Jarvis HA Ch. 14 Head, face, neck and lymphatics

A physician tells the nurse that a patient's vertebra prominens is tender and asks the nurse to reevaluate 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.

C

The C7 vertebra has a long spinous process, called the vertebra prominens, which is palpable when the head is flexed.

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.III

b.V

c.VII

d.VIII

C

Facial muscles are mediated by CN VII; asymmetry of palpebral fissures may be attributable to damage to CN VII (Bell palsy).

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

a.Bell palsy.

b.Damage to the trigeminal nerve.

c.Frostbite with resultant paresthesia to the cheeks.

d.Scleroderma.

B

Facial sensations of pain or touch are mediated by CN V, which is the trigeminal nerve. Bell palsy is associated with CN VII damage. Frostbite and scleroderma are not associated with this problem.

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

a.Occipital; submental

b.Parotid; jugulodigastric

c.Parotid; submandibular

d.Submandibular; occipital

C

Two pairs of salivary glands accessible to examination on the face are the parotid glands, which are in the cheeks over the mandible, anterior to and below the ear; and the submandibular glands, which are beneath the mandible at the angle of the jaw. The parotid glands are normally nonpalpable.

A patient comes to the clinic complaining of neck and shoulder pain and is unable to turn her head. The nurse suspects damage to CN ______ 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

B

The major neck muscles are the sternomastoid and the trapezius. They are innervated by CN XI, the spinal accessory. The innervated muscles assist with head rotation and head flexion, movement of the shoulders, and extension and turning of the head.

When examining a patient's CN function, the nurse remembers that the muscles in the neck that are innervated by CN XI are the:

a.Sternomastoid and trapezius.

b.Spinal accessory and omohyoid.

c.Trapezius and sternomandibular.

d.Sternomandibular and spinal accessory.

A

The major neck muscles are the sternomastoid and the trapezius. They are innervated by CN XI, the spinal accessory.

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

A

The thyroid gland is a highly vascular endocrine gland that secretes T4 and triiodothyronine (T3). The other glands do not secrete T4.

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, the finding that leads the nurse to suspect that this may not be a cancerous thyroid nodule is that the lump (nodule):

a.Is tender.

b.Is mobile and not hard.

c.Disappears when the patient smiles.

d.Is hard and fixed to the surrounding structures.

B

Painless, rapidly growing nodules may be cancerous, especially the appearance of a single nodule in a young person. However, cancerous nodules tend to be hard and fixed to surrounding structures, not mobile.

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

a.Infraclavicular area.

b.Supraclavicular area.

c.Area distal to the enlarged node.

d.Area proximal to the enlarged node.

D

When nodes are abnormal, the nurse should check the area into which they drain for the source of the problem. The area proximal (upstream) to the location of the abnormal node should be explored.

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.

D

Nodes are located throughout the body, but they are accessible to examination only in four areas: head and neck, arms, inguinal region, and axillae.

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 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.

C

The facial bones and orbits appear more prominent in the aging adult, and the facial skin sags, which is attributable to decreased elasticity, decreased subcutaneous fat, and decreased moisture in the skin.

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. The nurse should suspect:

a.Hypertension.

b.Cluster headaches.

c.Tension headaches.

d.Migraine headaches.

B

Cluster headaches produce pain around the eye, temple, forehead, and cheek and are unilateral and always on the same side of the head. They are excruciating and occur once or twice per day and last to 2 hours each.

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. The nurse suspects that he may be suffering from:

a.Hypertension.

b.Cluster headaches.

c.Tension headaches.

d.Migraine headaches

D

Migraine headaches tend to be supraorbital, retroorbital, or frontotemporal with a throbbing quality. They are severe in quality and are relieved by lying down. Migraines are associated with a family history of migraine headaches.

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 looks for other signs and symptoms of which problem?

a.Head injury

b.Cluster headache

c.Migraine headache

d.Meningeal inflammation

D

The acute onset of neck stiffness and pain along with headache and fever occurs with meningeal inflammation. A severe headache in an adult or child who has never had it before is a red flag. Head injury and cluster or migraine headaches are not associated with a fever or stiff neck.

