TERM-2 HEALTH ASSESSMENT JARVIS CH.13 "HEAD,FACE AND NECK,INCLUDING REGIONAL LYMPHATICS" Flashcards Preview

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Flashcards in TERM-2 HEALTH ASSESSMENT JARVIS CH.13 "HEAD,FACE AND NECK,INCLUDING REGIONAL LYMPHATICS" Deck (382):
1

STRUCTURE AND FUNCTION

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2

THE HEAD

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3

The______- is a rigid bony box that protects the brain and special sense organs, and it includes the bones of the cranium and the face .
A)skull
B)cervical
C)both a and b

A

4

cranial bones:are
A) frontal, parietal, occipital, and temporal.
B) frontal, parietal, occipital, and zygomatic.

A

5

The adjacent cranial bones unite at meshed immovable joints called the
A)sutures
B)phontenels

A

6

At birth the sutures are soft and messy when they ossify?
A) The sutures gradually ossify during early childhood
B)The sutures gradually ossify during early adult hood

A

7

The_______ suture crowns the head from ear to ear at the union of the frontal and parietal bones
A)coronal
B)parietal

A

8

The_______ suture separates the head lengthwise between the two parietal bones
A)sagittal
B)cornal

A

9

The_________ suture separates the parietal bones crosswise from the occipital bone.
A)lambdoid
B)cornal

A

10

The 14 facial bones also articulate at sutures (note the nasal bone, zygomatic bone, and maxilla), except for
A)the mandible (the lower jaw). It moves up, down, and sideways from the temporomandibular joint, which is anterior to each ear.
B)false 22 facial bones

A

11

The cranium is supported by the cervical vertebra: C1, the "atlas"; C2, the "axis"; and down to C7.
A)True
B)false

True

12

The cranium is supported by the cervical vertebra: C1, the
A)"atlas";
B)"axis";

A

13

The cranium is supported by the cervical vertebra: C2
A) "atlas"
B)"axis"

B

14

The expressions are formed by the facial muscle, which are mediated by cranial nerve
A)VII, the facial nerve.
B)IV, the facial nerve

A

15

Facial muscle function is symmetric bilaterally, except for an occasional quirk or wry expression.
A)true
B)false

True

16

The palpebral fissures-the openings between the eyelid are equal bilaterally
A)true
B)false

True

17

Facial sensations of pain or touch are mediated by the three sensory branches of cranial nerve
A)V, the trigeminal nerve.
B)VI, the trigeminal nerve

A

18

Two pairs of salivary glands are accessible to examination on the face.select all that apply
A) The parotid glands
B)The submandibular glands . ,
C)the sublingual glands
D)temporal gland

A B

19

The _____________ are in the cheeks over the mandible, anterior to and below the ear. They are the largest of the salivary glands but are not normally palpable.
A)The submandibular glands
B)parotid glands

B

20

. The _________________ are beneath the mandible at the angle of the jaw. A third pair, the sublingual glands, lie in the floor of the mouth.
A)parotid glands
B)submandibular glands

B

21

) The temporal artery lies superior to the temporalis muscle; its pulsation is palpable anterior to the ear.
A)true
B)false

True

22

THE NECK

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23

The______ is delimited by the base of the skull and inferior border of the mandible above, and by the manubrium sterni, the clavicle, the first rib, and the first thoracic vertebra below.
A)neck
B)cranial

A

24

Think of the neck as a conduit for the passage of many structures, which are lying in close proximity: blood vessels, muscles, nerves, lymphatics, and viscera of the respiratory and digestive systems. Blood vessels include the common and internal carotid arteries and their associated veins.
A)true
B)false

True

25

The internal carotid branches off the common carotid and runs inward and upward to supply the brain; the external carotid supplies the face, salivary glands, and superficial temporal area.
A)true
B)falsse

True

26

The ___________ carotid branches off the common carotid and runs inward and upward to supply the brain;
A)internal
B)external

A

27

the________ carotid supplies the face, salivary glands, and superficial temporal area.
A)internal
B)external

B

28

The carotid artery and internal jugular vein lie beneath the
A)sternomastoid muscle.
B)trapezes muscle

A

29

The external jugular vein runs diagonally across the sternomastoid muscle.
A)true
B)false

A

30

The major neck muscles are the sternomastoid and the trapezius; they are innervated by cranial nerve XI, the spinal accessory.
A)true
B)false

A

31

What are the two major neck muscles?
A)sternomastoid and trapezes
B)trapezes and biceps

A

32

The major neck muscles are the sternomastoid and the trapezius; they are innervated by cranial nerve
A)XI, the spinal accessory.
B)XII the spinal nerve

A

33

The sternomastoid muscle arises from the sternum and the clavicle and extends diagonally across the neck to the mastoid process behind the ear. It accomplishes head rotation and head flexion.
A)true
B)false

A

34

The two trapezius muscles on the upper back arise from the occipital bone and the vertebrae and extend fanning out to the scapula and clavicle. The trapezius muscles move the shoulders and extend and turn the head.
A)true
B)false

A

35

The sternomastoid muscle divides each side of the neck into two triangles. The anterior triangle lies in front, between the sternomastoid and the midline of the body, with its base up along the lower border of the mandible and its apex down at the suprasternal notch. The posterior triangle is behind the sternomastoid muscle, with the trapezius muscle on the
A)true
B)false

A

36

The anterior triangle lies in front,
A) between the sternomastoid and the midline of the body, with its base up along the lower border of the mandible and its apex down at the suprasternal notch.
B)is behind the sternomastoid muscle, with the trapezius muscle on the

A

37

. The posterior triangle is behind the sternomastoid muscle?
A)with the trapezius muscle on the other side and with its base along the clavicle below. It contains the posterior belly of the omohyoid muscle.
B)false, their are no triangles

A

38

The ________ gland is an important endocrine gland with a rich blood supply. It straddles the trachea in the middle of the neck. This highly vascular endocrine gland synthesizes and secretes thyroxine (T4) and triiodothyronine (T3), hormones that stimulate the rate of cellular metabolism.
A)thyroid
B)parotid
C) sublingual

A

39

The gland has two lobes, both conical in shape, each curving posteriorly between the trachea and the sternomastoid muscle. The lobes are connected in the middle by a thin isthmus lying over the second and third tracheal rings.
A)thyroid
B)sublingual
C)parotid

A

40

Just above the thyroid isthmus, within about 1 cm, is the ________ cartilage or upper tracheal ring.
A)cricoid
B)cartilage
C)hyoid

A

41

Just above the thyroid isthmus, within about 1 cm, is the cricoid cartilage or upper tracheal ring. The _______ cartilage is above that, with a small, palpable notch in its upper edge.
A)hyoid
B)thyroid
C)both a and b

B

42

Just above the thyroid isthmus, within about 1 cm, is the cricoid cartilage or upper tracheal ring. The thyroid cartilage is above that, with a small, palpable notch in its upper edge. This is the prominent "Adam's apple" in males.
A)true
B)false

A

43

The highest is the hyoid bone, palpated high in the neck at the level of the floor of the mouth.
A)true
B)false

A

44

LYMPHATICS

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45

the head and neck have a rich supply of
A)lymph nodes
B)lymph sections
C)both a and b

A

46

• Preauricular, in front of the ear
-Posterior auriwlar (mastoid), superficial to the mastoid process
• Occipital, at the base of the skull
Submental, midline, behind the tip of the mandible
• Submandibular, halfway between the angle and the tip of the mandible
-Jugulodigastric, under the angle of the mandible
-Superficial cervical, overlying the sternomastoid muscle
-Deep cervical, deep under the sternomastoid muscle
• Posterior cervical, in the posterior triangle along the edge of the trapezius muscle -Supraclavicular, just above and behind the clavicle, at the sternomastoid muscle
A)Note that their labels correspond to adjacent structures.
B)false

A

47

When nodes are abnormal, check the area they drain for the source of the problem. Explore the area proximal (upstream) to the location of the abnormal node
A)true
B)false

A

48

The lymphatic system is an extensive vessel system, which is separate from the cardiovascular system and is phylogenetically older.
A)true
B)false

A

49

The lymphatics are a major part of the immune system, whose job it is to detect and eliminate foreign substances from the body.
A)true
B)false

A

50

The vessels allow the flow of clear, watery fluid (lymph) from the tissue spaces into the circulation.
A)true
B)false

A

51

___________ are small, oval clusters of lymphatic tissue that are set at intervals along the lymph vessels tissue that are set at intervals along the lymph vessels like beads on a string.
A)phagocytes
B)Lymph nodes
C)both a and b

B

52

The nodes filter the lymph and engulf pathogens, preventing potentially harmful substances from entering the circulation.
A)true
B)false.

