Why does acute otitis media occur more often in young children than in adults?
Their eustachian tubes are shorter and more horizontal
✓
Their eardrums are thicker and less flexible
Their ear canals produce more cerumen
Their cochlear hair cells are still forming
Correct Answer
Their eustachian tubes are shorter and more horizontal
A child's eustachian tube is shorter and lies more horizontally, so it drains the middle ear poorly and lets secretions from the back of the nose reach it, which favors infection. Their eardrums are thicker and less flexible is not the reason; eardrum thickness does not explain the higher rate. Their ear canals produce more cerumen is incorrect; earwax sits in the outer canal and does not cause middle ear infection. Their cochlear hair cells are still forming is wrong; the cochlea is in the inner ear and has no role in otitis media.
Category: Ear Anatomy and Disorders
Question 2
Before a patient starts a course of a drug known to be ototoxic, which baseline assessment should the nurse make sure is done?
Visual acuity test
Hearing assessment
✓
Skin integrity check
Grip strength test
Correct Answer
Hearing assessment
Ototoxic drugs can damage the hearing and balance structures of the inner ear, so a baseline hearing assessment lets later changes be detected and compared. A visual acuity test checks the eyes, not the ears. A skin integrity check does not detect inner ear damage. A grip strength test measures muscle strength, which ototoxic drugs do not target.
Category: Ototoxicity
Question 3
When giving ear drops to a toddler, how should the nurse straighten the ear canal?
Pull the pinna up and back
Push the tragus firmly forward
Pull the pinna down and back
✓
Pull the earlobe up and forward
Correct Answer
Pull the pinna down and back
In infants and toddlers the ear canal angles upward, so gently pulling the pinna down and back straightens it and lets the drops reach the canal. Pull the pinna up and back is the technique for adults and older children. Push the tragus firmly forward would close off the canal opening. Pull the earlobe up and forward does not straighten a young child's canal.
Category: Ear Drop Technique
Question 4
Why does the nurse roll an ear drop bottle between the hands before instilling the drops?
Warming activates the drug in the bottle
Body heat kills bacteria in the solution
Cold drops form crystals in the canal
Cold drops can cause dizziness and nausea
✓
Correct Answer
Cold drops can cause dizziness and nausea
Drops instilled cold can stimulate the inner ear's balance organs and cause vertigo, dizziness and nausea, so they are warmed to about body temperature, but never heated beyond it. Warming activates the drug in the bottle is false; otic drugs are already active. Body heat kills bacteria in the solution is false; hand warmth does not sterilize anything. Cold drops form crystals in the canal is not a recognized effect.
Category: Ear Drop Technique
Question 5
After a nurse instills ear drops for a patient with otitis externa, what should the patient do next?
Stay lying with the treated ear facing up for a short time
✓
Turn the treated ear downward right away
Use a cotton swab to spread the drops
Shake the head gently to move the drops inward
Correct Answer
Stay lying with the treated ear facing up for a short time
Keeping the treated ear facing up for a short time lets the drops flow down the canal and limits leakage. Turn the treated ear downward right away lets the drug drain out before it acts. Use a cotton swab to spread the drops is wrong because swabs push debris inward and can injure the canal. Shake the head gently to move the drops inward is not part of the technique and can cause the drops to spill out.
Category: Ear Drop Technique
Question 6
A child with tympanostomy tubes receives ciprofloxacin-dexamethasone drops for acute otitis media. After instilling the drops, what does the nurse do to move them through the tube?
Pack the ear canal tightly with cotton
Press the tragus several times in a pumping motion
✓
Flush the canal with warm tap water
Pull the earlobe down firmly and hold it
Correct Answer
Press the tragus several times in a pumping motion
Pressing the tragus several times in a pumping motion pushes the drops through the tympanostomy tube into the middle ear, where the infection is. Pack the ear canal tightly with cotton would block the canal and is not advised. Flush the canal with warm tap water would wash the drug out and is not done with tubes in place. Pull the earlobe down firmly and hold it does not move drops through the tube.
Category: Ear Drop Technique
Question 7
Why are neomycin-containing ear drops avoided when the eardrum may be perforated?
Neomycin dissolves the tympanostomy tube material
Neomycin is inactive in the middle ear
Neomycin reaching the middle and inner ear can damage hearing
✓
Neomycin causes severe hypoglycemia when absorbed
Correct Answer
Neomycin reaching the middle and inner ear can damage hearing
With a hole in the eardrum, drops can reach the middle ear and inner ear, and aminoglycosides such as neomycin are ototoxic there, so fluoroquinolone drops such as ofloxacin are preferred when the eardrum is not intact. Neomycin dissolves the tympanostomy tube material is false. Neomycin is inactive in the middle ear is false; the concern is the damage it can do there. Neomycin causes severe hypoglycemia when absorbed is not a known effect.