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.

C

The temporomandibular joint is just below the temporal artery and anterior to the tragus.

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.

B

Swelling of the parotid gland is evident below the angle of the jaw and is most visible when the head is extended. Painful inflammation occurs with mumps, and swelling also occurs with abscesses or tumors. Swelling occurs anterior to the lower ear lobe.

A male patient with a history of acquired immunodeficiency syndrome (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.

B

The parotid gland may become swollen with the onset of mumps, and parotid enlargement has been found with human immunodeficiency virus (HIV).

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.Tachycardia

b.Constipation

c.Rapid dyspnea

d.Atrophied nodular thyroid gland

A

T4 and T3 are thyroid hormones that stimulate the rate of cellular metabolism, resulting in tachycardia. With an enlarged thyroid gland as in hyperthyroidism, the nurse might expect to find diffuse enlargement (goiter) or a nodular lump but not an atrophied gland. Dyspnea and constipation are not findings associated with hyperthyroidism.

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.

C

Examining this patient's thyroid gland from the back may be unsettling for him. It would be best to examine his thyroid gland using the anterior approach, asking him to tip his head forward and to the right and then to the left.

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

C

If the thyroid gland is enlarged, then the nurse should auscultate it for the presence of a bruit, which is a soft, pulsatile, whooshing, blowing sound heard best with the bell of the stethoscope

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

a.Exophthalmos.

b.Bowed long bones.

c.Coarse facial features.

d.Acorn-shaped cranium.

C

Acromegaly is excessive secretion of growth hormone that creates an enlarged skull and thickened cranial bones. Patients will have elongated heads, massive faces, prominent noses and lower jaws, heavy eyebrow ridges, and coarse facial features. Exophthalmos is associated with hyperthyroidism. Bowed long bones and an acorn-shaped cranium result from Paget disease.

A patient visits the clinic because he has recently noticed that the left side of his mouth is paralyzed. He states that he cannot raise his eyebrow or whistle. The nurse suspects that he has:

a.Cushing syndrome.

b.Parkinson disease.

c.Bell palsy.

d.Experienced a cerebrovascular accident (CVA) or stroke.

D

With an upper motor neuron lesion, as with a CVA, the patient will have paralysis of lower facial muscles, but the upper half of the face will not be affected owing to the intact nerve from the unaffected hemisphere. The person is still able to wrinkle the forehead and close the eyes.

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 syndrome.

c.Myxedema.

d.Scleroderma.

C

Myxedema (hypothyroidism) is a deficiency of thyroid hormone that, when severe, causes a nonpitting edema or myxedema. The patient will have a puffy edematous face, especially around the eyes (periorbital edema); coarse facial features; dry skin; and dry, coarse hair and eyebrows.

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.

C

Acutely infected lymph nodes are bilateral, enlarged, warm, tender, and firm but freely movable. Unilaterally enlarged nodes that are firm and nontender may indicate cancer.

The physician reports that a patient with a neck tumor 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.

B

The trachea is pushed to the unaffected side with an aortic aneurysm, a tumor, unilateral thyroid lobe enlargement, or a pneumothorax. The trachea is pulled to the affected side with large atelectasis, pleural adhesions, or fibrosis. Tracheal tug is a rhythmic downward pull that is synchronous with systole and occurs with aortic arch aneurysm.

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.

B

Most lymph nodes are nonpalpable in adults. The palpability of lymph nodes decreases with age. Normal nodes feel movable, discrete, soft, and nontender.

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 suspects that the patient:

a.Has an iodine deficiency.

b.Is exhibiting early signs of goiter.

c.Is exhibiting a normal enlargement of the thyroid gland during pregnancy.

d.Needs further testing for possible thyroid cancer.

C

The thyroid gland enlarges slightly during pregnancy because of hyperplasia of the tissue and increased vascularity

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.

