Sensory Deficits

1. 1. The client should wash the hands prior to instilling medication to ensure that bacteria do not fall into the eye. This action does not warrant intervention. 2. The client should squeeze the bridge of the nose gently after administering the medication to prevent systemic absorption of the medication. This action does not warrant intervention. 3. The client should keep the eyes closed for 1-2 minutes after instilling the eye drops to enhance the effectiveness of the medication. This action warrants the nurse correcting the behavior. 4. The client should not touch the eye with the dropper to help prevent trauma to the eye. This action does not warrant intervention.

1. The client diagnosed with open-angle glaucoma is prescribed pilocarpine (Isopto Carpine), miotic ophthalmic drops. The client is demonstrating instilling the medication. Which action by the client warrants intervention? 1. The client washes his or her hands prior to instilling the medication. 2. The client squeezes the bridge of the nose after administering the medication. 3. The client keeps the eyes open immediately after administering the medication. 4. The client does not touch the dropper to the eye when instilling the medication.

10. 1. The medication should not be administered in the inner canthus because it may increase systemic absorption of the medication. 2. The medication should not be administered on the pupil because the medication will not be retained in the eye. 3. The medication should be administered into the lower conjunctival sac. Then the client should close the eye for 1-2 minutes, which will help ensure the medication stays in the eye. 4. The medication should not be administered in the outer canthus because it will not be retained in the eye.

10. The nurse is preparing to administer ophthalmic medication to the client. To which area should the nurse administer the medication? 1. A 2. B 3. C 4. D

11. 1. In children older than 3 years, the pinna should be pulled upward and back to straighten the eustachian tube. 2. Gentle massage of the area immediately anterior to the ear facilitates the entry of drops into the ear canal. 3. This should be done with children younger than 3 years of age because it will straighten the ear canal. In children older than age 3, the pinna should be pulled upward and back. 4. After instillation of eardrops, the child should remain lying on the unaffected side for a few minutes. 5. The dropper should be held over the ear canal when instilling eardrops. Inserting the dropper deep into the ear could cause injury to the ear.

11. The nurse is teaching the parents how to instill antibiotic otic drops to the 6-year-old child with otitis media. Which instruction should the nurse discuss with the parent? Select all that apply. 1. Insert the otic medication in the affected ear after pulling the earlobe upward and back. 2. After instilling medication gently massage the area immediately anterior to the ear. 3. Gently pull the pinna downward and straight back when inserting the eardrops. 4. Allow the child to lie quietly on the side after instilling the eardrops into the affected ear. 5. Insert the dropper with prescribed medication deep into the ear canal and instill drops.

12. 1. The mother should never attempt to place anything inside the ear to clean the canal because the risk of rupturing the tympanic membrane is high. 2. Cold otic drops cause pain when they come in contact with the tympanic membrane. Therefore, otic solutions should be allowed to warm to room temperature before being administered. 3. A heating pad could cause the tympanic membrane to rupture. The mother should not put heat or cold over the ear. 4. The dropper should not be placed in the ear canal; the dropper should be held over the canal when releasing the drops into the canal.

12. Which statement indicates that the mother understands the procedure for administering otic drops to the child who has otitis media? 1. "I should clean my child's ear canal very gently with cotton swabs." 2. "I will warm the drops to room temperature before instilling them." 3. "I can place a heating pad over my child's ear after putting in drops." 4. "I need to place the dropper gently into my child's ear canal."

13. 1. Any age child can receive antibiotics. 2. This is "passing the buck," and the nurse should answer the mother's question. 3. Otitis media with effusion differs from acute otitis media in that there are no signs of acute infection. If there are no signs of infection, such as fever or pain, the nurse should explain that, with the emergence of antimicrobial-resistant organisms, recent recommendations discourage antibiotic use for otitis media with effusion because 50% of effusions will resolve on their own. 4. Acute otitis media with symptoms is treated with 5-7 days of oral antibiotics.

13. The 4-year-old child with otitis media with effusion is not prescribed systemic antibiotics. The mother asks the nurse, "Why didn't the doctor order antibiotics for my child?" Which statement is the nurse's best response? 1. "Your child is too young to receive antibiotics." 2. "You should discuss this with your child's health-care provider." 3. "Because your child did not have a fever the doctor did not order antibiotics." 4. "Most pediatricians prescribe eardrops instead of antibiotics."

