A nurse is caring for a client complaining of throbbing pain in the face, teeth, and cheeks. Upon palpation, the nurse notes swollen turbinates and a purulent discharge the nose. The nurse should recognize that the client's symptoms best correlate with which problem?

Frontal sinusitis

Maxillary sinusitis

Nasal fracture

Nasal polyps

Answer and Explanation

The Correct Answer is B

A) Frontal sinusitis:
This is incorrect. Frontal sinusitis typically causes pain and tenderness in the forehead area, above the eyes, and along the brow ridge. While frontal sinusitis can lead to headaches and facial pain, it generally does not cause pain in the teeth, cheeks, or nasal discharge as specifically as maxillary sinusitis. Pain in the cheeks and upper teeth, along with purulent nasal discharge, is more characteristic of maxillary sinus involvement.

B) Maxillary sinusitis:
This is the correct answer. Maxillary sinusitis is the inflammation or infection of the maxillary sinuses, which are located behind the cheeks. Common symptoms include throbbing pain in the cheeks, teeth, and upper jaw, swollen turbinates (the structures inside the nose that help with airflow and filtering), and purulent nasal discharge. These symptoms match the description provided, making maxillary sinusitis the most likely diagnosis.

C) Nasal fracture:
This is incorrect. A nasal fracture typically presents with pain, swelling, bruising, and sometimes deformity of the nose, often accompanied by epistaxis (nosebleeds). While a nasal fracture can cause pain, it would not typically cause the throbbing pain in the face, teeth, and cheeks, nor would it be associated with swollen turbinates and purulent nasal discharge as seen in sinusitis.

D) Nasal polyps:
This is incorrect. Nasal polyps are non-cancerous growths that form in the nasal passages or sinuses due to chronic inflammation. They often cause nasal obstruction, reduced sense of smell, or frequent sinus infections. However, they do not typically cause the throbbing facial pain, particularly in the teeth and cheeks, that is characteristic of maxillary sinusitis. They also do not cause the purulent discharge seen in sinus infections.

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Correct Answer is A

Explanation

A) Palpate the chest symmetrically:
Palpating the chest symmetrically is crucial when assessing tactile fremitus, as it allows the nurse to compare the intensity of vibrations felt on both sides of the chest. Tactile fremitus refers to the palpable vibrations transmitted through the bronchopulmonary system when a person speaks or breathes. Symmetrical palpation ensures that the nurse can detect any differences in fremitus, which may indicate abnormalities such as lung consolidation (e.g., pneumonia), pleural effusion, or pneumothorax. Uneven fremitus can suggest a pathological condition, and symmetrical palpation helps identify these variations.

B) Ask the client to cough:
Asking the client to cough is not directly related to the assessment of tactile fremitus. Coughing may be used in other aspects of the respiratory assessment (e.g., to clear secretions or to assess for a productive cough), but it is not necessary for palpating fremitus. Tactile fremitus is assessed while the client is speaking (e.g., repeating the phrase "ninety-nine") or breathing, not coughing.

C) Use the bell of the stethoscope:
The bell of the stethoscope is used for auscultating low-pitched sounds, such as heart murmurs or some lung sounds (e.g., certain adventitious sounds like crackles or wheezes). However, it is not used for palpating tactile fremitus, which is a physical exam technique that involves using the hands to feel for vibrations. Fremitus is a tactile (not auscultatory) finding, so the stethoscope, whether bell or diaphragm, is not relevant in this assessment.

D) Instruct the client to breathe deeply:
While it is important for the client to breathe deeply during a lung exam, deep breathing is not directly required for assessing tactile fremitus. Tactile fremitus is typically assessed while the client is speaking. When the client repeats a phrase like "ninety-nine," vibrations are transmitted through the chest wall, and the nurse can assess the intensity of the vibrations. Deep breathing would be more relevant for assessing breath sounds or the general respiratory effort.

A. The presence of cerumen in the ear canal B. A shiny, pearly white color tympanic membrane C. A clear presence of a cone of light D. A yellow or amber color to the tympanic membrane

Correct Answer is D

Explanation

A) The presence of cerumen in the ear canal:
This is incorrect. The presence of cerumen (earwax) in the ear canal is not inherently abnormal. In fact, cerumen is a natural substance produced by the body to protect and clean the ear canal. While excessive buildup can lead to blockages or hearing impairment, some amount of cerumen is normal and does not indicate an abnormal finding.

B) A shiny, pearly white color tympanic membrane:
This is incorrect. A shiny, pearly white tympanic membrane is a normal finding. This color and appearance indicate a healthy, intact eardrum. The tympanic membrane should be translucent with a smooth surface and this typical pearly appearance in a healthy ear.

C) A clear presence of a cone of light:
This is incorrect. The cone of light is a normal finding during otoscopic examination. It is a reflection of the otoscope light off the tympanic membrane and should be visible in the anterior-inferior quadrant of the tympanic membrane. The presence of the cone of light suggests that the eardrum is intact and in a normal position.

D) A yellow or amber color to the tympanic membrane:
This is the correct answer. A yellow or amber color of the tympanic membrane suggests the presence of fluid behind the eardrum, which may indicate an ear infection or otitis media. This color change is considered abnormal and should prompt further investigation, as it can be a sign of inflammation, infection, or the accumulation of fluid in the middle ear.

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A nurse is caring for a client complaining of throbbing pain in the face, teeth, and cheeks. Upon palpation, the nurse notes swollen turbinates and a purulent discharge the nose. The nurse should recognize that the client's symptoms best correlate with which problem?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is examining a client for tactile fremitus. The nurse should understand that what action is of primary importance when examining for tactile fremitus?

Correct Answer is A

Explanation

A nurse examines a client's auditory canal and tympanic membrane with an otoscope. The nurse should recognize that which of the following is considered an abnormal finding?

Correct Answer is D

Explanation

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