Exam 1: Ear Infections (Otitis Media) Questions

After many episodes of otitis media a 3-year-old child is to undergo myringotomy and have tubes implanted surgically. What should the nurse include in the discharge preparation for this family? 1. keep the child at home for 1 week 2. insert earplugs during the childs bath 3. apply an ointment to the ear canal daily 4. use cotton swabs to clean the inner ears

2 rationale: Water in the ears after myringotomy may be a source of infection. There is no reason that the child cannot be around other children, because there is no infectious process. Applying an ointment to the ear canal daily will clog the ear canal and serves no purpose. Cotton swabs may be used occasionally in the outer ear, but should not be inserted into the ear.

A nurse is providing preoperative teaching to the parents of a toddler who is to undergo myringotomy. The nurse explains that the type of infection most common in children that are prone to otitis media is what? 1. viral 2. fungal 3. bacterial 4. rickettsial

3 rationale: Haemophilus influenzae and Streptococcus pneumoniae, both bacteria, are the most frequent causes of otitis media. If an ear infection develops, the parents should contact their healthcare provider immediately so an antibiotic may be prescribed. Otitis media is not caused by viral, fungal, or rickettsial organisms.

A 2-year-old toddler has hearing loss caused by recurrent otitis media. What treatment does the nurse anticipate that the practitioner will recommend? 1. ear drops 2. myringotomy 3. mastoidectomy 4. steroid therapy

2 rationale: Myringotomy is a surgical opening into the eardrum to permit drainage of accumulated fluid associated with otitis media. Ear drops are not used because they will obscure the view of the tympanic membrane. Removal of the mastoid will not relieve pressure within inflamed ears. Antibiotics, not steroids, are used for an infectious process.

After performing an otoscopic examination on a client who reports a decrease in hearing acuity, the primary healthcare provider diagnoses the condition as otitis media. Which assessment finding supports the diagnosis? 1. nodules on the pinna 2. redness of the eardrum 3. lesions in the external canal 4. excessive soft cerumen in the external canal

2 rationale: Many conditions are associated with a decrease in hearing acuity. One such condition is otitis media. This condition is diagnosed by redness of the eardrum observed during the otoscopic examination. Nodules on the pinna may be an indication of rheumatoid arthritis, chronic gout, or basal or squamous cell carcinoma. Lesions in the external canal may cause a decrease in hearing acuity but not the manifestation of otitis media. Excessive soft cerumen in the external canal impacts the hearing acuity but not the manifestation of otitis media.

While teaching a parents' group about acute otitis media, the nurse includes the fact that among infants and children acute otitis media is an infection commonly caused by what? 1. a virus 2. bacteria 3. a fungus 4. rickettsia

2 rationale: Otitis media, one of the most prevalent illnesses in toddlers, is caused by a bacterial infection. The causative agent is not a fungus, virus, or rickettsial organism.

The parents of an 18-month-old toddler are anxious to know why their child has experienced several episodes of acute otitis media. What should the nurse explain to the parents about why toddlers are prone to middle ear infections? 1. Immunologic differences between adults and young children 2. Structural differences between eustachian tubes of younger and older children 3. Functional differences between eustachian tubes of younger and older children 4. Circumference differences between middle ear cavity size of adults and young children

2 rationale: The eustachian tube in young children is shorter and wider, allowing a reflux of nasopharyngeal secretions. Immunologic differences are not a factor in the development of otitis media. There is no difference in the function of the eustachian tube among age groups. The size of the middle ear does not play a role in the occurrence of otitis media in young children.

A nurse is caring for an infant who has undergone myringotomy because of recurrent otitis media. What does the nurse expect to note when assessing this child? 1. difficulty voiding 2. excessive tearing 3. drainage into the external auditory canal 4. symptoms of central nervous system irritation

3 rationale: Myringotomy is an incision made in the tympanic membrane of the ear that relieves pressure and prevents spontaneous rupture of the eardrum by allowing fluid to escape from the middle ear into the external auditory canal. Tearing, dysuria, and central nervous system irritation are not expected after myringotomy.

A nurse explains to the mother of a 1-year-old with a history of frequent ear infections that the primary cause of otitis media in young children is what? 1. sinusitis 2. recurrent tonsillitis 3. an inflamed mastoid process 4. an obstructed eustachian tube

4 rationale: A blocked eustachian tube impairs drainage and creates negative pressure; when the tube opens, bacteria are pulled into the middle ear. Sinusitis is not related to otitis media. Recurrent tonsillitis is not the direct cause of otitis media. Mastoiditis is a complication, not a cause, of otitis media.

