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NURS 502 MIDTERM Exam Questions and
Verified Correct Answers
Which of the following dental procedures does NOT requires antibiotic prophylaxis for individuals at high risk of bacterial endocarditis? Routine fillings Post-operative suture removal Dental cleaning Fluoride treatments Orthodontic appliance adjustment - answer>>>Fluoride treatments Which clinical finding distinguishes periodontitis from gingivitis? Inflammation of the gums White discoloration of the permanent teeth Enlarged pockets at the gum base Gingival hypertrophy - answer>>>Enlarged pockets at the gum base Which of the following is the least common site for the development of oral cancer? The tongue Floor of mouth Hard palate Lower lip - answer>>>Hard palate Which of the following factors reduces the risk for caries in adults? Low socioeconomic status
Existing tooth restoration A vegetarian diet Decreased salivary flow Low sugar diet - answer>>>Low sugar diet Which of the following patients require bacterial endocarditis antibiotic prophylaxis? A 26-year-old woman with mitral valve prolapse undergoing routine teeth cleaning with no anticipated bleeding. A 64-year-old man with a prosthetic mitral valve who is undergoing a tooth extraction. A 16-year-old boy with a ventricular septal defect completely repaired in infancy who requires extraction of an impacted wisdom tooth. A 32-year-old man who had bacterial endocarditis 5 years ago who is undergoing orthodontic appliance adjustment. - answer>>>A 64-year-old man with a prosthetic mitral valve who is undergoing a tooth extraction. Which of the following is an abnormal tooth change not explained by aging alone? Gingival recession Root caries Yellowing of teeth Wearing away of teeth with exposed dentin - answer>>>Root caries Which of the following statements concerning xerostomia, or dry mouth, is NOT true? Xerostomia is caused by a decrease in the production of saliva. Xerostomia can cause a burning sensation, change in taste, and difficulty swallowing. Medications can contribute to the development of xerostomia. Xerostomia increases risk for the development of caries. Xerostomia is rarely a problem for patients wearing complete dentures. - answer>>>Xerostomia is rarely a problem for patients wearing complete dentures.
Based on the information provided above, which of the following scenarios would most likely contribute to Mrs. Pederson's - answer>>>2. She has been taking zolpidem nightly for worsening insomnia following the recent death of her favorite cousin. Mrs. Pederson reduces her alcohol intake and stops taking diphenhydramine and zolpidem. She understands the need for her antihypertensive and diabetic medications and will continue to take those as directed. After these changes her dry mouth improves to some degree, but is still symptomatic. She inquires what else she can do to improve her symptoms. Which of the following interventions would be contraindicated for Mrs. Pederson? Use of an over-the-counter saliva substitute Sucking sugarless candy during the day to promote saliva production Starting cevimeline in an effort to increase saliva production Switching to an electric toothbrush from a traditional one Avoiding sugary and caffeinated drinks - answer>>>Starting cevimeline in an effort to increase saliva production Tanya is a 20 year old female who presents to your office with a painful mouth sore that has been present for three days. The sore developed spontaneously and has not changed since its appearance. Six months ago, she noticed similar sores that resolved spontaneously after two weeks. She denies fever or systemic symptoms. What is the most likely cause of Tanya's oral lesion? Primary oral herpes Gingival trauma Coxsackie virus Aphthous ulcer - answer>>>Aphthous ulcer Which of the following is true regarding Recurrent Aphthous Ulcers (RAU)? These lesions commonly present as a single painful ulcer that resolves after two months. RAUs have been associated with vitamin deficiencies. Most lesions require immediate treatment with topical steroids.
