Chapter 13 My Nursing Test Banks

Tabloski Gerontological Nursing, 3/e
Chapter 13

Question 1

Type: MCSA

The nurse is completing an assessment of an older patients oral cavity. Which finding is considered normal because of the aging process?

1. Leukoplakia

2. Gum recession

3. Increased saliva

4. Thickening tooth enamel

Correct Answer: 2

Rationale 1: Leukoplakia, a white patchy coating that occurs on the oral mucosa, is not normal and requires further evaluation and possibly biopsy.
Reference: Page 317

Rationale 2: With age, gums tend to recede leaving the newly exposed area of the teeth below the previous gum line vulnerable to tooth decay.
Reference: Page 317

Rationale 3: The production of saliva decreases with age.
Reference: Page 317

Rationale 4: Enamel on teeth is worn away and abraded with aging.
Reference: Page 317

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Explain normal changes of aging in the mouth and oral cavity.

Question 2

Type: MCSA

An older patient has several small vesicles with eroded centers on the lips. What does this finding suggest to the nurse?

1. Gingivitis

2. Leukoplakia

3. Herpes simplex

4. Oral candidiasis

Correct Answer: 3

Rationale 1: Gingivitis causes reddened gums that bleed easily.
Reference: Page 322

Rationale 2: Leukoplakia causes a white, patchy coating in the oral mucosa that may be a precancerous lesion.
Reference: Page 322

Rationale 3: Clusters of vesicles with eroded centers and ulcers on the lips and mucosa can indicate the presence of herpes simplex or zoster.
Reference: Page 322

Rationale 4: Candidiasis appears as cheesy, curdlike, white patches on the oral mucosa.
Reference: Page 322

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Identify common diseases of the mouth and oral cavity in older adults.

Question 3

Type: MCSA

An older patient is experiencing mouth pain rated 6 on a 10 point pain scale. What action should the nurse take first?

1. Medicate the patient with a prescribed mild analgesic.

2. Carefully inspect the patients mouth, teeth, and tongue.

3. Notify the physician in charge about the patients problem.

4. Instruct the patient to begin rinsing the mouth with an isotonic solution.

Correct Answer: 2

Rationale 1: The nurse should not medicate the patient for complaints of mouth pain until the source of the pain can be determined.
Reference: Page 322

Rationale 2: The first step the nurse should take in response to a patient complaining of mouth pain is to carefully conduct a thorough assessment of the oral cavity and visualize any obvious source for the pain.
Reference: Page 322

Rationale 3: Notifying the physician of the pain can be done after the patients oral cavity has been thoroughly assessed.
Reference: Page 322

Rationale 4: The nurse may suggest the patient rinse the oral cavity with an isotonic solution after the patients oral cavity has been thoroughly assessed.
Reference: Page 322

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Recognize nursing interventions that can be implemented to assist the aging patient with oral problems.

Question 4

Type: MCSA

What should the nurse use for mouth care in an older patient who is unable to perform teeth brushing independently?

1. Nystatin

2. Chlorhexidine (Peridex)

3. Lemon and glycerin swabs

4. Undiluted hydrogen peroxide

Correct Answer: 2

Rationale 1: Nystatin is an antifungal agent, which is used to treat oral candidiasis.
Reference: Page 322

Rationale 2: Chlorhexidine (Peridex) is used with patients in whom mechanical plaque removal is difficult to achieve. This mouth rinse is used to treat gingival and periodontal disease and oral infections.
Reference: Page 322

Rationale 3: The use of lemon and glycerin swabs is not recommended and has been found to be harmful to the oral tissues.
Reference: Page 322

Rationale 4: The use of hydrogen peroxide has been questioned because there is evidence suggesting that it is harmful to the oral mucosa.
Reference: Page 322

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4. Recognize nursing interventions that can be implemented to assist the aging patient with oral problems.

