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FNP 652 FINAL EXAM QUESTIONS & CORRECT ANSWERS GRADED A LATEST 2024, Exams of Nursing

York UniversityNursing

FNP 652 FINAL EXAM QUESTIONS & CORRECT ANSWERS GRADED A LATEST 2024

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2024/2025

Available from 07/03/2025

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FNP 652 FINAL EXAM QUESTIONS & CORRECT
ANSWERS GRADED A LATEST 2024
1. A patient who has chronic lower back pain reports increased difficulty sleeping unrelated to
discomfort, along with a desire to quit working. What will the provider do?
A. Ask the patient about addiction issues.
B. Consult with a social worker.
C. Increase the dosage of prescribed pain medications.
D. Order radiographic studies of the lower spine.
(ANS: B) Patients who exhibit poor sleep and poor coping may be developing mental defeat as a
result of chronic pain and should be evaluated and treated early for this to prevent further
disability and improve functionality. Substance abuse may be a part of mental defeat and should
be evaluated based on assessment findings. Unless the symptoms are related to pain, increasing
the dose of analgesics and ordering diagnostic studies are not indicated.
2. A patient with chronic leg pain describes the pain as “stabbing” and “throbbing.” This is
characteristic of which type of pain?
A. Neuropathic pain
B. Referred pain
C. Somatic pain
D. Visceral pain
(ANS: C) Somatic pain is caused by the activation of nociceptors in the peripheral tissues,
including skin, bones, muscles, and soft tissue and is usually well-localized and characterized as
stabbing, aching, or throbbing. Neuropathic pain occurs from injury to or disease of the nervous
system and is described as burning, shooting, or tingling. Referred pain is a kind of visceral pain
that is localized, but not attributable to the involved organ. Visceral pain is related to an organ
and is often referred and poorly localized.
3. A patient is beginning treatment for chronic pain and is unable to tolerate nonsteroidal anti-
inflammatory drugs. What will the provider prescribe for this patient?
A. A mixed opiate product
B. A pure opioid compound
C. A referral for a nerve block procedure
D. A selective serotonin reuptake inhibitor (SSRI)
(ANS: D) Using the three-step analgesic ladder, the provider should use step 1 medications that
include NSAIDs, tricyclic antidepressants, selective serotonin reuptake inhibitors, or anti-
convulsants. Since the patient cannot tolerate NSAIDs, an SSRI is an appropriate choice. The
next step if these fail is a mixed opioid product. The third step is a pure opioid product. If
medication therapy fails, a referral for nerve block may be necessary.
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FNP 652 FINAL EXAM QUESTIONS & CORRECT

ANSWERS GRADED A LATEST 2024

  1. A patient who has chronic lower back pain reports increased difficulty sleeping unrelated to discomfort, along with a desire to quit working. What will the provider do? A. Ask the patient about addiction issues. B. Consult with a social worker. C. Increase the dosage of prescribed pain medications. D. Order radiographic studies of the lower spine. (ANS: B) Patients who exhibit poor sleep and poor coping may be developing mental defeat as a result of chronic pain and should be evaluated and treated early for this to prevent further disability and improve functionality. Substance abuse may be a part of mental defeat and should be evaluated based on assessment findings. Unless the symptoms are related to pain, increasing the dose of analgesics and ordering diagnostic studies are not indicated.
  2. A patient with chronic leg pain describes the pain as “stabbing” and “throbbing.” This is characteristic of which type of pain? A. Neuropathic pain B. Referred pain C. Somatic pain D. Visceral pain (ANS: C) Somatic pain is caused by the activation of nociceptors in the peripheral tissues, including skin, bones, muscles, and soft tissue and is usually well-localized and characterized as stabbing, aching, or throbbing. Neuropathic pain occurs from injury to or disease of the nervous system and is described as burning, shooting, or tingling. Referred pain is a kind of visceral pain that is localized, but not attributable to the involved organ. Visceral pain is related to an organ and is often referred and poorly localized.
  3. A patient is beginning treatment for chronic pain and is unable to tolerate nonsteroidal anti- inflammatory drugs. What will the provider prescribe for this patient? A. A mixed opiate product B. A pure opioid compound C. A referral for a nerve block procedure D. A selective serotonin reuptake inhibitor (SSRI) (ANS: D) Using the three-step analgesic ladder, the provider should use step 1 medications that include NSAIDs, tricyclic antidepressants, selective serotonin reuptake inhibitors, or anti- convulsants. Since the patient cannot tolerate NSAIDs, an SSRI is an appropriate choice. The next step if these fail is a mixed opioid product. The third step is a pure opioid product. If medication therapy fails, a referral for nerve block may be necessary.

