N3153 Dallas Health Assessment Exam 3 SP26
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Free N3153 Dallas Health Assessment Exam 3 SP26 Questions
Patients with chronic allergies may have small, pale, round, firm overgrowths on the nasal mucosa. Which term should be used to describe this physical assessment finding?
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Perforated septum
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Chronic sinusitis
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Polyps
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Turbinates
Explanation
Explanation:
Correct Answer: (C) Polyps
Nasal polyps are small, pale, round, firm, noncancerous growths that develop on the lining of the nasal mucosa. They are commonly associated with chronic allergies, asthma, and recurrent sinus inflammation. Their pale color and smooth, round shape distinguish them from other nasal structures during physical assessment.
Why Other Options are Incorrect:
A. Perforated septum — A perforated septum refers to a hole in the nasal septum and is not described as an overgrowth on the mucosa.
B. Chronic sinusitis — Chronic sinusitis is an inflammatory condition of the sinuses, not a physical structure or growth visualized on the nasal mucosa.
D. Turbinates — Turbinates are normal bony structures within the nasal cavity that help filter and humidify air. They are not overgrowths and are not abnormal findings.
A nurse is assessing a patient suspected of having hyperthyroidism. Which of the following symptoms would support this diagnosis? (Select all that apply.)
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Diarrhea
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Constipation
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Bradycardia
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Unintentional weight loss
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Heat intolerance
Explanation
Explanation:
Correct Answers: (A) Diarrhea, (D) Unintentional weight loss, (E) Heat intolerance
Hyperthyroidism results from excess thyroid hormone production, which accelerates the body's metabolic processes. This leads to increased gastrointestinal motility causing diarrhea, rapid metabolism resulting in unintentional weight loss despite increased appetite, and an inability to tolerate heat due to increased thermogenesis.
Why Other Options are Incorrect:
B. Constipation — Constipation is associated with hypothyroidism, where metabolic processes are slowed, not hyperthyroidism.
C. Bradycardia — Hyperthyroidism causes tachycardia due to the overstimulation of the cardiovascular system. Bradycardia is characteristic of hypothyroidism.
The nurse asks for the patient to stick out their tongue. The tongue protrudes midline. What does this finding indicate?
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Loss of function CN XII
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Intact CN XII
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Loss of function of CN IX
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Intact CN IX
Explanation
Explanation:
Correct Answer: (B) Intact CN XII
Cranial Nerve XII, the hypoglossal nerve, controls the movement of the tongue. When a patient protrudes their tongue and it extends straight out along the midline, this indicates that the hypoglossal nerve is functioning bilaterally and symmetrically. A deviation of the tongue to one side upon protrusion would suggest damage or weakness of CN XII on the side toward which the tongue deviates.
Why Other Options are Incorrect:
A. Loss of function CN XII — Loss of CN XII function would cause the tongue to deviate toward the affected side upon protrusion, not extend midline. A midline tongue indicates normal CN XII function.
C. Loss of function of CN IX — CN IX, the glossopharyngeal nerve, is responsible for taste sensation on the posterior third of the tongue, swallowing, and the gag reflex. It does not control tongue protrusion and is not assessed by this maneuver.
D. Intact CN IX — While CN IX may indeed be intact, this specific assessment of tongue protrusion tests CN XII, not CN IX. Midline protrusion does not provide information about the status of CN IX.
The nurse is teaching a group of women about health-promoting interventions. Which health interventions are most responsible for the decline in cervical cancer rates? Select all that apply.
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Oral contraceptives.
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Female circumcision.
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Vitamin supplementation.
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Vaccination against human papillomavirus (HPV). E. Pap test screening.
Explanation
Explanation:
Correct Answers: (D) Vaccination against human papillomavirus (HPV) and (E) Pap test screening.
The two interventions most responsible for the dramatic decline in cervical cancer rates are HPV vaccination and regular Pap test screening. HPV vaccination prevents infection with the high-risk strains of HPV (types 16 and 18) responsible for approximately 70% of cervical cancers. Pap test screening enables early detection of precancerous cervical changes (dysplasia) before they progress to invasive cancer, allowing for timely treatment and prevention of cancer development.
Why Other Options are Incorrect:
A. Oral contraceptives are not associated with a decline in cervical cancer rates; in fact, long-term use of oral contraceptives is considered a mild risk factor for cervical cancer rather than a protective intervention.
B. Female circumcision has no evidence-based association with cervical cancer prevention and is not a recommended or ethical health-promoting intervention.
C. Vitamin supplementation has not been established as a primary intervention responsible for the decline in cervical cancer rates; while general nutrition supports immune function, it is not a direct preventive measure for cervical cancer.
The nurse assesses a 14-year-old patient who reports itchy eyes and matted eyelashes. Which parent and patient education is the top priority?
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Change pillowcase.
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Wash hands often.
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Don't share eye make-up.
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Use clean towels daily.
Explanation
Explanation:
Correct Answer: (B) Wash hands often.
Itchy eyes and matted eyelashes in a teenager are classic signs of conjunctivitis (pinkeye), which is highly contagious. The top priority education is frequent and thorough handwashing, as this is the single most effective measure to prevent the spread of infectious conjunctivitis to others and to prevent reinfection through hand-to-eye contact.
Why Other Options are Incorrect:
A. Changing pillowcases is an important hygiene measure to reduce reinfection, but it is a secondary measure compared to handwashing, which directly interrupts the transmission route of the infection.
C. Not sharing eye makeup is relevant hygiene advice particularly for older adolescents, but it is not the top priority education for a 14-year-old with active conjunctivitis where preventing spread through hand contact is paramount.
D. Using clean towels daily is a helpful infection control measure, but again it is secondary to the fundamental priority of handwashing in preventing the spread of conjunctivitis.
When assessing the maxillary sinuses for tenderness, which action should the nurse take?
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Press gently with both thumbs around the eyebrow ridges
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Have the patient lean forward and shine a light below their browbone
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Apply firm pressure with both thumbs below the cheekbones
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Have the patient breathe in and out while occluding each nostril
Explanation
Explanation:
Correct Answer: (C) Apply firm pressure with both thumbs below the cheekbones
The maxillary sinuses are located beneath the cheekbones in the facial structure. To assess for tenderness, the nurse applies firm upward pressure with both thumbs directly below the cheekbones. Tenderness upon palpation in this area suggests maxillary sinusitis or inflammation of the maxillary sinuses.
Why Other Options are Incorrect:
A. Press gently with both thumbs around the eyebrow ridges — This technique is used to assess the frontal sinuses, which are located above the eyes near the eyebrow ridges, not the maxillary sinuses.
B. Have the patient lean forward and shine a light below their browbone — Transillumination is an older assessment technique and is not the standard clinical method for assessing sinus tenderness through palpation.
D. Have the patient breathe in and out while occluding each nostril — This technique assesses nasal patency, not sinus tenderness, and is not relevant to maxillary sinus assessment.
The nurse is preparing to assess a 2-year-old child's ears. Which technique is appropriate for visualizing the tympanic membrane?
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Pull the pinna down and back
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Pull the pinna up and back
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Pull the pinna down and forward
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Pull the pinna up and forward
Explanation
Explanation:
Correct Answer: (A) Pull the pinna down and back
In children under 3 years of age, the ear canal curves upward, so the pinna must be pulled down and back to straighten the canal and allow proper visualization of the tympanic membrane with the otoscope. This technique differs from the approach used in adults.
Why Other Options are Incorrect:
B. Pull the pinna up and back — This is the correct technique for adults and older children, not for children under 3 years of age whose ear canal has a different anatomical orientation.
C. Pull the pinna down and forward — Pulling the pinna forward does not straighten the ear canal and would obstruct visualization of the tympanic membrane.
D. Pull the pinna up and forward — This direction neither straightens the canal nor follows any evidence-based technique for otoscopic examination in any age group.
The nurse teaches a patient to perform a breast self exam (BSE). Which finding does NOT need a follow-up with the patient's health care provider?
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Deviated nipple
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"peau d'organge" edema
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Cyclic tenderness
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Blood-tinged discharge
Explanation
Explanation:
Correct Answer: (C) Cyclic tenderness
Cyclic breast tenderness is a normal hormonal fluctuation that occurs in relation to the menstrual cycle, typically worsening before menstruation and resolving afterward. It does not indicate pathology and does not require follow-up with a healthcare provider. It is the only finding among the options that is considered a benign, expected physiological occurrence.
Why Other Options are Incorrect:
A. Deviated nipple — A newly inverted or deviated nipple can be a warning sign of an underlying mass or malignancy pulling on breast tissue and requires prompt evaluation.
B. "peau d'orange" edema — This refers to skin that resembles an orange peel due to lymphatic obstruction and is a classic sign of inflammatory breast cancer, requiring immediate follow-up.
D. Blood-tinged discharge — Bloody nipple discharge is an abnormal finding that may indicate intraductal papilloma or malignancy and always warrants further investigation.
A patient complains of tinnitus. Which question should the nurse ask next?
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"Are you yawning frequently?"
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"Are you having any ear drainage?"
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"Are you taking any antibiotics?"
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"How do you clean your ears?"
Explanation
Explanation:
Correct Answer: (C) "Are you taking any antibiotics?"
Certain antibiotics, particularly aminoglycosides such as gentamicin and tobramycin, are known to be ototoxic and can cause or worsen tinnitus. Asking about antibiotic use is a clinically relevant and priority follow-up question as it identifies a potentially modifiable and reversible cause of the patient's tinnitus that requires prompt attention and possible medication adjustment.
Why Other Options are Incorrect:
A. "Are you yawning frequently?" — Yawning is not a recognized cause or associated symptom of tinnitus and is not a clinically relevant follow-up question in this context.
B. "Are you having any ear drainage?" — While ear drainage may indicate infection, it is a separate symptom and not the most directly relevant follow-up question when a patient presents specifically with tinnitus.
D. "How do you clean your ears?" — While improper ear cleaning can cause cerumen impaction, this is a lower-priority question compared to identifying ototoxic medication use as a direct and reversible cause of tinnitus.
The nurse performs the cardinal fields of vision tests on a patient and notes the patient's failure to follow the nurse's finger in the lateral movement of the right eye. In which cranial nerve does the nurse suspect a problem?
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CN III
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CN VI
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CN IV
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CN VII
Explanation
Explanation:
Correct Answer: (B) CN VI.
Cranial Nerve VI, the Abducens nerve, controls the lateral rectus muscle responsible for lateral (outward) movement of the eye. Failure to follow the examiner's finger in the lateral direction indicates weakness or paralysis of this muscle, pointing to a deficit in CN VI.
Why Other Options are Incorrect:
A. CN III (Oculomotor) controls most eye movements including upward, downward, and medial gaze, as well as pupil constriction and eyelid elevation; it is not primarily responsible for lateral gaze.
C. CN IV (Trochlear) controls the superior oblique muscle, which is responsible for downward and inward eye movement, not lateral movement.
D. CN VII (Facial) controls facial expression muscles and has no role in eye movement or lateral gaze.
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