14. 1. There are only so many antibiotics that treat otitis media, and the HCP will not continue using antibiotics because the child can become resistant to antibiotics. 2. This is a therapeutic response, which is not appropriate because the mother needs factual information. This response is used to help the client ventilate feelings. 3. Dunking the head under water does not cause ear infections. 4. This is the most appropriate response. A myringotomy with insertion of tympanostomy tubes is performed on children with persistent ear infections despite antibiotic therapy or otitis media with effusion for more than 3 months with associated hearing loss.

14. The mother of a 5-year-old male child who has had five ear infections in the past 6 months asks the nurse, "What can be done because my child keeps having ear infections?" Which response by the nurse is most appropriate? 1. "There are many different types of antibiotics, and one will work." 2. "You are concerned your child keeps having ear infections." 3. "Does your child dunk his head under water during bath time?" 4. "Your child may need tubes inserted into both of his ears."

15. 1. Acetaminophen (Tylenol) is the drug of choice to help relieve discomfort in children. 2. Determining the last dose of antibiotic will not help relieve the child's pain. 3. Aspirin should not be given to children because of the possibility of their developing Reye's syndrome. 4. This is a good action to take, but the child needs medication to help ease pain.

15. The father of a 23-month-old female child with acute otitis media calls the clinic and tells the nurse his daughter is crying and pulling at her ears. Which action should the nurse implement? 1. Instruct the father to give acetaminophen elixir as prescribed on the bottle. 2. Determine when the father gave the last dose of prescribed antibiotic. 3. Tell the father to administer two chewable baby aspirins every 6 hours. 4. Encourage the father to hold the child and rock her until she falls asleep.

16. 3, 1, 4, 2, 5 3. The nurse should talk to the child and explain the procedure. This will help develop trust with the child. Many nurses talk to the parents and not the child. 1. Bracing the hand helps prevent the child from moving the head. 4. For children older than 3 years, the pinna should be pulled up and back to straighten the ear canal so that the drops get to the tympanic membrane. 2. After inserting the drops, massaging the tragus (anterior portion) ensures that the drops reach the tympanic membrane. 5. This prevents the medication from spilling out of the ear.

16. The nurse is administering otic drops to a 5-year-old child with acute otitis media. Which interventions should the nurse implement? Rank in order of performance. 1. Brace the administering hand against the child's head above the ear. 2. Insert the required number of drops and gently massage the tragus. 3. Explain the procedure to the child in developmentally appropriate terms. 4. Gently pull the top of the child's ear up and back. 5. Keep the child on the unaffected side for several minutes.

17. 1. This statement indicates the mother understands the medication teaching. Clients should keep all follow-up appointments. 2. Antibiotics are prescribed for a specific condition for a specific client. The mother should not give antibiotics prescribed for her daughter to her son. The mother does not understand the medication teaching. 3. The entire prescription of antibiotics should be taken whether the client is feeling better or not. 4. After 2 days of antibiotic therapy, the child should start feeling better. This statement indicates the mother understands the medication teaching.

17. The 3-year-old female child is diagnosed with acute otitis media. Which statement by the mother indicates the medication teaching has not been effective? 1. "I will be sure and take my daughter to her follow-up appointment with her doctor." 2. "My son starting pulling at his ears so I gave him some of my daughter's antibiotics." 3. "I will give my daughter all of the medication, even if she starts feeling better." 4. "If my daughter does not get better in 48 hours, I will call her health-care provider."

18. 1. Silicone earplugs can keep water out of the ear without reducing hearing significantly, but it is not the most important information to discuss with the client. 2. A 2% acetic acid solution or 2% boric acid in ethyl alcohol is effective in drying the canal and restoring its normal acidic environment. This is the most important information for the nurse to teach because, although suggesting ways to prevent water from entering is helpful, the client must dry the canal to prevent further episodes of external otitis. 3. A swim cap does not prevent water from entering the ear. It protects the ear from the cold and possibly slows the formation of bony growths in the ears. It also protects the ear from debris in the water. 4. Tilting the head to allow water to drain from the ear is helpful, but it does not ensure the ear will be restored to a normal acidic environment.

18. The mother of a 13-year-old child who is diagnosed with external otitis tells the nurse her child spends a lot of time swimming. Which information is most important for the nurse to discuss with the mother? 1. Insert silicone earplugs prior to entering the water. 2. Administer a drying agent in the ear canal after swimming. 3. Wear a tight-fitting swim cap, especially in cold water. 4. Tilt the head to allow water to drain from the ear.

