Chapter 17: Nose, Mouth, and Throat
Jarvis: Physical Examination and Health Assessment, 8th Edition
MULTIPLE CHOICE
1. What is the primary purpose of the ciliated mucous membrane in the nose?
a.
To warm the inhaled air
b.
To filter out dust and bacteria
c.
To filter coarse particles from inhaled air
d.
To facilitate the movement of air through the nares
2. What are the projections in the nasal cavity that increase the surface area are called?
a.
Meatus
b.
Septum
c.
Turbinates
d.
Kiesselbach plexus
3. The nurse is reviewing the development of the newborn infant. Regarding the sinuses, which
statement is true in relation to a newborn infant?
a.
Sphenoid sinuses are full size at birth.
b.
Maxillary sinuses reach full size after puberty.
c.
Frontal sinuses are fairly well developed at birth.
d.
Maxillary and ethmoid sinuses are the only sinuses present at birth.
4. What is the tissue that connects the tongue to the floor of the mouth called?
a.
Uvula
b.
Palate
c.
Papillae
d.
Frenulum
5. In assessing the tonsils of a 30-year-old, the nurse notices that they are involuted, granular in
appearance, and appear to have deep crypts. What is the correct response to these findings?
a.
Refer the patient to a throat specialist.
b.
No response is needed; this appearance is normal for the tonsils.
c.
Continue with the assessment, looking for any other abnormal findings.
d.
Obtain a throat culture on the patient for possible streptococcal (strep) infection.
6. The nurse is obtaining a health history on a 3-month-old infant. During the interview, the
mother states, “I think she is getting her first tooth because she has started drooling a lot.”
What is the best response by the nurse?
a.
“You’re right, drooling is usually a sign of the first tooth.”
b.
“It would be unusual for a 3-month-old to be getting her first tooth.”
c.
“This could be the sign of a problem with the salivary glands.”
d.
“She is just starting to salivate and hasn’t learned to swallow the saliva.”
7. The nurse is assessing an 80-year-old patient. Which of these findings would be expected for
this patient?
a.
Hypertrophy of the gums
b.
Increased production of saliva
c.
Decreased ability to identify odors
d.
Finer and less prominent nasal hair
8. The nurse is performing an oral assessment on a 40-year-old black patient and notices the
presence of a 1-cm, nontender, grayish-white lesion on the left buccal mucosa. Which one of
these statements is true about this lesion?
a.
It is leukoedema which is common in dark-pigmented people.
b.
It is indicative of cancer and should be immediately tested.
c.
It is the result of hyperpigmentation and is a normal finding.
d.
It is torus palatinus and would normally be found only in smokers.
9. While obtaining a health 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?
a.
“While sitting up, place a cold compress over your nose.”
b.
“Sit up with your head tilted forward and pinch your nose.”
c.
“Allow the bleeding to stop on its own, but don’t blow your nose.”
d.
“Lie on your back with your head tilted back and pinch your nose.”
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 these assessment findings?
a.
Epistaxis
b.
Rhinorrhea
c.
Dysphagia
d.
Xerostomia
11. While obtaining a health history from the mother of a 1-year-old child, the nurse notices that
the baby has had a bottle in his mouth the entire time. The mother states, “It makes a great
pacifier.” What is the best response by the nurse?
a.
“You’re right. Bottles make very good pacifiers.”
b.
“Using a bottle as a pacifier is better for the teeth than thumb-sucking.”
c.
“It’s okay to use a bottle as long as it contains milk and not juice.”
d.
“Prolonged use of a bottle can increase the risk for tooth decay and ear infections.”
12. A 72-year-old patient has a history of hypertension and chronic lung disease. Which is an
important question for the nurse to include in this patient’s health history?
a.
“Do you use a fluoride supplement?”
b.
“Have you had tonsillitis in the last year?”
c.
“At what age did you get your first tooth?”
d.
“Have you noticed any dryness in your mouth?”
13. The nurse is using an otoscope to assess the nasal cavity. Which of these techniques is
correct?
a.
Avoiding touching the nasal septum with the speculum
b.
Inserting the speculum at least 3 cm into the vestibule
c.
Gently displacing the nose to the side that is being examined
d.
Keeping the speculum tip medial to avoid touching the floor of the nares
14. The nurse is performing an assessment on a 21-year-old patient and notices that his nasal
mucosa appears pale, gray, and swollen. What would be the most appropriate question to ask
the patient?
a.
“Have you had any symptoms of a cold?”
b.
“Do you have an elevated temperature?”
c.
“Are you aware of having any allergies?”
d.
“Have you been having frequent nosebleeds?”
