Test bank for advanced practice nursing in the care of older adults 2nd by kennedy malone

Test Bank for Advanced Practice Nursing in the Care of Older Adults 2nd by Kennedy-Malone

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Chapter 7 Head, Neck, and Face Disorders

Multiple Choice

1 Which cranial nerve should be assessed in the examination for disorders of the face?

1 Cranial nerve III

2. Cranial nerve V

3. Cranial nerve VII

4. Cranial nerve IX

2 Which of the following medical specialists deals with the diagnosing of visual impairments and conditions?

1. Ophthalmologist

2. Optometrist

3. Otolaryngologists

4. Podiatrist

3. Which of the following conditions is signaled by bleeding from the nose?

1. Rhinitis

2. Telangiectasia

3. Retinopathy

4. Epistaxis

4. Mr. Jones, a 70-year-old male, visits the urgent care and presents symptoms of unilateral eye pain, visual blurring with halos around lights, red eye, and photophobia. He also reports nausea and vomiting. Visual acuity shows a loss in the affected eye. He is immediately referred for a complete ophthalmic examination. Which of the following conditions may Mr. Jones be experiencing?

1. Acute glaucoma

2. Conjunctivitis

3. Hyphema

4. Uveitis

5. Which of the following is the correct term for the eye condition that presents a sterile mass on the eyelid that is painless and has no reddening?

1. Blepharitis

2. Entropion

3. Hordeolum

4. Chalazion

6. Oral cancer is a malignant tumor presented by a nonhealing sore in the mouth or lip that

causes difficulty chewing or swallowing. Which of the following statements applies to an oral cancer diagnosis?

1. It cannot be prevented.

2. It involves unexplained lymph node swelling in the head and neck area

3. It is three times more likely in women than men.

4. It involves unexplained lymph node swelling in the axillary area

7. A 67-year-old female patient comes in for an office visit presenting symptoms of nasal congestion, itching, and sneezing and is diagnosed with rhinitis. Which of the following is true about the types of rhinitis?

1. Allergic rhinitis (AR) is a condition of adulthood and is more common in the older adult.

2. AR develops when the body’s respiratory system becomes sensitized and overreacts to something in the environment.

3. Nonallergic rhinitis (NAR) is most common between ages 10 and 39, declining after age 40.

4. NAR is a condition of adulthood and is more common in the older adult.

8. For which of the following evaluations should the patient be referred when sleep impairment is involved with chronic rhinitis?

1. Obstructive sleep apnea

2. Pharmacological therapy

3. Acupuncturist evaluation

4. Massage therapy

Multiple Response

9. Evaluation for head and neck disorders should be performed with a systemic and thorough examination, including inspections of the face, head, and scalp. This includes which of the following? Select all that apply.

1. Palpating bones of the head for any anatomical irregularities

2. Inspecting skin for any inflammation.

3. Inspecting the scalp and hair for any balding patterns

4. Inspecting patient’s features for any abnormalities.

5. Assessing for thoracic outlet syndrome.

10. When looking for disorders, which of the following parts of the body should be inspected in the examination of the head, face, and neck? Select all that apply.

1. Sinuses

2. Neck

3. Lungs

4. Skin

5. Cervical spine

11. Eye health education should be provided to maintain or minimize visual problems. Which of the following should be included in patient education? Select all that apply.

1. The importance of protecting the eyes from sunlight

2. Eye examinations should be performed every 5 years.

3. Eating more protein with meals will help eye health.

4. Information on age-related visual changes

5. The importance of wearing eye goggles when swimming.

12. Nosebleeds are generally minor and nonrecurring, but when a patient is seen for this, a consultation with an ear, nose, and throat (ENT) specialist is indicated when which of the following conditions occurs? Select all that apply.

1. Bleeding that is not controlled after 15 minutes of compression.

2. Second episode occurs within 1 week.

3. Itching sensation after the bleeding stops.

4. Sneezing after the bleeding stops.

5. Massive bleeding

13 Hearing loss is a decreased ability or inability to hear. The loss may involve the external, middle, or inner ear and can be unilateral or bilateral. Which of the following etiologies may result in hearing loss? Select all that apply.

