Deck 30: Ear Disorders

Question 1

The primary care pediatric nurse practitioner diagnoses acute otitis media in a 2­
year­old child who has a history of three ear infections in the first 6 months of life. The child's tympanic membrane is intact and the child has a temperature of 101.5°F. What will the nurse practitioner prescribe for this child?
A. Amoxicillin twice daily for 10 days
B. An analgesic medication and watchful waiting
C. Antibiotic ear drops and ibuprofen
D. Ceftriaxone given once intramuscularly

Answer 1

An analgesic medication and watchful waiting

Question 2

A 3­year­old child has had one episode of acute otitis media 3 weeks prior with a
normal tympanogram just after treatment with amoxicillin. In the clinic today, the child has a type B tympanogram, a temperature of 102.5°F, and a bulging tympanic membrane. What will the primary care pediatric nurse practitioner order?
A. A referral for tympanocentesis
B. Amoxicillin twice daily
C. Amoxicillin­clavulanate twice daily
D. Intramuscular ceftriaxone

Answer 2

Amoxicillin­clavulanate twice daily

Question 3

A child 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?
A. Insert a wick into the external auditory canal.
B. Irrigate the external auditory canal with saline.
C. Order systemic corticosteroids.
D. Prescribe an oral antibiotic medication.

Answer 3

Insert a wick into the external auditory canal.

Question 4

A 7­month­old infant has had two prior acute ear infections and is currently on the
10th day of therapy with amoxicillin­clavulanate after a failed course of amoxicillin. The primary care pediatric nurse practitioner notes marked middle ear effusion and erythema of the TM. The child is irritable and has a temperature of 99.8°F. What is the next step in management of this child's ear infection?
A. Order a second course of amoxicillin­clavulanate.
B. Perform tympanocentesis for culture.
C. Prescribe clindamycin twice daily.
D. Refer the child to an otolaryngologist.

Question 5

A child with a history of otitis externa asks about ways to prevent this condition. What will the primary care pediatric nurse practitioner recommend?
A. Cleaning ear canals well after swimming
B. Drying the ear canal with a hair dryer
C. Swimming only in chlorinated pools
D. Using cerumenolytic agents daily

Question 6

A school­age child has a history of chronic otitis media and is seen in the clinic
with vertigo. The primary care pediatric nurse practitioner notes profuse purulent otorrhea from both pressure­equalizing tubes and a pearly­white lesion on one tympanic membrane. Which condition is most likely?
A. Cholesteatoma
B. Mastoiditis
C. Otitis externa
D. Otitis media with effusion

Question 7

The primary care pediatric nurse practitioner notes a small, round object in a
child's external auditory canal, near the tympanic membrane. The child's parent thinks it is probably a dried pea. What will the nurse practitioner do to remove this object?
A. Irrigate the external auditory canal to flush out the object.
B. Refer the child to an otolaryngologist for removal.
C. Remove the object with a wire loop curette.
D. Use a bayonet forceps to grasp and remove the object.

Question 8

A child complains of itching in both ears and is having trouble hearing. The
primary care pediatric 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?
A. Obtain a culture of the external auditory canal.
B. Order ototopical antibiotic/corticosteroid drops.
C. Prescribe oral amoxicillin­clavulanate.
D. Refer the child to an otolaryngologist.

Question 9

The parent of a 4­month­old infant is concerned that the infant cannot hear.
Which test will the primary care pediatric nurse practitioner order to evaluate potential hearing loss in this infant?
A. Acoustic reflectometry
B. Audiometry
C. Auditory brainstem response (ABR)
D. Evoked otooacoustic emission (EOAE) testing

Question 10

An 18­month­old child with no previous history of otitis media awoke during the
night with right ear pain. The primary care pediatric nurse practitioner notes an axillary temperature of 100.5°F and an erythematous, bulging tympanic membrane. A tympanogram reveals of peak of +150 mm H2O. What is the recommended treatment for this child?
A. Amoxicillin 80 to 90 mg/kg/day in two divided doses
B. An analgesic medication and watchful waiting
C. Ceftriaxone 50 to 75 mg/kg/dose IM given once
D. Ototopical antibiotic drops twice daily for 5 days

Question 11

What will the primary care pediatric nurse practitioner teach the parents of a child who has new pressure­equalizing tubes (PET) in both ears?
A. Parents should notice improved hearing in their child.
B. PET will help by reducing the number of ear infections the child has.
C. The child should use earplugs when showering or bathing.
D. The tubes will most likely remain in place for 3 to 4 years.

Question 12

The primary care pediatric nurse practitioner obtains a tympanogram on a child that reveals a sharp peak of ­180 mm H2O. What does this value indicate?
A. A normal tympanic membrane
B. Middle ear effusion
C. Negative ear pressure
D. Tympanic membrane perforation

Question 13

A 3­year­old child with pressure­equalizing tubes (PET) in both ears has otalgia in
one ear. The primary care pediatric nurse practitioner is able to visualize the tube and does not see exudate in the ear canal and obtains a type A tympanogram. What will the nurse practitioner do?
A. Order ototopical antibiotic/corticosteroid drops.
B. Prescribe a prophylactic antibiotic medication.
C. Reassure the parent that this is a normal exam.
D. Refer the child to an otolaryngologist for follow­up

Question 14

A child who was treated with amoxicillin and then amoxicillin­clavulanate for acute
otitis media is seen for follow­up. The primary care pediatric nurse practitioner notes dull­gray tympanic membranes with a visible air­fluid level. The child is afebrile and without pain. What is the next course of action?
A. Administering ceftriaxone IM
B. Giving clindamycin orally
C. Monitoring ear fluid levels for 3 months
D. Watchful waiting for 48 to 72 hours