A

53

Nodes are located throughout the body but are accessible to examination only in four areas: head and neck, arms, axillae, and inguinal region. The greatest supply is in the head and neck.
A)true
B)false

A

54

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

A

55

The greatest supply is in the head and neck
A)lymph nodes
B)fugal

A

56

DEVELOPMENTAL COMPETENCE
Infants and Children

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57

The bones of the neonatal skull are separated by sutures and by fontanels, the spaces where the sutures intersect. These membrane-covered "soft spots" allow for growth of the brain during the 1st year.
A)true
B)false

A

58

__________They gradually ossify; the triangle-shaped posterior fontanel is closed by l to 2 months, and the diamond-shaped anterior fontanel closes between 9 months and 2 years.
A)fontanels
B)sutures

A

59

the triangle-shaped posterior fontanel is closed by
A)l to 2 months,
B) 9 months and 2 years

A

60

the diamond-shaped anterior fontanel closes
A) closed by l to 2 months,
B)between 9 months and 2 years

B

61

Head size is greater than chest circumference at birth.
A)true
B)false

A

62

The head size grows during childhood, reaching 90o/o of its final size when the child is 6 years old. But during infancy, trunk growth predominates so that head size changes in proportion to body height.
A)true
B)false

A

63

. Facial bones grow at varying rates, especially nasal and jaw bones.
A)true
B)false

True

64

In the toddler, the mandible and maxilla are small and the nasal bridge is low, so that the whole face seems small compared with the skull.
A)true
B)false

A

65

Lymphoid tissue is well developed at birth and grows to adult size when the child is
A)2 years old.
B)6 years old.
C)both a and b

B

66

The child's lymphatic tissue continues to grow rapidly until age 10 or 11 years, actually exceeding its adult size before puberty. Then the lymphatic tissue slowly atrophies.
A)true
B)false

A

67

In adolescence, facial hair appears on boys, first above the lip, then on cheeks and below the lip, and last on the chin.
A)true
B)false

A

68

A noticeable enlargement of the thyroid cartilage occurs, and with it, the voice deepens.
A)adolescents
B)school age
C)young adult

A

69

DEVELOPMENT COMPETENCE
The Pregnant Woman

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70

The thyroid gland enlarges slightly during pregnancy as a result of hyperplasia of the tissue and increased vascularity.
A)true
B)false

A

71

The ________ gland enlarges slightly during pregnancy as a result of hyperplasia of the tissue and increased vascularity.
A)submandibular
B)thyroid
C)patroid

B

72

DEVELOPMENT COMPETENCE
The Aging Adult

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73

The facial bones and orbits appear more prominent, and the facial skin sags as a result of decreased elasticity, decreased subcutaneous fat, and decreased moisture in the skin. The lower face may look smaller if teeth have been lost.
A)the pregnant women
B)aging adult

B

74

SUBJECTIVE DATA

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75

1. Headache
2. Head injury
3. Dizziness
4. Neck pain, limitation of motion
5. Lumps or swelling
6. History of head or neck surgery
A)objective data
B)subjective data

B

76

HEADACHE

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77

Any unusually frequent or unusually severe headaches?
A)This is a more meaningful question than "Do you ever have headaches?" because most people have had at least one headache. Because many conditions have a headache as a symptom, a detailed history is important.
B)false, do not answer

A

78

Ever had this kind of headache before?
A)A red flag is a severe headache in an adult or child who has never had it before.
B)Unilateral or bilateral (e.g., with cluster headaches, pain is always unilateral and always on the same side of the head).

A

79

Where do you feel it: frontal, temporal, behind your eyes, like a band around the head, in the sinus area, or in the occipital area?
A)Tension headaches tend to be occipital, frontal, or with bandlike tightness; migraines (vascular) tend to be supraorbital, retro-orbital, or frontotemporaL; cluster headaches (vascular) produce pain around the eye, temple, forehead, cheek.
B)false

A

80

Is pain localized on one side, or all over?
A)Unilateral or bilateral (e.g., with cluster headaches, pain is always unilateral and always on the same side of the head).
B)Character is typicaUy viselike with tension headache, throbbing with migraine or temporaJ arteritis.

A

81

Character. Throbbing (pounding, shooting) or aching (viselike, constant pressure, dull)?
A)Character is typically viselike with tension headache, throbbing with migraine or temporal arteritis.
B)false

A

82

Is it mild, moderate, or severe?
A)Pain is often severe with migraine, or excruciating with cluster headache.
B)false

A

83

Course and duration. What time of day do the headaches occur: morning, evening, awaken you from sleep?
A)Migraines occur about twice per month, each lasting 1 to 3 days; cluster headaches occur once or twice per day, each to 2 hours for 1 to 2 months, and remission may last for months or years.
B)false

A

84

Migraines occur about twice per month, each lasting 1 to 3 days;
A)true
B)false

A

85

cluster headaches occur once or twice per day, each to 2 hours for 1 to 2 months, and remission may last for months or years.
A)true
B)false

A

86

Precipitating factors. What brings it on: activity or exercise, work environment, emotional upset, anxiety, alcohol? (Also note signs of depression.)
A)Alcohol ingestion and daytime napping typically precipitate cluster headaches, whereas alcohol, letdown after stress, menstruation, and eating chocolate or cheese precipitate migraines.
B)false

A

87

Associated factors. Any relation to other symptoms: any nausea and vomiting? (Note which came first, headache or nausea.) Any vision changes, pain with bright lights, neck pain or stiffness, fever, weakness, moodiness, stomach problems?
A)Nausea, vomiting, and visual disturbances are associated with migraines; eye reddening and tearing, eyelid drooping, rhinorrhea, and nasal congestion are associated with cluster headaches; anxiety and stress are associated with tension headaches; nuchal rigidity and fever are associated with meningitis or encephalitis.
B)false,patient is okay

A

88

Do you have any other illness?
A)Hypertension, fever, hypothyroidism, and vasculitis produce headaches.
B)hypotension

A

89

Do you take any medications?
A)Oral contraceptives, bronchodilators, alcohol, nitrates, carbon monoxide inhalation produce headaches
B)weed smoking

A

90

What is the frequency of your headaches: once a week? Are your headaches occurring closer together?
A)Migraines are associated with family history of migraine
B)none

A

91

Effort to treat. What seems to help: going to sleep, medications, positions, rubbing the area?
A)With migraines, people lie down to feel better, whereas with cluster headaches they need to move-even to pace the floor-to feel better.
B)head injury

A

92

HEAD INJURY

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93

Lose consciousness and then fall?
A)Loss of consciousness before a fall may have a cardiac cause (e.g., heart block)
B)no change

A

94

Duration. How long were you unconscious? Any symptoms afterward-headache, vomiting, projectile vomiting? Any change in level of consciousness nfter injury: dazed or sleepy?
A)a change in level of consciousness is most important in evaluating a neurologic deficit.
B)no change noted

A

95

Associated symptoms. Any pain in the head or the neck, vision change, discharge from ear or nose-is it bloody or watery? Are you able to move all extremities? Any tremors, staggered walk, numbness and tingling
A)true
B)fase

A

96

DIZZINESS

.

97

Experienced any dizziness? (Determine exactly what the person means by dizziness.) Was it a feeling of light-headedness or of falling? Or was it a spinning sensation?
A)Dizziness is a light-headed, swimming sensation, feeling of falling. True vertigo is true rotational spinning from neurologic disease (labyrinthine-vestibular apparatus, vestibular nuclei in brainstem). When vertigo is objective, the person feels like the room spins. When vertigo is subjective, the perception is that the person spins.
B)person affect is cooperative

A

98

Dizziness is a light-headed, swimming sensation, feeling of falling. True vertigo is true rotational spinning from neurologic disease (labyrinthine-vestibular apparatus, vestibular nuclei in brainstem).
A)true
B)false

A

99

When vertigo is__________, the person feels like the room spins. .
A)subjective
B)objective

B

100

When vertigo is_______, the perception is that the person spins.
A)subjective
B)objective

A

101

Onset. Abrupt or gradual? After a change in position, such as sudden standing?
A)dizziness
B)headache

A

102

Associated factors. Any nausea and vomiting, pallor, immobility, decreased hearing acuity, or tinnitus along with the dizziness?
A) true
B) false

A

103

NECK PAIN

.

104

Any neck pain?
A)Acute onset of neck stiffness with headache and fever occurs with meningeal inflammation
B)false,

A

105

Associated symptoms. Any limitations to range of motion (ROM), numbness or tingling in shoulders, arms, or hands?
A)true
B)false

A

106

Pain creates a VICIOUS circle. Tension increases pain and disability, which produces more anxiety.
A)true
B)false

True

107

LUMPS OR SWELLING

.

