The nurse is preparing to examine a client's mouth floor. To move the tongue to one side for this examination, which tool should the nurse use?

Penlight

Gloves

Gauze pad

Tongue blade

Answer and Explanation

The Correct Answer is C

Choice a reason:
A penlight is used to provide illumination during an examination, not to move the tongue. It helps the nurse to visualize the mouth floor and other areas by casting light, but it does not have the physical structure to manipulate the tongue.

Choice b reason:
Gloves are worn by healthcare professionals to maintain hygiene and protect both the patient and the nurse from the transmission of infectious agents. They are not used to move the tongue to one side during an examination.

Choice c reason:
A gauze pad is the correct tool to use when the nurse needs to move the tongue to one side during an examination of the mouth floor. The nurse can wrap the gauze pad around the tongue for a better grip, which allows for safe and effective retraction of the tongue without causing discomfort to the patient.

Choice d reason:
A tongue blade, also known as a tongue depressor, is typically used to depress the tongue to examine the back of the throat, not to move the tongue to one side. It is used to hold the tongue down so that the nurse can inspect the oropharynx and other structures.

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Correct Answer is C

Explanation

Choice a reason:
A firm toothbrush is not recommended for plaque removal as it can damage the gums and tooth enamel. Soft-bristled toothbrushes are preferred because they are effective at removing plaque while being gentle on the gums and enamel.

Choice b reason:
Brushing more than twice per day does not necessarily irritate the gums unless done with improper technique or with a hard-bristled toothbrush. It is important to brush gently with a soft-bristled toothbrush and to use fluoride toothpaste to maintain oral hygiene and prevent gingivitis.

Choice c reason:
Ensuring that dental restorations such as fillings and crowns fit well is crucial in preventing gingivitis. Poorly fitted restorations can trap food particles and bacteria, leading to plaque buildup and gum inflammation. Regular dental check-ups can help ensure that restorations remain intact and do not contribute to gingivitis.

Choice d reason:
Flossing should not be avoided even if there is bleeding at the gumline. Bleeding can be a sign of gingivitis, and flossing can help remove the plaque and bacteria causing the inflammation. If bleeding persists, it is important to consult a dentist.

A. A client who has recently been diagnosed with a chronic illness. B. A client with hypotension, tachycardia, SpO2 85%, and a recent gunshot wound. C. A client who just confirmed she is pregnant. D. A client who makes frequent hospital visits reporting the same symptom.

Correct Answer is B

Explanation

Choice a reason:
A client recently diagnosed with a chronic illness would require a comprehensive health history that includes past medical history, medications, and lifestyle factors. While important, it is not typically categorized as an emergency health history unless the chronic condition has acutely worsened.

Choice b reason:
A client presenting with hypotension (low blood pressure), tachycardia (rapid heart rate), an oxygen saturation of 85% (indicating potential hypoxemia), and a recent gunshot wound is experiencing a life-threatening situation that requires immediate medical attention. An Emergency health history is crucial in this scenario to quickly gather information that will guide urgent treatment decisions.

Choice c reason:
A client who has just confirmed pregnancy would need a detailed health history, including obstetric and gynecological history, but this is not considered an emergency unless there are complications or concerns that require immediate attention.

Choice d reason:
A client who frequently visits the hospital reporting the same symptom may indicate a chronic issue that needs ongoing management rather than an emergency. However, if the symptom suggests an acute exacerbation or a new, serious condition, it could escalate to an emergency.

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The nurse is preparing to examine a client's mouth floor. To move the tongue to one side for this examination, which tool should the nurse use?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is B

Explanation

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