NURS 676 Advanced Pharmacology Midterm Exam Answers 2025-
Latest Questions and Answers 100% Original (WCU) Accurate
Summer- Fall Term
Question 1
A patient who works in a furniture manufacturing shop reports a sudden
onset of severe eye pain while sanding a piece of wood and now has tearing,
redness, and light sensitivity. What is the next step?
• Answer: Application of topical fluorescein dye
Rationale: This patient has symptoms consistent with a corneal foreign body or
abrasion from the wood sanding. Topical fluorescein dye will allow visualization
of corneal epithelial defects under a cobalt blue light. This is the standard initial
diagnostic test for suspected corneal injury, as it can identify abrasions, foreign
bodies, or ulcerations. The sudden onset of pain, tearing, redness, and photophobia
are classic signs of corneal involvement.
Question 2
A child has a localized nodule on one eyelid which is warm, tender, and
erythematous. On exam, the provider notes clear conjunctivae and no
discharge. What is recommended treatment?
• Answer: Warm compresses and massage of the lesion
Rationale: This presentation describes a hordeolum (stye), which is an acute
infection of the eyelid glands. The absence of conjunctival involvement and
discharge differentiates it from more extensive infections. Conservative
management with warm compresses (15 minutes, 4 times daily) and gentle
massage helps promote drainage and resolution. Antibiotics are typically reserved
for cases that do not respond to conservative therapy or when there is evidence of
spreading infection.
Question 3
A patient has a gradually enlarging nodule on one upper eyelid and reports
that the lesion is painful. On exam, the lesion appears warm and
erythematous. The provider knows that this is likely what?
• Answer: Hordeolum
Rationale: A hordeolum (stye) is characterized by an acute, painful, erythematous,
warm nodule on the eyelid. It is an infection of the sebaceous glands of the eyelid,
typically caused by Staphylococcus aureus. The pain and erythema are indicative
of an acute inflammatory process. This differs from a chalazion, which is a
chronic, painless granulomatous inflammation of the meibomian gland.
, Question 4
A patient reports he has been using artificial tears for comfort because of
burning and itching in both eyes, but reports worsening symptoms. The
provider notes redness and discharge along the eyelid margins. What is
recommended treatment?
• Answer: Compresses, lid scrubs, and antibiotic ointment
Rationale: This presentation is consistent with blepharitis, an inflammation of the
eyelid margins. Artificial tears alone will not address the underlying
infection/inflammation. Treatment includes:
• Warm compresses to loosen crusts
• Lid scrubs with diluted baby shampoo to remove debris
• Topical antibiotic ointment (erythromycin or bacitracin) to treat bacterial
overgrowth
• Artificial tears may be used for comfort but are not primary treatment
Question 5
A patient who has a cold develops conjunctivitis. The provider notes erythema
of one eye with profuse, watery discharge and enlarged anterior cervical
lymph nodes, along with a fever. Which treatment is indicated?
• Answer: Artificial tears and cool compresses
Rationale: This presentation is consistent with viral conjunctivitis, which is
typically self-limiting and associated with upper respiratory infections. Features
include:
• Watery discharge (not purulent)
• Preauricular lymphadenopathy
• Associated URI symptoms
Treatment is supportive with artificial tears for comfort and cool compresses.
Antibiotics are not indicated as they are ineffective against viruses. The condition
typically resolves spontaneously within 7-14 days.
Question 6
A patient reports bilateral reports burning and itching eyes for several days.
The provider notes a boggy appearance to the conjunctivae, along with clear,
watery discharge. Which type of conjunctivitis is most likely?
• Answer: Allergic conjunctivitis
Rationale: Allergic conjunctivitis is characterized by:
• Bilateral involvement
,• Intense itching (hallmark symptom)
• Clear, watery discharge
• "Boggy" (chemotic) conjunctivae
• No purulent discharge
This differs from bacterial (purulent discharge, unilateral) and viral (watery
discharge with preauricular lymphadenopathy) conjunctivitis. Seasonal or
perennial allergens are typically the cause.
Question 7
A patient with allergic conjunctivitis who has been using topical
antihistamine-vasoconstrictor medication reports worsening symptoms. What
is the provider's next step in managing the patient's symptoms?
• Answer: Determine duration of treatment with medication
Rationale: Topical antihistamine-vasoconstrictor combinations can cause rebound
vasodilation and worsening symptoms when used for more than 3-5 days. The
provider should assess how long the patient has been using the medication. If used
appropriately for a short duration, other options may be needed (mast cell
stabilizers, corticosteroids). If used long-term, discontinuation is indicated.
Rebound hyperemia is a well-known complication of prolonged use of
vasoconstrictors.
Question 8
An adolescent has fever, chills, and a severe sore throat. On exam, the
provider notes foul-smelling breath and a muffled voice with marked edema
and erythema of the peritonsillar tissue. What should you do?
• Answer: Perform a rapid strep and throat culture.