108

? Any recent infection? Any tenderness?
A)Tenderness suggests acute infection
B)check hands

A

109

For a lump that persists, how long have you had it? Has it changed in size?
A)A persistent lump arouses suspicion of malignancy. For people older than 40 years, suspect malignancy until proven otherwise.
B)Any history of prior irradiation of head, neck, upper chest?

A

110

Any history of prior irradiation of head, neck, upper chest?
A)Increased risk for salivary and thyroid tumors.
B)decrease risk of salivary tumors

A

111

Any difficulty swallowing?
A)Dysphagia.
B)mouthphagis

A

112

Do you smoke? For how long? How many packs a day? Do you chew tobacco?
A)Smoking and chewing tobacco increase risk for oral and respiratory cancer.
B)false

A

113

When was your last alcohol drink? How much alcohol do you drink a day?
A)Smoking and large alcohol consumption together increase the risk for cancer.
B)Smoking and large alcohol consumption together increase of no cancer.

A

114

HISTORY OF HEAD OR NECK SURGERY

.

115

had surgery of the head or neck? For what condition? When did the surgery occur? How do you feel about results?
A)Surgery for head and neck cancer often is disfiguring and increases risk for body image disturbance.
B)no, fase question

A

116

Additional History for Infants and Children

.

117

Did the mother use alcohol or street drugs during pregnancy? How often? How much was used per episode?
A)Alcohol increases the risk for fetal alcohol syndrome, with distinctive facial features (see Table 13-4, Pediatric Facial Abnormalities, p. 274). Cocaine use causes neurologic, developmental, and emotional problems
B)none

A

118

Was delivery vaginal or by cesarean section? Any difficulty? Use of forceps?
A)Forceps may increase the risk for caput succedaneum, cephalhematoma, and Bell's palsy.
B)Additional History for the Aging Adult

A

119

Additional History for the Aging Adult

.

120

If dizziness is a problem, how does this affect your daily activities? Are you able to drive safely, maneuver about the house safely?
A)Assess self-care. Assess potential for injury
B)false

A

121

OBJECTIVE DATA

.

122

Inspect and Palpate the Skull

.

123

Normocephalic is the term that denotes a round symmetric skull that is appropriately related to body size. Be aware that "normal" includes a wide range of sizes.
A)true
B)false

A

124

Deformities: microcephaly, abnormally small head; macrocephaly, abnormally large head (hydrocephaly, acromegaly, Paget's disease)
A)TURE for skull
B)false for skull

A

125

microcephaly,
A)abnormally small head
B)abnormally large head

A

126

macrocephaly,
A)abnormally small head;
B)abnormally large head

B

127

macrocephaly, abnormally large head are associated with which of the following diseases
A)hydrocephaly
B) acromegaly
C)Paget's disease
D)all the above

D

128

The skull normally feels symmetric and smooth. Cranial bones that have normal protrusions are the forehead, the side of each parietal bone, the occipital bone, and the mastoid process behind each ear. There is no tenderness to palpation
A)true
B)false

True

129

Note lumps, depressions, or abnormal protrusions
A)abnormal finding of the skull
B)abnormal finding of the hand

A

130

Palpate the temporal artery above the zygomatic (cheek) bone between the eye and top of the ear.
A)true
B)false

A

131

The artery looks tortuous, feels hardened and tender with temporal arteritis.
A)abnormal finding of temporal artery
B)normal finding

A

132

The temporomandibular joint is just below the temporal artery and anterior to the tragus. Palpate the joint as the person opens the mouth, and note normally smooth movement with no limitation or tenderness
A)true
B)false

A

133

Crepitation, limited ROM, or tenderness.
A)normal finding
B)abnormal finding of the TMJ

B

134

Inspect the Face

.

135

Anxiety is common in the hospitalized or ill person.
A)true
B)fase

A

136

Hostility or aggression. Tense, rigid muscles may indicate anxiety or pain; a flat affect may indicate depression.
A)abnormal finding in the face
B)normal finding

A

137

Note symmetry of eyebrows, palpebral fissures, nasolabial folds, and sides of the mouth.
A)true
B)false

A

138

Marked asymmetry with central brain lesion (e.g., stroke) or with peripheral cranial nerve Vll damage (Bell's palsy).
A)abnormal vision the face
B)normal vision

A

139

Note any abnormal facial structures (coarse facial features, exophthalmos, changes in skin color or pigmentation) or any abnormal swelling. Also note any involuntary movements (tics) in the facial muscles. Normally none occur.
A)true,normal for face
B)false

A

140

Edema in the face occurs first around the eyes (periorbital) and the cheeks where the subcutaneous tissue is relatively loose. Note grinding of jaws, tics, fasciculations, or excessive blinking.
A)abnormal finding of the face
B)normal finding

A

141

A habitual spasmodic contraction of the muscles in the face
A)tics
B)nicks

A

142

Inspect and Palpate the Neck

.

143

The head should be held erect and still.
A)normal finding
B)abnormal finding

A

144

Head tilt occurs with muscle spasm. Rigid head and neck occur with arthritis.
A)abnormal finding of the neck
B)normal finding of the neck

A

145

Note any limitation of movement during active motion. Ask the person to touch the chin to the chest, to turn the head to the right and left, to try to touch each ear to the shoulder (without elevating shoulders), and to extend the head backward. When the neck is supple, motion is smooth and controlled
A)normal finding
B)abnormal finding

A

146

Note pain at any particular movement. Note ratchety or limited movement from cervical arthritis or inflammation of neck muscles. The arthritic neck is rigid; the person turns at the shoulders rather than at the neck.
A)normal findings in ROM in the neck
B)abnormal findings in ROM in the neck

B

147

Test muscle strength and the status of cranial nerve Xl by trying to resist the person's movements with your hands as the person shrugs the shoulders and turns the head to each side
A)true, neck strength
B) false.shoulder workout

A

148

As the person moves the head, note enlargement of the salivary glands and lymph glands. Normally no enlargement is present. Note a swollen parotid gland when the head is extended; look for swelling below the angle of the jaw. Also, note thyroid gland enlargement. Normally none is present
A)true, normal finding
B)false, abnormal finding

A

149

Thyroid enlargement may be a unilateral lump, or it may be diffuse and look like a doughnut lying across the lower neck
A)abnormal finding of the eek
B) normal finding of the ECM

A

150

Also note any obvious pulsations. The carotid artery runs medial to the sternomastoid muscle, and it creates a brisk localized pulsation just below the angle of the jaw. Normally, there are no other pulsations while the person is in the sitting position
A)true, normal finding of the neck
B)false abnormal finding of the neck

A

151

INSPECT and PALPATE THE NECK
Lymph Nodes

.

152

Using a gentle circular motion of your fingerpads, palpate the lymph nodes
A)true
B)false

A

153

(Normally the salivary glands are not palpable. When symptoms warrant, check for parotid tenderness by palpating in a line from the outer corner of the eye to the lobule of the ear.)
A)true
B)false

A

154

check for parotid tenderness by palpating in a line from the outer corner of the eye to the lobule of the ear.
A)true
B)false

A

155

Beginning with the preauricular lymph nodes in front of the ear, palpate the 10 groups of lymph nodes in a routine order. Many nodes are closely packed, so you must be systematic and thorough in your examination. Once you establish your sequence, do not vary or you may miss some small nodes
A)true
B)false

A

156

The parotid is swollen with
A)mumps
B)herpes

A

157

Parotid enlargement has been found with what disease
A)herpes
B) AIDS

B

158

-Use gentle pressure because strong pressure could push the nodes into the neck muscles.
-It is usually most efficient to palpate with both hands, comparing the two sides symmetrically. However, the submental gland under the tip of the chin is easier to explore with one hand. -When you palpate with one hand, use your other hand to position the person's head.
-For the deep cervical chain, tip the person's head toward the side being examined to relax the ipsilateral muscle (Fig. 13-10). Then you can press your fingers under the muscle. -Search for the supraclavicular node by having the person hunch the shoulders and elbows forward (Fig. 13-ll ); this relaxes the skin.
-The inferior belly of the omohyoid muscle crosses the posterior triangle here; do not mistake it for a lymph node.
A)true
B)false

A

159

Use gentle pressure because strong pressure could push the nodes into the neck muscles. It is usually most efficient to palpate with both hands, comparing the two sides symmetrically.
A)true
B)fase

A

160

the submental gland under the tip of the chin is easier to explore with one hand. When you palpate with one hand, use your other hand to position the person's head.
A)true
B)false

A

161

For the deep cervical chain, tip the person's head toward the side being examined to relax the ipsilateral muscle. Then you can press your fingers under the muscle.
A)true
B)false

