A nurse is caring for a client who states, "No wonder we can't get control of my pain! You don't even believe me when I tell you how much I hurt!" Which of the following defense mechanisms should the nurse identify the client using?

Rationale:

A. Pull the client's pinna down and back to apply the solution.: Pulling the pinna down and back is the correct technique for infants and young children due to the angle of the ear canal. For adults, the pinna should be pulled up and back to straighten the ear canal. Using the incorrect direction can prevent proper visualization and reduce effectiveness of the irrigation.

B. Perform the procedure using sterile gloves.: Ear irrigation is a clean procedure, not a sterile one. The external ear canal is not a sterile environment, and using sterile gloves does not reduce infection risk. Clean gloves provide adequate protection while maintaining proper hygiene during cerumen removal.

C. Administer the irrigation solution at room temperature to the ear.: Using a solution at room temperature prevents stimulation of the vestibular system, which can cause dizziness, nausea, and vertigo. A temperature-neutral solution promotes client comfort and reduces physiologic irritation while effectively helping soften and remove cerumen.

D. Apply a stream of pressure as long as the client can tolerate.: Using forceful or prolonged pressure can damage the tympanic membrane or push cerumen deeper into the canal. Irrigation should be done gently, allowing the solution to flow along the canal wall and stopping immediately if the client reports pain or dizziness to avoid injury.

Rationale:

A. Hyperkalemia: Furosemide is a loop diuretic that promotes potassium excretion, which can lead to hypokalemia, not hyperkalemia. Monitoring for low potassium is important, but hyperkalemia is not a primary concern with these medications.

B. Hypoglycemia: Neither furosemide nor gentamicin directly affects blood glucose levels. Hypoglycemia is not a typical complication of these medications.

C. Ototoxicity: Gentamicin, an aminoglycoside antibiotic, and furosemide, a loop diuretic, can both cause ototoxicity, which may result in tinnitus, hearing loss, or balance disturbances. Monitoring for auditory changes is essential when these medications are used concurrently.

D. Liver toxicity: These medications are not primarily hepatotoxic. Liver function monitoring is not a routine requirement for furosemide or gentamicin unless there are other predisposing conditions.