Rationale: This presentation is concerning for peritonsillar abscess (PTA), a
complication of acute tonsillitis. However, the initial step is diagnostic testing for
GAS pharyngitis. Key findings include:
• Severe unilateral throat pain
• Muffled voice ("hot potato voice")
• Foul breath
• Peritonsillar swelling
• Trismus (not mentioned but common)
While this may eventually require referral for drainage, the immediate step is to
confirm GAS infection with rapid antigen detection testing (RADT) and culture.
Question 9
, A patient has a sore throat, temp of 38.5, tonsillar exudates, and cervical
lymphadenopathy. What will the provider do next to manage this patient's
symptoms?
• Answer: Perform a RADT
Rationale: This patient has a Centor score of at least 3-4 (fever, exudates,
lymphadenopathy, absence of cough). The next step is to perform a rapid antigen
detection test (RADT) for GAS. A positive RADT confirms GAS pharyngitis and
warrants antibiotic treatment. A negative RADT in adults does not require
confirmatory culture; in children, a negative RADT should be backed up with a
throat culture due to higher GAS prevalence.
Question 10
A patient reports a sudden onset of sore throat, fever, malaise, and cough. The
provider notes mild erythema of the pharynx and clear rhinorrhea without
cervical lymphadenopathy. What is most likely cause?
• Answer: Viral pharyngitis
Rationale: Viral pharyngitis (likely viral URI) is characterized by:
• Gradual or sudden onset
• Associated URI symptoms (cough, rhinorrhea)
• Mild pharyngeal erythema
• Absence of exudates and significant lymphadenopathy
• Constitutional symptoms (fever, malaise) are common
The presence of cough is a key feature that reduces likelihood of GAS pharyngitis.
Viral etiology is most common, accounting for 40-60% of pharyngitis cases.
Question 11
A school-aged child has 5 episodes of tonsillitis in the past year and 2 episodes
the previous year. The child's parents ask the provider if the child needs a
tonsillectomy. What will the provider say?
• Answer: Current recommendations do not support tonsillectomy for this child
Rationale: According to AAO-HNS guidelines, tonsillectomy indications include:
• ≥7 episodes in the past year
• ≥5 episodes per year for 2 years
• ≥3 episodes per year for 3 years
This child has 5 episodes in one year but only 2 in the previous year, not meeting
criteria. Other indications include: obstructive sleep apnea, peritonsillar abscess, or
suspected malignancy. The provider should discuss watchful waiting and consider
other management options.
Latest Questions and Answers 100% Original (WCU) Accurate
Summer- Fall Term
Question 1
A patient who works in a furniture manufacturing shop reports a sudden
onset of severe eye pain while sanding a piece of wood and now has tearing,
redness, and light sensitivity. What is the next step?
• Answer: Application of topical fluorescein dye
Rationale: This patient has symptoms consistent with a corneal foreign body or
abrasion from the wood sanding. Topical fluorescein dye will allow visualization
of corneal epithelial defects under a cobalt blue light. This is the standard initial
diagnostic test for suspected corneal injury, as it can identify abrasions, foreign
bodies, or ulcerations. The sudden onset of pain, tearing, redness, and photophobia
are classic signs of corneal involvement.
Question 2
A child has a localized nodule on one eyelid which is warm, tender, and
erythematous. On exam, the provider notes clear conjunctivae and no
discharge. What is recommended treatment?
• Answer: Warm compresses and massage of the lesion
Rationale: This presentation describes a hordeolum (stye), which is an acute
infection of the eyelid glands. The absence of conjunctival involvement and
discharge differentiates it from more extensive infections. Conservative
management with warm compresses (15 minutes, 4 times daily) and gentle
massage helps promote drainage and resolution. Antibiotics are typically reserved
for cases that do not respond to conservative therapy or when there is evidence of
spreading infection.
Question 3
A patient has a gradually enlarging nodule on one upper eyelid and reports
that the lesion is painful. On exam, the lesion appears warm and
erythematous. The provider knows that this is likely what?
• Answer: Hordeolum
Rationale: A hordeolum (stye) is characterized by an acute, painful, erythematous,
warm nodule on the eyelid. It is an infection of the sebaceous glands of the eyelid,
typically caused by Staphylococcus aureus. The pain and erythema are indicative
of an acute inflammatory process. This differs from a chalazion, which is a
chronic, painless granulomatous inflammation of the meibomian gland.
, Question 4
A patient reports he has been using artificial tears for comfort because of
burning and itching in both eyes, but reports worsening symptoms. The
provider notes redness and discharge along the eyelid margins. What is
recommended treatment?