These lesions typically occur on keratinized mucosal surfaces such as the gingival and hard palates. - answer>>>RAUs have been associated with vitamin deficiencies. Two months later Tanya returns with similar complaints. She has developed recurrent painful month sores that resemble her previous lesions. The lesions have been present for almost 2 weeks. In the past, her pain was minimal, but she now reports that it has become painful to eat, drink and speak. She has tried over the counter mouth rinses without much improvement. Which of the following is the most appropriate next step in management? Refer Tanya to an oral surgeon for biopsy of her lesion. Prescribe Thalidomide. Prescribe topical steroids. Prescribe an antiviral medication. - answer>>>Prescribe topical steroids. James, a 57-year-old man, presents to the community clinic to establish care. He complains of a loose tooth and oral pain. He reports a history of hypertension and type 2 diabetes. He takes lisinopril and metformin. Laboratory tests and examination findings demonstrate that he is in poor glycemic control with his current medication regimen. You are a member of a health care team that works collaboratively to provide James with appropriate and timely oral health care. Which of the following behaviors best exemplifies the mutual respect and trust that are foundational to interprofessional collaborative practice?
- Inform the patient that diabetes has no direct effect on his oral health, but seeing a dietician is important to help control his diabetes.
- Involve dental and primary care providers in the management of James' oral health.
- Explain to James that a dentist will take care of his teeth but will not be inv - answer>>>Involve dental and primary care providers in the management of James' oral health. During the initial visit with James, you perform an oral health history. You determine that he has not had consistent access to quality health care and has only seen dental providers for acute problems. Additionally, he reports eating frequent sugary snacks and brushing his teeth infrequently. These factors place him at high risk for oral disease. Which of the following behaviors best exemplifies the acknowledgement of roles and responsibilities of participating members of the healthcare team?
32 - answer>>> A caregiver asks you how many teeth her 3 year old child should have. What is the most appropriate response? 20 22 24 28 - answer>>> At what age do teeth typically begin to emerge in children? Before 6 months of age 6 - 15 months of age 15 - 21 months of age 21 - 27 months of age - answer>>>6-15 months of age Oral cancer is most common in which area of the mouth? Hard palate Top of tongue Inside of cheek Posterolateral surface of tongue - answer>>>Posterolateral surface of tongue When performing the "knee-to-knee" oral exam on a young child, in what position should the child start? Facing the examiner Standing up Sitting on the exam table
Facing the caregiver - answer>>>Facing the caregiver All of the following are needed by a primary care clinician to conduct a thorough oral exam on an adult EXCEPT? An exam light to illuminate key features in the mouth Tongue depressors to lift the lip and retract the cheek A mouth mirror to view the lingual surfaces of teeth Gauze pad to grasp the tongue - answer>>>A mouth mirror to view the lingual surfaces of teeth When examining the mouth of a 9-month old child, which of the following is a reason for early referral to see a dentist? The child has only 4 incisors Developmental tooth defects are present Molars are not present Canines are not present - answer>>>Developmental tooth defects are present You are performing an oral exam on a 21-year old patient who has been using smokeless tobacco for 4 years. Which part of this patient's oral cavity is especially important for you to examine? Sun-exposed areas of the cheeks Inner aspect of the lips and cheeks Discoloration or pitting of the teeth Plaque build-up along the gum line Posterior pharynx - answer>>>Inner aspect of the lips and cheeks A complete oral examination includes an assessment of each of the following EXCEPT: Temporomandibular joint (TMJ) Cervical nodes
Alzheimer's Dementia. He has a full upper denture because all of upper teeth were extracted second to rampant caries. His caregiver is concerned one of his remaining lower teeth may be hurting him as he holds his jaw and refuses to eat solid foods. She asks you to examine his mouth and advise her on what to do next. She adds that she tries very hard to keep his teeth clean but it is difficult due to lack of understanding and cooperation on his part. Which of the following is true about performing an oral examination on Peter? Removing his denture is not necessary since he has no remaining upper teeth. Recruiting extra staff to help hold Peter down when he resists will make his examination more accurate and easier. You d - answer>>>None of the above Mr. Green, a 52-year old male, presents to your office for his annual evaluation. As part of that visit, you plan to perform a comprehensive physical examination. Which one of the following statements describes the appropriate decision making process as to whether or not to include an intraoral examination as part of today's visit?
