Question 1

A 12-month-old child attends day care and is seen in a clinic for a second middle ear infection since age 8 months. The parent calls the nurse to report that after the third day of giving amoxicillin [Amoxil], the child continues to have a temperature of 39.5°C and is unable to sleep well because of pain. What will the nurse do?

A) Encourage the parent to discuss amoxicillin/clavulanate [Augmentin] with the child's provider.
B) Recommend that the parent consider removing the child from day care to reduce exposure to infection.
C) Schedule a clinic appointment for the child to receive ceftriaxone [Rocephin] IM.
D) Tell the parent the child will probably need surgery for tympanostomy tubes to reduce infections.

Accepted Answer

Resistant AOM is on the rise because of the emergence of resistant pathogens such as Haemophilus influenzae and Moraxella catarrhalis, which are resistant to beta-lactam antibiotics, and Streptococcus pneumoniae, which synthesizes altered penicillin-binding proteins. Resistance is treated with high-dose amoxicillin/clavulanate. The high dose of amoxicillin increases activity against amoxicillin-resistant S. pneumoniae, and the clavulanate component overcomes beta-lactam resistance of H. influenzae and M. catarrhalis. Removing a child from day care can help reduce the number of ear infections in infants and young children. This child has only experienced two episodes, and removing the child from day care may not be easy for this family, so this recommendation is not appropriate at this time. IM Rocephin is not recommended. Surgery for bilateral myringotomy tympanotomy tubes (BMTT) is used to reduce the number of episodes in children with recurrent AOM.

Question 2

Which are components of otitis externa management?&#10;A) Ciprofloxacin and hydrocortisone otic drops&#10;B) Cleaning the ear canals with a cotton-tipped applicator&#10;C) Keeping the external ear canal dry after swimming&#10;D) Taking systemic antibiotics, such as amoxicillin/clavulanate [Augmentin]&#10;E) Using a solution of alcohol and acetic acid to dry and acidify the ear

Accepted Answer

Antibiotic ear drops, rather than systemic antibiotics, are highly effective and are not ototoxic, so ciprofloxacin plus dexamethasone [Ciprodex] is commonly used. Drying the ear canals is important to maintain their natural defenses. Alcohol and acetic acid can be used to treat fungal external ear infections. Using a cotton-tipped applicator can abrade the skin and break down the body's natural defenses. Systemic antibiotics are not recommended.

Question 3

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?&#10;A) &#34;I should not give analgesics, because they may mask important symptoms.&#34;&#10;B) &#34;I will give ibuprofen or acetaminophen for pain or fever as needed.&#34;&#10;C) &#34;I will let my provider know if the symptoms are not better in 1 week.&#34;&#10;D) &#34;There is a slight risk of mastoiditis if antibiotic therapy is delayed.&#34;

Accepted Answer

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.

Question 4

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

Accepted Answer

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.

Question 5

The nurse is administering ear drops to a patient with acute bacterial otitis externa. Which procedure would assist drug penetration into the ear canal?&#10;A) Administering refrigerated drops&#10;B) Inserting a sponge wick into the ear canal and then administering the drops&#10;C) Cleaning out the earwax with a cotton-tipped swab before giving the drops&#10;D) Inserting earplugs after administering the drops

Accepted Answer

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.

Question 6

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."

Accepted Answer

A 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.

Question 7

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:&#10;A) allow the ears to drain well after every swim and shower.&#10;B) clean the ears with a cotton-tipped applicator after swimming.&#10;C) keep the ear canals free of cerumen.&#10;D) use antifungal ear drops before and after swimming.

Accepted Answer

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.

Question 8

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.

Accepted Answer

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.

Question 9

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:&#10;A) a condition with a heightened risk of acute otitis media.&#10;B) an acute ear infection with fluid in the middle ear.&#10;C) an infection of the skin and tissues of the outer ear.&#10;D) fluid in the middle ear without localized or systemic infection.

Accepted Answer

OME occurs in many children after an episode of AOM. It is characterized by fluid in the middle ear without evidence of local or systemic illness. It does not necessarily pose a heightened risk of AOM. OME is not an acute ear infection or an infection of the outer ear.

Question 10

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.

Accepted Answer

Recurrent AOM is defined as AOM that occurs 3 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.

Question 11

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?&#10;A) &#34;I should hold my baby in an upright position during feeding.&#34;&#10;B) &#34;I should keep my baby out of day care during cold and flu season.&#34;&#10;C) &#34;My baby should not use a pacifier after 6 months of age.&#34;&#10;D) &#34;The pneumococcal vaccine will prevent my baby from getting ear infections.&#34;

Accepted Answer

The answer of A nurse is discussing health maintenance with...

Question 12

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:&#10;A) acidifying drops for 1 week.&#10;B) antibiotic ear drops.&#10;C) intravenous (IV) antifungal agents.&#10;D) oral antibiotics.

Accepted Answer

The answer of A patient has been diagnosed with fungal...

Deck 106: Drugs for the Ear