ATI DERM BURN

A nurse is caring for an adult client who has atopic dermatitis. Which of the following findings should the nurse expect?

Chronic rash with thick skin

A nurse is caring for a client who is 2 days postoperative following abdominal surgery and observes that theclient's wound has eviscerated. After calling for help, Which of the following actions should the nurse take first?

Cover the area with a sterile dressing, moistened with 0.9% sodium chloride irrigation.

A nurse is assessing a client 1 day postoperative following abdominal surgery. Suddenly the client reports a pullingsensation and pain in his surgical incision. Which of the following actions should the nurse take?

Cover the area with saline-soaked sterile dressings.

A nurse is teaching a client who has a new prescription for topical betamethasone to treat contact dermatitis.Which of the following instructions should the nurse include?

"Use the cream for a few days after the area has healed."

A nurse is caring for a client who has malignant melanoma. Which of the following findings should the nurseexpect when assessing the lesion?

Purplish in color

A nurse is providing teaching for a client who is postoperative following below-the-knee amputation. The nurseshould instruct the client that which of the following nutrients is necessary for would healing?

Vitamin C

A nurse is teaching a client who is receiving radiation therapy about skin care. Which of the following instructionsshould the nurse include?

Walk outside in the early mornings.

A nurse in a dermatologist's office is planning an educational session about skin cancer. Which of the followingshould the nurse include as risk factors for skin cancer? (Select all that apply.)

Overexposure to ultraviolet light Previous skin injury Genetic predisposition

A nurse is providing discharge teaching to a client following an excisional biopsy of a skin lesion. Which of thefollowing information should the nurse include in the teaching?

"Clean the incisional site daily after the dressing is removed."

A nurse is planning an educational program about basal cell carcinoma. Which of the following information shouldthe nurse plan to include?

Basal cell carcinoma has a low incidence of metastasis.

A nurse in an emergency department is caring for a client who has burns on the front and back of both his legsand arms. Using the rule of nines the nurse should document burns to which percentage of the client's total bodysurface area (TBSA)?

54 percent

A nurse is developing a plan of care for a client who is rehabilitating from major burns. Which of the followinginterventions should the nurse include to provide emotional support?

Talk with the client during wound care.

A nurse in the outpatient clinic is assessing a client who has psoriasis. The nurse should expect which of thefollowing findings?

Silvery, white scales

A nurse is developing a plan of care to prevent skin breakdown for a client with a spinal cord injury and paralysis.Which of the following nursing actions are appropriate? (Select all that apply.)

Use pillows to keep heels off the bed surface. Minimize skin exposure to moisture.

A nurse is observing a newly licensed nurse who is performing a focused skin assessment on a client who reports askin condition. Which of the following questions by the newly licensed nurse requires intervention?

"How do you handle stress?"

A nurse is teaching a client about risk factors for skin cancer. Which of the following statements by the clientindicates an understanding of the teaching?

"I should apply sunscreen prior to going outside, even in the winter months."

A nurse is changing the dressing of a client who is 1 week postoperative following abdominal surgery and notesthe presence of serosanguineous drainage. The nurse should recognize that this is an indication of which of thefollowing circumstances?

Serosanguineous drainage at this time is a manifestation of possible dehiscence.

A nurse is providing teaching to a client who has widespread psoriasis and a prescription for phototherapy. Thenurse should include which of the following information in the teaching?

Treatment might be interrupted if areas of redness and tenderness develop."

A nurse is caring for a client involved in a suspected bioterrorism event involving exposure to cutaneous anthrax.Which of the following manifestations should the nurse anticipate?

Skin lesions with pruritus

A nurse is developing a teaching plan for a client who has psoriasis. Which of the following information should the nurse include in the plan?

Use bath oils to soften and soothe the skin.

A nurse is assessing a client who has a new diagnosis of systemic lupus erythematosus (SLE). The nurse shouldidentify which of the following as a cutaneous manifestation of SLE?