Question 5

Type: MCMA

An older patient tells the nurse that tooth brushing is seldom done. What should the nurse assess as reasons why the patient has stopped performing oral hygiene?

Standard Text: Select all that apply.

1. Vision changes

2. Malocclusion of teeth

3. Decrease in taste acuity

4. Lack of dental insurance

5. Loss of manual dexterity

Correct Answer: 1,5

Rationale 1: Among the reasons why older patients stop participating in oral hygiene practices, such as brushing the teeth, may include the inability to physically perform the action caused by loss in manual dexterity.
Reference: Page 321

Rationale 2: Malocclusion of teeth would decrease the patients ability to chew.
Reference: Page 321

Rationale 3: A decrease in the sense of taste may add to a lack of appetite.
Reference: Page 321

Rationale 4: A lack of dental insurance may be a factor as to why a patient does not see a dentist for checkups but would not be a reason for omitting oral hygiene altogether.
Reference: Page 321

Rationale 5: Among the reasons why older patients stop participating in oral hygiene practices, such as brushing the teeth, may include poor vision.
Reference: Page 321

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Recognize nursing interventions that can be implemented to assist the aging patient with oral problems.

Question 6

Type: MCMA

An older patient with oral candidiasis is prescribed Nystatin. Which actions will the nurse take when using this preparation with the patient?

Standard Text: Select all that apply.

1. Plan to use the medication four times a day for 2 weeks.

2. Soak dentures in 1 mL of the medication and water for at least 6 hours.

3. Teach to hold the solution in the mouth and swish for 2 minutes before swallowing.

4. Coat the gums and tongue with the medication and rinse with water after 5 minutes.

5. Provide the medication as a troche to be used twice a day if the patient has diabetes.

Correct Answer: 1,2,3

Rationale 1: The usual treatment with Nystatin in four times a day for 2 weeks.
Reference: Page 322

Rationale 2: Patients with dentures should remove their dentures before rinsing to ensure that the medication reaches all areas of the oral mucosa. One milliliter of nystatin oral suspension should be added to the water used to soak dentures at nighttime, and dentures should soak for at least 6 hours.
Reference: Page 322

Rationale 3: The nurse should carefully observe older patients to make sure they adequately swish for about 2 minutes and then swallow the solution.
Reference: Page 322

Rationale 4: Coating the gums and tongue with the medication and rinsing with water after 5 minutes is not the correct way to use Nystatin.
Reference: Page 322

Rationale 5: If an oral troche used, it must be held in the mouth and allowed to slowly dissolve. The troche contains sugar and should not be used with patients who have diabetes.
Reference: Page 322

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Recognize nursing interventions that can be implemented to assist the aging patient with oral problems.

Question 7

Type: MCSA

An older patient has a significant amount of dental plaque. What can the nurse include when instructing the patient about brushing the teeth and gums?

1. Use a foam swab and brush three times a day for 3 to 4 minutes.

2. Use a soft-bristled toothbrush at bedtime and brush for 1 minute.

3. Use a soft-bristled toothbrush and brush twice a day for 3 to 4 minutes.

4. Use a medium to hard-bristled toothbrush and brush twice a day for 3 to 4 minutes.

Correct Answer: 3

Rationale 1: Swabs are useful to moisten and cleanse oral mucosa but are ineffective in removing bacterial plaque.
Reference: Page 322

Rationale 2: Brushing should be done twice a day for 3 to 4 minutes with a soft-bristled toothbrush. Brushing once a day for 1 minute is not frequent enough.
Reference: Page 322

Rationale 3: The patient should brush the teeth twice per day for 3 to 4 minutes using a soft-bristled toothbrush, which works well to reach between teeth and remove plaque from teeth and from gingival margins.
Reference: Page 322

Rationale 4: A medium to hard-bristled toothbrush will not get between the teeth and may injury the delicate oral mucosa.
Reference: Page 322

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Recognize nursing interventions that can be implemented to assist the aging patient with oral problems.

