Head and Neck HA

A family member of a patient recovering from a traumatic brain injury asks the nurse what can be done to prevent future head injuries. What should the nurse instruct the family member? Select ALL that Apply. A. Wear helmets when playing all contact sports B. Never drive under the influence of alcohol C. Avoid the use of throw rugs D. Avoid skiing or riding motorcycles E. Wear shoes with heels when walking on ice

A, B, C

The nurse should ask about or assess which associated factors when a patient complains of cluster headaches? Select ALL that Apply A. Rhinorrhea B. Ptosis C. Tearing D. Red eye E. Photophobia

A, B, C, D Rhinorrhea, Ptosis, Tearing, Red Eye

During the health interview of the head and neck, a patient tells the nurse about always feeling cold and preferring warm weather. What additional questions can the nurse ask to learn more information about the client's symptoms? Select ALL that Apply. A. "Do you dress more warmly than other people? B. "Do you use more blankets than others at home?" C. "Do you perspire more than others?" D. "Do you perspire less than others?" E. "Have you lost weight recently?"

A, B, D

What are associated manifestations of a headache cause by a traumatic head injury? Select All that Apply A. Attention span deficit B. Changes in appetite C. Gait changes D. Seizures E. Apathy

A, C, D

A 72-year-old retired secretary is brought to the clinic by her daughter. The daughter is concerned because her mother seems to be more confused, she has gained more weight, but her appetite has decreased, and she seems to be more "swollen" in general. Blood work is obtained and a diagnosis of profound Hypothyroidism is made. On examination of the skin, one would expect to feel it as: A. Cool B. Hot C. Warm D. Moist

A. Cool

Select the statement that is true regarding migraine headaches? A. May have prodromal stage B. Sudden onset C. Aggrevated by coughing, sneezing D. Usually located in the frontal, temporal, or occipital region

A. May have prodromal stage

It is normal to palpate a lymph node in the neck of a health person. What are the characteristics of these nodes? A. Mobile, soft, nontender B. Large, clumped , tender C. Matted, fixed, tender, hard D. Matted, fixed, nontender

A. Mobile, soft, nontender

When assessing the face, which area is best for assessing symmetry of facial features? A. Nasolabial folds B. Inner canthus C. Anterior triangle D. Posterior triangle

A. Nasolabial folds

The nurse is caring for a patient who comes to the clinic reporting a lump by her ear. What are the symptoms of a cancerous lymph node? A. Node is fixed and rubbery B. Node is less than 1 cm in size and feels mushy C. Node is soft and moves freely D. Node matches the node on the opposite side

A. Node is fixed and rubbery

During a health history, a client reports complaints of headaches. Which of the following would lead the nurse to suspect that the client is experiencing cluster headaches? A. Pain radiating from eye to temporal region B. Throbbing and severe pain C. Report of ringing in the ears prior to headache D. Additional complaint of sensitivity to light

A. Pain radiating from eye to temporal region

Normal cervical lymph nodes are: A. Smaller than 1 cm B. Warm to palpation C. Fixed D. Firm

A. Smaller than 1 cm

Pain in the mandible during opening and closing of the mouth associated with a clicking sound suggests: A. Temporomandibular joint dysfunction B. Vascular spasm C. Dental abscess D. Swollen lymph nodes

A. Temporomandibular joint dysfunction

A 29-year-old female computer programmer comes to the office for evaluation of a headache. The tightening sensation of moderate intensity is located all over the head. It used to last minutes, but this time it has lasted for 5 days. She denies photophobia and nausea. She spends several hours at a computer monitor/keyboard. She has tried over-the-counter medication; it has dulled the pain, but not taken it away. Based on this description, what is the most likely diagnosis? A. Tension B. Migraine C. Cluster D. Sinus

A. Tension

When assessing your patient's head and neck, what would you assess the face for? Select All That Apply A. Hair color B. Asymmetry C. Affect D. Edema/swelling E. Involuntary movements

B, D, E

You are assessing the lymph nodes of the head and neck. Where are the tonsillar lymph nodes located? A. Under the jaw B. At the angle of the jaw C. Under the chin D. In front of the ears

B. At the angle of the jaw

A 16-year-old white female is brought to the clinic by her mother with a chief complaint of a severe headache lasting for more than 24 hours. The mother states, "Just before the headache started my daughter was craving food. I couldn't feed her enough." What is this called? A. Murphy's sign B. Prodrome C. Neurological onset D. Aberrant sign

B. Prodrome

An 18-year-old college student presents to the clinic with complaints that her heart is "racing". A diagnosis of Hyperthyroidism is made. On physical examination of her eyes, what would you expect to find? A. Recession B. Protrussion C. Clouding of the cornea D. Ciliary injection

B. Protrussion

When describing characteristics of an enlarged lymph node, you would note: A. Size, shape, color, tenderness mobility B. Size, shape delimitation, mobility, consistency, tenderness C. Size, shape, tenderness, vertical mobility D. Size, shape, lateral movement, tenderness

B. Size, shape delimitation, mobility, consistency, tenderness

Palpation of a normal temporal artery reveals: A. Softness of the surrounding bony structures B. Smooth, readily compressible, and nontender vessel C. Firm consistency and tenderness D. A stronger impulse than found with other peripheral pulses

B. Smooth, readily compressible and nontender vessel

The nurse can best palpate the superficial cervical nodes, the deep cervical chain, and the supraclavicular nodes by first locating which muscle? A. Infraspinous B. Sternomastoid C. Trapezius D. Platysma

