HEENT

The nurse receives report on the patient with acute bowel obstruction. The patient’s problem list includes controlled hypertension, uncontrolled diabetes, and presbycusis. Which action by the nurse is appropriate?

The fetuses of mothers with which infections during pregnancy are at an increased risk for hearing loss? Select all that apply.

The nurse is providing discharge education to the patient with acute laryngitis. Which information does the nurse include?

Which instruction does the nurse provide to the patient with recurrent otitis externa infections?

The nurse is providing medication teaching to the mother of a 4-year-old patient with recurrent otitis media infections who requires daily instillation of antibiotic drops into the ear. Which action indicates effective teaching?

The school nurse is creating a health pamphlet to send home with the students prior to summer break on how to prevent otitis externa. Which information does the nurse include on the cause of otitis externa?

The nurse is educating the 2-year-old patient’s parents on how to instill ear drops to treat acute otitis media. Which statement indicates a need for further teaching?

The patient has undergone a right myringotomy. Which nursing intervention is appropriate?

Following an infection with rhinovirus, the patient reports initial improvement followed by significant congestion and upper teeth pain. The nurse anticipates which diagnosis?

The patient has been diagnosed with ethmoid sinusitis. The nurse anticipates the patient to complain of tenderness upon percussion of which area?

Which radiologic finding indicates frontal sinusitis?

The patient presents to the emergency department (ED) with green sputum and severe pain over the top teeth, cheeks, and forehead following a respiratory viral infection. The provider requests the nurse use the transilluminator to assess for sinusitis. Which assessment indicates maxillary sinusitis?

The patient has been prescribed amoxicillin for the treatment of sinusitis. The patient states, “I thought I just had a cold. I don’t want to take antibiotics for a cold.” Which response by the nurse is most appropriate?

The nurse assesses the patient with acute ethmoid sinusitis for which symptom that indicates the patient is experiencing a severe complication of the condition?

The mother of a 1-month-old neonate brings the child to the clinic with concerns that the child’s head seems large. The nurse measures the occipitofrontal circumference (OFC) and notes a 4 cm increase in the OFC since birth. When reporting this information to the provider, the nurse requests which test?

The nurse caring for the patient with rheumatoid arthritis who is scheduled for an operation under general anesthesia advocates for which test prior to the procedure?

The pediatric patient has simple otitis externa (swimmer’s ear) and is afebrile. The nurse prepares educational materials for which treatment?

The patient with a brain neoplasm reports experiencing visual misperceptions. The nurse suspects the brain tumor is in which lobe of the brain? 

The nurse is assigned to the patient with a brain neoplasm who has been experiencing symptoms of depression. During shift report, the off-going nurse reports observing the patient in a trance-like state. The nurse suspects that the tumor is in which lobe of the brain?

The patient with a brain neoplasm is combative and cursing at the staff. The family reports that this is a drastic change in the patient's personality. The nurse suspects the tumor is in which lobe of the patient's brain?

Which information does the nurse provide to the patient with epilepsy who has been prescribed phenytoin?

A high school wide receiver suffered substantial head trauma during a tackle. The school nurse is concerned about concussion. The nurse provides which information to the adolescent and parents? Select all that apply.

Which report from the ophthalmologist indicates the patient with type 2 diabetes mellitus is experiencing early signs of poor glycemic control?

The patient with type 2 diabetes mellitus complains of worsening vision. Retinal changes are noted on ophthalmoscopic examination. The nurse prepares the patient for which test for diagnostic confirmation?

The patient presents to the emergency department (ED) complaining of sudden onset loss of vision in the right eye. The patient denies recent trauma or other symptoms. The nurse anticipates which report from the ophthalmoscopic exam of the retina?

The patient presents to the emergency department (ED) and states, “I don’t know what happened! I was walking and ran into a door with my right shoulder. I closed my right eye and my vision was normal, but when I closed my left eye, I couldn’t see anything at all!” The patient’s assessment is otherwise normal. The nurse reports this to the provider immediately for assessment. Which question is most important for the nurse to ask the patient while waiting for the provider to write orders for treatment?

The nurse learns the patient has a defect in the cone cells in the retina. The nurse anticipates the patient to have which vision?

The patient with laryngitis requests tips on nonpharmacological symptom management. The nurse makes which suggestion?

The nurse is caring for a patient with left-sided weakness in the hospital who had vocal cord surgery this morning. Which intervention is most important to promote safety?

The nurse is a first responder after a gas explosion at an apartment complex. Which patient does the nurse mark to be treated first?

The patient who underwent a partial thyroidectomy 1 day ago complains of tingling in the lips and tongue. Upon assessment, the nurse notes increased deep tendon reflexes. Which order does the nurse question for this patient?

A baby is born precipitously to a mother who did not have prenatal care. The neonate requires only the initial steps of resuscitation but is found to have a bilateral cleft lip and palate. Review the patient’s assessment here: Position at rest: Complete flexion Square window: 0° Arm recoil: 75° Popliteal angle: 80° Scarf sign: Elbow does not cross midline Heel to ear: Foot does not reach the umbilicus Skin: No veins visible, cracking of skin at joints, dry Lanugo: Mostly bald skin Plantar surface: Creases over entire sole Breast: 4 mm bud with raised areola Ear: Formed pinna with instant recoil Genitals: Descended testes bilaterally, rugae over entire scrotum For which referrals does the nurse advocate for the baby prior to discharge? Select all that apply.

