NRNP 6531 Final Exam part one (250 Questions) and Answers with Rationale 2022/2023

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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 c. A 5-year-old with fever of 38.0°C, severe otalgia, and red, bulging TM d. A 6-month-old with fever of 39.2°C, poor sleep and appetite and bulging TM {{Ans- ANS: A Children older than 24 months with fever less than 39°C and nonsevere symptoms may be watched for 24 hours with symptomatic treatment. Children with otorrhea, those with severe AOM, and any children with fever greater than 39°C should be given antibiotics. Which symptoms in children are evaluated using a parent-reported scoring system to determine the severity of pain in children with otitis media? (Select all that apply.) a. Appetite b. Difficulty sleeping c. Level of cooperation d. Poor hearing e. Tugging on ears {{Ans- ANS: A, B, E Decreased appetite, difficulty sleeping, and tugging on ears are part of the Acute Otitis Media Severity of Symptom Scale used to evaluate pediatric pain. Children may refuse to cooperate for reasons other than pain. Poor hearing is not part of the pain assessment. A patient reports ear pain and difficulty hearing. An otoscopic examination reveals a small tear in the tympanic membrane of the affected ear with purulent discharge. What is the initial treatment for this patient? a. Insert a wick into the ear canal. b. Irrigate the ear canal to remove the discharge. c. Prescribe antibiotic ear drops. d. Refer the patient to an otolaryngologist. {{Ans- ANS: C This perforation is most likely due to infection and should be treated with antibiotic ear drops. Wicks are used for otitis externa. The ear canal should not be irrigated to avoid introducing fluid into the middle ear. It is not necessary to refer unless the perforation does not heal. A patient reports ear pain after being hit in the head with a baseball. The provider notes a perforated tympanic membrane. What is the recommended treatment? a. Order antibiotic ear drops if signs of infection occur. b. Prescribe analgesics and follow up in 1 to 2 days. c. Reassure the patient that this will heal without problems. d. Refer the patient to an otolaryngologist for evaluation. {{Ans- ANS: D Patients with traumatic or blast injuries causing perforations of the tympanic membranes should be referred to specialists to determine whether damage to inner ear structures has occurred. For an uncomplicated perforation, the other interventions are all appropriate. A patient reports persistent nasal blockage, nasal discharge, and facial pain lasting on the right side for the past 5 months. There is no history of sneezing or eye involvement. The patient has a history of seasonal allergies and takes a non-sedating antihistamine. What does the provider suspect is the cause of these symptoms? a. Allergic rhinitis b. Autoimmune vasculitides c. Chronic rhinosinusitis d. Rhinitis medicamentosa {{Ans- ANS: C Chronic rhinosinusitis is present when symptoms occur longer than 12 weeks. Sneezing and itchy, watery eyes tend to occur with allergic rhinitis. Autoimmune vasculitides affects upper and lower respiratory tracts as well as the kidneys. Rhinitis medicamentosa occurs with use of nasal decongestants and not oral antihistamines. A provider determines that a patient has chronic rhinosinusitis without nasal polyps. What is the first-line treatment for this condition? a. Intranasal corticosteroids b. Oral decongestants c. Systemic corticosteroids d. Topical decongestants {{Ans- ANS: A Intranasal corticosteroids are the mainstay of treatment for CRS. Oral decongestants should be used sparingly, only when symptoms are intolerable. Topical decongestants can cause rebound symptoms. Systemic steroids are not indicated. [Show More]

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