Exam 1 Sherpath lesson questions

A patient undergoing radiation therapy for a malignant melanoma states, "I'm happy I'm doing radiation and not chemotherapy. At least I can keep my hair." Which response by the nurse is appropriate?

"Because skin cancer requires multiple radiology visits, the chances of hair loss due to radiation may increase along with other side effects." Radiation may require multiple radiology visits, increasing the risk of side effects such as alopecia, spider veins, atrophy, hyperpigmentation, depigmentation, ulceration, hearing loss, ocular damage, and mucositis

Which statement indicates the nurse is performing proper patient teaching during discharge of a patient who has recently undergone a dermatologic procedure?

"Check the site for any type of pus or drainage and call the health care provider immediately if you see it." Purulent drainage should be reported immediately to the health care provider.

A patient calls the clinic nurse complaining that the skin surrounding the area where a wart was removed last week is swollen and hot with a small amount of drainage. What is the appropriate response by the nurse?

"Come into the office so we can assess the site."

The nurse notes that a patient appears very withdrawn and depressed. When the nurse approaches the patient, the patient states, "I'll never look the same again with all these skin issues and treatments. I don't even want to leave this room." How should the nurse respond?

"Cosmetics can be helpful in situations like this. Would you like to discuss this more?" By concealing skin issues, cosmetics can help build the patient's self-esteem and confidence, thus allowing the patient to become more social.

A patient recently diagnosed with a bacterial skin infection exclaims, "I've never had so much as a cold!" Which statement by the nurse is the most appropriate?

"Good hygiene practices can help prevent skin infections."

A nurse is teaching a group of new nurses about working with patients with profound hearing loss. Which statement made by a new nurse requires correction?

"I should avoid using hand movements." A nonverbal aid such as hand movements would help the patient understand what the nurse is trying to communicate and should not be avoided. This statement requires correction.

Which response from a patient diagnosed with squamous cell carcinoma demonstrates effective patient teaching about the treatment by the health care team?

"I should be prepared to undergo surgery to treat this cancer." Squamous cell cancers are usually treated with surgery such as excision, cryosurgery, or electrosurgery. Chemotherapy and radiation may also be used. The patient has been adequately prepared for the treatment necessary for squamous cell cancer if a surgical procedure is expected.

The nurse teaches the patient the ABCDEs of skin self-examination. Which statement by the patient demonstrates that teaching has been effective?

"I should report any moles that are more than ¼ inch in diameter to my health care provider." Patient self-examination of the skin is based on ABCDE criteria (Asymmetry, Border irregularity, Color change and variation, Diameter of 6 mm or more, and Evolving in appearance). According to the "D" in the ABCDE of skin self-examination, a mole greater than ¼ inch in diameter should be reported to the health care provider.

A student nurse is caring for a patient with severe thermal burns. Which statement made by the student nurse to the charge nurse indicates that additional teaching is needed?

"I will check my patient hourly to make sure that he does not experience an inflammatory response from his burns." An inflammatory response is expected after a burn injury and is necessary for the healing process to begin. The nursing student needs additional teaching about the role of an inflammatory response in the healing process.

The health care provider is educating a 65-year-old patient on a new diagnosis of primary open-angle glaucoma (POAG). Which statement by the patient shows an understanding of the discussion?

"I will need to follow my treatment plan to prevent damage to the optic nerve." Once diagnosed, the priority for glaucoma is to keep the intraoptic pressure (IOP) low in order to prevent optic nerve damage.

Match the Fitzpatrick Classification of Skin Type to the patient statement.

"If I look at the sun I burn!" type 1 "I love the summertime; my tan is always nice and even." type 4 "Do you have any cold cream? I think I may have a slight sunburn." type 3 "I look like a lobster now, but in a couple of days my tan should look decent." type 2

A nurse is counseling a patient about to undergo cataract surgery. The patient will have cataracts removed from both eyes, but just the poorest eye will be operated on initially. Which statement demonstrates that the patient understands the procedure?

"If a complication arises in the eye with poorest vision, I will still have some vision in the better eye." Surgery must first be performed on the eye with lowest level of acuity because if surgery is unsuccessful, the patient will have some vision left in the other eye.

