NUR 676 FINAL OPTION EXAM QUESTIONS AND
CORRECT ANSWERS UPDATED FOR 2025/2026.
otitis externa
is cellulitis of the external canal that may extend to the auricle (swimmer's ear). p391
otitis externa risks factors
comprise the integrity of the inherent defense mechanism against infection, including; removal
of protective cerumen w damage to fragile skin from vigorous cleaning, accumulation of
moisture from swimming, and alterations to the tissues that result from wearing devices such as
headphones or earplugs. p391
Otitis Externa Expected findings
pain of the affected ear and auricle developing over the course of 48 hours or less, feeling of
fullness or itching. S&S that may be present drainage and hearing loss. Chronic Otitis externa-
pruritus
Otitis Externa bacterial cause
most common pseudonomas aeruginosa and staphyloccocus aureus. Uncommon candida, and
aspergillus organisms.
otitis externa diagnostics
usually unnecessary, culture of canal if symptoms persist with antibiotic sensitivity if no
improvement after 14 days of antibiotic therapy (C&S, and potassium hydroxide preparation of
drainage).
otitis externa Oral antimicrobial therapy
Fluoroquinolone antibiotics- effective against s aureus and P. aeruginosa (ofloxacin, ciproflaxin).
antibiotic-corticosteroids (Cipro Hc) for infection and inflammation. Improvement should occur
within 48 to 72 hours, and resolution occurs usually at 7 to 10 days. p392
Meniere's disease
chronic condition of the inner ear S&S recurrent vertigo and hearing loss. symptoms may or may
not occur simultaneously dizziness describe as spinning vertigo, low frequency sensorineural
hearing loss, tinnitus, and feeling of fullness in the affected ear p388
,Meniere's disease pathophysiology
excess fluid and pressure in the labyrinth of the inner ear that episodically distends the
structure of the labyrinth and damages the vestibular system (Involved in balance) & cochlear
cells (involve in hearing). Unknown etiology p388
Meniere's disease clinical presentation
PCP should ask patient about history of recurrent symptoms. Early-patients have intermittent
attacks of vertigo that last from minutes to hours often associated with nausea and vomiting.
these symptoms usually are accompanied by ear pressure, low-pitched tinnitus, fluctuating
intensity, and unilateral hearing loss
Meniere's disease diagnostics
essential diagnostics- 2 episodes of spontaneous vertigo lasting at least 20 minutes
Audiogram- documented hearing loss
Labs- TSH, serum glucose, rapid plasma reagin, lyme serology
Meniere's disease pharmacological management
should refer to otolaryngologist for testing and management.
Goals of therapy-managing the episodes of vertigo and arresting the disease process drug
therapy- short term oral steroid course, IM on affected ear may last longer.
symptom relief- Meclizine and antiemetics(least sedating), Benzodiazepines prescribe for GABA
agonist effect but not commonly used. Lorazepam has a quick onset may be appropriate for
infrequent use.
P.389
Oropharynx Pharyngitis
Streptococcus pyogenes. GAS can cause rheumatic fever. Infection with GAS peaks in late winter.
Group C is the most common in college students. p438
Oropharynx Pharyngitis clinical presentation Allergies
varies on the offending agent.
non-infectious- sore throat and dryness, if allergens are the cause S&S rhinorrhea, postnasal
drip, and watery eyes
Oropharynx Pharyngitis clinical presentation Viral
most common, self limiting- sore throat, fever, malaise, headache, myalgias, and fatigue,
rhinitis, and conjuctivitis, congestion, and cough with sputum. p438
, Oropharynx Strep throat clinical presentation bacterial
most prevalent in children under 15 y.o incubation period of 2 to 5 days. S&S onset of sore
throat, painful swallowing, fever (higher than 101.3F), chill, headache, vomiting, and abdominal
pain. GAS may present with erythema of the throat and tonsils, patchy, discrete white or
yellowish exudate, pharyngeal petechiae, and tender anterior cervical adenopathy. p439
Oropharynx Strep throat diagnostics
throat culture, a rapid antigen detection test (RADT), and sometimes an antistreptolysin (ASO)
titer.
Oropharynx Strep throat treatment
antibiotics: penicillin or amoxicillin for 10 days, penicillin is low cost, safe, and efficacy. If allergic
to PCN clindamycin or Clarithromycin for 10 days is given. Another option is Azithromycin for 5
days.
Mononucleosis clinical presentation
more common in adolescents and young adults. S&S headache, malaise, fatigue, and anorexia
before the sore throat occurs. Hepatosplenomegaly may be noted during examination. p439
Mononucleosis clinical diagnostics
CBC reveals leukocytosis with a right shift of atypical lymphocytes. A positive monospot test
reveals heterophil antibodies, this test may take 2 to 3 weeks of illness to produce a positive test
result. Patients should start to feel better 24 to 48 hours after antibiotic therapy has started.
p440
Sinusitis
Symptomatic inflammation of the mucosal surface of the paranasal sinuses.
acute (ARS) resolves in less than 4 wks
subacute- resolves in 4 to 12 wks
chronic (CRS)- continues beyond 12 wks
Acute Rhinosinusitis (ARS) clinical presenation
often confused with URIs. S&S nasal congestion, purulent nasal discharge, headache that
becomes more intense when pt bend forwards, fever, and fatigue. onset is abrupt, halitosis,
postnasal drip, ear fullness, otalgia, and decreased lack of smell p411
Acute Rhinosinusitis (ARS) diagnostics
CORRECT ANSWERS UPDATED FOR 2025/2026.
