Chapter 15 - Nose, Mouth, and Throat Flashcards
The primary purpose of the ciliated mucous membrane in the nose is to:
a. Warm the inhaled air.
b. Filter out dust and bacteria.
c. Filter coarse particles from inhaled air.
d. Facilitate the movement of air through the nares.
b. Filter out dust and bacteria.
Rationale: The nasal hairs filter the coarsest matter from inhaled air, whereas the mucous blanket filters out dust and bacteria. The rich blood supply of the nasal mucosa warms the inhaled air.
The projections in the nasal cavity that increase the surface area are called the:
a. Meatus.
b. Septum.
c. Turbinates.
d. Kiesselbach plexus.
c. Turbinates.
Rationale: The lateral walls of each nasal cavity contain three parallel bony projections: the superior, middle, and inferior turbinates. These increase the surface area, making more blood vessels and mucous membrane available to warm, humidify, and filter the inhaled air.
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.
d. Maxillary and ethmoid sinuses are the only sinuses present at birth.
Rationale: Only the maxillary and ethmoid sinuses are present at birth. The sphenoid sinuses are minute at birth and develop after puberty. The frontal sinuses are absent at birth, are fairly well developed at age 7 to 8 years, and reach full size after puberty.
The tissue that connects the tongue to the floor of the mouth is the:
a. Uvula.
b. Palate.
c. Papillae.
d. Frenulum.
d. Frenulum.
Rationale: The frenulum is a midline fold of tissue that connects the tongue to the floor of the mouth. The uvula is the free projection hanging down from the middle of the soft palate. The palate is the arching roof of the mouth. Papillae are the rough, bumpy elevations on the tongues dorsal surface.
The salivary gland that is the largest and located in the cheek in front of the ear is the ______ gland.
a. Parotid.
b. Stensen’s.
c. Sublingual.
d. Submandibular.
a. Parotid.
Rationale: The mouth contains three pairs of salivary glands. The largest, the parotid gland, lies within the
cheeks in front of the ear extending from the zygomatic arch down to the angle of the jaw. The
Stensen’s duct (not gland) drains the parotid gland onto the buccal mucosa opposite the second molar. The sublingual gland is located within the floor of the mouth under the tongue. The submandibular gland lies beneath the mandible at the angle of the jaw.
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 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.
b. No response is needed; this appearance is normal for the tonsils.
Rationale: The tonsils are the same color as the surrounding mucous membrane, although they look more granular and their surface shows deep crypts. Tonsillar tissue enlarges during childhood until puberty and then involutes.
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. The nurses best response would be:
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.
d. She is just starting to salivate and hasn’t learned to swallow the saliva.
Rationale: In the infant, salivation starts at 3 months. The baby will drool for a few months before learning to swallow the saliva. This drooling does not herald the eruption of the first tooth, although many parents think it does.
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.
c. Decreased ability to identify odors.
Rationale: The sense of smell may be reduced because of a decrease in the number of olfactory nerve fibers.
Nasal hairs grow coarser and stiffer with aging. The gums may recede with aging, not hypertrophy, and saliva production decreases.
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? This lesion is:
a. Leukoedema and is common in dark-pigmented persons.
b. The result of hyperpigmentation and is normal.
c. Torus palatinus and would normally be found only in smokers.
d. Indicative of cancer and should be immediately tested.
a. Leukoedema and is common in dark-pigmented persons.
Rationale: Leukoedema, a grayish-white benign lesion occurring on the buccal mucosa, is most often observed in Blacks.
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 nurses 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. Just 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.
b. Sit up with your head tilted forward and pinch your nose.
Rationale: With a nosebleed, the person should sit up with the head tilted forward and pinch the nose between the thumb and forefinger for 5 to 15 minutes.
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
c. Dysphagia
Rationale: Dysphagia is difficulty with swallowing and may occur with a variety of disorders, including stroke and other neurologic diseases. Rhinorrhea is a runny nose, epistaxis is a bloody nose, and xerostomia is a dry mouth.
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. The best response by the nurse would be:
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.
d. Prolonged use of a bottle can increase the risk for tooth decay and ear infections.
Rationale: Prolonged bottle use during the day or when going to sleep places the infant at risk for tooth decay and middle ear infections.
A 72 year-old patient has a history of hypertension and chronic lung disease. An important question for the nurse to include in the health history would be:
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?
d. Have you noticed any dryness in your mouth?
Rationale: Xerostomia (dry mouth) is a side effect of many drugs taken by older people, including antidepressants, anticholinergics, antispasmodics, anti-hypertensives, antipsychotics, and bronchodilators.
The nurse is using an otoscope to assess the nasal cavity. Which of these techniques is correct?
a. Inserting the speculum at least 3 cm into the vestibule.
b. Avoiding touching the nasal septum with the speculum.
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.
b. Avoiding touching the nasal septum with the speculum.
Rationale: The correct technique for using an otoscope is to insert the apparatus into the nasal vestibule, avoiding pressure on the sensitive nasal septum. The tip of the nose should be lifted up before inserting the speculum.
