NR 511 HEENT Practice Quiz | [GRADED A] Questions and Answer Solutions with Rationales | Download To Score An A.

Document Content and Description Below

Practice Quiz HEENT Question 1. Which of the following is not a cause of conductive hearing loss? 1. Presbycusis. 2. Cerumen impaction. 3. Otitis media. 4. Otosclerosis. Rationales Option 1: T... his is a cause of sensorineural hearing loss. Option 2: This is a cause of conductive hearing loss. Option 3: This is a cause of conductive hearing loss. Option 4: This is a cause of conductive hearing loss. [Page reference: 297] • Course Topic: HEENT Eye Problems • Area of Practice(s): Adult-Gerontology Acute Care; Adult-Gerontology Primary Care; Family Practice; Pediatrics • APN Knowledge Area(s): Disease Management • Testing Domain: Assess • Cognitive Level: Knowledge [Remembering] Question 2. You prescribe Levaquin (levofloxacin) for a severe sinus infection. What is not a possible adverse reaction to this medication? 1. Achilles tendon rupture. 2. Peripheral neuropathy. 3. Nephrotoxicity. 4. Stevens-Johnson syndrome. Rationales Option 1: Tendon ruptures can occur following fluoroquinolone use. Option 2: Peripheral neuropathy can occur following fluoroquinolone use. Option 3: Nephrotoxicity can occur following fluoroquinolone use. Option 4: Stevens-Johnson syndrome is usually caused by allopurinol and beta-lactam antibiotics. [Page reference: 331] • Course Topic: HEENT Eye Problems • Area of Practice(s): Adult-Gerontology Acute Care; Adult-Gerontology Primary Care; Family Practice; Pediatrics • APN Knowledge Area(s): Pharmacologic Therapy and Polypharmacy • Testing Domain: Diagnose • Cognitive Level: Knowledge [Remembering] Question 3. What is the most common cause of epistaxis? 1. Digital trauma. 2. Warfarin. 3. Vitamin C deficiency. 4. Hemophilia A. Rationales Option 1: Picking the nose is the most common cause of nosebleeds. Option 2: When an international normalized ratio (INR) is elevated, a patient on Coumadin can bleed from anywhere, including the nose. Option 3: This can cause nasal tissue friability and epistaxis. Option 4: This would increase the risk of bleeding from the nose, but hemophilia itself is not a cause of epistaxis. [Page reference: 346] • Course Topic: HEENT Eye Problems • Area of Practice(s): Adult-Gerontology Acute Care; Adult-Gerontology Primary Care; Family Practice; Pediatrics • APN Knowledge Area(s): Disease Management • Testing Domain: Assess • Cognitive Level: Knowledge [Remembering] Question 4. Which of the following is not recommended for hoarseness? 1. Vocal rest. 2. Tobacco cessation. 3. Decrease in caffeine use. 4. Oral steroids. Rationales Option 1: This is recommended for the treatment of hoarseness. Option 2: This is recommended for the treatment of hoarseness. Option 3: Caffeine is dehydrating and should not be used in excess with hoarseness. Option 4: Oral steroids are not routinely used to treat hoarseness. [Page reference: 354] • Course Topic: HEENT Eye Problems • Area of Practice(s): Adult-Gerontology Acute Care; Adult-Gerontology Primary Care; Family Practice; Pediatrics • APN Knowledge Area(s): Disease Management • Testing Domain: Assess • Cognitive Level: Knowledge [Remembering] Question 5. Jonathan, age 19, has just been given a diagnosis of mononucleosis. Which of the following statements is true? 1. The offending organism is a bacterium, and Jonathan should be treated with antibiotics. 2. Convalescence is usually only a few days, and Jonathan should be back to normal in a week. 3. Mononucleosis is rarely contagious. 4. Jonathan should avoid contact sports and heavy lifting. Rationales Option 1: Antibiotic therapy is not indicated for Epstein-Barr virus (EBV). Option 2: The patient should be instructed to avoid stress and that convalescence may take several weeks. Option 3: The virus that causes mononucleosis is transmitted through saliva, hence the nickname the “kissing disease.” It is contagious and can be transmitted through kissing or sharing utensils. Bed rest is necessary only in severe cases. Option 4: When teaching clients about mononucleosis, or Epstein-Barr virus (EBV), tell them to avoid contact sports and heavy lifting because of splenomegaly and a threat of rupture. [Page reference: 1025] • Course Topic: HEENT Eye Problems • Area of Practice(s): Family Practice; Pediatrics • APN Knowledge Area(s): Pathophysiology, Health Promotion and