Chapter 10 Head, Eyes, Ears, Nose, and Throat

Chapter 10  Head, Eyes, Ears, Nose, and Throat

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. A patient is admitted with edema of the occipital lobe following a head injury. The nurse correlates which finding with damage to this area?
a.
Ipsilateral ptosis
b.
Impaired vision
c.
Pupillary constriction
d.
Increased intraocular pressure

ANS: B

Feedback
A
Ipsilateral ptosis (drooping of the eye lid) is controlled by the oculomotor cranial nerve (CN III) that is located in the midbrain. The nurse must correlate anatomy with function and assessment.
B
The occipital lobe contains the visual context.
C
Pupillary constriction is controlled by the oculomotor cranial nerve (CN III) that is located in the midbrain.
D
This abnormality is associated with glaucoma rather than injury to the occipital lobe.

DIF: Cognitive Level: Analyze REF: 138
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

2. The nurse is taking a health history on a patient who reports frequent stabbing headaches occurring once a day lasting about an hour. Which statement by the patient is most indicative of cluster headaches?
a.
“I usually have nausea and vomiting with my headaches.”
b.
“My whole head is constantly throbbing.”
c.
“It feels like my head is in a vice.”
d.
“The pain is on the left side over my eye, forehead, and cheek.”

ANS: D

Feedback
A
This is descriptive of migraines rather than cluster headaches.
B
This is descriptive of migraines rather than cluster headaches.
C
This is descriptive of tension rather than cluster headaches.
D
This description is consistent with cluster headaches.

DIF: Cognitive Level: Apply REF: 144
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

3. A patient reports having migraine headaches on one side of the head that often start with an aura and last 1 to 3 days. As a part of the symptom analysis, the patient reports which associated symptoms of migraine headaches?
a.
Nausea, vomiting, or visual disturbances
b.
Nasal stuffiness or discharge
c.
Ringing in the ears or dizziness
d.
Red, watery eyes or drooping eyelids

ANS: A

Feedback
A
These are symptoms associated with migraine headaches.
B
This is a symptom associated with cluster headaches rather than migraine headaches.
C
These symptoms are not associated with migraine headaches.
D
These are symptoms associated with cluster headaches rather than migraine headaches.

DIF: Cognitive Level: Analyze REF: 144
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

4. The nurse is taking a health history on a patient who reports frequent headaches with pain in the front of the head, but sometimes felt in the back of the head. Which statement by the patient is most indicative of tension headaches?
a.
“I usually have nausea and vomiting with my headaches.”
b.
“My whole head is constantly throbbing.”
c.
“It feels like my head is in a vice.”
d.
“The pain is on the left side over my eye, forehead, and cheek.”

ANS: C

Feedback
A
This is descriptive of migraines rather than tension headaches.
B
This is descriptive of migraines rather than tension headaches.
C
This is descriptive of tension headaches, which is consistent with the rest of the data reported by the patient.
D
This is consistent with cluster headaches rather than tension headaches.

DIF: Cognitive Level: Apply REF: 144
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems

5. During symptom analysis, the nurse helps the patient distinguish between dizziness and vertigo. Which description by the patient indicates vertigo?
a.
“I felt faint, like I was going to pass out.”
b.
“I just could not keep my balance when I sat up.”
c.
“It seemed that the room was spinning around.”
d.
“I was afraid that I was going to lose consciousness.”

ANS: C

Feedback
A
This is a description of lightheadedness, a form of dizziness.
B
This is a description of disequilibrium, a form of dizziness.
C
This is consistent with vertigo because it includes a sensation of motion.
D
This is a description of syncope, a form of dizziness.

DIF: Cognitive Level: Analyze REF: 144
TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Physiologic Integrity: Physiologic Adaptation: Alteration in Body Systems