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 C

Explanation

A. XI: Cranial nerve XI, also known as the accessory nerve, is responsible for innervating the sternocleidomastoid and trapezius muscles, which are involved in shoulder and head movement. It does not play a role in tongue movement.

B. V: Cranial nerve V, the trigeminal nerve, is responsible for sensation in the face and motor functions such as biting and chewing. While it is important for overall oral sensation, it does not control tongue movement.

C. XII: Cranial nerve XII, the hypoglossal nerve, is responsible for motor control of the tongue muscles. When the patient sticks out their tongue, the nurse can assess the function of this nerve by observing the tongue's position, movement, and any signs of weakness or atrophy, which can indicate nerve damage.

D. VII: Cranial nerve VII, the facial nerve, is responsible for the muscles of facial expression and taste sensations from the anterior two-thirds of the tongue. Although it contributes to some oral functions, it is not directly involved in the movement of the tongue itself.

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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Correct Answer is C

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