Chapter 17: Obesity and Weight Management

  1. A woman who is obese has a neck circumference of 16.5 cm. Which test is necessary to assess for complications of obesity in this patient based on this finding? A. Electrocardiography B. Gallbladder ultrasonography C. Mammography D. Polysomnography (ANS: D) Women with a neck circumference greater than 16 cm have an increased risk of obstructive sleep apnea and should have polysomnography to assess for this complication. The other tests may be necessary for obese patients but are not specific to this finding.
  2. Which medications are associated with weight gain? (Select all that apply.) A. Antibiotics B. Antidepressants C. Antihistamines D. Insulin analogs E. Anticonvulsants (ANS: B, C, D, E) Antidepressants, antihistamines, insulin and insulin analogs, and seizure medications are all associated with weight gain. Antibiotics are not associated with weight gain.
  3. A provider performs an eye examination during a health maintenance visit and notes a difference of 0.5 mm in size between the patient’s pupils. What does this finding indicate? A. A relative afferent pupillary defect B. Indication of a difference in intraocular pressure C. Likely underlying neurological abnormality D. Probable benign, physiologic anisocoria (ANS: D) A difference in diameter of less than 1 mm is usually benign. Afferent pupillary defects are paradoxical dilations of pupils in response to light. This does not indicate differences in intraocular pressure. A difference of more than 1 mm is more likely to represent an underlying neurological abnormality.
  1. A patient has a gradually enlarging nodule on one upper eyelid and reports that the lesion is painful. On examination, the lesion appears warm and erythematous. The provider knows that this is likely to be which type of lesion? A. Blepharitis B. Chalazion C. Hordeolum D. Meibomian (ANS: C) Although hordeolum and chalazion lesions both present as gradually enlarging nodules, a hordeolum is usually painful, while a chalazion generally is not. Blepharitis refers to generalized inflammation of the eyelids. Meibomian is a type of gland near the eye.
  2. A patient reports using artificial tears for comfort because of burning and itching in both eyes but reports worsening symptoms. The provider notes redness and discharge along the eyelid margins with clear conjunctivae. What is the recommended treatment? A. Antibiotic solution drops four times daily B. Warm compresses, lid scrubs, and antibiotic ointment C. Oral antibiotics given prophylactically for several months D. Reassurance that this is a self-limiting condition (ANS: B) This patient has symptoms of blepharitis without conjunctivitis. Initial treatment involves lid hygiene and antibiotic ointment may be applied after lid scrubs. Antibiotic solution is used if conjunctivitis is present. Oral antibiotics are used for severe cases. This disorder is generally chronic.
  3. A child has a localized nodule on one eyelid which is warm, tender, and erythematous. On examination, the provider notes clear conjunctivae and no discharge. What is the recommended treatment? A. Referral to an ophthalmologist B. Surgical incision and drainage C. Systemic antibiotics D. Warm compresses and massage of the lesion (ANS: D) This child has a hordeolum, which is generally self-limited and usually spontaneously improves with conservative treatment. Warm compresses and massage of the lesion are recommended. Referral is not necessary unless a secondary infection occurs. Surgical intervention is not indicated. Systemic antibiotics are used to treat secondary cellulitis.
  1. A patient reports bilateral burning and itching eyes for several days. The provider notes a boggy appearance to the conjunctivae, along with clear, watery discharge. The patient’s eyelids are thickened and discolored. There are no other symptoms. Which type of conjunctivitis is most likely? A. Allergic B. Bacterial C. Chemical D. Viral (ANS: A) Allergic conjunctivitis generally presents simultaneously in both eyes with itching as a predominant feature. Discharge is generally clear or stringy and white and the patient will have lid discoloration, thickening, and erythema. Bacterial conjunctivitis is characterized by acute inflammation of the conjunctivae along with purulent discharge. Chemical conjunctivitis will not have purulent discharge. Viral conjunctivitis is usually in association with a URI.
