FULL SOLUTION GUIDE
◉ A child who was treated with amoxicillin and then amoxicillin-
clavulanate for acute otitis media is seen for follow-up. The primary
care nurse practitioner notes dull-gray tympanic membranes with a
visible air-fluid level. The child is afebrile and without pain. What is
the next course of action? Answer: Monitoring ear fluid levels for 3
months
◉ A 13-year-old with cerebral palsy receives all nutrition via
gastrostomy tube. What will the primary care nurse practitioner
recommend to promote dental health in this child? Answer: Daily
chlorhexidine gluconate
◉ A primary care provider may suspect cataract formation in a
patient with which finding? Answer: Asymmetric red reflex
◉ A patient has chronically dry eyes, sometimes with a foreign body
sensation, burning, and itching. A Schirmer test is abnormal. What is
the suspected cause of this patient's symptoms? Answer: Aqueous
Deficiency
◉ A teen who has otitis externa has severe swelling of the external
auditory canal that persists after 2 days of therapy with ototopical
,antibiotic/corticosteroid drops. What is the next step in treatment
for this child? Answer: Insert a wick into the external auditory canal
◉ A patient reports tooth pain in a lower molar and the provider
notes a mobile tooth with erythema and edema of the surrounding
tissues without discharge. Which is the initial course of action by the
provider? Answer: Prescribe amoxicillin and refer to a dentist in 2-3
days
◉ An elderly patient has a permanent loss of the sense of smell and
diminished taste. What will be included in teaching this patient
about managing these symptoms? Answer: 1. The importance of
installing smoke detectors
2. Putting dates on food in the fridge
3. Eating regular meals at scheduled times
◉ A toddler exhibits exotropia of the right eye during a cover-
uncover screen. The primary nurse practitioner will refer to a
pediatric ophthalmologist to initiate which treatment? Answer:
Patching of the unaffected eye for 2 hours each day
◉ An adolescent has localized bleeding of the gums when brushing
the teeth. An exam of the mouth reveals the presence of plaque and
calculus on the teeth which are not loose. What will the primary care
nurse practitioner recommend? Answer: Consistently brushing and
flossing the teeth twice daily
,◉ A provider is recommending a cerumenolytic for a patient who
has chronic cerumen buildup. The provider notes that the patient
has dry skin in the ear canal. Which preparation is FDA approved for
this use? Answer: Carbamide peroxide
◉ A parent asks about ways to promote dental health in school-aged
children while on family vacation that are convenient while camping
and picnicking. What will the primary care nurse practitioner
recommend? Answer: Offering gum containing xylitol after meals
◉ A patient reports several episodes of acute vertigo, some lasting
up to an hour with associated nausea and vomiting. What is part of
the initial diagnostic workup for this patient? Answer: Audiogram
and MRI
◉ A teen with a history of otitis externa asks about ways to prevent
this condition. What will the primary care nurse practitioner
recommend? Answer: Drying the ear canal with a hair dryer
◉ A 7-month-old infant has had two prior acute ear infections and is
currently on the 10th day of therapy with amoxicillin-clavulanate
after a failed course of amoxicillin. The primary care nurse
practitioner notes marker middle ear effusion and erythema of the
TM. The child is irritable and has a temperature of 99.8. What is the
, next step in management of this child's infection? Answer: Refer the
child to an otolayngologist
◉ A patient reports painful swelling in the mouth with increased
pain at mealtimes. The provider notes a mass in the salivary gland
region. What is the likely cause of these symptoms? Answer:
Sialolithiasis
◉ A child complains of itching in both ears and is having trouble
hearing. The primary care nurse practitioner notes periauricular
edema and marked swelling of the external auditory canal and elicits
severe pain when manipulating the external ear structures. Which is
an appropriate intervention? Answer: Order ototopical
antibiotic/corticosteroid drops
◉ During a well child assessment of an African American infant, the
primary care nurse practitioner notes a dark red-brown light reflex
in the left eye and a slightly brighter, red-orange light reflex in the
right eye. The nurse practitioner will... Answer: Refer the infant to an
opthalmologist
◉ Which are risk factors for development of cataracts? Answer: 1.
Smoking
2. Advancing Age
3. UV Light