Quiz Questions

HEENT

Question #1

What specific HEENT findings should be monitored during the assessment of an oncology patient, particularly one undergoing radiation therapy to the head and neck region, to identify potential complications such as mucositis, xerostomia, and impact on swallowing and nutrition?

Question #2

A pediatric patient presents to the craniofacial clinic for a pre-operative evaluation. The child has been diagnosed with Crouzon Syndrome (see photo). Based on your knowledge of Crouzon Syndrome, how many surgical procedures would you expect in this child’s future? Name and describe at least one of the potential procedures.

BONUS: What would be the rationale for surgical repair/reconstruction?

Question #3

A 30-year-old female presents to an urgent care reporting an all encompassing headache that has been constant in nature for approximately 1 week. Per the patient, nothing seems to make the headache feel better, though she reports laying down makes it feel worse. The headache is pulsatile, with her often feeling as if she can hear her blood gushing in her head. The day of presentation, she noted that her visual field has seemed to narrow, which has caused her alarm.

1. What eye assessment would you as the nurse perform to test her peripheral vision? What would constitute as an abnormal test result?

Based upon your assessment, the patient has an urgent referral to a neuro-ophthalmologist the next day and visual acuity testing is performed. The following is seen on her eye exams bilaterally (see the image on right):

2. What is the concern seen here on eye exam?
3. Based on this exam and her reports of headaches, what would you expect could happen next with this patient in terms of diagnostics and treatment?

Question #4

Peter, a 58-year-old man, presents to urgent care with a sudden onset of visual disturbances in his right eye. He describes seeing flashes of light and an increase in floaters earlier in the day, followed by what he describes as a "curtain coming down" over part of his visual field. He denies pain, redness, or discharge. His past medical history includes high myopia and cataract surgery two years ago. Based on Peter's symptoms and physical assessment, what is the most likely diagnosis, what is the most appropriate treatment option for this condition, and what recovery instructions should the nurse be sure to explain?

Question #5

You are a public health pediatric RN at West Gate Health Center and you are rooming a 2-year-old boy who was brought by his father to your clinic because he noted his son to have fever of 100.4 F, increased irritability, decreased appetite, trouble sleeping and has been incessantly crying for the past three days. While in bed, you noticed that the child is withdrawn and frequently pulls and tug his left ear (Figure 1). You also noticed a yellow discharge coming from his left ear accompanied by edema and redness of the ear canal. The father also mentioned that about two weeks ago they passed by the UW Quad and briefly checked the cherry blossoms which triggered the child’s allergies to pollen and exacerbated his asthma. The child had runny nose and productive cough for almost a week which then eventually resolved.

A new resident MD, Aldrin entered the room and briefly assessed the patient and concluded that the child’s symptoms are expected and part of his developmental milestones as a toddler and the pain and fever should resolve in few days with some OTC meds like Tylenol and Ibuprofen. You approached Dr. Aldrin while he prepares the child’s AVS and requested him to reconsider his decision. Based on the child’s distressing signs and symptoms, what common childhood infection would you want MD Aldrin to consider and when asked, how would you simply discuss its pathophysiology and suggestive measures of treatment?

Question #6

You are a school nurse and a 3-year-old preschool student is sent to the nurses office by their teacher. The teacher reports that the child has been frequently touching their ear, appears distracted, is not responding when called, and expresses concern by stating, “I think they may have an ear infection but is not telling me they have any pain.” Upon reviewing the student’s attendance record, you note that they were absent for two days earlier this week due to a cold. When looking at the students’ ear you noticed that they have bilateral membrane bulging, fluid buildup and discoloration of the membrane (see photo).

Question:

Based on the teacher’s observations and the student’s recent illness, what assessments should the school nurse perform? What ear condition would be the primary concern in this situation? Would you need to send the student home? What can you do for them at school?

Image retrieved from BMJ Best Practice

Question #7

Parents bring their six-year old daughter to the otolaryngologist for a history of mild snoring, occasional apnea over the last year, and recent left ear hearing loss. On exam, the otolaryngologist sees fluid in her left ear and diagnoses a chronic serous otitis media. Her tonsils also appear enlarged.

What recommendation is the provider likely to give in accordance with the American Academy of Pediatrics guidelines?

What patient/family education will you provide this nervous family surrounding this intervention?

Question #8

Lisa is a 62-year-old woman with a complex medical history who arrived in Seattle two days ago to visit her daughter. Overnight Lisa woke up to go to the bathroom and became dizzy. She states, “I couldn’t tell what was happening, the room was moving backwards, forwards, and sideways all at once.” She lowered herself to the ground and crawled back to bed. In the morning, she woke up and her daughter took her to your urgent care clinic for further evaluation upon hearing about the event. She says she feels better now but is still a little dizzy, her ears are ringing, and you notice that she asks you to repeat questions several times. She states that this has never happened before and there are no recent changes to any of her medications.