  2. A patient who has symptoms of a cold develops conjunctivitis. The provider notes erythema of one eye with profuse, watery discharge and enlarged anterior cervical lymph nodes, along with a fever. Which treatment is indicated? A. Antihistamine-vasoconstrictor drops B. Artificial tears and cool compresses C. Topical antibiotic eye drops D. Topical corticosteroid drops (ANS: B) Viral conjunctivitis accompanies upper respiratory tract infections and is generally self-limited, lasting 5 to 14 days. Symptomatic treatment is recommended. Antihistamine- vasoconstrictor drops are used for allergic conjunctivitis. Topical antibiotic drops are sometimes used for bacterial conjunctivitis. Topical corticosteroid drops are used for severe inflammation.
  3. A patient diagnosed with allergic conjunctivitis and prescribed a topical antihistamine- vasoconstrictor medication reports worsening symptoms. What is the provider’s next step in managing this patient’s symptoms? A. Consider prescribing a topical mast cell stabilizer. B. Determine the duration of treatment with this medication. C. Prescribe a non-sedating oral antihistamine. D. Refer the patient to an ophthalmologist for further care. (ANS: B) Antibiotic-vasoconstrictor agents can have a rebound effect with worsening symptoms if used longer than 3 to 7 days, so the provider should determine whether this is the cause. Topical mast cell stabilizers are useful as prophylaxis for recurrent or persistent allergic conjunctivitis and results do not occur for several weeks. Oral antihistamines may be the next step if it is determined that the cause of worsening symptoms is related to the allergy. It is not necessary to refer to ophthalmology at this time.
  1. A patient has evaporative dry eye syndrome with eyelid inflammation. What are some pharmacologic and nonpharmacologic measures the provider can recommend? (Select all that apply.) A. Apply over-the-counter artificial tears as needed. B. Avoid direct exposure to air conditioning. C. Topical steroid eye drops as a maintenance medication. D. Use non-tearing baby shampoo to gently scrub the eyelids. E. Use tetrahydrozoline drops for discomfort (ANS: A, B, D) Patients with dry eye are encouraged to use OTC artificial tears to help moisten the eyes. Avoiding exposure to fans, air conditioning, and wind is recommended. Non-tearing baby shampoo may be used to cleanse the lids in patients with eyelid inflammation. Topical steroid eye drops should be used sparingly and for short periods of time. Tetrahydozoline drops constrict blood vessels and may dry eyes further.
  2. An adult patient with a history of recurrent sinusitis and allergic rhinitis reports chronic tearing in one eye, ocular discharge, and eyelid crusting. The provider suspects nasolacrimal duct obstruction. Which initial treatment will the provider recommend? A. Antibiotic eye drops B. Nasolacrimal duct probing C. Systemic antibiotics D. Warm compresses (ANS: D) This is most likely acquired nasolacrimal duct obstruction. Initial treatment should include warm compresses. Antibiotics are only used if infection is present. Nasolacrimal duct probing is not useful for acquired conditions; definitive treatment usually requires surgery.
  3. A patient is diagnosed with Dacryocystitis. The provider notes a painful lacrimal sac abscess that appears to be coming to a head. Which treatment will be useful initially? A. Eyelid scrubs with baby shampoo B. Incision and drainage C. Lacrimal bypass surgery D. Topical antibiotic ointment (Ans: B) When an abscess is present and coming to a head, incision and drainage may be useful. Definitive treatment with lacrimal bypass surgery will be performed once the acute episode has resolved. Eyelid scrubs and topical ointments are not effective.
  1. Which is the most common cause of orbital cellulitis in all age groups? A. Bacteremic spread from remote infections B. Inoculation from local trauma or bug bites C. Local spread from the ethmoid sinus D. Paranasal sinus inoculation (ANS: C) Because the membrane separating the ethmoid sinus from the orbit is literally paper- thin, this is the most common source of orbital infection in all age groups. Bacteremic spread, inoculation from localized trauma, and paranasal sinus spread all may occur, but are less common.
  2. A child’s optic assessment data include unilateral eyelid edema, warmth, and erythema but no pain with ocular movement is reported. Which characteristic is most likely true about this child’s infection? A. Decreased visual acuity may occur. B. Increased intraocular pressure will be present. C. Optic nerve compromise is a complication. D. The eye is typically spared without conjunctivitis. (Ans D) the child has symptoms of preseptal cellulitis in which the eye is typically spared.