• Answer: Compresses, lid scrubs, and antibiotic ointment
Rationale: This presentation is consistent with blepharitis, an inflammation of the
eyelid margins. Artificial tears alone will not address the underlying
infection/inflammation. Treatment includes:
• Warm compresses to loosen crusts
• Lid scrubs with diluted baby shampoo to remove debris
• Topical antibiotic ointment (erythromycin or bacitracin) to treat bacterial
overgrowth
• Artificial tears may be used for comfort but are not primary treatment
Question 5
A patient who has a cold develops conjunctivitis. The provider notes erythema
of one eye with profuse, watery discharge and enlarged anterior cervical
lymph nodes, along with a fever. Which treatment is indicated?
• Answer: Artificial tears and cool compresses
Rationale: This presentation is consistent with viral conjunctivitis, which is
typically self-limiting and associated with upper respiratory infections. Features
include:
• Watery discharge (not purulent)
• Preauricular lymphadenopathy
• Associated URI symptoms
Treatment is supportive with artificial tears for comfort and cool compresses.
Antibiotics are not indicated as they are ineffective against viruses. The condition
typically resolves spontaneously within 7-14 days.
Question 6
A patient reports bilateral reports burning and itching eyes for several days.
The provider notes a boggy appearance to the conjunctivae, along with clear,
watery discharge. Which type of conjunctivitis is most likely?
• Answer: Allergic conjunctivitis
Rationale: Allergic conjunctivitis is characterized by:
• Bilateral involvement
,• Intense itching (hallmark symptom)
• Clear, watery discharge
• "Boggy" (chemotic) conjunctivae
• No purulent discharge
This differs from bacterial (purulent discharge, unilateral) and viral (watery
discharge with preauricular lymphadenopathy) conjunctivitis. Seasonal or
perennial allergens are typically the cause.
Question 7
A patient with allergic conjunctivitis who has been using topical
antihistamine-vasoconstrictor medication reports worsening symptoms. What
is the provider's next step in managing the patient's symptoms?
• Answer: Determine duration of treatment with medication
Rationale: Topical antihistamine-vasoconstrictor combinations can cause rebound
vasodilation and worsening symptoms when used for more than 3-5 days. The
provider should assess how long the patient has been using the medication. If used
appropriately for a short duration, other options may be needed (mast cell
stabilizers, corticosteroids). If used long-term, discontinuation is indicated.
Rebound hyperemia is a well-known complication of prolonged use of
vasoconstrictors.
Question 8
An adolescent has fever, chills, and a severe sore throat. On exam, the
provider notes foul-smelling breath and a muffled voice with marked edema
and erythema of the peritonsillar tissue. What should you do?
• Answer: Perform a rapid strep and throat culture.
Rationale: This presentation is concerning for peritonsillar abscess (PTA), a
complication of acute tonsillitis. However, the initial step is diagnostic testing for
GAS pharyngitis. Key findings include:
• Severe unilateral throat pain
• Muffled voice ("hot potato voice")
• Foul breath
• Peritonsillar swelling
• Trismus (not mentioned but common)
While this may eventually require referral for drainage, the immediate step is to
confirm GAS infection with rapid antigen detection testing (RADT) and culture.
Question 9
, A patient has a sore throat, temp of 38.5, tonsillar exudates, and cervical
lymphadenopathy. What will the provider do next to manage this patient's
symptoms?
• Answer: Perform a RADT
Rationale: This patient has a Centor score of at least 3-4 (fever, exudates,
lymphadenopathy, absence of cough). The next step is to perform a rapid antigen
detection test (RADT) for GAS. A positive RADT confirms GAS pharyngitis and
warrants antibiotic treatment. A negative RADT in adults does not require
confirmatory culture; in children, a negative RADT should be backed up with a
throat culture due to higher GAS prevalence.
Question 10
A patient reports a sudden onset of sore throat, fever, malaise, and cough. The
provider notes mild erythema of the pharynx and clear rhinorrhea without
cervical lymphadenopathy. What is most likely cause?
• Answer: Viral pharyngitis
Rationale: Viral pharyngitis (likely viral URI) is characterized by:
• Gradual or sudden onset
• Associated URI symptoms (cough, rhinorrhea)
• Mild pharyngeal erythema
• Absence of exudates and significant lymphadenopathy
• Constitutional symptoms (fever, malaise) are common
The presence of cough is a key feature that reduces likelihood of GAS pharyngitis.
Viral etiology is most common, accounting for 40-60% of pharyngitis cases.
Question 11
A school-aged child has 5 episodes of tonsillitis in the past year and 2 episodes
the previous year. The child's parents ask the provider if the child needs a
tonsillectomy. What will the provider say?
• Answer: Current recommendations do not support tonsillectomy for this child
Rationale: According to AAO-HNS guidelines, tonsillectomy indications include:
• ≥7 episodes in the past year
• ≥5 episodes per year for 2 years
• ≥3 episodes per year for 3 years
This child has 5 episodes in one year but only 2 in the previous year, not meeting
criteria. Other indications include: obstructive sleep apnea, peritonsillar abscess, or
suspected malignancy. The provider should discuss watchful waiting and consider
other management options.
