pharm chapter 58 exam 1

When reviewing a patient's medical record, the nurse notes an order for carbamide peroxide eardrops. Based on this information, the nurse interprets that these eardrops are being used for which purpose? a. To reduce inflammation b. To reduce production of cerumen c. To loosen the cerumen for easier removal d. To inhibit growth of microorganisms in the external canal

c. To loosen the cerumen for easier removal Wax emulsifiers such as carbamide peroxide work to loosen the cerumen for easier removal. The other options are incorrect.

During an examination, the nurse notes that a patient has a perforated tympanic membrane. There is an order for ciprofloxacin eardrops. Which is the nurse's most appropriate action at this time? a. give the medication as ordered. b. check the patient's hearing, and then give the drops. c. hold the medication, and check with the prescriber. d. administer the drops with a cotton wick.

A ciprofloxacin and ofloxacin can be used with perforated eardrums.

Before giving eardrops, the nurse checks for potential contraindications to the use of otic preparations, such as which of these conditions? A. Eardrum perforation B. Infection C. Presence of cerumen D. Mastoiditis

A. Eardrum perforation

When assessing for otitis media, the nurse remembers that common symptoms of this condition include which of the following? (SATA) A. Pain B. Malaise C. Ear drainage D. Hearing loss E. Fever

A. Pain B. Malaise D. Hearing loss E. Fever

Ear disorders of the external ear (pinna) are self limiting and heal with time. A. True B. False

A. True

The nurse is preparing to administer carbamide peroxide (debrox) to an adult patient with impacted cerumen. Which actions by the nurse are correct? Select all that apply A. have the patient lie on his side with the affected ear up B. chill the medication before administering it C. pull the pinna of the ear down and back D. pull the pinna of the ear up and back E. gently irrigate the ear with warm water to remove the softened ear wax

A. have the patient lie on his side with the affected ear up D. pull the pinna of the ear up and back E. gently irrigate the ear with warm water to remove the softened ear wax

The nurse is administering eardrops that contain a combination of an antibiotic and a corticosteroid. What is the rationale for combining these two drugs in eardrops? a. The combination works to help soften and eliminate cerumen. b. The corticosteroid reduces pain associated with ear infections. c. The drops help to eliminate fungal infections. d. The corticosteroid reduces the inflammation and itching associated with ear infections.

ANS: D Corticosteroids, such as hydrocortisone, are commonly used in combination with otic antibiotics to reduce the inflammation and itching associated with ear infections. Antibiotics do not eliminate fungal infections. The other options are incorrect.

An older adult patient has a buildup of cerumen in his left ear. The nurse expects that this patient will receive which type of drug for this problem? A. Antifungal B. Wax emulsifier C. Steroid D. Local analgesic

B. Wax emulsifier

The nurse is preparing to administer Cortic and acetasol HC. the nurse would anticipate the patient is experiencing which disorder? a. viral otitis externa b. bacterial otitis media c. fungal otitis media d. bacterial otitis externa

C - Cortic & Acetasol are antifungal combinations with corticosteroids

During an exam, the nurse notes that a patient has perforated tympanic membrane. There is an order for eardrops. Which action by the nurse is most appropriate? A. Give the medication as ordered B. Check the patient's hearing and then give the drops C. Hold the medication and check with the prescriber D. Administer the drops with a cotton wick

C. Hold the medication and check with the prescriber

A child has a case of otitis media. The nurse knows that otitis media in children is usually preceded by- A. Participation on a swim team B. Injury with a foreign object C. Upper respiratory tract infection D. Mastoiditis

C. Upper respiratory tract infection

Gentle massage of the tragus area of the ear after administering eardrops results in A. decreased absorption of the medication. B. softening of the cerumen in the ear canal. C. increased coverage of the medication in the ear canal. D. reduced pain in the ear.

Correct answer: C- Rationale: Gentle massage of the tragus area of the ear after instillation of eardrops helps to increase the coverage or distribution of the medication in the ear canal.

While administering medications, the nurse finds a patient's eardrops in the medication refrigerator. If the nurse gives the eardrops immediately, what response might the patient have? A. No unusual response B. Immediate relief of ear discomfort C. A vestibular-type reaction D. Increased ear pain

Correct answer: C- Administration of cold eardrops may cause a vestibular type of reaction, resulting in vomiting and dizziness.