  3. A patient is experiencing eyelid swelling with erythema and warmth and reports pain with eye movement. Which diagnostic tests will be performed to confirm a diagnosis of orbital cellulitis? (Select all that apply.) A. Blood cultures B. Complete blood count C. CT scan of orbits D. Lumbar puncture E. Visual acuity testing (ANS: B, C) A complete blood count will help distinguish infectious from noninfectious orbital cellulitis. A CT scan or the orbits is necessary to confirm the diagnosis. Blood cultures do not confirm the diagnosis of orbital cellulitis but may be used to evaluate whether septicemia is occurring. Lumbar puncture is indicated if meningitis is suspected. Visual acuity testing may be used to monitor recovery.
  1. During a routine physical examination, a provider notes a shiny, irregular, painless lesion on the top of one ear auricle and suspects skin cancer. What will the provider tell the patient about this lesion? A. A biopsy should be performed. B. Immediate surgery is recommended. C. It is benign and will not need intervention. D. This is most likely malignant. (ANS: A) This lesion is characteristic of basal cell carcinoma, which is a slow-growing cancer least likely to metastasize. A biopsy should be performed to evaluate this. Immediate surgery is not necessary. Until a biopsy is performed, the provider cannot determine whether it is benign. Chapter 63: Cerumen Impaction
  2. A child has recurrent impaction of cerumen in both ears and the parent asks what can be done to help prevent this. What suggestion will the provider provide? A. Cleaning the outer ear and canal with a soft cloth B. Removing cerumen with a cotton-tipped swab C. Trying thermal-auricular therapy when needed D. Using an oral irrigation tool to remove cerumen (ANS: A) Parents should be instructed to use a soft cloth to clean the outer ear and canal only. Use of a cotton-tipped swab or any other implement may push cerumen deeper into the canal and risk damaging the tympanic membrane. Thermal-auricular therapy is not recommended. Oral irrigation tools have high pressure and a risk of damage to the tympanic membrane.
  3. A patient reports symptoms of otalgia and difficulty hearing from one ear. The provider performs an otoscopic exam and notes a dark brown mass in the lower portion of the external canal blocking the patient’s tympanic membrane. What is the initial action? A. Ask the patient about previous problems with that ear. B. Irrigate the canal with normal saline. C. Prescribe a ceruminolytic agent for that ear. D. Use a curette to attempt to dislodge the mass. (ANS: A) Before attempting to remove impacted cerumen, the provider must determine whether the tympanic membrane (TM) is intact and should ask about pressure equalizing ear tubes, a history of ruptured TM, and previous ear surgeries. Once the TM is determined to be intact, the other methods may be attempted, although the curette should only be used if the mass is in the lateral third of the ear canal.
  1. 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 US Food and Drug Administration (FDA) approved for this use? A. Carbamide peroxide B. Hydrogen peroxide C. Liquid docusate sodium D. Mineral oil (ANS: A) Any preparation with carbamide peroxide is FDA approved as a cerumenolytic. Patients with dry skin in the ear canal should not use any product containing hydrogen peroxide. Liquid docusate sodium and mineral oil are often used, but do not have specific FDA approval. Chapter 64: Cholesteatoma
  2. A young child has a pale, whitish discoloration behind the tympanic membrane. The provider notes no scarring on the tympanic membrane (TM) and no retraction of the pars flaccida. The parent states that the child has never had an ear infection. What do these findings most likely represent? A. Chronic cholesteatoma B. Congenital cholesteatoma C. Primary acquired cholesteatoma D. Secondary acquired cholesteatoma (ANS: B) Patients without history of otitis media or perforation of the TM most likely have congenital cholesteatoma. Primary acquired cholesteatoma will include retraction of the pars flaccida. Secondary acquired cholesteatoma has findings associated with the underlying etiology.
  3. A child is diagnosed as having a congenital cholesteatoma. What is included in management of this condition? (Select all that apply.) A. Antibacterial treatment B. Insertion of pressure equalizing tubes (PETs) C. Irrigation of the ear canal D. Removal of debris from the ear canal E. Surgery to remove the lesion (ANS: A, D, E) Cholesteatoma is treated with antibiotics, removal of debris from the ear canal, and possibly surgery. PETs and irrigation of the ear canal are not part of treatment for cholesteatoma.

