Deck 14: Head, Face, and Neck, and Regional Lymphatics

Question 1

The nurse notices that a patient's submental lymph nodes are enlarged. In an effort to identify the cause of the node enlargement, what should the nurse assess?

A) Infraclavicular area
B) Supraclavicular area
C) Area distal to the enlarged node
D) Area proximal to the enlarged node

Answer 1

Area proximal to the enlarged node

Question 2

A 19-year-old college student is brought to the emergency department with a severe headache he describes as, "Like nothing I've ever had before." His temperature is 40 $\degree$ C, and he has a stiff neck. The nurse looks for other signs and symptoms of which problem?

A) Head injury
B) Cluster headache
C) Migraine headache
D) Meningeal inflammation

Answer 2

Meningeal inflammation

Question 3

A patient, an 85-year-old woman, is complaining about the fact that the bones in her face have become more noticeable. What explanation should the nurse give her?

A) Diets low in protein and high in carbohydrates may cause enhanced facial bones.
B) Bones can become more noticeable if the person does not use a dermatologically approved moisturizer.
C) More noticeable facial bones are probably due to a combination of factors r/t aging, such as decreased elasticity, subcutaneous fat, and moisture in her skin.
D) Facial skin becomes more elastic with age. This increased elasticity causes the skin to be more taught, drawing attention to the facial bones.

Answer 3

More noticeable facial bones are probably due to a combination of factors r/t aging, such as decreased elasticity, subcutaneous fat, and moisture in her skin.

Question 4

When examining the face of a patient, what are the two pairs of salivary glands that are accessible for examination?

A) Occipital; submental
B) Parotid; submandibular
C) Submandibular; occipital
D) Sublingual; parotid

Question 5

A patient reports excruciating headache pain on one side of his head, especially around his eye, forehead, and cheek that has lasted approximately to 2 hours, occurring once or twice each day. What should the nurse suspect?

A) Hypertension
B) Cluster headaches
C) Tension headaches
D) Migraine headaches

Question 6

A patient says that she has recently noticed a lump in the front of her neck below her "Adam's apple" that seems to be getting bigger. During the assessment, what finding would lead the nurse to suspect that this may not be a cancerous thyroid nodule?

A) It is tender.
B) It is mobile and soft.
C) It disappears when the patient smiles.
D) It is hard and fixed to the surrounding structures.

Question 7

A patient has come in for an examination and states, "I have this spot in front of my ear lobe on my cheek that seems to be getting bigger and is tender. What do you think it is?" The nurse notes swelling below the angle of the jaw. What does the nurse suspect?

A) Inflammation of the thyroid gland
B) Inflammation of the parotid gland
C) Infection in the occipital lymph node
D) Infection in the submental lymph node

Question 8

A mother brings her 2-month-old daughter in for an examination and says, "My daughter rolled over against the wall, and now I have noticed that she has this spot that is soft on the top of her head. Is something terribly wrong?" How should the nurse respond?

A) "Perhaps that could be a result of your dietary intake during pregnancy."
B) "Your baby may have craniosynostosis, a disease of the sutures of the skull."
C) "That 'soft spot' may be an indication of cretinism or congenital hypothyroidism."
D) "That 'soft spot' is normal, and actually allows for growth of the brain during the first year of your baby's life."

Question 9

The nurse notices that a patient's palpebral fissures are not symmetric. On examination, the nurse may find that damage has occurred to which cranial nerve (CN)?

A) V
B) VII
C) XI
D) XIII

Question 10

A patient is unable to differentiate between sharp and dull stimulation to both sides of her face. What does the nurse suspect?

A) Bell palsy
B) Scleroderma
C) Damage to the trigeminal nerve
D) Frostbite with resultant paresthesia to the cheeks

Question 11

A male patient with a history of acquired immunodeficiency syndrome (AIDS) has come in for an examination and states, "I think that I have the mumps." What should the nurse examine first?

A) Thyroid gland
B) Parotid gland
C) Cervical lymph nodes
D) Mouth and skin for lesions

Question 12

A patient comes to the clinic complaining of neck and shoulder pain and is unable to turn her head. Which nerve does the nurse suspect is damaged and how should the nurse proceed with the examination?

A) XII; assess for a positive Romberg sign.
B) XI; palpate the anterior and posterior triangles.
C) XI; have patient shrug their shoulders against resistance.
D) XII; percuss the sternomastoid and submandibular neck muscles.

Question 13

During a well-baby checkup, the nurse notices that a 1-week-old infant's face looks small compared with his cranium, which seems enlarged. On further examination, the nurse also notices dilated scalp veins and downcast or "setting sun" eyes. The nurse suspects which condition?

