HEENT Assessment with
correct answers
2025/2026
The nurse palpates the lymph nodes of a child. The lymph nodes are palpable, 0.5 cm, and firm.
How should the nurse interpret this finding? - Correct answerThese assessment findings are
considered normal for the pediatric patient.Children often have small, palpable, firm lymph
nodes. This is considered a normal assessment finding.
The pediatric nurse assesses a newborn and notes strabismus. What should be the nurse's initial
response? - Correct answerContinue to monitor the newborn for vision problems.
Strabismus is a normal finding in a newborn but should be transient. The nurse should continue
to assess for any other vision problems or consistent strabismus.
, The nurse is concerned that the infant may have microcephaly. What should be the nurse's
initial action? - Correct answerMeasure the newborn's head circumference.Measuring head
circumference will give an indication if the child has microcephaly. This measurement needs to
be done at every visit for the first two years of life
A 5-year-old child is nervous about having his mouth inspected. What is the best action for the
nurse to take before beginning the assessment? - Correct answerDemonstrate the assessment
on the parent of the child so the child can see that it does not cause pain.
A 5-year-old will likely feel less anxious after seeing what the exam entails and how it is going to
be performed on a trusted caregiver such as a parent.
The nurse is preparing a 4-year-old for an internal ear exam. How should the nurse position the
child? - Correct answerThe head of the child should be slightly tilted and the pinna pulled up
and back.
The pinna should be pulled up and back for children older than 3.
The nurse is preparing for vision screening on an 8-year-old. What assessment tools should the
nurse use?Select all that apply. - Correct answerAn eye cover
An eye cover is used for several vision tests including the Snellen chart.
A Snellen chart
A Snellen chart is appropriate for testing the visual acuity of an 8-year-old.
An Ishihara chart
The nurse should be prepared to perform this screening of color vision because it should be
performed at least once between the ages of 4 and 8.
A nondistracting environmentAny screenings should be performed in a nondistracting
environment to help increase accuracy and efficiency of the examination.
The parents of a 5-year-old child bring her into the health care provider's office because of
concerns about her performance in kindergarten. The parents say she is bright but seems to be
correct answers
2025/2026
The nurse palpates the lymph nodes of a child. The lymph nodes are palpable, 0.5 cm, and firm.
How should the nurse interpret this finding? - Correct answerThese assessment findings are
considered normal for the pediatric patient.Children often have small, palpable, firm lymph
nodes. This is considered a normal assessment finding.
The pediatric nurse assesses a newborn and notes strabismus. What should be the nurse's initial
response? - Correct answerContinue to monitor the newborn for vision problems.
Strabismus is a normal finding in a newborn but should be transient. The nurse should continue
to assess for any other vision problems or consistent strabismus.
, The nurse is concerned that the infant may have microcephaly. What should be the nurse's
initial action? - Correct answerMeasure the newborn's head circumference.Measuring head
circumference will give an indication if the child has microcephaly. This measurement needs to
be done at every visit for the first two years of life
A 5-year-old child is nervous about having his mouth inspected. What is the best action for the
nurse to take before beginning the assessment? - Correct answerDemonstrate the assessment
on the parent of the child so the child can see that it does not cause pain.
A 5-year-old will likely feel less anxious after seeing what the exam entails and how it is going to
be performed on a trusted caregiver such as a parent.
The nurse is preparing a 4-year-old for an internal ear exam. How should the nurse position the
child? - Correct answerThe head of the child should be slightly tilted and the pinna pulled up
and back.
The pinna should be pulled up and back for children older than 3.
The nurse is preparing for vision screening on an 8-year-old. What assessment tools should the
nurse use?Select all that apply. - Correct answerAn eye cover
An eye cover is used for several vision tests including the Snellen chart.
A Snellen chart
A Snellen chart is appropriate for testing the visual acuity of an 8-year-old.
An Ishihara chart
The nurse should be prepared to perform this screening of color vision because it should be
performed at least once between the ages of 4 and 8.
A nondistracting environmentAny screenings should be performed in a nondistracting
environment to help increase accuracy and efficiency of the examination.
The parents of a 5-year-old child bring her into the health care provider's office because of
concerns about her performance in kindergarten. The parents say she is bright but seems to be