B. Sternomastoid

When identifying the midline structures of the neck from the mandible to the sterna notch, the nurse notes the structures in what order? A. Cricoid cartilage, Hyoid bone, tracheal rings, thyroid isthmus B. Thyroid cartilage, Thyroid isthmus, cricoids cartilage, hyoid bone C. Hyoid bone, thyroid cartilage, cricoids cartilage, isthmus of the thyroid D. Hyoid bone, tracheal rings, cricoids cartilage, lobes of the thyroid

C

When assessing the thyroid gland, you locate the isthmus. Where is the isthmus located? A. Below the hyoid bone B. Below the thyroid cartilage C. Below the cricoid cartilage D. Below the tracheal rings

C. Below the cricoid cartilage

A 55-year-old construction worker presents to the clinic for evaluation of fatigue and weakness. During the course of the interview, the patient reveals that he has noticed both an increase in his ring size and his shoe size; you ask to look at his driver's license and also at any pictures that he has in his wallet of himself from an earlier time. Upon looking at these pictures, you are able to strongly theorize that he has Acromegaly. Which physical finding is most consistent with this diagnosis? A. High forehead B. Small, recessed jaw C. Coarsening and enlargement of the facial features D. Ptosis

C. Coarsening and enlargement of the facial features

What activity is known to aggravate a tension headache? A. Listening to music B. Exercise C. Driving D. Prolonged sleep

C. Driving

A nurse performs palpation of a client's lymph nodes. Which finding should be reported to the health care provider? A. Mobile from side to side B. Soft consistency C. Fixed to the underlying tissue D. Round and 2mm in size

C. Fixed to the underlying tissue

You are assessing the lymph nodes of the head and neck. Where are the posterior cervical nodes located? A. On the sternomastoid muscle B. In the anterior angle C. In the posterior triangle D. Above the clavicle

C. In the posterior triangle

During your physical examination of the patient you note an enlarged tender tonsillar lymph node. What would you do? A. Assess for meningitis B. Look for involvement of other regions of the body C. Look for a source such as infection in the area that it drains D. Assess for dietary changes

C. Look for a source such as infection in the area that it drains

A nursing instructor is teaching a group of students how to examine the thyroid gland. The instructor would determine that a student needs additional instruction when the student demonstrates which technique? A. Inspection B. Palpation C. Percussion D. Auscultation

C. Percussion

To facilitate palpation of the thyroid gland, you instruct your patient to: A. Rotate the neck B. Hyperextend the neck C. Swallow D. Hold breath

C. Swallow

The anterior and posterior triangles are two landmarks used to assess the neck. What two muscles make up these triangles? A. Omohyoid and trapezius B. Masseter and sternomastoid C. Trapezius and sternomastoid D. Temporalis and omohyoid

C. Trapezius and sternomastoid

You are assessing the lymph nodes of the head and neck. Where are the submental nodes located? A. Under the jaw B. Behind the ears C. Under the chin D. At the angle of the jaw

C. Under the chin

When inspecting the shape of the patient's head, you note an abnormal enlargement of the skull and bony facial structures. The term used to describe this finding is: A. Craniotabes B. Hydrocephalus C. Craniosynostosis D. Acromegaly

D. Acromegaly

The nurse palpates enlarged, tender bilateral submandibular lymph nodes. What action should the nurse perform next? A. Assess for other signs of lymphadenopathy B. Assess for tenderness of the neck C. Assess for bilateral ear pain D. Assess for nasal congestion and sore throat

D. Assess for nasal congestion and sore throat

You are assessing the lymph nodes of the head and neck. Where are the occipital nodes located? A. In front of the ears B. Behind the sternomastoid muscle C. Behind the ears D. At the base of the skull

D. At the base of the skull

A nurse palpates an elderly client's thyroid and detects an enlargement over the right lateral lobe. What action should the nurse take first? A. Immediately notify the health care provider B. Document the findings in the nurses notes C. Ask the client about past history of hypothyroidism D. Auscultate with the bell over the lateral lobes

D. Auscultate with the bell over the lateral lobes

When inspecting your patient's face, you notice asymmetry of the palpebral fissures, nasolabial folds, and facial expression. These findings are characteristic of: A. Down syndrome B. Hypertelorism C. Parkinson's disease D. Bell's palsy

D. Bells palsy

When examining a client's thyroid gland, the nurse ensures that which equipment is readily available? A. Penlight B. Tongue depressor C. Centimeter-scale ruler D. Cup of water

D. Cup of water

A 72-year-old male arrives in the emergency department by ambulance after falling down his front steps. You note two soft lumps, approximately 3 cm in diameter on the right side of his head. What would you identify these as? A. Pilar cysts B. Pigmented nevi C. Signs of abuse D. Edema/swelling from the fall

D. Edema/swelling from the fall

A 43-year-old Asian female presents at the clinic for a routine check-up. The nurse notes that she is dressed in warm clothing even though the temperature outside is 87 F. The nurse also notes that the patient has gained 10 pounds since her last visit 3 months ago. What might the nurse suspect? A. Effect of age-related changes B. Brain tumor C. Hyperthyroidism D. Hypothyroidism

D. Hypothyroidism

If the thyroid gland is enlarged bilaterally, which of the following maneuvers is appropriate? A. Check for deviation of the trachea B. Listen for a bruit over the carotid arteries C. Listen for a murmur over the aortic area D. Listen for a bruit over the thyroid lobes

D. Listen for a bruit over the thyroid lobes