19. 1. The nurse should have the mother demonstrate how to use the measuring device to ensure the mother knows how to use the device. Verbal instructions alone do not ensure that the mother knows how to administer medication correctly. 2. Providing the mother with a sample of antibiotics will not ensure compliance. 3. A follow-up visit will not ensure compliance with the medication regimen. 4. Many times in the HCP's office the mother may be nervous. The child is in the room, and there are many distractions. Therefore, verbal instructions stood. Written information may increase compliance with the medication regimen.

19. The 2-year-old child has acute otitis media. Which intervention will help increase the mother's compliance with the medical regimen? 1. Instruct the parent verbally on how to use a calibrated measuring device. 2. Give the mother a sample of the antibiotic therapy to take home. 3. Make an appointment for a follow-up visit in 1 week. 4. Provide written and oral instructions about antibiotic therapy.

2. 1. The Ocusert Pilo should be placed in the conjunctival sac, preferably under the upper lid. This positioning is different from that for most eye medications. 2. The pilocarpine may cause blurred vision; therefore, it should be applied at night. This is a special system that allows medication to be applied to the eye with an ophthalmic device. 3. The system should be removed daily and is replaced weekly. 4. Lacrimation and headache are expected side effects, and the client does not need to call the HCP.

2. The client with glaucoma is using an Ocusert system when applying pilocarpine, a miotic ophthalmic medication. Which intervention should the nurse discuss with the client? 1. Place the Ocusert Pilo system in the lower conjunctival sac. 2. Apply the Ocusert Pilo system at bedtime. 3. Replace the system daily the first thing in the morning. 4. Notify the HCP if increased lacrimation or headache occurs.

20. 1. This indicates the nurse understands the correct procedure for administering otic drops; therefore, this does not warrant intervention by the charge nurse. 2. This procedure does not warrant wearing nonsterile gloves because the nurse will not come into contact with any blood or body fluids. The nurse should wash his or her hands and administer medication. This action warrants intervention by the charge nurse. 3. This is correct procedure prior to administering medications; therefore, this action does not warrant intervention by the charge nurse. 4. Assistance in restraining a young child might be necessary; therefore, this would not warrant intervention by the charge nurse.

20. The primary nurse is administering antibiotic otic drops to a 2-year-old child. Which action by the primary nurse warrants intervention by the charge nurse? 1. The primary nurse asks the mother if the child has any known allergies. 2. The primary nurse dons nonsterile gloves before inserting the otic drops. 3. The primary nurse washes his or her hands prior to administering medication. 4. The primary nurse gets assistance to restrain the child when giving otic drops.

21. 1. The oral medication Diamox has a diuretic effect. Therefore, it should be taken in the morning to prevent sleep deprivation because of the need to get up to urinate during the night. 2. This is an oral medication that is used as adjunctive therapy for clients diagnosed with glaucoma. It is not instilled into the eye. 3. This is an oral medication that is used as adjunctive therapy for clients diagnosed with glaucoma. The client does not have to wash hands prior to taking an oral medication. 4. This is an oral medication that is used as adjunctive therapy for clients diagnosed with glaucoma. It is not instilled into the eye, and there is no reason for the client to hold the eyes shut.

21. The client diagnosed with glaucoma is prescribed oral acetazolamide (Diamox), a carbonic anhydrase inhibitor. Which information should the client discuss with the client? 1. Administer the medication in the morning. 2. Instill medication in the lower conjunctival sac. 3. Wash hands prior to administering medication. 4. Hold the eyes shut for 2 minutes after taking medication.

22. 1. Not letting the dropper touch the eye ensures that the eye will not be injured during application of the artificial tears. 2. Keeping the eyes shut for a minute or two after instilling the drops will enhance the effectiveness of the medication. 3. Applying pressure to the inner canthus is not an appropriate intervention because this prevents systemic absorption of the medication and artificial tears are not a medication that would cause systemic effects. 4. Washing the hands is an appropriate intervention so that bacteria on the hands will not fall into the eye when instilling eye drops. 5. Lying on the stomach (prone position) is not an appropriate intervention to discuss with the client. This position would allow the drops to leak out of the eye. MEDICATION MEMORY JOGGER: "Select all that apply" questions require the test taker to view each option as a True/False question. One option cannot assist the test taker to eliminate another option.

