Correct Answer: D

Rationale: The correct answer is D. Performing the otoscopic examination at the end of the assessment is the best approach for a 3-year-old with a suspected ear infection. This allows the child to become familiar with the nurse and the environment, reducing anxiety and increasing cooperation. It also prevents the child from becoming upset early in the examination, making it easier to complete the assessment. Choice A is incorrect because omitting the otoscopic exam based on the presence of a fever could lead to a missed diagnosis. Choice B is incorrect as pulling the ear up and back before inserting the speculum is not recommended as it may cause discomfort and increase resistance from the child. Choice C is incorrect as having the mother leave the room may increase the child's anxiety and make the examination more challenging.

Correct Answer: C

Rationale: The correct answer is C: Pull the pinna up and back before inserting the speculum. This is because pulling the pinna up and back straightens the auditory canal, allowing for easier and more accurate insertion of the speculum without causing discomfort or injury. Option A is incorrect as tilting the head forward may obstruct the view. Option B is incorrect as maintaining traction is essential for stability. Option D is incorrect as using the smallest speculum may not provide a clear view or proper insertion depth.

Correct Answer: A

Rationale: Correct Answer: A Rationale: 1. Head control typically develops around 4 months, so it is normal for a 2-month-old to lack this skill. 2. Reassuring the mother that her baby is within the normal developmental range is important for reducing parental anxiety. 3. Avoiding overly alarming responses helps maintain trust and open communication with the parent. Summary: - Choice B is incorrect as it does not address the mother's concern and may come across as dismissive. - Choice C is incorrect as it may unnecessarily worry the mother and lead to undue stress. - Choice D is incorrect as it introduces a serious and unlikely scenario without evidence at this stage of development.

Correct Answer: C

Rationale: The correct answer is C because shining a light across the pupil from the side allows for both direct (ipsilateral) and consensual (contralateral) pupillary constriction to be observed. This technique helps to assess the integrity of the cranial nerves involved in the pupillary light reflex (CN II and III). Direct constriction occurs in the eye exposed to the light, while consensual constriction occurs in the opposite eye. This comprehensive assessment ensures that both pupils are responding appropriately to light stimulation, providing a more accurate evaluation of the reflex. Choice A is incorrect because inspecting for pupillary constriction from directly in front may not adequately assess for consensual constriction in the opposite eye. Choice B is incorrect as asking the patient to follow the penlight in eight directions does not specifically target the pupillary light reflex. Choice D is incorrect as it focuses on accommodation rather than the pupillary light reflex.

Correct Answer: D

Rationale: The correct answer is D: migraine headaches. The patient's symptoms of severe throbbing headache in the frontotemporal area, triggered by stress (studying for an exam), partially relieved by lying down, and family history of similar headaches are indicative of migraines. Migraines commonly present with these characteristics, often exacerbated by stress and have a genetic component. A: Hypertension does not typically present with throbbing headaches in a specific area or relief with lying down. B: Cluster headaches are characterized by severe, unilateral headaches around the eye area, not frontotemporal. C: Tension headaches usually present as dull, constant pressure-type headaches, not throbbing, and do not have the familial pattern described by the patient.