Nose, Mouth, Throat

Question 1

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

Answer 1

C

Question 2

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

Answer 2

ANS: C
The projections in the nasal cavity that increases the surface area are called turbinates. 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. A meatus is the
passageway or canal underlying each turbinate that collects drainage. The septum is what
divides the nasal cavity into two slitlike air passages. The Kiesselbach plexus is a rich
vascular network in the anterior part of the septum.

Question 3

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.

Answer 3

D

Question 4

4. What is the tissue that connects the tongue to the floor of the mouth called?
   a. Uvula
   b. Palate
   c. Papillae
   d. Frenulum

Answer 4

D

Question 5

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

Answer 5

B

Question 6

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.

Answer 6

D

Question 7

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

Answer 7

C

Question 8

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

Answer 8

A

Question 9

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.”

Answer 9

B

Question 10

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

Answer 10

B

Question 11

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

Answer 11

D

Question 12

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?”

Answer 12

D

Question 13

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

Answer 13

A

Question 14

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

Answer 14

C

Question 15

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

Answer 15

B

Question 16

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

Answer 16

B

Question 17

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

Answer 17

A

Question 18

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?”

Answer 18

C

Question 19

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

Answer 19

C

Question 20

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.

Answer 20

D

Question 21

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

Answer 21

B

Question 22

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

Answer 22

C

Question 23

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

Answer 23

C

Question 24

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.

Answer 24

C

Question 25

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.

Answer 25

D

Question 26

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

Answer 26

A

Question 27

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.

Answer 27

ANS: C
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. It is not caused by the same bacteria as his lung infection but occurred after the use of antibiotics, which
inhibit normal bacteria and allow a proliferation of fungus. There is no need to get a biopsy.

Question 28

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)

Answer 28

D

Question 29

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.

Answer 29

D

Question 30

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 1/2 years, 16 deciduous teeth are expected.”
    d. “All 20 deciduous teeth are expected to erupt by age 4 years

Answer 30

B

Question 31

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

Answer 31

D

Question 32

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

Answer 32

D

Question 33

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

Answer 33

A

Question 34

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

Answer 34

D

Question 35

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

Answer 35

D