A nurse is preforming a focus physical assessment of the head and neck of a 20 year old male client. In assessing the lymph nodes what part of the head and neck should the nurse perform gentle circular motion to assess the occipital lymph nodes?

A) Ptosis: Ptosis refers to the drooping of the upper eyelid, often caused by muscle weakness or nerve damage. It does not describe the condition of unequal pupil sizes, which is the issue in the question. Ptosis affects eyelid position, not the pupil size.

B) Strabismus: Strabismus refers to the misalignment of the eyes, where they do not look in the same direction. This condition can cause one eye to turn inward, outward, upward, or downward, but it does not relate to unequal pupil size. Strabismus is a misalignment issue rather than a size discrepancy of the pupils.

C) Exophthalmos: Exophthalmos refers to the protrusion of the eyeballs, which can occur in conditions like Graves' disease. It does not pertain to unequal pupil sizes, but rather to the positioning of the eyes themselves.

D) Anisocoria: Anisocoria is the term used to describe a condition in which the pupils are unequal in size. This condition can be physiological (normal for some individuals) or pathological, and it can result from various causes such as neurological issues, trauma, or certain medications. This is the appropriate term to document when noting unequal pupil sizes.

A) Bacterial: Bacterial infections in the mouth typically result in symptoms like foul odor, swelling, or pus, but they do not generally cause a black, hairy appearance on the tongue. A black, hairy tongue is more commonly associated with fungal overgrowth or other non-bacterial factors.

B) Fungal: A black, hairy tongue is often caused by an overgrowth of yeast or fungi, particularly Candida. This condition occurs when the normal balance of microorganisms in the mouth is disrupted, leading to the growth of fungi on the tongue’s papillae. These elongated, discolored papillae can trap food, bacteria, and dead cells, leading to a dark, furry appearance.

C) Parasite: Parasitic infections in the mouth are rare and usually cause symptoms such as sores, swelling, or difficulty swallowing, but they do not typically result in a black, hairy tongue. A parasitic infection would have a different set of symptoms and appearance.

D) Viral: Viral infections, such as those caused by the herpes simplex virus, can cause sores or ulcers in the mouth but do not typically cause a black, hairy appearance of the tongue. Viral infections might also cause symptoms like fever, pain, or swelling, but not this specific characteristic.