PrepU Abrams' Clinical Drug Therapy (12th ed) Chapter 60 Ears
A young child has been brought to the clinic with signs and symptoms that are consistent with otitis externa. What assessment question should the nurse ask to address the etiology of this health problem?
"Has your child been swimming a lot lately?"
The nurse educates a client about using the prescribed otic 0.5% hydrocortisone, 10,000 units polymyxin B, 4 drops QID in right ear x 10 days. Which client statement determines the need for further clarification?
"I will place the bottle tip into the ear and instill the 4 drops."
After teaching a client how to administer eye drops, the nurse determines that additional teaching is needed when the client makes which statement? Select all that apply.
"I'll drop the solution into the nasal side of the lower eye sac."
A nurse in an extended care facility has instilled medicated ear drops into a resident's left ear as prescribed. What instruction should the nurse provide to a client after instilling ear drops into the client's left ear?
"Keep lying on your right side for the next 20 minutes or so."
A mother is frustrated that her 2-year-old daughter keeps developing ear infections. "I don't understand. Her older brother seldom has any. Why does she have so many?" The nurse explains there can be several different reasons for this. Which of the following might be one of those reasons?
"The eustachian tube is straighter in younger children, allowing easy access to pathogens."
An older adult diagnosed with necrotizing otitis externa has been receiving IV ciprofloxacin and is now transitioning to the oral form of the drug. What health education should the nurse provide to the client?
"You can take this medication with food to reduce the chance that it will upset your stomach."
A client has presented with otalgia and otorrhea and has been diagnosed with acute otitis media. The health care provider has prescribed oral amoxicillin. The client asks the nurse, "Will the medication help me to get my hearing back?" What is the nurse's best response?
"Your hearing should return to normal as the infection clears."
A male client has just begun to use Cortisporin Otic for otitis externa. The nurse knows that the client will continue this therapy for how long?
10 days
A nurse is providing education to a client who has been prescribed polymyxin B-neomycin-hydrocortisone suspension. The nurse should indicate that the maximum duration of treatment should not exceed how many days?
10 days
The nurse is assessing a 4-year-old boy who reports an earache. Examination reveals a bulging tympanic membrane. The child reports pain and not hearing well. The nurse recognizes that amoxicillin (Amoxil, Trimox) is the drug of choice in this situation and calculates his dosage according to:
20 to 50 mg/kg/d. **Children older than 3 months and greater than 40 kg are prescribed amoxicillin at 20 to 50 mg/kg/d PO in divided doses every 8 to 12 hours. In severe cases the dosage can be 80 to 90 mg/kg/d.
A client with complicated otitis externa has been prescribed ciprofloxacin 400 mg IV. The medication is provided by pharmacy in a preconstituted bag of 400 mg/200 mL 0.9% NaCl. The nurse checks the parenteral drug therapy manual and reads that the medication may be administered at 400 mg/hour. At what rate should the nurse set the client's IV pump?
200 **The dose of 400 mg is contained in 200 mL of normal saline. The 400 mg dose may be administered over one hour, which would require the 200 mL to be administered over one hour. Thus, the nurse should set the IV pump at 200 mL/hour.
A client is prescribed two ophthalmic drugs that are to be administered at about the same time each day. The nurse instructs the client to separate the drug administration by which amount of time?
5-10 minutes
A school-aged child was diagnosed with otitis media and prescribed a 10-day course of oral amoxicillin. On the seventh day of treatment, the child's mother has contacted the nurse and stated that the child has been symptom-free for the past three days. What is the nurse's best action?
Advise completion of the antibiotics as prescribed.
A 10-year-old client is diagnosed with acute otitis media. What does the nurse anticipate the health care provider will prescribe?
Amoxicillin
A client has received a diagnosis of acute otitis externa and been prescribed a combination otic solution. The nurse should teach the client that this medication contains which components? Select all that apply.
An antibiotic a steroid an antiseptic
The nurse is reviewing a client's medication list before teaching the client about Cipro, a new drug the health care provider has ordered. The nurse warns the client to avoid what until the client finishes the Cipro?
Antacids
A child has been diagnosed with acute otitis media. Before the child begins antibiotic treatment, what assessment should the nurse perform?
Assess the child for allergies to penicillins.
The nurse is assessing a patient who reports ear pain. In addition to the pain and fever, what other assessments should the nurse conduct?
Balance
After teaching a group of nursing students about various ophthalmic drugs, the instructor determines that the teaching was successful when the students correctly choose which drug as a carbonic anhydrase inhibitor?
Brinzolamide
When assessing an infant for a possible ear infection, which behavior(s) would the nurse note? Select all that apply.
Change in behavior Irritability Ear tugging Fever
The client with necrotizing otitis externa has been prescribed ciprofloxacin. The nurse instructs the client to avoid what foods within 2 hours of taking the medication?
Dairy products
A nurse received a small bottle of drops that read "for otic use only." What part of the body does the nurse know that these drops are to be used in?
Ear
The nurse is administering trifluridine to a client with epithelial keratitis. The nurse will prioritize which finding on the ongoing assessment of this client?
Edema of the eyes
A client is admitted to the health care facility with acute glaucoma. After administering the prescribed ophthalmic drugs, the nurse continues to assess the client for pain relief at which frequency?