A) Craniotabes
B) Microcephaly
C) Hydrocephalus
D) Caput succedaneum

Question 14

When examining a patient's CN function, what muscles should the nurse assess to assess the function of CN XI?

A) Sternomastoid and trapezius
B) Spinal accessory and omohyoid
C) Trapezius and sternomandibular
D) Sternomandibular and spinal accessory

Question 15

The nurse is explaining to a student nurse the four areas in the body where lymph nodes are accessible. Which areas should the nurse include in her explanation to the student?

A) Head, breasts, groin, and abdomen
B) Arms, breasts, inguinal area, and legs
C) Head and neck, arms, breasts, and axillae
D) Head and neck, arms, inguinal area, and axillae

Question 16

A patient complains that while studying for an examination he began to notice a severe headache in the frontotemporal area of his head that is throbbing and is somewhat relieved when he lies down. He tells the nurse that his mother also had these headaches. What should the nurse suspect?

A) Hypertension
B) Cluster headaches
C) Tension headaches
D) Migraine headaches

Question 17

A mother brings her newborn in for an assessment and asks, "Is there something wrong with my baby? His head seems so big." Which statement is true regarding the relative proportions of the head and trunk of the newborn?

A) At birth, the head is one fifth the total length.
B) Head circumference should be greater than chest circumference at birth.
C) The head size reaches 90% of its final size when the child is 3 years old.
D) When the anterior fontanel closes at 2 months, the head will be more proportioned to the body.

Question 18

A patient's laboratory data reveal an elevated thyroxine (T4) level. What gland should the nurse assess?

A) Thyroid
B) Parotid
C) Adrenal
D) Parathyroid

Question 19

A physician tells the nurse that a patient's vertebra prominens is tender and asks the nurse to reevaluate the area in 1 hour. What area of the body will the nurse assess?

A) At the level of the C7 vertebra
B) At the level of the T11 vertebra
C) At the level of the L5 vertebra
D) At the level of the S3 vertebra

Question 20

The nurse needs to palpate the temporomandibular joint for crepitation. Where is this joint located?

A) Just below the hyoid bone and posterior to the tragus
B) Just below the vagus nerve and posterior to the mandible
C) Just below the temporal artery and anterior to the tragus
D) Just below the temporal artery and anterior to the mandible

Question 21

During an assessment of an infant, the nurse notes that the fontanels are depressed and sunken. The nurse suspects which condition?

A) Rickets
B) Dehydration
C) Mental retardation
D) Increased intracranial pressure

Question 22

During an admission assessment, the nurse notices that a male patient has an enlarged and rather thick skull. The nurse suspects acromegaly. What additional finding would the nurse assess for to confirm this suspicion?

A) Exophthalmos
B) Bowed long bones
C) Acorn-shaped cranium
D) Coarse facial features

Question 23

A visitor from Poland who does not speak English seems to be somewhat apprehensive about the nurse examining his neck. How should the nurse proceed that would allow the patient to feel more comfortable with the nurse examining his thyroid gland?

A) Behind with the nurse's hands placed firmly around his neck
B) The side with the nurse's eyes averted toward the ceiling and thumbs on his neck
C) The front with the nurse's thumbs placed on either side of his trachea and his head tilted forward
D) The front with the nurse's thumbs placed on either side of his trachea and his head tilted backward

Question 24

A patient visits the clinic because he has recently noticed that the left side of his mouth is paralyzed. He states that he cannot whistle but the nurse notes he can still raise his eyebrows. What does the nurse suspect?

A) Bell palsy
B) Cushing syndrome
C) Parkinson syndrome
D) Experienced a cerebrovascular accident (CVA) or stroke

Question 25

When examining children affected with Down syndrome (trisomy 21), what should the nurse look for r/t this disorder?

A) Ear dysplasia
B) Long, thin neck
C) Protruding thin tongue
D) Narrow and raised nasal bridge

Question 26

The physician reports that a patient with a neck tumor has a tracheal shift. The nurse should understand that what is occurring to the patient's trachea?

A) Pushed downward
B) Pulled to the affected side
C) Pushed to the unaffected side
D) Pulled downward in a rhythmic pattern

Question 27

While performing a well-child assessment on a 5 year old, the nurse notes the presence of palpable, bilateral, cervical, and inguinal lymph nodes. They are approximately 0.5 cm in size, round, mobile, and nontender. What do these findings lead the nurse to conclude?

A) The child has chronic allergies.
B) The child likely has an infection.
C) These are normal findings for a well child of this age.
D) These findings indicate a need for additional evaluation.

