. Beta-blockers
and alpha-2 agonists decrease aqueous production. Cholinergic agonists increase trabecular
outflow.
5. A patient complains of gradual, painless vision loss characterized by a central scotoma and
distorted vision (metamorphopsia). What is the most likely diagnosis?
a. Open-angle glaucoma
b. Macular degeneration
c. Cataracts
d. Diabetic retinopathy
Correct Answer: b. Macular degeneration
Rationale: Age-related macular degeneration (AMD) typically presents with painless central
vision loss and metamorphopsia. Glaucoma presents with peripheral vision loss initially.
Cataracts present with glare, halos, and generalized blurring. Diabetic retinopathy may be
asymptomatic early or present with floaters and blurred vision.
2
,6. Which of the following is a major risk factor for the development of open-angle glaucoma?
a. Young age
b. African American descent
c. Hyperthyroidism
d. Myopia
Correct Answer: b. African American descent
Rationale: African American individuals have a significantly higher risk of developing open-angle
glaucoma, often at an earlier age and with more severe progression. Other risk factors include
advanced age, family history, diabetes, and elevated IOP.
7. A patient presents with a "red eye" and reports waking up with their eyelids stuck together.
The eye has purulent discharge. What is the most appropriate treatment?
a. Topical antihistamines
b. Topical antibiotics
c. Topical corticosteroids
d. Warm compresses only
Correct Answer: b. Topical antibiotics
Rationale: Purulent discharge and morning matting are hallmark signs of bacterial
conjunctivitis. Topical antibiotics (e.g., erythromycin ointment or fluoroquinolone drops) are
indicated. Antihistamines are for allergic conjunctivitis (watery, itchy eyes). Corticosteroids are
contraindicated in bacterial infections.
8. A patient is diagnosed with viral conjunctivitis. What is the most important patient
education point?
a. The condition is highly contagious and they should practice strict hand hygiene.
b. They need immediate antibiotic drops to prevent secondary infection.
c. They can return to work immediately without restrictions.
d. The condition will require long-term steroid therapy.
Correct Answer: a. The condition is highly contagious and they should practice strict hand
hygiene.
Rationale: Viral conjunctivitis (pink eye) is highly contagious. Patients should be educated on
hand hygiene, avoiding sharing towels, and staying home from work/school until symptoms
improve. Antibiotics are ineffective against viruses.
3
, 9. Which medication is contraindicated in a patient with a history of asthma who has
glaucoma?
a. Latanoprost
b. Timolol
c. Brimonidine
d. Dorzolamide
Correct Answer: b. Timolol
Rationale: Timolol is a non-selective beta-blocker. Systemic absorption can cause bronchospasm
and exacerbate asthma. Prostaglandins (latanoprost), alpha-2 agonists (brimonidine), and
carbonic anhydrase inhibitors (dorzolamide) are generally safe for asthmatics.
10. A patient presents with a sudden onset of floaters and flashes of light in the right eye.
What is the priority nursing action?
a. Refer immediately to an ophthalmologist for evaluation of retinal detachment.
b. Prescribe artificial tears and reassure the patient.
c. Schedule a routine eye exam in one month.
d. Apply a patch to the affected eye.
Correct Answer: a. Refer immediately to an ophthalmologist for evaluation of retinal
detachment.
Rationale: Sudden flashes and floaters (photopsia and vitreous floaters) can indicate a posterior
vitreous detachment or retinal tear, which can quickly progress to retinal detachment. This is a
medical emergency requiring immediate ophthalmologic evaluation.
4
COMPLETE PRACTICE TEST BANK WITH DETAILED
RATIONALES
Section 1: Eyes and Glaucoma
1. Acute angle-closure glaucoma involves a sudden severe rise in intraocular pressure. Which
of the following ranges represents normal intraocular pressure?
a. 0 to 7 mm Hg
b. 8 to 21 mm Hg
c. 22 to 40 mm Hg
d. 40 to 80 mm Hg
Correct Answer: b. 8 to 21 mm Hg
Rationale: Normal intraocular pressure (IOP) ranges from 10 to 21 mm Hg. Option a is too low
(indicative of hypotony). Option c represents ocular hypertension or early glaucoma. Option d
represents an acute, severe glaucoma attack requiring immediate intervention.
2. Which of the following medications used in the treatment of glaucoma works by
constricting the pupils to open the angle and allow aqueous fluid to escape?
a. Pilocarpine
b. Timolol
c. Brinzolamide
d. Acetazolamide
Correct Answer: a. Pilocarpine
Rationale: Pilocarpine is a direct-acting cholinergic agonist (miotic) that constricts the pupil,
pulling the iris away from the trabecular meshwork to facilitate aqueous humor outflow. Timolol
is a beta-blocker that decreases aqueous production. Brinzolamide and Acetazolamide are
carbonic anhydrase inhibitors that also decrease aqueous production.