A

162

Search for the supraclavicular node by having the person hunch the shoulders and elbows forward; this relaxes the skin. The inferior belly of the omohyoid muscle crosses the posterior triangle here; do not mistake it for a lymph node.
A)true
B) fase

True

163

If any nodes are palpable, note their location, size, shape, delimitation (discrete or matted together), mobility, consistency, and tenderness. Cervical nodes often are palpable in healthy persons, although this palpability decreases with age (Fig. 13-12). Normal nodes feel movable, discrete, soft, and nontender.
A)true
B)false

A

164

. Cervical nodes often are palpable in healthy persons, although this palpability decreases with age (Fig. 13-12).
A)true
B)false

True

165

Normal nodes feel movable, discrete, soft, and nontender.
A)true
B)false

A

166

_________is enlargement of the lymph nodes (> 1 em) from infection, allergy, or neoplasm.
A)Lymphadenopathy
B)edema

A

167

If nodes are enlarged or tender, check the area they drain for the source of the problem. For example, those in the upper cervical or submandibular area often relate to inflammation or a neoplasm in the head and neck. Follow up on or refer your findings.
A)true
B)false

A

168

An enlarged lymph node, particularly when you cannot find the source of the problem, deserves prompt attention.
A)true
B)false

A

169

Acute infection-acute onset, s lymphoma
A)true
B)false

True

170

____________-acute onset, duration, nodes are bilateral, enlarged, warm, tender, and firm but freely movable.
A)acute infection lymph nodes
B) chronic infection lymph nodes

A

171

______________ (e.g., in tuberculosis the nodes are clumped).
A)chronic inflammation
B)cancerous

A

172

_________nodes are hard, >3 em, unilateral, nontender, matted, and fixed.
A)Cancerous
B)noncancerous

A

173

• Nodes with HIV infection are enlarged, firm, nontender, and mobile. Occipital node enlargement is common with HIV infection.
A)true
B)false

A

174

Occipital node enlargement is common with
A)HIV
B)herpes

A

175

• A single enlarged, nontender, hard, left supraclavicular node (Virchow's node) may indicate
A)neoplasm in thorax or abdomen.
B) Hodgkin's lymphoma

A

176

• Painless, rubbery, discrete nodes that gradually appear occur with
A)Hodgkin's lymphoma
B)herpes

A

177

INSPECT AND PALPATE THE NECK
TRACHEA

.

178

Normally, the trachea is midline; palpate for any tracheal shift. Place your index finger on the trachea in the sternal notch, and slip it off to each side (Fig. 13-13). The space should be symmetric on both sides. Note any deviation from the midline.
A)true
B)false

A

179

Conditions of tracheal shift:

.

180

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

A

181

• The trachea is pushed to the unaffected (or healthy) side with an aortic aneurysm, a tumor, unilateral thyroid lobe enlargement, and pneumothorax.
A)abnormal finding of the trachea
B)normal finding of the trachea

A

182

• The trachea is pulled toward the affected (diseased) side with large atelectasis, pleural adhesions, or fibrosis.
A)normal finding of the trachea
B)abnormal finding of the trachea

B

183

• Tracheal tug is a rhythmic downward pull that is synchronous with systole and that occurs with aortic arch aneurysm
A)abnormal finding of the trachea
B)normal finding of the trachea

A

184

INSPECT AND PALPATE THE NECK
Thyroid Gland

.

185

The thyroid gland is difficult to palpate; arrange your setting to maximize your likelihood of success. Position a standing lamp to shine tangentially across the neck to highlight any possible swelling. Supply the person with a glass of water, and first inspect the neck as the person takes a sip and swallows. Thyroid tissue moves up with a swallow
A)true
B)false

A

186

Look for diffuse enlargement or a nodular Jump
A)abnormal finding of the thyroid gland
B) normal finding of the thyroid gland

A

187

Posterior Approach. To thyroid is?

- To palpate, move behind the person. Ask the person to sit up very straight and then to bend the head slightly forward and to the right. This will relax the neck muscles on the right side. Use the fingers of your left hand to push the trachea slightly to the right.
- Then curve your right fingers between the trachea and the sternomastoid muscle, retracting it slightly, and ask the person to take a sip of water. The thyroid moves up under your fingers with the trachea and larynx as the person swallows. Reverse the procedure for the left side.
-Usually you cannot palpate the normal adult thyroid. If the person has a long, thin neck, you sometimes will feel the isthmus over the tracheal rings. The lateral lobes usually are not palpable; check them for enlargement, consistency, symmetry, and the presence of nodules.

Read again true

188

Abnormalities: enlarged Lobes that are easily palpated before swallowing or are tender to palpation (see large goiter ) found in
A)thyroid
B)submandibular

A

189

Anterior Approach. To the thyroid is?

-This is an alternate method of palpating the thyroid, but it is more awkward to perform, especially for a beginning examiner. Stand facing the person. Ask him or her to tip the head forward and to the right. Use your right thumb to displace the trachea slightly to the person's right. Hook your left thumb and fingers around the sternomastoid muscle. Feel for lobe enlargement as the person swallows

Read again true

190

Auscultate the Thyroid

.

191

If the thyroid gland is enlarged, auscultate it for the presence of a bruit. This is a soft, pulsatile, whooshing, blowing sound heard best with the bell of the stethoscope. The bruit is not present normally.
A)true
B)fase

A

192

A_______ occurs with accelerated or turbulent blood flow, indicating hyperplasia of the thyroid (e.g., hyperthyroidism).
A)bruit
B)crack

A

193

. This is a soft, pulsatile, whooshing, blowing sound heard best with the bell of the stethoscope.
A)bruit
B)crack

A

194

DEVELOPMENTAL COMPETENCE
Infants and Children

.

195

Measure an infant's head size with measuring tape at each visit up to age 2 years, then yearly up to age 6 years.
A)true
B)false

A

196

Note an abnormal increase in head size or failure to grow.
A)true
B)false

A

197

The newborn's head measures about 32 to 38 em (average around 34 cm) and is 2 cm larger than chest circumference. At age 2 years, both measurements are the same.
A)true
B)false

A

198

During childhood, the chest circumference grows to exceed head circumference by 5 to 7 cm
A)true
B)flase

True

199

Microcephalic-
A)head size below norms for age
B)head size above norms for age

A

200

Macrocephalic-
A)an enlarged head or rapidly increasing in size (e.g., hydrocephalus [increase cerebrospinal fluid])
B)big legs

A

201

Frontal bulges, or "bossing," occur with A)prematurity
B)rickets
C)both a and b

C

202

Nordic children tend to have
A)long heads
B)have broad heads

A

203

Asian children have
A)broad heads
B) have long heads

A

204

A __________ is edematous swelling and ecchymosis of the presenting part of the head caused by birth trauma. It feels soft, and it may extend across suture lines. It gradually resolves during the first few days of life and needs no treatment.
A)caput succedanewn
B)cephalhematoma

A

205

A_____________ is a subperiosteal hemorrhage, which is also a result of birth trauma. It is soft, fluctuant, and well defined over one cranial bone because the periosteum (i.e., the covering over each bone) holds the bleeding in place. It appears several hours after birth and gradually increases in size. No discoloration is present, but it looks bizarre, so parents need reassurance that it will be reabsorbed during the first few weeks of life without treatment. Rarely, a large hematoma may persist to 3 months.
A)cephalhematoma
B)macromicro

A

206

An infant with cephalhematoma is at greater risk for
A)jaundice as the red blood cells within the hematoma are broken down and reabsorbed
B)no greater risk.

A

207

As you palpate the newborn's head, the suture lines feel like ridges. By 5 to 6 months, they are smooth and not palpable.
A)true
B)false

A

208

As you palpate the newborn's head, the suture lines feel like ridges. By ____ to ____ months, they are smooth and not palpable.
A)2,4
B)5,6
C)7,9

B

209

Sutures palpable when the child is older than 6 months.
A)normal finding
B)abnormal finding

B

210

A newborn's head may feel asymmetric and the involved ridges more prominent due to molding of the cranial bones during engagement and passage through the birth canal.
A)true
B)false

A

211

Marked asymmetry, as in__________, a severe deformity caused by premature closure of the sutures. Premature closing of the suture results in a long, narrow head.
A)craniosynostosis
B)closetosis

A

212

Marked asymmetry, as in craniosynostosis, a severe deformity caused by premature closure of the sutures. Premature closing of the suture results
A)in a long, narrow head.
B)board flat head

A

213

________is overriding of the cranial bones; usually, the parietal bone overrides the frontal or occipital bone. Reassure parents that this lasts only a few days or a week.
A)Molding
B)jaundice

A

214

Babies delivered by ___________ are noted for their evenly round heads.
A)cesarean section
B)flat section

A

215

Also, some asymmetry may occur if an infant continually sleeps in one position; which the nurse knows that
A)this is a flattening of the dependent cranial bone, usually the occiput
B)false, stronger suture building

A

216

Flattening of the skull also occurs with
A)rickets
B)mental retardation.
C)both a and b

C

217

Gently palpate the skull and fontanels while the infant is calm and somewhat in a sitting position (crying, lying down, or vomiting may cause the anterior fontanel to look full and bulging). The skull should feel smooth and fused except at the fontanels.
A)true
B)false

A

218

The fontanels feel firm, slightly concave, and well defined against the edges of the cranial bones. You may see slight arterial pulsations in the anterior fontanels.
A)true
B)false

A

219

A true tense or bulging fontanel occurs with A)acute increased intracranial pressure. B)dehydration or malnutrition.

