NRNP 6541 TEST BANK 2026/2027 LATEST SPRING
SUMMER ACTUAL EXAM ACTUAL EXAM Complete
Verified Questions And Correct Detailed Answers|
GUARANTEED PASS Graded A+!
A young child has a pale, whitish discoloration behind the tympanic membrane. The provider notes no
scarring on the tympanic membrane (TM) and no retraction of the pars flaccida. The parent states that
the child has never had an ear infection. What do these findings most likely represent?
a. Chronic cholesteatoma
b. Congenital cholesteatoma
c. Primary acquired cholesteatoma
d. Secondary acquired cholesteatoma ANS: B
Patients without history of otitis media or perforation of the TM most likely have congenital
cholesteatoma. Primary acquired cholesteatoma will include retraction of the pars flaccida. Secondary
acquired cholesteatoma has findings associated with the underlying etiology.
A child is diagnosed as having a congenital cholesteatoma. What is included in management of this
condition? (Select all that apply.)
a. Antibacterial treatment
b. Insertion of pressure equalizing tubes (PETs)
c. Irrigation of the ear canal
d. Removal of debris from the ear canal
e. Surgery to remove the lesion ANS: A, D, E
Cholesteatoma is treated with antibiotics, removal of debris from the ear canal, and possibly surgery.
PETs and irrigation of the ear canal are not part of treatment for cholesteatoma.
A child who has recurrent otitis media fails a hearing screen at school. The provider suspects which type
of hearing loss in this child?
a. Central
b. Conductive
c. Mixed type
d. Sensorineural ANS: B
1
,A common cause of conductive loss is fluid in the middle ear as a result of chronic otitis media with
effusion. Central hearing loss is related to CNS disorders. Mixed-type hearing loss is related to causes of
both conductive and sensorineural hearing loss. Sensorineural hearing loss is caused by damage to the
structures in the inner ear, usually caused by infection, barotrauma, or trauma.
A result of screening audiogram on a patient is abnormal. Which test may the primary provider perform
next to further evaluate the cause of this finding?
a. Impedance audiometry
b. Pure tone audiogram
c. Speech reception test
d. Tympanogram ANS: D
A screening tympanogram may be performed by a primary provider to determine tympanic membrane
mobility and may help in identifying the presence of infection, fluid, or changes in middle ear pressure.
The other tests are performed by audiologists, not primary care providers.
Which are risk factors for developing hearing loss caused by presbycusis? (Select all that apply.)
a. Diabetes
b. GERD
c. High blood pressure
d. Liver disease
e. Smoking ANS: A, C, E
Presbycusis is a gradual degeneration within the cochlea that accompanies aging. Diabetes, high blood
pressure, and smoking may hasten these changes. GERD and liver disease are not associated with an
increased rate of changes.
A patient is suspected of having vestibular neuritis. Which finding on physical examination is consistent
with this diagnosis?
a. Facial palsy and vertigo
b. Fluctuating hearing loss and tinnitus
c. Spontaneous horizontal nystagmus
d. Vertigo with changes in head position ANS: C
Many patients with vestibular neuritis will exhibit spontaneous horizontal or rotary nystagmus, away
from the affected ear. Facial palsy with vertigo occurs with Ramsay Hunt syndrome, caused by herpes
zoster. Fluctuating hearing loss with tinnitus is common in Meniere's disease. Tinnitus may occur with
vestibular neuritis but hearing loss does not occur. Patients with benign paroxysmal positional vertigo
will exhibit vertigo associated with changes in head position.
2
,A patient reports several episodes of acute vertigo, some lasting up to an hour, associated with nausea
and vomiting. What is part of the initial diagnostic workup for this patient?
a. Audiogram
b. Auditory brainstem testing
c. Electrocochleography
d. Vestibular testing ANS: A
An audiogram and magnetic resonance imaging (MRI) are part of basic testing for Meniere's
disease. The other testing may be performed by an otolaryngologist after referral.
1. Which symptoms may occur with vestibular neuritis? (Select all that apply.)
a. Disequilibrium
b. Fever
c. Hearing loss
d. Nausea and vomiting
e. Tinnitus ANS: A, D, E
Vestibular neuritis can cause severe vertigo, disequilibrium, nausea, vomiting, and tinnitus, but not fever
or hearing loss.
A patient reports a feeling of fullness and pain in both ears and the practitioner elicits exquisite pain
when manipulating the external ear structures. What is the likely diagnosis?
a. Acute otitis externa
b. Acute otitis media
c. Chronic otitis externa
d. Otitis media with effusion ANS: A
This patient's symptoms are classic for acute otitis externa. Chronic otitis externa more commonly
presents with itching. Acute otitis media is accompanied by fever and tympanic membrane
inflammation, but not external canal inflammation. Otitis media with effusion causes a sense of fullness
but not pain.
