A client reports experiencing chronic headaches after a recent upper respiratory tract infection. On physical examination, the nurse notes tenderness when palpating over the sinuses. Which condition is likely?

Rhinitis medicamentosa

Acute bacterial sinusitis

Epistaxis

Allergic rhinitis

Answer and Explanation

The Correct Answer is B

Choice A Reason:
Rhinitis medicamentosa, also known as rebound congestion, is a condition of nasal congestion without other cold or allergy symptoms, typically caused by the overuse of nasal decongestant sprays. It does not usually present with chronic headaches or tenderness over the sinuses, which are more indicative of sinusitis.

Choice B Reason:
Acute bacterial sinusitis is likely the correct diagnosis in this scenario. It often follows a viral upper respiratory infection and presents with symptoms such as thick, discolored nasal mucus, decreased sense of smell, and facial pain or tenderness over the affected sinuses. The chronic headache and noted tenderness upon palpation over the sinuses in the client are consistent with this condition.

Choice C Reason:
Epistaxis, or nosebleed, is bleeding from the nose that can be caused by various factors, including trauma, medication, or environmental conditions. While it can be a symptom of other nasal conditions, it is not typically associated with chronic headaches or sinus tenderness following an upper respiratory infection.

Choice D Reason:
Allergic rhinitis is an allergic reaction to allergens such as pollen, dust, or pet dander, causing symptoms like sneezing, runny nose, itchy eyes, and sometimes headaches. However, the chronic headache and sinus tenderness described by the client after an infection are more suggestive of sinusitis rather than allergic rhinitis.

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Correct Answer is B

Explanation

Choice A Reason:
Angular cheilitis is characterized by inflammation of one or both corners of the mouth. It often presents as red, swollen patches in the corners of the mouth and can be associated with fungal or bacterial infection. However, it does not typically cause vesicular eruptions, which are more indicative of viral infections like herpes simplex.

Choice B Reason:
Herpes simplex virus (HSV) is known for causing vesicular eruptions, commonly referred to as cold sores or fever blisters, around the lips and mouth area. These eruptions are fluid-filled blisters that can be painful and are highly indicative of an HSV infection, particularly HSV type 1, which commonly affects the oral region.

Choice C Reason:
Angioedema involves the rapid swelling of the deeper layers of the skin, often seen with hives. While it can affect the lips and surrounding areas, it does not cause vesicular eruptions. Angioedema is more associated with allergic reactions and can be part of anaphylaxis, a severe systemic reaction.

A. Review of Systems B. Chief Complaint C. History of Present Illness D. Past Medical History

Correct Answer is C

Explanation

Choice A Reason:
The Review of Systems (ROS) is a systematic approach for collecting the patient's self-reported data on all body systems. It is not typically where the narrative of symptoms is documented. Instead, the ROS is used to uncover symptoms the patient may not have mentioned during the initial recounting of their history.

Choice B Reason:
The Chief Complaint (CC) is a concise statement describing the symptom, problem, condition, diagnosis, or other factors that are the reason for the encounter, usually stated in the patient's words¹. While it does include the symptom prompting the visit, it is not the section where a detailed narrative or description of symptoms is provided.

Choice C Reason:
The History of Present Illness (HPI) is indeed where the detailed narrative of the patient's symptoms is documented. It includes the onset of the problem, the setting in which it developed, its manifestations, and any treatments to date. The HPI tells the story of the patient's chief complaint and provides context for the clinical reasoning process.

Choice D Reason:
The Past Medical History (PMH) includes information about the patient's past experiences with illnesses, operations, injuries, and treatments. It does not contain the current symptoms' narrative but rather the patient's health status before the present illness or concern.

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A client reports experiencing chronic headaches after a recent upper respiratory tract infection. On physical examination, the nurse notes tenderness when palpating over the sinuses. Which condition is likely?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

During the physical examination of the mouth, the nurse identifies vesicular eruptions along the client's lips and surrounding skin. Which problem should the nurse document?

Correct Answer is B

Explanation

During a health history assessment, where is the symptoms description/narrative typically documented?

Correct Answer is C

Explanation

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