Deck 16: Nose, mouth, and Throat

Question 1

During an oral assessment of a 30-year-old black patient,the nurse notes bluish lips and a dark line along the gingival margin.What would the nurse do in response to this finding?
1)Check the patient's hemoglobin for anemia.
2)Assess for other signs of insufficient oxygen supply.
3)Proceed with assessment,knowing that this is a normal finding.
4)Ask if he has been exposed to an excessive amount of carbon monoxide.

Answer 1

3
Black persons normally may have bluish lips.

Question 2

While obtaining a history from the mother of a 1-year-old,the nurse notices that the baby has had a bottle in his mouth the entire time.The mother states,"it makes a great pacifier." The best response by the nurse would be:
1)"You're right,bottles make very good pacifiers."
2)"Use of a bottle is better for the teeth than thumb sucking."
3)"It's okay to do this as long as the bottle contains milk and not juice."
4)"Prolonged use of a bottle can increase the risk for tooth decay and ear infections."

Answer 2

4
Prolonged use of a bottle during the day or when going to sleep places the infant at risk for tooth decay and middle ear infections.

Question 3

Which of the following best describes the test the nurse should use to assess the function of cranial nerve X?
1)Observe the patient's ability to articulate specific words.
2)Assess movement of the hard palate and uvula with the gag reflex.
3)Have the patient stick out the tongue and observe for tremors or pulling to one side.
4)Ask the patient to say "ahhh" and watch for movement of the soft palate and uvula.

Answer 3

4
Ask the person to say "ahhh" and note that the soft palate and uvula rise in the midline.This tests one function of CN X,the vagus nerve.

Question 4

Immediately after birth,the nurse is unable to suction the nares of a newborn.An attempt is made to pass a catheter through both nasal cavities with no success.What would be the nurse's best response?
1)Attempt to suction again with a bulb syringe.
2)Wait a few minutes and try again once the infant stops crying.
3)Recognize this is a situation that requires immediate intervention.
4)Contact the physician and request assistance when he gets a chance.

Question 5

The nurse is palpating the sinus areas.If the findings are normal,the patient would report which sensation?
1)No sensation
2)Firm pressure
3)Pain during palpation
4)Pain sensation behind eyes

Question 6

The nurse is doing an oral assessment on a 40-year-old black patient and notes the presence of a 1-cm,nontender,grayish-white lesion on the left buccal mucosa.Which of the following is true concerning this lesion?
1)This lesion is leukoedema and is common in blacks.
2)This is the result of hyperpigmentation and is normal.
3)This is torus palatinus and would normally only be found in smokers.
4)This type of lesion is indicative of cancer and should be tested immediately.

Question 7

During the history,a patient tells the nurse that he has frequent nosebleeds and asks the best way to get them to stop.What would be the nurse's best response?
1)"While sitting up,place a cold compress over your nose."
2)"Sit up with your head tilted forward and pinch your nose."
3)"Just let the bleeding stop on its own,but don't blow your nose."
4)"Lie on your back with your head tilted back and pinch your nose."

Question 8

Which of the following is true in relation to a newborn infant?
1)The sphenoid sinuses are full size at birth.
2)The maxillary sinuses reach full size after puberty.
3)The frontal sinuses are fairly well developed at birth.
4)The maxillary and ethmoid sinuses are the only ones present at birth.

Question 9

The primary purpose of the ciliated mucous membrane in the nose is to:
1)warm the inhaled air.
2)filter out dust and bacteria.
3)filter coarse particles from inhaled air.
4)facilitate movement of air through the nares.

Question 10

A 92-year-old patient has had a stroke.The right side of his face is drooping.The nurse might also suspect which of the following?
1)Epistaxis
2)Agenesis
3)Dysphagia
4)Xerostomia

Question 11

In assessing the tonsils of a 30-year-old,the nurse notes that they are involuted,granular in appearance,and appear to have deep crypts.What is correct response to these findings?
1)Refer the patient to a throat specialist.
2)Nothing,this is the appearance of normal tonsils.
3)Continue with assessment looking for any other abnormal findings.
4)Obtain a throat culture on the patient for possible strep infection.

