HA select all that apply

A 55-year-old male presents to the health care clinic with reports of decreased hearing over the past year. Which subjective data in the client's review of systems should the nurse recognize as risk factors for hearing loss? Select all that apply.

Chronic ear infections as a child • History of measles at 3 years of age • Wax blocking the ear canal

The nurse is caring for an adult client admitted to the unit 10 days ago with pneumonia. When making shift assessment, the nurse notes white patchy lesions in the client's mouth. The nurse suspects candidiasis and updates the care plan to include the findings. One outcome written for this client is "Oral mucous membranes pink, moist, and without coating, lesions, or masses." What interventions might the nurse use to achieve this outcome? Select all that apply.

Encourage fluids • Provide oral care every shift

A client has a sore throat and difficulty swallowing that has lasted for months. There are no lesions on the lips. The nurse suspects that the client may have oropharyngeal cancer. Which of the following are risk factors the nurse should assess for in this client?

Heavy use of alcohol • Frequent pipe smoking

The nurse is performing an assessment of the neck and identifies tracheal deviation. What is the most appropriate response of the nurse?

Notify the health care provider

What information should the nurse include when documenting the data associated with the physical examination of a patient's eyes? (Select all that apply.)

Shape and size of the pupils • Appearance of the optic disc

Which nursing action is most appropriate when caring for the patient with ear pain?

Use a pain scale to monitor pain intensity • Use music therapy as a distraction • Provide pain medication as ordered

A family member of a client recovering from a traumatic brain injury asks the nurse what safeguards can be put in place at home to prevent future head injuries. What should the nurse instruct this family member?

Use rails on stairs • Remove extension cords from high traffic areas • Avoid the use of throw rugs.

The nurse is presenting an educational event for a local civic group about the risk factors for neck cancer. What would the nurse list? (Select all that apply.)

• Age older than 50 years • Tobacco use • Male gender

What does the nurse assess the face for? (Select all that apply.)

• Asymmetry • Edema • Involuntary movements

When providing client education on hearing, the nurse should remind clients to utilize ear plugs when they are what? (Select all that apply.)

• At train stations • Using lawnmowers • At concerts

The nurse is teaching about the importance of regular eye examinations and should include information about which conditions that place clients at highest risk for blindness? (Select all that apply.)

• Diabetes • Hypertension

When considering eye safety, what instructions should the nurse provide to a patient newly prescribed contact lenses? (Select all that apply.)

• Do not share lenses. • Discard unused portions of contact solutions at the expiration date. • Wash hands before inserting or removing the lenses. • Keep the lenses clean.

A nurse practitioner is assessing a client in the ED following a motor vehicle accident. The client complains of ear pain. The nurse practitioner is performing an otoscopic examination. What would demonstrate the correct technique for using the otoscope?

• Holding the otoscope so that the thumb is by the window • Holding the client's ear at the helix • Rotating the otoscope slightly

In examining a client's external auditory canal with an otoscope, the nurse discovers impacted ear wax, known as cerumen. Which of the following is characteristic of cerumen? Select all that apply.

• Keeps the tympanic membrane soft • Has bacteriostatic properties • Serves as a defense against foreign bodies • Has a sticky consistency

A nurse is providing information to a high school health class about drinking during pregnancy. What descriptors would the nurse use when talking about fetal alcohol syndrome? (Select all that apply.)

• Microcephaly • Small eyes • Flattened upper lip

A nursing instructor is discussing areas of health promotion related to the nose, sinuses, mouth, and throat. What topics would the instructor be most likely to cite? (Select all that apply.)

• Obstructive sleep apnea • Tobacco use • Oral health

A client has presented with "a terrible head cold," and the nurse is assessing for signs and symptoms of sinusitis. The nurse should utilize what assessment techniques? Select all that apply.

• Palpation • Percussion • Transillumination

Equipment used for objective data collection involving the eyes includes which of the following? Select all that apply.

• Penlight • Ophthalmoscope • Snellen chart • Occlusive covers

Nursing students are learning about assessment of the head and neck. What cultural considerations would the students learn to assess in relation to this area?

• Shape of the lips • Shape of the nose • Shape of the eyes

Which glands are responsible for mouth drainage?

• Sublingual • Parotid • Submandibular

The nurse is teaching at a community clinic. She explains to the clients that what increases the risk for head and neck cancer? Select all that apply.

• Tobacco products • Alcohol

When assessing the client's risk for hearing loss, it is important to ask about the history of exposure to noise. What related client teaching would be important? (Select all that apply.)

• Types of protective equipment used • Instructions for the use of protective ear equipment • Effectiveness of protective equipment

Which clinical manifestation would the nurse expect to find when assessing the patient with pharyngitis? Select all that apply

• exudates • fever • dysphagia