1. Sensorineural

2. Vascular occlusive disease

3. Conductive

4. Cerebral neoplasia

5. Aphasia

14. There is no specific diagnostic test for hordeolum or chalazion unless it becomes recurrent. Which of the following may be a differential diagnosis for these conditions? Select all that apply.

1. Orbital cellulitis

2. Contact dermatitis

3. Acute dacryocystitis

4. Strabismus

5. Amblyopia

15. The most common diagnostic test for AR is skin testing that involves scratching the surface of the skin with a single stylus for each allergen. Which of the following are possible if further testing is needed? Select all that apply.

1. Skin prick testing

2. CT scan

3. Blood test

4. MRI

5. Myelogram

Answers

1. Answer: 3 Page: 127

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1. Cranial nerve III: oculomotor. This nerve is also known as the common ocular motor nerve. It controls eye movement and is also responsible for pupil size. It originates in the midbrain.

2. Cranial nerve V: trigeminal. This nerve’s function is to carry sensitive information to the face and convey information for the chewing process. The sensory fibers convey sensations of touch, pain, and temperature from the front of the head, including the mouth and the meninges.

3. Cranial nerve VII: facial. This nerve should be assessed in the examination for disorders of the face. It consists of several nerve fibers that perform different functions, like ordering the muscles of the face to create facial expressions, as well as sending signals to the salivary and lacrimal glands.

4. Cranial nerve IX: glossopharyngeal. This nerve’s influence lies in the tongue and pharynx. It collects information from the taste buds (tongue) and sensory information from the pharynx.

2. Answer: 1 Page: 129

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1. An ophthalmologist is a medical doctor who specializes in eye and vision care. An ophthalmologist diagnoses and treats all eye diseases, performs eye surgery, and prescribes and fits eyeglasses and contact lenses to correct vision problems.

2. An optometrist is an eye doctor who has earned the doctor of optometry (OD) degree. Optometrists examine eyes for both vision and health problems, and correct refractive errors by prescribing eyeglasses and contact lenses.

3. Otolaryngologists are physicians trained in the medical and surgical management, and treatment of patients with diseases and disorders of the ear, nose, and throat, and related structures of the head and neck.

4. A podiatrist is a medical doctor devoted to the study and medical treatment of disorders of the foot, ankle, and lower extremities.

3. Answer: 4 Page: 130

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1. Rhinitis is inflammation of the nose. Symptoms of rhinitis include runny nose

(rhinorrhea), nasal itching, nasal congestion, and sneezing.

2. Telangiectasia, also known as spider veins, are small dilated blood vessels near the surface of the skin or mucous membranes. These dilated blood vessels can develop anywhere on the body but are commonly seen on the face around the nose, cheeks, and chin.

3. Retinopathy is a disease of the retina that results in impairment or loss of vision.

4. Epistaxis is a condition signaled by bleeding from the nose and is the result of a spontaneous rupture of a blood vessel in the anterior septum. Causes include, but are not limited to, trauma, irritation or inflammation of the nasal mucosa, a septal defect, or paranasal tumors.

4. Answer: 1 Page: 132

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1. Symptoms for acute glaucoma include unilateral eye pain, visual blurring with halos around lights, conjunctival injection, and photophobia. This requires immediate referral for a complete ophthalmic examination.

2. Symptoms for chronic glaucoma include tunnel vision, night blindness, and halos around lights. The treatment goal is to minimize the progression of the disease and preserve vision.

3. Hyphema is defined as the presence of blood within the aqueous fluid of the anterior chamber. The blood may cover most or all of the iris and the pupil, blocking vision partially or completely. The most common cause of hyphema is trauma.

4. Uveitis is a form of eye inflammation. It affects the middle layer of tissue in the eye wall (uvea). Symptoms include eye redness; eye pain; light sensitivity; blurred vision; dark, floating spots in the field of vision (floaters); and decreased vision. Possible causes of uveitis are infection, injury, or an autoimmune or inflammatory disease.