A patient has an initial episode otitis external associated with swimming. The patient's ear canal is mildly
inflamed, and the tympanic membrane is not involved. Which medication will
be ordered?
a. Cipro HC
b. Fluconazole
3
, c. Neomycin
d. Vinegar and alcohol ANS: A
In the absence of a culture, the provider should choose a medication that is effective against both P.
aeruginosa and S. aureus. Cipro HC covers both organisms and also contains a corticosteroid for
inflammation. Fluconazole is an oral antifungal medication used when fungal infection is present.
Neomycin alone does not cover these organisms. Vinegar and alcohol are used to treat mild fungal
infections.
Which are risk factors for developing otitis externa? (Select all that apply.)
a. Cooler, low-humidity environments
b. Exposure to someone with otitis externa
c. Having underlying diabetes mellitus
d. Use of ear plugs and hearing aids
e. Vigorous external canal hygiene ANS: C, D, E
Otitis externa is a cellulitis of the external canal that develops when the integrity of the skin is
compromised. Diabetes mellitus predisposes patients to skin disorders. Using devices that
cause moisture retention and irritation will increase the risk. Vigorous cleansing removes protective
cerumen. Warm, high-humidity environments increase risk. The disease is not contagious.
A pediatric patient's assessment confirms the patient has otalgia, a fever of 38.8°C, and a recent history
of upper respiratory examination. The examiner is unable to visualize the tympanic membranes in the
right ear because of the presence of cerumen in the ear canal. The left tympanic membrane is dull gray
with fluid levels present. What is the correct action?
a. Perform a tympanogram on the right ear.
b. Recommend symptomatic treatment for fever and pain.
c. Remove the cerumen and visualize the tympanic membrane.
d. Treat empirically with amoxicillin 80 to 90 mg/kg/day. ANS: C
The AAP 2013 guidelines strongly recommend visualization of the tympanic membrane to accurately
diagnose otitis media and not to treat based on symptoms alone. The practitioner should attempt to
remove the cerumen to visualize the tympanic membrane. A tympanogram cannot be performed when
cerumen is blocking the canal. Because the child may have an acute ear infection, antibiotics may be
necessary.
Which patient may be given symptomatic treatment with 24 hours follow-up assessment without initial
antibiotic therapy?
a. A 36-month-old with fever of 38.5°C, mild otalgia, and red, non-bulging TM
b. A 4-year-old, afebrile child with bilateral otorrhea
4
SUMMER ACTUAL EXAM ACTUAL EXAM Complete
Verified Questions And Correct Detailed Answers|
GUARANTEED PASS Graded A+!
A young child has a pale, whitish discoloration behind the tympanic membrane. The provider notes no
scarring on the tympanic membrane (TM) and no retraction of the pars flaccida. The parent states that
the child has never had an ear infection. What do these findings most likely represent?
a. Chronic cholesteatoma
b. Congenital cholesteatoma
c. Primary acquired cholesteatoma
d. Secondary acquired cholesteatoma ANS: B
Patients without history of otitis media or perforation of the TM most likely have congenital
cholesteatoma. Primary acquired cholesteatoma will include retraction of the pars flaccida. Secondary
acquired cholesteatoma has findings associated with the underlying etiology.
A child is diagnosed as having a congenital cholesteatoma. What is included in management of this
condition? (Select all that apply.)
a. Antibacterial treatment
b. Insertion of pressure equalizing tubes (PETs)
c. Irrigation of the ear canal
d. Removal of debris from the ear canal
e. Surgery to remove the lesion ANS: A, D, E
Cholesteatoma is treated with antibiotics, removal of debris from the ear canal, and possibly surgery.
PETs and irrigation of the ear canal are not part of treatment for cholesteatoma.
A child who has recurrent otitis media fails a hearing screen at school. The provider suspects which type
of hearing loss in this child?
a. Central
b. Conductive
c. Mixed type
d. Sensorineural ANS: B
1
,A common cause of conductive loss is fluid in the middle ear as a result of chronic otitis media with
effusion. Central hearing loss is related to CNS disorders. Mixed-type hearing loss is related to causes of
both conductive and sensorineural hearing loss. Sensorineural hearing loss is caused by damage to the
structures in the inner ear, usually caused by infection, barotrauma, or trauma.
A result of screening audiogram on a patient is abnormal. Which test may the primary provider perform
next to further evaluate the cause of this finding?
a. Impedance audiometry
b. Pure tone audiogram
c. Speech reception test
d. Tympanogram ANS: D
A screening tympanogram may be performed by a primary provider to determine tympanic membrane
mobility and may help in identifying the presence of infection, fluid, or changes in middle ear pressure.
The other tests are performed by audiologists, not primary care providers.
