When palpating the child's cervical lymph nodes, the nurse notes that they are tender, enlarged, and warm.
The best explanation for this is.
some form of cancer.
local scalp infection common in children.
infection or inflammation distal to the site.
infection or inflammation close to the site.
The Correct Answer is D
Choice A rationale:
Some form of cancer. Rationale: Tender, enlarged, and warm cervical lymph nodes are indicative of infection or inflammation close to the site. Cancerous lymph nodes are usually painless and firm. In this case, the symptoms suggest an active immune response to infection or inflammation in proximity to the palpated lymph nodes.
Choice B rationale:
Local scalp infection common in children. Rationale: Local scalp infection, while possible, typically does not cause tender, enlarged, and warm cervical lymph nodes. These symptoms are more consistent with an active immune response to infection or inflammation in the area near the lymph nodes.
Choice C rationale:
Infection or inflammation distal to the site. Rationale: Symptoms such as tenderness, enlargement, and warmth in cervical lymph nodes indicate a local response to infection or inflammation close to the site. "Distal" refers to a location away from the affected area, making this choice inappropriate for the described symptoms.
Choice D rationale:
Infection or inflammation close to the site. Rationale: Tender, enlarged, and warm cervical lymph nodes suggest an active immune response to infection or inflammation in the vicinity. These symptoms are signs of localized inflammation and are commonly seen in conditions such as tonsillitis, pharyngitis, or other upper respiratory infections.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","D","E","F"]
Explanation
Choice A rationale:
A review of systems is essential in a health history because it helps in understanding the patient's overall health status and can reveal symptoms or issues that the patient might not consider significant. This information aids in making a comprehensive assessment.
Choice D rationale:
Height, weight, and BMI data are crucial parameters to assess a patient's nutritional status and overall health. These measurements help in identifying obesity, malnutrition, or other health-related issues.
Choice E rationale:
Diet and nutritional intake provide insights into the patient's eating habits, dietary restrictions, allergies, and potential deficiencies. This information is vital for assessing the patient's overall health and planning appropriate interventions.
Choice F rationale:
Family medical history is valuable as it helps in identifying genetic predispositions, hereditary diseases, and other health conditions that might run in the family. This information is crucial for understanding the patient's risk factors and developing a personalized healthcare plan. Choice B and C rationales: Physical assessment is indeed essential in healthcare, but it is not a part of the health history, which specifically focuses on the patient's past and current health status, medical conditions, medications, allergies, surgeries, and lifestyle habits. Similarly, a sexual history is important, especially for specific medical conditions, but it might not be relevant to every patient and might not always be included in the general health history.
Correct Answer is B
Explanation
Choice A rationale:
Telling the patient that she should have felt the baby move by now might cause unnecessary anxiety if she hasn't experienced fetal movement yet. Fetal movement can vary, and some women might not feel it until later in their pregnancy. This statement does not provide accurate and reassuring information.
Choice B rationale:
Around 14 to 25 weeks of gestation, most women begin to feel fluttering sensations, which are the early movements of the baby. By stating that the patient should start feeling these sensations within the next month or so, the nurse provides an accurate and reassuring response based on the typical timeline for fetal movement.
Choice C rationale:
This statement is incorrect. While the baby is moving, it might not be perceivable to the mother due to various factors such as the position of the placenta or the baby's own activity patterns. Simply stating that the baby is moving does not address the patient's concern about feeling the movements.
Choice D rationale:
Some babies are indeed quiet, and their movements might not be as noticeable to the mother. However, this statement does not provide a specific timeframe or address the patient's immediate concern about when she will start feeling the baby move. It is essential to provide a more informative and reassuring response.
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