NCLEX Saunders book Integumentary questikns
The nurse reinforces instructions to a group of clients regarding measures that will assist with the prevention of skin cancer. Which statement by the client indicates the need for further teaching??? A. "I need to wear sunscreen when participating in outdoor activities." B. "I need to avoid sun exposure before 10:00 AM and after 4:00 PM." C. "I need to wear a hat, opaque clothing and sunglasses when in the sun." D. "I need to examine my body monthly for any lesions that may be suspicious."
I need to avoid sun exposure before 10 a.m. and after 4 p.m.
The burn client is receiving treatments of topical mafenide acetate (Sulfamylon) to the site of injury. The nurse monitors the client knowing that which indicates a systemic effect has occurred??? A. Hyperventilation B. Elevated blood pressure C. Local pain at the burn site D. Local rash at the burn site
Hyperventilation
The nurse inspects the skin of a client who is suspected of having psoriasis. Which findings should the nurse note if this disorder is present??? A. Oily skin B. Silvery-white scaly lesions C. Patchy hair loss and round, red macules with scales D. The presence of wheal patches scattered about the trunk
Silvery white scale lesions
A client arrives at the emergency department and has experience frostbite to the right hand. Which should the nurse expect to find when inspecting the client's hand??? A. A pink, edematous hand B. Fiery red skin with edema in the nail beds C. Black fingertips surrounded by an erythematous rash D. A white color of the skin, which is insensitive to touch
A white color of the skin which is insensitive to touch
Which should be the anticipated therapeutic outcome of an escharotomy procedure performed for a circumferential arm burn??? A. The return of distal pulses B. Decreasing edema formation C. Brisk bleeding from the injury site D. The formation of granulation tissue
The rectum of distal pulse
The camp nurse as the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that the chemical sunscreen are most effective when applied at which time??? A. Immediately before swimming B. 15 minutes before exposure to the sun C. Immediately before exposure to the sun D. At least 30 minutes before exposure to the sun
30 minutes before exposure to the Sun
An adult client was burned as a result of an explosion the burn initially affected the client's entire face the interior half of the head and the upper half of the anterior torso and there were circumferential Burns to the lower half of both of the arms. The clients clothes caught on fire in the client ran which caused subsequent burn injuries of the posterior surface of the head and the upper half of the posterior torso according to the rule of nines What is extent of the client's burn injury
36%
Isotretinion (Amnesteem, Clavaris) is prescribed for a client with severe acne. Before the administration of this medication the nurse anticipate that which Laboratory test will be prescribed??? A. Platelet count B Triglyceride level C. Complete blood count D. White blood cell count
Triglyceride level
The nurse is caring for a client with circumferential Burns of both legs which leg position is appropriate for this type of burn??? A. A dependent position B. Elevation of the knees C. Flat, without elevation D. Elevation above the level of the heart
Elevation above the level of the heart
The clinic nurse is collecting data on a client being admitted. The nurse notes that the client is taking azelaic acid (Azelex). Because of the medication prescription the nursery suspect that the client is being treated for which condition??? A. Acne B. Eczema C. Hair loss D. Herpes simplex
Acne
The nurse is reviewing the healthcare record of a client with a lesion that has been diagnosed as malignant melanoma. The nurse should expect which characteristics of this type of lesion to be documented in the client's record??? A. An irregularly shaped lesion B. A small papule with a dry, rough scale C. A firm nodular lesion topped with a crust D. A pearly papule with a central crater and a waxy border
An irregularly shaped lesion
The nurse employed in a long-term care facility is planning the clinical assignments for the day. The nurse knows not to assign which staff member to the client with a diagnosis of herpes zoster??? A. A staff member who has never had roseola B. A staff member who has never had mumps C. An unlicensed assistive personnel who has never had chickenpox D. An unlicensed assistive personnel who has never had German measles
An unlicensed assistive personnel who has never had chickenpox
The nurse is applying a topical corticosteroid to a client with eczema. The nurse should monitor for the potential for increased systemic absorption or the medication if the medication is being applied to which body area??? A. Back B. Axilla C. Soles of the feet D. Palms of the hands
Axilla
The nurse assigned to care for a client with herpes zoster. Which characteristic should the nurse expect to know when checking the lesions of this infection??? A. Clustered skin vesicles B. A generalized body rash C. Small blue-white spots with red bases D. A fiery red edematous rash on the cheeks
Clustered skin vessels
Mafenide acetate (Sulfamylon) is prescribed for the client with a burn injury period when applying the medication the client complains of local discomfort and burning. Which is most appropriate nursing action??? A. Notifying the registered nurse B. Discontinuing the medication C. Informing the client that this is normal D. Applying a thinner film than prescribed to the burn site
Informing the client that this is normal
The client returns to the clinic for a follow-up treatment after a skin biopsy of a suspicious lesion that was performed one week ago. The biopsy report indicates that the lesion is a melanoma. The nurse understands that which describes a characteristics of this type of lesions??? A. Metastasis is rare. B. It is encapsulated. C. It is highly metastatic. D. It is characterized by local invasions.