A

220

Depressed and sunken fontanels occur with A)dehydration or malnutrition.
B)Marked pulsations occur with increased intracranial pressure.

A

221

. Marked pulsations occur with increased intracranial pressure.
A)true
B)fase

A

222

The posterior fontanel may not be palpable at birth. If it is, it measures 1 cm and closes by I to 2 months. The anterior fontanel may be small at birth and enlarge to 2.5 cm x 2.5 cm. A large diameter of 4 to 5 cm occasionally may be normal under 6 months. A small fontanel usually is normal. The anterior fontanel closes between 9 months and 2 years. Early closure may be insignificant if head growth proceeds normally.
A)true
B)fase

A

223

The______ fontanel may not be palpable at birth. If it is, it measures 1 cm and closes by I to 2 months.
A)posterior
B)anterior

A

224

The _________ fontanel may be small at birth and enlarge to 2.5 cm x 2.5 cm. A large diameter of 4 to 5 cm occasionally may be normal under 6 months.
A)posterior
B)anterior

B

225

A small fontanel usually is normal. The _______ fontanel closes between 9 months and 2 years. Early closure may be insignificant if head growth proceeds normally.
A)anterior
B)posterior

A

226

Posterior fontanels close first
A)true
B)false

A

227

Delayed closure or larger-than-normal fontanel size occurs with?select all that apply
A)hydrocephalus
B)Down syndrome
C)hypothyroidism
D)rickets.

A B C D

228

A small fontanel is a sign of microcephaly, as is early closure.
A)true
B)false

A

229

A small fontanel is a sign of________, as is early closure.
A)microcephaly
B)macrocephaly

A

230

The infant can turn the head side to side by 2 weeks and shows the tonic neck reflex when supine and the head is turned to one side (extension of same arm and leg, flexion of opposite arm and leg).
A)true
B)flase

A

231

The tonic neck reflex disappears between 3 and 4 months, and then the head is maintained in the midline.
A)true
B)false

A

232

Head control is achieved by 4 months, when the baby can hold the head erect and steady when pulled to a vertical position.
A)true
B)false

A

233

Head control is achieved by____ months, when the baby can hold the head erect and steady when pulled to a vertical position.
A)4
B)7

A

234

The tonic neck reflex disappears between ___ and ___ months, and then the head is maintained in the midline.
A)2,7
B)3,4
C)3,9

B

235

Tonic neck reflex beyond 5 months may indicate brain damage. In children, head tilt occurs with habit spasm, poor vision, and brain tumor. Head lag after 4 months may indicate mental or motor retardation.
A)true
B) fase

A

236

Tonic neck reflex beyond____ months may indicate brain damage.
A)5
B)2
C)3

A

237

In children, head tilt occurs with
A)habit spasm
B)poor vision
C)brain tumor
D)all the above

D

238

Head lag after 4 months may indicate
A)mental
B)motor retardation
C)both a and b

C

239

Check facial features for symmetry, appearance, and presence of swelling. Note symmetry of wrinkling when the infant cries or smiles (e.g., both sides of the lips rise and both sides of forehead wrinkle). Children love to comply when you ask them to "make a face." Normally, no swelling is evident. Parotid gland enlargement is seen best when the child sits and looks up at the ceiling; the swelling appears below the angle of the jaw.
A)true
B)false

A

240

Children love to comply when you ask them to "make a face." Normally, no swelling is evident.
A)true
B)false

A

241

Parotid gland enlargement is seen best when the child
A)sits and looks up at the ceiling; the swelling appears below the angle of the jaw.
B)is prone with chin up ad straight

A

242

Unilateral immobility indicates nerve damage (central or peripheral) (e.g., note angle of mouth droop on paralyzed side). Some facies are characteristic of congenital abnormalities or chronic allergy.
A)abnormal finding of the face
B)normal finding of the face

A

243

An infant's neck looks short; it lengthens during the first 3 to 4 years. You can see the neck better by supporting the infant's shoulders and tilting the head back a little. This positioning also enhances palpation of the trachea, which is buried deep in the neck. Feel for the row of cartilaginous rings in the midline or just slightly to the right of midline.
A)true
B)false

A

244

An infant's neck looks short; it lengthens during the first ___ to ___ years.
A)3,4
B)6,7

A

245

You can see the neck better by
A)supporting the infant's shoulders and tilting the head back a little. This positioning also enhances palpation of the trachea, which is buried deep in the neck. Feel for the row of cartilaginous rings in the midline or just slightly to the right of midline.
B)false put infant in prone

A

246

A short neck or webbing (loose fanlike folds) may indicate
A)congenital abnormality (e.g., Down or Turner syndrome)
B)it may occur alone
C) both a and b

C

247

Assess muscle development with gentle passive ROM. The nurse thens
A)Cradle the infant's head with your hands and turn it side to side and test forward flexion, extension, and rotation.
B)Note any resistance to movement, especially flexion.
C)Ask a child to actively move through the ROM, as you would an adult.
D)all the above

D

248

Head tilt and limited ROM occur with which of the following?
A)torticollis (wryneck)
B)sternomastoid muscle injury during birth or a congenital defect.
C)both a and b

C

249

Resistance to flexion (nuchal rigidity) and pain on flexion indicate
A)meningeal irritation
B)meningitis
C)both a and b

C

250

During infancy, cervical lymph nodes are not palpable normally.
A)true
B)false

A

251

a child's lymph nodes are-they feel more prominent than an adult's until after puberty, when lymphoid tissue begins to atrophy.
A)true
B)false

A

252

At what age do lymph nodes begin to atrophy.
A)puberty
B)young adult
C)older adult

A

253

Palpable nodes less than 3 mm are normal. They may be up to 1 cm in size in the cervical and inguinal areas but are discrete, move easily, and are nontender.
A)true
B)false

A

254

Children have a higher incidence of infection, so you will expect a greater incidence of inflammatory adenopathy. No other mass should occur in the neck.
A)true
B)false

A

255

Cervical nodes > 1 cm are considered enlarged.
A)true
B) false

A

256

Thyroglossal duct cyst-cystic lump high up in midline, freely movable, and rises up when swallowing.
A)abnormal finding in the infant
B)normal finding

A

257

Supraclavicular nodes enlarge with
A)Hodgkin's disease
B)HIV
C) AIDS
D)both b and c

A

258

The thyroid gland is difficult to palpate in an infant because of the short, thick neck.
A)true
B)false

A

259

The child's thyroid may be palpable normally.
A)true
B)false

A

260

The nurse would have a hard time palpating which of the following lymph nodes on a patient.
A)adult
B)infant
C)child
D)aging adult

B

261

Special Procedures
INFANTS AND CHILDREN

.

262

_________. With an infant, you may directly percuss with your plexor finger against the head surface. This yields a resonant or "cracked pot" sound, which is normal before closure of the fontanels?
A)percussion
B)auscultation

A

263

The sound occurs with hydrocephalus from separation of cranial sutures (Macewen's sign)
A)abnormal finding in percussion
B)abnormal finding in auscultation

A

264

The sound occurs with hydrocephalus from separation of cranial sutures, and when the nurse checks the percussion it is called what sign
A) (Macewen's sign)
B) fontanels sign

A

265

__________. Bruits are common in the skull in children younger than 4 or 5 years or in children with anemia. They are systolic or continuous and are heard over the temporal area
A)percussion
B)auscultation

B

266

After 5 years of age, bruits indicate
A)increased intracranial pressure
B)aneurysm
C)arteriovenous shunt
D)all the above

D

267

DEVELOPMENTAL COMPETENCE
THE PREGNANT WOMAN

.

