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Silvestri Chapter 55 Ed#573

Silvestri Chapter 55 Ed#573

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Published by Linda Kuglarz

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Published by: Linda Kuglarz on Oct 14, 2008
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Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 055 (edited file)—"Opthalmic and Otic Medications"10/14/08, Page 1 of 6, 0 Figure(s), 0 Table(s), 14 Box(es)
55: Ophthalmic and Otic Medications
PRACTICE QUESTIONS
1. In preparation for cataract surgery, the nurse is to administer cyclopentolate hydrochloride(Cyclogyl) eye drops. The nurse administers the medication knowing that the purpose of themedication is to:1. Provide lubrication to the operative eye.2. Produce miosis of the operative eye.3. Dilate the pupil of the operative eye.4. Constrict the pupil of the operative eye.Answer: 3Rationale: Cyclopentolate is a rapidly acting mydriatic and cycloplegic medication. It iseffective in 25 to 75 minutes, and accommodation returns in 6 to 24 hours. Cyclopentolate isused for preoperative mydriasis. Options 1, 2, and 4 are not actions of this medication.Test-Taking Strategy: Use the process of elimination. Options 2 and 4 are similar becausemiosis refers to constricted pupil. Note that the question identifies a client being prepared for eye surgery. The pupil would need to be dilated for the surgical procedure. Review the actionand purpose of this medication if you had difficulty with this question.Level of Cognitive Ability: ComprehensionClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/ImplementationContent Area: Adult Health/EyeReference: Lehne, R. (2004).
 Pharmacology for nursing care
(5th ed.). Philadelphia: W.B.Saunders, p. 1104.2. A nurse is reinforcing instructions to the client regarding the administration of the prescribedeye drops. Which of the following statements by the client indicates a need for further instructions?1. "I can tilt my head back, pull down on the lower lid, and place the drop in the lower lid."2. "I can lie down, pull down on the lower lid, and place the drop in the lower lid."3. "I can lie down, pull up on the upper lid, and place the drop in the lower lid."4. "I can lie on my side opposite to the eye in which I am going to place the drop, put the drop inthe corner of the lid nearest my nose, and then slowly turn to my other side while blinking."Answer: 3Rationale: The client can either lie down or sit with the head tilted back. The lower lid should be pulled downward with the thumb or fingers. The client holds the bottle like a pencil, with thetip downward, and squeezes the bottle gently, allowing one drop to fall into the sac. The clientgently closes the eye. An alternative method for clients who blink very easily is to place theclient in the supine position with the head turned to one side. The eye to receive the eye dropsshould be uppermost. With the eye closed, drop the prescribed dose on the inner canthus of theeye. Have the client turn from side to midline and to the other side while blinking. The eyedrops will move via gravity and surface tension into the conjunctival sac.Test-Taking Strategy: Note the key words,
a need for further instructions
. These words indicate
 
Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 055 (edited file)—"Opthalmic and Otic Medications"10/14/08, Page 2 of 6, 0 Figure(s), 0 Table(s), 14 Box(es)
a false response question and that you need to select the incorrect client statement. Knowing thatthe client places drops into the eye by pulling down on the lower lid will direct you to the correctoption. Review the procedure for the administration of eye medications if you had difficultywith this question.Level of Cognitive Ability: ComprehensionClient Needs: Health Promotion and MaintenanceIntegrated Process: Teaching/LearningContent Area: Adult Health/EyeReferences: deWit, S. (2005).
 Fundamental concepts and skills for nursing.
Philadelphia: W.B.Saunders, pp. 650-651.McKenry, L., & Salerno, E. (2003).
Mosby’s pharmacology in nursing 
(21st ed.). St. Louis:Mosby, p. 793.3. A nurse is preparing to administer ear drops to an infant. The nurse plans to:1. Pull up and back on the ear and direct the solution onto the eardrum.2. Pull down and back on the ear and direct the solution onto the eardrum.3. Pull down and back on the ear and direct the solution toward the wall of the canal.4. Pull up and back on the ear lobe and direct the solution toward the wall of the canal.Answer: 3Rationale: When administering ear drops to an infant, the ear is pulled down and straight back.In the adult or a child older than 3 years, the ear is pulled up and back to straighten the auditorycanal. The medication is administered by aiming it at the wall of the canal rather than directlyonto the eardrum.Test-Taking Strategy: Use the process of elimination. Eliminate options 1 and 2 because youwould not direct ear solution directly onto the eardrum. Remember that, in a child younger than3 years, pulling the ear down and straight back is the correct procedure for administering ear medications. Review the procedure for the administration of ear medications if you haddifficulty with this question.Level of Cognitive Ability: ApplicationClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/ImplementationContent Area: Child HealthReference: deWit, S. (2005).
 Fundamental concepts and skills for nursing 
.
 
