Question 1

A parent brings in a 2-month-old infant with a 5-day history of a white coating on the tongue and decreased oral intake.The primary care NP should prescribe:&#10;A) clotrimazole, one troche tid.&#10;B) chlorhexidine, 15 mL oral rinse bid.&#10;C) carbamide peroxide, 2 to 3 drops tid.&#10;D) nystatin oral suspension, 200,000 units qid.

Accepted Answer

Nystatin is an antifungal medication and is indicated for treatment of oral candidiasis,or thrush.Clotrimazole is an antifungal but is not indicated for oral candidiasis in infants because the patient must be able to allow the troche to dissolve.Chlorhexidine is used to treat gingivitis.Carbamide peroxide is used to treat minor oral inflammation.

Question 2

The primary care NP examines an adolescent who complains of severe right ear pain for the past 3 days.When retracting the pinna of the right ear to examine the ear,the NP notes erythema,edema,and pain and a large amount of white exudate in the ear canal.The NP should prescribe:

A) benzocaine otic drops tid.
B) ciprofloxacin otic drops qid.
C) glycerin oil drops weekly.
D) acetic acid, boric acid, and isopropyl alcohol solution.

ciprofloxacin otic drops qid.

Accepted Answer

This patient has otitis externa.Ciprofloxacin otic drops instilled onto a wick in the ear canal are indicated to treat this condition.Benzocaine is a local anesthetic and would not treat the infection.Glycerin oil drops are used to soften cerumen.An acetic acid,boric acid,and isopropyl alcohol solution is used to prevent,not treat,otitis externa.

Question 3

A primary care NP examines a patient who complains of chronic,intermittent watery eyes and runny nose.The NP notes cobblestone-like papillae inside the upper eyelid with nonerythematous conjunctivae.The NP should:

A) prescribe intranasal corticosteroids.
B) refer the patient to an ophthalmologist.
C) prescribe trifluridine ophthalmic eye drops.
D) apply fluorescein dye to examine the cornea.

Accepted Answer

This patient has symptoms characteristic of allergic conjunctivitis.Any allergic rhinitis should be treated first.Intranasal corticosteroids are often effective.It is not necessary to refer to an ophthalmologist.Trifluridine is an antiviral solution used to treat documented herpetic keratitis.Fluorescein dye is used to assess for corneal abrasions or tears.

Question 4

A patient who has year-round allergic rhinitis uses an intranasal corticosteroid and a daily oral antihistamine.The patient reports persistent watery and itchy eyes.The primary care NP observes profuse clear,watery discharge and a cobblestone appearance inside the upper eyelids,with clear conjunctivae.The patient has tried topical azelastine (Astelin)and topical diclofenac (Voltaren)without improvement.The NP should prescribe _____ drops.

A) timolol (Timoptic)
B) pilocarpine (Isopto)
C) nedocromil (Tilade)
D) dexamethasone (Decadron)

Accepted Answer

Topical mast cell stabilizers,such as nedocromil,are good for long-term treatment of allergic conjunctivitis.Timolol and pilocarpine are used to treat glaucoma.Dexamethasone is prescribed for severe cases of conjunctivitis but should be prescribed only by an ophthalmologist.

Question 5

A primary care nurse practitioner (NP)sees a patient who has a 1-week history of watery,painful eyes with copious amounts of clear discharge and a sore throat.The NP observes bilateral erythema of the conjunctivae and palpates enlarged preauricular lymph nodes.The NP should prescribe _____ drops.

A) ganciclovir
B) ophthalmic antibiotic
C) sympathomimetic ophthalmic
D) nonsteroidal antiinflammatory

Accepted Answer

The patient has symptoms of viral conjunctivitis; clear discharge is characteristic.Antibiotic drops are often prescribed to prevent a bacterial infection.Ganciclovir drops are antiviral drops but are reserved for patients with a clinical diagnosis of herpetic keratitis by an ophthalmologist.Sympathomimetic drops are used to treat glaucoma.Nonsteroidal antiinflammatory drops are sometimes used for allergic conjunctivitis.

Question 6

The primary care NP teaches a patient how to instill eye drops for a prescription that requires two drops twice daily.Which statement by the patient indicates understanding of the teaching?&#10;A) &#34;I should gently massage my eyes for 3 to 5 minutes after instilling the drops.&#34;&#10;B) &#34;I should put in one drop and wait 5 minutes before putting in the other one.&#34;&#10;C) &#34;To make sure the medicine is evenly distributed, I should blink several times.&#34;&#10;D) &#34;I may continue wearing my soft contact lenses while I am using this medication.&#34;

Accepted Answer

One drop of medication is all the eye can retain.If more than one drop is used,teach the patient to wait 5 minutes before applying the second drop.The eyes should not be rubbed after instillation of the drops.Patients should look down for a few seconds and then close the eyes.Soft contact lenses can absorb the medication and should not be worn.

Question 7

An 80-year-old patient has a diagnosis of glaucoma,and the ophthalmologist has prescribed timolol (Timoptic)and pilocarpine eye drops.The primary care NP should counsel this patient:&#10;A) that systemic side effects of these medications may be severe.&#10;B) that the combination of these two drugs may cause drowsiness.&#10;C) to begin an exercise program to improve cardiovascular health.&#10;D) that a higher dose of one or both of these medications may be needed.

Accepted Answer

Older patients are susceptible to systemic effects of topical eye drops.Timolol can cause cerebrovascular,central nervous system,and respiratory side effects,and pilocarpine can cause systemic b-blocker effects.The combination does not cause drowsiness.Although there is some correlation between cardiovascular health and glaucoma,beginning a new exercise program is not indicated.A higher dose of the medications would increase systemic side effects.

Deck 14: Eye, Ear, Throat, and Mouth Agents