When teaching an adult patient about eardrops, which statement will the nurse include? A. "Hold your ear down and back to instill the drops." B. "If you feel dizzy after instilling the ear drops, stand up and walk around the room." C. "Warm the ear drops up for 30 seconds in the microwave before using them." D. "Lie on the opposite side of that of your affected ear for about 5 minutes after instilling the drug."

D. "Lie on the opposite side of that of your affected ear for about 5 minutes after instilling the drug." The adult ear should be held up and back to instill eardrops. Warn the patient that dizziness may occur after application of the medication, requiring the patient to remain supine or sitting during instillation and for a few minutes thereafter. Advise the patient not to heat the medication; for example, a microwave oven must not be used for warming—because eardrops that are overheated may lose potency.

The patient with external otitis asks the nurse why the physician placed a small piece of cotton in the patient's ear and told the patient to leave it in place. How should the nurse respond? A. "The physician made an error; I will remove the cotton." B. "The cotton traps the medication and doesn't allow it to exit the ear." C. "The cotton is designed to gradually reabsorb over the next 24 hours." D. "The cotton is called a wick and enables the medication to get to the infected area more effectively."

D. "The cotton is called a wick and enables the medication to get to the infected area more effectively."

The nurse is preparing to administer eardrops. Which technique for administration is correct? A. Warm the solution to 100 degree F before using B. Position the patient so that the unaffected ear is accessible C. massage the tragus before administering the drops D. Gently insert a cotton ball into the outer ear canal after the drops are given

D. Gently insert a cotton ball into the outer ear canal after the drops are given

the nurse is preparing to administer eardrops and finds that the bottle has been stored in the refrigerator. Which is the best action by the nurse? A. Remove the bottle from the fridge and administer the drops B. Heat the bottle for 5 seonds in the microwave before administering C. Let the bottle sit in a cup of hot water for 15 minutes before administering D. Remove the bottle from the fridge 1 hour before the drops are to be given

D. Remove the bottle from the fridge 1 hour before the drops are to be given

A patient with a severe middle ear infection will generally require treatment with which type of drug? A. Topical steroids B. Systemic steroids C. Topical antibiotics D. Systemic antibiotics

D. Systemic antibiotics

Which assessment does the nurse give priority before administering carbamide peroxide (Debrox) for the removal of cerumen? A. The patient's complaint B. The patient's hearing acuity C. The patient's ability to cooperate D. The presence of an intact tympanic membrane

D. The presence of an intact tympanic membrane The most important assessment before the administration of any medication in the ear is whether the tympanic membrane is intact; if it is not, medication could reach the inner ear. Complete understanding of the patient's complaint and assessment of the patient's ability to hear and ability to cooperate are reasonable nursing interventions before the administration of carbamide peroxide, but they are less important than protection of the inner ear.

A patient is complaining of excessive earwax, leading to diminished hearing ability. The nurse will expect to teach the patient regarding administration of which medication to correct this problem? A. hydrocortisone B. pramoxine C. acetic acid D. carbamide peroxide

D. carbamide peroxide

The nurse is teaching the mother of a 1-year-old patient how to instill ear drops for OE. What instructions on instillation does the nurse provide to the mother? a. "Hold the pinna down and back." b. "Just put in as many drops as you can get into the ear." c. "Put a cotton ball in to keep the medication in the ear." d. "Keep the ear drops in cold place so they work better."

a. "Hold the pinna down and back." When administering eardrops to adults, hold the pinna up and back. In children younger than 3 years of age, hold the pinna down and back. Allow a period of time for adequate coverage of the ear by the medication. Store eardrops, solutions, and ointments at room temperature before instillation. Administration of solutions that are too cold may cause a vestibular type of reaction with vomiting and dizziness.

The nurse is providing education to a client diagnosed with otitis externa (OE). Which statement by the client indicates an understanding of the OE treatment plan? a. "I will use the eardrops in the ear canal to treat this condition." b. "I will finish taking all of my antibiotic pills for my ear infection." c. "This is contagious, so I need to stay away from others for 24 hours." d. "The cold I had last week caused this to occur; it will go away on its own."

a. "I will use the eardrops in the ear canal to treat this condition." The treatment for OE is use of otic drops in the ear canal.

The nurse is educating the mother of an infant on how to instill eardrops for otitis media with a perforated eardrum. Which is an appropriate nursing outcome criterion for the mother? a. Demonstrates accurate medication administration technique b. Takes infant's oral temperature before administration of medication c. Uses a hot washcloth over affected ear to reduce ear pain and discomfort d. Instructs infant to remain supine for 5 minutes after instillation of ear drops

a. Demonstrates accurate medication administration technique The outcome criterion for this client is for the mother to demonstrate the appropriate administration of the medication to the infant.

