A patient presents to the emergency room with symptoms of severe eye pain, blurred vision, and nausea. The ophthalmologist diagnoses the patient with acute narrow-angle glaucoma. Which of the following interventions should be prioritized to alleviate the patient’s symptoms and prevent further complications?

Administer intravenous acetazolamide to reduce intraocular pressure.

Apply warm compresses to the affected eye to relieve pain.

Encourage the patient to drink plenty of fluids to stay hydrated.

Administer a mydriatic agent to dilate the pupil.

Advising the patient to limit fluid intake to prevent kidney damage is not appropriate. In fact, adequate hydration is crucial for patients with multiple myeloma to help flush out toxins and prevent kidney damage. Limiting fluid intake can lead to dehydration and worsen kidney function, which is already at risk due to the disease.

Answer and Explanation

The Correct Answer is A

Choice A Reason:

Administering intravenous acetazolamide is a critical intervention for acute narrow-angle glaucoma. Acetazolamide is a carbonic anhydrase inhibitor that reduces the production of aqueous humor, thereby lowering intraocular pressure (IOP) quickly. Reducing IOP is essential to prevent optic nerve damage and preserve vision. Normal IOP ranges from 10 to 21 mmHg, and in acute narrow-angle glaucoma, it can exceed 30 mmHg. Rapid reduction of IOP is crucial to alleviate symptoms and prevent further complications.

Choice B Reason:

Applying warm compresses to the affected eye is not an appropriate intervention for acute narrow-angle glaucoma. Warm compresses may provide temporary relief for some eye conditions, but they do not address the underlying issue of elevated intraocular pressure. In fact, warm compresses can potentially increase blood flow to the eye, which might exacerbate the condition.

Choice C Reason:

Encouraging the patient to drink plenty of fluids to stay hydrated is generally good advice for overall health, but it is not a prioritized intervention for acute narrow-angle glaucoma. Hydration does not directly impact intraocular pressure or alleviate the acute symptoms of glaucoma. The primary focus should be on reducing IOP to prevent optic nerve damage.

Choice D Reason:

Administering a mydriatic agent to dilate the pupil is contraindicated in acute narrow-angle glaucoma. Mydriatic agents can worsen the condition by further narrowing the anterior chamber angle, increasing intraocular pressure, and potentially causing more damage to the optic nerve. It is crucial to avoid pupil dilation in this scenario.

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Correct Answer is A

Explanation

Choice A Reason:

Administering IV levothyroxine is the priority intervention for a patient with myxedema coma. Myxedema coma is a severe form of hypothyroidism that requires immediate thyroid hormone replacement to correct the deficiency and stabilize the patient’s condition. Intravenous levothyroxine is preferred because it provides a rapid increase in thyroid hormone levels, which is crucial for reversing the life-threatening symptoms of myxedema coma, such as hypothermia, bradycardia, and altered mental status.

Choice B Reason:

Starting broad-spectrum antibiotics is not the primary intervention for myxedema coma. While infections can precipitate myxedema coma and should be treated if present, the immediate priority is to address the severe hypothyroidism with thyroid hormone replacement. Antibiotics may be administered if an infection is suspected or confirmed, but they do not directly address the underlying thyroid hormone deficiency.

Choice C Reason:

Administering corticosteroids immediately is important but not the highest priority. Corticosteroids are often given to patients with myxedema coma to treat potential adrenal insufficiency, which can coexist with severe hypothyroidism. However, the primary intervention remains the administration of thyroid hormone replacement to correct the hypothyroid state.

Choice D Reason:

Initiating fluid restriction is not appropriate for managing myxedema coma. Patients with myxedema coma often require careful fluid management to address potential hyponatremia and maintain hemodynamic stability. Fluid restriction is not a standard intervention for this condition and does not address the critical need for thyroid hormone replacement.

A. Tilt the head to the side, pull the earlobe up and back, and instill the drops into the ear canal. B. Lay flat on your back, place the drops on a cotton ball, and insert the cotton ball into the ear canal. C. Tilt the head to the side, pull the earlobe down and back, and instill the drops into the ear canal. D. Tilt the head forward, pull the earlobe up and forward, and instill the drops into the ear canal.

Correct Answer is A

Explanation

Choice A Reason:

Tilting the head to the side and pulling the earlobe up and back is the recommended method for adults to straighten the ear canal, allowing the drops to flow directly into the ear canal and reach the site of infection effectively. This method ensures that the medication is properly administered and can work effectively to treat the infection.

Choice B Reason:

Laying flat on your back and placing the drops on a cotton ball before inserting it into the ear canal is not a recommended method for administering ear drops. This method can prevent the medication from reaching the ear canal properly and may not be as effective in treating the infection. Additionally, using a cotton ball can absorb the medication, reducing its effectiveness.

Choice C Reason:

Tilting the head to the side and pulling the earlobe down and back is the correct method for administering ear drops to children under three years old. For adults, this method is not recommended as it does not straighten the ear canal properly, which can prevent the medication from reaching the site of infection effectively.

Choice D Reason:

Tilting the head forward and pulling the earlobe up and forward is not a recommended method for administering ear drops. This method does not properly straighten the ear canal and can prevent the medication from reaching the site of infection. It is important to follow the correct technique to ensure the medication is effective.

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