The nurse is caring for a client with a history of chewing tobacco use. Which finding requires immediate follow-up from the nurse?

Receding gum line and bleeding of the gums

Thick raised white patch on the edge of the tongue

Persistent sore throat and red tonsils

Mild tongue discoloration and discolored teeth

Answer and Explanation

The Correct Answer is B

A. Receding gum line and bleeding of the gums are common oral effects of chewing tobacco. These signs indicate periodontal disease or gingival irritation caused by the abrasive and chemical effects of tobacco on oral tissues. While these findings require assessment, oral hygiene interventions, and patient education, they are generally chronic and not immediately life-threatening.

B. Thick raised white patch on the edge of the tongue is highly concerning because it may represent leukoplakia, a precancerous lesion often associated with chronic tobacco use. Leukoplakia appears as a white, firm, raised area that cannot be scraped off and can potentially progress to oral squamous cell carcinoma if left untreated. In a client with a history of chewing tobacco, this finding requires immediate follow-up, including referral to a dentist, oral surgeon, or primary care provider for biopsy and evaluation. Early detection and intervention are critical to prevent malignant transformation and improve prognosis.

C. Persistent sore throat and red tonsils may indicate infection or inflammation, such as pharyngitis or tonsillitis. While these symptoms need assessment and possible treatment with antibiotics or supportive care, they are generally less urgent than a lesion suspicious for malignancy, especially in a high-risk client with chronic tobacco use.

D. Mild tongue discoloration and discolored teeth are typically cosmetic or minor mucosal changes caused by prolonged chewing tobacco. While these changes reflect the oral health risks associated with tobacco use, they do not indicate acute pathology or precancerous changes and are not a priority for immediate follow-up.

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Correct Answer is D

Explanation

A. Lanugo is the fine hair covering a newborn’s body that helps protect the skin. Its presence or replacement with vellus hair is a normal developmental finding and does not directly affect the newborn’s risk for fluid loss.

B. Cradle cap, or seborrheic dermatitis, is a superficial scaling of the scalp. It is a cosmetic and dermatologic condition that does not increase fluid loss or compromise skin integrity systemically.

C. Vernix caseosa is a white, cheesy substance covering the skin at birth. It protects the skin from amniotic fluid in utero and assists with thermoregulation and moisture retention initially. Its presence at birth actually reduces the risk of fluid loss rather than increases it.

D. Newborns, especially preterm infants, have thin, immature, and highly permeable skin, which allows for increased transepidermal water loss. This places the infant at greatest risk for dehydration and fluid and electrolyte imbalances. The skin’s barrier function is underdeveloped, making thermoregulation and fluid retention more challenging. Newborns with this skin characteristic require careful monitoring of hydration status, fluid intake, and temperature control to prevent complications.

A. White, cheesy, curd-like patches on the buccal mucosa B. Small, painful round ulcers on the oral mucosa C. Clear vesicles with a red base that evolve into pustules D. Chalky white, thick raised patch on the side of the tongue

Correct Answer is A

Explanation

A. White, cheesy, curd-like patches on the buccal mucosa are characteristic of oral candidiasis (thrush), a common fungal infection of the mouth caused by Candida albicans. These patches can often be wiped off, leaving a red, raw, or bleeding surface underneath. This is the classic presentation, making this the correct answer.

B. Small, painful round ulcers on the oral mucosa describe aphthous ulcers (canker sores), which are not fungal infections. They are usually idiopathic or associated with stress, trauma, or immune factors, so this option is incorrect.

C. Clear vesicles with a red base that evolve into pustules are more consistent with herpetic lesions caused by the herpes simplex virus. They are viral, not fungal, in origin, making this incorrect.

D. Chalky white, thick raised patches on the tongue may suggest leukoplakia, which is a precancerous lesion often linked to smoking or chronic irritation. Leukoplakia is not caused by fungal infection, so this option is incorrect.

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The nurse is caring for a client with a history of chewing tobacco use. Which finding requires immediate follow-up from the nurse?

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