Patient Education • Testing Domain: Plan • Cognitive Level: Application [Applying] Question 6. A 44-year-old banker comes to your office for evaluation of a pulsating headache over the left temporal region, and he rates the pain as an 8 on a scale of 1 to 10. The pain has been constant for the past several hours and is accompanied by nausea and sensitivity to light. He has had frequent, though less severe, headaches for many years, and they are usually relieved by over-the-counter medicines. He is unclear as to a precipitating event but notes that he has had visual disturbances before each headache and he has been under a lot of stress in his job. Based on this description, what is the most likely diagnosis of this type of headache? 1. Tension. 2. Migraine. 3. Cluster. 4. Temporal arteritis. Rationales Option 1: Tension headaches are not associated with photophobia and are usually bilateral and associated with limited neck range of motion (ROM). Tension headaches are not preceded by an aura. Option 2: Migraines are classically preceded by an aura and accompanied by nausea, vomiting (sometimes), and photophobia. They are usually unilateral. Option 3: Cluster headaches are unilateral, frequently occur at night, and bear some resemblance to migraines; however, cluster headaches are accompanied by tearing, nasal stuffiness, and sweating on the same side as the headache, and they come in clusters. Option 4: The client is not in the age range (older than 50) for temporal arteritis. [Page reference: 85] • Course Topic: HEENT Eye Problems • Area of Practice(s): Adult-Gerontology Primary Care; Family Practice • APN Knowledge Area(s): Differential Diagnosis Clinical Decision-Making • Testing Domain: Diagnose • Cognitive Level: Analysis [Analyzing] Question 7. Max, age 35, states that he thinks he has an ear infection because he just flew back from a business trip and feels unusual pressure in his ear. You diagnose barotrauma. What is your next action? 1. Prescribe nasal steroids and oral decongestants. 2. Prescribe antibiotic ear drops. 3. Prescribe systemic antibiotics. 4. Refer Max to an ear, nose, and throat specialist. Rationales Option 1: Barotrauma of the auditory canal, causing a sensation of abnormal middle ear pressure, may be relieved by the use of nasal steroids and oral decongestants. Option 2: With barotrauma, there is no infection, just swelling of the airways, which causes the sensation of abnormal pressure; therefore, antibiotics are not indicated. Option 3: With barotrauma, there is no infection, just swelling of the airways, which causes the sensation of abnormal pressure; therefore, antibiotics are not indicated. Option 4: This condition is certainly within the practitioner’s scope of practice, and a referral is not indicated. [Page reference: 293] • Course Topic: HEENT Eye Problems • Area of Practice(s): Adult-Gerontology Primary Care; Family Practice • APN Knowledge Area(s): Disease Management, Pathophysiology • Testing Domain: Plan • Cognitive Level: Analysis [Analyzing] Question 8. Susan is a 19-year-old college student and avid swimmer. She frequently gets swimmer’s ear and asks if there is anything she can do to help prevent it other than wearing earplugs, which do not really work for her. What do you suggest? 1. Start using a cotton-tipped applicator to dry the ears after swimming. 2. Use ear drops made of a solution of equal parts alcohol and vinegar in each ear after swimming. 3. Use a hair dryer on the highest setting to dry the ears. 4. Stop swimming. Rationales Option 1: The adage “You shouldn’t put anything smaller than your elbow in your ear” holds true today. Option 2: Using ear drops made of a solution of equal parts alcohol and vinegar in each ear after swimming is effective in drying the ear canal and maintaining an acidic environment, therefore preventing a favorable medium for the growth of bacteria, the cause of swimmer’s ear. Option 3: A hair dryer operated on the lowest setting several inches from the ear may be used to dry the canal. Option 4: There is no reason for the client to stop swimming. [Page reference: 311] • Course Topic: HEENT Eye Problems • Area of Practice(s): Adult-Gerontology Primary Care; Family Practice; Pediatrics • APN Knowledge Area(s): Health Promotion and Patient Education, Population Health and Epidemiology • Testing Domain: Plan • Cognitive Level: Application [Applying] Question 9. Which of the following conditions produces sharp, piercing facial pain that lasts for seconds to minutes? 