NR 509 - Advanced Physical Assessment
Midterm Exam
1.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 something terribly wrong? The nurses 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 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 babys life.
ANS: D
2. Membrane-covered soft spots allow for growth of the brain during the first year
of life. 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.
,The nurse notices that a patients palpebral fissures are not symmetric. On
examination, the nurse may find that damage has occurred to which cranial nerve
(CN)?
a. III
b. V
c. VII
d. VIII
ANS: C
Facial muscles are mediated by CN VII; asymmetry of palpebral fissures may be
attributable to damage to CN VII (Bell palsy).
3. A patient is unable to differentiate between sharp and dull stimulation to both
sides of her face. The nurse suspects:
a. Bell palsy.
b. Damage to the trigeminal nerve.
c. Frostbite with resultant paresthesia to the cheeks.
d. Scleroderma.
ANS: B
Facial sensations of pain or touch are mediated by CN V, which is the trigeminal
, nerve. Bell palsy is associated with CN VII damage. Frostbite and scleroderma are
not associated with this problem.
4. When examining the face of a patient, the nurse is aware that the two pairs of
salivary glands that are accessible to examination are the ___________ and
___________ glands.
a. Occipital; submental
b. Parotid; jugulodigastric
c. Parotid; submandibular
d. Submandibular; occipital
ANS: C
Two pairs of salivary glands accessible to examination on the face are the parotid
glands, which are in the cheeks over the mandible, anterior to and below the ear;
and the submandibular glands, which are beneath the mandible at the angle of the
jaw. The parotid glands are normally nonpalpable.
5. A patient comes to the clinic complaining of neck and shoulder pain and is
unable to turn her head. The nurse suspects damage to CN ______ and proceeds
with the examination by _____________.
a. XI; palpating the anterior and posterior triangles
b. XI; asking the patient to shrug her shoulders against resistance
Midterm Exam
1.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 something terribly wrong? The nurses 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 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 babys life.
ANS: D
2. Membrane-covered soft spots allow for growth of the brain during the first year
of life. 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.
,The nurse notices that a patients palpebral fissures are not symmetric. On
examination, the nurse may find that damage has occurred to which cranial nerve
(CN)?
a. III
b. V
c. VII
d. VIII
ANS: C
Facial muscles are mediated by CN VII; asymmetry of palpebral fissures may be
attributable to damage to CN VII (Bell palsy).
3. A patient is unable to differentiate between sharp and dull stimulation to both
sides of her face. The nurse suspects:
a. Bell palsy.
b. Damage to the trigeminal nerve.
c. Frostbite with resultant paresthesia to the cheeks.
d. Scleroderma.
ANS: B
Facial sensations of pain or touch are mediated by CN V, which is the trigeminal
, nerve. Bell palsy is associated with CN VII damage. Frostbite and scleroderma are
not associated with this problem.
4. When examining the face of a patient, the nurse is aware that the two pairs of
salivary glands that are accessible to examination are the ___________ and
___________ glands.
a. Occipital; submental
b. Parotid; jugulodigastric
c. Parotid; submandibular
d. Submandibular; occipital
ANS: C
Two pairs of salivary glands accessible to examination on the face are the parotid
glands, which are in the cheeks over the mandible, anterior to and below the ear;
and the submandibular glands, which are beneath the mandible at the angle of the
jaw. The parotid glands are normally nonpalpable.
5. A patient comes to the clinic complaining of neck and shoulder pain and is
unable to turn her head. The nurse suspects damage to CN ______ and proceeds
with the examination by _____________.
a. XI; palpating the anterior and posterior triangles
b. XI; asking the patient to shrug her shoulders against resistance