Question 12

A 10-year-old is at the clinic for "a sore throat lasting 6 days." The nurse is aware that which of the following would be consistent with an acute infection?
1)Tonsils 1+/1-4+ and pink
2)Tonsils 2+/1-4+ with small plugs of white debris
3)Tonsils 3+/1-4+ with large white spots
4)Tonsils 3+/1-4+ with yellowish exudate

Question 13

The nurse is doing an assessment on a 21-year-old patient and notes that his nasal mucosa appears pale,gray,and swollen.What would be the most appropriate question to ask the patient?
1)"Are you aware of having any allergies?"
2)"Do you have an elevated temperature?"
3)"Have you had any symptoms of a cold?"
4)"Have you been having frequent nosebleeds?"

Question 14

A 32-year-old woman is at the clinic for "little white bumps in my mouth." During the assessment,the nurse notes that she has a 0.5 cm white,nontender papule under her tongue and one on the mucosa of her right cheek.What would the nurse tell the patient?
1)"These spots are seen with infections such as strep throat."
2)"These could be indicative of a serious lesion,so I will refer you to a specialist."
3)"This is called leukoplakia and can be caused by chronic irritation such as smoking."
4)"These bumps are Fordyce's granules,which are sebaceous cysts and not a serious condition."

Question 15

A 72-year-old patient has a history of hypertension and chronic lung disease.An important question for the nurse to include in the history would be:
1)"Do you use a fluoride supplement?"
2)"Have you had tonsillitis in the last year?"
3)"At what age did you get your first tooth?"
4)"Have you noticed any dryness in your mouth?"

Question 16

During an assessment of a 20-year-old patient with a 3-day history of nausea and vomiting,the nurse notes the following: dry mucosa and deep fissures in the tongue.This finding is reflective of:
1)dehydration.
2)irritation by gastric juices.
3)a normal oral assessment.
4)side effects from nausea medication.

Question 17

The nurse is obtaining a history on a 3-month-old infant.During the interview,the mom states,"I think she is getting her first tooth because she has started drooling a lot." The nurse's best response would be:
1)"You're right,drooling is usually a sign of the first tooth."
2)"It would be unusual for a 3-month-old to be getting her first tooth."
3)"This could be the sign of a problem with the salivary glands."
4)"She is just starting to salivate and hasn't learned to swallow the saliva."

Question 18

During an assessment of an 80-year-old patient,the nurse would expect to find:
1)hypertrophy of the gums.
2)an increased production of saliva.
3)a decreased ability to identify odors.
4)finer and less prominent nasal hair.

Question 19

The tissue that connects the tongue to the floor of the mouth is the:
1)uvula.
2)palate.
3)papillae.
4)frenulum.

Question 20

The projections in the nasal cavity that increase the surface area are called the:
1)meatus.
2)septum.
3)turbinates.
4)Kiesselbach's plexus.

Question 21

A patient comes into the clinic complaining of facial pain,fever,and malaise.On examination,the nurse notes swollen turbinates and purulent discharge from the nose.The patient also complains of a dull,throbbing pain in his cheeks and teeth on the right side and pain when the nurse palpates the areas.The nurse recognizes that this patient has:
1)posterior epistaxis.
2)frontal sinusitis.
3)maxillary sinusitis.
4)nasal polyps.

Question 22

Which of the following assessment findings would the nurse be most concerned about?
1)A painful vesicle inside the cheek for 2 days
2)The presence of moist,nontender Stenson's ducts
3)Stippled gingival margins that adhere snugly to the teeth
4)An ulceration on the side of the tongue with rolled edges.

Question 23

During a check-up,a 22-year-old woman tells the nurse that she uses an over-the-counter nasal spray because of her allergies.She also notes that it does not work as well as it used to when she started using it.The best response by the nurse would be:
1)"You should never use over-the-counter nasal sprays because of the risk of addiction."
2)"You should try switching to another brand of medication to prevent this problem."
3)"It is important to keep using this spray to keep your allergies under control."
4)"Using these nasal medications irritates the lining of the nose and may cause rebound swelling."

Question 24

A patient has been diagnosed with strep throat.The nurse is aware that without treatment which complication may occur?
1)Rubella
2)Leukoplakia
3)Rheumatic fever
4)Scarlet fever

Question 25

A mother brings her 4-month-old to the clinic with concerns regarding a small pad in the middle of the upper lip that has been there since 1 month of age.The infant has no health problems.On physical examination,the nurse notes a 0.5-cm,fleshy,elevated area in the middle of the upper lip.There is no evidence of inflammation or drainage.What would the nurse tell this mother?
1)"This is an area of irritation caused from teething and is nothing to worry about."
2)"This is an abnormal finding and should be evaluated by another health care provider."
3)"This is the result of chronic drooling and should resolve within the next month or two."
4)"This is a sucking tubercle caused from the friction of breast- or bottle-feeding and is normal."