1
,3. A 65-year-old patient presents with severe eye pain, nausea, vomiting, and a fixed mid-
dilated pupil. What is the priority immediate action?
a. Administer oral acetazolamide and refer to ophthalmology emergently.
b. Apply a warm compress and prescribe antibiotic drops.
c. Prescribe pilocarpine drops and schedule a follow-up in one week.
d. Dilate the eye with tropicamide to relieve pressure.
Correct Answer: a. Administer oral acetazolamide and refer to ophthalmology emergently.
Rationale: This is a classic presentation of acute angle-closure glaucoma. Immediate reduction
of IOP is required to prevent permanent optic nerve damage. Acetazolamide (oral or IV) and
topical beta-blockers are used emergently. Warm compresses and antibiotics are for
blepharitis/conjunctivitis. Pilocarpine is used but works slowly; immediate referral is crucial.
Dilation would worsen the condition.
4. Which class of glaucoma medications lowers IOP by increasing uveoscleral outflow?
a. Beta-blockers
b. Prostaglandin analogs
c. Alpha-2 agonists
d. Cholinergic agonists
Correct Answer: b. Prostaglandin analogs
Rationale: Prostaglandin analogs (e.g., latanoprost) increase uveoscleral outflow. Beta-blockers
and alpha-2 agonists decrease aqueous production. Cholinergic agonists increase trabecular
outflow.
5. A patient complains of gradual, painless vision loss characterized by a central scotoma and
distorted vision (metamorphopsia). What is the most likely diagnosis?
a. Open-angle glaucoma
b. Macular degeneration
c. Cataracts
d. Diabetic retinopathy
Correct Answer: b. Macular degeneration
Rationale: Age-related macular degeneration (AMD) typically presents with painless central
vision loss and metamorphopsia. Glaucoma presents with peripheral vision loss initially.
Cataracts present with glare, halos, and generalized blurring. Diabetic retinopathy may be
asymptomatic early or present with floaters and blurred vision.
2
,6. Which of the following is a major risk factor for the development of open-angle glaucoma?
a. Young age
b. African American descent
c. Hyperthyroidism
d. Myopia
Correct Answer: b. African American descent
Rationale: African American individuals have a significantly higher risk of developing open-angle
glaucoma, often at an earlier age and with more severe progression. Other risk factors include
advanced age, family history, diabetes, and elevated IOP.
7. A patient presents with a "red eye" and reports waking up with their eyelids stuck together.
The eye has purulent discharge. What is the most appropriate treatment?
a. Topical antihistamines
b. Topical antibiotics
c. Topical corticosteroids
d. Warm compresses only
Correct Answer: b. Topical antibiotics
Rationale: Purulent discharge and morning matting are hallmark signs of bacterial
conjunctivitis. Topical antibiotics (e.g., erythromycin ointment or fluoroquinolone drops) are
indicated. Antihistamines are for allergic conjunctivitis (watery, itchy eyes). Corticosteroids are
contraindicated in bacterial infections.
8. A patient is diagnosed with viral conjunctivitis. What is the most important patient
education point?
a. The condition is highly contagious and they should practice strict hand hygiene.
b. They need immediate antibiotic drops to prevent secondary infection.
c. They can return to work immediately without restrictions.
d. The condition will require long-term steroid therapy.
Correct Answer: a. The condition is highly contagious and they should practice strict hand
hygiene.
Rationale: Viral conjunctivitis (pink eye) is highly contagious. Patients should be educated on
hand hygiene, avoiding sharing towels, and staying home from work/school until symptoms
improve. Antibiotics are ineffective against viruses.
3
, 9. Which medication is contraindicated in a patient with a history of asthma who has
glaucoma?
a. Latanoprost
b. Timolol
c. Brimonidine
d. Dorzolamide
Correct Answer: b. Timolol
Rationale: Timolol is a non-selective beta-blocker. Systemic absorption can cause bronchospasm
and exacerbate asthma. Prostaglandins (latanoprost), alpha-2 agonists (brimonidine), and
carbonic anhydrase inhibitors (dorzolamide) are generally safe for asthmatics.
10. A patient presents with a sudden onset of floaters and flashes of light in the right eye.
What is the priority nursing action?
a. Refer immediately to an ophthalmologist for evaluation of retinal detachment.
b. Prescribe artificial tears and reassure the patient.
c. Schedule a routine eye exam in one month.
d. Apply a patch to the affected eye.
Correct Answer: a. Refer immediately to an ophthalmologist for evaluation of retinal
detachment.
Rationale: Sudden flashes and floaters (photopsia and vitreous floaters) can indicate a posterior
vitreous detachment or retinal tear, which can quickly progress to retinal detachment. This is a
medical emergency requiring immediate ophthalmologic evaluation.
4