Butterfly rash on face

A nurse is providing care for four clients on a medical-surgical unit. Which of the following clients should the nurseidentify as being at risk for the development of pressure ulcers? (Select all that apply.)

C. A client who has protein calorie malnutrition D. A client who has right-sided heart failure and 4+ edema to the lower extremities E. A client who has postoperative delirium

A nurse is assessing a client who is postoperative and finds the client's abdominal incision has eviscerated. Whichof the following actions should the nurse take?

Cover the wound with a sterile saline-soaked dressing.

A nurse is caring for a client who has questions concerning the various treatment options for his new diagnosis ofbasal cell carcinoma (BCC). Which of the following treatments should the nurse include in the discussion? (Selectall that apply.)

Cryosurgery Electrosurgery Radiation therapy Topical corticosteroids Micrographic surgery

A nurse is teaching a client who has psoriasis about possible treatment options. Which of the following treatmentsshould the nurse include in the teaching? (Select all that apply.)

Tar preparations Corticosteroids Ultraviolet light therapy

A nurse is assessing a client who is brought to the emergency room with burn injuries. Which of the followingfindings should the nurse identify as a deep partial-thickness burn?

The burned area is red in color with eschar present.

A nurse is teaching a client who has herpes simplex virus type 2 about disease transmission. Which of thefollowing statements by the client indicates understanding of the teaching?

"Itching or tingling occurs at the site where a blister forms."

A charge nurse is conducting an in-service about smallpox with a group of nurses. Which of the followingstatements should the nurse include in the teaching?

"Smallpox lesions appear similar those of the varicella zoster virus."

A nurse is assessing a client who presents to the provider's office for evaluation of multiple nevi. Which of thefollowing findings should the nurse report to the provider as a possible sign of malignancy?

Irregular borders

A nurse is developing an education program about skin cancer for a community center. Which of the followinginstructions should the nurse plan to include?

Keep a body map of skin lesions.

A nurse is monitoring the fluid replacement of a client who has sustained burns. The nurse should administerwhich of the following fluids in the first 24 hr following a burn injury?

Lactated Ringer's

A nurse is assessing the depth and extent of injury on a client who has severe burns to the face, neck, and upperextremities. Which of the following factors is the nurse's priority when assessing the severity of the client's burns?

Localized of the burn

A nurse in an emergency department is caring for a client who has deep partial- and full-thickness burns to hischest, abdomen, and upper arms. What is the nurse's priority intervention for this client during the resuscitation ofphase of injury?

Maintain the airway

A nurse is teaching a client about the uses of aloe vera. Which of the following information should the nurseinclude in the teaching?

"Aloe vera can act as a laxative."

A nurse in the emergency department is caring for a client who has a 30% burn injury to her lower extremities.Which of the following interventions should the nurse perform first?

Administer IV fluids.

A nurse is caring for a client who has burns to his face, ears, and eyelids. The nurse should identify which of thefollowing is the priority finding to report to the provider?

Difficulty swallowing

A nurse is caring for a client who has herpes zoster. Which of the following actions should the nurse take?

Prepare to administer acyclovir.

A nurse is caring for a client who has myasthenia gravis. The nurse should recognize that this disease is causedby which of the following types of hypersensitivities?

Cytotoxic

A nurse is providing teaching to a client about preventing skin cancer. Which of the following client statementsindicates a need for further teaching?

"Eating a high fiber diet will reduce my risk for developing skin cancer."

A nurse is teaching a client about the side effects of chemotherapy medication. Which of the following nursing statements should the nurse include in the teaching?

"Hair loss is common and includes eyebrows and eyelashes."

A nurse is developing a teaching plan for a client who has psoriasis. Which of the following actions should thenurse include in the plan?

Identify effective stress reduction techniques.

A nurse is preparing to start an IV infusion of lactated Ringer's for a client who sustained a burn injury. The client isprescribed 5,200 mL of fluid over the first 24 hr. How many mL/hr should the nurse set the pump to infuse for thefirst 8 hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailingzero.)