5. Answer: 4 Page: 138

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Advanced Practice Nursing in the Care of Older Adults, 2e Page 5

1. Blepharitis is an inflammation of the eyelids, usually resulting in redness, swelling, and itching.

2. Entropion is the inward turning of the upper or lower eyelid so that the lid margin rests against and rubs the eyeball.

3. Hordeolum is an acute, purulent area of inflammation in the meibomian gland, commonly called a stye. It typically contains bacteria and can occur internally or externally at the lid margin. Not all styes are sterile.

4. Chalazion is an eye condition that presents a sterile mass on the eyelid that is painless and has no reddening. It is caused by an inflammation and obstruction of a meibomian gland of the upper or lower eyelid. Chalazion can interfere with vision at times and develops a rubbery consistency.

Kennedy-Malone

6. Answer: 2 Page: 141

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1. The most important way to control oral cancer is the combination of early diagnosis and timely and appropriate treatment. Preventions include lifestyle changes, periodic checkups, and protection from sun exposure.

2. Unexplained lymph node swelling in the head and neck area is one of the symptoms of oral cancer. Additionally, a nonhealing sore in the mouth or lip and difficulty chewing or swallowing are also symptoms

3. Men are almost three times more likely to develop oral cancer than women.

4. Unexplained lymph node swelling in the head and neck area is a symptom, but lymph node swelling in the axillary area is not.

7. Answer: 4 Page: 147

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1. AR is a condition of adulthood that declines in diagnosis after age 40.

2. AR develops when the body’s immune system, not the respiratory system, becomes sensitized and overreacts to something in the environment that typically causes no problem in most people.

3. NAR is a condition of adulthood and is more common in the older adult

4. NAR could be related to physiological changes in the older adult, as well as interactions from medications.

8. Answer: 1 Page: 148

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1. Patients with chronic rhinitis may be referred for evaluation of obstructive sleep apnea in the presence of sleep-disordered breathing.

2. Pharmacological therapy is directed at control of the specific patient symptoms.

3. Acupuncture evaluation may be helpful to improve sleep, but may not be helpful in treating rhinitis.

4. Massage therapy may be helpful to improve sleep, but it is not helpful in treating rhinitis.

9. Answer: 1, 3, 4 Page: 127

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Advanced Practice Nursing in the Care of Older Adults, 2e Page 6

1. Palpating bones of the head for any anatomical irregularities should be included in the inspection and examination of the face, head, and scalp.

2. Inspecting the skin is not a part of this examination, however, cranial nerve VII, the facial nerve, should be assessed at this time, noting any facial asymmetry, weakness,

drooping of the lower eyelid, and unilateral paralysis. Cranial nerve VIII is the auditory and vestibular nerve, responsible for balance and orientation in space and auditory function.

3. Areas of uniform alopecia should be noted, along with discovery of any nits or seborrhea.

4. Inspecting the patient’s features includes examination of facial expressions, presence of tremor, edema, or facial drooping.

5. Thoracic outlet syndrome is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed. This can cause pain in the shoulders and neck, and numbness in the fingers.

10. Answer: 1, 2

Page: 128

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1. The sinuses should be inspected and palpated, noting any gross tenderness or inflammation

2. Inspection should include looking for symmetry, masses, scars, tracheal position, deviation, and other things.

3. Inspection of the lungs is only possible by performing diagnostic testing and not possible by sight and touch.

4. Inspection of the skin, although important, is not a focus in the examination for head, face, and neck disorders.

5. The cervical spine, or neck, begins at the base of the skull and through a series of seven vertebral segments connects to the thoracic, or chest, region of the spine. It houses the spinal cord, which sends messages from the brain to control all aspects of the body. This is not evaluated in examination of the head, face, and neck.

11. Answer: 1, 4

Page: 129

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1. The importance of protecting the eyes from sunlight with UV-blocking sunglasses should be included in the patient eye health education.