A child has been diagnosed with bacterial otitis externa and will be receiving eardrops. Which of these eardrops are appropriate for this infection? (Select all that apply.) a. Floxin Otic b. Cortic c. Debrox d. Acetasol HC e. Cipro HC Otic

a. Floxin Otic e. Cipro HC Otic Both Floxin Otic and Cipro HC Otic are antibacterial eardrops. Cipro HC also contains a corticosteroid. Both Cortic and Acetasol HC are antifungal products; Debrox (carbamide peroxide) is an earwax emulsifier used to loosen earwax for easier removal.

The camp nurse reviews the "shopping list" of supplies needed for the upcoming camping season. What product is recommended to prevent and treat chronic impaction of cerumen? a. Hydrogen peroxide b. Rubbing alcohol c. Charcoal d. Salt solution

a. Hydrogen peroxide

The nurse is educating the mother of an infant on how to instill eardrops for otitis media with a perforated eardrum. Which is an appropriate nursing outcome criterion for this patient? a. Mother demonstrates accurate medication administration technique. b. Mother takes infant's temperature prior to administration of medication. c. Patient lies still for administration of medication and 5 minutes after administration. d. Patient stops using medication when the ear no longer has active drainage.

a. Mother demonstrates accurate medication administration technique. The outcome criterion for this patient is for the mother to demonstrate the appropriate administration of the medication to the infant.

A 2-year-old is seen in the pediatrician's office with a bacterial middle ear infection. Which medication does the nurse anticipate being prescribed for the child? a. amoxicillin b. Cortic c. carbamide peroxide (Debrox) d. Acetasol HC

a. amoxicillin Amoxicillin is the first-line drug for most children with bacterial otitis media. Cortic is composed of hydrocortisone (a steroid), pramoxine (a local anesthetic), chloroxylenol (an antiseptic antifungal), propylene glycol diacetate (an emulsifying drug), and benzalkonium chloride (an antiseptic preservative), and is used for fungal infections of the ear. Carbamide peroxide (Debrox) is a commonly used earwax emulsifier. Acetasol HC is used to treat fungal infections of the ear.

The nurse is preparing to administer carbamide peroxide to an adult patient with impacted cerumen. Which actions by the nurse are correct? (select all that apply) a. have the patient lie on his or her side with the affected ear up. b. chill the medication before administering it. c. pull the pinna of the ear down and back d. pull the pinna of the ear up and back e. gently irrigate the ear with warm water to remove the softened earwax.

a. have the patient lie on his or her side with the affected ear up. d. pull the pinna of the ear up and back e. gently irrigate the ear with warm water to remove the softened earwax.

While teaching a patient about treatment of otitis media, the nurse should mention that untreated otitis media may lead to a. mastoiditis b. throat infections c. funga ear infections d. decreased cerumen production

a. mastoiditis

While teaching a patient about treatment of otitis media, the nurse should mention that untreated otitis media may lead to which condition? a. mastoiditis b. throat infections c. fungal ear infection d. decreased cerumen production

a. mastoiditis

The nurse is assisting a nursing student who is about to administer eardrops. Which technique by the nursing student indicates a need for further instruction (select all that apply) a. warm the solution to 100F b. position the patient so that the affected ear is accessible c. massage the tragus before administering the eardrops. d. have the patient lie in the same position for 5 min after the drops are given.

a. warm the solution to 100F c. massage the tragus before administering the eardrops.

A mother of a young child asks what she can use to help keep her child's ears clean from wax. What over-the-counter medication will the nurse suggest? a. Cortic b. Debrox c. Floxin d. Ciprodex

b. Debrox Carbamide peroxide (Debrox) is a commonly used earwax emulsifier. It is combined with other components (e.g., glycerin, a lubricant) that help soften and lubricate cerumen before irrigation. Carbamide peroxide slowly releases hydrogen peroxide and oxygen when exposed to moisture. The others are antifungals or antibacterial otic drugs.

