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

Question 1

A patient who is 7 months pregnant is at the clinic for her routine checkup.During assessment the nurse notes that the patient's thyroid is palpable.The nurse will:

A)Refer the patient to a thyroid specialist.
B)Send the patient for laboratory tests for thyroid hormones.
C)Document the findings as normal.
D)Ask a colleague to check the findings.

Answer 1

Document the findings as normal.

Question 2

A patient comes to the clinic complaining of neck and shoulder pain and is unable to turn her head.The nurse suspects damage to cranial nerve ______ and proceeds with the examination by ________________________.

A)XI; palpating the anterior and posterior triangles
B)XI; asking the patient to shrug her shoulders against resistance
C)XII; percussing the sternomastoid and submandibular neck muscles
D)XII; assessing for a positive Romberg sign

Answer 2

XI; asking the patient to shrug her shoulders against resistance

Question 3

A patient reports to the nurse that he has been experiencing excruciating headache pain on one side of his head, especially around his eye, forehead, and cheek that lasts approximately one-half to 2 hours, occurring once or twice each day.The nurse suspects that he is having:

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

Answer 3

Cluster headaches.

Question 4

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 and suspects that it could be an inflammation of his:

A)Thyroid gland.
B)Parotid gland.
C)Occipital lymph node.
D)Submental lymph node.

Question 5

A patient, an 85-year-old woman, is concerned that the bones in her face have become more noticeable.The nurse tells her that:

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 caused by a combination of factors related to 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.

Question 6

A physician tells the nurse that a patient's vertebra prominens is tender and asks the nurse to re-evaluate the area in 1 hour.The area of the body the nurse will assess is:

A)Just above the diaphragm.
B)Just lateral to the knee cap.
C)At the level of the C7 vertebra.
D)At the level of the T11 vertebra.

Question 7

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 fontanelle closes at 2 months, the head will be more proportionate to the body.

Question 8

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 assessment, the nurse suspects a noncancerous finding as the lump:

A)Is singular and firm.
B)Consists of multiple nodules.
C)Disappears when the patient smiles.
D)Is hard and fixed to the surrounding structures.

Question 9

The nurse needs to palpate the temporomandibular joint for crepitation.This joint is located just below the temporal artery and anterior to the:

A)Hyoid bone.
B)Vagus nerve.
C)Tragus.
D)Mandible.

Question 10

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 11

The nurse is aware that the four areas in the body where lymph nodes are accessible are the:

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 12

A patient is concerned that while studying for an examination he began to notice a severe headache in the left front and side of his head that was throbbing and was relieved when he lay down.He tells the nurse that his mother also had these headaches.The nurse suspects that he may be suffering from:

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

Question 13

When examining a patient after a biopsy of the cervical lymph nodes, to ensure there is no damage to the major neck muscles, the nurse should check the function of cranial nerve:

A)V; trigeminal nerve.
B)XI; spinal accessory nerve.
C)VII; facial nerve.
D)VI; abducens nerve.

Question 14

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° C, and he has a stiff neck.The nurse recognizes that he needs testing for:

A)A head injury.
B)Cluster headaches.
C)Migraine headaches.
D)Meningeal inflammation.

Question 15

A patient's laboratory data reveal an elevated thyroxine (T₄) level.The nurse would proceed with an examination of the _____ gland.

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

Question 16

The nurse notices that a patient's palpebral fissures are unequal.On examination, the nurse may find that damage has occurred to which cranial nerve (CN)?

A)III
B)V
C)VII
D)VIII

Question 17

When examining the face of a patient, the nurse is aware that the two pairs of salivary glands that are accessible for examination are the ___________ and ___________ glands.

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

Question 18

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?" The nurse's best response would be:

A)"Perhaps that is a result of your dietary intake during pregnancy."
B)"Your baby may have craniosynostosis, a disease of the sutures of the brain."
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 19

A patient is unable to differentiate between sharp and dull stimulations to both sides of her face.The nurse suspects:

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

Question 20

The nurse notices that a patient's submental lymph nodes are enlarged.To identify the cause of the enlargement of the patient's nodes, the nurse assesses the:

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

Question 21

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." The nurse will assess for other signs and symptoms of:

A)Cachexia.
B)Parkinson's disease.
C)Myxedema.
D)Scleroderma.

