16.24 Learning Activities
Learning Activities
Otitis Media Case Study[1]
Use the following information to answer questions 1-6.
Handoff Report:
0755: This is a 3-year-old male, Mateo Garcia, brought to the emergency room for potential acute otitis media. He has no known allergies and is up to date on immunizations. He weighs 15 kg. He has a history of recurrent ear infections. He presented to the ED with a fever of 102.5°F (39.2°C), pulling at his ears, irritability, and decreased appetite. Upon examination, his tympanic membranes are erythematous and bulging bilaterally with poor mobility. He received a dose of acetaminophen in the ED and his most recent temperature is 99.5°F (37.5°C). Other vital signs are: HR 100 bpm, RR 24 breaths/min, BP 95/60 mmHg, and oxygen saturation 99% on room air. Please monitor his temperature and pain level closely and encourage fluids.
Provider Orders:
| Order: |
| Acetaminophen 160 mg PO q4h PRN for fever/pain |
| Obtain CBC, BMP |
| Amoxicillin 400mg/5ml suspension, 5 ml PO every 12 hours for 10 days |
| Advance to regular diet as tolerated, encourage fluids |
| Follow up with ENT service within 1 week |
- When reviewing Mateo’s electronic health record, which assessment finding requires immediate follow-up by the nurse?
a. History of recurrent otitis media
b. Oxygen saturation of 98% on room air
c. Temperature of 39.2°C (102.5°F) documented one hour prior to arrival
d. Erythematous and bulging tympanic membranes bilaterally
2. Based on Mateo’s presentation and history, which nursing diagnosis is the priority?
a. Acute pain related to inflammation of the middle ear
b. Risk for fluid deficit related to decreased appetite
c. Impaired hearing related to fluid in the middle ear
d. Risk for infection transmission related to contagious illness
3. Forty-five minutes after receiving Acetaminophen, Mateo is still pulling at his ears and crying. What should the nurse do next?
a. Reassure the parents that this is a normal reaction to pain.
b. Administer a second dose of Acetaminophen immediately.
c. Reassess Mateo’s pain level and vital signs and notify the provider of his response to the medication.
d. Distract Mateo with age-appropriate toys and activities.
4. The nurse is preparing to administer the first dose of amoxicillin to Mateo. Which action demonstrates best practice?
a. Administer the medication immediately, as it is due now.
b. Verify Mateo’s identity using the client armband and confirm with the parents.
c. Prepare the medication and ask another nurse to verify the dose and client.
d. Administer the medication and then document it in the client’s MAR.
- What is an important teaching point for the parents prior to discharge?
a. The importance of finishing all antibiotics as prescribed, even if symptoms improve.
b. Over-the-counter ear drops can be used to treat Mateo’s ear infection.
c. Mateo should not attend daycare until he has been off antibiotics for at least one week.
d. It is normal for Mateo’s hearing to be muffled for several weeks after the infection resolves.
6. The nurse is reviewing Mateo’s discharge instructions with his parents. Which statement by the parents indicates a need for further teaching?
a. We will make sure he finishes all of his antibiotics, even if he starts feeling better.
b. If his fever comes back in a few days, we can give him ibuprofen instead of acetaminophen.
c. We’ll call the doctor if he’s still pulling at his ears or seems fussy over the next couple of days.
d. It’s important for him to drink plenty of fluids, so we’ll offer him his favorite juice and water.
Pediculosis Capitis Case Study[2]
Use the following information to answer questions 1-6.
Handoff Report:
1430: Sofia Gonzalez is an 8-year-old female who comes to the clinic today for treatment of pediculosis capitis (head lice). She has no known allergies and weighs 26 kg. She has been experiencing intense itching of the scalp for the past week. Her mother reports that Sofia’s school has had recent outbreaks of lice. Sofia shares a bedroom with two younger siblings, increasing the risk of transmission. Upon examination, live lice are observed on the scalp, along with nits attached to the hair shafts. The scalp is red and irritated from scratching, but no open lesions are observed. Sofia’s mother reports she has been using over-the-counter permethrin cream, but it has not been effective. Vital signs: BP 100/60 mmHg, HR 90 bpm, RR 20 breaths/min, Temp 98.6°F (37°C), Oxygen saturation 100% on room air. Recommendations for care include a prescription-strength pediculicide, education on proper treatment and prevention of lice reinfestation, and assessment for any emotional distress related to the diagnosis.
