A nurse is reinforcing teaching about the administration of an otic medication with the parent of a 2-year-old toddler. Which of the following instructions should the nurse include?
"You should place your child in a side-lying position on the affected side after you administer the medication."
"You should allow your child's medication to reach room temperature prior to administration."
"You should sit your child in an upright position to administer the medication."
"You should gently pull your child's ear upward.".
The Correct Answer is C
Choice A rationale:
Placing a toddler in a side-lying position on the affected side after administering otic medication is not recommended. This position can cause the medication to leak out, reducing its effectiveness, and can also increase the risk of infection. It's important to keep the medication in the ear canal for an adequate amount of time to allow it to work properly.
Choice B rationale:
Allowing the medication to reach room temperature prior to administration is not a critical step for otic medications. While warming certain medications can reduce discomfort, this is not a specific requirement for ear drops. Ensuring the cleanliness of the ear, proper positioning, and correct administration technique are more important.
Choice C rationale:
The correct choice. Sitting the child in an upright position is the recommended approach for administering otic medication. This position helps ensure that the medication remains in the ear canal and is not immediately expelled. It also facilitates better penetration of the medication into the ear canal, increasing its effectiveness.
Choice D rationale:
Gently pulling a child's ear upward is a technique used for administering otic medications to straighten the ear canal and allow better access to the medication. However, this step alone is not sufficient. Proper positioning of the child is equally important to prevent the medication from leaking out.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
The nurse should report the finding of a 6-month-old infant with a spiral fracture to a lower extremity to local authorities. Spiral fractures in infants, especially those who are not yet independently mobile, raise concerns about possible child abuse or non-accidental trauma. The unique pattern of spiral fractures is often associated with twisting forces, which are unlikely to occur accidentally in infants who cannot perform such movements. Reporting such cases is essential to ensure the safety and well-being of the child.
Choice B rationale:
A 9-month-old infant exposed to bedbugs and cellulitis is not an emergency that requires reporting to local authorities. While cellulitis can be serious, it is not an immediate threat to the child's safety, and the focus should be on providing appropriate medical care.
Choice C rationale:
A 4-year-old preschooler with rivalry among siblings does not indicate a need for reporting to local authorities. Sibling rivalry is a common occurrence in families and does not pose a threat to the child's safety. It is a social and developmental issue that can be addressed within the family.
Choice D rationale:
A 24-month-old toddler experiencing occasional incontinence does not require reporting to local authorities. Occasional incontinence can be a normal part of toddler development as they learn to control their bladder. It does not indicate abuse or immediate danger to the child.
Correct Answer is D
Explanation
Choice A rationale:
Extremities warm to the touch. This manifestation is not indicative of decreased cardiac output. Warm extremities suggest adequate peripheral perfusion and circulation. In a child with decreased cardiac output, the body might attempt to shunt blood away from the extremities to prioritize vital organs, leading to cooler extremities.
Choice B rationale:
Capillary refill 2 seconds. A capillary refill time of 2 seconds is within the normal range for a preschool-aged child. This quick capillary refill suggests adequate circulation and is not a sign of decreased cardiac output. Prolonged capillary refill time might be indicative of poor peripheral perfusion.
Choice C rationale:
Blood pressure 112/66 mm Hg. While a blood pressure of 112/66 mm Hg might be within the normal range for a preschooler, it is not the most reliable indicator of decreased cardiac output. Blood pressure can be influenced by various factors, and a seemingly normal blood pressure does not rule out decreased cardiac output if other manifestations are present.
Choice D rationale:
Diminished pulses. This is the correct choice. Diminished or weak pulses are indicative of decreased cardiac output. Inadequate blood volume being pumped by the heart can lead to reduced peripheral perfusion, resulting in diminished pulses. This sign is important in assessing the child's cardiovascular status postoperatively, especially after a corrective procedure for tetralogy of Fallot.
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