Question 22

During an examination of a female patient, the nurse notes lymphadenopathy and suspects an acute infection.Acutely infected lymph nodes would be:

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

Question 23

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

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

Question 24

A patient's thyroid gland is enlarged, and the nurse is preparing to auscultate the thyroid gland for the presence of a bruit.A bruit is a __________ sound that is heard best with the __________ of the stethoscope.

A)Low gurgling; diaphragm
B)Loud, whooshing, blowing; bell
C)Soft, whooshing, pulsatile; bell
D)High-pitched tinkling; diaphragm

Question 25

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

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

Question 26

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.These findings are characteristic of:

A)Allergies.
B)Sinus infection.
C)Nasal congestion.
D)Upper respiratory infection.

Question 27

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.The nurse recognizes that the patient:

A)Has an iodine deficiency.
B)Is exhibiting early signs of goitre.
C)Is exhibiting a normal enlargement of the thyroid gland during pregnancy.
D)Needs further testing for possible thyroid cancer.

Question 28

The nurse suspects that a patient has hyperthyroidism, and the laboratory data indicate that the patient's T₄ and T₃ levels are elevated.During assessment, the nurse will likely find the patient has:

A)Tachycardia.
B)Constipation.
C)Rapid dyspnea.
D)Atrophied nodular thyroid gland.

Question 29

The physician reports that a patient with a neck tumour has a tracheal shift.The nurse is aware that this means that the patient's trachea is:

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

Question 30

When examining children affected with Down's syndrome (trisomy 21), the nurse looks for the possible presence of:

A)Misshapen ears.
B)Long, thin neck.
C)Thin tongue sticking out.
D)Narrow and raised nasal bridge.

Question 31

During an examination, the nurse knows that the best way to palpate the lymph nodes in the neck is by:

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

Question 32

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."

Question 33

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.The nurse documents that the child:

A)Has chronic allergies.
B)Has an infection.
C)Has normal findings for a 5-year-old child.
D)Should be referred for additional evaluation.

Question 34

A patient is admitted to the hospital with paralysis to the left side of his mouth.On assessment, the nurse notes that the patient can close his eyes but is not able to whistle or smile when asked to.The nurse recognizes that the patient needs additional assessment for:

A)Cushing's syndrome.
B)Parkinson's disease.
C)Lower motor lesion.
D)Upper motor lesion.

Question 35

A male patient with a history of AIDS has come in for an examination and he states, "I think that I have the mumps." The nurse would begin by examining the:

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

Question 36

A mother brings in her newborn infant for an assessment and tells the nurse that she has noticed that whenever her newborn's head is turned to the right side, she straightens out the arm and leg on the same side and flexes the opposite arm and leg.After observing this on examination, the nurse tells her that this reflex is:

A)Abnormal and is called the atonic neck reflex.
B)Normal and should disappear by the first year of life.
C)Normal and is called the tonic neck reflex, which should disappear between 3 and 4 months of age.
D)Abnormal and the baby should be flexing the arm and leg on the right side of his body when the head is turned to the right.

Question 37

A visitor from Poland, who does not speak English, seems to be somewhat apprehensive about the nurse examining his neck.He would probably be more comfortable with the nurse examining his thyroid gland from:

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 38

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

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

Question 39

During an admission assessment, the nurse notices that a male patient has an enlarged and rather thick skull.The nurse suspects acromegaly and assesses the patient for:

A)Exophthalmos.
B)Sunken eyes.
C)Coarse facial features.
D)Rounded moonlike face.

Question 40

The nurse has just completed a lymph node assessment on a 60-year-old healthy female patient.The nurse knows that most lymph nodes in healthy adults are normally:

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

Question 41

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

Question 42

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)Crepitation
B)Mastoiditis
C)Temporal arteritis
D)Bell's palsy

Question 43

The nurse is providing an educational session to parents in the community on concussions.The nurse shares some of the signs and symptoms to watch for after a head injury which can indicate a concussion and the need to seek medical attention: (Select all that apply.)

A)Fatigue
B)Calmness
C)Photophobia
D)Happiness
E)Feeling woozy
F)Insomnia