The nurse assesses a client's submental lymph nodes. In which area of the client's head should the nurse palpate these lymph nodes?

In front of the ear.

In the midline, a few centimeters behind the tip of the mandible.

Superficial to the sternomastoid.

At the angle of the mandible.

Answer and Explanation

The Correct Answer is B

Choice A reason:

Palpating in front of the ear would assess the preauricular lymph nodes, not the submental lymph nodes. The preauricular nodes are located just in front of the ears and are typically examined when there is an infection or inflammation in the eyes, ears, or scalp.

Choice B reason:

The submental lymph nodes are located in the midline, just under the chin, behind the bony prominence of the mandible. This is the correct area for palpation when assessing the submental lymph nodes. These nodes drain the lower lip, the floor of the mouth, the tip of the tongue, and the incisors, and they can become enlarged due to infections or malignancies in these areas.

Choice C reason:

Palpating superficial to the sternomastoid would assess the cervical lymph nodes, specifically the anterior cervical nodes, which are not the submental lymph nodes. The sternomastoid muscle is a landmark for several lymph node groups in the neck, but not for the submental group.

Choice D reason:

Palpating at the angle of the mandible would assess the submandibular lymph nodes, not the submental lymph nodes. The submandibular nodes are located beneath the jawline and can become enlarged due to infections or malignancies in the mouth, throat, and salivary glands.

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Correct Answer is C

Explanation

Choice A reason:
Tachycardia, or an abnormally rapid heart rate, is not a typical finding in myxedema. Myxedema is associated with hypothyroidism, which usually presents with bradycardia, or a slower than normal heart rate, due to the decreased metabolic demands on the body.
Choice B reason:
Diarrhea is not commonly associated with myxedema. Instead, patients with hypothyroidism and myxedema often experience constipation due to slowed gastrointestinal motility.
Choice C reason:
Facial edema, particularly around the eyes, is a classic sign of myxedema. Myxedema is a severe form of hypothyroidism that can cause mucopolysaccharide deposition in the skin, leading to non-pitting edema. This can be particularly noticeable in the face and periorbital area.
Choice D reason:
Heat intolerance is more commonly associated with hyperthyroidism, not hypothyroidism. Patients with myxedema typically have cold intolerance due to a decrease in basal metabolic rate and reduced heat production.

A. Begin above the right clavicle and percuss each section, comparing the right chest with the left chest. B. Begin at the sternal notch and percuss all areas on the left chest, then all areas on the right chest. C. Begin at the sternal notch and percuss all areas on the right chest, then all areas on the left chest. D. Begin above the left clavicle and percuss all areas on the left chest, then reverse the process and assess the right chest, moving upward from the liver.

Correct Answer is A

Explanation

Choice A Reason:
This approach is recommended as it allows for a systematic comparison between the two sides of the chest. Percussion should start at the apices of the lungs, which are located just above the clavicles, and proceed downwards. This method ensures that any differences in percussion note, which could indicate underlying pathology, are identified by direct comparison.

Choice B Reason:
While this approach also involves a systematic assessment, it does not allow for immediate comparison between the two sides of the chest. It is important to compare corresponding areas on each side as you go to detect any asymmetry or changes in resonance.

Choice C Reason:
This method, similar to choice B, does not facilitate immediate side-to-side comparison during the assessment. Immediate comparison is crucial for identifying subtle differences that may indicate conditions such as pleural effusion or pneumothorax.

Choice D Reason:
Starting the percussion above the left clavicle and moving to the right chest after completing the left side does not allow for direct comparison of symmetrical chest areas. Additionally, assessing the right chest moving upward from the liver is not a standard practice, as the liver dullness can interfere with the percussion of the lower right lung fields.

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The nurse assesses a client's submental lymph nodes. In which area of the client's head should the nurse palpate these lymph nodes?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who has myxedema. Which of the following findings should the nurse expect?

Correct Answer is C

Explanation

The nurse is preparing to percuss a client's anterior chest area. Which approach will the nurse use for this assessment?

Correct Answer is A

Explanation

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