Complete NURS 652 Blueprint: FNP
Thinking Skills & HEENT Guaranteed
Solutions
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?
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?
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?
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?
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?
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?
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?
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?
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?
Drying the ear canal with a hair dryer
What are the guidelines for safe and effective implementation?
Partnerships, Reassess, Competency, Caring, Modifications, Consistency, Asking questions, and
Repertoire (using your full range of skills)
What should nurses consider when planning ahead for implementation?
,Organization and efficiency, anticipating needs, patient and family involvement, environment,
right person/right task, anticipating unexpected outcomes, ensuring safe and quality care,
promoting self-care, and patient/family education
What are the three types of potentially dangerous situations in implementation?
Technical issues, Human issues, and System failures
What variables can affect achievement of outcomes?
Patient variables, Nursing variables, Resources, Standards of care, Research findings, Ethical and
legal guidelines
What are the 5 Rights of Delegation?
Right task
Right circumstance
Right person
Right direction and communication
Right supervision and evaluation
What should a student nurse include in organizing clinical responsibilities?
Patient profile and preferred name
Chief complaint and reason for admission
Current health status
Routine assistance for basic needs
Priorities for nursing care and special daily events
Special teaching, counseling, or advocacy needs
Special family needs
What should a student NEVER do in clinical practice?
Never perform an intervention you are uncertain of or lack training in
What is the main purpose of evaluation in the nursing process?
To determine if the plan of care was effective — "Did it work? Now what?"
What are the five classic elements of evaluation?
Identifying evaluative criteria and standards
Collecting data to determine if criteria are met
Interpreting and summarizing findings
Documenting judgment (met, partially met, not met)
Terminating, continuing, or modifying the plan
What are the four types of outcomes evaluation in nursing?
Physiologic, Psychomotor, Cognitive, and Affective
How is physiologic outcome evaluation performed?
By using physical assessment skills to collect and compare data ( vital signs)
How is psychomotor outcome evaluation performed?
By asking the patient to demonstrate a new skill
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?
Refer the child to an otolaryngologist
,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?
Sialolithiasis
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?
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?
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?
Daily chlorhexidine gluconate rinses
A primary care provider may suspect cataract formation in a patient with which finding?
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?
Aqueous-deficiency
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?
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...
refer the infant to an ophthalmologist
Which are risk factors for development of cataracts?
Smoking
Advancing age
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?
Prescribe topical antibiotic drops
The primary care NP is performing a well-child examination on a 2-year-old child with a
history of intrauterine growth retardation whose height remains less than the 3rd
percentile on a WHO growth chart. What will the NP do?
Refer the child to a pediatric endocrinologist
, An infant has congenital adrenal hyperplasia. At a routine well baby checkup, the primary
care NP notes vomiting, poor feeding, lethargy, and mild dehydration. Which action is
correct?
Refer the infant to the ED for fluids, dextrose, and steroids
A patient with T2DM becomes insulin dependent after a year of therapy with oral diabetes
medication. When explaining this change in therapy, the provider will tell the patient:
this is because of the natural progression of the disease
A 16-year-old female whose BMI is at the 90th percentile reports irregular periods. The
primary care NP notes widespread acne on her face and back and an abnormal
distribution of facial hair. The NP will evaluate her further based on a suspicion of which
diagnosis?
Polycystic ovary syndrome
A patient recently diagnosed with T1DM is in clinic for a follow-up evaluation. The
provider notes that the patient appears confused and irritable and is sweating and shaking.
What intervention will the provider expect to perform once the POC blood glucose is
known?
giving a rapid-acting carbohydrate
A 15-year-old child has a recent history of increased thirst and frequent urination. The
child's weight has been in the 95th percentile for several years. A dipstick UA is positive for
glucose, and random plasma glucose is 350mg/dL. Which test will the primary care NP
order to determine the type of diabetes in this child?
Pancreatic antibodies
A patient has thyroid nodules and the provider suspects thyroid cancer. To evaluate
thyroid nodules for potential malignancy, which test is performed?
Thyroid ultrasound
The primary care NP diagnoses a 14-year-old child with T1DM after a routine urine screen
is positive for glucose and negative for ketones and plasma glucose is 350mg/dL. The child's
weight is normal and the parents report a mild increase in thirst and urine output in the
past few days. Which course of action is correct?
Begin insulin and refer the child to a children's diabetes center
An initial key part of management of a child suspected of having an inborn error of
metabolism is
consulting a metabolic specialist
The primary care NP is performing a well-child examination on a 5-year-old girl. The
parents ask if the child's adult height can be predicted. The NP learns that the mother is
5'8" tall and the father is 5'11" tall. The NP will estimate which expected adult height for
this child?
5'7"
A diabetic patient who is taking a statin drug to treat dyslipidemia has begun a diet and
exercise program. The patient reports new onset of muscle pain several weeks after
beginning therapy. What is the initial action of the provider?
Obtain a creatinine kinase level
The mother of a female infant is concerned that her daughter is developing breasts. The
primary care NP notes mild breast development but no pubic or axillary hair. What is the
likely diagnosis?
