NUR 652 - Final review
A 5-year-old 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 studies are negative for facial fractures. What is the
recommended treatment? ANS: Refer the child to the dentist immediately for further evaluation
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? ANS: 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? ANS: Daily chlorhexidine
gluconate
A primary care provider may suspect cataract formation in a patient with which finding? ANS:
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? ANS: 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? ANS: 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? ANS: 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? ANS: 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? ANS: 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? ANS: 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? ANS: 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? ANS: 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? ANS: 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? ANS: 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? ANS: 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? ANS: 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? ANS:
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... ANS: Refer the infant to an opthalmologist
Which are risk factors for development of cataracts? ANS: 1. Smoking
2. Advancing Age
3. UV Light
A preschool age child who attend daycare has a 2 day history of matted eyelids in the morning and
burning and itching of the eyes. The primary care NP notes yellow-green purulent discharge from both
eyes, conjunctival erythema and mild URI symptoms. Which action is correct? ANS: Prescribe topical
antibiotic drops
An 18-month-old child with no previous history of otitis media awoke during the night with right ear
pain. The primary care NP notes an axillary temperature of 100.5 and an erythematous, bulging TM. A
tympanogram reveals a peak of +15-mm H2O. What is the recommended treatment for this child? ANS:
An analgesic medication and watchful waiting
, 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 TM.
What is the initial action? ANS: Ask the patient about previous problems with the ear
The primary care NP 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
cleaning of secretions, the infant's symptoms have not improved. Which action is correct? ANS: Refer to
an ophthalmologist
A patient has a chronic swelling of the parotid gland that is unresponsive to antibiotics and which has
not increased in size. Which diagnostic test is indicated? ANS: Fine needle aspiration
During a well-child exam on a 4-year-old child, the primary care NP notes that the clinic nurse recorded
20/50 for the child's vision and noted that the child has difficulty cooperating with the exam. What will
the NP recommend? ANS: Test the child's vision in 1 month
Causes of cough, not related to pulmonary issues ANS: Allergies, GERD, medications (lisinopril)
The primary care NP is providing nutritional counseling for a 9-year-old female whose weight is at the
95th percentile for her age. What is the goal for this patient? ANS: Maintenance of her current weight
The primary care NP is performing a well child examination on a 12-year-old child who was diagnosed
with type 1 DM at age 9. The child had a lipid screen at age 10 with an LDL cholesterol <100mg/dL. What
will the NP recommend as part of ongoing management for this child? ANS: Comprehensive
ophthalmologic exams
The primary care NP is reviewing lab work and diabetes management with a school-aged child whose
HbA1C is 7.6% who reports usual blood sugars before meals as being 80-90mg/dL. The NP will consult
with the child's endocrinologist to consider which therapy? ANS: Continuous glucose monitoring
A 5-year-old 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 studies are negative for facial fractures. What is the
recommended treatment? ANS: Refer the child to the dentist immediately for further evaluation
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? ANS: 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? ANS: Daily chlorhexidine
gluconate
A primary care provider may suspect cataract formation in a patient with which finding? ANS:
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? ANS: 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? ANS: 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? ANS: 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? ANS: 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? ANS: 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? ANS: 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? ANS: 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? ANS: 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? ANS: 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? ANS: 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? ANS: 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? ANS: 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? ANS:
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... ANS: Refer the infant to an opthalmologist
Which are risk factors for development of cataracts? ANS: 1. Smoking
2. Advancing Age
3. UV Light
A preschool age child who attend daycare has a 2 day history of matted eyelids in the morning and
burning and itching of the eyes. The primary care NP notes yellow-green purulent discharge from both
eyes, conjunctival erythema and mild URI symptoms. Which action is correct? ANS: Prescribe topical
antibiotic drops
An 18-month-old child with no previous history of otitis media awoke during the night with right ear
pain. The primary care NP notes an axillary temperature of 100.5 and an erythematous, bulging TM. A
tympanogram reveals a peak of +15-mm H2O. What is the recommended treatment for this child? ANS:
An analgesic medication and watchful waiting
, 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 TM.
What is the initial action? ANS: Ask the patient about previous problems with the ear
The primary care NP 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
cleaning of secretions, the infant's symptoms have not improved. Which action is correct? ANS: Refer to
an ophthalmologist
A patient has a chronic swelling of the parotid gland that is unresponsive to antibiotics and which has
not increased in size. Which diagnostic test is indicated? ANS: Fine needle aspiration
During a well-child exam on a 4-year-old child, the primary care NP notes that the clinic nurse recorded
20/50 for the child's vision and noted that the child has difficulty cooperating with the exam. What will
the NP recommend? ANS: Test the child's vision in 1 month
Causes of cough, not related to pulmonary issues ANS: Allergies, GERD, medications (lisinopril)
The primary care NP is providing nutritional counseling for a 9-year-old female whose weight is at the
95th percentile for her age. What is the goal for this patient? ANS: Maintenance of her current weight
The primary care NP is performing a well child examination on a 12-year-old child who was diagnosed
with type 1 DM at age 9. The child had a lipid screen at age 10 with an LDL cholesterol <100mg/dL. What
will the NP recommend as part of ongoing management for this child? ANS: Comprehensive
ophthalmologic exams
The primary care NP is reviewing lab work and diabetes management with a school-aged child whose
HbA1C is 7.6% who reports usual blood sugars before meals as being 80-90mg/dL. The NP will consult
with the child's endocrinologist to consider which therapy? ANS: Continuous glucose monitoring
