Ch 11
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Questions and Answers

When a physician mentions a patient's vertebra prominens, which area of the body should the nurse assess?

  • At the level of the C7 vertebra (correct)
  • Just above the diaphragm
  • At the level of the T11 vertebra
  • Just lateral to the knee cap

    • A mother brings her 2-month-old daughter in for an examination and mentions a soft spot on the top of her head. What is the nurse's best response?

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

    • What may asymmetric palpebral fissures indicate?

  • Damage to cranial nerve XI (CN XI)
  • Damage to the optic nerve
  • Damage to cranial nerve VII (CN VII) (correct)
  • Damage to cranial nerve V (CN V)

    • What might inability to differentiate between sharp and dull stimulation on the face suggest?

    <p>Damage to the trigeminal nerve (CN V)</p> Signup and view all the answers

    Which glands are accessible for examination on the face?

    <p>Parotid and submandibular glands</p> Signup and view all the answers

    What may neck and shoulder pain with inability to turn the head indicate?

    <p>Damage to cranial nerve XI (CN XI)</p> Signup and view all the answers

    What would elevated thyroxine (T4) levels prompt an examination of?

    <p>The thyroid gland</p> Signup and view all the answers

    What might a lump in the neck that is mobile and not hard not be?

    <p>A cancerous thyroid nodule</p> Signup and view all the answers

    What would enlarged submental lymph nodes prompt assessment of?

    <p>The area proximal to the enlarged node</p> Signup and view all the answers

    Where are lymph nodes accessible for examination?

    <p>Head and neck, arms, inguinal area, and axillae</p> Signup and view all the answers

    At what stage should the head circumference be greater than the chest circumference?

    <p>At birth</p> Signup and view all the answers

    When does head growth predominate?

    <p>During the fetal period</p> Signup and view all the answers

    What is the impact of the anterior fontanel closing at 2 months?

    <p>Does not significantly impact the relative proportion of the head to the body</p> Signup and view all the answers

    Which type of headache is characterized by excruciating pain around the eye, temple, forehead, and cheek, lasting up to 2 hours, occurring once or twice per day?

    <p>Cluster headache</p> Signup and view all the answers

    What is a characteristic symptom of meningeal inflammation?

    <p>Photophobia</p> Signup and view all the answers

    Which physical feature is characteristic of hydrocephalus?

    <p>Enlarged head and small face</p> Signup and view all the answers

    Where is the temporomandibular joint located?

    <p>Just below the temporal artery and anterior to the tragus</p> Signup and view all the answers

    What could swelling below the angle of the jaw indicate?

    <p>Inflammation of the parotid gland</p> Signup and view all the answers

    Why is parotid gland examination crucial for a patient with acquired immunodeficiency syndrome (AIDS) suspecting mumps?

    <p>Potential complications due to mumps infection</p> Signup and view all the answers

    What should be examined for lesions in a patient suspecting mumps?

    <p>Thyroid gland, cervical lymph nodes, mouth, and skin</p> Signup and view all the answers

    Why should the nurse palpate the temporomandibular joint for crepitation?

    <p>To assess for joint inflammation</p> Signup and view all the answers

    What is a characteristic feature of cluster headaches?

    <p>Unilateral and always on the same side of the head</p> Signup and view all the answers

    What is a common association with migraines?

    <p>Family history of migraine headaches</p> Signup and view all the answers

    What is a characteristic location for migraine headaches?

    <p>Supraorbital, retroorbital, or frontotemporal</p> Signup and view all the answers

    What is a contributing factor to the increased noticeability of facial bones with age?

    <p>Decreased elasticity, subcutaneous fat, and moisture in the skin</p> Signup and view all the answers

    What would the nurse most likely find on examination of a patient with elevated T4 and T3 hormone levels due to hyperthyroidism?

    <p>Tachycardia</p> Signup and view all the answers

    How should the nurse examine the thyroid gland of a non-English speaking patient who seems apprehensive?

    <p>The front with the nurses thumbs placed on either side of his trachea and his head tilted forward</p> Signup and view all the answers

    How should the nurse auscultate an enlarged thyroid gland for the presence of a bruit?

    <p>Soft, whooshing, pulsatile; bell</p> Signup and view all the answers

    What is the likely explanation for a soft, fluctuant, and well-defined lump appearing several hours after birth and gradually increasing in size?