- If he has seen his dentist within the last 6 months, there is no need to examine his oral cavity.
- If he has not seen his dentist within the last 6 months, an open-mouth observational examination is adequate.
- If he does not smoke cigarettes, his risk of oral cancer can be assumed to be very low, so an oral examination is not necessary.
- If he smokes cigarettes, he is at increased risk for both lip and intraoral cancer, so a careful examination is necessary. - answer>>>4. If he smokes cigarettes, he is at increased risk for both lip and intraoral cancer, so a careful examination is necessary. Mr. Green responds "no" when asked about whether he smokes cigarettes. However, on further inquiry, he acknowledges that he uses smokeless tobacco on a daily basis. As you prepare to perform an oral examination, which of the following choices best describes the supplies and equipment you will require to perform an adequate examination? Gloves and a small piece of gauze Gloves, a small piece of gauze and a tongue blade Gloves, a small piece of gauze, a tongue blade and a mouth mirror
Gloves, a small piece of gauze, a tongue blade, a mouth mirror, and a dedicated examination chair with a headrest. - answer>>>Gloves, a small piece of gauze and a tongue blade You are the primary care physician caring for Grace, a 79-year-old woman, who is a resident in a long- term care facility. You are a board certified internist with a Certificate of Added Qualification in Geriatric Medicine. Grace has a history of moderate dementia and right-sided hemiplegia from a stroke at age
- You are new to the practice and are seeing Grace for the first time. The nursing team leader of Grace's floor has listed "oral care" as one of three primary concerns of her family, along with choking on solid foods and poor sleep. Which behavior best exemplifies the mutual respect and trust that are foundational to interprofessional collaborative practice?
- Acknowledge that it is not always possible in a long-term care facility to examine the patient in a non- private setting.
- Acknowledge the importance of the patients' interests.
- Recognize that individual and cultural differences that are character - answer>>>Acknowledge the importance of the patients' interests. You perform an oral examination and encounter severe gingival recession and several loose teeth. You note that Grace has significant xerostomia. You determine that Grace requires the urgent intervention of her dentist, who, after your call, agrees to see her in a few days. You also feel there would be benefit from the involvement of a social worker as a member of her health care team. You notify the nursing home social worker using the flag system in your EMR and ask the nursing team leader to communicate this plan with the patient's family. Which behavior best exemplifies effective communication among participating members of the healthcare team?
- Encourage use of paper-based forms of communication between team members.
- Use proper dental terminology when referring to any of the patient's oral health concerns, regardless of their medical background.
- Explain that you will arrange for a dentist to take care of - answer>>>4. Encourage the social worker on the team to share ideas and opinions regarding the patients' care. During the initial visit with Grace, you perform a thorough medical history including an oral health history. You determine that even though Grace has hemiplegia and dementia that prevents her from adequately caring for her own teeth, she has had excellent oral care, provided by a trained clinical assistant. She was seen by a dentist 8 months ago (6 months after being admitted to this facility). At that time the dentist recommended that she increase her brushing frequency, use fluoride gel on the
Aortic and pulmonary - answer>>>Aortic and pulmonary Most valves have 3 leaflets but which one has only two? Tricuspid Mitral Aortic Pulmonary - answer>>>Mitral This is not a recommended patient position for auscultation... Left lateral recumbent position Kneeling Sitting Standing - answer>>>Kneeling The Valsalva maneuver will increase the intensity of this murmur... Hypertrophic obstructive cardiomyopathy Aortic stenosis Atrial septal defect Tricuspid regurgitation - answer>>>Hypertrophic obstructive cardiomyopathy This maneuver increases the intensity of the hypertrophic obstructive cardiomyopathy murmur: Standing to squatting Isometric hand gripping Squatting to standing Leg raising - answer>>>Squatting to standing
Transient arterial occlusion increases the intensity of left-sided murmurs, which do not include... Aortic regurgitation Mitral regurgitation Ventricular septal defect Pulmonary regurgitation - answer>>>Pulmonary regurgitation Breath sounds can be distinguished from heart sounds in that... They are off sync from heart sounds They are softer than heart sounds They are more vibratory than heart sounds They are in a lower frequency range - answer>>>They are off sync from heart sounds Systole and diastole are created by the ______ Ejection of blood from the AV to SL valves Contraction and relaxation of the ventricles Contraction and relaxation of the atria Pumping of the blood through the heart - answer>>>Contraction and relaxation of the ventricles The sounds of S1 and S2 are created by ______ The closing of the AV and SL valves Turbulent blood flow The opening of the AV and SL valves The opening and closing of the AV and SL valves - answer>>>The closing of the AV and SL valves S3 and S4 are not associated with this condition...