Chapter 66: Inner Ear Disturbances

  1. A patient is suspected of having vestibular neuritis. Which finding on physical examination is consistent with this diagnosis? A. Facial palsy and vertigo B. Fluctuating hearing loss and tinnitus C. Spontaneous horizontal nystagmus D. Vertigo with changes in head position (ANS: C) Many patients with vestibular neuritis will exhibit spontaneous horizontal or rotary nystagmus, away from the affected ear. Facial palsy with vertigo occurs with Ramsay Hunt syndrome, caused by herpes zoster. Fluctuating hearing loss with tinnitus is common in Meniere’s disease. Tinnitus may occur with vestibular neuritis but hearing loss does not occur. Patients with benign paroxysmal positional vertigo will exhibit vertigo associated with changes in head position.
  2. A patient reports several episodes of acute vertigo, some lasting up to an hour, associated with nausea and vomiting. What is part of the initial diagnostic workup for this patient? A. Audiogram and MRI B. Auditory brainstem testing C. Electrocochleography D. Vestibular testing (ANS: A) An audiogram and magnetic resonance imaging (MRI) are part of basic testing for Meniere’s disease. The other testing may be performed by an otolaryngologist after referral.
  3. Which symptoms may occur with vestibular neuritis? (Select all that apply.) A. Disequilibrium B. Fever C. Hearing loss D. Nausea and vomiting E. Tinnitus (ANS: A, D, E) Vestibular neuritis can cause severe vertigo, disequilibrium, nausea, vomiting, and tinnitus, but not fever or hearing loss.

Chapter 67: Otitis Externa

  1. A patient reports a feeling of fullness and pain in both ears and the practitioner elicits exquisite pain when manipulating the external ear structures. What is the likely diagnosis? A. Acute otitis externa B. Acute otitis media C. Chronic otitis externa D. Otitis media with effusion (ANS: A) This patient’s symptoms are classic for acute otitis externa. Chronic otitis externa more commonly presents with itching. Acute otitis media is accompanied by fever and tympanic membrane inflammation, but not external canal inflammation. Otitis media with effusion causes a sense of fullness but not pain.
  2. A patient has an initial episode otitis external associated with swimming. The patient’s ear canal is mildly inflamed, and the tympanic membrane is not involved. Which medication will be ordered? A. Cipro HC B. Fluconazole C. Neomycin D. Vinegar and alcohol (ANS: A) In the absence of a culture, the provider should choose a medication that is effective against both P. aeruginosa and S. aureus. Cipro HC covers both organisms and also contains a corticosteroid for inflammation. Fluconazole is an oral antifungal medication used when fungal infection is present. Neomycin alone does not cover these organisms. Vinegar and alcohol are used to treat mild fungal infections.
  3. Which are risk factors for developing otitis externa? (Select all that apply.) A. Cooler, low-humidity environments B. Exposure to someone with otitis externa C. Having underlying diabetes mellitus D. Use of ear plugs and hearing aids E. Vigorous external canal hygiene (ANS: C, D, E) Otitis externa is a cellulitis of the external canal that develops when the integrity of the skin is compromised. Diabetes mellitus predisposes patients to skin disorders. Using devices that cause moisture retention and irritation will increase the risk. Vigorous cleansing removes protective cerumen. Warm, high-humidity environments increase risk. The disease is not contagious.

