final Exam 4 Pharm Practice Questions and answers.docx
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Course
Material Health
Institution
Material Health
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 cana...
,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. - 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.
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 - Correct Answers: 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
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