22. The nurse is discussing how to instill artificial tears into the client's eyes. Which information should the nurse discuss with the client? Select all that apply. 1. Do not allow the artificial tear dropper to touch the eye. 2. Keep the eyes closed 1-2 minutes after instilling drops. 3. Apply pressure to the inner canthus after instilling eye drops. 4. Wash the hands prior to instilling the artificial tears into the eyes. 5. Lie in the prone position when instilling the eye drops.

23. 1. Betoptic is a beta blocker that if absorbed systemically may cause bradycardia and hypotension. The nurse should discuss orthostatic hypotension with the client, but there is no need for the client to call the HCP. 2. If the vision gets worse, the client should call the HCP because this is an adverse reaction that warrants intervention. 3. This is a beta blocker that if absorbed systemically may cause bradycardia and hypotension. The nurse should discuss ways to prevent orthostatic hypotension. 4. The client should apply pressure at the inner canthus (closest to nose) to help prevent systemic absorption of the medication.

23. The client diagnosed with glaucoma is prescribed betaxolol (Betoptic), a beta-adrenergic blocker, ophthalmic drops. Which information should the nurse discuss with the client? 1. Instruct the client to call the HCP if dizziness occurs when getting up too fast. 2. Discuss that the drops will cause the vision to get worse initially. 3. Teach the client how to prevent orthostatic hypotension. 4. Explain the importance of applying pressure at the outer canthus.

24. 1. Antivert helps prevent dizziness and the whirling sensation characteristic of Meniere's disease. 2. An antiemetic medication, not Antivert, would be prescribed to help prevent nausea and vomiting. 3. An oral diuretic, not Antivert, is prescribed for clients with Meniere's disease to help maintain a lower labyrinthine pressure. 4. Vasoconstriction should be avoided in clients with Meniere's disease because it may precipitate an attack. Tobacco products, alcohol, and caffeine should be avoided because they cause vasoconstriction.

24. The client diagnosed with Meniere's disease, also known as endolymphatic hydrops, is prescribed meclizine (Antivert), an antivertigo medication. Which statement best describes the scientific rationale for this medication? 1. It will help decrease the whirling sensation experienced in Meniere's disease. 2. It will help prevent an acute episode of nausea and vomiting. 3. It will help maintain a lower labyrinthine pressure in the ears. 4. It will help the ear canal vasoconstrict, reducing the pressure in the ears.

25. 1. Diazepam cannot be diluted because it is oil based and will not dissolve with normal saline. 2. Diazepam cannot be diluted because it is oil based and will not dissolve with normal saline. Diazepam should be administered via a saline lock or at the port closest to the client if administered through an existing intravenous line. 3. Diazepam is administered via intravenous push over 2-5 minutes, but it is not administered via an intravenous piggyback over 30 minutes. 4. Diazepam can be administered via intravenous push.

25. The client diagnosed with Meniere's disease is admitted with an acute attack and prescribed intravenous diazepam (Valium), a sedative-hypnotic. Which intervention should the nurse implement when administering this medication? 1. Dilute the Valium to a 10-mL bolus with normal saline. 2. Administer the diazepam undiluted via a saline lock 3. Infuse the diazepam via an IV piggyback over 1 hour. 4. Question the order because diazepam cannot be given IVP.

26. 3, 4, 2, 5, 1 3. Warming the medications promotes comfort when the eardrops are instilled. 4. Sitting with the head tilted toward the unaffected side allows gravity to assist in moving the medication to the inner portion of the ear canal. 2. Pulling the pinna up and back straightens the ear canal in adults and allows the medication to travel along the length of the canal. 5. This ensures the full amount of prescribed medication will be administered to penetrate the length of the canal and achieve full effectiveness. 1. Leaving a small piece of cotton in the auditory meatus for 15 to 20 minutes helps keep the medication in the canal.

26. Which interventions should be included when the nurse is teaching the 28-year-old client diagnosed with external otitis how to instill otic drops? Rank in the order of performance. 1. Loosely place a small piece of cotton in the auditory meatus. 2. Demonstrate pulling the pinna of the ear up and back when inserting drops. 3. Warm the medication by holding the container in the hand for 5 minutes. 4. Tilt the head toward the unaffected side when in the sitting position. 5. Administer the prescribed number of drops into the ear canal.

