Chapter 105: Drugs for the Ear

Chapter 105: Drugs for the Ear

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1. The parent of a 2-year-old telephones the nurse to report that the child has a fever of 103.2° F and complains of right ear pain. The parent tells the nurse that the child has been taking amoxicillin/clavulanate (Augmentin) for 3 days, and pus is now draining from the ear. The nurse should advise the parent to do which of the following?

a.	“Administer aspirin and apply warm compresses.”
b.	“Bring your child to the office for assessment, because another medication may be needed.”
c.	“Administer alcohol ear drops every 2 to 3 hours.”
d.	“Allow another couple of days for the medicine to work.”

 

 

ANS:   B

A persistent high fever indicates infection, and after 3 days of antibiotics, some sign should be evident that the antibiotic is effective. The child’s body may be resistant to the medication, therefore another one is indicated.

Administration of aspirin is contraindicated in children because of the risk of Reye’s syndrome.

Alcohol ear drops are not indicated.

The antibiotic should begin working within 48 to 72 hours. The child may be showing indicators of antibiotic resistance (fever, pain in the right ear, and pus draining from the ear).

 

DIF:    Cognitive Level: Application             REF:    p. 1246

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

2. The nurse is caring for a happy, playful baby who has been treated for recurrent ear infections. Upon assessment, the nurse finds fluid in the middle ear, but the baby has no apparent signs of local or systemic illness. The nurse suspects that the baby is experiencing mild hearing loss, because the father must speak to her a couple of times before the baby responds. The nurse should suspect

a.	acute otitis media.
b.	otitis media with effusion.
c.	acute otitis externa.
d.	otomycosis.

 

 

ANS:   B

Otitis media with effusion (OME) is characterized by fluid in the middle ear but without evidence of local or systemic illness. OME may cause mild hearing loss, but it does not cause pain. The condition can persist for weeks to months after OME has resolved.

Acute otitis media is characterized by inflammation and fluid in the middle ear, pain, fever, vomiting, irritability, impaired hearing, sleeplessness, and otorrhea.

Acute otitis externa, also known as swimmer’s ear, is a bacterial infection of the external auditory canal. It is marked by a rapid-onset ear pain with pruritus, impaired hearing, purulent drainage, and increased tenderness upon manipulation of the auricle.

Otomycosis, or fungal otitis externa, manifests as intense pruritus and erythema and may or may not involve pain and hearing loss.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 1245 | p. 1248

TOP:    Nursing Process: Assessment

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

 

3. A nurse is acting as a preceptor for a group of student nurses. The group is discussing common problems associated with the ear. To evaluate the group’s understanding, the nurse asks, “What is the difference between otitis media with effusion (OME) and acute otitis media (AOM)? What response by a student nurse best demonstrates understanding?

a.	“AOM may require treatment with short-term antibacterial therapy. OME may cause mild hearing loss without pain, and antibacterial therapy is minimally effective.”
b.	“Both AOM and OME need treatment with short-term antibacterial therapy.”
c.	“OME can occur after AOM and lasts for a few days, whereas AOM is not as serious and can be treated at home.”
d.	“With AOM, parents should consider having tubes inserted into ear. With OME, parents need not be too concerned.”

 

 

ANS:   A

AOM is characterized by rapid-onset middle ear effusion and middle ear inflammation. It may be bacterial or viral in origin, or both. Treatment with antibiotic therapy is based on age and certainty of diagnosis. OME is characterized by fluid in the middle ear but without evidence of local or systemic illness, and it may cause mild hearing loss. Antibiotics have a minimal effect in OME.

Antibiotics have minimal effect in OME and should not be used.

OME can persist for weeks to months after AOM has resolved.

Tubes in the ears are indicated for recurrent otitis media, not for AOM or OME.

 

DIF:    Cognitive Level: Application             REF:    p. 1245 | p. 1248

TOP:    Nursing Process: Evaluation

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

 

4. A nurse who works at an ear, nose, and throat (ENT) clinic is approached by a neighbor who recently took up swimming as a hobby. The neighbor complains that she has a thick, foul-smelling fluid draining from her right ear and that she has been having difficulty hearing out of that ear for 2 days. The neighbor asks the nurse whether she should wait and let the condition resolve on its own or see a practitioner. Select the nurse’s best response.

a.	“It sounds as if you might have otitis media. Warm compresses applied to the external ear should help your problem.”
b.	“You should see your practitioner, because you could have an infection and need antibiotics.”
c.	“Irrigate your right ear with a solution of half hydrogen peroxide and half warm water to resolve this problem.”
d.	“The fluid could be caused by several different ear problems. You should see your practitioner if the symptoms do not resolve in a week.”

 

 

ANS:   B

The neighbor most likely has acute otitis externa, also known as swimmer’s ear. The thick, foul-smelling drainage indicates that an infection may have developed that requires administration of antibiotics.

The neighbor’s symptoms correlate with otitis externa, which is a bacterial infection best treated with cleaning and topical antimicrobials. Warm compresses would not be effective in treating the underlying cause.

Self-treatment with homemade ear drops should be avoided.

Although the fluid could be caused by several different problems, the neighbor demonstrates evidence of infection and should not wait a week to seek health care.

 

DIF:    Cognitive Level: Application             REF:    p. 1248

TOP:    Nursing Process: Assessment

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