ATI TESTING QUESTIONS EXAM 3 HEALTH ASSESSMENT

A physician tells the nurse that a patient's vertebra prominens is tender and asks the nurse to reevaluate the area in 1 hour. The area of the body the nurse will assess is the area: A) just above the diaphragm. B) just lateral to the knee cap. C) at the level of the C7 vertebra. D)at the level of the T11 vertebra. CThe C7 vertebra has a long spinous process, called the vertebra prominens, that is palpable when the head is flexed. A mother brings her 2-month-old daughter in for an examination and says, "My daughter rolled over against the wall and now I have noticed that she has this spot that is soft on the top of her head. Is there something terribly wrong?" The nurse's best response would be: A)"Perhaps that could be a result of your dietary intake during pregnancy." B)"Your baby may have craniosynostosis, a disease of the sutures of the brain." C)"That 'soft spot' you are referring to may be an indication of cretinism or congenital hypothyroidism." D)"That 'soft spot' is normal, and actually allows for growth of the brain during the first year of your baby's life." D Membrane-covered "soft spots" allow for growth of the brain during the first year. They gradually ossify; the triangular-shaped posterior fontanel is closed by 1 to 2 months, and the diamond-shaped anterior fontanel closes between 9 months and 2 years. 5 Sanity-Saving Tips for Arguing on the Internet 0:07/1:27 EXAM The nurse notices that a patient's palpebral fissures are not symmetrical. On examination, the nurse may find that there has been damage to cranial nerve: A)III. B)V. C)VII. D)VIII. C Facial muscles are mediated by cranial nerve (CN) VII; asymmetry of palpebral fissures may be due to CN VII damage (Bell's palsy). We have an expert-written solution to this problem! A patient is unable to differentiate between sharp and dull stimulation to both sides of her face. The nurse suspects: A)Bell's palsy. B)damage to the trigeminal nerve. C)frostbite with resultant paresthesia to the cheeks. D)scleroderma. B Facial sensations of pain or touch are mediated by cranial nerve (CN) V, which is the trigeminal nerve. Bell's palsy is associated with CN VII damage. Frostbite and scleroderma are not associated this problem.