27. 1. A live insect cannot be removed from the ear; the insect must be killed prior to removing the insect. 2. Water should not be inserted into the ear canal because organic foreign bodies such as an insect or bean will swell when water is inserted into the ear canal, which makes removal more difficult. 3. Mineral oil or topical lidocaine drops are used to immobilize or kill insects prior to their removal from the ear. 4. There is no such thing as medicated cotton balls available over the counter; therefore, this is not an appropriate action.

27. The client calls the clinic and tells the nurse that a live insect is in the client's right ear. Which intervention should the clinic nurse implement? 1. Encourage the client to get someone to remove the insect. 2. Instruct the client to put water into the ear canal. 3. Have the client put mineral oil into the ear canal. 4. Tell the client to put a medicated cotton ball in the ear.

28. 1. The solution should be directed laterally toward the midline of the superior concha of the ethmoid bone, not at the base of the nasal cavity because then it will run down the throat and into the eustachian tube. 2. The client should blow his or her nose to clear the nasal passages prior to instilling the nasal solution. 3. The client should discard any solution remaining in the dropper. 4. The client should not squeeze the nostrils but should remain with the head tilted for 5 minutes after instilling the nasal solution.

28. The client with nasal congestion is prescribed nasal solution. Which information should be included in the medication teaching? 1. Direct the solution toward the base of the nasal cavity. 2. Tell the client to blow the nose prior to instilling solution. 3. Replace remaining nasal solution in the dropper back into the bottle. 4. Have the client squeeze the nostrils shut after instilling nasal solution.

29. 1. A thin line of ointment should be applied evenly along the inner edge of the lower lid margin of the eye. 2. The client should look upward when applying the ointment. 3. The eye should be cleaned with warm water prior to applying antibiotic ointment. There is no antibiotic solution used prior to using ophthalmic ointment. 4. When applying ointment, a thin line of ointment should be applied evenly along the inner edge of the lower lid margin, from the inner canthus to the outer canthus.

29. The client is diagnosed with acute bacterial conjunctivitis. The health-care provider prescribed erythromycin ophthalmic ointment. Which information should the nurse discuss with the client? 1. Apply a thick line of ointment in the upper lid margin of the eye. 2. Instruct the client to look downward when applying the ointment. 3. Instruct the client to clean the eye with antibiotic solution prior to applying ointment. 4. Apply the ophthalmic ointment from the inner to the outer canthus.

3. 1. Eye pain may indicate an attack of angle-closure glaucoma and must be reported to the HCP immediately. 2. The client should avoid using any overthe- counter sinus and cold medications containing pseudoephedrine and phenylephrine, which may accentuate the side effects of epinephrine. 3. If the client experiences any central nervous system side effects, such as anxiety, nervousness, or muscle tremors, the client should notify the HCP. Depending on the severity of the side effects, the HCP may or may not discontinue the medication. 4. There is no reason the client must lie down for 1 hour after administering this medication.

3. The client with glaucoma is prescribed epinephrine (Epitrate), mydriatic ophthalmic drops. Which statement indicates the client understands the client teaching? 1. "I will call my health-care provider if I start experiencing any eye pain." 2. "This medication does not interfere with any over-the-counter medication." 3. "I will probably experience anxiety, nervousness, and muscle tremors." 4. "After putting the medication in my eyes I must lie down for 1 hour."

30. 1. The nurse must take action as soon as possible to prevent vomiting because vomiting will increase intraocular pressure. 2. Determining if the client had anything to eat preoperatively should have been done prior to the client having surgery. It is not pertinent information at this time. 3. A cold washcloth will not help prevent the client from vomiting. The client needs an antiemetic medication. 4. The client in the recovery room would have an intravenous route. The nurse should administer the antiemetic via the route that would decrease the nausea as fast as possible; that is the intravenous route.

30. The client who has undergone eye surgery is complaining of being nauseated. Which intervention should the PACU recovery room nurse implement? 1. Administer an intravenous antiemetic medication. 2. Determine if the client had anything to eat preoperatively. 3. Place a cold washcloth under the chin along the client's throat. 4. Put the client on the left side and insert a rectal antiemetic medication.

31. 1. The child should be in the supine position. 2. The nurse should hyperextend the neck slightly by placing a rolled towel or small blanket under the shoulder blades. 3. Turning the head slightly from side to side and back to the midline position will help disperse the medication to the maxillary and frontal sinuses. 4. The child should be kept in the midline position for at least 3 minutes after the medication is instilled into the nose to allow the medication to reach the ethmoid and sphenoid sinuses.

