A nurse is performing a lymphatic system assessment on a client reporting fatigue and malaise for one week. In which order should the nurse perform the head to toe assessments? Indicate the correct order from first to last. All options must be used.

Palpate the popliteal nodes

Palpate the preauricular nodes

Palpate the axillary nodes

Palpate the submandibular nodes

Palpate the supraclavicular nodes

Answer and Explanation

The Correct Answer is {"A":{"answers":"E"},"B":{"answers":"A"},"C":{"answers":"D"},"D":{"answers":"B"},"E":{"answers":"C"}}

Palpate the preauricular nodes (1st):

The preauricular lymph nodes are located in front of the ears, near the temple. The nurse starts at the head and neck to assess the regional nodes. Palpation of the preauricular nodes is often performed first because they are closest to the head and may be involved in infections affecting the eyes, ears, or sinuses.

Palpate the submandibular nodes (2nd):

The submandibular nodes are located beneath the jaw and are often involved in respiratory or oral infections. They are assessed after the preauricular nodes, as they are still part of the head and neck region, just below the chin.

Palpate the supraclavicular nodes (5th):

These nodes are located above the clavicle and are often associated with more serious conditions, such as cancer. Assessing them early in the examination can help identify any potential red flags.

Palpate the axillary nodes (3rd):

The axillary lymph nodes are located in the armpits and are important for breast tissue, upper limb, and chest infections. These are assessed after the head and neck nodes because they are part of the upper body region and located further down, near the chest.

Palpate the popliteal nodes (4th):

The popliteal nodes are located behind the knees. These nodes are assessed next, as part of the lower extremity examination. Palpating these nodes after the axillary nodes ensures a thorough systematic approach from upper to lower body.

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Correct Answer is B

Explanation

A. Exophthalmos, or bulging eyes, is associated with hyperthyroidism (such as in Graves' disease), not acromegaly.
B. This is a hallmark sign of acromegaly. People with acromegaly often develop coarse, enlarged facial features (e.g., thickened lips, enlarged nose, protruding jaw, and enlarged tongue), which occur due to excess growth hormone.
C. While acromegaly can cause abnormal bone growth, especially in the hands and feet, it does not typically result in bowed long bones. This would be more suggestive of conditions like rickets or osteomalacia.
D. While acromegaly can lead to changes in the skull, it does not typically result in a distinctly acorn- shaped cranium. This is not a primary diagnostic feature of acromegaly.

A. Increased tactile fremitus and dull percussion tones. B. Muffled voice sounds and symmetric tactile fremitus. C. Adventitious sounds and limited chest expansion. D. Absent voice sounds and hyper resonant percussion tones.

Correct Answer is B

Explanation

A. Increased tactile fremitus and dull percussion tones would suggest consolidation or pathology, which is not normal.
B. Muffled voice sounds and symmetric tactile fremitus are normal findings in healthy lung tissue.
C. Adventitious sounds and limited chest expansion would indicate pathology such as pneumonia or other lung diseases.
D. Absent voice sounds and hyper resonant percussion tones would be indicative of a pneumothorax or emphysema, not normal lung findings.

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A nurse is performing a lymphatic system assessment on a client reporting fatigue and malaise for one week. In which order should the nurse perform the head to toe assessments? Indicate the correct order from first to last. All options must be used.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

During an admission assessment, the nurse notices that a male patient has an enlarged and rather thick skull. The nurse suspects acromegaly. What additional finding would the nurse assess for to confirm this suspicion?

Correct Answer is B

Explanation

During an assessment, the nurse knows that expected assessment findings in the normal adult lung include the presence of:

Correct Answer is B

Explanation

The nurse suspects that a patient has hyperthyroidism, and the laboratory data indicate that the patient's T4 and T3 hormone levels are elevated. Which of these findings would the nurse most likely find on examination?

The RN is explaining to an elderly client why the skin folds and sags as part of the normal aging process. What is the correct mechanism for this?

What component of the conduction system is referred to as the pacemaker of the heart?

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A 92-year-old patient has had a stroke. The right side of his face is drooping. The nurse might also suspect which of these assessment findings?

The nurse palpates a swollen inguinal lymph node. Which assessment should the nurse perform next?

The nurse has just completed a lymph node assessment on a healthy 40-year-old female patient. Which of the following is an expected finding?

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