FINAL EXAM 4 PHARM PRACTICE QUESTIONS | WITH COMPLETE SOLUTIONS | LATEST UPDATE { MARYVILLE}
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Course
NURS 623.
Institution
NURS 623.
FINAL EXAM 4 PHARM PRACTICE QUESTIONS |
WITH COMPLETE SOLUTIONS | LATEST
UPDATE { MARYVILLE}
991. An adolescent patient who is on the school swim team asks a nurse about ways to
prevent swimmer's ear. The nurse will tell the patient to:
a. allow the ears to drain well after every swim and show...
FINAL EXAM 4 PHARM PRACTICE QUESTIONS |
WITH COMPLETE SOLUTIONS | LATEST
UPDATE { MARYVILLE}
991. An adolescent patient who is on the school swim team asks a nurse about ways to
prevent swimmer's ear. The nurse will tell the patient to:
a. allow the ears to drain well after every swim and shower.
b. clean the ears with a cotton-tipped applicator after swimming.
c. keep the ear canals free of cerumen.
d. use antifungal ear drops before and after swimming. - ANS: A
Acute otitis externa (OE) can be minimized by keeping the natural defenses of the
external auditory canal (EAC) healthy. Swimmers should be taught to dry the EAC after
showering and swimming. Cleaning the ears with cotton-tipped swabs can remove the
cerumen and abrade the epithelium. Removing cerumen removes the natural barrier to
infection. Antifungal ear drops are used to treat acute OE but not as a preventive
measure.
992. 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.
,993. A patient has been diagnosed with fungal otitis externa (otomycosis). The nurse
correctly explains that for the first course of treatment the patient should expect:
a. acidifying drops for 1 week.
b. antibiotic ear drops.
c. intravenous (IV) antifungal agents.
d. oral antibiotics. - ANS: A
As a rule, otomycosis can be managed with thorough cleansing and application of
acidifying drops (2% acetic acid solution applied three or four times a day for 7 days). If
that does not work, an antifungal drug solution can be tried. If the infection fails to
respond to the drug, oral antifungal therapy may be needed. Neither antibiotic ear drops
nor oral antibiotics are indicated as the first course of treatment. IV antifungal agents
are not indicated at all.
994. 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.
995. A 6-year-old child has otitis media and is being treated with amoxicillin [Amoxil]
and ibuprofen [Motrin]. The child's parent calls the nurse to report that the child's pain is
not relieved with the ibuprofen. The child is afebrile and there is no drainage from either
ear. The nurse will discuss which additional treatment with the child's provider?
a. Adding acetaminophen [Tylenol] to the pain medication regimen
b. Applying antipyrine and benzocaine [Aurodex] solution to the ear canals
c. Changing the antibiotic to amoxicillin/clavulanate [Augmentin]
d. Performing a tympanostomy to relieve pressure in the middle ear - ANS: B
For children over age 5 years, the AAP guidelines recommend topical anesthetic ear
drops for pain relief; this is contraindicated if the TM is perforated. This child does not
have drainage, indicating intact eardrums. Adding another oral analgesic will not be as
effective as a topical anesthetic. The child is afebrile, so there is no concern about a
resistant infection. Tympanostomy is not indicated.
,996. 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.
997. A 2-year-old child is seen in the clinic in July with otalgia, erythematous, bulging
tympanic membranes (TMs), 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
otolaryngologist.
d. prescribe high-dose amoxicillin [Amoxil] and administer the influenza vaccine. - ANS:
C
Recurrent AOM is defined as AOM that occurs three or more times within 6 months or
four or more times in a year. Giving an antibiotic, such as Augmentin, is appropriate for
each episode, and referral to an ENT specialist is recommended to help reduce risk. IM
Rocephin might be an appropriate treatment for an episode, but a flu vaccine is not
recommended in July. Prophylactic antibiotic therapy is not recommended. High-dose
amoxicillin might be an appropriate treatment for an episode, but a flu vaccine is not
recommended in July.
998. The nurse is administering ear drops to a patient with acute bacterial otitis externa.
Which procedure would assist drug penetration into the ear canal?
a. Administering refrigerated drops
b. Inserting a sponge wick into the ear canal and then administering the drops
c. Cleaning out the earwax with a cotton-tipped swab before giving the drops
d. Inserting earplugs after administering the drops - ANS: B
Insertion of a sponge wick can aid delivery of the ear drops to the epithelium of the ear
canal. Medication is absorbed into the wick, which delivers the drug to the epithelium.
Ear drops should be warmed before administration to prevent dizziness, which may
occur with instillation of cold drops. Cerumen should not be removed. Inserting cotton-
tipped swabs may damage the epithelium. The use of earplugs may lead to further
problems with bacterial otitis externa.
, 999. 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.
1000. A child has been diagnosed with otitis media with effusion (OME), and the child's
parent asks the nurse what this means. The nurse will explain that OME is:
a. a condition with a heightened risk of acute otitis media.
b. an acute ear infection with fluid in the middle ear.
c. ban binfection bof bthe bskin band btissues bof bthe bouter bear.
d. bfluid bin bthe bmiddle bear bwithout blocalized bor bsystemic binfection. b- b bANS: bD
OME boccurs bin bmany bchildren bafter ban bepisode bof bAOM. bIt bis bcharacterized bby bfluid bin
bthe bmiddle bear bwithout bevidence bof blocal bor bsystemic billness. bIt bdoes bnot bnecessarily
bpose ba bheightened brisk bof bAOM. bOME bis bnot ban bacute bear binfection bor ban binfection bof
bthe bouter bear.
1001. bA b12-month-old bchild battends bday bcare band bis bseen bin ba bclinic bfor ba bsecond
bmiddle bear binfection bsince bage b8 bmonths. bThe bparent bcalls bthe bnurse bto breport bthat
c. bSchedule ba bclinic bappointment bfor bthe bchild bto breceive bceftriaxone b[Rocephin] bIM.
d. bTell bthe bparent bthe bchild bwill bprobably bneed bsurgery bfor btympanostomy btubes bto
breduce
infections. b- b bANS: bA
Resistant bAOM bis bon bthe brise bbecause bof bthe bemergence bof bresistant bpathogens bsuch
bas bHaemophilus binfluenzae band bMoraxella bcatarrhalis, bwhich bare bresistant bto bbeta-
lactam bantibiotics, band bStreptococcus bpneumoniae, bwhich bsynthesizes baltered
bpenicillin-binding bproteins. bResistance bis btreated bwith bhigh-dose
bamoxicillin-resistant bS. bpneumoniae, band bthe bclavulanate bcomponent bovercomes bbeta-
blactam bresistance bof bH. binfluenzae band bM. bcatarrhalis. bRemoving ba bchild bfrom bday bcare
bcan bhelp breduce bthe bnumber bof bear binfections bin binfants band byoung bchildren. bThis bchild
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