Question 8

Type: MCMA

The nurse is planning interventions for a patient with xerostomia. What will the nurse include in the patients plan of care?

Standard Text: Select all that apply.

1. Use a mouth rinse.

2. Avoid artificial lubricants.

3. Place a humidifier next to the bed.

4. Avoid foods that are difficult to chew or swallow.

5. Use sugar-free chewing gum, hard candies, and mints.

Correct Answer: 1,3,4,5

Rationale 1: The use of a mouth rinse is an appropriate intervention to help with xerostomia.
Reference: Pages 320, 322

Rationale 2: Artificial lubricants can be used to help with xerostomia.
Reference: Pages 320, 322

Rationale 3: Placing a humidifier next to the bed is an appropriate intervention to help with xerostomia.
Reference: Pages 320, 322

Rationale 4: Avoiding foods that are difficult to chew or swallow is an appropriate intervention to help with xerostomia.
Reference: Pages 320, 322

Rationale 5: Using sugar-free chewing gum, hard candies, and mints is an appropriate intervention to help with xerostomia.
Reference: Pages 320, 322

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Recognize nursing interventions that can be implemented to assist the aging patient with oral problems.

Question 9

Type: MCSA

How should the nurse respond to an older patient who does not receive regular dental examinations?

1. Losing teeth is considered a normal part of the aging process.

2. Patients who have no teeth do not need to see a dentist for regular checkups.

3. Oral malignancies seldom occur in older people so oral examinations are not necessary.

4. Regular dental examinations can improve an older persons ability to eat healthful foods.

Correct Answer: 4

Rationale 1: Tooth loss is not considered a normal part of the aging process.
Reference: Page 317

Rationale 2: Persons without teeth still should receive care from a dentist to maintain properly fitting dentures and receive oral examinations.
Reference: Page 317

Rationale 3: Oral malignancies are higher in males with peak ages for diagnosis being in the 60s and 70s in African American males and in the 80s for white males.
Reference: Page 317

Rationale 4: Patients who receive regularly scheduled dental care are more likely to keep their teeth; maintain the ability to chew properly; and eat healthy foods, such as fruits and vegetables.
Reference: Page 317

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1. Explain normal changes of aging in the mouth and oral cavity.

Question 10

Type: MCMA

The nurse is reviewing an older patients prescribed medications and realizes the patient is at risk for xerostomia. Which medications would increase the patients risk for this disorder?

Standard Text: Select all that apply.

1. Diuretics

2. Antibiotics

3. Antihistamines

4. Anticoagulants

5. Tricyclic antidepressants

Correct Answer: 1,3,5

Rationale 1: The most common cause of xerostomia is medication with the most common offenders to include diuretics.
Reference: Page 320

Rationale 2: Antibiotics are not identified as causing xerostomia in an older patient.
Reference: Page 320

Rationale 3: The most common cause of xerostomia is medication with the most common offenders to include antihistamines.
Reference: Page 320

Rationale 4: Anticoagulants are not identified as causing xerostomia in an older patient.
Reference: Page 320

Rationale 5: The most common cause of xerostomia is medication with the most common offenders to include tricyclic antidepressants.
Reference: Page 320

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Identify medications that may cause or aggravate oral problems.

Question 11

Type: MCSA

Which actions will the nurse include when performing a complete oral exam on an older cooperative patient?

1. Inform the patient that halitosis is considered normal.

2. Do not wear gloves while examining the tongue including the posterior surface.

3. Palpate the head and neck lymph nodes and assesses for tenderness and enlargement.

4. Tell the patient that white patches on the surface of the oral mucosa is expected with aging.

Correct Answer: 3

Rationale 1: Halitosis is not a normal finding and may be associated with xerostomia or infection of the teeth or gums.
Reference: Page 320

Rationale 2: The nurse must wear gloves in following infection control policies for the protection of the patient and nurse.
Reference: Page 320

Rationale 3: A complete oral exam includes an oral health history, examination of the oral cavity including the teeth, and palpation of the lymph nodes of the head and neck noting enlargement or tenderness.
Reference: Page 320

Rationale 4: White patches on the oral mucosa, or leukoplakia, are of concern and the patient should be referred to an oral surgeon or dentist for further examination.
Reference: Page 320

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2. Identify common diseases of the mouth and oral cavity in older adults.