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. Are you aware of having any allergies?
b. Do you have an elevated temperature?
c. Have you had any symptoms of a cold?
d. Have you been having frequent nosebleeds?
a. Are you aware of having any allergies?
Rationale: With chronic allergies, the mucosa looks swollen, boggy, pale, and gray. Elevated body temperature, colds, and nosebleeds do not cause these mucosal changes.
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.
b. Firm pressure.
Rationale: The person should feel firm pressure but no pain. Sinus areas are tender to palpation in persons with chronic allergies or an acute infection (sinusitis).
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 patients hemoglobin for anemia.
b. Assess for other signs of insufficient oxygen supply.
c. Proceed with the assessment, knowing that this appearance is a normal finding.
d. Ask if he has been exposed to an excessive amount of carbon monoxide.
c. Proceed with the assessment, knowing that this appearance is a normal finding.
Rationale: Some Blacks may have bluish lips and a dark line on the gingival margin; this appearance is a normal finding.
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. These findings are reflective of:
a. Dehydration.
b. Irritation by gastric juices.
c. A normal oral assessment.
d. Side effects from nausea medication.
a. Dehydration.
Rationale: Dry mouth occurs with dehydration or fever. The tongue has deep vertical fissures.
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.
d. These bumps are Fordyce granules, which are sebaceous cysts and are not a serious condition.
Rationale: Fordyce granules are small, isolated white or yellow papules on the mucosa of the cheek, tongue, and lips. These little sebaceous cysts are painless and are not significant. Chalky, white raised patches would indicate leukoplakia. In strep throat, the examiner would see tonsils that are bright red, swollen, and may have exudates or white spots.
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 1+/1-4+ and pink; the same color as the oral mucosa.
b. Tonsils 2+/1-4+ with small plugs of white debris.
c. Tonsils 3+/1-4+ with large white spots.
d. Tonsils 3+/1-4+ with pale coloring.
c. Tonsils 3+/1-4+ with large white spots.
Rationale: With an acute infection, tonsils are bright red and swollen and may have exudate or large white spots. Tonsils are enlarged to 2+, 3+, or 4+ with an acute infection.
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 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.
c. Recognize that this situation requires immediate intervention.
Rationale: Determining the patency of the nares in the immediate newborn period is essential because most
newborns are obligate nose breathers. Nares blocked with amniotic fluid are gently suctioned with a bulb syringe. If obstruction is suspected, then a small lumen (5 to 10 Fr) catheter is passed down each naris to confirm patency. The inability to pass a catheter through the nasal cavity indicates choanal atresia, which requires immediate intervention.
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. During an inspection of his mouth, the nurse should look for:
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.
c. Bruising on the buccal mucosa or gums.
Rationale: The nurse should notice any bruising or laceration on the buccal mucosa or gums of an infant or
young child. Trauma may indicate child abuse from a forced feeding of a bottle or spoon.
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.
c. Perform an otoscopic examination of the left nares.
Rationale: Children are prone to put an object up the nose, producing unilateral purulent drainage with a foul odor. Because some risk for aspiration exists, removal should be prompt.
During an assessment of a 26 year old at the clinic for a spot on my lip I think is cancer, the 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 would be the most appropriate response 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.
d. Tell the patient that these vesicles are most likely the result of a riboflavin deficiency and discuss nutrition.
c. Tell the patient that these vesicles are indicative of herpes simplex I or cold sores.
Rationale: Cold sores are groups of clear vesicles with a surrounding erythematous base. These evolve into
pustules or crusts and heal in 4 to 10 days. The most likely site is the lip-skin junction. Infection often recurs in the same site. Recurrent herpes infections may be precipitated by sunlight, fever, colds, or allergy.
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.
b. When the patient first noticed the lesion.
Rationale: With carcinoma, the initial lesion is round and indurated, but then it becomes crusted and ulcerated with an elevated border. Most cancers occur between the outer and middle thirds of the lip. Any lesion that is still unhealed after 2 weeks should be referred.
A pregnant woman states that she is concerned about her gums because she has noticed they are swollen and have started bleeding. 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 its 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 the change in hormonal balance in your system during pregnancy and puberty.
d. Swollen and bleeding gums can be caused by the change in hormonal balance in your system during pregnancy and puberty.
Rationale: Gum margins are red and swollen and easily bleed with gingivitis. A changing hormonal balance may cause this condition to occur in pregnancy and puberty.
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. The nurse recognizes that this abnormality is:
a. Aphthous ulcers.
b. Candidiasis.
c. Leukoplakia.
d. Koplik spots.
b. Candidiasis.
Rationale: Candidiasis is a white, cheesy, curd-like patch on the buccal mucosa and tongue. It scrapes off, leaving a raw, red surface that easily bleeds. It also occurs after the use of antibiotics or corticosteroids and in persons who are immunosuppressed.
The nurse is assessing a patient in the hospital who has received numerous antibiotics 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.
c. Black, hairy tongue is a fungal infection caused by all the antibiotics you have received.
Rationale: A black, hairy tongue is not really hair but the elongation of filiform papillae and painless overgrowth of mycelial threads of fungus infection on the tongue. It occurs after the use of antibiotics, which inhibit normal bacteria and allow a proliferation of fungus.
