You are administering an otic drop for an ear infection to a 12-year-old client. What is the proper method for otic drop instillation in this client?
Shake bottle well, pull car outward and downward, instill drops.
Shake bottle well, pull ear outward and upward, instill drops
Warm bottle in hand pull ear outward and upward, instill drops
Warm bottle in hand, pull ear outward and downward, instill drops
The Correct Answer is C
A) Shake bottle well, pull ear outward and downward, instill drops: This method is typically used for younger children, such as infants or toddlers, as the ear canal in younger children is more horizontal. However, this is not the appropriate method for a 12-year-old.
B) Shake bottle well, pull ear outward and upward, instill drops: This method is incorrect because the ear should be pulled outward and upward for a child under 3 years old, not for a 12-year-old.
C) Warm bottle in hand, pull ear outward and upward, instill drops: This is the correct method for a 12-year-old client. The ear should be pulled outward and upward to straighten the ear canal, allowing the drops to reach the deeper parts of the ear. Additionally, warming the bottle in your hands prevents discomfort that might arise from cold drops being instilled in the ear.
D) Warm bottle in hand, pull ear outward and downward, instill drops: This method is appropriate for children under 3 years old. For children older than 3 years, the ear should be pulled upward to open the ear canal.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Here’s the step-by-step process:
After the first half-life (1 half-life), 50% of the initial drug is left.
200 mg → 100 mg (half is eliminated, 100 mg remains).
After the second half-life (2 half-lives), 50% of the remaining drug is eliminated again.
100 mg → 50 mg (half of 100 mg is eliminated, 50 mg remains).
After the third half-life (3 half-lives), 50% of the remaining drug is eliminated again.
50 mg → 25 mg (half of 50 mg is eliminated, 25 mg remains).
Correct Answer is B
Explanation
A) Planning: The planning phase of the nursing process involves identifying specific goals and outcomes for the patient based on their condition. In this scenario, the nurse has already administered the medication and is assessing the effectiveness, which is a part of evaluating the plan of care. Planning would have occurred prior to medication administration to decide on interventions, but it is not the phase the nurse is in now.
B) Evaluation: Evaluation is the phase where the nurse assesses whether the nursing interventions and treatments are effective in achieving the desired outcomes. In this scenario, the nurse is evaluating the effect of the baclofen dose by observing whether it reduced muscle spasms and pain. The nurse's focus on assessing the result of the medication and its impact on the client’s condition indicates the evaluation phase of the nursing process.
C) Diagnosis: The diagnosis phase occurs before interventions and involves identifying health problems or conditions that need attention. In this case, a nursing diagnosis such as "impaired mobility" or "pain related to muscle spasticity" might have been formulated earlier, but the focus now is on evaluating the effectiveness of the treatment, not on diagnosing the problem.
D) Implementation: Implementation is the phase where the planned interventions are carried out. Administering baclofen to the client would fall under this phase. However, since the nurse is now assessing the effect of the medication after its administration, this action takes place after the intervention and falls under the evaluation phase, not implementation.
E) Assessment: Assessment is the phase where data is gathered about the patient’s condition, including physical and mental health. In this case, the nurse would have assessed the client initially to determine the need for baclofen, but four hours later, the nurse is evaluating the outcome of the medication, not gathering initial data. Therefore, the action described is not part of the assessment phase but rather the evaluation phase.
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