Question 12

Type: MCSA

The nurse is planning to teach a nursing assistant to use the hand-over-hand method to assist an older patient with dementia in performing mouth care. Which instruction should the nurse provide to the assistant?

1. Place a hand over the patients hand and guide the patient to perform mouth care.

2. Use lemon and glycerin swabs to cleanse the gums around the teeth in the front.

3. Speak sternly and instruct the patient to open the mouth and brush the teeth quickly.

4. Carefully place two fingers of a gloved hand in the patients mouth to access the back teeth.

Correct Answer: 1

Rationale 1: The hand-over-hand method involves the caregiver placing a hand over the patients hand and guiding the patient in performing the activity.
Reference: Page 325

Rationale 2: Lemon and glycerin swabs dehydrate the mucosa and should not be used to perform oral care because they are not effective and may be harmful. This does not describe the hand-over-hand method.
Reference: Page 325

Rationale 3: Speaking sternly and in an authoritative manner to the cognitively impaired patient may be interpreted as a threat and evoke agitation.
Reference: Page 325

Rationale 4: Caregivers should never place their hands inside the mouth of any cognitively impaired patient who is apt to bite or clamp down.
Reference: Page 325

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Recognize nursing interventions that can be implemented to assist the aging patient with oral problems.

Question 13

Type: MCMA

After completing an assessment the nurse determines that an older patient is demonstrating signs of gingivitis. What did the nurse assess in the patient?

Standard Text: Select all that apply.

1. Red, painful gums

2. Foul-smelling breath

3. Dry tongue and oral tissue

4. White patches on the oral mucosa

5. Bleeding gums with toothbrushing

Correct Answer: 1,5

Rationale 1: Gingivitis is inflammation of the gum tissue and is associated with red and tender gums.
Reference: Page 322

Rationale 2: Halitosis is offensive-smelling breath and may occur with xerostomia, oral infections, or infected teeth.
Reference: Page 322

Rationale 3: A dry tongue and oral tissue are manifestations of dehydration and are not routinely seen in gingivitis.
Reference: Page 322

Rationale 4: Leukoplakia is a white, patchy coating on the oral mucosa, which is considered precancerous.
Reference: Page 322

Rationale 5: Gingivitis is inflammation of the gum tissue that is associated gum bleeding with brushing.
Reference: Page 322

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Identify common diseases of the mouth and oral cavity in older adults.

Question 14

Type: MCSA

The nurse determines that an older patient is at risk for periodontal disease. What risk factor did the nurse assess in this patient?

1. Takes calcium supplements

2. Experiences excessive saliva

3. Smokes two packs of cigarettes per day

4. Brushes teeth with a soft-bristled toothbrush

Correct Answer: 3

Rationale 1: Taking calcium supplements will reduce the risk of periodontal disease.
Reference: Page 323

Rationale 2: Excessive saliva will not predispose a patient to develop periodontal disease. Dry mouth or xerostomia increases the risk.
Reference: Page 323

Rationale 3: Smoking cigarettes greatly increases the risk of periodontal disease and lowers the chances of success of dental treatments.
Reference: Page 323

Rationale 4: Regularly brushing the teeth with a soft-bristled toothbrush removes plaque from the teeth and gums, and lowers the risk for periodontal disease.
Reference: Page 323

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Identify common diseases of the mouth and oral cavity in older adults.

Question 15

Type: MCSA

The nurse is planning care for an older patient with stomatitis caused by chemotherapy medication. Which nursing diagnosis should the nurse identify for this patient?

