During an inspection of a client's tonsils with a penlight and tongue depressor, the nurse notes that the tonsils contact the client's uvula. The patient states they have had a sore throat and have been using lidocaine spray as directed by the provider. What would be the most accurate documentation of this finding?

Answer and Explanation

The Correct Answer is A

Choice A reason: Tonsils touching the uvula indicate 4+ grading, where they obstruct over 75% of the oropharynx. This severe enlargement, with sore throat, fits the highest scale, reflecting significant inflammation or infection impacting airway and swallowing, accurately documented here.

Choice B reason: 1+ tonsils are slightly enlarged, less than 25% of the oropharynx, visible but not near the uvula. This underestimates the finding of tonsils contacting the uvula, misrepresenting the degree of obstruction and inflammation present in this case entirely.

Choice C reason: 2+ tonsils occupy 25-50% of the oropharynx, not touching the uvula. This moderate grade doesn’t match the observed contact, understating the severity of enlargement and potential airway compromise noted during the inspection clearly and significantly.

Choice D reason: 3+ tonsils cover 50-75% of the oropharynx, nearing but not contacting the uvula. This is close but inaccurate, as the finding shows full contact, warranting the higher 4+ grade for precise documentation of this advanced tonsillar size fully.

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Correct Answer is A

Explanation

Choice A reason: Human papillomavirus (HPV), especially types 16 and 18, is the primary cervical cancer risk, causing 99% of cases. This STI triggers oncogenic changes in cervical cells, making it the key factor for this class accurately and fully here.
Choice B reason: HIV weakens immunity, raising HPV persistence risk, but isn’t a direct cervical cancer cause. Its role is secondary, amplifying HPV effects, not independently driving carcinogenesis, excluding it as the major factor comprehensively here entirely.
Choice C reason: Syphilis, a bacterial STI, causes sores, not cervical cancer. It lacks the viral oncogenic mechanism of HPV, rendering it irrelevant as a primary risk factor for this malignancy in the educational context fully here.
Choice D reason: Gonorrhea causes inflammation, not cancer. This bacterial STI doesn’t alter cervical DNA like HPV, making it an incorrect choice for a major risk factor in cervical cancer education for these students entirely here fully.

A. Impaired judgment. B. Loss of remote memory. C. Tremors accompanying intentional movement. D. Lack of sensation in distal extremities.

Correct Answer is D

Explanation

Choice A reason: Impaired judgment suggests frontal lobe pathology, like dementia, not normal aging. Age-related changes slow processing, not executive function, making this a disease sign, not a typical neurological shift in an 81-year-old fully here.
Choice B reason: Loss of remote memory indicates Alzheimer’s, not normal aging. Aging may slow recall, but long-term memory typically persists, excluding this as an expected age-related change in this neurological assessment entirely and accurately here.
Choice C reason: Intention tremors signal cerebellar disease, like Parkinson’s, not aging. Normal aging may reduce fine motor speed, but not cause action tremors, distinguishing this as pathological, not a standard age-related finding fully here.
Choice D reason: Reduced distal sensation, from nerve conduction slowing, is a common age-related change. Aging thins myelin, impairing peripheral nerves, making this the expected finding in an 81-year-old’s neurological exam accurately and comprehensively here.

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Naxlex Comprehensive Predictor Exams

The nurse is presenting a class to a group of high school students about sexually transmitted infections. What would the nurse include as a major risk factor for cervical cancer?

Correct Answer is A

Explanation

The nurse is conducting a focused neurologic assessment on an 81-year-old client. What finding below is an age-related neurologic change?

Correct Answer is D

Explanation

The nurse's inspection of a client's extremities reveals a deep, circular, painful wound on the client's great toe. What should the nurse suspect as the etiology of the client's wound?

A nurse is working with a client who has a history of headaches for greater than two months. When preparing to assess the client's temporomandibular joint, what instruction provided to the client would indicate the nurse needs more teaching?

A client has a family history of prostate cancer and is committed to regular screening. What should the nurse teach the client about prostate-specific antigen (PSA) blood testing?

An older adult client has been admitted due to decreased cognition. What assessment finding is most suggestive of delirium as the cause of the client's cognitive impairment?

The nurse has begun the objective assessment of a client's heart and neck vessels and is assessing the client's jugular veins. What finding would the nurse consider to be expected in a healthy client?

The nurse is reviewing a client's electronic health record before assessing her mouth. Which of the following diagnoses would the nurse recognize as an indication for immediate medical follow up?

The nurse's auscultation of a client's lung fields reveals the presence of a wheeze. The nurse should recognize that this adventitious sound results from what pathophysiologic process in the lungs?