Progress Notes:
- 10/26/2023 13:00 – Client arrived at the clinic with her mother. Client reports intense itching and scratching head. Mother reports trying over-the-counter permethrin cream without success. Denies any other symptoms. -R.N. Smith
- 10/26/2023 13:15 – Prescription provided for prescription-strength permethrin cream. Education given to client and mother on proper application, combing technique, and hygiene practices to prevent reinfestation. Client and mother verbalize understanding. Client to follow up in one week for re-evaluation. -R.N. Smith
- Based on Sofia’s presenting symptoms and history, what is the initial priority nursing assessment?
a. Assessing Sofia’s scalp for the presence of live lice and nits.
b. Inquiring about Sofia’s current hygiene practices, including sharing of personal items.
c. Exploring Sofia’s understanding of pediculosis capitis and its transmission.
d. Determining if Sofia has any known allergies to over-the-counter or prescription medications.
2. Which nursing intervention is most important for Sofia’s mother to implement at home to prevent the spread of pediculosis capitis?
a. Apply a warm compress to Sofia’s scalp daily to reduce itching.
b. Wash all bedding and clothing used by Sofia in hot water and dry on high heat.
c. Keep Sofia home from school until lice free to prevent further transmission.
d. Encourage frequent handwashing for Sofia and family members.
3. Which nursing diagnosis is most relevant for Sofia?
a. Impaired Skin Integrity related to scratching and irritation of the scalp.
b. Risk for Infection related to open lesions on the scalp.
c. Deficient Knowledge related to lack of information about head lice transmission.
d. Ineffective Health Maintenance related to unsuccessful use of over-the-counter treatment.
4. Which instruction is crucial for the nurse to include when educating Sofia’s mother about the prescribed permethrin cream?
a. Apply the cream to wet hair and leave it in for at least 30 minutes before rinsing.
b. It is essential to repeat the treatment with the cream in 7 days, even if no lice are seen.
c. The cream will continue to kill lice for up to two weeks, so a second application is unnecessary.
d. Use a fine-toothed comb daily to remove nits, but only for the first three days after treatment.
5. Beyond medication administration, what additional interventions should the nurse implement during Sofia’s clinic visit?
a. Provide Sofia and her mother with detailed written and visual instructions on combing out nits.
b. Contact Sofia’s school nurse to report the case of head lice and coordinate treatment efforts.
c. Administer a prescribed antihistamine to Sofia to alleviate the itching and discomfort.
d. Refer Sofia to a dermatologist for further evaluation of her scalp irritation.
6. How should the nurse evaluate the effectiveness of interventions for Sofia’s pediculosis capitis?
a. Assess Sofia’s scalp for the presence of live lice and nits at a follow-up appointment in one week.
b. Monitor Sofia’s level of comfort and reduction in scratching behaviors within the next 24 hours.
c. Obtain feedback from Sofia’s mother regarding the successful eradication of lice from their home.
d. Observe Sofia’s interaction with other children at school to ensure no further transmission occurs.
Test your knowledge on teaching and learning using this NCLEX Next Generation-style case study. You may reset and resubmit your answers to this question an unlimited number of times.[3]
- Otitis Media Case Study by Angela Landry for OpenRN is licensed under CC BY-NC 4.0 ↵
- Pediculosis Capitis Case Study by Angela Landry for OpenRN is licensed under CC BY-NC 4.0 ↵
- “HP Chapter 16 Case Study A" by Kelly Ewen for OpenRN is licensed under CC BY-NC 4.0 ↵
