The nurse is performing an assessment on a 7-year-old child who has symptoms of chronic watery eyes, sneezing, and clear nasal drainage. The nurse notices the presence of a transverse line across the bridge of the nose, dark blue shadows below the eyes, and a double crease on the lower eyelids. What does the nurse suspect is the cause of these signs and symptoms?
Lymphadenopathy
Nasal congestion
Upper respiratory infection
Chronic allergies
The Correct Answer is D
A. Lymphadenopathy: Enlarged lymph nodes typically indicate an immune response to infection or inflammation. While allergies can cause mild lymph node enlargement due to chronic irritation, they do not directly cause the characteristic facial signs described, such as the transverse nasal crease and allergic shiners.
B. Nasal congestion: Nasal congestion is a symptom rather than a primary diagnosis. Although allergies can cause nasal congestion, the child exhibits additional hallmark signs of allergic rhinitis, including allergic shiners, Dennie-Morgan lines, and a nasal crease, suggesting a chronic allergic process rather than isolated congestion.
C. Upper respiratory infection: Viral upper respiratory infections (URIs) can cause nasal congestion, sneezing, and watery eyes, but they are usually short-lived and accompanied by fever, malaise, or yellow-green nasal discharge. The presence of a nasal crease and allergic shiners suggests a chronic process like allergic rhinitis rather than an acute infection.
D. Chronic allergies: The presence of a transverse nasal crease from frequent "allergic salute" rubbing, dark periorbital circles (allergic shiners) due to venous congestion, and Dennie-Morgan lines (double creases under the eyes) are classic findings in allergic rhinitis. These symptoms, along with watery eyes and clear nasal drainage, strongly indicate a chronic allergic condition rather than an infectious cause.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
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.
Correct Answer is D
Explanation
A. Nystagmus in extreme superior gaze: A few beats of nystagmus in extreme lateral gaze may be normal, but sustained nystagmus, especially in superior gaze, suggests neurological impairment such as vestibular dysfunction or multiple sclerosis.
B. Slight amount of lid lag when moving the eyes from a superior to an inferior position: Lid lag, where the upper eyelid lags behind the downward movement of the eye, is often associated with hyperthyroidism (e.g., Graves' disease). It is not a normal finding in the diagnostic positions test.
C. Convergence of the eyes: Convergence is assessed when a person focuses on a near object, such as during an accommodation test. The diagnostic positions test evaluates extraocular muscle function and cranial nerves III, IV, and VI, focusing on coordinated movement rather than convergence.
D. Parallel/synchronized movement of both eyes: The normal finding in the diagnostic positions test is smooth, coordinated movement of both eyes in all six cardinal directions without lagging, misalignment, or significant nystagmus. This indicates intact extraocular muscles and proper cranial nerve function.
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