A

Using gentle pressure is recommended because strong pressure can push the nodes into the neck muscles. Palpating with both hands to compare the two sides symmetrically is usually most efficient.

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 palsy

C

With temporal arteritis, the artery appears more tortuous and feels hardened and tender. These assessment findings are not consistent with the other responses.

40. During an examination, the nurse finds that a patients 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 palsy

c.Temporal arteritis

Mr. Sanchez is a 54-year-old patient with asthma. He has been taking oral steroids to control the asthma, which has been out of control for many years. Excessive corticotropin hormone production and chronic steroid use leads to a condition that is characterized by a rounded "moon-like" face, plethora, prominent jowls, hirsutism, and chest acne, which is called:

A. acromegaly.

B. scleroderma.

C. myxedema.

D. Cushing's syndrome.

D. Cushing's syndrome

On examination of Mrs. Jones, who is 55 years of age, you note hard, shiny skin on the forehead and cheeks; thin, pursed lips with radial furrowing; facial and neck muscle atrophy; and expressionless facies. Which disorder is suggested by these findings?

A. Myxedema

B. Scleroderma

C. Systemic lupus erythematosus

D. Cachexia

B. Scleroderma

Hard, shiny skin on the forehead and cheeks; thin, pursed lips with radial furrowing; facial and neck muscle atrophy; and expressionless facies are the characteristic features of a connective tissue disease known as scleroderma. Myxedema presents with nonpitting edema; coarse facial features; dry skin; dry, coarse hair; and a severe deficiency of thyroid hormone. Systemic lupus erythematosus is a systemic autoimmune inflammatory disease. Cachexia accompanies chronic wasting diseases such as cancer, dehydration, and starvation, and features include sunken eyes; hollow cheeks; and an exhausted, defeated expression.

Scleroderma is a/an ________ disease that causes chronic hardening and shrinking and degenerative changes in the skin.

A. autoimmune

B. collagen

C. autonomic nervous system

D. None of the above

B. collagen

Scleroderma is a collagen disease that causes chronic hardening and shrinking and degenerative changes in the skin. Scleroderma is not an autoimmune, autonomic nervous system, or endocrine disease.

Mr. Staley is a 38-year-old patient who comes to the office for a new patient examination. As the health care provider, what are you assessing when you observe facial muscles?

A. CN III

B. CN V

C. CN VII

D. CN XI

C. CN VII

When assessing the strength of the major neck muscles—the sternocleidomastoid (also called sternomastoid) and the trapezius—you are assessing the spinal accessory nerve. This nerve is also called:

A. CN V

B. CN VII

C. CN X

D. CN XI

D. CN XI

Craniosynostosis is a severe deformity caused by:

A. premature closure of the sutures.

B. increased intracranial pressure.

C. a localized bone disease that softens, thickens, and deforms bone.

D. excess growth hormone or deficit thyroid hormone.

A. premature closure of the sutures.

Mr. Colt, a 35-year-old patient, comes to the office presenting with complaints of flu-like symptoms. As the health care provider, you examine his lymph nodes. Which of the following findings are considered suspicious for lymph node malignancy?

A. Palpable, smooth, soft, discrete, and nontender lymph nodes

B. Palpable, shoddy, bilateral jugulodigastric nodes

C. Unilateral, hard, fixed, and nontender lymph nodes

D. Enlarged, tender, warm, firm, and mobile lymph nodes

C. Unilateral, hard, fixed, and nontender lymph nodes

On examination of Mr. Treacher, who is a 46-year-old patient, you note a smooth, firm, fluctuant swelling on the scalp. Which of the following best describes this finding?

A. Pilonidal cyst

B. Sebaceous cyst

C. Pilar cyst

D. Follicular cyst

C. Pilar cyst

Palpable lymph nodes that are nonsuspicious are described as:

A. nontender, discrete, and mobile.

B. nontender, discrete, and fixed.

C. tender, mobile, and soft.

D. nontender, nonmobile, and firm.

A. nontender, discrete, and mobile