Otic and Ophthalmic Medications

A client is prescribed an eyedrop and an eye ointment for the right eye. How should the nurse best administer the medications? a) Administer the eyedrop first, followed by the eye ointment. b) Administer the eye ointment first, followed by the eyedrop. c) Administer the eyedrop, wait 15 minutes, and administer the eye ointment. d) Administer the eye ointment, wait 15 minutes, and administer the eyedrop.

a) Administer the eyedrop first, followed by the eye ointment. Rationale: When an eyedrop and an eye ointment are scheduled to be administered at the same time, the eyedrop is administered first. The instillation of two medications is separated by 3 to 5 minutes.

The nurse prepares a client for an ear irrigation as prescribed by the health care provider. Which action should the nurse take when performing the procedure? a) Warm the irrigating solution to 98.6° F. b) Position the client with the affected side up following the irrigation. c) Direct a slow steady stream of irrigation solution toward the eardrum. d) Assist the client to turn his or her head so that the ear to be irrigated is facing upward.

a) Warm the irrigating solution to 98.6° F. Rationale: Before ear irrigation, the nurse should inspect the tympanic membrane to ensure that it is intact. The irrigating solution should be warmed to 98.6 ° F because a solution temperature that is not close to the client's body temperature will cause ear injury, nausea, and vertigo. The affected side should be down following the irrigation to assist in drainage of the fluid. When irrigating, a direct and slow steady stream of irrigation solution is directed toward the wall of the canal, not toward the eardrum. The client is positioned sitting, facing forward with the head in a natural position; if the ear is faced upward, the nurse would not be able to visualize the canal.

The nurse is preparing to administer eyedrops. Which interventions should the nurse take to administer the drops? Select all that apply. a) Wash hands. b) Put gloves on. c) Place the drop in the conjunctival sac. d) Pull the lower lid down against the cheek bone. e) Instruct the client to squeeze the eyes shut after instilling the eyedrop. f) Instruct the client to tilt the head forward, open the eyes, and look down.

a, b, c, d Rationale: To administer eye medications, the nurse should wash hands and put gloves on. The client is instructed to tilt the head backward, open the eyes, and look up. The nurse pulls the lower lid down against the cheekbone and holds the bottle like a pencil with the tip downward. Holding the bottle, the nurse gently rests the wrist of the hand on the client's cheek and squeezes the bottle gently to allow the drop to fall into the conjunctival sac. The client is instructed to close the eyes gently and not to squeeze the eyes shut to prevent the loss of medication.

A client was just admitted to the hospital to rule out a gastrointestinal (GI) bleed. The client has brought several bottles of medications prescribed by different specialists. During the admission assessment, the client states, "Lately, I have been hearing some roaring sounds in my ears, especially when I am alone." Which medication would the nurse identify as the cause of the client's complaint? a) Doxycycline (Vibramycin) b) Acetylsalicylic acid (aspirin) c) Atropine sulfate (Isopto Atropine) d) Diltiazem hydrochloride (Cardizem)

b) Acetylsalicylic acid (aspirin) Rationale: Aspirin is contraindicated for gastrointestinal bleeding and is potentially ototoxic. The client should be advised to notify the prescribing health care provider so the medication can be discontinued and/or a substitute that is less toxic to the ear can be taken instead. Options 1, 3, and 4 do not have effects that are potentially associated with hearing difficulties.

Which medication, if prescribed for the client with glaucoma, should the nurse question? a) Betaxolol (Betoptic) b) Atropine sulfate (Isopto Atropine) c) Pilocarpine hydrochloride (Isopto Carpine) d) Pilocarpine (Ocusert Pilo-20, Ocusert Pilo-40)

b) Atropine sulfate (Isopto Atropine) Rationale: Options 1, 3, and 4 are miotic agents used to treat glaucoma. The correct option is a mydriatic and cycloplegic (also anticholinergic) medication, and its use is contraindicated in clients with glaucoma. Mydriatic medications dilate the pupil and can cause an increase in intraocular pressure in the eye.

In preparation for cataract surgery, the nurse is to administer cyclopentolate (Cyclogyl) eyedrops. The nurse understands that which characterizes the medication action? a) Produces miosis of the operative eye b) Dilates the pupil of the operative eye c) Constricts the pupil of the operative eye d) Provides lubrication to the operative eye

b) Dilates the pupil of the operative eye Rationale: Cyclopentolate is a rapidly acting mydriatic and cycloplegic medication. Cyclopentolate is effective in 25 to 75 minutes, and accommodation returns in 6 to 24 hours. Cyclopentolate is used for preoperative mydriasis.

Betaxolol hydrochloride eyedrops have been prescribed for a client with glaucoma. Which nursing action is most appropriate related to monitoring for side/adverse effects of this medication? a) Monitoring temperature b) Monitoring blood pressure c) Assessing peripheral pulses d) Assessing blood glucose level

b) Monitoring blood pressure Rationale: Hypotension, dizziness, nausea, diaphoresis, headache, fatigue, constipation, and diarrhea are side/adverse effects of the medication. Nursing interventions include monitoring the blood pressure for hypotension and assessing the pulse for strength, weakness, irregular rate, and bradycardia. Options 1, 3, and 4 are not specifically associated with this medication.

A miotic medication has been prescribed for the client with glaucoma and the client asks the nurse about the purpose of the medication. Which response should the nurse provide to the client? a) "The medication will help dilate the eye to prevent pressure from occurring." b) "The medication will relax the muscles of the eyes and prevent blurred vision." c) "The medication causes the pupil to constrict and will lower the pressure in the eye." d) "The medication will help block the responses that are sent to the muscles in the eye."

c) "The medication causes the pupil to constrict and will lower the pressure in the eye." Rationale: Miotics cause pupillary constriction and are used to treat glaucoma. They lower the intraocular pressure, thereby increasing blood flow to the retina and decreasing retinal damage and loss of vision. Miotics cause a contraction of the ciliary muscle and a widening of the trabecular meshwork. Options 1, 2, and 4 are incorrect.

The nurse is providing instructions to a client who will be self-administering eyedrops. To minimize systemic absorption of the eyedrops, the nurse should instruct the client to take which action? a) Eat before instilling the drops. b) Swallow several times after instilling the drops. c) Blink vigorously to encourage tearing after instilling the drops. d) Occlude the nasolacrimal duct with a finger after instilling the drops.

d) Occlude the nasolacrimal duct with a finger after instilling the drops. Rationale: Applying pressure on the nasolacrimal duct prevents systemic absorption of the medication. Options 1, 2, and 3 will not prevent systemic absorption.