Chapter 69: Tympanic Membrane Perforation

  1. 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: 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.
  2. 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: 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. Chapter 70: Chronic Nasal Congestion and Discharge
  3. 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: 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.
  1. 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: 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.
  2. A pregnant woman develops nasal congestion with chronic nasal discharge. What is the recommended treatment for this patient? A. Intranasal corticosteroids B. Prophylactic antibiotics C. Saline lavage D. Topical decongestants (ANS: C) Saline lavage is recommended for pregnancy rhinitis; the condition will resolve after delivery. There is no human data on the safety of intranasal corticosteroids during pregnancy. Prophylactic antibiotics are not indicated; this is not an infectious condition. Topical decongestants can cause rebound symptoms. Chapter 71: Epistaxis
  3. A patient has bilateral bleeding from the nose with bleeding into the pharynx. What is the initial intervention for this patient? A. Apply firm, continuous pressure to the nostrils. B. Assess airway safety and vital signs. C. Clear the blood with suction to identify site of bleeding. D. Have the patient sit up straight and tilt the head forward. (ANS: B) Bilateral epistaxis into the pharynx is more indicative of a posterior bleed which is more likely to be severe. The most important intervention is to ensure airway safety and determine stability of vital signs. Other measures are taken as needed.
  1. A patient has seasonal rhinitis symptoms and allergy testing reveals sensitivity to various trees and grasses. What is the first-line treatment for this patient? A. Antihistamine spray B. Intranasal cromolyn C. Intranasal steroids D. Oral antihistamines (ANS: C) Intranasal steroids are the mainstay of treatment and are the most effective medication for preventing symptoms. Antihistamine sprays are helpful but are not first-line treatments. Intranasal cromolyn can be effective but must be used four times daily. Oral antihistamines are used in conjunction with intranasal steroids but are less effective than the steroids.
  2. A patient is concerned about frequent nasal stuffiness and congestion that begins shortly after getting out of bed in the morning. The patient denies itching and sneezing. A physical examination reveals erythematous nasal mucosa with scant watery discharge. What treatment will the provider recommend for this patient? A. Consultation for immunotherapy B. Daily intranasal steroids C. Oral antihistamines each morning D. Oral decongestants as needed (ANS: B) This patient has symptoms of vasomotor or idiopathic rhinitis. Intranasal steroids are an effective treatment. Immunotherapy is not effective. This type of rhinitis typically does not respond to antihistamines. Oral decongestants are effective, but are best used around the clock, not just prn.

Chapter 74: Sinusitis

  1. A patient presenting with nasal congestion, fever, purulent nasal discharge, headache, and facial pain begins treatment with amoxicillin-clavulanate. At a follow-up visit 10 days after initiation of treatment, the patient continues to have purulent discharge, congestion, and facial pain without fever. What is the next course of action for this patient? A. A CT scan of the paranasal sinuses B. A referral to an otolaryngologist C. An antibiotic based on likely resistant organism D. A trial of azithromycin (ANS: C) Treatment failure is seen in patients who do not have symptom improvement and the provider has re-confirmed the diagnosis of ABRS and assessed for complications. In these patients, the choice of antibiotic treatment is based on likely resistant organisms. The lack of fever shows improvement, so this antibiotic may be used. CT scan is usually not performed in adults unless other complications are present or suspected. Referral to an otolaryngologist is necessary if no improvement after the second course of antibiotics. Azithromycin is not used in adults unless pregnant, due to resistance patterns.
  2. A patient with allergic rhinitis develops acute sinusitis and begins treatment with an antibiotic. Which measure may help with symptomatic relief for patients with underlying allergic rhinitis? A. Intranasal steroids B. Oral mucolytics C. Saline solution rinses D. Topical decongestants (ANS: A) Intranasal steroids should be considered for symptomatic relief for patients with sinusitis, especially those with allergic rhinitis. Oral mucolytics have little support in efficacy. Saline solution rinses may provide some relief, but there is no evidence to support their usefulness. Topical decongestants do decrease nasal congestion and edema, but the potential harm of rebound congestion requires recommendation with caution.
  3. Which are potential complications of chronic or recurrent sinusitis? (Select all that apply.) A. Allergic rhinitis B. Asthma C. Meningitis D. Orbital infection E. Osteomyelitis