NCLEX Eye, Ear, ENT & Skin questions
The PrepScore bank has 34 Eye, Ear, ENT & Skin questions, each with a rationale and two tags: the Client Needs category from the test plan and the clinical judgment step it tests. In this topic the items lean on Generate solutions and Take action, which is worth knowing before you practise it. Three worked samples are below, answers behind a reveal.
Glaucoma (open-angle vs angle-closure emergency) + meds, cataract pre/post-op, retinal detachment emergency, otitis media vs externa, Ménière disease, epistaxis management, sinusitis acute vs chronic, skin cancer ABCDE + biopsy, cellulitis vs necrotizing fasciitis, herpes zoster + PHN + vaccine, EENT/skin multi-patient priority.
Three worked questions
Q1. A 35-year-old fair-skinned female with family history of melanoma at her dermatology visit asks the nurse about prevention. The clinic nurse provides evidence-based teaching. Which actions are APPROPRIATE for melanoma prevention and early detection? Select all that apply.
- A. SPF 30+ broad-spectrum sunscreen applied 15-30 min before sun exposure + reapply every 2 hours and after swimming/sweating
- B. Avoid peak sun exposure between 10am-4pm when UV index is highest
- C. Monthly skin self-examination (ABCDE method) + annual dermatology screening for high-risk patients
- D. Use tanning beds for skin health (INCREASES melanoma risk 75% if used before age 35 — avoid)
- E. Wide-brimmed hat + UV-protective clothing (UPF 50+) + sunglasses with UV protection
- F. Skip sunscreen on cloudy days because UV penetration is reduced (UV penetrates clouds — sunscreen still needed)
Show answer and rationale
Answer: SPF 30+ broad-spectrum sunscreen applied 15-30 min before sun exposure + reapply every 2 hours and after swimming/sweatingAvoid peak sun exposure between 10am-4pm when UV index is highestMonthly skin self-examination (ABCDE method) + annual dermatology screening for high-risk patientsWide-brimmed hat + UV-protective clothing (UPF 50+) + sunglasses with UV protection
Melanoma prevention: SPF 30+ + avoid peak sun + monthly self-exam (ABCDE) + annual derm screening + wide-brimmed hat/UPF clothing/sunglasses. Tanning beds INCREASE risk; skipping sunscreen on cloudy days is wrong (UV penetrates clouds).
Q2. A 50-year-old female with Meniere's disease (vertigo + tinnitus + sensorineural hearing loss + aural fullness) asks the clinic nurse for diet advice to reduce attacks. The clinic nurse provides evidence-based teaching. Which is the BEST recommendation?
- A. High-sodium diet despite the established Meniere's disease management standards and the vertigo-tinnitus-hearing loss triad
- B. Low-sodium diet (< 1500 mg/day) + limit caffeine + alcohol + avoid MSG + stay well-hydrated with water + identify and avoid personal triggers; medication options include diuretics + meclizine for acute attacks
- C. High-fluid intake daily without sodium restriction despite the established Meniere's disease management standards
- D. No dietary changes needed despite the established Meniere's disease management standards and the vertigo-tinnitus-hearing loss triad
Show answer and rationale
Answer: Low-sodium diet (< 1500 mg/day) + limit caffeine + alcohol + avoid MSG + stay well-hydrated with water + identify and avoid personal triggers; medication options include diuretics + meclizine for acute attacks
Meniere's disease diet: low-sodium (< 1500 mg/day) + limit caffeine/alcohol/MSG + hydration + trigger avoidance + diuretics + meclizine for acute attacks. High-sodium, high fluid without sodium restriction, or no changes are wrong.
Q3. An ED nurse triages 4 patients with eye complaints during the morning shift. The triage nurse identifies findings warranting urgent ophthalmology evaluation. Which findings WARRANT URGENT OPHTHALMOLOGY EVALUATION? Select all that apply.
- A. Sudden vision loss (retinal detachment, central retinal artery occlusion, acute glaucoma, stroke)
- B. Severe eye pain (acute glaucoma, foreign body, corneal abrasion, endophthalmitis)
- C. Flashes + floaters + curtain over vision (retinal detachment or vitreous hemorrhage)
- D. Chemical splash to the eye (ocular emergency requiring immediate irrigation)
- E. Mild allergic itching for 1 hour without vision changes or pain (routine outpatient management)
- F. Routine annual ophthalmology exam without acute symptoms or vision changes (scheduled follow-up)
Show answer and rationale
Answer: Sudden vision loss (retinal detachment, central retinal artery occlusion, acute glaucoma, stroke)Severe eye pain (acute glaucoma, foreign body, corneal abrasion, endophthalmitis)Flashes + floaters + curtain over vision (retinal detachment or vitreous hemorrhage)Chemical splash to the eye (ocular emergency requiring immediate irrigation)
Urgent ophthalmology evaluation: sudden vision loss + severe eye pain + flashes/floaters/curtain + chemical splash. Mild allergic itching or routine annual exam are not urgent.
