Advanced Medical-Surgical HESI Study
Guide, Practice Test Questions (latest
Update 2026), 100% Correct and
Complete Answers with Explanations,
Highly Recommended, Download to Score
A+
The difference between open & closed angle glaucoma
• Chronic open-angle glaucoma is also known as simple adult
primary glaucoma and as primary open-angle glaucoma.
Description: Condition characterized by increased
intraocular pressure (IOP)
A. Glaucoma involves gradual, painless vision loss
B. Glaucoma may lead to blindness if untreated
C. Glaucoma is the second leading cause of blindness in the U.S.
D. There is an increased incidence in glaucoma in older adult
populations
E. Glaucoma usually occurs bilaterally in those who have a family
history of the condition
F. Aqueous fluid is inadequately drained from the eye
G. It is generally asymptomatic, especially in the early stages
H. It tends to be diagnosed during routine visual examinations
I. It cannot be cured, but can be treated with success
pharmacologically and surgically
HESI HINT*
, Glaucoma is often painless and symptom-free. It is usually picked
up as part of a regular eye examination.
Nursing Assessment
A. Early Signs
1. Increase in IOP >22 mm Hg
2. Decreased accommodation or ability to focus
B. Late signs include:
1. Loss of peripheral vision
2. Seeing halos around lights
3. Decreased visual acuity not correctable with glasses
4. Headache or eye pain that may be so severe as to
cause nausea and vomiting (Acute closed-angle
glaucoma)
C. Risk factors include the following:
1. Family hx of glaucoma
2. Family hx of diabetes
3. Medication use and interaction of medications (e.g.
glaucoma is a side effect of antihistamines,
anticholinergics)
Primary Open-Angle Glaucoma: is the most common type of
glaucoma. The outflow of aqueous humor is decreased in the
trecbecular meshwork (area of tissue in the eye located around the base
of the cornea, near the ciliary body, and is responsible for draining the
aqueous humor from the eye via the anterior chamber). The drainage
channels become clogged like a clogged kitchen sink. Damage to the
optic nerve can then result.
,Primary Closed-Angle Glaucoma: is due to a reduction in outflow of
aqueous humor that results from angle closure. Usually this is caused
by the lens bulging forward as a result of the aging process. Angle
closure may also occur as a result of pupil dilation in the patient with
anatomically narrow angles. It may also occur due to drug-induced
myadriasis (dilation of pupil), emotional excitement, or darkness.
HESI HINT*
Eye drops are used to cause pupil constriction because movement of
the muscles to constrict the pupil also allows aqueous humor to flow
out, thereby decreasing the pressure in the eye. Pilocarpine is
commonly used. Caution the client that vision may be blurred for 1-2
hours after administration of Pilocarpine and that adaptation to dark
environments is difficult because of pupillary constriction (the desired
effect of the drug)
HESI HINT*
There is an increased incidence of glaucoma in older adult
populations. Older clients are prone to problems associated with
constipation. Therefore, the nurse should assess these clients for
constipation and postoperative complications associated with
constipation and should implement a plan of care directed at
prevention of, and if necessary, treatment for constipation.
…. Constipation and straining at stool causes an increase in intraocular
pressure (IOP)!
Syndrome of Inappropriate Antidiuretic Hormone(SIADH)
, Rare; usually the result of an underlying condition such as Diabetes
Insipidus
Results from abnormally high production/release of ADH
Characterized by hyponatremia and high urine specific gravity aka
concentrated urine (greater 1.030).
BE ALERT FOR LOW URINE OUTPUT WITH A HIGH SPECIFIC
GRAVITY*** KEY ASSESSMENT
What patient exhibits: Decreased urine output, edema, weight gain,
thirst, dyspnea on exertion, fatigue, nausea, weakness, weight gain,
headache confusion, irritablilty, coma and seizures
Treatment: fluid restriction 800-1000 mL/day; decreased Na diet (salty
foods will cause pt to be thirsty so look out!)
Weigh patient daily to monitor changes in fluid balance, and the use
of ice chips and sugarless gum help decrease thirst
Hyperthyroidism(Graves Disease, Goiter)
Description: Excessive activity of the thyroid gland, resulting in an
elevated level of circulating thyroid hormones. Possibly long-term or
lifelong treatment.
A. Hyperthyroidism can result from a primary disease state; from
the use of replacement hormone therapy; or from excess thyroid
stimulating hormone (TSH) being produced by an anterior
pituitary tumor.
B. Graves disease is thought to be an autoimmune process and
accounts for most cases.