What is your differential diagnosis and what intervention do you expect next?

a. Orthostatic hypotension – take orthostatic blood pressures and provide patient education
b. Cerumen impaction – inspect ear canal with an otoscope and perform irrigation
c. Inappropriate levothyroxine dose – check TSH levels and refer patient to endocrinologist
d. Medication side effects – review Lisa’s medication list and look for potential interactions

Explain the rationale for your answer.

Integumentary

Question #9

You receive a patient from PACU who just had a minimally invasive spine surgery. The patient is alert, oriented, and complaining of mild pain. You assess your patient’s surgical site, and the dressing looks clean, dry, and intact. However, you notice a singular 9 mm mole-like spot on your patient’s left upper back and no other moles on his body. According to the patient’s chart, his history includes hypertension, HIV, and asthma. You ask the patient if they are aware of the mole on their back and they said they yes, but it wasn’t that big before. You take a photo to be uploading into their chart for the provider to review.

1. What description would you include with the photo?
2. What do you suspect and why?
3. What additional history would you ask the patient to support your suspicion? Give at least 3.

Question #10

John, a 45-year-old man, came into the clinic because his wife noticed an irregularly shaped mole (nevus) on his back. He generally has a large number of moles on his body and didn’t think anything of it, but his wife was concerned because the one on his back does not look like the others. John’s mother has a history of melanoma, and he works outside daily in construction.

As his nurse, what features of the nevus would you assess? How would you know if this was a normal nevus, atypical/dysplastic mole, or melanoma?

Question #11

John is a 45-year-old male with a past medical history of type II diabetes and asthma who was in a motor vehicle accident one month ago. The accident caused injury to his spinal cord at T-5 which has paralyzed John. Before today, John was too medically unstable to be able to tolerate turning. While performing your skin assessment, you find a pressure injury on John’s sacrum. Based on the image, what stage of pressure injury does John have on his sacrum (please also state your rationale for your answer)? What are three interventions that could be used to help treat John’s pressure ulcer?

Question #12

A 26-year-old woman presents to her primary care provider (PCP) with months of fatigue, anxiety, depression, forgetfulness, weight loss, sleep disturbance, dry eyes, muscle weakness, joint pain, and swelling in the ankles following an extended period of standing. Although not active now, she also reports a diffuse mild rash that occurs randomly and discoloration that becomes prominent when sitting in the sun for too long (reference images). The provider referred her to a rheumatologist and ordered some diagnostic lab work.

What is the likely diagnosis based on these symptoms? Name at least three labs (there are quite a few) you would expect to be ordered to confirm the diagnosis.

Question #13

A 30-year-old male came to the ER with complaints of painful abscesses on his right arm and left thigh, which he believes are the results of recent unsafe injection of a drug. His last infection was 24 hours ago, and he mentions using a dirty needle he found at a friend's house. He reports fever, chills and increased pain in the abscessed areas. the abscesses are red, swollen and tender to touch, and he describes the drainage as pus-like. patient has hx of several infections related to the abscesses from the injections, some of which required hospitalization. this time he was too tired to go to the ER to seek medical help. His girlfriend found him shivering in fever at his friend's house and brought him to the ER. upon arrival to the ER, pt had elevated BP 170/90 , HR 110bmp, no heart murmur and Temp 101.2f, RR 18 and 98% on RA. appeared ill, erythema and swelling noted on his right arm with some Purulent discharge, tenderness and warmth. left thigh has similar presentation but wound was much bigger than the right arm. he also had swollen lymph nodes in his left inguinal area.

briefly describe the following questions. looking for basic information for the answers.

What kind of diagnosis are you expecting?
What labs and diagnostic tests will the ER provider going to order?
What are the nursing priorities for this patient?

Question #14

One day, the parents noticed a black line on their 9-year-old daughter's nail but were unsure how long it had been there. There was no previous history of skin or nail issues. The parents initially thought it might be due to an accidental injury, so they decided to wait and observe. A few months later, the black line was still present, even though the nail continued to grow. They then decided to take their daughter to see a dermatologist.

What kind of diagnosis would you rule out first and why? Describe this disease in a short paragraph.

Question #15

Scenario:

You are a nurse in an outpatient clinic setting. Mr. Smith, a 67-year-old man with a history of hypertension, presents for his physical. He has recently been prescribed a new medication, and you are responsible for providing patient education regarding this change. During your assessment, you record the following vital signs: BP 158/92 (MAP 114), HR 72, SpO₂ 97%. Mr. Smith has a history of smoking 1 pack per day for 15 years, and he stopped smoking 10 years ago.

As you continue your evaluation, you observe bulbous, rounded fingernails with noticeable curvature and softening of the nail beds, which are consistent with digital clubbing. When you mention this to Mr. Smith, he replies, “Yeah, I’ve noticed my nails have been looking different lately. I’ve also been feeling more out of breath than usual when I walk to the bathroom, but I figured it was just because I’m getting older.”

Questions:

Based on your clinical findings and the patient’s comments, answer the following:

1) Apply your knowledge of physical assessment and pathophysiology to interpret the clinical significance of this finding in Mr. Smith. Identify and briefly explain at least one potential underlying cause that could be considered, given his normal SpO₂, new-onset dyspnea, and history of smoking.
2) As the nurse in this setting, what are your top two clinical priorities for this patient? Describe how you would escalate your findings and collaborate with the provider.