31. The pediatric nurse is administering nasal medication to the 13-month-old child. Which intervention should the nurse implement? 1. Place the child in a prone position with the head to the side. 2. Gently place the child's chin on the chest using the nondominant hand. 3. Turn the child's head slightly from side to side and back to midline. 4. Allow the child to sit up immediately after the medication is instilled.

32. 1. The nurse should apply the drops first because if the drops are placed after the ointment, the ophthalmic drops will not be absorbed. This action would warrant intervention by the charge nurse. 2. This is the correct procedure to instill the ophthalmic drops; therefore, this intervention would not warrant intervention by the charge nurse. 3. This is the correct procedure; therefore, this intervention would not warrant intervention by the charge nurse. 4. The ophthalmic drops should be administered first because if the ointment is instilled first, the ophthalmic drops will not be absorbed. This action would not warrant intervention by the charge nurse.

32. The 3-year-old child with an eye infection has both an ophthalmic ointment and ophthalmic drops prescribed. Which action by the primary nurse warrants intervention by the charge nurse? 1. The primary nurse applies the ophthalmic ointment first. 2. The primary nurse instills the ophthalmic drops in the lower lid. 3. The primary nurse does not allow the dropper to touch the eye. 4. The primary nurse instills the ophthalmic drops first.

33. 1. Herpes simplex is a virus and is not treated with an antibiotic. 2. This antibiotic ointment is used to prevent an eye infection secondary to the mother having a sexually transmitted disease. It is administered to all newborns within 1 hour of birth. 3. A 1-hour-old infant would not have bacterial conjunctivitis; therefore, this is not the scientific rationale for administering this medication. 4. Antibiotics are not used to treat fungal infections.

33. The nurse is administering silver nitrate 1% (Dey-Drop), an antibiotic, to a 1-hour-old infant. Which statement is the scientific rationale for administering this medication? 1. It is used to prevent herpes simplex keratitis. 2. It is used to prevent ophthalmia neonatorum. 3. It is used to treat bacterial conjunctivitis. 4. It is used to treat a fungal infection of the eyes.

34. 1. There is no reason for the client to patch the eyes after administering the medication. 2. There is no reason for the client to apply cool packs after instilling the medication. 3. The nurse should instruct the client that this medication may cause temporary blurring of the vision and may cause transient stinging. 4. The ophthalmic medication is administered one drop every 2 hours for the first 3-4 days; after that, 1 drop should be administered every 3 hours for 14-21 days.

34. The client with a fungal infection of the eye is prescribed natamycin (Natacyn Ophthalmic) drops. Which medication teaching should the nurse discuss with the client? 1. Instruct the client to patch both eyes after instilling the medication. 2. Tell the client to apply cool packs to the eye after instilling medication. 3. Explain that the medication may cause temporary blurred vision. 4. Discuss the need to instill drops once a day prior to going to sleep.

35. 1. The client with swimmer's ear would need a 2% acetic acid solution or 2% boric acid in ethyl alcohol to help dry the ear canal and restore its normal acidic environment. 2. A ceruminolytic medication helps to loosen and remove impacted cerumen (earwax) from the ear canal. 3. This is an inflammation of the external ear that would not require a ceruminolytic. 4. Cataracts are eye disorders, not ear disorders.

35. Which client should the health-care provider recommend Debrox, an over-the-counter ceruminolytic? 1. The client with "swimmer's ear." 2. The client with impacted earwax. 3. The client with external otitis. 4. The client with bilateral cataracts.

36. 1. The medication can be taken with or without food. 2. This medication does not cause photosensitivity. 3. There is no need for the client to get a culture after antibiotic therapy; otitis media is not diagnosed with a culture but with a visual examination of the ear. 4. Yogurt and buttermilk will help to maintain the intestinal flora, which may be destroyed when receiving antibiotic therapy. The destruction of intestinal flora will lead to a superinfection, resulting in diarrhea.

36. The client with otitis media is prescribed clarithromycin (Biaxin), an antibiotic, 500 mg PO every 12 hours for 10 days. Which medication teaching should the nurse discuss with the client? 1. Discuss the need to take medication with food. 2. Tell the client to wear sunglasses when going outdoors. 3. Instruct the client to get cultures after completing medications. 4. Encourage the client to eat yogurt or buttermilk daily.