Question 26

While performing an assessment of the mouth,the nurse notices that the patient has a 1-cm ulceration that is crusted with an elevated border.It is located on the outer third of the lower lip.What other information would be most important for the nurse to assess?
1)Nutritional status
2)When the patient first noticed the lesion
3)Whether the patient has had a recent cold
4)Whether the patient has had any recent exposure to sick animals

Question 27

During an assessment of a 26-year-old at the clinic for "a spot on my lip I think is cancer" the nurse notes the following findings: a group of clear vesicles with an erythematous base around them located at the lip-skin border.The patient mentions that she just returned from Hawaii.What would be the most appropriate response by the nurse?
1)Tell the patient she will need to see a skin specialist.
2)Discuss the benefits of having a biopsy done of any unusual lesion.
3)Tell the patient this is herpes simplex I and will heal in 4 to 10 days.
4)Tell the patient that this is most likely the result of a riboflavin deficiency and discuss nutrition.

Question 28

When examining an elderly patient,the nurse recognizes that which finding is due to the aging process?
1)Teeth that appear shorter
2)A tongue that looks smoother in appearance
3)Buccal mucosa that is beefy red in appearance
4)A small,painless lump on the dorsum of the tongue

Question 29

During an oral examination of a 4-year-old American Indian child,the nurse notices that her uvula is partially split.Which of the following statements is accurate?
1)This is a cleft palate and is common in American Indians.
2)This is a bifid uvula,which occurs in some American Indian groups.
3)This is due to an injury and should be reported to the authorities.
4)This is torus palatinus,which occurs frequently in American Indians.

Question 30

The nurse is assessing a 3-year-old who is here for "drainage from the nose." On assessment,it is found that there is a purulent drainage from the left nares that has a very foul odor and no drainage from the right nares.The child is afebrile with no other symptoms.What should the nurse do next?
1)Refer to the physician for an antibiotic order.
2)Have the mother bring the child back in 1 week.
3)Perform an otoscopic examination of the left nares.
4)Tell the mother that this is normal for children of this age.

Question 31

The nurse is assessing a patient with a history of intravenous drug abuse.In assessing his mouth,the nurse notices a dark red confluent macule on the hard palate.This could be an early sign of:
1)AIDS.
2)measles.
3)leukemia.
4)carcinoma.

Question 32

A 40-year-old patient who has just finished chemotherapy for breast cancer tells the nurse that she is concerned about her mouth.During the assessment the nurse finds the following: areas of buccal mucosa that are raw and red with some bleeding as well as other areas that have a white,cheesy coating.The nurse recognizes that this abnormality is:
1)carcinoma.
2)candidiasis.
3)leukoplakia.
4)Koplik's spots.

Question 33

A woman who is in the second trimester of pregnancy mentions that she has had "more nosebleeds than ever" since she became pregnant.The nurse recognizes that this is due to:
1)a problem with the patient's coagulation system.
2)increased vascularity in the upper respiratory tract as a result of the pregnancy.
3)increased susceptibility to colds and nasal irritation.
4)inappropriate use of nasal sprays.

Question 34

The nurse is teaching a health class to high-school-age boys.When discussing the topic of the use of smokeless tobacco (SLT),which of the following statements are accurate? (Select all that apply. )
1)One pinch of SLT in the mouth for 30 minutes delivers the equivalent of one cigarette.
2)The use of SLT has been associated with a greater risk of oral cancer than smoking has.
3)Pain is an early sign of oral cancer.
4)Pain is rarely an early sign of oral cancer.
5)Tooth decay is another risk of SLT because of the use of sugar as a sweetener.
6)SLT is considered a healthy alternative to smoking.

Question 35

When assessing the tongue of an adult,the nurse knows that an abnormal finding would be:
1)a smooth glossy dorsal surface.
2)a thin white coating over the tongue.
3)raised papillae on the dorsal surface.
4)visible venous patterns on the ventral surface.

Question 36

When examining the nares of a 45-year-old patient who has complaints of rhinorrhea,itching of the nose and eyes,and sneezing,the nurse notes the following: pale turbinates,swelling of the turbinates,and clear rhinorrhea.Which of the following is most likely the cause?
1)Nasal polyps
2)Acute sinusitis
3)Allergic rhinitis
4)Nasal carcinoma