A nurse is teaching a client's caregiver how to administer an otic medication to the client. Which of the following statements by the caregiver indicates an understanding of the teaching?

"I will pull the top of the ear up and back before I give the drops."

"I will have them lie flat in bed to give the drops."

"I will wait for the drops to cool before administering them."

"I will tell them to tilt their head back while I am instilling the drops."

Answer and Explanation

The Correct Answer is A

Otic medication administration involves the instillation of sterile or non-sterile solutions into the external auditory canal. Proper positioning of the auricle is essential to straighten the ear canal and ensure the medication reaches the tympanic membrane.

Rationale:

A. Pulling the pinna up and back is the correct technique for an adult client to straighten the external auditory canal. This maneuver allows the drops to flow freely toward the eardrum rather than becoming trapped in the curves of the canal. For children under the age of 3, the nurse should teach the caregiver to pull the pinna down and back instead to achieve the same result.

B. Lying flat in bed is not the ideal position for receiving otic drops, as the medication may not flow deep enough into the canal. The client should be in a side-lying position with the affected ear facing upward to facilitate the gravitational flow of the solution. This position should be maintained for several minutes after instillation to ensure maximum absorption and prevent the medication from leaking out.

C. Cooling otic drops before administration is incorrect because cold solutions can cause extreme discomfort and trigger a vestibular response known as the caloric reflex. This reflex can result in severe vertigo, nausea, and nystagmus. Caregivers should be instructed to warm the medication container by rolling it between their hands to reach body temperature, ensuring a more comfortable and safe administration.

D. Tilting the head back is a technique used for ophthalmic or nasal instillations rather than otic medications. For the ear, the head must be tilted toward the opposite shoulder so the affected ear is horizontal and pointing toward the ceiling. Tilting the head backward would cause the drops to run down the side of the face rather than entering the ear canal effectively.

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Correct Answer is D

Explanation

Anaphylaxis is a severe type I hypersensitivityreaction characterized by systemic mast cell degranulation and bronchoconstriction. While epinephrine is the first-line treatment for its vasopressorand bronchodilatory effects, refractory respiratory distress requires secondary interventions to stabilize the airway. Targeted beta-2 agonists are used to provide localized relief of bronchospasm.

Rationale:

A.Selegiline is a monoamine oxidase inhibitor (MAOI) used primarily in the management of Parkinson's disease. It has no role in the acute treatment of anaphylaxis or respiratory distress. Administering an MAOI in an emergency setting could actually lead to dangerous drug interactions with the epinephrine already given, potentially triggering a hypertensive crisis or cardiac arrhythmia.

B.Abatacept is a selective costimulation modulator used for the treatment of rheumatoid arthritis by inhibiting T-cell activation. It is a maintenance medication for chronic autoimmune conditions and does not provide the rapid bronchodilation required for an acute allergic emergency. Its onset of action is far too slow to address the immediate threat of airway occlusion following a bee sting.

C.Sucralfate is a gastroprotective agent that forms a complex over ulcer sites in the stomach. It is administered orally and has no systemic effect on the respiratory or cardiovascular systems. Using sucralfate in a client with severe dyspnea is inappropriate and dangerous, as the patient is at high risk for aspiration and requires immediate parenteral or inhaled interventions.

D.Albuterol is a rapid-acting beta-2 adrenergic agonist that provides direct bronchodilation to relieve the wheezing and airway constriction associated with anaphylaxis. When a client has a suboptimal response to epinephrine, inhaled albuterol helps to further relax the smooth muscles of the bronchioles. This is a critical secondary intervention to improve ventilation and reduce the work of breathing.

A. "Use a nasal decongestant 15 minutes before the medication if you have a stuffy nose." B. "Administer the medication into one nostril once per week." C. "Lie down for 1 hour after administering the medication." D. "Plan to self-administer this medication for the next 6 months."

Correct Answer is B

Explanation

Pernicious anemia is a condition caused by a deficiency of intrinsic factor, preventing the absorption of dietary Vitamin B12(cyanocobalamin). Because the oral route is ineffective in these clients, B12 must be administered via parenteral or nasal routes to bypass the gastrointestinal tract. This therapy is essential for erythropoiesisand preventing irreversible neurological damage.

Rationale:

A.Using a nasal decongestant shortly before administering nasal cyanocobalamin is not recommended because it can alter the absorption of the vitamin by constricting the nasal vasculature. The client should be taught to avoid hot foods or liquids immediately before or after administration as well. If the client has a significant upper respiratory infection, they may need to switch to an intramuscular injection temporarily.

B.Nasal cyanocobalamin is typically administered once per week in a single nostril for maintenance therapy in clients with pernicious anemia. This schedule ensures a consistent supply of Vitamin B12 to maintain adequate red blood cell production and nerve health. The nurse must emphasize the weekly schedule to ensure the client remains compliant and avoids a return of hematologic symptoms.

C.There is no clinical requirement for a client to lie down for 1 hour after using nasal cyanocobalamin. The medication is absorbed through the nasal mucosa quite efficiently while the client is in a normal upright position. Instructing the client to lie down for such an extended period is unnecessary and would place an undue burden on their daily routine without improving drug efficacy.

D.Pernicious anemia is a chronic, lifelong condition because the lack of intrinsic factor cannot be cured. Therefore, Vitamin B12 replacement therapy must be continued for the duration of the client's life, not just for 6 months. Stopping the medication will eventually lead to a recurrence of megaloblastic anemia and potentially permanent damage to the spinal cord and peripheral ne

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A nurse is teaching a client's caregiver how to administer an otic medication to the client. Which of the following statements by the caregiver indicates an understanding of the teaching?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in an emergency department is caring for a client who is experiencing severe dyspnea and wheezing following a bee sting. After administering epinephrine, the client is still experiencing manifestations. Which of the following medications should the nurse plan to administer?

Correct Answer is D

Explanation

A nurse is teaching a client who has pernicious anemia to self-administer nasal cyanocobalamin. Which of the following information should the nurse include in the teaching?

Correct Answer is B

Explanation

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