37. 1. The client should swish the medication in the mouth for at least 2 minutes and then swallow the medication. 2. The client should swish the medication in the mouth for at least 2 minutes and then swallow the medication. 3. The client should not swish the mouth with normal saline because the medication should remain in the mouth even after the medication is swallowed. 4. This is not the correct procedure for administering this medication.

37. The client with multiple mouth ulcers is prescribed Nystatin to swish and swallow. Which intervention should the nurse implement when administering this medication? 1. Instruct the client to swish the medication in the mouth and spit it out. 2. Encourage the client to swish the medication in the mouth for at least 2 minutes. 3. Tell the client to swish the mouth with normal saline after swallowing the medication. 4. Apply the Nystatin medication to the mouth ulcers with a sterile cotton swab.

38. 3, 5, 4, 2, 1 3. The client should first breathe through the mouth. 5. The tip of the dropper should not touch the nose because this could cause contamination of the dropper when being replaced into the bottle. 4. The solution should be inserted laterally toward the midline of the superior concha of the ethmoid bone, not the base of the nasal cavity where it will run down the throat and into the eustachian tube. 2. The client should remain lying down for 5 minutes so that the solution will not run out of the nose. 1. The remaining solution should be discarded to prevent contamination of the bottle.

38. The nurse is discussing how to instill nasal drops. Which instructions should the nurse discuss with the client? Rank in order of performance. 1. Discard any remaining solution that is in the dropper. 2. Instruct the client to remain in position for 5 minutes. 3. Instruct the client to open and breathe through the mouth. 4. Instill the solution laterally toward the nasal septum. 5. Hold the tip of the dropper just above the nostril without touching the nose.

39. 1. Vision is reduced in dim lights; therefore, the client should use a nightlight to prevent falls. This statement indicates the client understands the teaching. 2. Vision is reduced in dim lights; therefore, the client should avoid night driving for the safety of himself and others. This statement indicates the client understands the teaching. 3. Visual acuity may be decreased during the initiation of therapy; therefore, the client should avoid tasks requiring sharp vision. This statement indicates the client understands the teaching. 4. This medication should be taken routinely every day to reduce intraocular pressure. Glaucoma is painless, so if the client experiences pain, the client should call the HCP immediately. This statement indicates the client needs more teaching.

39. The client just diagnosed with glaucoma is prescribed pilocarpine, a miotic ophthalmic eye drop. Which statement indicates the client needs more teaching concerning the medication? 1. "I will use nightlights in the halls and in the bathroom." 2. "I will get my wife or son to drive me around at night." 3. "I will avoid doing tasks that require sharp vision." 4. "I will take the eye drops every time I have eye pain."

4. 1. The nurse does not have to don sterile gloves when applying ophthalmic medication; nonsterile gloves can be used. 2. The client's eyelids should not be shut during surgery. This medication paralyzes the eye during surgery. 3. There is no such thing as an eye catheter that is inserted into the outer canthus of the eye. 4. Cycloplegic medication paralyzes the eye for 1 to 2 days and the client should be aware of this information because most ophthalmic surgery is performed in day surgery. Because the client will be at home, he or she needs to be knowledgeable about the medication.

4. The client is undergoing eye surgery and the nurse is administering a cycloplegic, a ciliary paralytic ophthalmic medication. Which intervention should the nurse implement? 1. Don sterile gloves prior to administering medication. 2. Tape the client's eyelids shut with nonadhesive tape. 3. Place an eye catheter at the outer canthus to insert medication. 4. Explain that the eyes will be paralyzed for 24 to 48 hours.

40. 1. Gentle pressure should be applied to the inner canthus (lacrimal sac) for 1- 2 minutes to increase the local effect and decrease systemic absorption. 2. Gentle pressure to the eyelid is not helpful when instilling ophthalmic medication. 3. Gentle pressure to the lower conjunctival sac is not helpful when instilling ophthalmic medication. 4. Gentle pressure to the outer canthus is not helpful when instilling ophthalmic medication.

40. The nurse is administering ophthalmic medication to the client. To which area should the nurse instruct the client to apply pressure for 1-2 minutes after instilling the medication? 1. A 2. B 3. C 4. D

5. 1. The client should instill eye ointment into the lower conjunctival sac, which is the inner edge of the lower lid margin. 2. Applying pressure to the nasolacrimal duct will prevent systemic absorption of the medication. 3. The client does not have to wear gloves when applying the ointment to his or her own eyes. The client should be instructed to wash hands prior to and after applying the ointment. 4. The antibiotic ointment should be applied from the inner canthus to the outer canthus, from the nose side of the eye to the outer area. 5. The client should sit with the head slightly tilted back or lie supine when applying ophthalmic ointment or drops to better access the lower conjunctival sac. MEMORY MEDICATION JOGGER: The nurse must know the correct technique when administering medications. This is considered one of the "six rights" of medication administration.

