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Chapter 16: Mouth, throat, nose
Terms in this set (54)
The nurse is caring for a patient with an infection at the lip-skin junction caused by the herpes simplex virus (HSV-1). What should the nurse teach the patient?
The infection is highly contagious.
The nurse is examining the teeth of a patient. What is considered a normal finding?
The upper teeth rest directly on the lower teeth.
The nurse is caring for a patient with epistaxis. Which symptom is most likely to be seen in this patient?
Bleeding from the anterior nasal septum
What is the total number of permanent teeth in an adult?
The nurse is assessing a patient who reports having lost the sense of smell. Which cranial nerve may be affected in this patient?
Cranial nerve I
While assessing the throat of a child, the nurse documents the tonsils as 3+. What does this indicate?
Tonsils touch the uvula
Which finding does the nurse expect in a patient with acute tonsillitis?
Presence of exudate or white spots on the tonsils
The nurse is assessing the buccal mucosa of a patient and documents the presence of aphthous ulcers. What did the nurse observe during the examination?
A small, round, "punched-out" ulcer with a white base surrounded by a red halo.
A patient in the hospital experiences epistaxis. What should the nurse instruct the patient to do to stop the bleeding?
"Sit up with the head tilted forward and pinch the nose."
The nurse is examining the throat of a patient. What does the nurse document as a normal finding?
The tonsils have crypts on their rough surfaces.
When examining an elderly patient, what changes in the structure and function of the nose would the nurse expect to find?
The nose appears to be more prominent.
Which statement accurately describes the parotid gland?
It is a salivary gland.
The nurse is assessing a patient diagnosed with ankyloglossia. What does this condition indicate?
The patient has a speech defect.
During an assessment a patient reports watery nasal secretions, pale turbinates, and sneezing. What diagnosis is likely for this patient?
When assessing a patient for furuncles, what signs does the nurse look for?
Small, reddened boils on the skin or mucosa
The nurse documents the presence of Epstein pearls in a 1-month-old infant. What does this finding indicate?
Presence of small retention cysts
The nurse is assessing a patient with a monilial infection. What are the causes of this infection?
During the dental examination of a patient, the nurse notes a nontender, fibrous nodule on the gum between the teeth. What term should the nurse use to document this condition?
The nurse is preparing a young child with a cleft lip for surgery. What would be the consequence of delayed treatment?
What is the cause of a peritonsillar abscess?
Untreated acute pharyngitis
The nurse notices that a patient has a deviated nasal septum. What action should the nurse take when caring for this patient?
Chart the findings for future reference.
Which statement best describes the appearance of a geographic tongue?
Bright red with shiny, circular bald areas and pearly borders
Which findings are causes of concern to the nurse while examining a patient's gums?
There is a dark line on the gingival margins.
The gums bleed even with a slight pressure.
There are crevices between the teeth and gums.
The nurse is assessing a patient who reports feeling like there is a valve that moves in the nose while breathing. What would the nurse expect to find during the examination of the nose?
What is the characteristic feature of the submandibular salivary gland?
It contains ducts that open at each side of the frenulum.
The nurse is caring for an elderly patient who developed a nosebleed after forceful coughing and sneezing. Which specific part of the nose is likely to bleed in this patient?
Which statement best describes a tonsillar tissue?
Tonsillar tissue enlarges until puberty and then shrinks.
The nurse assesses the hypoglossal nerve or cranial nerve XII by asking the patient to stick out the tongue. Which finding should the nurse associate with a fine tremor of the tongue?
What are the functions of the tongue?
Cleans the teeth
Enables taste sensation
Helps with speech formation
What should the nurse teach the patient about the changes in the nose and mouth during pregnancy?
Increased risk of nosebleeds
Increased risk of gum bleeds
Increased occurrence of nasal stuffiness
The nurse is examining the anterior structures a patient's mouth. In which conditions may the nurse find cherry-red lips?
Carbon monoxide poisoning
The nurse asks a nursing student to list the functions of the nose. Which statement by the student nurse needs correction?
"The paranasal sinuses in the nasal cavity lighten the weight of the skull bones."
The nurse is examining the mouth of a 20-month-old infant. What is the expected number of deciduous teeth in this infant? Record your answer using a whole number.
What are the functions of the paranasal sinuses?
Produce needed mucus
Lighten the skull bones
Vibrate to produce sound
The nurse identifies macroglossia during the assessment of a patient. Patients with which conditions are likely to have macroglossia?
Which changes in the elderly patient should the nurse document as age-related alterations?
The nose appears to be larger and more prominent.
The mouth and lips have a purse-string appearance.
The teeth appear longer and develop vertical cracks.
Which conditions are likely to affect the speech of a patient?
The nurse is assessing a patient with a history of smoking and alcohol use. What should the nurse specifically assess for when examining the patient's tongue?
Palpate under the tongue for indurations.
The nurse should assess for early signs of oral cancer during an oral examination of a patient who uses smokeless tobacco (SL-T). What assessment findings require further investigation?
Difficulty in chewing
Leathery white patch
Restricted jaw movements
The nurse needs to assess the posterior pharyngeal wall of a patient whose gag reflex is easily triggered. What should the nurse do to prevent discomfort in the patient?
Allow the patient to depress the tongue with the tongue blade.
Ask the patient to lower the tongue without a tongue blade.
Use the tongue blade to depress the tongue slightly off-center.
The nurse is assessing a young patient who uses smokeless tobacco (SL-T). What are the health risks that the nurse should discuss with the patient?
Oral cancer lesions
Lower sperm count
Which actions by the nurse would be indicated during the oral examination of a 2-week-old infant?
Save the mouth for the end of the examination.
Put the infant supine on the examination table.
Restrain the infant's arms during examination.
The nurse identifies malocclusion while examining dentition in an elderly patient. What is the effect of this condition on the patient?
Possibility of further tooth loss
Inability to open the mouth fully
Occurrence of chronic headaches
Erosion of teeth at the gumline
What interventions should the nurse implement to determine the patency of the nares in a newborn?
Observe the newborn for any flaring nares.
Suction both nares by using a bulb syringe.
Insert a small lumen catheter into the nares.
What are the likely causes of epistaxis in a patient?
Vigorous nose blowing
Continuous nose picking
Presence of foreign body
The nurse is assessing a child with unilateral mucopurulent drainage from the nose. What is the most probable diagnosis?
Presence of foreign body
The nurse observes dappled brown patches inside on a patient's cheek. What does this indicate?
The nurse is caring for a young child who has inserted a tiny battery into the nostril. What is the impending risk for this patient?
The nasal mucosa will become burned.
The nurse is preparing to do a physical examination of a patient's nose. What equipment should the nurse gather to complete this assessment?
The nurse is examining a patient with gingivitis. What are the causes that lead to this condition?
Poor dental hygiene habits
Poor ingestion of vitamin C
Changes of hormone levels
The nurse is examining the mouth of a patient and notices a musty breath odor. What is the most likely cause of this finding?
The nurse is assessing a patient's tongue for color, characteristics, and moisture. Which findings would be normal during the assessment?
The dorsal surface feels rough.
The tongue is pink and even.
The ventral surface is smooth.
The nurse is examining the mouth of an African American patient. Which finding is a cause for concern?
The presence of a white cheesy curd-like patch that can be scraped off
The nurse is caring for a patient with erythematous, scaling, shallow, and painful fissures at the corners of the mouth. The patient also has excess salivation. What is the possible diagnosis for this patient?
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