B.W. is a 44-year-old man who presents to the family practice with complaints of sore throat, hoarseness, and
a dry cough that worsens at night. He states that the cough started 6 days ago, and the sore throat and
hoarseness began 3 days ago and appear to be getting worse The patient has a history of prediabetes, which
is controlled through diet and exercise. Vital signs are T 99.5, P 58, R 16, and BP 110/55.
• 1. What subjective information should the nurse obtain?
• 2. The nurse is assessing the structures of the oral cavity. What are the physical features?
The nurse notes that the patient’s teeth are stained yellow and asks the patient about tobacco use. The patient
states that he chews one bag of tobacco every other day.
• 3. What health promotion concepts should the nurse include in the teaching plan?
• 4.What is the most likely cause of this patient’s cough, sore throat, and hoarseness?
Part 2
P.A. is a 72-year-old female who presents to the family practice with her 40-year-old daughter. The daughter
states that her mother has been confused lately, complaining of a headache, shortness of breath, and
coughing. The cough has been persistent for 6 days, and a fever developed 2 days ago. The patient states that
she is bringing up yellow-green mucus and has a cough, which gets worse at night. Vital signs are T 100.5, P
88, R 16, and BP 110/55. Lungs are positive bilaterally for wheezing, positive egophony. A chest x-ray reveals
consolidation indicative of bacterial pneumonia. Labs and culture are pending for specific antigen. The nurse
proceeds with the physical exam of the head, face, neck, and associated lymphatic system.
• 1. When performing a review of systems, the nurse obtains subjective data concerning the patient’s
headache. What specific questions will assist the nurse in determining the cause of the headache?
The nurse proceeds to palpate the lymph nodes.
• 2. Which lymph nodes are located in the neck?
• 3. When performing the physical examination, what objective data should the nurse inspect and palpate for
the head and neck?
• 4. How might the physical examination vary given the patient’s age?
Part 3
P.P. is a 4-year-old boy who presents to the pediatrician’s office with pain in his right ear.
Subjective Data
Mom states that her son woke up in the middle of the night, crying, 2 nights ago. She gave the child ibuprofen,
and he went back to sleep. Last night he woke up in pain, and he was inconsolable. She felt the physician
should see him.
Attends preschool program
Lives with mother
Father estranged
Objective Data
TM appears inflamed—it is red and may be bulging and immobile
T = 100.3
Last ibuprofen 3 hours ago
Questions
1. What other assessments should be included for this patient?
2. What questions are appropriate for a patient presenting with earache?
3. What risk factors are associated with earaches for this age group? 
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4. From the readings, what is the difference between otitis media and otitis externa?
5. From the readings, what is the most probable cause of the earache in this patient?
6. What are three nursing diagnoses?
7. What interventions should be included in the nursing care plan?