A patient presents with severe ear pain, itching, and discharge from the ear. Upon examination, the external auditory canal is swollen and red. Which of the following is the most appropriate initial intervention for a patient diagnosed with otitis externa?
Recommend cleaning the ear with cotton swabs daily.
Advise the patient to use over-the-counter ear drops.
Administer oral antibiotics.
Administer topical antibiotics and corticosteroids.
The Correct Answer is D
Choice A Reason:
Recommending cleaning the ear with cotton swabs daily is not appropriate for managing otitis externa. Using cotton swabs can further irritate the ear canal, potentially worsening the inflammation and increasing the risk of infection. It is generally advised to avoid inserting anything into the ear canal to prevent damage and irritation.
Choice B Reason:
Advising the patient to use over-the-counter ear drops is not the best initial intervention. While some over-the-counter ear drops may provide temporary relief, they are not as effective as prescription topical antibiotics and corticosteroids in treating the underlying infection and inflammation associated with otitis externa. Proper medical treatment is necessary to ensure effective management of the condition.
Choice C Reason:
Administering oral antibiotics is not typically the first-line treatment for uncomplicated otitis externa. Oral antibiotics are reserved for cases where the infection has spread beyond the ear canal or in patients with risk factors for severe infection. Topical antibiotics and corticosteroids are preferred for their direct action on the affected area and fewer systemic side effects.
Choice D Reason:
Administering topical antibiotics and corticosteroids is the most appropriate initial intervention for otitis externa. Topical treatments effectively target the infection and reduce inflammation, providing relief from symptoms such as pain, itching, and discharge. This approach is supported by clinical guidelines and is considered the standard of care for managing otitis externa.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C"]
Explanation
Choice A Reason:
Administering diuretics to increase urine output is not appropriate in this scenario. Diuretics would exacerbate dehydration and further increase serum sodium levels by promoting additional water loss. This approach would worsen the patient’s condition rather than improve it.
Choice B Reason:
Administering desmopressin is a suitable intervention for this patient. Desmopressin is a synthetic analog of vasopressin (antidiuretic hormone) and is used to treat conditions like diabetes insipidus, which can cause symptoms such as excessive thirst, frequent urination, and dehydration. Desmopressin helps to reduce urine output and correct the imbalance of fluids and electrolytes.
Choice C Reason:
Administering intravenous hypotonic saline is appropriate for managing high serum sodium levels and dehydration. Hypotonic saline helps to lower serum sodium levels by diluting the blood and rehydrating the patient. This intervention addresses both the dehydration and the electrolyte imbalance effectively.
Choice D Reason:
Restricting fluid intake to reduce urine output is not appropriate in this case. Fluid restriction would worsen dehydration and could lead to further complications. The patient needs adequate fluid replacement to correct the dehydration and normalize serum sodium levels.
Choice E Reason:
Administering hypertonic saline is not suitable for this patient. Hypertonic saline would increase serum sodium levels further, exacerbating the hypernatremia. This intervention would be counterproductive and could lead to severe complications.
Correct Answer is A
Explanation
Choice A Reason:
Administering intravenous fluids and pain management is the most appropriate initial intervention for a patient with sickle cell anemia presenting with severe pain, fever, and dehydration. Sickle cell crises often lead to severe pain due to vaso-occlusion, where sickled red blood cells block blood flow to various parts of the body. Intravenous fluids help to rehydrate the patient and reduce blood viscosity, which can alleviate the vaso-occlusive crisis. Pain management is crucial to provide relief and improve the patient’s comfort. This approach addresses the immediate symptoms and stabilizes the patient.
Choice B Reason:
Applying cold compresses to the painful areas is not recommended for patients with sickle cell anemia. Cold can cause vasoconstriction, which may worsen the vaso-occlusion and increase pain. Instead, warm compresses are often suggested to help dilate blood vessels and improve blood flow.
Choice C Reason:
Administering antibiotics immediately is not the primary intervention unless there is a clear indication of an infection. While fever can be a sign of infection, it can also occur due to the inflammatory response associated with a sickle cell crisis. The priority is to manage pain and dehydration first, and then evaluate the need for antibiotics based on clinical findings.
Choice D Reason:
Encouraging the patient to perform light exercise is not appropriate during an acute sickle cell crisis. Physical activity can increase oxygen demand and exacerbate the pain and vaso-occlusion. Rest and adequate hydration are more suitable to manage the crisis effectively.
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