It is highly metastatic
A client with severe acne is seen in the clinic and the health care provider (HCP) prescribes isotretinoin (Amnesteem, Clavaris). The nurse reviews the clients medication record and should contact the HCP if the client is taking which medication??? A. Vitamin A B. Digoxin (Lanoxin) C. Furosemide (Lasix) D. Phenytoin (Dilantin)
Vitamin A
The nurses told that in the same client is suspected of having methicillin-resistant Staphylococcus aureus (MRSA). Which precautions should the nurse Institute during the care of the client??? A. Wear gloves only. B. Wear a mask and gloves. C. Wear a gown and gloves. D. Avoid touching the client's clothes.
Wear a gown and gloves
The evening nurse reviews the nursing documentation in the client's chart and notes that the day nurse has documented that the client has a stage 2 pressure ulcer in the sacral area. Which should the nurse expect to find when checking the clients sacral area??? A. Intact skin B. The presence of tunneling C. A deep, crater-like appearance D. Partial-thickness skin loss of the epidermis
Partial thickness skin loss of the epidermis
The nurse is caring for a client who has just been admitted to the nursing unit after receiving flame burn to the face and chest. The nurse notes a hoarse cough and the client is expectorating sputum with black flecks. The client suddenly becomes restless and his color is becoming Dusky the nurse should interpret this data as indicating which??? A. The client is hypotensive. B. Pain is present from the burn injury. C. The burn has probably caused laryngeal edema, which has occluded the airway. D. The client is afraid and is having a panic attack as a result of the unfamiliar surroundings.
The burn has probably cause laryngeal edema which has occluded the airway
The health care provider has prescribed silver sulfadiazine (Silvadene) for the client with a partial thickness burn that has culture positive for gram-negative bacteria. The nurse is reinforcing information to the client about the medication. Which statement made by the client indicates a lack of understanding about the treatment??? A. "The medication is an antibacterial." B. "The medication will help heal the burn." C. "The medication will permanently stain my skin." D "The medication should be applied directly to the wound."
The medication will permanently stain my skin
Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client knowing the which would indicate the presence of a systemic toxicity from this medication??? A. Tinnitus B. Diarrhea C. Constipation D. Decreased respirations
Tinnitus
The nurse is assisting with caring for a client who is receiving intravenous fluids and who has sustained full thickness Burns injuries of the back and legs the nurse understands that which would provide the most reliable indicator for determining the adequacy of the fluid resuscitation??? A. Vital signs B. Urine output C. Mental status D. Peripheral pulses
Urine output
The health education nurse reinforces instructions to a group of clients regarding measures that will assist in preventing skin cancer. Which instructions should the nurse reinforce to the client??? A. Sunscreen should be applied every 8 hours. B. Use sunscreen when participating in outdoor activities. C. Wear a hat, opaque clothing, and sunglasses when in the sun. D. Avoid sun exposure in the late afternoon and early evening hours. E. Examine your body monthly for any lesions that may be suspicious.
Use sunscreen when participating in outdoor activities. Wear a hat opaque clothing and sunglasses in the sun. Examine your body monthly for any lesions that may be suspicious
The client arrives at the emergency department after a burn injury that occurred in the basement at home and inhalation injury is suspected which should the nurse anticipate as being prescribed for the client??? A. Oxygen via nasal cannula at 10 L B. Oxygen via nasal cannula at 15 L C. 100% oxygen via an aerosol mask D. 100% oxygen via a tight-fitting, nonrebreather face mask
100% oxygen via a tight fitting nonrebreather face mask