325 ml/hr

A nurse is planning care for an older adult client who has herpes zoster. Which of the following interventionsshould the nurse include in the plan?

Administer analgesics for pain.

A nurse is caring for a client who is postoperative following abdominal surgery. The nurse discovers a loop ofbowel through an opening in the surgical incision. Which of the following actions should the nurse take?

Apply moistened sterile gauze to the site.

A nurse is assessing a client at a dermatology clinic. Which of following findings places the client at risk fordeveloping malignant melanoma?

History of chronic skin irritation

A nurse is caring for a client who is brought into the emergency department immediately following a snake bite tohis forearm. The client suspects the snake to be venomous. Which of the following interventions should the nursetake?

Place the extremity in a dependent position.

A charge nurse is teaching a group of health care workers about hand hygiene to prevent infection. Which of thefollowing information should the charge nurse include in the teaching?

Use chlorhexidine to wash hands if the client is immunosuppressed.

A nurse is providing teaching to a client who has psoriasis and a new prescription for the topical corticosteroidcream betamethasone valerate. Which of the following information should the nurse include in the teaching?

Wrapping plastic around the site can increase the medication's effectiveness.

A nurse is teaching a newly licensed nurse about the risk factors for dehiscence for clients who have surgicalincisions. Which of the following factors should the nurse include in the teaching? (Select all that apply.)

poor nutritional state obesity wound infection

A nurse is assessing a lesion on a client who has basal cell carcinoma. The nurse should expect which of thefollowing findings?

A pearly, shiny nodule

A nurse in an emergency department is reviewing the medical record of a client who has an extensive burn injury.Which of the following laboratory results should the nurse expect?

Hyperkalemia

A nurse is formulating a teaching plan about herpes zoster for a group of older adults at a community center. Thenurse should include which of the following information in the plan?

Many clients experience pain in the affected area for weeks after the lesions have resolved.

A nurse is assessing a client who has viral rhinitis and a history of herpes simplex virus type 1 (HSV-1) lesions.The nurse should assess which of the following areas of the body for the recurrence of HSV-1 lesions?

Mouth

A nurse is completing discharge teaching to a client about nutrition therapy for wound healing following majorsurgery. Which of the following vitamins that promote wound healing should the nurse include in the teaching?(Select all that apply.)

Vitamin A Vitamin B12 Vitamin C Vitamin K

A nurse in a long-term care facility is caring for an older adult client who had a stroke 4 weeks ago and who isunable to move independently. The nurse should monitor for which of the following complications of immobility?

A reddened area over the sacrum

A nurse is assessing a client who has basal cell carcinoma on her nose. The nurse should expect which of thefollowing findings?

A small, translucent papule with rolled borders

A nurse working in an emergency room is caring for a client who has third degree frostbite to both lowerextremities. The nurse should plan to take which of the following actions?

Elevate the legs.

A nurse is developing a teaching plan for a client who has an ileostomy and will require stoma care. Which of thefollowing information should the nurse include?

Empty the pouch when it is 1/2 full.

A nurse is assessing a client following the application of an aquathermia pad. Which of the following is the firstindication to the nurse that the client is experiencing a superficial burn injury to the application site?

Erythema

A nurse is assessing a client who reports a nevus that has increased in size and an irregularly shaped lesion thatvaries in color. These findings are consistent with which of the following medical diagnoses?

Malignant melanoma

A nurse is caring for a toddler who arrives at the emergency department with burns to his lower legs. Which of thefollowing actions should the nurse take?

Pour tepid water over the burns.

A nurse is caring for a client who has pruritus following treatment for scabies. Which of the following actions should the nurse take?

Provide mittens for the client to wear at night.

A nurse is planning care for a client who is confined to bed. Which of the following actions should the nurse includein the plan?

Reposition the client every 2 hr.

A nurse is providing teaching to a client who has a superficial lesion and has had a biopsy indicates malignantmelanoma. The nurse should include which of the following options as the treatment of choice?

Surgical excision