TEST BANK LEHNE’S PHARMACOLOGY
CHAPTERS 106-110
Chapter 106: Drugs for the Ear
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.
DIF: Cognitive Level: Application REF: Acute Otitis Media |
Characteristics, Pathogenesis, and Microbiology | Standard Treatment
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 may 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.
DIF: Cognitive Level: Application REF: Acute Otitis Media | Standard
Treatment 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.
DIF: Cognitive Level: Application REF: Acute Otitis Media | Standard
Treatment 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.
DIF: Cognitive Level: Application REF: Treatment of Antibiotic-Resistant
AOM TOP: Nursing Process: Implementation MSC: NCLEX
Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies
5. A nurse is discussing health maintenance with the parent of a newborn infant. Which
statement by the parent indicates understanding of ways to reduce the incidence of otitis
media?
a. “I should hold my baby in an upright position during feeding.”
b. “I should keep my baby out of day care during cold and flu season.”
c. “My baby should not use a pacifier after 6 months of age.”
d. “The pneumococcal vaccine will prevent my baby from getting ear infections.”
ANS: B
Avoiding child care centers when respiratory infections are prevalent can significantly
reduce the incidence of AOM. Holding infants in an upright position is an unproved
recommendation. Avoiding pacifier use in the second 6 months of life is an unproved
recommendation. The pneumococcal vaccine can slightly reduce the risk of AOM.
DIF: Cognitive Level: Application REF: Acute Otitis Media | Prevention
TOP: Nursing Process: Planning MSC: NCLEX Client Needs
Category: Health Promotion and Maintenance
6. A 2-year-old child is seen in the clinic in July with otalgia; erythematous, bulging
tympanic membranes; and rupture of the right TM. The child also has a temperature of
39.4° C. The child’s parent tells the nurse, “This is the fifth ear infection this year. What
can we do?” The nurse will expect the provider to:
a. administer ceftriaxone (Rocephin) IM and give the influenza vaccine.
b. begin prophylactic antibiotic therapy with trimethoprim/sulfamethoxazole
(Septra).
c. prescribe amoxicillin/clavulanate (Augmentin) and refer the child to an
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