15. The nurse is palpating the sinus areas. If the findings are normal, then the patient should
report which sensation?
a.
No sensation
b.
Firm pressure
c.
Pain during palpation
d.
Pain sensation behind eyes
16. During an oral assessment of a 30-year-old black patient, the nurse notices bluish lips and a
dark line along the gingival margin. What action would the nurse perform in response to this
finding?
a.
Check the patient’s Hb for anemia.
b.
Assess for other signs of insufficient oxygen supply.
c.
Proceed with the assessment, this appearance is a normal finding.
d.
Ask if he has been exposed to an excessive amount of carbon monoxide.
17. During an assessment of a 20-year-old patient with a 3-day history of nausea and vomiting,
the nurse notices dry mucosa and deep vertical fissures in the tongue. What do these findings
indicate?
a.
Dehydration
b.
A normal oral assessment
c.
Irritation from gastric juices
d.
Side effects from nausea medication
18. 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?
a.
“These spots indicate an infection such as strep throat.”
b.
“These bumps could be indicative of a serious lesion, so I will refer you to a
specialist.”
c.
“This condition is called leukoplakia and can be caused by chronic irritation such
as with smoking.”
d.
“These bumps are Fordyce granules, which are sebaceous cysts and are not a
serious condition.”
19. A 10-year-old is at the clinic for “a sore throat that has lasted 6 days.” Which of these findings
would be consistent with an acute infection?
a.
Tonsils 3+/1-4+ with pale coloring
b.
Tonsils 3+/1-4+ with large white spots
c.
Tonsils 2+/1-4+ with small plugs of white debris
d.
Tonsils 1+/1-4+ and pink; the same color as the oral mucosa
20. Immediately after birth, the nurse is unable to suction the nares of a crying newborn. An
attempt is made to pass a catheter through both nasal cavities with no success. What should
the nurse do next?
a.
Attempt to suction again with a bulb syringe.
b.
Wait a few minutes, and try again once the infant stops crying.
c.
Recognize that this situation requires immediate intervention.
d.
Contact the physician to schedule an appointment for the infant at his or her next
hospital visit.
21. The nurse notices that the mother of a 2-year-old boy brings him into the clinic quite
frequently for various injuries and suspects there may be some child abuse involved. What
should the nurse look for during an inspection of this child’s mouth?
a.
Swollen, red tonsils
b.
Ulcerations on the hard palate
c.
Bruising on the buccal mucosa or gums
d.
Small yellow papules along the hard palate
22. The nurse is assessing a 3-year-old for “drainage from the nose.” On assessment, a purulent
drainage that has a very foul odor is noted from the left naris and no drainage is observed
from the right naris. The child is afebrile with no other symptoms. What should the nurse do
next?
a.
Refer to the physician for an antibiotic order.
b.
Have the mother bring the child back in 1 week.
c.
Perform an otoscopic examination of the left nares.
d.
Tell the mother that this drainage is normal for a child of this age.
23. During an assessment of a 26-year-old for “a spot on my lip I think is cancer,” the clinic nurse
notices 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 is the most appropriate
action by the nurse?
a.
Tell the patient she needs to see a skin specialist.
b.
Discuss the benefits of having a biopsy performed on any unusual lesion.
c.
Tell the patient that these vesicles are indicative of herpes simplex I or cold sores
and that they will heal in 4 to 10 days.
d.
Tell the patient that these vesicles are most likely the result of a riboflavin
deficiency and discuss nutrition.
24. 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 and located on the outer third of the lower
lip. What other information would be most important for the nurse to assess?
a.
Nutritional status
b.
When the patient first noticed the lesion
c.
Whether the patient has had a recent cold
d.
Whether the patient has had any recent exposure to sick animals
25. A pregnant woman states that she is concerned about her gums because she has noticed they
are swollen and have started to bleed. What would be an appropriate response by the nurse?
a.
“Your condition is probably due to a vitamin C deficiency.”
b.
“I’m not sure what causes swollen and bleeding gums, but let me know if it’s not
better in a few weeks.”
c.
“You need to make an appointment with your dentist as soon as possible to have
this checked.”
d.
“Swollen and bleeding gums can be caused by a change in hormonal balance
during pregnancy.”
26. 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 areas of buccal
mucosa that are raw and red with some bleeding, as well as other areas that have a white,
cheesy coating. What do these findings indicate?
a.
Candidiasis
b.
Leukoplakia
c.
Koplik spots
d.
Aphthous ulcers
27. The nurse is assessing a patient in the hospital who has received numerous antibiotics for a
lung infection and notices that his tongue appears to be black and hairy. In response to his
concern, what would the nurse say?
a.
“We will need to get a biopsy to determine the cause.”
b.
