Rosenthal: Lhene's Pharmacotherapeutics for Advanced Practice chapter 84 to 86:Drug for the Ear, Eye &Skin TEST Q & A VERIFIED2023

d. use antifungal ear drops before and after swimming. correct answers 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. correct answers 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. correct answers 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." correct answers 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 correct answers 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." correct answers 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. correct answers 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.