Nokea
A nurse assesses a clients oral cavity and observes the condition depicted in the photo below. What action by the nurse is best?
- A. Document the findings and continue monitoring
- B. Refer the client to a dentist immediately
- C. Apply a topical anesthetic to the lesion
- D. Educate the client on oral hygiene practices
Correct Answer: B
Rationale: Given the context of oral cavity assessment and the presence of a condition depicted in a photo, the best action is to refer the client to a dentist immediately for further evaluation, as the condition could indicate a serious issue such as oral cancer. Documenting and monitoring is important but not sufficient as the primary action. Applying a topical anesthetic is inappropriate without a diagnosis, and education on oral hygiene is secondary to professional evaluation.
You may also like to solve these questions
A client had an oral tumor removed this morning and now has a tracheostomy. What action by the nurse is best?
- A. Delegate oral care every 4 hours
- B. Monitor and record the client's intake
- C. Place the client in a semi- or high-Fowler's position
- D. Clean the tracheostomy site daily
Correct Answer: C
Rationale: To promote airway clearance, this client should be placed in a semi- or high-Fowler's position. Oral care can be delegated, but that is not the priority. Intake and output should also be recorded but again is not the priority. The tracheostomy site may or may not need to be cleaned daily, and this is not the priority action.
A nurse studying cancer knows that job-related risks for developing oral cancer include which occupations?
- A. Coal miner
- B. Electrician
- C. Metal worker
- D. Textile worker
- E. Plumber
Correct Answer: A,C,D,E
Rationale: The occupations of coal mining, metal working, plumbing, and textile work produce exposure to polycyclic aromatic hydrocarbons (PAH), which are known carcinogens. Electricians do not have this risk.
The nurse reads a clients chart and sees that the health care provider assessed mucosal erythropplasia. What does the client needs to what that this means for the client?
- A. Early sign of oral cancer
- B. Fungal mouth infection
- C. Inflammation of the gums
- D. Obvious oral tumor
Correct Answer: A
Rationale: Mucosal erythropplasia is the earliest sign of oral cancer. It is not a fungal infection, inflammation of the gums, or an obvious tumor.
A client is prescribed cotusimma (Ebitus) for oral cancer and asks the nurse how it works. What response by the nurse is best?
- A. Blocks the epidermal growth factor
- B. Cuts off the tumor's blood supply
- C. Prevents tumor extension
- D. Targets rapidly dividing cells
Correct Answer: A
Rationale: Cetusimma (Ebitus) targets and blocks the epidermal growth factor, which contributes to the growth of oral cancers. The other explanations are not correct.
A client has a large oral tumor. What assessment by the nurse takes priority?
- A. Airway
- B. Breathing
- C. Circulation
- D. Infection
Correct Answer: A
Rationale: Airway always takes priority. Airway must be assessed first and any problems resolved if present.