Chapter 53, Otic and Ophthalmic Preparations Introductory Clinical Pharmacology 12th Edition by Susan M Ford

Introductory Clinical Pharmacology 12th Edition by Susan M Ford 1. A client is diagnosed with springtime allergic conjunctivitis. The nurse predicts the client will be prescribed which otic solution? a. Brimonidine b. Gatifloxacin c. Betaxolol d. Nedocromil Answer: D Rationale: Mast cell stabilizers, such as nedocromil, are ophthalmic drugs useful in a client who has allergic conjunctivitis during the spring. Brimonidine is used to lower IOP in clients with open-angle glaucoma or ocular hypertension. Gatifloxacin is an antibiotic. Betaxolol is a beta-adrenergic blocking drug used for chronic open-angle glaucoma and ocular hypertension. Question format: Multiple Choice Chapter: 53 Learning Objective: 1 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 744, Summary Drug Table 2. A nurse is caring for a client who is prescribed 1% hydrocortisone/4.71 mg neomycin for bacterial infection of the external auditory canal. Which instructions should the nurse utilize when administering the otic solution? a. With the client upright, remove the solution running out of the ear with gauze. b. After instilling the drops, insert a cotton piece deep into the ear to keep the drops in. c. Keep the client lying on the untreated side for 30 minutes after instilling the drops. d. Insert the applicator or dropper tip sufficiently to reach into the external auditory canal. Answer: A Rationale: Once the client is upright, the solution running out of the ear may be gently removed with gauze. A piece of cotton can be loosely inserted into the ear canal, but it should never be inserted deeply because if inserted too deeply it may cause increased pressure within the ear canal. The client is kept lying on the untreated side after the medication is instilled for approximately 5 minutes to facilitate the penetration of the drops into the ear canal. The nurse should not insert the applicator or dropper tip anywhere into the ear or allow the tip to become contaminated. Question format: Multiple Choice Chapter: 53 Learning Objective: 4 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 735, Client Receiving an Otic Preparation 3. A client with chronic open-angle glaucoma has been prescribed brimonidine tartrate. After administering the drug, the nurse should monitor the client for which potential adverse reaction? a. Allergic lip reactions b. Foreign body sensation c. Deposits in the cornea d. Brow ache and headache Answer: B Rationale: Although side effects are usually mild, treatment with brimonidine tartrate includes local effects like foreign body sensation, ocular hyperemia, burning and stinging, headache, visual blurring, ocular allergic reactions, and ocular pruritus. Allergic lip reactions, deposits in the cornea, brow ache, and headache are the transient local reactions to sympathomimetic drugs. Question format: Multiple Choice Chapter: 53 Learning Objective: 2 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 739, Cycloplegic Mydriatics 4. The nurse is administering trifluridine to a client with epithelial keratitis. The nurse will prioritize which finding on the ongoing assessment of this client? a. Edema of the eyes b. Loss of visual acuity c. Cataract formation d. Delayed wound healing Answer: A Rationale: Trifluridine is an antiviral drug, and administration of antiviral ophthalmics may cause local reactions such as edema of the eyes or eyelids, irritation, pain, pruritus, inflammation, foreign body sensation, and corneal clouding. Loss of visual acuity, cataract formation, and delayed wound healing are the local adverse reactions associated with the administration of corticosteroid ophthalmic preparations such as dexamethasone phosphate and are not related to the administration of trifluridine. Question format: Multiple Choice Chapter: 53 Learning Objective: 2 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 739, Antibiotics, and Sulfonamides 5. A client is admitted to the health care facility with acute glaucoma. After administering the prescribed ophthalmic drugs, the nurse continues to assess the client for pain relief at which frequency? a. Every hour b. Every 2 hours c. Every 3 hours d. Every 4 hours Answer: B Rationale: Clients admitted for treatment of acute glaucoma should be assessed every 2 hours for relief of pain. Pain in the eye may indicate increased intraocular pressure. Question format: Multiple Choice Chapter: 53 Learning Objective: 2 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 741, Client Receiving an Ophthalmic Preparation 6. A client receiving ophthalmic drugs reports blurred vision. The client tells the nurse, “I almost fell yesterday.” The nurse will prioritize which nursing diagnosis for this client? a. Risk for infection b. Risk for injury c. Acute pain d. Anxiety Answer: B Rationale: The client's report of blurred vision and the report of almost falling support the nursing diagnosis of risk for injury. Risk for infection would be appropriate if the client had an infection or did not correctly instill the eye drops, contaminating the container and/or solution. Acute pain would be more appropriate if the client reported pain either from the disorder or as an adverse effect. Although the client may be anxious, there is no evidence to support it. Question format: Multiple Choice Chapter: 53 Learning Objective: 3 Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 742, Injury Risk 7. After teaching a client how to administer eye drops, the nurse determines that additional teaching is needed when the client makes which statement?