C. Diagnosis is made on the basis of serum hormone levels
Guide, Practice Test Questions (latest
Update 2026), 100% Correct and
Complete Answers with Explanations,
Highly Recommended, Download to Score
A+
The difference between open & closed angle glaucoma
• Chronic open-angle glaucoma is also known as simple adult
primary glaucoma and as primary open-angle glaucoma.
Description: Condition characterized by increased
intraocular pressure (IOP)
A. Glaucoma involves gradual, painless vision loss
B. Glaucoma may lead to blindness if untreated
C. Glaucoma is the second leading cause of blindness in the U.S.
D. There is an increased incidence in glaucoma in older adult
populations
E. Glaucoma usually occurs bilaterally in those who have a family
history of the condition
F. Aqueous fluid is inadequately drained from the eye
G. It is generally asymptomatic, especially in the early stages
H. It tends to be diagnosed during routine visual examinations
I. It cannot be cured, but can be treated with success
pharmacologically and surgically
HESI HINT*
, Glaucoma is often painless and symptom-free. It is usually picked
up as part of a regular eye examination.
Nursing Assessment
A. Early Signs
1. Increase in IOP >22 mm Hg
2. Decreased accommodation or ability to focus
B. Late signs include:
1. Loss of peripheral vision
2. Seeing halos around lights
3. Decreased visual acuity not correctable with glasses
4. Headache or eye pain that may be so severe as to
cause nausea and vomiting (Acute closed-angle
glaucoma)
C. Risk factors include the following:
1. Family hx of glaucoma
2. Family hx of diabetes
3. Medication use and interaction of medications (e.g.
glaucoma is a side effect of antihistamines,
anticholinergics)
Primary Open-Angle Glaucoma: is the most common type of
glaucoma. The outflow of aqueous humor is decreased in the
trecbecular meshwork (area of tissue in the eye located around the base
of the cornea, near the ciliary body, and is responsible for draining the
aqueous humor from the eye via the anterior chamber). The drainage
channels become clogged like a clogged kitchen sink. Damage to the
optic nerve can then result.
,Primary Closed-Angle Glaucoma: is due to a reduction in outflow of
aqueous humor that results from angle closure. Usually this is caused
by the lens bulging forward as a result of the aging process. Angle
closure may also occur as a result of pupil dilation in the patient with
anatomically narrow angles. It may also occur due to drug-induced
myadriasis (dilation of pupil), emotional excitement, or darkness.
HESI HINT*
Eye drops are used to cause pupil constriction because movement of
the muscles to constrict the pupil also allows aqueous humor to flow
out, thereby decreasing the pressure in the eye. Pilocarpine is
commonly used. Caution the client that vision may be blurred for 1-2
hours after administration of Pilocarpine and that adaptation to dark
environments is difficult because of pupillary constriction (the desired
effect of the drug)
HESI HINT*
There is an increased incidence of glaucoma in older adult
populations. Older clients are prone to problems associated with
constipation. Therefore, the nurse should assess these clients for
constipation and postoperative complications associated with
constipation and should implement a plan of care directed at
prevention of, and if necessary, treatment for constipation.
…. Constipation and straining at stool causes an increase in intraocular
pressure (IOP)!
Syndrome of Inappropriate Antidiuretic Hormone(SIADH)
, Rare; usually the result of an underlying condition such as Diabetes
Insipidus
Results from abnormally high production/release of ADH
Characterized by hyponatremia and high urine specific gravity aka
concentrated urine (greater 1.030).
BE ALERT FOR LOW URINE OUTPUT WITH A HIGH SPECIFIC
GRAVITY*** KEY ASSESSMENT
What patient exhibits: Decreased urine output, edema, weight gain,
thirst, dyspnea on exertion, fatigue, nausea, weakness, weight gain,
headache confusion, irritablilty, coma and seizures
Treatment: fluid restriction 800-1000 mL/day; decreased Na diet (salty
foods will cause pt to be thirsty so look out!)
Weigh patient daily to monitor changes in fluid balance, and the use
of ice chips and sugarless gum help decrease thirst
Hyperthyroidism(Graves Disease, Goiter)
Description: Excessive activity of the thyroid gland, resulting in an
elevated level of circulating thyroid hormones. Possibly long-term or
lifelong treatment.
A. Hyperthyroidism can result from a primary disease state; from
the use of replacement hormone therapy; or from excess thyroid
stimulating hormone (TSH) being produced by an anterior
pituitary tumor.
B. Graves disease is thought to be an autoimmune process and
accounts for most cases.
C. Diagnosis is made on the basis of serum hormone levels