268

During the second trimester, chloasma may show on the face. This is a blotchy, hyperpigmented area over the cheeks and forehead that fades after delivery. The thyroid gland may be palpable normally during pregnancy.
A)true
B)false

A

269

During the second trimester,________ may show on the face. This is a blotchy, hyperpigmented area over the cheeks and forehead that fades after delivery. The thyroid gland may be palpable normally during pregnancy.
A)chloasma
B)hyperpigmental

A

270

DEVELOPMENTAL COMPETENCE
The Aging Adult

.

271

The temporal arteries may look twisted and prominent. In some aging adults, a mild rhythmic tremor of the head may be normal.
A)aging adult
B)young adult

A

272

_________ are benign and include head nodding (as if saying yes or no) and tongue protrusion.
A)Senile tremors
B)chloasma

A

273

If some teeth have been lost, the lower face looks unusually small, with the mouth sunken in.
A)aging adult
B)younger adult

A

274

The neck may show an increased anterior cervical (concave or inward) curve when the head and jaw are extended forward to compensate for kyphosis of the spine.
A)aging adult
B)infant

A

275

During the examination, direct the __________ to perform ROM slowly; he or she may experience dizziness with side movements.
A)aging adult
B)infant

A

276

An ______ may have prolapse of the submandibular glands, which could be mistaken for a tumor. But drooping submandibular glands will feel soft and be present bilaterally.
A)aging adult
B)younger adult

A

277

PROMOTING A HEAL THY LIFESTYLE:
BRAIN INJURY PREVENTION
Use Your Head. Wear a Helmet.

.

278

Helmets are designed to protect the brain from injury and trauma by absorbing the impact energy in a collision or fall.
A)true
B)false

A

279

Children and adults should wear a sport- or activity-specific helmet when participating in the following sports or recreational activities:
• Alpine sports, including skiing, snowboarding, and
snowmobiling
• ATV riding and Go-karting
• Baseball and softball
• Bicycling
• Football
• Horseback riding
• Ice hockey
• Lacrosse
• Roller and in-line skating
• Rock climbing
• Scooter riding and segways
• Skateboarding

True

280

ABNORMAL FINDINGS

.

281

Primary Headaches-Compare and Contrast

.

282

Tension headaches

.

283

-Usually both sides, across the frontal, temporal, and/or occipital region of head: forehead, sides and back of head
-Bandlike tightness, viselike Non-throbbing
-Gradual onset, lasts 30 minutes to days -Diffuse, dull, aching pain Mild to moderate pain
-Situational, in response to overwork, posture
-Stress, anxiety, depression, poor posture
-Fatigue, anxiety, stress ,Sensation of a band tightening around head, of being gripped like a VICe
-Sometimes photophobia or phonophobia
-Rest, massaging muscles in area, NSAlD
A)tension headaches
B)migraine headaches

A

284

Migraine headaches

.

285

-Commonly one-sided but may occur on both sides
-Pain is often behind the eyes, the temples, or forehead
-Throbbing, pulsating
-Rapid onset, peaks 1-2 hr, lasts 4 hr to 72 hr, sometimes longer
-Moderate to severe pain
-About 2/month, lasts 1-3 days
-Hormonal fluctuations (premenstrual)
-Foods (e.g., alcohol, caffeine, MSG, nitrates, chocolate, cheese)
-Letdown after stress Changes in sleep pattern -Sensory stimuli (e.g., flashing lights or perfumes)
-Changes in weather
-Physical activity
-Often preceded by an aura (visual changes such as blind spots or flashes of light, tingling in an arm or leg, vertigo)
-Nausea, vomiting, photophobia, abdominal pain
-Family history of migraine
-Lie down, darken room, use eyeshade, sleep, take NSAID or narcotic when severe
A)migraines headaches
B)cluster headaches

A

286

Cluster headaches

.

287

-Always one-sided
-Often behind or around the eye, temple forehead, cheek
-Continuous, burning,piercing, excruciating
-Abrupt onset, peaks in minutes, lasts 45-90 min
-Can occur multiple times a day, in "clusters" -Severe stabbing pain
-1-2/day, each lasting to 2 hr, for 1 to 2 months; then remission for months or years
-Exacerbated by alcohol, stress, wind or heat exposure
-Nasal congestion or runny nose, watery or reddened eye, eyelid drooping, miosis, feelings of agitation
-Need to move, pace the floor
A)cluster headaches
B) tension headaches

A

288

Abnormalities in Head Size and Contour

.

289

Obstruction of drainage of cerebrospinal fluid results in excessive accumulation, increasing intracranial pressure, and enlargement of the head. The face looks small compared with the enlarged cranium. The increasing pressure also produces dilated scalp veins, frontal bossing, and downcast or "setting sun" eyes (sclera visible above iris). The cranial bones thin, sutures separate, and percussion yields a "cracked pot" sound (Macewen's sign).
A)Hydrocephalus
B)Paget's Disease of Bone (Osteitis Deformans)

A

290

A skeletal disease of increased bone resorption and formation, which softens, thickens, and deforms bone. It affects 1Oo/o of those older than 80 years and occurs more often in males. The disease is characterized by bowed long bones, sudden fractures, frontal bossing, and enlarging skull bones that form an acorn-shaped cranium. Enlarging skull bones press on cranial nerves, causing symptoms of headache, vertigo, tinnitus, progressive deafness, and optic atrophy and compression of the spinal cord.
A)Acromegaly
B)Paget's Disease of Bone (Osteitis Deformans)

B

291

Excessive secretion of growth hormone from the pituitary gland after puberty creates an enlarged skull and thickened cranial bones. Note the elongated head, massive face, prominent nose and lower jaw, heavy eyebrow ridge, and coarse facial features, especially when compared with the same woman's face on the left pictured several years before she had a pituitary tumor.
A)Acromegaly
B)wry neck

A

292

Swellings on the Head or Neck

.

293

A hematoma in one sternomastoid muscle, probably injured by intrauterine malposition, results in head tilt to one side and limited neck ROM to the opposite side. You will feel a firm, cliscrete, nontender mass in mid-muscle on the involved side. This requires treatment, or the muscle becomes fibrotic and permanently shortened with permanent limitation of ROM, asymmetry of head and face, and visual problems from a non-horizontal position of the eyes.
A)goiter
B)Torticollis (Wryneck)

B

294

A chronic enlargement of the thyroid gland that occurs in some regions of the world where the soil is low in iodine. Not due to a neoplasm.
A)Goiter
B)thyroidpathogy

A

295

Multiple nodules usually indicate inflammation or a multinodular goiter rather than a neoplasm. However, suspect any rapidly enlarging or firm nodule.
A)Thyroid-Multiple Nodules
B)single nodules

A

296

Most solitary nodules are benign, although a solitary nodule poses a greater risk for malignancy than do multiple nodules and poses a greater risk in a young person. Suspect any painless, rapidly growing nodule, especially the appearance of a single nodule in a young person. Cancerous nodules tend to be hard and are fixed to surrounding structures.
A)Single Nodule
B)multiple nodule

A

297

Smooth, firm, fluctuant swelling on the scalp that contains sebum and keratin. Tense pressure of the contents causes overlying skin to be shiny and taut. It is a benign growth
A)Pilar Cyst (Wen)
B). Parotid Gland Enlargement .

A

298

Rapid painful inflammation of the parotid occurs with mumps. Parotid swelling also occurs with blockage of a duct, abscess, or tumor. Note swelling anterior to lower ear lobe. Stensen duct obstruction can occur in aging adults dehydrated from diuretics or anticholinergics.
A)Parotid Gland Enlargement
B)fetal alcohol syndrome

A

299

Pediatric Facial Abnormalities

.