1. Impaired Dentition

2. Fluid Volume Deficit

3. Altered Physical Mobility

4. Impaired Oral Mucous Membranes

Correct Answer: 4

Rationale 1: Impaired Dentition would relate to the patient who has some or all teeth missing.
Reference: Page 327

Rationale 2: There is no evidence to suggest that the patient has a fluid volume deficit.
Reference: Page 327

Rationale 3: There is no evidence to suggest that the patient has an alteration in physical mobility. This would not be related to stomatitis.
Reference: Page 327

Rationale 4: Stomatitis is inflammation of the mouth and usually consists of erosions and ulcerations of the oral mucous membranes, with the potential for secondary infection. The chemotherapy medication can alter the integrity of oral tissue. Impaired Oral Mucous Membrane is an appropriate nursing diagnosis related to the stomatitis.
Reference: Page 327

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 3. List common nursing diagnoses related to oral problems in older adults.

Question 16

Type: MCMA

The nurse is reviewing risk factors for the development of oral cancer with a group of senior citizens at a community center. What will the nurse include in this instruction?

Standard Text: Select all that apply.

1. Do not use tobacco.

2. Limit or refrain from alcohol use.

3. Ensure a daily intake of vitamin D.

4. Use a sunscreen when out of doors.

5. Have dental exams to check for infections.

Correct Answer: 1,2,4,5

Rationale 1: Smoking cigarettes, pipes, and cigars accounts for 90% of oral cancers. Cigar, pipe, and chewing tobacco users have the same risk as cigarette smokers.
Reference: Page 324

Rationale 2: The risks for oral cancer are great for people who chronically use alcohol.
Reference: Page 324

Rationale 3: Vitamin D intake is not identified as a way to reduce the onset of oral cancer.
Reference: Page 324

Rationale 4: Limiting sun exposure to the lips by wearing a brimmed hat and lip balm with sunscreen helps reduce the risk of oral cancer.
Reference: Page 324

Rationale 5: Bacterial, viral, and fungal infections of the mouth including the human papilloma virus (HPV16), a common sexually transmitted virus affecting 40 million Americans, has emerged as a serious biologic risk factor for oral cancer.
Reference: Page 324

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Recognize nursing interventions that can be implemented to assist the aging patient with oral problems.

Question 17

Type: MCSA

The nurse has completed teaching a group of nursing assistants on oral hygiene approaches for the older patient. Which statement indicates that additional instruction is needed?

1. Patients should brush teeth twice daily.

2. A toothbrush is a better tool than a foam swab.

3. Hydrogen peroxide can be used as a mouth rinse.

4. Tooth brushing should be done for 3 to 4 minutes.

Correct Answer: 3

Rationale 1: Older patients should brush the teeth twice per day.
Reference: Pages 324, 322

Rationale 2: A toothbrush is to be used for oral care and not a foam swab.
Reference: Pages 324, 322

Rationale 3: Recent evidence suggests that hydrogen peroxide harms the oral mucosa and causes negative subjective reaction in patients.
Reference: Pages 324, 322

Rationale 4: Tooth brushing should be performed for 3 to 4 minutes.
Reference: Pages 324, 322

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4. Recognize nursing interventions that can be implemented to assist the aging patient with oral problems.

Question 18

Type: MCMA

The nurse assesses the teeth, gums, and tongue of an older patient complaining of mouth pain. What additional actions should the nurse take at this time?

Standard Text: Select all that apply.

1. Review vital signs.

2. Assess respiratory status.

3. Encourage the patient to gargle.

4. Review the patients tooth brushing routine.

5. Palpate lymph nodes along the patients jaw.

Correct Answer: 1,2,5

Rationale 1: When older patients complain of mouth pain the vital signs should be checked to rule out an acute infection.
Reference: Page 322

Rationale 2: When older patients complain of mouth the respiratory status should be checked to rule out an acute infection.
Reference: Page 322

Rationale 3: Encouraging gargling does not address the concerns of the patient.
Reference: Page 322

Rationale 4: Reviewing the patients tooth brushing schedule may provide information about hygiene but does not provide a response to the concerns being voiced.
Reference: Page 322

Rationale 5: Patients with a dental abscess will often have swollen or enlarged lymph nodes under the ear or jaw.
Reference: Page 322

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Recognize nursing interventions that can be implemented to assist the aging patient with oral problems.

