A nurse is reinforcing teaching with a client who has chronic open angle glaucoma. The client has been prescribed pilocarpine ophthalmic solution. Which of the following statements by the client demonstrates an understanding of the teaching?

Choice A rationale Although these are topical drops, pilocarpine can be absorbed through the nasolacrimal duct into the systemic circulation. This can lead to cholinergic side effects such as bradycardia, bronchospasm, or increased secretions. To minimize this risk, patients are taught to perform punctal occlusion by applying pressure to the inner canthus for one to two minutes after instillation. Believing there are no systemic effects is a dangerous misconception that could lead the client to ignore serious adverse reactions. Choice B rationale Pilocarpine is a miotic agent that causes the pupil to constrict by contracting the iris sphincter muscle. It also causes contraction of the ciliary muscle, which leads to accommodative spasm. This change in the lens shape and the reduction in light entering the eye frequently result in blurred vision and difficulty focusing, especially shortly after administration. Informing the client that this effect can last for a couple of hours helps them manage their activities and expectations safely. Choice C rationale Because pilocarpine causes miosis, or pupillary constriction, it significantly limits the amount of light that can enter the eye. In low-light environments or at night, the eye normally needs to dilate to capture more light for clear vision. Since the medication prevents this dilation, clients often experience significant difficulty seeing in the dark. This creates a safety risk for night driving or walking in dimly lit areas, which is the opposite of seeing better. Choice D rationale Pilocarpine ophthalmic solution typically has a relatively short duration of action compared to newer glaucoma medications. While dosing schedules can vary based on the concentration and the specific needs of the patient, it is rarely administered only once daily in the morning for chronic open-angle glaucoma. It often requires administration three to four times a day to maintain the necessary reduction in intraocular pressure. Following a once-daily regimen would likely result in inadequate pressure control.