Every 2 hours
A patient has been admitted to the unit with necrotizing otitis externa. The nurse anticipates the patient will receive ciprofloxacin (Cipro) via which route initially?
IV **Necrotizing otitis externa is treated with Cipro initially IV until symptoms decrease
The nurse is evaluating the effectiveness of antibiotic therapy for a client who has been treated for acute otitis media. What assessments will indicate a resolution of the infection? (Select all that apply.)
Improved hearing No bulging of the tympanic membrane Normal body temperature
The nurse is caring for an older adult with functional limitations and otitis externa in the right ear. After instilling the client's prescribed eardrops, how should the nurse position the client?
Left side-lying
A client has been diagnosed with necrotizing otitis externa and has been prescribed a course of oral ciprofloxacin. The nurse should encourage the client to avoid which foods for the duration of treatment?
Milk and dairy products
A nurse is teaching a client with glaucoma about the prescribed eye drops. The nurse emphasizes the importance of therapy to prevent which complication(s)? Select all that apply.
Nerve damage Visual loss Blindness
The nurse is preparing to teach a client diagnosed with glaucoma about the medication that the primary health care provider has prescribed. Which adverse reaction(s) should the nurse point out in the session? Select all that apply.
Ocular burning Headache Tearing Blurred vision
A school-aged child reporting several days of right ear pain has presented for care, accompanied by a parent. The health care provider has diagnosed the child with otitis media, so the nurse should anticipate what treatment?
Oral amoxicillin **Oral amoxicillin is the treatment of choice for otitis media
The nurse is admitting a client with necrotizing otitis externa. The nurse expects the client to exhibit which symptoms? (Select all that apply.)
Otalgia Pain while chewing Otorrhea
When teaching a client about Cortisporin Otic, the nurse will mention which of the following as a potential adverse effect?
Ototoxicity **Can cause burning, stinging, & Ototoxicity.
A nurse is discussing amoxicillin with a 21-year-old female student who has just been diagnosed with acute otitis media. Which of the following should the nurse inquire about before the woman starts this medication?
Pregnancy status
A patient has been prescribed amoxicillin for acute otitis media. The nurse reviews the patient's current medication list and recognizes one that should not be taken with amoxicillin. Which of the following medications did the nurse see?
Probenecid
The nurse is aware that what is the most common bacterium found in clients with otitis externa?
Pseudomonas aeruginosa
The nurse identifies which as the correct method to instill ear drops in the adult client?
Pull the pinna of the ear up and back
The nurse is preparing to administer ear drops to a client diagnosed with otitis externa. What action should the nurse perform prior to administration?
Removing any excess cerumen from the client's ear
The nurse is preparing to initiate IV Cipro in a patient with necrotizing otitis externa. The nurse is aware that dosage adjustment will be necessary if the patient has a history of which of the following?
Renal impairment
A client has nearly completed a prescribed course of ciprofloxacin for the treatment of necrotizing otitis externa. During the nurse's most recent assessment, the client describes pain to his Achilles tendon, increasing in recent days. What is the nurse's best action?
Report this finding promptly to the health care provider. **Tendon pain can signal the onset of a grave complication of ciprofloxacin, and one that may lead to spontaneous tendon rupture. The nurse should inform the health care provider promptly since this warrants medical follow-up. The medication is likely to be discontinued, but the nurse should not unilaterally suggest this without consulting with the health care provider. Cold compresses and mobility limitation may provide temporary comfort but do nothing to reduce the likelihood of tendon rupture.
A mother has returned to the clinic with her child who appears to have another ear infection. During the assessment the mother mentions that putting the ear drops in is such a pain and after the child starts to feel better, she sometimes forgets to administer them. The nurse cautions the mother that which of the following can occur when antibiotics are not administered correctly?
Superinfection
An adult client with otitis media has had aspirin recommended by the health care provider to provide pain relief. What client education should the nurse provide?
Take the medication with food.
The nurse will notify the health care provider immediately if the client taking amoxicillin for otitis media is also taking what medication?
Tetracycline for acne **Tetracycline, if taken with amoxicillin, inhibits the action of amoxicillin.
The nurse recognizes that Cipro HC drops are more convenient for parents with small children because of which of the following?
Twice-daily administration
Which of the following are important points for the nurse to remember when administering an otic preparation to a client? Select all that apply:
Warm the otic preparation prior to administration. Straighten the ear canal. Never insert the dropper tip into the ear canal. Insert a piece of cotton loosely into the ear canal to prevent the drug from flowing out
What is the proper order for the steps required to administer ear drops to a child?
Wash hands. Tilt the head toward the opposite shoulder. Pull the superior aspect of the auricle upward. Instill the ear drops in the ear canal. Lie on the opposite side of administration. Place a cotton ball in the ear canal.
A client has a diagnosis of otitis media and has just begun antibiotic treatment. The client reports otalgia and has asked for medication. The nurse should anticipate the administration of:
acetaminophen (Tylenol)
When describing the various ingredients used in otic preparations, the nurse understands that antipyrine is used in which otic preparations?
analgesic
A client has been treated with ofloxacin multiple times for an ear infection. The nurse instructs the client to report signs of local adverse reactions. What would this include? (Select all that apply.)
ear irritation itching burning