Question 28

During an examination, the nurse knows that the best way to palpate the lymph nodes in the neck is described by which statement?

A) Using gentle pressure, palpate with both hands to compare the two sides.
B) Using strong pressure, palpate with both hands to compare the two sides.
C) Gently pinch each node between one's thumb and forefinger, and then move down the neck muscle.
D) Using the index and middle fingers, gently palpate by applying pressure in a rotating pattern.

Question 29

During an examination of a female patient, the nurse notes lymphadenopathy and suspects an acute infection. How do acutely infected lymph nodes typically appear?

A) Clumped
B) Unilateral
C) Firm but freely movable
D) Soft and nontender

Question 30

A patient's thyroid gland is enlarged, and the nurse is preparing to auscultate the thyroid gland for the presence of a bruit. What technique should the nurse use to assess for a bruit.

A) Palpate the thyroid while the patient is swallowing.
B) Auscultate the thyroid with the bell of the stethoscope.
C) Palpate the thyroid while the patient holds their breath.
D) Auscultate the thyroid with the diaphragm of the stethoscope.

Question 31

A woman comes to the clinic and states, "I've been sick for so long! My eyes have gotten so puffy, and my eyebrows and hair have become coarse and dry." For what condition should the nurse assess for other signs and symptoms?

A) Cachexia
B) Myxedema
C) Graves disease
D) Parkinson syndrome

Question 32

The nurse is performing an assessment on a 7-year-old child who has symptoms of chronic watery eyes, sneezing, and clear nasal drainage. The nurse notices the presence of a transverse line across the bridge of the nose, dark blue shadows below the eyes, and a double crease on the lower eyelids. What does the nurse suspect is the cause of these signs and symptoms?

A) Chronic allergies
B) Lymphadenopathy
C) Nasal congestion
D) Upper respiratory infection

Question 33

The nurse has just completed a lymph node assessment on a 60-year-old healthy female patient. When palpating the nodes on this healthy 60-year-old adult, how did the lymph nodes feel?

A) Fixed
B) Nonpalpable
C) Rubbery, discrete, and mobile
D) Large, firm, and fixed to the tissue

Question 34

The nurse is assessing a 1-month-old infant at his well-baby checkup. Which assessment findings are appropriate for this age? (Select all that apply.)

A) Absent tonic neck reflex
B) Nonpalpable cervical lymph nodes
C) Fontanels firm and slightly concave
D) Head circumference equal to chest circumference
E) Head circumference less than chest circumference
F) Head circumference greater than chest circumference

Question 35

During an examination, the nurse finds that a patient's left temporal artery is tortuous and feels hardened and tender, compared with the right temporal artery. The nurse suspects which condition?

A) Bell palsy
B) Crepitation
C) Mastoiditis
D) Temporal arteritis

Question 36

The nurse notices that an infant has a large, soft lump on the side of his head and that his mother is very concerned. The mother tells the nurse that she noticed the lump approximately 8 hours after her baby's birth and that it seems to be getting bigger. What is a possible explanation for this?

A) Hydrocephalus
B) Craniosynostosis
C) Cephalhematoma
D) Caput succedaneum

Question 37

During an examination of a patient in her third trimester of pregnancy, the nurse notices that the patient's thyroid gland is slightly enlarged. No enlargement had been previously noticed. What does the nurse suspect?

A) An iodine deficiency
B) Early signs of goiter
C) A normal enlargement of the thyroid gland during pregnancy
D) Possible thyroid cancer and the need for further evaluation

Question 38

During an examination of a 3-year-old child, the nurse notices a bruit over the left temporal area. What should the nurse do?

A) Check for the bruit again in 1 hour.
B) Stop the examination, and notify the physician.
C) Continue the examination because a bruit is a normal finding for this age.
D) Notify the parents that a bruit has been detected in their child and requires further evaluation.

Question 39

The nurse suspects that a patient has hyperthyroidism, and the laboratory data indicate that the patient's T4 and T3 hormone levels are elevated. Which of these findings would the nurse most likely find on examination?

A) Dyspnea
B) Tachycardia
C) Constipation
D) Atrophied nodular thyroid gland

Question 40

During a well-baby checkup, a mother is concerned because her 2-month-old infant cannot hold her head up when she is pulled to a sitting position. Which response by the nurse is appropriate?

A) "Head control is usually achieved by 4 months of age."
B) "You shouldn't be trying to pull your baby up like that until she is older."
C) "Head control should be achieved by this time."
D) "This inability indicates possible nerve damage to the neck muscles."