2. Recommending periodic eye examinations every 2 years should be included in the patient eye health education.

3. The patient should be instructed to maintain a nutritionally balanced diet including green, leafy vegetables.

4. Because age-related changes do occur with vision, giving patients this information will help them be aware of what to look for.

5. Though not generally a part of patient education, the recommendation to wear eye goggles when swimming may be helpful to minimize eye irritation from chlorine, salt water, or any other contaminants.

12. Answer: 1, 2, 5

Page: 131

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1. Most nosebleeds do not require medical attention; however, the individual should seek medical attention if a nosebleed lasts longer than 15 minutes, or if it occurs after an injury. This may be a sign of a posterior nosebleed, which is more serious.

2. If a second episode occurs within 1 week, a consultation with an ENT specialist is indicated, as it may have underlying conditions associated with the recurrence of symptoms such as sinusitis, septal hematoma/perforation, or mucosal pressure necrosis.

3. Dry air is the most common cause of nosebleeds. Living in a dry climate and using a central heating system can dry out the nasal membranes, which are tissues inside the nose. This dryness causes crusting inside the nose. Crusting may itch or become irritated if the nose is scratched or picked, and it can bleed.

4. Sneezing is an allergic reaction and can also dry out the nasal membranes and cause nosebleeds. Frequent nose blowing is another cause of nosebleeds.

5. ENT consultation is indicated when there is evidence of massive bleeding that cannot be stopped, as there can be a large amount of blood loss.

13. Answer: 1, 3

Page: 136

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1. A lesion in the organ of Corti or in the central pathways, including the cranial nerve VIII and auditory cortex, causes sensorineural hearing loss. Presbycusis, noiseinduced hearing loss, and ototoxic drug-related hearing loss all are sensorineural.

2. Vascular occlusive disease is predominantly a disease of the lower extremities and not an etiology of hearing loss.

3. Conductive hearing loss is caused by a lesion involving the outer and middle ear to the level of the oval window. Various structural abnormalities, cerumen impaction, perforation of the tympanic membrane, middle ear fluid, damage to the ossicles from trauma or infection, middle ear tumors, temporal bone fractures, injuries related to trauma, and congenital problems are some of the causes.

4. Cerebral neoplasia is a brain tumor that may affect body organs; however, it is not a primary etiology that leads to hearing loss.

5. Aphasia is a loss of ability to understand or express speech caused by brain damage.

14. Answer: 1, 2, 3 Page: 138

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1. Orbital cellulitis is an infection of the soft tissues of the orbit posterior to the orbital septum. It is most often caused by extension of infection from adjacent sinuses, or by direct infection accompanying local trauma or contiguous spread of infection from the face or teeth.

2. Contact dermatitis is a red, itchy rash caused by direct contact with a substance or an

allergic reaction to it. The rash isn’t contagious or life threatening, but it can be very uncomfortable.

3. Acute dacryocystitis is an infection of the tear (lacrimal) sac usually due to a blockage in the tear (nasolacrimal) duct. The patient presents with pain, redness, and edema around the lacrimal sac.

4. Strabismus is a visual problem in which the eyes are not aligned properly and point in different directions.

5. Amblyopia is the medical term used when the vision in one of the eyes is reduced because the eye and the brain are not working together properly. The eye itself looks normal, but it is not being used normally because the brain is favoring the other eye. This condition is also sometimes called lazy eye. Many people make the mistake of saying that a person who has a crossed or turned eye (strabismus) has a lazy eye, but lazy eye (amblyopia) and strabismus are not the same condition. Strabismus can cause amblyopia.

15. Answer: 1, 2 Page: 148

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1. Skin prick testing is a next step, but intradermal testing may be needed if results are negative.

2. CT scan should not be used in the absence of recurrent infection.

3. Blood test is a not common diagnostic testing for AR.

4. MRI is a not common diagnostic testing for AR.

Advanced Practice Nursing in the Care of Older Adults, 2e Page 9

5. A myelogram is a diagnostic imaging test generally done by a radiologist. It uses a contrast dye and x-rays or CT scan to look for problems in the spinal canal.