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.
Give this one a try later!
, 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
960. A patient has had dilation of the eyes with an anticholinergic agent. What will the
nurse say when preparing this patient to go home after the examination?
a. "Systemic side effects will not occur with this agent."
b. "You may experience an increased heart rate, but this is a harmless side effect."
c. "You may need to wear dark glasses until this medication wears off."
d. "You will be able to read as soon as the examination is completed."
Give this one a try later!
ANS: C
Because the agent causes cycloplegia, which paralyzes the iris sphincter,
the eyes are unable to respond to bright light, so patients should be
advised to wear sunglasses until this effect wears off. Systemic side effects
do occur with these agents. Tachycardia is a systemic effect and may
indicate toxicity. Mydriasis is an effect of this drug, causing the eye to be
unable to focus; patients will have blurred vision until this effect wears off.
A patient admitted to the hospital has been using phenylephrine nasal spray [Neo-
Synephrine], 2 sprays every 4 hours, for a week. The patient complains that the
medication is not working, because the nasal congestion has increased. What will the
nurse do?
a. Request an order for an oral decongestant to replace the intranasal phenylephrine.
b. Request an order for an intranasal glucocorticoid to be used while the
,phenylephrine is
withdrawn.
c. Tell the patient to increase the dose of phenylephrine to 4 sprays every 4 hours.
d. Tell the patient to stop using the phenylephrine and begin using an intranasal
antihistamine.
Give this one a try later!
ANS B.
This patient is experiencing rebound congestion, which develops when
topical sympathomimetics are used for longer than a few days. Abrupt
withdrawal can stop the cycle of rebound congestion but is uncomfortable,
so using an intranasal glucocorticoid, beginning 1 week before
discontinuing the decongestant, while withdrawing the decongestant, is
recommended. An oral decongestant is not recommended. Increasing the
dose of the intranasal decongestant will only compound the problem of
rebound congestion. Stopping the intranasal decongestant will only
increase the congestion; using an intranasal antihistamine will not help with
congestion
A pregnant patient asks the nurse if she can take antihistamines for seasonal allergies
during her pregnancy. What will the nurse tell the patient?
Antihistamines should be avoided unless absolutely necessary.
Second-generation antihistamines are safer than first-generation antihistamines.
Antihistamines should not be taken during pregnancy but may be taken when
breastfeeding.
The margin of safety for antihistamines is clearly understood for pregnant patients.
Give this one a try later!
Antihistamines should be avoided unless absolutely necessary.
, A patient has been taking phentermine and topiramate [Osymia] for 6 months for
weight loss. The nurse weighs the patient and notes a 3% weight loss since beginning
the drug. The nurse will expect the prescriber to:
continue the current dosage for 4 more weeks.
discontinue the drug.
increase the drug dosage.
switch to another nonamphetamine agent.
Give this one a try later!
discontinue the drug.
Which of the following is most likely an intervention for otitis media?
Amoxicillin
Aspirin
Immunoglobulins
Corticosteroids
Give this one a try later!
Amoxicillin
A nurse is teaching a patient who has taken glucocorticoids for over a year about
glucocorticoid withdrawal. Which statement by the patient indicates a need for
further teaching?
"I should reduce the dose by half each day until I stop taking the drug."
"I will need to have cortisol levels monitored during the withdrawal process."
"The withdrawal schedule may take several months."
"If I have surgery, I may need to take the drug for a while, even after I have stopped."
Give this one a try later!
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.
Give this one a try later!
, 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
960. A patient has had dilation of the eyes with an anticholinergic agent. What will the
nurse say when preparing this patient to go home after the examination?
a. "Systemic side effects will not occur with this agent."
b. "You may experience an increased heart rate, but this is a harmless side effect."
c. "You may need to wear dark glasses until this medication wears off."
d. "You will be able to read as soon as the examination is completed."
Give this one a try later!
ANS: C
Because the agent causes cycloplegia, which paralyzes the iris sphincter,
the eyes are unable to respond to bright light, so patients should be
advised to wear sunglasses until this effect wears off. Systemic side effects
do occur with these agents. Tachycardia is a systemic effect and may
indicate toxicity. Mydriasis is an effect of this drug, causing the eye to be
unable to focus; patients will have blurred vision until this effect wears off.
A patient admitted to the hospital has been using phenylephrine nasal spray [Neo-
Synephrine], 2 sprays every 4 hours, for a week. The patient complains that the
medication is not working, because the nasal congestion has increased. What will the
nurse do?
a. Request an order for an oral decongestant to replace the intranasal phenylephrine.
b. Request an order for an intranasal glucocorticoid to be used while the
,phenylephrine is
withdrawn.
c. Tell the patient to increase the dose of phenylephrine to 4 sprays every 4 hours.
d. Tell the patient to stop using the phenylephrine and begin using an intranasal
antihistamine.
Give this one a try later!
ANS B.
This patient is experiencing rebound congestion, which develops when
topical sympathomimetics are used for longer than a few days. Abrupt
withdrawal can stop the cycle of rebound congestion but is uncomfortable,
so using an intranasal glucocorticoid, beginning 1 week before
discontinuing the decongestant, while withdrawing the decongestant, is
recommended. An oral decongestant is not recommended. Increasing the
dose of the intranasal decongestant will only compound the problem of
rebound congestion. Stopping the intranasal decongestant will only
increase the congestion; using an intranasal antihistamine will not help with
congestion
A pregnant patient asks the nurse if she can take antihistamines for seasonal allergies
during her pregnancy. What will the nurse tell the patient?
Antihistamines should be avoided unless absolutely necessary.
Second-generation antihistamines are safer than first-generation antihistamines.
Antihistamines should not be taken during pregnancy but may be taken when
breastfeeding.
The margin of safety for antihistamines is clearly understood for pregnant patients.
Give this one a try later!
Antihistamines should be avoided unless absolutely necessary.
, A patient has been taking phentermine and topiramate [Osymia] for 6 months for
weight loss. The nurse weighs the patient and notes a 3% weight loss since beginning
the drug. The nurse will expect the prescriber to:
continue the current dosage for 4 more weeks.
discontinue the drug.
increase the drug dosage.
switch to another nonamphetamine agent.
Give this one a try later!
discontinue the drug.
Which of the following is most likely an intervention for otitis media?
Amoxicillin
Aspirin
Immunoglobulins
Corticosteroids
Give this one a try later!
Amoxicillin
A nurse is teaching a patient who has taken glucocorticoids for over a year about
glucocorticoid withdrawal. Which statement by the patient indicates a need for
further teaching?
"I should reduce the dose by half each day until I stop taking the drug."
"I will need to have cortisol levels monitored during the withdrawal process."
"The withdrawal schedule may take several months."
"If I have surgery, I may need to take the drug for a while, even after I have stopped."
Give this one a try later!