1. Trigeminal neuralgia. 2. Temporomandibular joint (TMJ) syndrome. 3. Goiter. 4. Preauricular adenitis. Rationales Option 1: Trigeminal neuralgia is described as a sharp, piercing, shooting facial pain that is severe but usually lasts only a short time. The origin is cranial nerve V (CN V), the trigeminal nerve. Option 2: TMJ dysfunction is associated with pain on opening and closing the mouth and is also associated with crepitus of that joint. Option 3: A goiter is generally painless. Option 4: Preauricular adenitis (enlarged and inflamed preauricular nodes) would be sustained until the etiological cause was identified and treated. [Page reference: 134] • Course Topic: HEENT Eye Problems • Area of Practice(s): Adult-Gerontology Primary Care; Family Practice • APN Knowledge Area(s): Pathophysiology, Health Assessment • Testing Domain: Assess • Cognitive Level: Comprehension [Understanding] Question 10. A 64-year-old obese woman comes in complaining of difficulty swallowing for the past 3 weeks. She states that “some foods get stuck” and she has been having “heartburn” at night when she lies down, especially if she has had a heavy meal. Occasionally, she awakes at night coughing. She denies weight gain and/or weight loss, vomiting, or change in bowel movements or color of stools. She denies alcohol and tobacco use. There is no pertinent family history or findings on review of systems (ROS). Physical examination is normal, with no abdominal tenderness, and the stool is occult blood (OB) negative. What is the most likely diagnosis? 1. Esophageal varices. 2. Esophageal cancer. 3. Gastroesophageal reflux disease (GERD). 4. Peptic ulcer disease (PUD). Rationales Option 1: Though the historical data are incomplete, this client has no obvious risk factors for esophageal varices. Option 2: Though the historical data are incomplete, this client has no obvious risk factors for esophageal cancer. Option 3: Though the historical data are incomplete, this client has no obvious risk factors for esophageal varices or esophageal cancer. She is a nondrinker and denies weight loss and changes in bowel function or color of stools, which could be a clue to a gastrointestinal bleed. The fact that her worst symptoms occur at night with regurgitation and heartburn is classic for GERD. Dysphagia is frequently a prominent symptom of GERD. She has no abdominal tenderness, and aside from the nighttime symptoms and dysphagia, she reports no symptoms with food or lack of food. Option 4: Clients with PUD frequently complain of clusters of pain episodes separated by periods of no symptoms. [Page reference: 565-568] • Course Topic: HEENT Eye Problems • Area of Practice(s): Adult-Gerontology Primary Care; Family Practice • APN Knowledge Area(s): Differential Diagnosis Clinical Decision-Making • Testing Domain: Diagnose • Cognitive Level: Analysis [Analyzing] Question 11. Marcia, age 4, is brought in to the office by her mother. She has a sore throat, difficulty swallowing, copious oral secretions, respiratory difficulty, stridor, and a temperature of 102°F but no pharyngeal erythema or cough. What do you suspect? 1. Epiglottitis. 2. Group A beta-hemolytic streptococcal pharyngitis. 3. Tonsillitis. 4. Diphtheria. Rationales Option 1: A symptom cluster of severe throat pain with difficulty swallowing, copious oral secretions, respiratory difficulty, stridor, and fever but without pharyngeal erythema or cough is indicative of epiglottitis. Option 2: Streptococcal pharyngitis presents with cervical adenitis, petechiae, a beefy-red uvula, and a tonsillar exudate. Option 3: A mild case of tonsillitis may appear to be only a slight sore throat. A more severe case would involve inflamed, swollen tonsils; a very sore throat; and a high fever. Option 4: Diphtheria starts with a sore throat, fever, headache, and nausea, and then progresses to patches of grayish or dirty-yellowish membranes in the throat that eventually grow into 1 membrane. [Page reference: 331] • Course Topic: HEENT Eye Problems • Area of Practice(s): Family Practice; Pediatrics • APN Knowledge Area(s): Differential Diagnosis Clinical Decision-Making • Testing Domain: Diagnose • Cognitive Level: Analysis [Analyzing] Question 12. You are assessing a first grader and find that the tonsils are touching the uvula. How would you grade this finding? 