5. The client diagnosed with bilateral conjunctivitis is prescribed antibiotic ophthalmic ointment. Which interventions should the nurse implement when discussing the medication with the client? Select all that apply. 1. Apply a thin line of ointment evenly along inner edge of lower lid margin. 2. Press the nasolacrimal duct after applying the antibiotic ointment. 3. Don nonsterile gloves prior to administering the medication. 4. Apply antibiotic ointment from the outer canthus to the inner canthus. 5. Instruct the client to sit with head slightly tilted back or lie supine. Nothing has really happened until it has been recorded. —Virginia Woolf Sensory Deficits13 337

6. 1. If there is no redness, inflammation, or other signs of an infection, then the nurse could recommend using artificial tears, which is an over-the-counter medication, but this is not the first intervention. 2. The nurse should first assess the eyes for redness or inflammation to determine if there is any type of infection, which would need an HCP's prescription for antibiotics. 3. The nurse could use the ophthalmoscope to assess the client's eyes, but the first intervention is a visual inspection. 4. The nurse could evaluate the client's cardinal fields of vision, but the first intervention is a visual inspection.

6. The client reports having dry and irritated eyes to the clinic nurse. Which intervention should the nurse implement first? 1. Recommend the client use artificial tears in both eyes. 2. Assess the eyes for any redness or discharge. 3. Check the client's eyes using the ophthalmoscope. 4. Evaluate the client's cardinal fields of vision.

7. 1. The client should come to the emergency department to determine if permanent damage has occurred and to be seen by an ophthalmologist, but that is not the first intervention. 2. Normal saline flush would help cleanse the bleach from the eyes, but it is not the first intervention. 3. Regular antibiotic ointment should not be used in the eye, and bilateral patching is not appropriate for chemical irritation to the eye. 4. The nurse should instruct the client to rinse the eye with tap water for at least 5 minutes in each eye and then to come to the emergency department. The bleach must be thoroughly removed from the eyes.

7. The client called the emergency department and told the nurse that bleach had splashed into both eyes. Which action should the nurse tell the client to perform first? 1. Come to the emergency department immediately. 2. Determine if the client has normal saline flush. 3. Apply antibiotic ointment and patch the eyes bilaterally. 4. Cleanse the eye continuously with tap water.

8. 1. This medication is prescribed for clients with open-angle glaucoma. 2. There is no contraindication to administering this eye drop to a client in liver failure because the medication should not be absorbed systemically. 3. There is no contraindication to administering this eye drop to a client who is allergic to sulfa. 4. Contraindications to using this medication include clients who may be receiving beta-blocker therapy, including clients diagnosed with COPD, asthma, heart block, and heart failure.

8. Which client should the nurse question administering the beta-adrenergic blocker betaxolol (Betoptic) ophthalmic drops? 1. The client diagnosed with open-angle glaucoma. 2. The client diagnosed with end-stage liver failure. 3. The client diagnosed with allergies to sulfa. 4. The client diagnosed with chronic obstructive pulmonary disease (COPD).

9. 1. Miotic medications, not mydriatic medications, constrict the pupil and block sympathetic nervous system input, which causes the pupil to dilate in low light and contracts the ciliary muscle. 2. Mydriatic medications dilate the pupil, reduce the production of aqueous humor, and increase the absorption effectiveness of aqueous humor, thus reducing intraocular pressure in open-angle glaucoma. 3. Beta-adrenergic blockers decrease the production of aqueous humor, which reduces intraocular pressure, but they do not affect pupil size and lens accommodation. 4. Carbonic anhydrase inhibitors are used as adjunctive therapy to reduce intraocular pressure.

9. Which statement best describes the scientific rationale for administering a mydriatic ophthalmic medication to a client diagnosed with glaucoma? 1. It constricts the pupil, which causes the pupil to dilate in low light. 2. It dilates the pupil to reduce the production of aqueous humor. 3. It decreases production of aqueous humor but does not affect the eye. 4. It is used as adjunctive therapy primarily to reduce intraocular pressure.