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A patient complains of otalgia and difficulty hearing from
one ear. The provider performs an otoscopic exam and
notes a dark brown mass in the lower portion of the
external canal blocking the patient's tympanic membrane.
What is the initial action?
A. Ask the patient about previous problems with that ear.
B. Use a curette to dislodge the mass.
C. Irrigate the canal with normal saline.
D. Prescribe a ceruminolytic agent for that ear. - Answers-
Ans: A
Before attempting to remove impacted cerumen, the
provider must determine whether the tympanic membrane
(TM) is intact and should ask about pressure equalizing
ear tubes, a history of ruptured TM, and previous ear
surgeries. Once the TM is determined to be intact, the
other methods may be attempted, although the curette
should only be used if the mass is in the lateral third of the
ear canal.
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A 5yearold child is hit in the face with a baseball bat and is
brought to the clinic by a parent. An exam reveals three
avulsed front teeth. Radiologic studiesare negative for
facial fractures. What is the recommended treatment?
A. Remove the teeth, place them in saline, and refer the
child to a dentist
B. Prescribe tetracycline 4.4mg/kg twice daily for 7 to 10
days.
C. Refer the child to a dentist for reimplantation of the
avulsed teeth.
D. Refer the child to a dentist immediately for further
evaluation. - Answers-Ans: D
Refer the child to a dentist immediately
The primary care pediatric nurse practitioner is treating an
infant with lacrimal duct obstruction who has developed
bacterial conjunctivitis. After 2 weeks of treatment with
topical antibiotics along with massage and frequent
cleansing of secretions, the infant's symptoms have not
improved. Which action is correct?
A. Refer to an ophthalmologist.
B. Perform massage more frequently.
C. Recommend hot compresses.