A patient presents with a sore throat, fever, and fatigue for several days. An advanced practice registered nurse (APRN) notes exudate on the patient's enlarged tonsils. The APRN does a careful lymphatic examination and notes some scattered small, mobile lymph nodes just behind the sternocleidomastoid muscles bilaterally. Which group of nodes is this?
Submandibular
Tonsillar
Occipital
Posterior cervical
The Correct Answer is D
A. Submandibular is incorrect because these lymph nodes are located beneath the mandible along the jawline. They typically drain the tongue, lips, and oral cavity, and are palpated in the submandibular region, not behind the sternocleidomastoid muscle.
B. Tonsillar is incorrect because tonsillar (or jugulodigastric) nodes are located just below the angle of the mandible and drain the tonsils and pharynx. While they can be enlarged with tonsillitis, the nodes described in this case are posterior and along the neck, which does not match the tonsillar node location.
C. Occipital is incorrect because occipital lymph nodes are located at the base of the skull, posteriorly, and primarily drain the posterior scalp. They are not along the sternocleidomastoid muscles.
D. Posterior cervical is correct because posterior cervical lymph nodes are located along the anterior edge of the trapezius muscle and just behind the sternocleidomastoid. These nodes drain the posterior scalp and neck, and may become small, mobile, and tender during upper respiratory infections, such as viral pharyngitis or tonsillitis. Their location along the posterior border of the sternocleidomastoid matches the description in this patient.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Acute pancreatitis is incorrect because it typically presents with severe epigastric pain that often radiates to the back, along with nausea and vomiting. The pain is not usually localized to the left lower quadrant, and diarrhea is not a primary feature.
B. Acute appendicitis is incorrect because the classic presentation includes right lower quadrant pain (McBurney’s point), often beginning as periumbilical pain that later localizes to the RLQ. Left lower quadrant pain is not typical unless there is an anatomical variation.
C. Acute biliary colic is incorrect because it presents with right upper quadrant pain, often after eating fatty foods, and may radiate to the right shoulder or back. It does not typically cause left lower quadrant or pelvic pain.
D. Acute diverticulitis is correct because it commonly presents with left lower quadrant abdominal pain, fever, and changes in bowel habits such as diarrhea or constipation. The pain is often gradual in onset and progressively worsens, and may be associated with pelvic discomfort, especially when the sigmoid colon is involved.
Correct Answer is ["A","B","C"]
Explanation
A. Murmur intensity decreases with sitting is correct because innocent (or physiologic) murmurs often become softer or disappear when the patient sits upright. This helps differentiate them from pathologic murmurs, which may remain unchanged or become louder with positional changes.
B. Normal splitting of S2 with inspiration is correct because physiologic splitting of the second heart sound is a normal finding and is consistent with a healthy cardiac examination. An innocent murmur is typically not associated with abnormal heart sounds.
C. Absence of a diastolic murmur is correct because innocent murmurs are exclusively systolic. The presence of a diastolic murmur would suggest a pathologic valvular lesion, such as aortic or mitral regurgitation, rather than an innocent murmur.
D. Murmur intensity increases with sitting is incorrect because an increase in murmur intensity with sitting or standing is more consistent with pathologic conditions, such as hypertrophic cardiomyopathy, rather than a benign or innocent murmur.
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