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

Answer and Explanation

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.

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Correct Answer is B

Explanation

A. Top-to-bottom comparison: Systematic progression from top to bottom is important, but it does not ensure direct comparison between corresponding lung fields. Without a side-to-side comparison, asymmetrical lung sounds may go unnoticed, leading to an incomplete assessment.

B. Side-to-side comparison: The correct method for auscultation is to compare lung sounds bilaterally, moving from one side to the other at each level. This approach helps identify asymmetries, such as unilateral crackles, wheezing, or decreased breath sounds, which may indicate conditions like pneumonia, pleural effusion, or pneumothorax. A zigzag pattern from right to left ensures an accurate evaluation of lung symmetry.

C. Posterior-to-anterior comparison: While both anterior and posterior thoracic assessments are necessary, comparing sounds from posterior to anterior does not ensure side-to-side evaluation. Since lung sounds can vary based on body positioning and structure, direct lateral comparisons are essential for detecting differences.

D. Interspace-by-interspace comparison: Although breath sounds should be assessed at each intercostal space, a method focusing only on progressing downward would miss direct left-to-right comparisons. Identifying localized abnormalities requires listening at the same level on both sides before moving downward.

A. intercostals B. scalene C. sternomastoid D. diaphragm E. pectoralis major

Correct Answer is ["A","D"]

Explanation

A. Intercostals: The intercostal muscles, including the external and internal intercostals, are primary muscles of respiration. They play a crucial role in expanding and contracting the thoracic cavity during inhalation and exhalation, facilitating airflow into and out of the lungs.

B. Scalene: The scalene muscles assist in elevating the first two ribs during deep inhalation, making them accessory muscles of respiration rather than primary muscles. They support breathing but are not the main muscles involved in the normal respiratory cycle.

C. Sternomastoid: The sternocleidomastoid muscles are also considered accessory muscles of respiration. They help elevate the sternum during forced inhalation, but they are not classified as primary muscles of respiration, which are more involved in the regular breathing process.

D. Diaphragm: The diaphragm is the primary muscle of respiration and is crucial for normal breathing. It contracts and flattens during inhalation, increasing the volume of the thoracic cavity and allowing air to flow into the lungs. This muscle is essential for the majority of airflow during normal breathing.

E. Pectoralis major: The pectoralis major is primarily involved in shoulder movement and is not a primary muscle of respiration. Although it can assist during forceful inhalation when the arms are raised, it does not function as a main muscle in the respiratory process.

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Naxlex Comprehensive Predictor Exams

The nurse is observing the auscultation technique of a student nurse. What is the correct method to use when progressing from one auscultatory site on the thorax to another?

Correct Answer is B

Explanation

Which of the following are the PRIMARY muscles of respiration? (Select All that Apply.)

Correct Answer is ["A","D"]

Explanation

The nurse is reviewing the development of the newborn infant. Regarding the sinuses, which statement is true in relation to a newborn infant?

In performing a voice test to assess hearing, which of these actions would the nurse perform?

The nurse is performing an otoscopic examination on an adult. Which of these actions is correct?

Which of the following tests could be used to assess the acoustic nerve? (Select All that Apply.)

During an examination of a female patient, the nurse notes lymphadenopathy and suspects an acute infection. How do acutely infected lymph nodes typically appear?

A nurse is assessing a patient with a complaint of cold and sinus pain. Which sinuses would the nurse palpate?

A 20 year old male patient reports loss of interest and depressed mood during his appointment. The nurse would utilize what screening tool to further evaluate the patient?