The nurse is speaking to the client and suspects a weakness in eye muscle after observing the eyes cross.
What test should the nurse administer to further assess this problem?

Choice A rationale

Leukoplakia refers to white patches or plaques that develop on the mucous membranes of the oral cavity. It is usually seen as a precancerous condition and is associated with chronic irritation, smoking, or other risk factors. These white patches are not typically associated with redness and bleeding of the gums.

Choice B rationale

Gingival hyperplasia involves the overgrowth or enlargement of the gums. It can be due to various factors, including medications (such as anticonvulsants or calcium channel blockers), hormonal changes, or certain systemic conditions. While the gums may appear enlarged and possibly bleed, gingival hyperplasia is not characterized by redness and bleeding as primary symptoms.

Choice C rationale

Gingivitis is the inflammation of the gums (gingiva) and is characterized by redness, swelling, and bleeding. It is usually caused by plaque buildup along the gumline, leading to irritation and inflammation. Gingivitis is considered an early stage of gum disease and can be reversed with proper oral hygiene and dental care.

Choice D rationale

Periodontitis is an advanced stage of gum disease that occurs when gingivitis is left untreated. It involves the destruction of the supporting structures of the teeth, including the alveolar bone and periodontal ligaments. Symptoms of periodontitis include gum recession, pockets forming between the gums and teeth, and possible tooth loss. While periodontitis can lead to bleeding gums, it is more severe than the initial symptoms of redness and bleeding seen in gingivitis.

Choice A rationale

The general survey is an overall assessment of a client's physical appearance, behavior, mobility, and neurological status. It provides a comprehensive overview of the client's health and well-being, making it the focus of the nurse's observations in this scenario.

Choice B rationale

Medical history includes past and current health conditions, surgeries, medications, and family health history. While important, it is not the focus of the nurse's immediate observations in this scenario.

Choice C rationale

Biographical data involves personal information such as age, gender, occupation, and marital status. While relevant to the client's health, it is not the primary focus of the nurse's observations in this scenario.

Choice D rationale

Social history includes information about the client's lifestyle, habits, and social environment. While valuable for understanding the client's overall health context, it is not the focus of the nurse's immediate observations in this scenario. .