300

A pregnant woman who abuses alcohol is at great risk for producing a baby with a wide range of growth and developmental abnormalities. Facial malformations may be recognizable at birth. Characteristic facies include narrow palpebral fissures, epicanthal folds, and midfacial hypoplasia
A)Fetal Alcohol Syndrome
B)Congenital Hypothyroidism

A

301

Thyroid deficiency at an early age produces impaired growth and neurologic deficit. Without neonatal screening, characteristic facies develop by 3 to 6 months of age: low hairline, hirsute forehead, swollen eyelids, narrow palpebral fissures, widely spaced eyes, depressed nasal bridge, puffy face, thick tongue protruding through an open mouth, and a dull expression. Head size is normal, but the anterior and posterior fontanels are wide open.
A)fetal alcohol syndrome
B)Congenital Hypothyroidism

B

302

Chromosomal aberration (trisomy 21). Head and face characteristics may include upslanting eyes with inner epicanthal folds; flat nasal bridge; small, broad, flat nose; protruding, thick tongue; ear dysplasia; short, broad neck with webbing; and small hands with single palmar crease
A)Down Syndrome
B)Atopic (Allergic) Facies

A

303

Children with chronic allergies such as atopic dermatitis often develop characteristic facial features. These include exhausted face, blue shadows below the eyes ("allergic shiners") from sluggish venous return, a double or single crease on the lower eyelids (Morgan's lines), central facial pallor, and open-mouth breathing (allergic gaping). The open-mouth breathing can lead to malocclusion of the teeth and malformed jaw because the child's bones are still forming
A)Atopic (Allergic) Facies
B)Allergic Salute and Crease

A

304

The transverse line on the nose is also a feature of chronic allergies. It is formed when the child chronically uses the hand to push the nose up and back (the "allergic salute") to relieve itching and to free swollen turbinates, which allows air passage.
A)down syndrome
B)Allergic Salute and Crease

B

305

Abnormal Facies with Chronic Illnesses

,

306

A deficiency of the neurotransmitter dopamine and degeneration of the basal gan glia in the brain. The immobility of features produces a face that is flat and expressionless, "masklike," with elevated eyebrows, staring gaze, oily skin, and drooling.
A)Parkinson Syndrome
B)Cushing Syndrome p

A

307

With excessive secretion of corticotropin hormone (ACTH) and chronic steroid use, the person develops a plethoric, rounded, "moonlike" face; prominent jowls; red cheeks; hirsutism on the upper lip, lower cheeks, and chin; and acneiform rash on the chest.
A)down syndrome
B)fetal alcohol syndrome
C)Cushing Syndrome

C

308

Goiter is an increase in the size of the thyroid gland and occurs with hyperthyroidism, Hashimoto's thyroiditis, and hypothyroidism. Graves' disease (shown here) is the most common cause of hyperthyroidism, manifested by goiter and exophthalmos (bulging eyeballs). Symptoms include nervousness, fatigue, weight loss, muscle cramps, and heat intolerance; signs include tachycardia, shortness of breath, excessive sweating, fine muscle tremor, thin silky hair and skin, infrequent blinking, and a staring appearance.
A)Hyperthyroidism
B)Myxedema (Hypothyroidism) .

A

309

A deficiency of thyroid hormone, when severe, causes a nonpitting edema or myxedema. Note puffy, edematous face, especially around eyes (periorbital edema), coarse facial features, dry skin, and dry, coarse hair and eyebrows.
A)Myxedema (Hypothyroidism)
B)Bell's Palsy (Right Side)

A

310

A lower motor neuron lesion (peripheral), producing cranial nerve VII paralysis, which is almost always unilateral. It has a rapid onset, and its cause is currently thought to be herpes simplex virus (HSV). Note complete paralysis of one half of the face; the person cannot wrinkle forehead, raise eyebrow, close eye, whistle, or show teeth on the right side. Usually presents with smooth forehead, wide palpebral fissure, flat nasolabial fold, drooling, and pain behind the ear.
A)Stroke or Cerebrovascular Accident
B)Bell's Palsy (Right Side)

B

311

An upper motor neuron lesion (central). A stroke (or brain attack) is an acute neurologic deficit caused by an obstruction of a cerebral vessel, as in atherosclerosis, or a rupture in a cerebral vessel. If you suspect a stroke, ask if the person can smile. Note paralysis of the lower facial muscles, but also note that the upper half of face is not affected because of the intact nerve from the unaffected hemisphere. The person is still able to wrinkle the forehead and close the eyes.
A)Stroke or Cerebrovascular Accident
B)Cachectic Appearance

A

312

Accompanies chronic wasting diseases such as cancer, dehydration, and starvation. Features include sunken eyes; hollow cheeks; and exhausted, defeated expression.
A)Cachectic Appearance
B)Scleroderma

A

313

Literally, "hard skin," this rare connective tissue disease is characterized by chronic hardening and shrinking degenerative changes in the skin, blood vessels, synovium, and skeletal muscles. Changes can occur in the skin, heart, esophagus, kidney, lung. Characteristic facies: hard, shiny skin on forehead and cheeks; thin, pursed lips with radial furrowing; absent skinfolds; muscle atrophy on face and neck; absence of expression.
A)Scleroderma
B)fetal alcohol syndrome

A

314

Summary Checklist: Head, Face, and Neck, Including Regional Lymphatics Examination

.

315

1. Inspect and palpate the skull
General size and contour
Note any deformities, lumps, tenderness
Palpate temporal artery, TMJ

2. Inspect the face
Facial expression
Symmetry of movement (cranial nerve VII)
Any involuntary movements, edema, lesions

3. Inspect and palpate the neck Active ROM Enlargement of salivary glands, lymph nodes, thyroid gland Position of the trachea

4. Auscultate the thyroid (if enlarged) for bruit

True

316

EXTRA INFORMATION

,

317

Nausea, vomiting, and visual disturbances are associated with
A)migraines;
B)tension headaches

A

318

eye reddening and tearing, eyelid drooping, rhinorrhea, and nasal congestion are associated with
A)cluster headaches;
B)migraines

A

319

anxiety and stress are associated with
A)tension headaches;
B)cluster headaches

A

320

nuchal rigidity and fever are associated with A)meningitis
B)encephalitis
C)both a and b

C

321

________— a complete or partial collapse of a lung or lobe of a lung — develops when the tiny air sacs (alveoli) within the lung become deflated.
A)lungsio
B)Atelectasis

B

322

_________: A sign to detect hydrocephalus and brain abscess. Percussion (tapping) on the skull at a particular spot (near the junction of the frontal, temporal and parietal bones) yields an unusually resonant sound in the presence of hydrocephalus or a brain abscess.
A)Macewen sign
B)hydropervuse sign

A

323

A patient comes to the trauma unit in respiratory distress following a motor vehicle accident. On examination, the nurse notices that his trachea is deviated from the midline. What does this finding indicate?
Choose one of the following
A)Flail chest
B)Tension pneumothorax
C)Severe neck fracture
D)Cardiac tamponade

B

324

A patient is being assessed for a headache. Symptoms include throbbing and severe pain lasting for the last 8 hours and vomiting. What type of headache could these findings indicate?
Choose one of the following
A)Benign
B)Tension
C)Migraine
D)Cluster

C

325

Risk factors for cancers of the neck include which of the following? Select all that apply.
Select all that apply:
A)Alcohol consumption
B)Tobacco use
C)Age older than 35 years
D)Improper diet
E)Male gender

A B E

326

Risk factors for cancers of the neck include male gender, age older than 50 years, tobacco use, and alcohol consumption. Risk factors do not include age older than 35 years or an improper diet.
A)true
B) false

A

327

A woman brings her 1-month-old infant to the ED. The mother states the baby's head bulges when he cries. The nurse assesses the baby and notices both fontanels appear normal and the baby seems perfectly healthy. What should the nurse do next?
Choose one of the following
A)Assess for dehydration
B)Document a normal finding
C)Call the physician
D)Get the baby to cry

B

328

A bulging fontanel may be normal when an infant cries but otherwise needs further evaluation as a sign of possible increased intracranial pressure. Documenting normal findings would be the nurse's next action. It would be inappropriate to call the physician, assess for dehydration, or make the baby cry.
A)true
B)false

A

329

Where is the temporal artery palpated?
Choose one of the following
A)Between the mandibular joint and the base of the ear
B)Just left or right of the spine at the base of the skull
C)Above the cheek bone near the scalp line
D)Just left of midline at the base of the neck

C

330

If the patient is wearing a wig or hairpiece, the nurse asks him or her to remove it. The nurse then washes the hands. The patient is usually seated, facing the examiner. The nurse can instruct the patient to report any discomfort as he or she performs the different parts of the head and neck examination. The nurse would don gloves if the patient has an open lesion or wound.
A)true
B)false

A

331

A nurse is going to inspect and palpate a patient's head and neck. After asking the patient to remove the wig, what should the nurse do next?
Choose one of the following
A)Wash hands
B)Put on examination gloves
C)Instruct the patient to lie flat with feet together
D)Instruct the patient to report any discomfort

A

332

A nurse is caring for a 56-year-old woman who has just undergone surgery to remove a thyroid tumor. The nurse is assessing for symptoms of hyperthyroidism. What are some of the symptoms of hypermetabolism? Select all that apply.
Select all that apply:
A)Bradycardia
B)Headache
C)Anxiety
D)Tachycardia
E)Diarrhea

C D E

333

Hyperthyroidism may present as an emergency, with symptoms of hypermetabolism in all systems. The most common sign is tachycardia, but other possibilities include diarrhea, anxiety, fever, weakness, and even psychosis, coma, or death. Nurses should recognize patients at greatest risk for this emergency state. Such patients include those with thyroid tumors and those who have undergone thyroid surgery.
A)true
B)false

