# A nurse is assessing a 68-year-old client who presents to the emergency department with severe eye pain and reports seeing halos around lights, suspected of acute angle-closure glaucoma. Which assessment finding would be most indicative of this emergency condition? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541561 > language: ko > subject: Adult Health ## 문제 A nurse is assessing a 68-year-old client who presents to the emergency department with severe eye pain and reports seeing halos around lights, suspected of acute angle-closure glaucoma. Which assessment finding would be most indicative of this emergency condition? The client presents to the emergency department with severe eye pain and reports seeing halos around lights. ## 보기 1. Gradual loss of peripheral vision over several months 2. Painless, progressive vision loss with increased cup-to-disc ratio 3. Fluctuating vision with mild eye discomfort during reading 4. Sudden onset of severe eye pain with nausea and vomiting **✔ 정답** **정답: 4** ## 해설 Sudden onset of severe eye pain with nausea and vomiting is most indicative of acute angle-closure glaucoma, an ophthalmologic emergency. Other options describe findings more typical of chronic open-angle glaucoma or other non-emergent conditions. ## 심화 해설 Understanding Acute Angle-Closure Glaucoma The client's presentation of severe eye pain and halos around lights is a classic red flag for acute angle-closure glaucoma (AACG). To understand why option 4 is the most indicative finding, we need to examine the underlying pathophysiology. In AACG, the drainage angle where the iris meets the cornea becomes suddenly blocked. This blockage prevents the outflow of aqueous humor, the fluid that normally circulates through the front of the eye [1]. When this fluid cannot drain, it accumulates rapidly, causing a swift and dramatic rise in intraocular pressure (IOP) [1,2]. This sharp pressure increase directly damages the optic nerve and causes the hallmark symptoms. Why Option 4 is the Most Indicative Finding The sudden, severe rise in IOP is not just an eye problem; it becomes a systemic crisis. The extreme pressure stimulates the oculocardiac reflex, which can trigger intense nausea and vomiting. This is a critical distinguishing feature of an acute attack. A patient with a non-urgent eye condition will rarely present with vomiting. The combination of a sudden onset of severe eye pain and these systemic symptoms points directly to an ophthalmic emergency requiring immediate intervention to prevent permanent vision loss [1]. The report of halos around lights occurs because the elevated IOP causes corneal epithelial edema, which diffracts light. Analysis of Incorrect Options The other options describe findings associated with different, less emergent forms of glaucoma or other ocular conditions. Distinguishing between them is a high-yield concept for the NCLEX-RN. * Option 1: Gradual loss of peripheral vision over several months. This is the classic presentation of primary open-angle glaucoma (POAG), the most common form of the disease. In POAG, the drainage angle remains open, but the trabecular meshwork becomes less efficient at draining aqueous humor, leading to a slow, painless increase in IOP over time. This chronic pressure gradually damages the optic nerve, resulting in insidious peripheral vision loss that the patient may not notice until it is advanced. It is not an emergency in the same way as AACG. * Option 2: Painless, progressive vision loss with increased cup-to-disc ratio. An increased cup-to-disc ratio is a hallmark fundoscopic finding in chronic glaucoma, again most commonly POAG. The elevated IOP causes cupping, or excavation, of the optic disc as nerve fibers atrophy. While this is a key assessment finding for a nurse to recognize, the process is painless and progressive, not a sudden, painful crisis. This finding confirms glaucomatous damage but does not define the acute emergency of angle closure. * Option 3: Fluctuating vision with mild eye discomfort during reading. This presentation is more suggestive of other issues, such as dry eye syndrome, uncorrected refractive error, or a very early, intermittent form of angle closure. In subacute angle-closure, the angle may narrow and close transiently, causing brief episodes of blurred vision, halos, and mild brow ache that resolve on their own. However, the question describes a patient in severe pain with halos, which indicates a complete and sustained closure, not a mild, fluctuating discomfort. The severity and persistence of symptoms are what make option 4 the emergency.References (research sources) - [1]Chronic Closed Angle GlaucomaResearch articleDave SD, Zeppieri M, Meyer JJ. (2026) ## 임상 시나리오 Recognizing Acute Angle-Closure GlaucomaKey Assessment Findings for an Ophthalmic Emergency The hallmark presentation is a sudden onset of severe, unilateral eye pain and blurred vision with halos around lights. The halos result from corneal epithelial edema caused by a rapid spike in intraocular pressure (IOP), often to 40-60 mmHg or higher. A critical differentiating symptom is the presence of nausea and vomiting. This systemic response is triggered by the oculocardiac reflex due to extreme IOP elevation and is a key indicator distinguishing this from less urgent eye conditions. CautionDo not mistake the vomiting for a primary gastrointestinal issue. This is an ophthalmic emergency. Immediate ophthalmology consultation is needed to lower IOP and prevent permanent vision loss from optic nerve damage. ## 핵심 개념 - **Acute Angle-Closure Glaucoma** — An ophthalmic emergency where the iris blocks the eye's drainage angle, causing a sudden, rapid increase in intraocular pressure. - **Intraocular Pressure (IOP)** — The fluid pressure inside the eye; a sudden spike above normal levels (typically 10-21 mmHg) can damage the optic nerve. - **Oculocardiac Reflex** — A reflex arc triggered by pressure on the eye or traction of extraocular muscles, leading to bradycardia, nausea, and vomiting. - **Aqueous Humor** — The clear fluid produced in the eye that nourishes tissues and maintains intraocular pressure; its blocked outflow causes glaucoma. - **Corneal Edema** — Swelling of the cornea due to elevated intraocular pressure, which causes light to diffract, leading to the perception of halos around lights. ## 같은 주제 문제 - [A nurse is assessing a 68-year-old client diagnosed with primary open-angle glaucoma. 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