Category: Otic Anti-infectives
Question 8
What does the hydrocortisone in neomycin, polymyxin B and hydrocortisone otic drops contribute?
It kills gram-negative bacteria
It softens and loosens earwax
It numbs pain in the ear canal
It reduces inflammation, swelling and itching
✓
Correct Answer
It reduces inflammation, swelling and itching
Hydrocortisone is a corticosteroid that suppresses the inflammatory response, easing swelling, redness, itching and the pain that comes with them. It kills gram-negative bacteria describes the job of the antibiotic components, not the steroid. It softens and loosens earwax describes a cerumenolytic such as carbamide peroxide. It numbs pain in the ear canal describes a local anesthetic, which this product does not contain.
Category: Otic Corticosteroids
Question 9
Otic drops that combine an antibiotic with a corticosteroid are contraindicated in which type of ear canal infection?
Viral infection such as herpes simplex or varicella
✓
Pseudomonas infection of the ear canal
Staphylococcal infection of the ear canal
Bacterial infection after a mastoidectomy
Correct Answer
Viral infection such as herpes simplex or varicella
The corticosteroid in these products can worsen a viral infection, and the antibiotic has no effect on viruses, so viral infections such as herpes simplex or varicella of the canal are a contraindication. Pseudomonas infection of the ear canal is a common reason these drops are prescribed. Staphylococcal infection of the ear canal is another bacterial target of these products. Bacterial infection after a mastoidectomy is a labeled use of the neomycin, polymyxin B and hydrocortisone combination.
Category: Otic Corticosteroids
Question 10
For which patient is ear irrigation to remove impacted earwax contraindicated?
A patient with dry, hard earwax
A patient with tympanostomy tubes
✓
A patient with muffled hearing in one ear
A patient who used softening drops beforehand
Correct Answer
A patient with tympanostomy tubes
Irrigation forces fluid into the canal, and with tympanostomy tubes or a perforated eardrum that fluid can enter the middle ear and cause infection, so irrigation is not done. A patient with dry, hard earwax is a typical candidate once the wax is softened. A patient with muffled hearing in one ear has an expected symptom of impacted wax. A patient who used softening drops beforehand has been prepared correctly, since cerumenolytics are often used before irrigation.
Category: Cerumenolytics
Question 11
How does carbamide peroxide help remove impacted earwax?
It digests the wax with a protein enzyme
It dries the canal with a strong alcohol
It releases oxygen that foams and breaks up the wax
✓
It kills the bacteria that produce earwax
Correct Answer
It releases oxygen that foams and breaks up the wax
Carbamide peroxide releases oxygen in the ear canal, and the foaming action softens and breaks up wax so it can work its way out or be irrigated away; it also has a weak antibacterial effect. It digests the wax with a protein enzyme is incorrect; it does not act as an enzyme. It dries the canal with a strong alcohol describes drying drops used for swimmers. It kills the bacteria that produce earwax is false because earwax is made by glands in the canal, not by bacteria.
Category: Cerumenolytics
Question 12
Before a patient uses carbamide peroxide, which finding means the nurse should hold the drops and check with the provider?
Muffled hearing in that ear
A feeling of fullness in the ear
Dark wax visible in the outer canal
Drainage from the ear
✓
Correct Answer
Drainage from the ear
Ear drainage can mean an infection or a perforated eardrum, and the label says not to use carbamide peroxide with drainage, ear pain, injury or perforation of the eardrum, or recent ear surgery. Muffled hearing in that ear is an expected sign of wax buildup. A feeling of fullness in the ear is also typical of impacted wax. Dark wax visible in the outer canal is the reason the drug is being used.
Category: Cerumenolytics
Question 13
A patient using carbamide peroxide drops reports a bubbling, crackling sound in the ear. How should the nurse respond?
This is the expected foaming action of the drug
✓
This sound means the eardrum has ruptured
This sound means the drops are contaminated
This is the start of an allergic reaction
Correct Answer
This is the expected foaming action of the drug
As carbamide peroxide releases oxygen it foams, and many people hear bubbling or crackling while it works, which is expected. This sound means the eardrum has ruptured is incorrect; foaming sounds do not signal perforation. This sound means the drops are contaminated is incorrect. This is the start of an allergic reaction is incorrect; allergy shows as rash, itching or swelling, not a sound.
Category: Cerumenolytics
Question 14
Which teaching helps a patient prevent earwax from becoming impacted?