Question 19

Type: MCMA

The nurse notes that several older patients are experiencing halitosis. What should the nurse consider as underlying causes of the condition?

Standard Text: Select all that apply.

1. Ill-fitting dentures

2. Stomach disorders

3. The limited amount of fluid intake

4. The number of medications being administered

5. Limited attention to hygiene caused by problems with manual dexterity

Correct Answer: 1,3,4,5

Rationale 1: Ill-fitting dentures can serve as a source of halitosis.
Reference: Pages 318, 320

Rationale 2: Stomach disorders are not specifically linked to halitosis.
Reference: Pages 318, 320

Rationale 3: Reduced fluid intake can lead to xerostomia, which is a cause of halitosis.
Reference: Pages 318,320

Rationale 4: Multiple medications can cause xerostomia, which is a cause of halitosis.
Reference: Pages 318, 320

Rationale 5: Aging may be associated with mobility problems that hinder the individual from performing comprehensive mouth care.
Reference: Pages 318, 320

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Recognize nursing interventions that can be implemented to assist the aging patient with oral problems.

Question 20

Type: MCMA

An older patient is surprised to learn of the diagnosis of oral candidiasis. What responses should the nurse make to this patient?

Standard Text: Select all that apply.

1. It can be seen in people who have diabetes.

2. It is often caused by eating spicy or irritating foods.

3. Sometimes people who use oral inhaled steroids for asthma can develop this.

4. It is a bacterial infection that may be transmitted by contact with dirty utensils.

5. It is an infection that results when there is an alteration in the normal flora of the mouth.

Correct Answer: 1,3,5

Rationale 1: People who have diabetes and have high or elevated glucose levels are at risk for candidiasis because the oral flora is altered and the organism Candida albicans is encouraged to overgrow.
Reference: Page 322

Rationale 2: Food intake has no influence on the development of candidiasis.
Reference: Page 322

Rationale 3: Older patients using inhaled steroids to treat asthma should rinse their mouths carefully each time the inhaler is used to prevent the formation of oral candidiasis.
Reference: Page 322

Rationale 4: Candidiasis is a fungal infection.
Reference: Page 322

Rationale 5: Candidiasis results when the normal flora is altered.
Reference: Page 322

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2. Identify common diseases of the mouth and oral cavity in older adults.

Question 21

Type: MCSA

An older patient says that gargling is done every day with hydrogen peroxide and asks the nurse how frequently this should be done. What information should the nurse provide to the patient?

1. Advise to suspend the practice.

2. Mix the hydrogen peroxide with mouthwash for gargling.

3. Dilute the hydrogen peroxide solution with water prior to gargling.

4. Gargle with the hydrogen peroxide only one time per day to reduce irritation.

Correct Answer: 1

Rationale 1: Recent evidence suggests that hydrogen peroxide harms the oral mucosa and causes negative subjective reaction in patients. The nurse should advise the patient to suspend the practice.
Reference: Page 322

Rationale 2: Recent evidence suggests that hydrogen peroxide harms the oral mucosa and causes negative subjective reaction in patients. The nurse should advise the patient to suspend the practice and not mix the peroxide in mouthwash.
Reference: Page 322

Rationale 3: Recent evidence suggests that hydrogen peroxide harms the oral mucosa and causes negative subjective reaction in patients. The nurse should advise the patient to suspend the practice and not dilute the peroxide with water.
Reference: Page 322

Rationale 4: Recent evidence suggests that hydrogen peroxide harms the oral mucosa and causes negative subjective reaction in patients. The nurse should advise the patient to suspend the practice and not to gargle at all with peroxide.
Reference: Page 322

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2. Identify common diseases of the mouth and oral cavity in older adults.

