ati Dermatological
A nurse estimates the extent of burns a client rescued from a house fire has sustained. The nurse shades in the burned areas on the diagrams displayed below and correctly estimates which of the following to be the percentage of burn surface area?
50%
A client is admitted for treatment of a malignant melanoma of the left upper leg. Initially, the nurse plans to prepare the client for which of the following?
Surgical excision
A nurse is caring for a client who sustained a thermal burn 4 days ago. Most of the burns are superficial partial thickness and deep partial thickness, but there are large areas of full thickness burns as well. Which finding should the nurse report to the client's provider?
Temperature of 39. 1° C (102.4° F)
A client has had a basal cell carcinoma removed by surgical excision. The nurse should remind the client to watch for indications of potential malignancy and other moles, including which of the following?
Ulceration
To promote healing for a client with a large wound healing by secondary intention, the nurse recommends a diet high in protein and which of the following?
Vitamin C
A nurse reinforces teaching to a wheelchair bound client to reduce the risk of pressure ulcer formation by reminding the client to do which of the following?
Shift your weight in the wheelchair every 15 minutes
A 15 year old girl was admitted with burns of her face and hands. Which statement indicates to the nurse that the client has adapted to her changed body image?
"Can I go with my family to the visitor's lounge?"
When targeting a group of clients for health teaching, the nurse should be aware that which group is at greatest risk for developing malignant melanoma?
Clients who are fair- haired, fair-skinned, and of Celtic descent.
A client with a large Healing deep partial- thickness burn of the forearm and wrist is being discharged from the burn treatment clinic. Which of the following should the nurse remind the client to avoid for a year?
Exposure to the Sun
A nurse on a surgical unit is caring for four clients with healing wounds. Which of the four clients' wounds should the nurse anticipate will heal by primary intention?
Gastroplasty incision
A client is being discharged after surgical excision of a malignant melanoma. Which statement indicates to the nurse an understanding of the danger of ultraviolet light?
I reapply my sunscreen every 2 hours when I'm out in the Sun
When collecting data from a bedridden client admitted from home, the nurse notes a shallow crater in the epidermis of the client's sacral area. The nurse documents the presence of a pressure ulcer noting that it is stage...
II
A client arrives at the emergency department with a snakebite of the lower left leg. What should the nurse do?
Immobilize the limb below level of the heart
A client is prescribed 1% silver sulfadiazine cream (silvadene) to be applied to her burn wounds twice daily. After 3 days of treatment, the nurse suspects an adverse reaction to the medication when the client develops which of the following?
Leukopenia
A client with an undiagnosed lesion on the back of his right hand is concerned about the possibility of skin cancer. When the client asks what the most serious type of skin cancer is, the nurse responds based on the knowledge that most malignant tumors are...
Melanomas
A nurse is bathing a client with burn injuries in a hydrotherapy tub. The nurse limits the clients hydrotherapy sessions to no more than 30 minutes to...
Minimize sodium loss
A client comes to the clinic reporting skin lesions. The nurse accesses the lesions and notes that they are 0.5 in size, elevated and solid, with very distinct borders. Based on the findings, which of the following should the nurse document the presence of?
Papules
A client is hospitalized with extensive full thickness burns of both legs. In response to the clients questions, the nurse explains that during the acute phase of burn injury, biological dressings are used primarily to...
Promote healing
A client is brought to the emergency department with severe frostbite. The nurse knows the burned appearance of frostbitten tissue is a direct result of which of the following?
Red blood cell aggregation with microvascular occlusion
A client is about to undergo a biopsy of a 6-mm, bluish-red lesion. In addition to a thorough skin examination, the nurse knows the most critical data to collect at this time should be the status of the client's...
Regional lymph nodes