Lymphatic

Question #16

You are caring for a 17-year-old named Nigel who was referred to the ED by his PCP and ultimately admitted for enlarged lymph nodes and abnormal lab values with strong suspicion for lymphoma. Nigel is otherwise asymptomatic. On physical assessment you note palpable lymphadenopathy of left cervical supraclavicular nodes and right inguinal nodes. Biopsies from both sites confirm the presence of Reed-Sternberg Cells.

Which type of lymphoma is characterized by the presence of Reed-Sternberg Cells? Why is this finding significant in establishing a diagnosis?

Considering your nursing assessment of the lymph nodes, how would you expect Nigel’s lymphoma to be staged? How does the distribution of the affected lymph nodes affect staging for Nigel’s Diagnosis?

Question #17

Michael, a 24-year-old previously healthy male, presents to the ED with complaints of intermittent fevers over the past 3 weeks, significant night sweats that soak through his sheets, and unintentional weight loss of approximately 10 pounds. He reports feeling fatigued and describes a persistent, painless swelling in the left side of his neck that he noticed about a month ago. He denies recent travel, sick contacts, or drug use.

On physical exam, the nurse notes:

Enlarged, firm, non-tender left cervical lymph node (approx. 2.5 cm)
Pale skin tone
Vitals: T 38.4°C (101.1°F), HR 98, BP 120/74, RR 18, SpO₂ 98% RA
No signs of acute respiratory distress or hemodynamic instability

Past medical history is unremarkable. No known allergies. No current medications.

Initial nursing actions include:

Vital signs monitoring
Detailed health history and symptom review
Preparing patient for labs (CBC, ESR, LDH) and imaging (chest X-ray/CT if ordered)
Patient education and reassurance

What assessment findings and reported symptoms should lead the nurse to suspect Hodgkin’s Lymphoma in this patient, and what priority nursing actions should follow?

Question #18

A 29-year-old female presents to your clinic complaining of heart palpitations, weight loss, and heat intolerance. She states that despite having a bigger appetite than usual, she has lost 9 pounds in the last 5 weeks. The patient also states that her menstrual periods have become irregular and has difficulty sleeping. She denies recent travel, infections, and medication changes. You perform your physical assessment and find the following:

Vital signs: HR: 106 bpm, BP: 130/76 mmHg, Temp: 37.6°C/99.7°F
Skin: Warm and moist
Eyes: (+) mild exophthalmos
Thyroid: Diffusely enlarged, non-tender, no nodules
Hands: Fine tremor on outstretched hands
(-) pregnancy test

Laboratory investigations requested by her physician revealed the following results:

Questions:

1. Describe how to properly examine the thyroid gland from behind.
2. What is the most likely diagnosis for this patient?
3. What medications are expected to be prescribed for this patient’s diagnosis (answer to question #1)? Please list at least one medication and rationale for giving this certain medication.

Question #19

A 43-year-old female presents to an urgent care clinic with swelling of the supraclavicular lymph nodes on the right side. The patient states she has been managing intense fatigue and though typically goes to the gym 4-5 times weekly, has only managed to take walks with her dog once a day for the past few weeks. She reports feeling feverish and chilly in the evenings, though her temperature has not been elevated when measured. The patient states the swelling has been going on for about 2 weeks.

Upon visual examination, the patient appears asymmetrical when comparing the left and right sides of the neck and shoulders near the clavicles. The patient reports no pain upon palpation of the swelling. The patient’s vitals are all within defined limits including temperature. The patient’s lung sounds are clear bilaterally and the patient denies other symptoms of viral infection such as nausea, diarrhea, congestion, or sore throat.

The physician orders testing for COVID, flu, and mononucleosis. All viral tests return negative and the physician orders a chest x-ray. You. Are the urgent care nurse caring for this patient and she asks you, “Why is the doctor ordering a chest x-ray?” What education might you provide to this patient about the function of lymph nodes and the rationale for doing x-ray imaging at this stage of the patient’s care?

Question #20

You are a case manager for Mr. Jefferson, 75-year-old male. He went to urgent care with complaints of abdominal pain that has last about 3 months. He reports experiencing nausea intermittently throughout the day and has had several on and off episodes of a UTI in the past months. His past medical history is significant for metastatic melanoma, with known lymph node involvement. He denies any vomiting but has been having changes in his bowel movements and a decrease in his appetite. He appears fatigued and has shared that he is emotional drained.

In his assessment findings, his abdomen is tender in the lower quadrants, no rebound tenderness and mild distension.

As the nursing case manager for Mr. Jefferson and meeting him every other week, place the following nursing actions in order of priority? Explain rationale.

A. Educate the patient about dietary changes to reduce nausea and improve appetite
B. Notify the provider about the persistent abdominal pain and recurrent UTIs
C. Administer anti-nausea medication as prescribed
D. Encourage fluid intake to prevent further urinary tract infections

Page updated

Report abuse