The nurse is percussing the lungs of a patient.
The nurse knows that percussion over normal adult lungs will reveal:

Choice A rationale

A normocephalic skull indicates a normal head size and shape, not increased intracranial pressure. Increased intracranial pressure typically manifests with symptoms like headache, altered mental status, and papilledema, and may or may not involve changes in head circumference depending on the patient's age and the chronicity of the pressure increase.

Choice B rationale

"Normocephalic" is a clinical term indicating that the patient's head is of a normal size and shape, appearing symmetrical and proportionally related to the rest of the body. This finding suggests the absence of conditions like microcephaly (abnormally small head) or macrocephaly (abnormally large head), reflecting healthy cranial development and morphology.

Choice C rationale

An abnormally large head is termed macrocephaly, which is distinctly different from normocephalic. Macrocephaly can be indicative of various underlying conditions, including hydrocephalus, genetic disorders, or brain tumors, leading to an enlarged skull circumference that deviates significantly from age and gender norms.

Choice D rationale

An abnormally small head is known as microcephaly, which is the opposite of normocephalic. Microcephaly is often associated with impaired brain development and can result from genetic factors, infections during pregnancy, or other congenital conditions, leading to a head circumference significantly below the expected range. .

Choice A rationale

Giving water after a buccal medication would cause the medication to be swallowed. Buccal medications are designed for absorption through the rich vascularization of the buccal mucosa, allowing direct entry into the systemic circulation and bypassing first-pass hepatic metabolism. Swallowing defeats this purpose.

Choice B rationale

Buccal medications are intended to dissolve slowly in the buccal pouch (between the cheek and gums) and be absorbed directly into the bloodstream through the mucous membranes. Consuming water would wash the medication away, leading to premature swallowing and subsequent degradation by gastric enzymes or first-pass metabolism in the liver, thus reducing its therapeutic effect.

Choice C rationale

The client's preference for water does not supersede the pharmacokinetic principles governing buccal medication administration. The route of administration is chosen specifically for its absorption profile, and introducing water compromises the intended local absorption mechanism, regardless of patient comfort.

Choice D rationale

The type of medication is precisely why water should be avoided. Buccal medications, by their very design, rely on sustained contact with the oral mucosa for systemic absorption. Regardless of the specific drug, water interferes with this fundamental mechanism, rendering the buccal route ineffective.