Premature thelarche which will resolve over time
Thinking Skills & HEENT Guaranteed
Solutions
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?
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?
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?
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?
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?
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?
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?
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?
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?
Drying the ear canal with a hair dryer
What are the guidelines for safe and effective implementation?
Partnerships, Reassess, Competency, Caring, Modifications, Consistency, Asking questions, and
Repertoire (using your full range of skills)
What should nurses consider when planning ahead for implementation?
,Organization and efficiency, anticipating needs, patient and family involvement, environment,
right person/right task, anticipating unexpected outcomes, ensuring safe and quality care,
promoting self-care, and patient/family education
What are the three types of potentially dangerous situations in implementation?
Technical issues, Human issues, and System failures
What variables can affect achievement of outcomes?
Patient variables, Nursing variables, Resources, Standards of care, Research findings, Ethical and
legal guidelines
What are the 5 Rights of Delegation?
Right task
Right circumstance
Right person
Right direction and communication
Right supervision and evaluation
What should a student nurse include in organizing clinical responsibilities?
Patient profile and preferred name
Chief complaint and reason for admission
Current health status
Routine assistance for basic needs
Priorities for nursing care and special daily events
Special teaching, counseling, or advocacy needs
Special family needs
What should a student NEVER do in clinical practice?
Never perform an intervention you are uncertain of or lack training in
What is the main purpose of evaluation in the nursing process?
To determine if the plan of care was effective — "Did it work? Now what?"
What are the five classic elements of evaluation?
Identifying evaluative criteria and standards
Collecting data to determine if criteria are met
Interpreting and summarizing findings
Documenting judgment (met, partially met, not met)
Terminating, continuing, or modifying the plan
What are the four types of outcomes evaluation in nursing?
Physiologic, Psychomotor, Cognitive, and Affective
How is physiologic outcome evaluation performed?
By using physical assessment skills to collect and compare data ( vital signs)
How is psychomotor outcome evaluation performed?
By asking the patient to demonstrate a new skill
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?
Refer the child to an otolaryngologist
,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?
Sialolithiasis
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?
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?
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?
Daily chlorhexidine gluconate rinses
A primary care provider may suspect cataract formation in a patient with which finding?
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?
Aqueous-deficiency
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?
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...
refer the infant to an ophthalmologist
Which are risk factors for development of cataracts?
Smoking
Advancing age
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?
Prescribe topical antibiotic drops
The primary care NP is performing a well-child examination on a 2-year-old child with a
history of intrauterine growth retardation whose height remains less than the 3rd
percentile on a WHO growth chart. What will the NP do?
Refer the child to a pediatric endocrinologist
, An infant has congenital adrenal hyperplasia. At a routine well baby checkup, the primary
care NP notes vomiting, poor feeding, lethargy, and mild dehydration. Which action is
correct?
Refer the infant to the ED for fluids, dextrose, and steroids
A patient with T2DM becomes insulin dependent after a year of therapy with oral diabetes
medication. When explaining this change in therapy, the provider will tell the patient:
this is because of the natural progression of the disease
A 16-year-old female whose BMI is at the 90th percentile reports irregular periods. The
primary care NP notes widespread acne on her face and back and an abnormal
distribution of facial hair. The NP will evaluate her further based on a suspicion of which
diagnosis?
Polycystic ovary syndrome
A patient recently diagnosed with T1DM is in clinic for a follow-up evaluation. The
provider notes that the patient appears confused and irritable and is sweating and shaking.
What intervention will the provider expect to perform once the POC blood glucose is
known?
giving a rapid-acting carbohydrate
A 15-year-old child has a recent history of increased thirst and frequent urination. The
child's weight has been in the 95th percentile for several years. A dipstick UA is positive for
glucose, and random plasma glucose is 350mg/dL. Which test will the primary care NP
order to determine the type of diabetes in this child?
Pancreatic antibodies
A patient has thyroid nodules and the provider suspects thyroid cancer. To evaluate
thyroid nodules for potential malignancy, which test is performed?
Thyroid ultrasound
The primary care NP diagnoses a 14-year-old child with T1DM after a routine urine screen
is positive for glucose and negative for ketones and plasma glucose is 350mg/dL. The child's
weight is normal and the parents report a mild increase in thirst and urine output in the
past few days. Which course of action is correct?
Begin insulin and refer the child to a children's diabetes center
An initial key part of management of a child suspected of having an inborn error of
metabolism is
consulting a metabolic specialist
The primary care NP is performing a well-child examination on a 5-year-old girl. The
parents ask if the child's adult height can be predicted. The NP learns that the mother is
5'8" tall and the father is 5'11" tall. The NP will estimate which expected adult height for
this child?
5'7"
A diabetic patient who is taking a statin drug to treat dyslipidemia has begun a diet and
exercise program. The patient reports new onset of muscle pain several weeks after
beginning therapy. What is the initial action of the provider?
Obtain a creatinine kinase level
The mother of a female infant is concerned that her daughter is developing breasts. The
primary care NP notes mild breast development but no pubic or axillary hair. What is the
likely diagnosis?
Premature thelarche which will resolve over time
