Chapter 106: Drugs for the Ear

Chapter 106: Drugs for the Ear

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. A provider has told a parent that a 3-year-old child has a minor ear infection and that an antibiotic would be prescribed in a couple of days if the child’s symptoms worsened. The parent asks the nurse why the child cannot get an antibiotic today. Which response by the nurse is correct?

a.	“If the eardrum ruptures, we can culture the fluid to determine which antibiotic is best.”
b.	“Most ear infections are caused by viruses, so antibiotics are not effective.”
c.	“Most ear infections will resolve on their own without antibiotics.”
d.	“Your child will develop tolerance to antibiotics if they are prescribed too often.”

 

 

ANS:  C

The vast majority of acute otitis media (AOM) episodes resolve without treatment, so unless the child is very ill, observation is the initial choice. Spontaneous rupture of the tympanic membrane can occur, but clinicians do not wait for it to happen to obtain a culture that will guide treatment. About 70% to 90% of AOM episodes are bacterial in origin. Patients do not develop tolerance to antibiotic effects; overuse of antibiotics can lead to resistant organisms.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 1297-1298

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

2. A nurse is teaching a parent about the observation strategy for managing a 3-year-old child’s ear infection. Which statement by the parent indicates understanding of the teaching?

a.	“I should not give analgesics, because they may mask important symptoms.”
b.	“I will give ibuprofen or acetaminophen for pain or fever as needed.”
c.	“I will let my provider know if the symptoms are not better in 1 week.”
d.	“There is a slight risk of mastoiditis if antibiotic therapy is delayed.”

 

 

ANS:  B

Observation is defined as management by symptomatic relief alone for 48 to 72 hours to allow time for AOM to resolve on its own. Parents should be taught to administer analgesics/antipyretics. Providing pain relief does not mask an important symptom. Parents should notify the provider if symptoms worsen or do not improve in 48 to 72 hours. There is no significant difference in the risk of developing mastoiditis.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 1297-1298

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation

 

3. An 18-month-old child is seen in the clinic with a temperature of 40°C. The child’s parents tell the nurse that the child developed the fever the previous evening and was inconsolable during the night. The provider examines the child and notes a bulging, erythematous tympanic membrane. The nurse will expect to:

a.	ask the parent to return to the clinic in 2 days to see whether antibiotics need to be started.
b.	discuss a referral to an ear, nose, and throat specialist for follow-up treatment.
c.	teach the parent to give analgesics for 3 days while observing for worsening symptoms.
d.	tell the parent to administer amoxicillin at 45 mg/kg/dose twice daily.

 

 

ANS:  D

Patients with severe symptoms of AOM should begin treatment with antibiotics upon diagnosis. For children 6 months to 2 years of age, treatment should begin when the diagnosis is certain, as evidenced by erythema of the tympanic membrane (TM) and distinct discomfort. Amoxicillin 45 mg/kg/dose twice daily is indicated. Observation for 2 days is not recommended for this child, because the diagnosis is certain; therefore, asking the parent to return in 2 days or to give only symptomatic treatment is incorrect. Referral to an ear, nose, and throat (ENT) specialist is not recommended unless the child has recurrent AOM or if treatments repeatedly fail.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 1297-1298

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation

 

4. A 12-month-old child attends day care and is seen in a clinic for a second middle ear infection since age 8 months. The parent calls the nurse to report that after the third day of giving amoxicillin [Amoxil], the child continues to have a temperature of 39.5°C and is unable to sleep well because of pain. What will the nurse do?

a.	Encourage the parent to discuss amoxicillin/clavulanate [Augmentin] with the child’s provider.
b.	Recommend that the parent consider removing the child from day care to reduce exposure to infection.
c.	Schedule a clinic appointment for the child to clinic to receive ceftriaxone [Rocephin] IM.
d.	Tell the parent the child will probably need surgery for tympanostomy tubes to reduce infections.

 

 

ANS:  A

Resistant AOM is on the rise because of the emergence of resistant pathogens such as Haemophilus influenzae and Moraxella catarrhalis, which are resistant to beta-lactam antibiotics, and Streptococcus pneumoniae, which synthesizes altered penicillin-binding proteins. Resistance is treated with high-dose amoxicillin/clavulanate. The high dose of amoxicillin increases activity against amoxicillin-resistant S. pneumoniae, and the clavulanate component overcomes beta-lactam resistance of H. influenzae and M. catarrhalis. Removing a child from day care can help reduce the number of ear infections in infants and young children. This child has only experienced two episodes, and removing the child from day care may not be easy for this family, so this recommendation is not appropriate at this time. IM Rocephin is not recommended. Surgery for bilateral myringotomy tympanotomy tubes (BMTT) is used to reduce the number of episodes in children with recurrent AOM.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 1299

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies