Chapter 14
unable to differentiate between sharp and dull stimulation to both sides of her face. what CN is affected
trigeminal nerve
headache pain on one side of his head, especially around his eye, forehead, and cheek that has lasted approximately ½ to 2 hours, occurring once or twice each day
culture headache
describe physical exam finding for lymphadenopathy and suspects an acute infection.
Firm but freely movable
A patient’s vision is recorded as 20/40 when the Snellen eye chart is used.
The patient can read at 20 feet what a person with normal vision can read at 40 feet.
NORMAL tympanic membrane look?
Pearly gray and slightly concave
name the two pairs of salivary glands
Parotid; submandibular
evere headache he describes as, “Like nothing I’ve ever had before.” His temperature is 40° C, and he has a stiff neck.
Meningitis
chronic watery eyes, sneezing, and clear nasal drainage. The nurse notices the presence of a transverse line across the bridge of the nose, dark blue shadows below the eyes, and a double crease on the lower eyelids. What does the nurse suspect is the cause of these signs and symptoms?
Chronic allergies
During an assessment of the sclera of a black patient, the nurse would consider which of these an expected finding?
Presence of small brown macules on the sclera
Which CN is responsible for conducting nerve impulses to the brain from the organ of Corti?
VIII
how do you test CN XI
have patient shrug their shoulders against resistance
what gland should be assessed for suspected mumps
parotid
what CN stimulates movement of the extraocular muscles?
Is stimulated by CNs III, IV, and VI.
The nurse notices the presence of periorbital edema when performing an eye assessment on a 70-year-old patient. What should the nurse do next?
Ask the patient if he or she has a history of heart failure.
The nurse is performing an otoscopic examination on an adult. Which of these actions is correct?
Pulling the pinna up and back before inserting the speculum.
what gland produces thyroxine (T4
thyroid
hyperthyroidism list 4 signs/symptoms
Tachycardia ......
Which of these assessment findings would the nurse expect to see when examining the eyes of a black patient?
Dark retinal background
see the image
pustule at the lid margin that is painful to touch, red, and swollen
HORDELUM
The nurse is assessing a 16-year-old patient who has suffered head injuries from a recent motor vehicle accident. Which of these statements indicates the most important reason for assessing for any drainage from the ear canal?
Bloody or clear watery drainage can indicate a basal skull fracture.
mobile and soft thyroid nodules means what?
most likely not cancerous
list physical exam findings of Down syndrome (trisomy 21)
Ear dysplasia
Use the Snellen chart positioned _____ feet away from the patient.
20 FEET
A 68-year-old woman is in the eye clinic for a checkup. She tells the nurse that she has been having trouble reading the paper, sewing, and even seeing the faces of her grandchildren. On examination, the nurse notes that she has some loss of central vision but her peripheral vision is normal. What do these findings suggest?
MD
While performing the otoscopic examination of a 3-year-old boy who has been pulling on his left ear, the nurse finds that his left tympanic membrane is bright red and that the light reflex is not visible. What do these findings indicate?
An acute otitis media