otitis externa
is cellulitis of the external canal that may extend to the auricle (swimmer's ear). p391
otitis externa risks factors
comprise the integrity of the inherent defense mechanism against infection, including; removal
of protective cerumen w damage to fragile skin from vigorous cleaning, accumulation of
moisture from swimming, and alterations to the tissues that result from wearing devices such as
headphones or earplugs. p391
Otitis Externa Expected findings
pain of the affected ear and auricle developing over the course of 48 hours or less, feeling of
fullness or itching. S&S that may be present drainage and hearing loss. Chronic Otitis externa-
pruritus
Otitis Externa bacterial cause
most common pseudonomas aeruginosa and staphyloccocus aureus. Uncommon candida, and
aspergillus organisms.
otitis externa diagnostics
usually unnecessary, culture of canal if symptoms persist with antibiotic sensitivity if no
improvement after 14 days of antibiotic therapy (C&S, and potassium hydroxide preparation of
drainage).
otitis externa Oral antimicrobial therapy
Fluoroquinolone antibiotics- effective against s aureus and P. aeruginosa (ofloxacin, ciproflaxin).
antibiotic-corticosteroids (Cipro Hc) for infection and inflammation. Improvement should occur
within 48 to 72 hours, and resolution occurs usually at 7 to 10 days. p392
Meniere's disease
chronic condition of the inner ear S&S recurrent vertigo and hearing loss. symptoms may or may
not occur simultaneously dizziness describe as spinning vertigo, low frequency sensorineural
hearing loss, tinnitus, and feeling of fullness in the affected ear p388
,Meniere's disease pathophysiology
excess fluid and pressure in the labyrinth of the inner ear that episodically distends the
structure of the labyrinth and damages the vestibular system (Involved in balance) & cochlear
cells (involve in hearing). Unknown etiology p388
Meniere's disease clinical presentation
PCP should ask patient about history of recurrent symptoms. Early-patients have intermittent
attacks of vertigo that last from minutes to hours often associated with nausea and vomiting.
these symptoms usually are accompanied by ear pressure, low-pitched tinnitus, fluctuating
intensity, and unilateral hearing loss
Meniere's disease diagnostics
essential diagnostics- 2 episodes of spontaneous vertigo lasting at least 20 minutes
Audiogram- documented hearing loss
Labs- TSH, serum glucose, rapid plasma reagin, lyme serology
Meniere's disease pharmacological management
should refer to otolaryngologist for testing and management.
Goals of therapy-managing the episodes of vertigo and arresting the disease process drug
therapy- short term oral steroid course, IM on affected ear may last longer.
symptom relief- Meclizine and antiemetics(least sedating), Benzodiazepines prescribe for GABA
agonist effect but not commonly used. Lorazepam has a quick onset may be appropriate for
infrequent use.
P.389
Oropharynx Pharyngitis
Streptococcus pyogenes. GAS can cause rheumatic fever. Infection with GAS peaks in late winter.
Group C is the most common in college students. p438
Oropharynx Pharyngitis clinical presentation Allergies
varies on the offending agent.
non-infectious- sore throat and dryness, if allergens are the cause S&S rhinorrhea, postnasal
drip, and watery eyes
Oropharynx Pharyngitis clinical presentation Viral
most common, self limiting- sore throat, fever, malaise, headache, myalgias, and fatigue,
rhinitis, and conjuctivitis, congestion, and cough with sputum. p438
, Oropharynx Strep throat clinical presentation bacterial
most prevalent in children under 15 y.o incubation period of 2 to 5 days. S&S onset of sore
throat, painful swallowing, fever (higher than 101.3F), chill, headache, vomiting, and abdominal
pain. GAS may present with erythema of the throat and tonsils, patchy, discrete white or
yellowish exudate, pharyngeal petechiae, and tender anterior cervical adenopathy. p439
Oropharynx Strep throat diagnostics
throat culture, a rapid antigen detection test (RADT), and sometimes an antistreptolysin (ASO)
titer.
Oropharynx Strep throat treatment
antibiotics: penicillin or amoxicillin for 10 days, penicillin is low cost, safe, and efficacy. If allergic
to PCN clindamycin or Clarithromycin for 10 days is given. Another option is Azithromycin for 5
days.
Mononucleosis clinical presentation
more common in adolescents and young adults. S&S headache, malaise, fatigue, and anorexia
before the sore throat occurs. Hepatosplenomegaly may be noted during examination. p439
Mononucleosis clinical diagnostics
CBC reveals leukocytosis with a right shift of atypical lymphocytes. A positive monospot test
reveals heterophil antibodies, this test may take 2 to 3 weeks of illness to produce a positive test
result. Patients should start to feel better 24 to 48 hours after antibiotic therapy has started.
p440
Sinusitis
Symptomatic inflammation of the mucosal surface of the paranasal sinuses.
acute (ARS) resolves in less than 4 wks
subacute- resolves in 4 to 12 wks
chronic (CRS)- continues beyond 12 wks
Acute Rhinosinusitis (ARS) clinical presenation
often confused with URIs. S&S nasal congestion, purulent nasal discharge, headache that
becomes more intense when pt bend forwards, fever, and fatigue. onset is abrupt, halitosis,
postnasal drip, ear fullness, otalgia, and decreased lack of smell p411
Acute Rhinosinusitis (ARS) diagnostics
