ATI RN
NCLEX Practice Questions Health Assessment Questions
Question 1 of 5
The primary purpose of the ciliated mucous membrane in the nose is to:
Correct Answer: B
Rationale: The correct answer is B: filter out dust and bacteria. The ciliated mucous membrane in the nose traps dust and bacteria present in the inhaled air through the mucus layer and then moves them towards the throat to be swallowed or expelled. This helps in protecting the respiratory system from harmful particles. Choice A is incorrect as the warming of inhaled air is primarily done by the nasal passages and sinuses, not the ciliated mucous membrane. Choice C is incorrect because the filtering of coarse particles is also done by the nasal hairs and the mucous membrane working together, not just the ciliated mucous membrane alone. Choice D is incorrect as the movement of air through the nares is mainly controlled by the size of the nostrils and is not the primary function of the ciliated mucous membrane.
Question 2 of 5
The nurse is doing an oral assessment on a 40-year-old patient of African descent and notes the presence of a 1-cm, nontender, greyish-white lesion on the left buccal mucosa. Which of the following about this lesion is true?
Correct Answer: A
Rationale: Step-by-step rationale for why answer A is correct: 1. Leukoedema is a common benign condition in individuals of African descent. 2. Leukoedema presents as greyish-white lesions on the buccal mucosa. 3. It is typically asymptomatic and does not require treatment. 4. Leukoedema is not associated with any serious health concerns. Summary of why other choices are incorrect: B. Hyperpigmentation would present as dark patches, not greyish-white lesions. C. Torus palatinus is a bony growth on the hard palate, not a mucosal lesion. D. Cancerous lesions typically have different characteristics and would require further investigation.
Question 3 of 5
A 72-year-old patient has a history of hypertension and chronic lung disease. An important question for the nurse to include in history-taking would be:
Correct Answer: D
Rationale: The correct answer is D: "Have you noticed any dryness in your mouth?" This question is important as dryness in the mouth can be a side effect of certain medications used to manage hypertension and chronic lung disease. Dry mouth can lead to oral health issues and impact the patient's overall well-being. A: "Do you use a fluoride supplement?" is not directly relevant to the patient's medical history of hypertension and lung disease. B: "Have you had tonsillitis in the last year?" is not as crucial as dry mouth in relation to managing hypertension and lung disease. C: "At what age did you get your first tooth?" is not pertinent to the current medical conditions and management of hypertension and lung disease. In summary, the question about dryness in the mouth is the most relevant as it pertains to potential medication side effects and oral health implications for the patient with hypertension and chronic lung disease.
Question 4 of 5
During the oral assessment of a 30-year-old patient of African descent, the nurse notes bluish lips and a dark line along the gingival margin. What would the nurse do in response to this finding?
Correct Answer: B
Rationale: Correct Answer: B Rationale: 1. Bluish lips indicate cyanosis, a sign of inadequate oxygen supply. 2. Dark line along gingival margin suggests lead poisoning. 3. The nurse should assess for other signs of inadequate oxygen supply to determine the severity and underlying cause. 4. This finding is not normal and requires further evaluation to prevent complications. Summary: A: Checking hemoglobin for anemia is not the immediate priority when cyanosis and lead poisoning are suspected. C: Assuming this is a normal finding can lead to overlooking a potentially serious condition. D: Carbon monoxide exposure could be a consideration, but assessing for overall oxygen supply is more crucial in this scenario.
Question 5 of 5
A 10-year-old is at the clinic for"a sore throat lasting 6 days." Which of the following would be consistent with an acute infection?
Correct Answer: D
Rationale: The correct answer is D. In an acute infection, such as streptococcal pharyngitis, the tonsils may exhibit yellowish exudates due to bacterial pus formation. This is consistent with the presence of inflammation and infection. Choices A, B, and C describe varying degrees of tonsillar enlargement and white debris, which could be present in different conditions but are not as specific to acute infection. Therefore, the presence of yellowish exudates on the tonsils is the key indicator of an acute bacterial infection like strep throat.