Smoking Obesity - answer>>>Congenital A PDA puts strain on the premature baby's heart because... Oxygenated blood does not reach the rest of the body Blood from the aorta mixes with blood from the pulmonary artery Blood from the pulmonary artery is not pumped efficiently to the lungs Not enough blood is being pumped through the heart - answer>>>Blood from the aorta mixes with blood from the pulmonary artery In what population do symptoms of an ASD typically appear? Newborn Premature babies toddler Late childhood - answer>>>Late childhood What defect is not associated with Tetralogy of Fallot? Ventricular septal defect Pulmonary stenosis Patent ductus arteriosus Overriding aorta - answer>>>Patent ductus arteriosus This is not a category to describe a murmur... Grade Radiation Intensity
Pressure - answer>>>Pressure A diamond-shaped murmur... Increases and then decreases in intensity Begins low and gradually increases in intensity Increases in intensity Decreases in intensity - answer>>>Increases and then decreases in intensity If the sound of a murmur radiates, it tends to do so... In the direction of the blood flow Away from the blood flow With the heart beat Differently depending on the cause - answer>>>In the direction of the blood flow This condition is not known to cause an innocent murmur... Pregnancy Fever Hyperthyroidism Hypothyroidism - answer>>>Hypothyroidism When pathologic murmurs appear in the adult population they are likely caused by... A congenital heart defect A PDA that never fully closed Valve calcification Smoking or other lifestyle factors - answer>>>Valve calcification
Gas exchange between the alveolar ducts and the alveoli Blood moving through the pulmonary artery Reduced breath capacity Air passing through the respiratory tract - answer>>>Air passing through the respiratory tract The purpose of auscultating in a stepwise manner is to: Identify asymmetry in the breath sounds Distinguish between breath and bowel sounds Compare heart and lung sounds Ensure that the sounds on both sides of the chest wall are identical - answer>>>Identify asymmetry in the breath sounds When preforming pulmonary auscultation, you are listening for intensity of the sound, asymmetry in sounds, quality of the sound, length of inspiration and expiration and: The loudness of heart sounds Time between inspiration and expiration Adventitious sounds The presence of bowel sounds - answer>>>Adventitious sounds The diaphragm is the ideal part of the stethoscope to use for pulmonary auscultation because:
- It allows for both high and low frequency sounds to be heard clearly
- It limits low-frequency sounds which mask high-frequency illness indicators
- It amplifies low-frequency sounds which mask high-frequency illness indicators
- The diaphragm is not the ideal part of the stethoscope for auscultation - answer>>>It limits low- frequency sounds which mask high-frequency illness indicators Common patient positions for pulmonary auscultation do NOT include:
Sitting Left-lateral decubitis Supine Standing - answer>>>Standing In addition to auscultation, a chest examination should be preformed and consists of: Measuring chest circumference Tapping the thorax to determine the quality of the percussion note Thoracic ultrasound Asking the patient to cough - answer>>>Tapping the thorax to determine the quality of the percussion note When are breath sounds generally most audible? Upon inspiration Upon expiration During illness Equally audible during inspiration and expiration - answer>>>Upon inspiration One of these is NOT a type of normal breath sound... Bronchial Vesicular Vascular Bronchovesicular - answer>>>Vascular Bronchial lung sounds should be listened for...
