To perform palpation of the lymph nodes, the nurse would face the patient and palpate
a. first one side of the neck, then the other side.
b. following a systematic sequence in a clockwise manner.
c. moving the fingers from side to side, using firm pressure.
d. using the pads and tips of the middle three fingers.
D
To palpate the lymph nodes, face the patient and conduct the examination of both sides of the neck simultaneously. Move the pads and tips of the middle three fingers in small circles, using gentle pressure. Gentle pressure is used because firm, strong pressure could push the nodes into the neck muscles. Follow a systematic, routine sequence beginning with the preauricular, postauricular, occipital, submental, submandibular, and tonsillar nodes. Moving down to the neck, evaluate the anterior cervical chain, the posterior cervical chain, and the supraclavicular nodes.
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Several children arrived at the emergency department accompanied only by their fathers. The nurse knows that the father who legally may sign emergency medical consent for treatment is:
1. The non-biologic one from the heterosexual cohabitating family. 2. The divorced one from the binuclear family. 3. The divorced one when the single-parent mother has custody. 4. The stepfather from the blended or reconstituted family.
The nurse is utilizing an assessment form that includes a checklist with an area to document a narrative description. This type of form is considered:
a. Open-ended c. Specialty b. Checklist d. Combination
A collection of fluid between the pleural layers is called a
a. pleural effusion c. pneumothorax b. hemothorax d. tension pneumotho-rax
The nasogastric (NG) tube is removed on the second postoperative day, and the patient is placed on a clear liquid diet. Four hours later, the patient complains of sharp, cramping gas pains. What action by the nurse is the most appropriate?
a. Reinsert the NG tube. b. Give the PRN IV opioid. c. Assist the patient to ambulate. d. Place the patient on NPO status.