Philadelphia: W.B.Saunders, p. 652.4. To minimize the systemic effects that eye drops can produce, the nurse plans to instruct theclient to:1. Eat before instilling the drops.2. Swallow several times after instilling the drops.3. Blink vigorously to encourage tearing after instilling the drops.4. Occlude the nasolacrimal duct with a finger for several minutes after instilling the drops.Answer: 4Rationale: Applying pressure on the nasolacrimal duct prevents systemic absorption of themedication. Options 1, 2, and 3 will not prevent this.Test-Taking Strategy: Use the process of elimination. Eliminate options 1 and 2 because eating
 
Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 055 (edited file)—"Opthalmic and Otic Medications"10/14/08, Page 3 of 6, 0 Figure(s), 0 Table(s), 14 Box(es)
and swallowing are similar and are unrelated to the systemic absorption of an eye medication.Blinking vigorously to produce tearing may result in the loss of the administered medication.Review this procedure if you had difficulty with this question.Level of Cognitive Ability: ApplicationClient Needs: Health Promotion and MaintenanceIntegrated Process: Teaching/LearningContent Area: Adult Health/EyeReferences: Christensen, B., & Kockrow, E. (2003).
 Adult health nursing 
(4th ed.). St. Louis:Mosby, p. 680.Christensen, B., & Kockrow, E. (2003).
 Foundations of nursing 
(4th ed.). St. Louis: Mosby, p.587.5. A client is receiving both epinephrine hydrochloride (Epifrin, Glaucon) and timolol maleate(Timoptic) eye drops. When instructing the client on the administration of the eye drops, thenurse plans to tell the client to:1. Administer the epinephrine hydrochloride first, followed by the timolol maleate.2. Administer the timolol maleate first, followed by the epinephrine HCl..3. Administer epinephrine hydrochloride in the morning and the timolol maleate in the evening4. Wait 3 minutes between the instillation of each medication.Answer: 4Rationale: When two or more medications are to be administered, the client should wait 3 to 5minutes between instillations. Options 1, 2, and 3 are incorrect.Test-Taking Strategy: Use the process of elimination and focus on the issue, the administrationof two different prescribed eye drops. Note that option 4 is different from the other options and provides specific information related to the question. Also, remember that when two or moremedications are to be administered, the client should wait 3 to 5 minutes between instillations.Review the administration of eye medications if you had difficulty with this question.Level of Cognitive Ability: ApplicationClient Needs: Health Promotion and MaintenanceIntegrated Process: Teaching/LearningContent Area: Adult Health/EyeReference: Potter, P., & Perry, A. (2005).
 Fundamentals of nursing 
(6th ed.). St. Louis: Mosby, p. 862.6. A licensed practical nurse (LPN) is assigned to care for a client with glaucoma. The LPNreviews the client’s medication record and would notify the registered nurse (RN) if whichmedication was noted on the client’s record?1. Carbachol (Carboptic)2. Pilocarpine hydrochloride (Isopto Carpine)3. Pilocarpine nitrate (Ocusert Pilo-20, Ocusert Pilo-40)4. Atropine sulfate (Isopto Atropine)Answer: 4Rationale: Atropine sulfate is a mydriatic and cycloplegic medication and its use iscontraindicated in clients with glaucoma. Mydriatic medications dilate the pupil and can causean increase in intraocular pressure in the eye. Options 1, 2, and 3 are miotic agents used in the

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