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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A Reason:
The dorsal aspect of the hand, rather than the finger pads, is more sensitive to temperature due to its thinner skin. Therefore, while the finger pads can detect temperature, they are not the best tool for this purpose.
Choice B Reason:
Vibrations, such as those produced by vocal fremitus, are typically assessed using the ulnar edge or the palmar aspect of the hand, not the finger pads. The finger pads are sensitive but do not provide the best surface for detecting vibrations.
Choice C Reason:
The finger pads are densely innervated and are the most sensitive part of the hand, making them ideal for palpating pulses. Pulses are subtle and require a fine touch to assess properly, which is why the finger pads are the preferred area for this assessment.
Choice D Reason:
Fremitus refers to the palpable vibrations transmitted through the bronchopulmonary tree to the chest wall as someone speaks. It is best felt with the ball of the hand or the ulnar edge, not the finger pads.
Correct Answer is C
Explanation
Choice a reason:
Getting a longer cord for the telephone may reduce the risk of tripping over a short cord but could potentially introduce new tripping hazards if not managed properly. It's important to keep cords secured and out of walkways to prevent falls.
Choice b reason:
Placing a throw rug over electrical cords is not advisable as it can create a tripping hazard. Rugs should be secured with non-slip backing and kept away from high-traffic areas to prevent falls.
Choice c reason:
Using handrails in the bathroom is a recommended safety measure to prevent falls. Bathrooms can be slippery, and handrails provide support and stability for residents when moving around in this area.
Choice d reason:
Using chairs without armrests is not a recommended practice for fall prevention. Chairs with armrests can aid residents in safely sitting down and standing up, providing support and reducing the risk of falls.
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