Chapter 13: Head, Face, and Neck, Including Regional Lymphatics

Question 1

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 will be:

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.

Answer 1

c.

Question 2

A mother brings her 2-month-old daughter in for an examination and says, “My daughter rolled over and hit her head on the wall, and now I have noticed that she has this spot that is soft on the top of her head. Is there something terribly wrong?” The nurse’s response would be:

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 brain.”
c. “That ‘soft spot’ you are referring to 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.”

Answer 2

d.

Question 3

The nurse notices that a patient’s palpebral fissures are not symmetrical. On examination, the nurse may find that there has been damage to:

a. CN III.
b. CN V.
c. CN VII.
d. CN VIII.

Answer 3

c.

Question 4

A patient is unable to differentiate between sharp and dull stimulation 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 with a pronounced proliferation of connective tissue in the face and cheeks.

Answer 4

b.

Question 5

When examining the face, the nurse is aware that the two pairs of salivary glands that are accessible to examination are the _____ glands.

a. occipital and submental
b. parotid and jugulodigastric
c. parotid and submandibular
d. submandibular and occipital

Answer 5

c.

Question 6

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 starts 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’s sign.

Answer 6

b.

Question 7

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.

Answer 7

a.

Question 8

A patient’s laboratory data reveal an elevated thyroxine level. The nurse would examine the:

a. thyroid gland.
b. parotid gland.
c. adrenal gland.
d. thyroxine gland.

Answer 8

a.

Question 9

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 reassures the nurse 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.

Answer 9

b.

Question 10

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:

a. infraclavicular area.
b. supraclavicular area.
c. area distal to the enlarged node.
d. area proximal to the enlarged node.

Answer 10

d.

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.

Answer 11

d.

Question 12

A mother brings her newborn in for an assessment and asks, “Is there something wrong with my baby? His head seems so big.” The nurse knows the following about relative proportions of the head and trunk in 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 appear proportionate to the body.

Answer 12

b.

Question 13

An 85-year-old female patient is complaining about the fact that the bones in her face have become more noticeable. What explanation should the nurse provide?

a. Diets low in protein and high in carbohydrates may cause enlargement of facial bones.
b. It is probably because she does not use a dermatologist- approved moisturizer.
c. It is probably due to a combination of factors 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 13

c.

Question 14

A patient presents with excruciating pain on one side of his head, especially around his eye, forehead, and cheek that occurs once or twice each day and lasts about 30 minutes to 2 hours. The nurse suspects:

a. hypertension.
b. cluster headaches.
c. tension headaches.
d. migraine headaches.

Answer 14

b.

Question 15

A patient reports a severe throbbing headache in the frontotemporal area of his head that he experienced while studying for an examination, He says that the headache was somewhat relieved when he lay down. He tells the nurse that his mother also used to get these headaches. The nurse suspects that he may be suffering from:

a. hypertension.
b. cluster headaches.
c. tension headaches.
d. migraine headaches.

Answer 15

d.

Question 16

A 19-year-old community 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 (104°F), and his neck is stiff. What do these signs and symptoms suggest?

a. Head injury
b. Cluster headache
c. Migraine headache
d. Meningeal inflammation

Answer 16

d.

Question 17

During a well-baby checkup, the nurse notices that a 1-week-old infant’s face looks small, compared with an enlarged cranium. On further examination, the nurse also notes dilated scalp veins and downcast, or “setting sun,” eyes. What condition does the nurse suspect?

a. Craniotabes
b. Microcephaly
c. Hydrocephalus
d. Caput succedaneum

Answer 17

c.

Question 18

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

a. hyoid.
b. vagus.
c. tragus.
d. mandible.

Answer 18

c.

Question 19

A patient has come in for an examination and states, “I have this spot on my cheek here in front of my ear lobe. The spot seems to be getting bigger and is very 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.

Answer 19

b.

Question 20

A male patient with AIDS has come in for an examination and says, “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.

Answer 20

b.

Question 21

The nurse suspects that a patient has hyperthyroidism, and laboratory data also indicate that the patient’s thyroxine and tri-iodothyronine hormone levels are elevated. Which of the following would the nurse most likely find on examination?

a. Tachycardia
b. Constipation
c. Rapid dyspnea
d. Atrophied nodular thyroid

Answer 21

a.

Question 22

A visitor from Poland who does not speak English appears somewhat apprehensive while the nurse is examining his neck. He would probably be most comfortable if the nurse were examining his thyroid:

a. from behind, with the nurse’s hands placed firmly around his neck.
b. from the side, with the nurse’s eyes averted toward the ceiling and the thumbs on his neck.
c. from the front, with the nurse’s thumbs placed on either side of his trachea and his head tilted forward.
d. from the front, with the nurse’s thumbs placed on either side of his trachea and his head tilted backward.

Answer 22

c.

Question 23

The nurse is preparing to auscultate a patient’s enlarged thyroid for the presence of a bruit. A bruit is a:

a. low gurgling sound best heard with the diaphragm of the stethoscope.
b. loud, whooshing, blowing sound best heard with the bell of the stethoscope.
c. soft, whooshing, pulsatile sound best heard with the bell of the stethoscope.
d. high-pitched tinkling sound best heard with the diaphragm of the stethoscope.

