A nurse is assessing a patient with a complaint of cold and sinus pain. Which sinuses would the nurse palpate?
ethmoid
maxillary
mastoid
sphenoid
The Correct Answer is B
A. Ethmoid: The ethmoid sinuses are located between the eyes and are not typically accessible for palpation during a physical examination. Instead, tenderness in this area is assessed through inspection and indirect methods rather than direct palpation.
B. Maxillary: The maxillary sinuses are located in the cheeks and are accessible for palpation. The nurse can assess for tenderness or swelling in this area, which can indicate sinusitis or infection. Palpating the maxillary sinuses is a standard part of the examination for patients with cold and sinus pain.
C. Mastoid: The mastoid process is located behind the ear and contains air cells, but it is not directly involved in sinus pain associated with cold symptoms. While mastoid tenderness may indicate a different type of infection (such as mastoiditis), it is not part of the sinus assessment.
D. Sphenoid: The sphenoid sinuses are located deep within the skull, behind the nasal cavity, and are not accessible for palpation during a physical examination. Any issues with the sphenoid sinuses would typically be assessed through imaging studies rather than physical palpation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Thyroid: The thyroid gland produces thyroxine (T4) and triiodothyronine (T3), which are essential hormones that regulate metabolism, growth, and development. An elevated T4 level typically indicates hyperthyroidism or other thyroid disorders, making it necessary to assess the function and health of the thyroid gland.
B. Parathyroid: The parathyroid glands regulate calcium levels in the blood through the secretion of parathyroid hormone (PTH). They do not produce T4 or directly influence thyroid hormone levels, so assessing the parathyroid glands would not be relevant in the context of elevated T4.
C. Adrenal: The adrenal glands produce hormones such as cortisol, aldosterone, and adrenaline. While adrenal function can impact overall hormonal balance in the body, they are not directly involved in the production of thyroxine (T4), making them unrelated to the assessment for elevated T4 levels.
D. Parotid: The parotid glands are major salivary glands that secrete saliva. They do not play a role in thyroid hormone production or regulation, so assessing the parotid glands would not be appropriate when investigating elevated T4 levels.
Correct Answer is A
Explanation
A. Pericardial sac: The pericardial sac, also known as the pericardium, is a double-walled sac that surrounds and protects the heart. It consists of an outer fibrous layer and an inner serous layer, which produces pericardial fluid to reduce friction between the heart and surrounding structures during heartbeats. This structure provides support and helps maintain the position of the heart within the thorax.
B. Endocardial sac: The endocardium is the innermost layer of the heart wall that lines the heart chambers and covers the heart valves. It does not refer to a protective sac surrounding the heart.
C. Pleural sac: The pleural sac consists of two layers (visceral and parietal pleura) that encase the lungs and provide a lubricated surface for lung expansion and contraction during respiration. It is not related to the heart.
D. Myocardial sac: The myocardium refers to the muscular middle layer of the heart wall responsible for contraction and pumping blood. It is not a sac and does not surround or protect the heart.
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