A patient comes into the clinic complaining of facial pain, fever, and malaise. On examination, the nurse notes swollen turbinates and purulent discharge from the nose. The patient also complains of a dull, throbbing pain in his cheeks and teeth on the right side and pain when the nurse palpates the areas. What do these findings indicate?

Maxillary sinusitis

Posterior epistaxis

Frontal sinusitis

Nasal polyps

Answer and Explanation

The Correct Answer is A

A. Maxillary sinusitis: The symptoms described, including facial pain, fever, malaise, swollen turbinates, purulent nasal discharge, and dull, throbbing pain in the cheeks and teeth, are consistent with maxillary sinusitis. The maxillary sinuses are located in the cheeks, and inflammation or infection in this area can lead to referred pain in the teeth and facial areas. Tenderness upon palpation of the maxillary sinus area further supports this diagnosis.

B. Posterior epistaxis: Posterior epistaxis refers to bleeding from the back of the nasal cavity. While it can be associated with nasal pain, it does not typically present with fever, malaise, purulent discharge, or sinus-related pain.

C. Frontal sinusitis: Frontal sinusitis involves inflammation of the frontal sinuses located above the eyes, which may cause pain in the forehead and around the eyes. The patient's complaint of cheek and teeth pain is more indicative of maxillary sinusitis rather than frontal sinusitis.

D. Nasal polyps: Nasal polyps are non-cancerous growths that can occur in the nasal passages or sinuses, often leading to obstruction and difficulty breathing. While they can be associated with sinusitis, the acute presentation of fever, malaise, and purulent discharge, along with facial pain, is more indicative of an active infection, such as maxillary sinusitis.

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Correct Answer is B

Explanation

A. Mitral and pulmonic: The mitral valve closure is best heard at the apex of the heart (the left fifth intercostal space) rather than at the base. The pulmonic valve is indeed located near the base but, combined with the mitral valve, does not represent the sounds best heard at the base of the heart.

B. Aortic and pulmonic: The aortic and pulmonic valves are located at the base of the heart. The aortic valve is located in the right second intercostal space at the sternal border, while the pulmonic valve is located in the left second intercostal space. The closure of these valves (S2) is typically loudest at this area, making this option correct.

C. Mitral and tricuspid: The mitral valve is best heard at the apex, and the tricuspid valve is best heard along the left lower sternal border. Both valves are not located at the base of the heart.

D. Tricuspid and aortic: The tricuspid valve is not located at the base of the heart; it is situated along the left lower sternal border, while the aortic valve is at the base. Therefore, this combination does not represent the best valves to listen for at the base.

A. Insert a nasal tube into each nostril to ensure no blockage is present. B. Refer patient to a nasal specialist to ensure there is not any blockage in the nasal cavity. C. Press each nostril shut and have the patient sniff to ensure air passage through each nostril. D. Have the patient blow their nose into a tissue forcefully.

Correct Answer is C

Explanation

A. Insert a nasal tube into each nostril to ensure no blockage is present: Inserting a nasal tube is an invasive procedure that is not necessary for assessing nostril patency. This method can cause discomfort and does not provide a simple or effective assessment of airflow through the nostrils.

B. Refer patient to a nasal specialist to ensure there is not any blockage in the nasal cavity: Referral to a specialist is unnecessary for a basic assessment of nostril patency. The nurse can perform a simple, non-invasive test before considering a referral for further evaluation.

C. Press each nostril shut and have the patient sniff to ensure air passage through each nostril: This method effectively assesses nostril patency. By occluding one nostril at a time, the nurse can evaluate airflow and determine if there is any blockage or obstruction in the nasal passages. It is a quick and straightforward assessment technique.

D. Have the patient blow their nose into a tissue forcefully: Asking the patient to blow their nose can provide information about mucus presence or drainage but does not specifically assess nostril patency. This action may also cause discomfort and is not the best initial assessment for airflow through the nostrils.

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Naxlex Comprehensive Predictor Exams

When listening to heart sounds, which valve closures are heard best at the base of the heart?

Correct Answer is B

Explanation

The nurse is assessing a patient's nostrils for patency. How should the nurse best perform this assessment?

Correct Answer is C

Explanation

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