The nurse is preparing to give an earwax emulsifier to a patient and will assess the patient for which contraindication before administering the drops? a. Allergy to penicillin b. Drainage from the ear canal c. Partial deafness in the affected ear d. Excessive earwax in the outer ear canal

b. Drainage from the ear canal Earwax emulsifiers are indicated for excessive earwax in the outer ear canal and are not to be used without prescription when ear drainage, tympanic membrane rupture, or significant pain or other irritation is present. Cerumen impaction may cause partial deafness in the affected ear.

The nurse is evaluating the effectiveness of the otic medication used for OE. What will the nurse evaluate for to determine if the goals of therapy have been met? a. Increased pain in ear b. Improved hearing c. Redness around ear d. Discharge in canal

b. Improved hearing The therapeutic effects of otic drugs, as with all drugs, are gauged by evaluating whether goals and objectives have been met. Therapeutic effects of otic drugs include less pain, redness, and swelling in the ear; a reduction in fever; and resolution of any other signs and symptoms associated with the ear disorder. Improvement in hearing may also be an anticipated therapeutic effect. The other options are indicative the therapy was not effective and further evaluation needs to be completed by the health care provider.

A 14-year-old patient is diagnosed with perforated tympanic membrane, OE, and otitis media. What does the nurse anticipate the provider will prescribe? a. Otic antimicrobials only b. Otic and oral antimicrobials c. Oral antimicrobial only d. Otic antimicrobial and otic antifungal

b. Otic and oral antimicrobials The patient will need a topical/local otic antimicrobial for the OE and perforated tympanic membrane in addition a systemic (oral) antimicrobial to treat the otitis media.

The nurse is preparing to administer a new order for eardrops. Which is a potential contraindication to the use of many otic preparations? a. Ear canal itching b. Perforated eardrum c. Staphylococcus aureus otitis externa infection d. Escherichia coli ear infection

b. Perforated eardrum Potential contraindications to the use of otic preparations include perforated eardrum. The other options are potential indications for eardrops.

The nurse is teaching a patient's wife about administering eardrops to her husband. The nurse will use which technique when demonstrating the skill? a. Pull the pinna of the ear down and back. b. Pull the pinna of the ear up and back. c. Pull the pinna of the ear down and forward. d. Pull the pinna of the ear up and forward.

b. Pull the pinna of the ear up and back.

The health care provider has ordered ciprofloxacin/dexamethasone (Ciprodex) otic drops for a patient with OE. The nurse knows the combination medication has both antibacterial medication and topical steroid medication. What is the purpose of the steroid in this medication? a. Relieve pain b. Reduce inflammation c. Treat infection d. Decrease the amount of earwax

b. Reduce inflammation The purpose of a steroid included in otic drops is to assist in decreasing inflammation in the canal and the itching associated with the inflammation.

During a teaching session about eardrops, the patient tells the nurse, "i know why an antibiotic is in this medicine, but why is hydrocortisone in these eardrops? What is the nurses best response? a. the hydrocortisone will help to soften the cerumen b. the hydrocortisone reduces itching and inflammation c. the hydrocortisone also has antifungal effects d. this medication helps to anesthetize the area to decrease pain

b. the hydrocortisone reduces itching and inflammation

The nurse is discussing treatment of earwax buildup with a patient. which statement about earwax emulsifiers is correct? a. these drugs are useful for treatment of ear infections b. they loosen impacted cerumen so that it may be removed by irrigation c. they are used to rinse out excessive earwax d. they enhance the secretion of earwax

b. they loosen impacted cerumen so that it may be removed by irrigation

The nurse bases the plan of care regarding administration of eardrops on knowledge that a. proper administration includes holding the pinna up and out in an infant. b. warming the eardrops to room temperature before administration helps reduce a vestibular-type reaction. c. the pinna of an adult should be held down and back. d. eardrops may be warmed in the microwave before administration.

b. warming the eardrops to room temperature before administration helps reduce a vestibular-type reaction.

The nurse is providing education to a patient diagnosed with otitis externa (OE). Which statement by the patient indicates an understanding of the OE treatment plan? a. "I will finish taking all the pills for my ear infection." b. "This is contagious, and I need to stay away from others for 24 hours." c. "I will use the eardrops in the ear canal to treat this condition." d. "The cold I had last week caused this to occur; it will go away on its own."

c. "I will use the eardrops in the ear canal to treat this condition." The treatment for OE is use of otic drops in the ear canal.