A nurse is obtaining the health history of a 7-month-old who has had repeated episodes of otitis media. What question is most important for the nurse to include in the interview with the mother? 1. please describe your childs feeding pattern 2. tell me how often your child has had ear infections 3. what medicine do you give your child for the ear infections 4. do any of your children other than your baby have this problem

1 rationale: It is important to determine the infant's feeding pattern, because drinking formula from a bottle while in a recumbent position may lead to pooling of fluid in the pharyngeal cavity, which hinders eustachian tube drainage. Although knowing the frequency of ear infections is important, the factor that precipitated the otitis media is more significant. Although it is important to determine what medication has been given for otitis media, it is more important to determine the cause of this infection. Asking about the other family members is irrelevant, because otitis media is an inflammatory response, not a hereditary disease.

A nurse in the pediatric clinic is testing a 4-year-old child with recurrent otitis media for signs of hearing loss. The child's parent asks what can be done if there is a hearing loss. The nurse responds that the most common treatment is what? 1. myringotomy 2. adeniodectomy 3. neomycin ear drops 4. systemic steroid therapy

1 rationale: Myringotomy is surgical incision of the eardrum to permit drainage of infected middle ear fluid and thus improve hearing. Removal of the adenoids will not relieve the pressure from inflamed ears. Antibiotics are administered systemically, not locally, if needed. Systemic antibiotics, not steroids, are prescribed; a myringotomy is performed if antibiotics are ineffective.

A child is being treated with oral ampicillin for otitis media. What should be included in the discharge instructions that the nurse provides to the parents of the client? 1. complete the entire course of antibiotic therapy 2. herbal fever remedies are highly discouraged 3. administer the medication with meals 4. stop the antibiotic therapy when the child no longer has a fever

1 rationale: Once antibiotic therapy is initiated, the antibiotics start to destroy specific bacterial infections that the healthcare provider is trying to treat. Antibiotic therapy takes a specific dose and number of days to completely eliminate the bacteria. If the caregivers start a dose and stop it before the course is complete, the remaining bacteria have a chance to grow again, become resistant to antibiotic treatment, and multiply. The nurse should not discourage use of herbal fever remedies; however, the herbal treatment should be reviewed to see if it is contraindicated. Ampicillin should be taken 1 to 2 hours after meals. Antibiotic therapy should be completed as prescribed.

The nurse is reviewing the problems that may occur after frequent episodes of otitis media in infants. What complications may be precipitated by this infection? Select all that apply. 1. mastoiditis 2. heart failure 3. hearing loss 4. gastroenteritis 5. bacterial meningitis

1, 3, 5 rationale: Mastoiditis is an inflammation of the mastoid gland; it may occur as a complication of otitis media because of the mastoid gland's proximity to the ear. Hearing loss is a common complication of otitis media; the child should be assessed frequently for this problem. The closeness of the infant's structures results in infections of surrounding organs; meningitis is a complication of otitis media. Heart failure and gastroenteritis are not complications of otitis media.

The parents of a 4-month-old infant with a diagnosis of acute otitis media and fever ask the nurse about the use of antibiotics to treat this condition. What is the best response by the nurse? 1. antiinflammatory medications are recommended for this condition 2. typically antiviral medications are given to treat acute otitis media 3. current practice is to wait 72 hours to see whether the condition resolves 4. antibiotics are recommended for infants younger than 6 months with acute otitis media

4 rationale: All cases of acute otitis media (AOM) in infants younger than 6 months should be treated with antibiotics because of their immature immune systems and the potential for infection with bacteria. Current literature indicates that waiting up to 72 hours for spontaneous resolution is safe and appropriate management of AOM in healthy infants older than 6 months and children. However, the watchful waiting approach is not recommended for children younger than 2 years of age who have persistent acute symptoms of fever and severe ear pain. Antiviral or antiinflammatory medications would not be recommended in an acute case of otitis media.

The parent of a 10-month-old infant with otitis media tells the nurse in the pediatric clinic that this is the baby's third episode in 3 months. The infant is tugging at the ear but is not acutely ill. What factor should the nurse consider before responding? 1. analgesics are contraindicated 2. oral antibiotics will be prescribed 3. the labyrinth and chochlea are inflamed 4. the eustachian tube is short and horizontal

4 rationale: This anatomical difference in young children permits easier migration of microorganisms from the oral cavity into the middle ear, predisposing them to otitis media. Analgesics such as acetaminophen or ibuprofen are recommended to relieve discomfort. Studies have shown that antibiotics are not effective in children younger than 2 years if the child is not severely ill. Antibiotic therapy is necessary when the infant has a fever or is in severe pain. The labyrinth and cochlea are part of the inner ear and are not affected by otitis media.