Clean deep in the canal daily with cotton swabs
Avoid cleaning inside the canal with cotton swabs
✓
Use wax-removal drops every day
Irrigate the ears with cold water each week
Correct Answer
Avoid cleaning inside the canal with cotton swabs
The ear canal normally clears itself, and cotton swabs push wax deeper and can injure the canal, so patients are taught not to put them in the ear. Clean deep in the canal daily with cotton swabs is the habit that causes impaction. Use wax-removal drops every day is not advised; cerumenolytics are used only for short courses when needed. Irrigate the ears with cold water each week is wrong because cold water can cause vertigo and routine irrigation is unnecessary.
Category: Cerumenolytics
Question 15
A patient being treated with antibiotic drops for otitis externa asks about swimming during the course. What should the nurse teach?
Swim daily so the pool water rinses the canal
Rinse the canal with tap water after each dose
Keep water out of the canal until the infection clears
✓
Dry deep inside the canal with a cotton swab
Correct Answer
Keep water out of the canal until the infection clears
Moisture in the canal softens the skin and supports bacterial growth, so the treated ear is kept dry and swimming is avoided until the infection has cleared. Swim daily so the pool water rinses the canal adds the moisture that caused the problem. Rinse the canal with tap water after each dose washes the drug out and wets the canal. Dry deep inside the canal with a cotton swab can injure the inflamed skin and push debris inward.
Category: Otic Anti-infectives
Question 16
A patient asks about using pseudoephedrine for ear congestion. Which history should prompt the patient to check with a provider first?
Seasonal allergies with sneezing
Iron deficiency anemia
Osteoarthritis of the knee
Urinary retention from an enlarged prostate
✓
Correct Answer
Urinary retention from an enlarged prostate
Pseudoephedrine stimulates alpha-adrenergic receptors, which tightens the bladder neck and can make urinary retention from an enlarged prostate worse. Seasonal allergies with sneezing are a common reason to use a decongestant, not a caution. Iron deficiency anemia is not affected by the drug. Osteoarthritis of the knee is not a concern with pseudoephedrine.
Category: Systemic and Decongestant Therapy
Question 17
A patient with Meniere disease has sudden episodes of severe vertigo and is taking an antihistamine for symptom relief. Which nursing measure is a priority?
Implementing fall precautions
✓
Restricting all oral fluids
Encouraging caffeinated drinks
Keeping the room brightly lit
Correct Answer
Implementing fall precautions
Vertigo attacks combined with the drowsiness of an antihistamine put this patient at high risk of falling, so fall precautions come first. Restricting all oral fluids is not indicated and could cause dehydration. Encouraging caffeinated drinks is not advised; caffeine is often limited in Meniere disease. Keeping the room brightly lit can worsen symptoms; a quiet, dim room is usually better during an attack.
Category: Ear Anatomy and Disorders
Question 18
During IV aminoglycoside therapy, a patient reports new ringing and a sense of fullness in both ears. What should the nurse do?
Reassure the patient that this is expected
Report the symptoms to the provider before the next dose
✓
Give the next dose more quickly than ordered
Encourage chewing gum to open the ears
Correct Answer
Report the symptoms to the provider before the next dose
New ringing or fullness can be an early sign of ototoxicity, and the damage can become permanent, so the nurse reports it before the next dose so the drug can be reviewed. Reassure the patient that this is expected ignores a sign of harm. Give the next dose more quickly than ordered would raise peak levels and the risk of injury. Encourage chewing gum to open the ears treats pressure changes, not drug toxicity.
Category: Ototoxicity
Question 19
Which statement by a patient using ciprofloxacin-hydrocortisone drops for otitis externa shows a need for more teaching?
"I will warm the bottle in my hands first."
"I will lie with the treated ear up afterward."
"I will stop the drops as soon as the pain eases."
✓
"I will wash my hands before each dose."
Correct Answer
"I will stop the drops as soon as the pain eases."
Stopping when the pain eases can leave the infection partly treated, so the patient should use the drops for the full course prescribed, but not longer. "I will warm the bottle in my hands first." is correct technique. "I will lie with the treated ear up afterward." is correct and keeps the drops in the canal. "I will wash my hands before each dose." is correct infection control.
Category: Otic Anti-infectives
Question 20
A patient's ear canal is so swollen from otitis externa that drops cannot flow in. What may the provider place in the canal?
A tympanostomy tube
A hearing aid mold
A tightly packed cotton plug
An ear wick
✓
Correct Answer
An ear wick
An ear wick is a small compressed sponge or gauze strip placed in the swollen canal; it absorbs the drops and carries them along the canal to the infected skin. A tympanostomy tube goes through the eardrum to ventilate the middle ear, not the outer canal. A hearing aid mold would irritate the inflamed canal. A tightly packed cotton plug would block the drug from reaching the canal.
Category: Otic Anti-infectives