The rules that decide these questions
From the pack's rule cards — the reasoning shortcuts a wrong answer usually means you were missing.
POAG: gradual painless peripheral vision loss + cupping. Topical ladder: prostaglandin analog (latanoprost qHS, eyelash + iris darkening) → beta-blocker (timolol, avoid asthma/brady) → CAI → alpha agonist. ACG EMERGENCY: sudden severe pain + halos + N/V + FIXED MID-DILATED PUPIL + IOP > 40. Treat: IV mannitol + acetazolamide + topical timolol + brimonidine + PILOCARPINE (miotic to open angle); definitive = LASER IRIDOTOMY both eyes. AVOID anticholinergics + dilating drops. Drop technique: nasolacrimal pressure × 1-2 min (reduces systemic absorption).
Activity × 1-2 wk: NO bending at waist, NO lift > 5-10 lbs, NO straining (stool softener), NO rubbing/pressing eye, NO swimming/water in eye. Sleep on UNAFFECTED side or back (eye shield at night). Multi-drop regimen with 5+ min between + nasolacrimal pressure. Sunglasses for photophobia. Mild OTC analgesic — AVOID aspirin/NSAID. Report: severe pain, sudden vision change, flashes + floaters (retinal detachment), purulent drainage. Normal: mild ache, tearing, glare, photophobia first few days.
Sudden FLASHES + new FLOATERS + CURTAIN over vision (painless) = retinal detachment until proven otherwise → STAT ophthalmology (same-day). Risk: myopia, trauma, cataract surgery, diabetic retinopathy, age. Restrict activity + bedrest + position with detachment dependent + avoid Valsalva. Treatment: laser, cryo, pneumatic retinopexy (face-down 50% waking × 1-2 wk + NO AIR TRAVEL — gas bubble expands), scleral buckle, vitrectomy. Time-critical; macula-on = better prognosis. Distinguish from PVD (no curtain), migraine aura (HA), retinal vein occlusion.
Otitis media (middle): post-URI + fever + bulging TM + decreased mobility → watchful wait OR amoxicillin high-dose × 10 days. Otitis externa (canal, swimmer): pain WORSE with pinna pull + canal erythema + drainage → topical antibiotic + steroid drops + keep ear DRY. Pinna pull for drops: < 3 yr DOWN + BACK; ≥ 3 yr + adult UP + BACK. Prevention OE: dry ears + no Q-tips + avoid prolonged moisture.
Ménière disease tetrad: episodic VERTIGO + TINNITUS (roaring low-pitch) + fluctuating SENSORINEURAL HEARING LOSS + AURAL FULLNESS. Lifestyle: LOW SODIUM (< 2 g/day) + avoid caffeine/alcohol/nicotine/MSG + stress reduction + regular sleep. Pharm: diuretic (HCTZ + triamterene), betahistine; acute attack — antihistamine (meclizine), antiemetic (ondansetron), benzo (lorazepam vestibular sedation); intratympanic steroid/gentamicin or surgery for refractory. Safety: don't drive during attacks. Distinguish from BPPV (positional, < 1 min, Epley)/vestibular neuritis/labyrinthitis.
Anterior epistaxis (90% from Kiesselbach's): SIT UP + LEAN FORWARD (not back — aspiration) + pinch SOFT part of nose × 10-15 min continuous + ice; oxymetazoline → silver nitrate cautery → anterior pack. Posterior epistaxis (10%, sphenopalatine artery, severe in elderly + anticoagulants): STAT ENT + POSTERIOR PACK (balloon/Foley) + reverse warfarin (IV vitamin K + 4-factor PCC) + admit. Prevention: humidifier + saline spray + Vaseline cotton swab application + control HTN + careful anticoag.
Practise the whole pack, tagged and explained
Every item carries its Client Needs category and clinical judgment step, so a wrong answer names the step that failed.
Frequently asked questions
How many Eye, Ear, ENT & Skin questions does the bank have?
34 multiple-choice items, plus 10 unfolding cases in the Eye, Ear, ENT & Skin pack, each with a rationale.
Are the samples real bank items?
Yes — the three questions above are drawn from the live bank, with their real rationales and tags.
Which clinical judgment steps does this topic train?
Most items in this topic test Generate solutions and Take action, though every step appears.
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