    <p>Cephalhematoma</p> Signup and view all the answers

    What is the reflex observed in an infant when the head is turned to one side, resulting in extension of the same arm and leg, and flexion of the opposite arm and leg?

    <p>Normal and is called the tonic neck reflex, which should disappear between 3 and 4 months of age</p> Signup and view all the answers

    What is the likely cause of a soft, fluctuant, and well-defined lump appearing several hours after birth and gradually increasing in size in an infant?

    <p>Cephalhematoma</p> Signup and view all the answers

    What is the expected outcome of the tonic neck reflex in an infant?

    <p>It is normal and is called the tonic neck reflex, which should disappear between 3 and 4 months of age</p> Signup and view all the answers

    What is the characteristic sound of a bruit heard in an enlarged thyroid gland?

    <p>Soft, whooshing, pulsatile; bell</p> Signup and view all the answers

    What is the likely cause of a large, soft lump on the side of an infant's head, appearing approximately 8 hours after birth and gradually increasing in size?

    <p>Cephalhematoma</p> Signup and view all the answers

    What would be the nurse's likely finding on examination of a patient with hyperthyroidism and elevated T4 and T3 hormone levels?

    <p>Tachycardia</p> Signup and view all the answers

    In hyperthyroidism, elevated T4 and T3 hormone levels would most likely result in:

    <p>Tachycardia</p> Signup and view all the answers

    When examining a patient's thyroid gland, the nurse should place the thumbs on either side of the trachea and tilt the patient's head:

    <p>Forward</p> Signup and view all the answers

    When auscultating an enlarged thyroid gland for the presence of a bruit, the nurse should use the:

    <p>Soft, whooshing, pulsatile; bell</p> Signup and view all the answers

    A soft, fluctuant, and well-defined lump appearing several hours after birth and gradually increasing in size is most likely a result of:

    <p>Cephalhematoma</p> Signup and view all the answers

    The reflex where an infant straightens out the arm and leg on the same side and flexes the opposite arm and leg when the head is turned to one side is known as:

    <p>Normal and is called the tonic neck reflex, which should disappear between 3 and 4 months of age</p> Signup and view all the answers

    An infant showing the tonic neck reflex when supine and the head is turned to one side exhibits:

    <p>Flexion of same arm and leg, extension of opposite arm and leg</p> Signup and view all the answers

    A soft, pulsatile, whooshing, blowing sound heard best with the bell of the stethoscope is indicative of:

    <p>Thyroid bruit</p> Signup and view all the answers

    A subperiosteal hemorrhage that appears several hours after birth and gradually increases in size is most likely:

    <p>Cephalhematoma</p> Signup and view all the answers

    When a newborn's head is turned to the right side, straightening out the arm and leg on the same side and flexing the opposite arm and leg is known as the:

    <p>Tonic neck reflex, which should disappear between 3 and 4 months of age</p> Signup and view all the answers

    When the head is turned to one side, the infant straightening out the arm and leg on the same side and flexing the opposite arm and leg is known as:

    <p>Tonic neck reflex, which should disappear between 3 and 4 months of age</p> Signup and view all the answers

    Study Notes

    Facial bones become more noticeable with age due to decreased elasticity, subcutaneous fat, and moisture in the skin Cluster headaches produce excruciating pain around the eye, temple, forehead, and cheek, lasting up to 2 hours, occurring once or twice per day Migraine headaches tend to be supraorbital, retroorbital, or frontotemporal with a throbbing quality, and are relieved by lying down Meningeal inflammation is suspected with acute onset of neck stiffness, headache, and fever Hydrocephalus is characterized by an enlarged head, small face, dilated scalp veins, and setting sun eyes The temporomandibular joint is located just below the temporal artery and anterior to the tragus Swelling below the angle of the jaw could indicate inflammation of the parotid gland Parotid gland examination is crucial for a patient with acquired immunodeficiency syndrome (AIDS) suspecting mumps Thyroid gland, cervical lymph nodes, mouth, and skin should be examined for lesions in a patient suspecting mumps The nurse should palpate the temporomandibular joint for crepitation Cluster headaches are unilateral and always on the same side of the head Migraines are associated with a family history of migraine headaches

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    Description

    Test your knowledge of head and neck assessment with this quiz covering topics such as facial bone changes with age, different types of headaches, signs of meningeal inflammation, characteristics of hydrocephalus, and examination techniques for the temporomandibular joint and parotid gland.

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