Question 22

Type: MCSA

The gerontological nurse is planning a presentation on dental care of older patients for the nursing staff in a skilled facility. What information should the nurse include in the presentation?

1. The older adult should brush the teeth once daily.

2. Flossing should be limited to avoid dental complications.

3. The use of alcohol-based mouthwashes is helpful to reduce bacteria.

4. The older adult should have dental cleaning performed two times per year.

Correct Answer: 4

Rationale 1: The older adult should brush the teeth twice a day.
Reference: Page 324

Rationale 2: The older adult should floss daily.
Reference: Page 324

Rationale 3: The use of alcohol-based mouthwashes is limited due the drying effects of the alcohol.
Reference: Page 324

Rationale 4: Dental assessments and cleaning should be performed two times per year.
Reference: Page 324

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2. Identify common diseases of the mouth and oral cavity in older adults.

Question 23

Type: MCSA

An older patient reports having a white patch inside the mouth. The nurse assesses a 2 cm by 2 cm lesion on the inner aspect of the left jaw. How should the nurse respond to the patient?

1. Rinse with a mild solution of hydrogen peroxide and water.

2. The white patch is the result of aging and no cause for concern.

3. You should contact your healthcare provider for an evaluation of the area.

4. I think the patch looks like a bacterial infection and you will most likely need an antibiotic.

Correct Answer: 3

Rationale 1: The patient should not be directed to use hydrogen peroxide since this is irritating to delicate oral tissues.
Reference: Page 320

Rationale 2: White patches are not usual signs of aging.
Reference: Page 320

Rationale 3: The lesions description is consistent with leukoplakia. The final diagnosis and treatment of the lesion will need to be made by a physician.
Reference: Page 320

Rationale 4: White patches are not caused by bacterial infections.
Reference: Page 320

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2. Identify common diseases of the mouth and oral cavity in older adults.

Question 24

Type: MCSA

An older patient diagnosed with an oral cancer questions how the disease was contracted without a smoking history. Which response by the nurse is most appropriate?

1. Dietary intake high in fat has been linked to oral cancer.

2. Your history of periodontal disease is a significant risk factor.

3. It is highly unusual for a nonsmoker to be affected by oral cancer.

4. Studies show sun exposure may play a role in the development of oral cancers.

Correct Answer: 4

Rationale 1: Dietary fat intake is not associated with the development of oral cancer.
Reference: Page 324

Rationale 2: Periodontal disease is not associated with the development of oral cancer.
Reference: Page 324

Rationale 3: Explaining to the patient the links between smoking and the cancers development does not meet the patients request for information.
Reference: Page 324

Rationale 4: Oral cancer may affect sun-exposed areas of the face and mouth.
Reference: Page 324

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2. Identify common diseases of the mouth and oral cavity in older adults.

Question 25

Type: MCSA

An older patient with bleeding gums is directed by the physician to make dietary changes. After providing education regarding the diet, which patient statement indicates understanding?

1. I should avoid cranberry products.

2. I am going to drink orange juice every morning.

3. Adding bananas to my morning smoothie will help manage my condition.

4. Increasing the amount of fiber in my diet will reduce the bleeding in my gums.

Correct Answer: 2

Rationale 1: Adding cranberry products will not improve the vitamin deficiency causing bleeding gums.
Reference: Page 321

Rationale 2: Bleeding gums may be associated with a deficiency of vitamins C or K. Orange juice will provide vitamin C.
Reference: Page 321

Rationale 3: Adding bananas will not improve the vitamin deficiency that causes bleeding gums.
Reference: Page 321

Rationale 4: Adding fiber will not improve the vitamin deficiency that causes bleeding gums.
Reference: Page 321

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4. Recognize nursing interventions that can be implemented to assist the aging patient with oral problems.

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