The nurse is teaching a client how to correctly administer prescribed eye drops.
Which of the following steps indicates the correct understanding of the procedure?

Choice A rationale

Amiodarone is a class III antiarrhythmic medication primarily utilized for ventricular and supraventricular tachycardias. Its common side effect profile includes pulmonary toxicity, thyroid dysfunction, and corneal microdeposits. Unlike certain other cardiac medications, it is not traditionally classified as a primary ototoxic agent. It does not typically cause significant damage to the hair cells of the cochlea or the vestibulocochlear nerve during standard therapeutic use.

Choice B rationale

Loop diuretics, such as furosemide, are well-documented ototoxic agents. These medications inhibit the sodium-potassium-chloride symporter in the thick ascending limb of the loop of Henle and can also alter the electrolyte balance in the stria vascularis of the inner ear. This disruption in endolymph composition can lead to temporary or permanent hearing loss and tinnitus, particularly when administered rapidly or at high doses via intravenous routes.

Choice C rationale

Nonsteroidal anti-inflammatory drugs, or NSAIDs, including aspirin and ibuprofen, can cause ototoxicity when taken in high doses. These agents inhibit prostaglandin synthesis and can decrease blood flow to the cochlea, leading to cellular metabolic stress. Patients frequently report tinnitus, which is often reversible once the medication is discontinued. Monitoring is essential as chronic high-dose therapy can result in a more persistent sensorineural hearing impairment.

Choice D rationale

Vancomycin is a potent glycopeptide antibiotic used for serious gram-positive infections. It is recognized for its potential to cause nephrotoxicity and ototoxicity, especially when serum trough levels exceed the normal range of 15 to 20 mcg/mL. The mechanism involves direct damage to the auditory nerve or the cochlear hair cells. Risk increases significantly when combined with other ototoxic drugs, requiring close monitoring of hearing and renal function.

Choice E rationale

Cimetidine is a histamine H2-receptor antagonist used to reduce gastric acid secretion in conditions like peptic ulcer disease and GERD. While it has several systemic side effects and drug interactions due to cytochrome P450 inhibition, it is not classified as an ototoxic medication. It does not typically interfere with the delicate neurosensory structures of the ear or the fluid dynamics necessary for normal auditory processing.

Choice A rationale

Scleroderma typically causes a thickening and hardening of the skin, known as sclerodactyly, rather than thinning. The pathophysiology involves the excessive deposition of collagen in the dermis and subcutaneous tissues. This overproduction leads to skin that feels tight, bound down, and loses its natural elasticity. Thinning of the skin is more commonly associated with chronic corticosteroid use or natural aging rather than the fibrotic process that defines the progression of systemic or localized scleroderma.

Choice B rationale

Clients with scleroderma often suffer from xerostomia, which is extreme dryness of the mouth, rather than excessive salivation. This occurs because the fibrotic process can affect the salivary glands, reducing their ability to produce adequate moisture. Furthermore, many scleroderma patients also have secondary Sjogren syndrome, which further decreases glandular secretions. Excessive salivation would be an unusual finding and is not a clinical marker for the progression of the connective tissue fibrosis seen in this disease.

Choice C rationale

While some facial changes occur in scleroderma, such as a mask like appearance or restricted mouth opening, periorbital edema is not a standard expectation. Periorbital edema is more frequently associated with renal failure, nephrotic syndrome, or inflammatory conditions like dermatomyositis. In scleroderma, the skin around the eyes is more likely to become tight and taut due to collagen accumulation. The fibrotic nature of the disease usually results in tissue contraction and firmness rather than fluid accumulation.

Choice D rationale

Decreased range of motion is a common finding in scleroderma due to the hardening of the skin and fibrosis of the underlying connective tissues and tendons. As the skin becomes increasingly tight and rigid, it restricts the movement of the joints beneath it. This contracture development significantly impacts the functional mobility of the hands and limbs. Assessing for joint flexibility is essential to document disease progression as the fibrosis moves from the skin into deeper musculoskeletal structures.