The school nurse is assessing the tympanic membranes of a ...

[jazziefee]

The school nurse is assessing the tympanic membranes of a 3-year-old child. Which of the following demonstrates proper technique?
 
  a. Using an inverted otoscope grip while pulling the auricle downward
  b. Pulling the auricle upward and backward
  c. Holding the handle of the otoscope between the thumb and index finger while the child lies on the weight scale
  d. Using an inverted otoscope grip while pulling the auricle upward

Question 2

While the nurse is changing the ties on a tracheostomy collar, the patient coughs, dislodging the tracheostomy tube. What is the nurse's first nursing action?
 
  a. Press the emergency response button.
  b. Place the patient on a face mask delivering 100 oxygen.
  c. Insert a spare tracheostomy without the obturator.
  d. Manually occlude the tracheostomy with sterile gauze.

[beccamahon]

Answer to Question 1

A
Using the inverted otoscope grip while pulling the auricle downward is a common approach with child examinations because it prevents accidental movement of the otoscope deeper into the ear canal, as could occur with an unexpected pediatric reaction to the ear examination. The other techniques could result in injury to the child's tympanic membrane.

Answer to Question 2

C
The nurse's first priority is to establish a stable airway by inserting a spare trach into the patient's airway; ideally an obturator should be used, but it is not life threatening to omit this. The nurse could activate the emergency response team if the patient is still unstable after the tracheostomy is placed. A patient with a tracheostomy has an impairment that causes him not to be able to breathe normally; a face mask would not be an effective method of getting air into the lungs. Manually occluding pressure over the tracheostomy site is not appropriate.

[jazziefee]

Thanks for the timely response, appreciate it

[mjenn52]

Gracias!