The ear canal should be straightened when instilling eardrops to provide direct access to deeper ear structures. In what direction should the auricle be pulled in an infant to straighten the ear canal?

A) Ask the client if he would prefer to give the medication to himself: While involving the client in their care is important, this option does not assess the client’s ability to safely take the medication. The nurse should first ensure that the client can swallow the medication safely.

B) Assess the swallowing reflex by offering a sip of water: This is the correct action. Assessing the swallowing reflex is essential, especially in older adults, to determine if they can safely swallow liquid medications without risk of aspiration.

C) Mix thoroughly in applesauce or pudding: This option is not appropriate unless specifically ordered or indicated. Mixing medications in food may not be suitable for all clients, and it can affect the medication's absorption or effectiveness. Additionally, it does not assess the client's swallowing ability.

D) Assess the ability to understand information relative to the medication: While this is important, it is secondary to ensuring that the client can physically take the medication safely. Assessing understanding can occur after confirming the client’s ability to swallow the medication.

A. "I should wait 20 to 30 seconds between puffs and 2 to 5 minutes between inhalations of different medications. I should administer the inhaled steroids first followed by the bronchodilator."

Explanation:

• Inhaled bronchodilators (such as albuterol) should be administered before inhaled steroids (such as fluticasone). This is because bronchodilators help open up the airways, allowing better delivery of the steroid medication to the lungs.
• Steroids should not be given first because they are not effective in immediately opening the airways, which can reduce the effectiveness of the steroid if given before a bronchodilator.

Here’s a breakdown of the other options, which are correct:

• B: Correct. The proper technique is to remove the mouthpiece cover, shake the inhaler well (2 to 5 seconds), and then insert the inhaler into the spacer.
• C: Correct. Rinsing the mouth with warm water and spitting it out after using an inhaled steroid is important to prevent oral thrush (a fungal infection).
• D: Correct. The proper technique involves closing the mouth around the spacer mouthpiece, pressing the MDI to release the medication, inhaling slowly and deeply for about 5 seconds, and holding the breath for about 10 seconds to allow for better absorption.

Thus, A is the statement that requires further teaching because the client has the incorrect sequence of medication administration (steroid first, bronchodilator second).