1. Grade 1. 2. Grade 2. 3. Grade 3. 4. Grade 4. Rationales Option 1: Grade 1 indicates the tonsils are visible. Option 2: Grade 2 indicates the tonsils are halfway between the tonsillar pillars and the uvula. Option 3: Grade 3 indicates the tonsils are touching the uvula. Tonsils are enlarged to 2, 3, or 4 with an acute infection. Option 4: Grade 4 indicates the tonsils are touching each other. [Page reference: 339-340] • Course Topic: HEENT Eye Problems • Area of Practice(s): Family Practice; Pediatrics • APN Knowledge Area(s): Health Assessment, Pathophysiology • Testing Domain: Assess • Cognitive Level: Application [Applying] Question 13. Nystatin (Mycostatin) is ordered for Michael, a 56-year-old banker who has an oral fungal infection. What instructions for taking the medication do you give Michael? 1. “Dilute the oral medication with one tablespoon of water for easier digestion.” 2. “Take the medication with meals so that it’s absorbed better.” 3. “Swish and swallow the medication.” 4. “Apply the medication only to the lesions.” Rationales Option 1: The oral medication should not be diluted, as that may compromise the absorption. Option 2: Taking the medication with meals may compromise the absorption. Option 3: When ordering nystatin (Mycostatin) for an oral fungal infection, tell the client to swish the medication in the mouth to coat all the lesions and then to swallow it. Option 4: It is almost impossible to apply this liquid medication to only the lesions; swishing it in the mouth coats all the lesions more effectively. [Page reference: 336] • Course Topic: HEENT Eye Problems • Area of Practice(s): Adult-Gerontology Primary Care; Family Practice • APN Knowledge Area(s): Health Promotion and Patient Education, Pharmacologic Therapy and Polypharmacy • Testing Domain: Plan • Cognitive Level: Application [Applying] Question 14. Erica, age 39, has a sudden onset of shivering, sweating, headache, aching in the orbits, and general malaise and misery. Her temperature is 102°F. The nurse practitioner diagnosed her with influenza (flu). What is your next course of action? 1. Order amoxicillin (Amoxil) 500 mg every 12 hours for 7 days. 2. Prescribe rest, fluids, acetaminophen (Tylenol), and possibly a decongestant and an antitussive. 3. Order a complete blood count (CBC). 4. Consult with your collaborating physician. Rationales Option 1: Amoxicillin, an antibiotic, is not used in the treatment of influenza, a viral infection. Option 2: Management of flu is generally symptomatic and includes rest, fluids, acetaminophen (Tylenol), and possibly a decongestant and an antitussive. The client should be advised to call or return to the clinic in 4 days if symptoms are not improving. Option 3: Influenza diagnosis is usually made clinically and does not require a CBC. Option 4: Consulting with the collaborating physician is unnecessary and will result in the same treatment for influenza. [Page reference: 373-374] • Course Topic: HEENT Eye Problems • Area of Practice(s): Adult-Gerontology Primary Care; Family Practice • APN Knowledge Area(s): Differential Diagnosis Clinical Decision-Making, Disease Management • Testing Domain: Plan • Cognitive Level: Analysis [Analyzing] Question 15. Regular ocular pressure testing is indicated for older adults taking: 1. High-dose inhaled glucocorticoids. 2. Nonsteroidal anti-inflammatory drugs (NSAIDs). 3. Angiotensin-converting enzyme (ACE) inhibitors. 4. Insulin. Rationales Option 1: Although regular ocular pressure testing is indicated on a routine basis for all older adults, it is especially important for clients taking an extended regimen of high-dose inhaled glucocorticoids because prolonged continuous use increases the risk of ocular hypertension or open-angle glaucoma. Option 2: NSAIDs do not require ocular pressure monitoring. Option 3: ACE inhibitors do not require ocular pressure monitoring. Option 4: Older adults taking insulin need to have regular eye examinations because they are diabetic and have a risk of diabetic retinopathy, not because they are taking insulin. [Page reference: 281] • Course Topic: HEENT Eye Problems • Area of Practice(s): Adult-Gerontology Primary Care; Family Practice • APN Knowledge Area(s): Pharmacologic Therapy and Polypharmacy • Testing Domain: Plan • Cognitive Level: Application [Applying] Question 16. In a young child, unilateral purulent rhinitis is most often caused by: 1. A foreign body. 2. A viral infection. 