A client is complaining of excessive earwax, leading to diminished hearing ability. The nurse will anticipate to teach the client about which medication to treat this condition? a. Pramoxine (Caladryl) b. Ofloxacin (Floxin Otic) c. Carbamide peroxide (Debrox) d. Hydrocortisone (A-Hydrocort)

c. Carbamide peroxide (Debrox) Carbamide peroxide works to soften earwax for easy removal while providing a weak antibacterial action to prevent infection

The nurse is assessing a child with otitis media. Which statement about otitis media is correct? a. It is treated with over-the-counter medications. b. In children, it commonly follows a lower respiratory tract infection. c. Common symptoms include pain, fever, malaise, and a sensation of fullness in the ears. d. Hearing deficits are associated only with inner ear infections, not with otitis media.

c. Common symptoms include pain, fever, malaise, and a sensation of fullness in the ears. Otitis media is rarely treated with over-the-counter medications and commonly follows an upper respiratory tract infection in children. Hearing deficits may occur if prompt therapy is not started. Common symptoms include pain, fever, malaise, and a sensation of fullness in the ear.

A client is diagnosed with a perforated tympanic membrane, OE, and otitis media. What does the nurse anticipate the health care provider will prescribe? a. Oral antibacterial only b. Otic antibacterials only c. Otic and oral antibacterials d. Otic antibacterial and otic antifungal

c. Otic and oral antibacterials The client will need a topical or local otic antibacterial for the OE and perforated tympanic membrane in addition to a systemic (oral) antibacterial to treat the otitis media.

The nurse is teaching a patient about proper administration of eardrops. Which statements are correct? (Select all that apply.) a. Remove cerumen with a cotton-tipped swab before instilling the drops. b. Instill the drops while still cool from refrigeration. c. Warm the eardrops to room temperature before instillation. d. The adult patient should pull the pinna of the ear up and back. e. Insert a dry cotton ball firmly into the ear canal after instillation. f. Massage the earlobe after instillation.

c. Warm the eardrops to room temperature before instillation. d. The adult patient should pull the pinna of the ear up and back. e. Insert a dry cotton ball firmly into the ear canal after instillation. emove cerumen before instillation by irrigation, not with cotton-tipped swabs. The drops must be at room temperature; cold drops may cause dizziness or other discomfort. Hold the pinna of the ear up and back when giving eardrops to adults or children older than 3 years of age. Massage the tragus area after instillation to encourage flow through the ear canal. A small cotton ball may be inserted gently into the ear canal to keep the drug in place, but do not force or jam it into the ear canal. Gentle massage to the tragus area of the ear (not the earlobe) may also help to increase coverage of the medication after it is given.

A child is in the clinic with a severe case of otitis media. The prescriber has decided to treat it with an antibiotic, and the nurse anticipates that which antibiotic will be prescribed as a first-line drug for this condition? a. tetracycline b. penicillin c. amoxicillin d. ciprofloxacin

c. amoxicillin

The nurse is administrating eardrops that have been refrigerated. Which action by the nurse is correct before administering the drops? a. Leave the drops in the refrigerator until use. b. Heat the chilled solution for 10 seconds in the microwave. c. Soak the bottle for 60 seconds in a container of very hot water. d. Take the drops out of the refrigerator 1 hour before the dose is due.

d. Take the drops out of the refrigerator 1 hour before the dose is due. Give eardrops at room temperature. If the pharmacy indicates that the drug is to be refrigerated, it should be taken out of the refrigerator up to 1 hour before it is to be instilled so that it can warm up to room temperature. They are not to be placed in the microwave or soaked in hot water; eardrops that are overheated may lose potency. Administration of solutions that are too cold may cause a vestibular reaction that includes vomiting and dizziness. If the solution has been refrigerated, allow it to warm to room temperature.

A patient is complaining of excessive earwax, leading to diminished hearing ability. The nurse will expect to teach the patient regarding administration of which medication to correct this problem? a. hydrocortisone b. pramoxine c. acetic acid d. carbamide peroxide

d. carbamide peroxide Carbamide peroxide works to soften earwax for easy removal while providing a weak antibacterial action to prevent infection.

The nurse is preparing to administer eardrops and finds that the bottle has been stored in the medication room refrigerator. Which is the nurse's best action at this time? a. remove the bottle from the refrigerator, and administer the drops. b. heat the bottle for 5 seconds in the microwave oven before administering the drops. c. let the bottle sit in a cup of hot water for 15 min before administering the drops. d. remove the bottle from the refrigerator 1 hr before the drops are due to be given.

d. remove the bottle from the refrigerator 1 hr before the drops are due to be given.