The patient is scheduled to undergo a Wood’s light examination. Which instruction does the nurse include in preprocedure teaching?

The 24-year-old patient presents to the emergency department complaining of malaise and intractable sore throat with onset 24 hours previously. Upon assessment, the nurse notes swollen cervical lymph nodes and a temperature of 39.3°C. The patient denies nasal discharge or cough. Which question by the nurse is most important?

The 15-year-old emancipated minor patient who weighs 32 kg presents to the emergency department with fever, malaise, cervical lymphadenopathy, and severe throat pain that was not preceded by an upper respiratory infection. The nurse anticipates providing teaching about which prescription?

The nurse is providing preoperative education regarding total laryngectomy to the patient with laryngeal cancer. Which statement indicates a need for further teaching?   

The nurse is providing preoperative teaching to the patient prior to a total laryngectomy. Which information does the nurse include in teaching? Select all that apply.

The nurse is providing discharge education to the patient who has a tracheostomy following a total laryngectomy. Which instruction does the nurse give the patient to maintain airway patency?   

The nurse learns the patient has a tracheoesophageal fistula following a resection of laryngeal cancer. How does the nurse interpret this information?  

The nurse counsels the patient with prostate cancer to choose transurethral resection of the prostate based on which characteristic? 

The nurse assessing the 4-month-old brought to the emergency room for poor feeding and signs of dehydration notes the infant seems to be looking down and sclera is visible superior to the iris. The nurse reports this assessment to the provider and receives orders for care. Which order does the nurse question? 

The patient in the emergency department begins projectile vomiting. Which intervention is most important?  

The nurse is preparing to care for a baby antenatally diagnosed with type C esophageal atresia with tracheoesophageal fistula. Which interventions are the priority in the first day after birth?  

The 20-year-old mother brings her 6-day-old infant to the clinic because the child has had yellow drainage from both eyes since yesterday that returns despite wiping it away. Upon assessment, bilateral eyes are closed due to a sticky, mucopurulent discharge. The mother reports a normal spontaneous vaginal delivery after an uncomplicated history. The baby went to breast immediately and the pair were discharged from the hospital 48 hours after birth. The nurse performs a swab of the drainage and anticipates which gram stain result? 

The 5-day-old 38-week-gestation neonate was born to a 25-year-old primigravida woman after a pregnancy and vacuum-assisted delivery complicated by gestational diabetes, large for gestational age fetus, and shoulder dystocia. The neonate required vigorous stimulation and positive pressure ventilation. Apgar scores were 3 and 8 at 1 and 5 minutes of life. At the pediatrician’s appointment after discharge, the neonate is found to have a large bruise at the back of the head that was sustained during birth and eyes glued shut with yellow, mucopurulent discharge. A gram stain of the drainage reveals gram-negative cocci in pairs. The mother states, “No matter what I do, it keeps coming back. I’ve used warm compresses and washed it away.” Additionally, the mother reports the infant is breastfeeding well with 4 wet diapers and 1 stool per day. The nurse informs the provider of the assessment and requests which order first?  

The 75-year-old patient presents to the emergency department complaining of a severe headache that is localized behind the right eye. The patient is nauseous and vomits upon standing. While wearing glasses, the visual acuity is 20/25 in the left eye and 20/110 in the right (records show it is normally also 20/25 corrected). Her left pupil is equal, round, and reactive to light and accommodation; it is measured at 3 mm. Her right pupil reacts only minimally to light and measures at 5 mm; it is round. The provider palpates the eye and reports that it is tense. Her heart rate is 102 bpm and blood pressure is 118/84 mmHg. The nurse anticipates providing which intervention first?  

The 24-year-old male patient presents to the clinic to request a consultation for rhinoplasty. He reports his unsightly nose ruined his most recent relationship because his girlfriend would not stop staring at it; he has missed work due to embarrassment and has started to use makeup to make it look smaller. Upon assessment, the nose appears normal and proportional to his face. Which course of action is the most appropriate?  

During the provider’s exam of the 6-hour-old neonate, the provider reports observing a red reflex in the neonate’s right eye, but not the left. The provider observes whiteness at the back of the eye. The nurse compiles information for the new parents about which procedure?  

During the provider’s exam of the 6-hour-old neonate, the provider reports observing a red reflex in the neonate’s right eye, but not the left. The provider observes whiteness at the back of the eye. Enucleation is performed and the diagnosis of retinoblastoma with clear tumor margins is confirmed. No chemotherapy or radiation is required. The infant is ready to be discharged home as a healthy baby. Which health screening information is most relevant to this family? 

The nurse notes the 4-day-old infant develops circumoral cyanosis while breastfeeding. Once the seal is broken and the neonate begins to cry, the cyanosis resolves and the child becomes pink. There are no nasal secretions and the neonate’s vitals are normal. Which action by the nurse is most helpful?