Which are risk factors for developing hearing loss caused by presbycusis? (Select all that apply.)
a. Diabetes
b. GERD
c. High blood pressure
d. Liver disease
e. Smoking ANS: A, C, E
Presbycusis is a gradual degeneration within the cochlea that accompanies aging. Diabetes, high blood
pressure, and smoking may hasten these changes. GERD and liver disease are not associated with an
increased rate of changes.
A patient is suspected of having vestibular neuritis. Which finding on physical examination is consistent
with this diagnosis?
a. Facial palsy and vertigo
b. Fluctuating hearing loss and tinnitus
c. Spontaneous horizontal nystagmus
d. Vertigo with changes in head position ANS: C
Many patients with vestibular neuritis will exhibit spontaneous horizontal or rotary nystagmus, away
from the affected ear. Facial palsy with vertigo occurs with Ramsay Hunt syndrome, caused by herpes
zoster. Fluctuating hearing loss with tinnitus is common in Meniere's disease. Tinnitus may occur with
vestibular neuritis but hearing loss does not occur. Patients with benign paroxysmal positional vertigo
will exhibit vertigo associated with changes in head position.
2
,A patient reports several episodes of acute vertigo, some lasting up to an hour, associated with nausea
and vomiting. What is part of the initial diagnostic workup for this patient?
a. Audiogram
b. Auditory brainstem testing
c. Electrocochleography
d. Vestibular testing ANS: A
An audiogram and magnetic resonance imaging (MRI) are part of basic testing for Meniere's
disease. The other testing may be performed by an otolaryngologist after referral.
1. Which symptoms may occur with vestibular neuritis? (Select all that apply.)
a. Disequilibrium
b. Fever
c. Hearing loss
d. Nausea and vomiting
e. Tinnitus ANS: A, D, E
Vestibular neuritis can cause severe vertigo, disequilibrium, nausea, vomiting, and tinnitus, but not fever
or hearing loss.
A patient reports a feeling of fullness and pain in both ears and the practitioner elicits exquisite pain
when manipulating the external ear structures. What is the likely diagnosis?
a. Acute otitis externa
b. Acute otitis media
c. Chronic otitis externa
d. Otitis media with effusion ANS: A
This patient's symptoms are classic for acute otitis externa. Chronic otitis externa more commonly
presents with itching. Acute otitis media is accompanied by fever and tympanic membrane
inflammation, but not external canal inflammation. Otitis media with effusion causes a sense of fullness
but not pain.
A patient has an initial episode otitis external associated with swimming. The patient's ear canal is mildly
inflamed, and the tympanic membrane is not involved. Which medication will
be ordered?
a. Cipro HC
b. Fluconazole
3
, c. Neomycin
d. Vinegar and alcohol ANS: A
In the absence of a culture, the provider should choose a medication that is effective against both P.
aeruginosa and S. aureus. Cipro HC covers both organisms and also contains a corticosteroid for
inflammation. Fluconazole is an oral antifungal medication used when fungal infection is present.
Neomycin alone does not cover these organisms. Vinegar and alcohol are used to treat mild fungal
infections.
Which are risk factors for developing otitis externa? (Select all that apply.)
a. Cooler, low-humidity environments
b. Exposure to someone with otitis externa
c. Having underlying diabetes mellitus
d. Use of ear plugs and hearing aids
e. Vigorous external canal hygiene ANS: C, D, E
Otitis externa is a cellulitis of the external canal that develops when the integrity of the skin is
compromised. Diabetes mellitus predisposes patients to skin disorders. Using devices that
cause moisture retention and irritation will increase the risk. Vigorous cleansing removes protective
cerumen. Warm, high-humidity environments increase risk. The disease is not contagious.
A pediatric patient's assessment confirms the patient has otalgia, a fever of 38.8°C, and a recent history
of upper respiratory examination. The examiner is unable to visualize the tympanic membranes in the
right ear because of the presence of cerumen in the ear canal. The left tympanic membrane is dull gray
with fluid levels present. What is the correct action?
a. Perform a tympanogram on the right ear.
b. Recommend symptomatic treatment for fever and pain.
c. Remove the cerumen and visualize the tympanic membrane.
d. Treat empirically with amoxicillin 80 to 90 mg/kg/day. ANS: C
The AAP 2013 guidelines strongly recommend visualization of the tympanic membrane to accurately
diagnose otitis media and not to treat based on symptoms alone. The practitioner should attempt to
remove the cerumen to visualize the tympanic membrane. A tympanogram cannot be performed when
cerumen is blocking the canal. Because the child may have an acute ear infection, antibiotics may be
necessary.
Which patient may be given symptomatic treatment with 24 hours follow-up assessment without initial
antibiotic therapy?
a. A 36-month-old with fever of 38.5°C, mild otalgia, and red, non-bulging TM
b. A 4-year-old, afebrile child with bilateral otorrhea
4