A

334

Signs of hypermetabolism do not include bradycardia or headache.
A)true
B)false

A

335

For patients with chronic back problems, what can the nurse teach?
Choose one of the following
A)Ways to reduce the risk of falling
B)Which medications to take and when
C)To sleep in the semi-Fowler's position
D)Proper posture, bending, and lifting techniques

D

336

A useful neck landmark is the vertebral prominence, which is the spinous process of C7, the longest cervical vertebrae. Of the vertebrae of the neck, C7 and T1 are usually the most easily palpable, and the one that protrudes the furthest is C7. Locating C7 during assessment of the head, neck, and posterior thorax facilitates more accurate description of findings.
A)true
B)false

A

337

A useful neck landmark is the __________, which is the spinous process of C7, the longest cervical vertebrae.
A)cervical
B)prominence

B

338

A 63-year-old man comes to the ED with a new onset of pain in his neck and jaw. What system requires emergency assessment?
Choose one of the following
A)Integumentary
B)Nervous
C)Respiratory
D)Cardiovascular

D

339

Acute situations that need emergency assessment and intervention include head or neck injuries, neck pain (may be cardiac),
A)true
B)false

A

340

In infants, the posterior fontanel closes by 2 months and the anterior fontanel closes by 12 to 18 months.
Choose one of the following
A)True
B)False

True

341

Which type of vessels filter pathogens from the body and drain the fluid that has moved outside of the circulation back into the vessels?
Choose one of the following
A)Aortic
B)Lymphatic
C)Veins
D)Arteries

B

342

Hypothyroidism in the older adult can be difficult to diagnose. Why? Select all that apply.
Select all that apply:
A)Symptoms attributed to the aging process
B)Denial of problems
C)Communication deficits
D)Subtle onset
E)Chronic diseases

A D E

343

What is the most common type of hyperthyroidism?
Choose one of the following
A)Moon face
B)Thyroid cancer
C)Graves' disease
D)Cushing's syndrome

C

344

The nurse is discharging a 26-year-old man who received 18 staples for a head laceration he got while mountain biking. What can the nurse focus on while doing discharge teaching?
Choose one of the following
A)Encourage the patient to take a safety course
B)Teach proper posture, bending, and lifting
C)Encourage the use of safety equipment
D)Encourage proper nutrition to promote healing

C

345

The nurse is assessing a patient complaining of swelling in his neck. While palpating his neck, the nurse finds a 2-cm lump that is fixed and hard. Why does this finding require emergency investigation?
Choose one of the following
A)This could be a sign of pneumothorax
B)This could be a sign of a parotid stone
C)This could be a sign of cancer
D)This could be a sign of an embolus

C

346

A 25-year-old man has just had X-rays and computed tomography scanning of the head and neck following a mountain bicycling accident. All results are negative. What should the nurse assess for next?
Choose one of the following
A)Headache
B)Shortness of breath
C)Range of motion of the neck
D)Range of motion of the arms and shoulders

C

347

The nurse is assessing an elderly woman who reports lethargy and weakness. During the examination, the nurse notices that the patient's face is drooping slightly on the right side. Why does this finding require emergency intervention?
Choose one of the following
A)This is a sign of hypothyroidism
B)This is a sign of hyperthyroidism
C)The patient could be experiencing a stroke
D)The patient could be suffering from dehydration

C

348

The thyroid gland is usually palpable in healthy people.
Choose one of the following
A)True
B)False

B

349

A woman brings her 1-month-old infant to the ER. She says the baby is not eating or drinking well. The nurse finds the fontanels are depressed slightly. Why does this require further assessment?
Choose one of the following
A)This could be a sign of increased intracranial pressure
B)This could be a sign of physical abuse
C)This could be a sign of dehydration
D)This is a normal finding and needs no further assessment

C

350

• In acute infection: nodes are bilateral, enlarged, warm, tender, and firm but not freely movable.
A)true
B)false

A

351

• In chronic inflammation: nodes are clumped.
A)true
B)false

A

352

• In cancer: nodes are hard, unilateral, nontender, and fixed.
A)true
B)false

A

353

• ____________ is an edematous swelling and ecchymosis of the presenting part of the head due to birth trauma (see Fig. 13-16, p. 265). It feels soft and may extend across suture lines, but requires no treatment and gradually resolves in a few days.
A) Caput succedaneum
B)herpes

A

354

• _________ is a subperiosteal hemorrhage that is soft, fluctuant, and well defined over one cranial bone because the periosteum holds the bleeding in place. It is also due to birth trauma, and is reabsorbed gradually, over time, without treatment. See Fig. 13-17, p. 265.
A)Cephalhematoma
B)fundus

A

355

Facial characteristics of_________: puffy edematous face, especially around the eyes (periorbital edema), coarse facial features, dry skin, and dry coarse hair and eyebrows.
A)hyperthyroidism
B)hypothyroidism

B

356

The tonic neck reflex in an infant occurs when supine; the head is turned to one side (extension of same arm and leg, flexion of opposite arm and leg). After ages 3 to 4 months, the head is maintained in the midline.
A)true
B)false

A

357

blowing, swooshing sound heard through the stethoscope over an area of abnormal blood flow
A)bruit
B)goiter

A

358

Bleeding into the periosteum during birth is known as:
A)caput succedaneum.
B)Craniosynostosis
C)Molding
D)cephalhematoma.

D

359

A __________ is edematous swelling and ecchymosis of the presenting part of the head caused by birth trauma.
A)caput succedaneum
B)craniosynostosis.

A

360

bleeding into the periosteum during birth is known as
A)cephalhematoma
B)molding

A

361

craniosynotosis is a serve deformity caused by
A)premature closure of the sutures
B)hydrocephalus

A

362

increased intracranial pressure, obstruction of drainage of the CSF results in excessive accumulation of CSF,increasing pressure, and enlarging the head.
A)hydrocephalus
B)paget diseaase

A

363

(Ostetitis deformans) is a localized bone disease of unknown etiology that softens,thickens and deforms the bone
A)paget disease
B)acromegaly

A

364

narrow palpebral fissures, epicanthal folds, and midfacial hypoplasia are characteristic of
A)down syndrome
B)fetal alcohol syndrome

Be

365

upslanting eyes with inner epicanthal fold, flat nasal bridge, small broad flat nose,protruding thick tongue and ear dysplasia
A)down syndromme
B)fetal alcohol snydrome

A

366

kyphosis of the spine is common with aging. to compensate, older adults will
A)extend their heads and jaws forward
B)shuffle

A

367

a statement is accurate related to aggravating symptoms or triggers of headaches
A)alcohol consumption may precipitate the on set of cluster or migraine headaches
B)poor posture

A

368

Most facial bones articulate at a suture. which facial bone articulates at a joint
A)Mandible
B)zygomattic

A

369

a server deficiency of the thyroid hormone leading to nonpittinng edema, coarse facial features,, dry skin, and dry coarse hair is known as
A)Myxedema(hypothyoridism)
B)scleroderma

A

370

which of the following statements describing a headache would warrant an immediate referral
A)i have never had a headache like this before, it is so bad i cant function
B)this is the worst headache i had since puberty

A

371

what diseaseis characterized by a flat,expressionless, or mask like face a starring gaze, oily skin and elevated eyebrows.
A)parkinson disease
B)cushing syndrome

A

372

a patient is admitted to the ER after a MVA. the trachea is deviated to the left side. this finding is characteristic of;
A)right pneumothorax
B)aortic anerysum

A

373

in infant the nurse will measure the head size and palpate the fontanels
A)true
B)false

A

374

in a pregnant woman the nurse, assess for chloasma and thyroid gland enlargement
A)true
B)false

A

375

in ann aging adult, observe for prominent temporal arteries and senile tremors.
A)true
B)false

A

376

Tension headaches tend to be
A)occipital, frontal, or with bandlike tightness
B) (vascular) tend to be supraorbital, retro-orbital, or frontotemporaJ;

A

377

migraines (vascular) tend to be
A)supraorbital, retro-orbital, or frontotemporal;
B) produce pain around the eye, temple, forehead, cheek

A

378

cluster headaches (vascuJar) produce pain around the
A)eye, temple, forehead, cheek
B)everywhere

A

379

With migraines, people lie down to feel better
A)true
B)false

A

380

With cluster headaches they need to move-even to pace the floor-to feel better. To feel better
A)true
B)false

A

381

a primitive reflex in which forcibly turning the head of a normal newborn elicits extension of the limbs on the side to which the head is turned and flexion of the contralateral limbs.
A)tonic neck reflex
B)false

A

382

Head, Face, and Neck, Including Regional Lymphatics

.

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