nclex practice questions 2023 health assessment

Questions 46

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nclex practice questions 2023 health assessment Questions

Question 1 of 5

A patient has come in for an examination and states,"I have this spot on my cheek here in front of my ear lobe. The spot seems to be getting bigger and is very tender. What do you think it is?" The nurse notes swelling below the angle of the jaw and suspects that it could be an inflammation of his:

Correct Answer: B

Rationale: The correct answer is B: parotid gland. The parotid gland is located in front of the ear lobe, and swelling below the angle of the jaw is a common sign of parotid gland inflammation. The tenderness and increasing size of the spot also point towards a parotid gland issue. The other choices, such as thyroid gland (A), occipital lymph node (C), and submental lymph node (D), are incorrect as they are not typically associated with the specific symptoms described by the patient. It is essential to consider the location and function of each structure to arrive at the correct diagnosis.

Question 2 of 5

While performing an examination of a 3-year-old with a suspected ear infection, the nurse would:

Correct Answer: D

Rationale: The correct answer is D. Performing the otoscopic examination at the end of the assessment is the best approach for a 3-year-old with a suspected ear infection. This allows the child to become familiar with the nurse and the environment, reducing anxiety and increasing cooperation. It also prevents the child from becoming upset early in the examination, making it easier to complete the assessment. Choice A is incorrect because omitting the otoscopic exam based on the presence of a fever could lead to a missed diagnosis. Choice B is incorrect as pulling the ear up and back before inserting the speculum is not recommended as it may cause discomfort and increase resistance from the child. Choice C is incorrect as having the mother leave the room may increase the child's anxiety and make the examination more challenging.

Question 3 of 5

A semiconscious woman is brought to the emergency department after being found on the floor in her kitchen. Her face, nail beds, lips, and oral mucosa are a bright cherry-red colour. The nurse suspects that this colouring is due to:

Correct Answer: B

Rationale: The bright cherry-red coloring in a semiconscious woman found on the floor in her kitchen indicates carbon monoxide poisoning. Carbon monoxide binds to hemoglobin with a higher affinity than oxygen, leading to tissue hypoxia and the characteristic cherry-red coloration. Polycythemia would result in a purplish-red color, carotenemia in a yellow-orange hue, and uremia in a pale or yellowish complexion. Therefore, the correct answer is B, as it aligns with the clinical presentation and pathophysiology of carbon monoxide poisoning.

Question 4 of 5

During an admission assessment, the nurse notices that a male patient has an enlarged and rather thick skull. The nurse suspects acromegaly and would further assess for:

Correct Answer: C

Rationale: Step 1: The nurse notices an enlarged and thick skull, which are common signs of acromegaly. Step 2: Acromegaly results from excess growth hormone, leading to changes in facial features. Step 3: Coarse facial features such as enlarged nose, lips, and jaw are classic signs of acromegaly. Step 4: Therefore, assessing for coarse facial features is crucial in confirming acromegaly. Summary: A: Exophthalmos is associated with hyperthyroidism, not acromegaly. B: Bowed long bones are seen in conditions like rickets, not acromegaly. D: An acorn-shaped cranium is not a typical feature of acromegaly.

Question 5 of 5

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

Correct Answer: D

Rationale: The correct answer is D: migraine headaches. The patient's symptoms of severe throbbing headache in the frontotemporal area, triggered by stress (studying for an exam), partially relieved by lying down, and family history of similar headaches are indicative of migraines. Migraines commonly present with these characteristics, often exacerbated by stress and have a genetic component. A: Hypertension does not typically present with throbbing headaches in a specific area or relief with lying down. B: Cluster headaches are characterized by severe, unilateral headaches around the eye area, not frontotemporal. C: Tension headaches usually present as dull, constant pressure-type headaches, not throbbing, and do not have the familial pattern described by the patient.

Similar Questions

A patient reports a severe throbbing headache in the frontotemporal area of his head that he experienced while studying for an examination, He says that the headache was somewhat relieved when he lay down. He tells the nurse that his mother also used to get these headaches. The nurse suspects that he may be suffering from:
During an assessment of a 20-year-old Aboriginal patient, the nurse notices that he has dry, flaky cerumen in his ear canal. What is the significance of this finding?
An assessment of a 23-year-old patient reveals the following: an auricle that is tender and reddish blue in colour and has small vesicles. What additional information would the nurse need to know?
Which of the following physiological changes is responsible for presbyopia?
During the oral assessment of a 30-year-old patient of African descent, the nurse notes bluish lips and a dark line along the gingival margin. What would the nurse do in response to this finding?

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