Answer 23

c.

Question 24

A very concerned mother is at the clinic with her infant who has a large, soft lump on the side of his head. She tells the nurse that she noticed the lump about 8 hours after her baby’s birth and that it seems to be getting bigger. One possible explanation for this is:

a. hydrocephalus.
b. craniosynostosis.
c. cephalhematoma.
d. caput succedaneum.

Answer 24

c.

Question 25

A mother who has brought her newborn infant for assessment tells the nurse that she has noticed that whenever her newborn’s head is turned to the right side, the baby straightens out the arm and leg on the same side and flexes the opposite arm and leg. After confirming this on examination, the nurse would tell the mother that this is:

a. abnormal and is called the atonic neck reflex.
b. normal and should disappear by the first year of life.
c. normal and should disappear between 3 and 4 months of age.
d. abnormal. The baby should be flexing the arm and leg on the right side of his body when the head is turned to the right.

Answer 25

c.

Question 26

Which of the following findings during examination would indicate Paget’s disease?

a. Positive Macewen’s sign
b. Premature closure of the sagittal suture
c. Headache, vertigo, tinnitus, and deafness
d. Elongated head with heavy eyebrow ridge

Answer 26

c.

Question 27

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. an acorn-shaped cranium.

Answer 27

c.

Question 28

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

a. ear dysplasia.
b. a long, thin neck.
c. a protruding thin tongue.
d. a narrow and raised nasal bridge.

Answer 28

a.

Question 29

A patient is at 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’s syndrome.
b. Parkinson’s syndrome.
c. Bell’s palsy.
d. had a cerebrovascular accident (CVA, or stroke).

Answer 29

d.

Question 30

A woman is at the clinic for a checkup and says, “My eyes have gotten puffy, and my eyebrows and hair have become coarse and dry.” The nurse suspects:

a. cachexia.
b. cretinism.
c. myxedema.
d. scleroderma.

Answer 30

c.

Question 31

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

a. clumped.
b. unilateral.
c. firm but freely movable.
d. hard and nontender.

Answer 31

c.

Question 32

The physician has diagnosed a tracheal shift in a patient. The nurse is aware that this means that the patient’s trachea is:

a. pulled to the side that is affected by systole.
b. pushed to the side that is not affected by a tumour.
c. pulled to the side that is not affected by plural adhesions.
d. pushed to the side that is affected by thyroid enlargement.

Answer 32

b.

Question 33

During the assessment of an infant, the nurse notes that the fontanelles are depressed and sunken. Which condition does the nurse suspect?

a. Rickets
b. Dehydration
c. Mental retardation
d. Increased intracranial pressure

Answer 33

b.

Question 34

The nurse is performing an assessment on a 7-year-old child who has the following symptoms: chronic watery eyes, sneezing, and clear nasal drainage. The nurse notes the presence of a transverse line across the bridge of the nose, dark blue shadows under the eyes, and a double crease on the lower eyelids. These findings are characteristic of:

a. allergies.
b. a sinus infection.
c. nasal congestion.
d. an upper respiratory infection.

Answer 34

a.

Question 35

While performing a well-child assessment on a 5-year-old, the nurse notes the presence of palpable, bilateral, cervical, and inguinal lymph nodes. The nodes are approximately 0.5 cm in size, round, mobile, and nontender. The nurse suspects that this:

a. child has chronic allergies.
b. child may have an infection.
c. is a normal finding for a well child of this age.
d. child should be referred for additional evaluation.

Answer 35

c.

Question 36

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

a. shotty.
b. not palpable.
c. large, firm, and fixed to the tissue.
d. rubbery, discrete, and mobile.

Answer 36

b.

Question 37

During the 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 noted previously. The nurse suspects that:

a. she has an iodine deficiency.
b. she is exhibiting early signs of goitre.
c. this is a normal finding during pregnancy.
d. further tests are needed for possible thyroid cancer.

Answer 37

c.

Question 38

Which of the following is the best way to palpate the lymph nodes in the neck?

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 move down the neck muscle.
d. Using the index and middle fingers, gently palpate by applying pressure in a rotating pattern.

Answer 38

a.

Question 39

During a well-baby checkup, the mother expresses concern that her 2-month-old infant is not able to hold her head up when she is pulled to a sitting position. Which of the following responses by the nurse is appropriate?

a. “This is not a concern because head control is usually not achieved until 4 months of age.”
b. “You shouldn’t be trying to pull your baby up like that until she is older.”
c. “This is a concern because head control should be achieved by this time.”
d. “This is a concern because it indicates possible nerve damage to the neck muscles.”

Answer 39

a.

Question 40

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

a. Continue the examination because this 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.

Answer 40

a.

Question 41

During an examination, the nurse finds that a patient’s left temporal artery is more tortuous and feels hardened and tender compared with the right temporal artery. What condition does the nurse suspect?

a. Crepitation
b. Mastoiditis
c. Temporal arteritis
d. Bell’s palsy

Answer 41

c.