“This is an overgrowth of hair and will go away in a few days.”
c.
“Black, hairy tongue is a fungal infection caused by all the antibiotics you have
received.”
d.
“This is probably caused by the same bacteria you had in your lungs.”
28. 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 what disease or disorder?
a.
Measles
b.
Leukemia
c.
A carcinoma
d.
Acquired immunodeficiency syndrome (AIDS)
29. A mother brings her 4-month-old infant 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 notices a 0.5-cm, fleshy, elevated area in the
middle of the upper lip. No evidence of inflammation or drainage is observed. What would the
nurse tell this mother?
a.
“This area of irritation is caused from teething and is nothing to worry about.”
b.
“This finding is abnormal and should be evaluated by another health care
provider.”
c.
“This area of irritation is the result of chronic drooling and should resolve within
the next month or two.”
d.
“This elevated area is a sucking tubercle caused from the friction of breastfeeding
or bottle-feeding and is normal.”
30. A mother is concerned because her 18-month-old toddler has 12 teeth. She is wondering if
this is normal for a child of this age. Which is the best response by the nurse?
a.
“How many teeth did you have at this age?”
b.
“This is a normal number of teeth for an 18 month old.”
c.
“Normally, by age 2 years, 16 deciduous teeth are expected.”
d.
“All 20 deciduous teeth are expected to erupt by age 4 years.”
31. When examining the mouth of an older patient, the nurse recognizes which finding is due to
the aging process?
a.
Teeth appearing shorter
b.
Tongue that looks smoother in appearance
c.
Buccal mucosa that is beefy red in appearance
d.
Small, painless lump on the dorsum of the tongue
32. When examining the nares of a 45-year-old patient who is experiencing rhinorrhea, itching of
the nose and eyes, and sneezing, the nurse notices the following: pale turbinates, swelling of
the turbinates, and clear rhinorrhea. Which of these conditions is most likely the cause?
a.
Nasal polyps
b.
Acute rhinitis
c.
Acute sinusitis
d.
Allergic rhinitis
33. When assessing the tongue of an adult, what finding would be considered abnormal?
a.
Smooth glossy dorsal surface
b.
Thin white coating over the tongue
c.
Raised papillae on the dorsal surface
d.
Visible venous patterns on the ventral surface
34. The nurse is performing an assessment. Which of these findings would cause the greatest
concern?
a.
A painful vesicle inside the cheek for 2 days
b.
The presence of moist, nontender Stensen’s ducts
c.
Stippled gingival margins that snugly adhere to the teeth
d.
An ulceration on the side of the tongue with rolled edges
35. A patient has been diagnosed with strep throat. The nurse is aware that without treatment,
which complication may occur?
a.
Rubella
b.
Leukoplakia
c.
Scarlet fever
d.
Rheumatic fever
36. During a checkup, a 22-year-old woman tells the nurse that she uses an over-the-counter nasal
spray because of her allergies. She also states that it does not work as well as it used to when
she first started using it. Which is the best response by the nurse?
a.
“You should never use over-the-counter nasal sprays because of the risk for
addiction.”
b.
“You should try switching to another brand of medication to prevent this
problem.”
c.
“Continuing to use this spray is important to keep your allergies under control.”
d.
“Frequent use of these nasal medications irritates the lining of the nose and may
cause rebound swelling.”
37. During an oral examination of a 4-year-old American-Indian child, the nurse notices that her
uvula is partially split. Which of these statements is accurate?
a.
A bifid uvula may occur in some American-Indian groups.
b.
This condition is a cleft palate and is common in American Indians.
c.
A bifid uvula is torus palatinus, which frequently occurs in American Indians.
d.
This condition is due to an injury and should be reported to the authorities.
38. 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. What do these findings indicate?
a.
Nasal polyps
b.
Frontal sinusitis
c.
Posterior epistaxis
d.
Maxillary sinusitis
39. A woman who is in the second trimester of pregnancy mentions that she has had “more
nosebleeds than ever” since she became pregnant. What is the likely reason for this?
a.
Inappropriate use of nasal sprays
b.
A problem with the patient’s coagulation system
c.
Increased susceptibility to colds and nasal irritation
d.
Increased vascularity in the upper respiratory tract as a result of the pregnancy
MULTIPLE RESPONSE
1. During an assessment, a patient mentions that “I just can’t smell like I used to. I can barely
smell the roses in my garden. Why is that?” For which possible causes of changes in the sense
of smell will the nurse assess? (Select all that apply.)
a.
Aging
b.
Chronic allergies
c.
Cigarette smoking
d.
Chronic alcohol use
e.
Herpes simplex virus I
f.
Frequent episodes of strep throat