The nurse assesses thick, white plaques on a client's tongue and hard palate. Which of the following nursing actions should the nurse do next?

Choice A reason: Medications like antipsychotics can cause tremors, but tongue fasciculations often signal neurological issues, not just drug effects. Reviewing regimen is secondary to assessing cranial nerve XII (hypoglossal), which controls tongue movement, for a more immediate etiology here.

Choice B reason: Diet recall might explore nutritional deficits, but tongue fasciculations tie to nerve or muscle pathology, not food intake. This lacks a direct link to neurological signs, making it less relevant than assessing nerve function for this specific finding fully.

Choice C reason: Thyroid issues cause coarse tremors, not fine fasciculations, which are more neuromuscular. Preparing for screening diverts from the priority of cranial nerve XII assessment, misaligning with the neurological basis of tongue movement observed in this examination entirely.

Choice D reason: Fasciculations suggest cranial nerve XII dysfunction, like in ALS or stroke, affecting tongue motor control. Assessing cranial nerves, especially hypoglossal, directly targets the finding’s neurological root, making it the best response to evaluate this abnormality accurately and promptly.

Choice A reason: Thick, white plaques suggest oral thrush, often Candida, linked to HIV immunosuppression. Facilitating HIV testing addresses a potential underlying cause, as CD4 decline allows opportunistic infections, making this the critical next step for diagnosis and management here.

Choice B reason: Referral for medication treats thrush symptomatically but misses underlying HIV risk. Antifungals help, yet without addressing immunosuppression, recurrence persists, making this less urgent than testing for a systemic condition driving the plaques in this scenario fully.

Choice C reason: Jaundice causes yellowing, not white plaques, which are fungal, not hepatic. Assessing for this misaligns with the finding’s etiology, as thrush ties to immunity, not liver function, rendering it irrelevant to the client’s oral presentation entirely here.

Choice D reason: Zinc deficiency causes taste loss or ulcers, not thick plaques like thrush. Lab review for this overlooks the infectious, possibly HIV-related cause, missing the immunological context critical to addressing the client’s specific oral condition accurately and promptly.