3. A bacterial infection. 4. An allergic reaction. Rationales Option 1: In a young child, unilateral purulent rhinitis is most often caused by a foreign body. The key word here is unilateral. Option 2: Viral infections usually affect both nares. Option 3: Bacterial infections usually affect both nares. Option 4: Allergic reactions usually affect both nares. [Page reference: 322] • Course Topic: HEENT Eye Problems • Area of Practice(s): Family Practice; Pediatrics • APN Knowledge Area(s): Health Assessment, Pathophysiology • Testing Domain: Assess • Cognitive Level: Comprehension [Understanding] Question 17. Which manifestation is noted with carbon monoxide poisoning? 1. Circumoral pallor of the lips. 2. Cherry-red lips. 3. Cyanosis of the lips. 4. Pale pink lips. Rationales Option 1: In light-skinned clients, circumoral pallor of the lips occurs with shock and anemia. Option 2: Cherry-red lips are a manifestation of carbon monoxide poisoning. They also occur with ketoacidosis or acidosis from aspirin poisoning. Option 3: Cyanosis of the lips occurs with hypoxemia and chilling. Option 4: Some lips are normally pale pink. [Page reference: 1250] • Course Topic: HEENT Eye Problems • Area of Practice(s): Adult-Gerontology Primary Care; Family Practice • APN Knowledge Area(s): Pathophysiology, Health Assessment • Testing Domain: Assess • Cognitive Level: Comprehension [Understanding] Question 18. At the clinic, you are assessing Kyle, a 4-month-old baby, for the first time and notice that both eyes are turning inward. What is this called? 1. Pseudostrabismus. 2. Strabismus. 3. Esotropia. 4. Exotropia. Rationales Option 1: Pseudostrabismus has the appearance of strabismus because of the presence of epicanthic folds but is normal in young children. Option 2: Strabismus, also called tropia, is the constant malalignment of the eye axes. It is likely to cause amblyopia. Option 3: Esotropia is the inward turning of the eyes. Option 4: Exotropia is the outward turning of the eyes. [Page reference: 262-263] • Course Topic: HEENT Eye Problems • Area of Practice(s): Family Practice; Pediatrics • APN Knowledge Area(s): Health Assessment • Testing Domain: Assess • Cognitive Level: Application [Applying] Question 19. You diagnose 46-year-old Mabel with viral conjunctivitis. Your treatment should include: 1. Gentamicin ophthalmic ointment. 2. Ciprofloxacin ophthalmic drops. 3. Supportive measures and lubricating drops (artificial tears). 4. Oral erythromycin for 14 days. Rationales Option 1: Antibiotics should not be used in clients with viral conjunctivitis. Option 2: Antibiotics should not be used in clients with viral conjunctivitis. Option 3: Viral conjunctivitis is treated with supportive measures, including cold compresses and lubricating eye drops. Preventive measures, such as frequent handwashing, are important, as viral conjunctivitis is highly contagious. Option 4: Antibiotics should not be used in clients with viral conjunctivitis. [Page reference: 272-276] • Course Topic: HEENT Eye Problems • Area of Practice(s): Adult-Gerontology Primary Care; Family Practice • APN Knowledge Area(s): Disease Management, Pharmacologic Therapy and Polypharmacy • Testing Domain: Plan • Cognitive Level: Application [Applying] Question 20. You diagnose acute epiglottitis in Sally, age 5, and immediately send her to the local emergency room. Which of the following symptoms would indicate that an airway obstruction is imminent? 1. Reddened face. 2. Screaming. 3. Grabbing her throat. 4. Stridor. Rationales Option 1: A reddened face does not indicate a lack of oxygenation. Option 2: Although the child may scream and grab at her throat, these are not primary indicators of impending airway obstruction. Option 3: Although the child may scream and grab at her throat, these are not primary indicators of impending airway obstruction. Option 4: In a pediatric client with acute epiglottitis, a number of symptoms can indicate that airway obstruction is imminent: stridor, restlessness, nasal flaring, as well as the use of accessory muscles of respiration. [Page reference: 343] • Course Topic: HEENT Eye Problems • Area of Practice(s): Family Practice; Pediatrics • APN Knowledge Area(s): Health Assessment • Testing Domain: Assess • Cognitive Level: Application [Applying] [Show More]

Last updated: 2 years ago

Preview 1 out of 16 pages