A nurse is caring for a patient with hearing loss. The patient asks the nurse what it means to have sensorineural hearing loss. Which response from the nurse is correct?

"It is an impairment of one of your cranial nerves that affects the function of your ear." Sensorineural hearing loss is caused by impairment of function of the inner ear or the vestibulocochlear nerve (CN VII).

A patient shares with the nurse a concern about a skin tag on the inner thigh. The patient is becoming worried that the skin tag is cancerous. How should the nurse respond?

"Most skin tags are harmless and won't require any treatment, unless they are irritating and you want them removed." Skin tags may or may not become irritated; treatment is not necessary unless the patient wants them removed.

The nurse is caring for a patient with a family history of age-related macular degeneration (AMD), a medical history of high blood pressure, and a social history including daily cigar smoking. The patient asks if there is any way to prevent development of the disease. Which responses by the nurse are correct? Select all that apply.

"Reduce or quit smoking cigars." "Keep your blood pressure under control."

A family member of a patient with a severe facial burn asks the nurse why the patient's face is swollen. Which statement made by the nurse is appropriate?

"Swelling is an expected inflammatory response of the body to a burn injury." Swelling is expected after a burn injury because of increased capillary permeability, which results in leakage of fluids and electrolytes into the interstitium.

A patient with eczema is admitted to the unit for intravenous antibiotic therapy for a severe skin infection. The patient states, "Make sure you wear gloves. I don't want you to catch what I have." Which response by the nurse is appropriate?

"The gloves are for your safety to prevent any organisms spreading from me to you because your skin is compromised."

The nurse is caring for a patient with age-related macular degeneration (AMD) and refers the patient to a psychologist. Which responses by the nurse are appropriate when the patient questions the reason for the referral? Select all that apply.

"The permanent loss of central vision can be very difficult." "This is done to discuss the need for additional support systems."

A patient in the emergency department is diagnosed with Ménière's disease after an acute episode and asks the nurse how long the attack will last. What is the nurse's correct response?

"These attacks can last for hours to days." Attacks of Ménière's disease can last for hours or days and may occur several times a year.

A patient with skin cancer undergoing radiation therapy tells the nurse that she has become self-conscious about changes in her skin. What recommendations can the nurse make to the patient so that she can avoid further skin damage?

"Wear a scarf on your head to protect your scalp." "Find some activities that will help you reduce stress levels." "Use gentle, nonirritating soaps when you wash your hands and bathe."

A patient with facial burns frequently asks the nurse, "When will I look normal again?" Which is an appropriate response by the nurse?

"You seem to be very anxious. Would you like to talk about how you're feeling?" The patient is verbally expressing signs of anxiety. The nurse should attend to the patient's psychologic and emotional needs at this time.

A nurse receives orders for a patient with an acute attack of Ménière's disease. Which drug order should the nurse question?

ACE inhibitors This is an angiotensin-converting enzyme inhibitor and normally used for cardiac disease, not Ménière's disease. Calcium channel blockers may be used for the treatment of acute attacks.

A young adult female was recently prescribed oral birth control pills. The patient states that since she started taking the pills, her skin has become "problematic." The nurse understands that which skin disorder is a common side effect of oral contraceptives?

Acne vulgaris Flare-ups of acne vulgaris can occur with corticosteroid and birth control pill use.

A patient in the clinic states, "I found this reddish brown mole on my scalp. It can't be cancer: I only sunbathe twice a year." The nurse understands that this characteristic finding is common in which type of skin cancer?

Atypical nevi A single atypical nevus (mole) can include a variety of colors and is commonly found on the back, scalp, or buttocks.

A patient calls the office and reports that his 78-year-old spouse has suddenly lost hearing in one ear. Which recommendation by the nurse is correct?

Bring his spouse in to be evaluated immediately Sudden hearing loss is a medical emergency, and the patient should see the health care provider immediately.

Match the cause of the burn injury to its clinical manifestations.

Burn odor, visible contact point, impaired circulation to the area--- chemical cough, increasing hoarseness, singed nasal or facial hair-- electrical moist blisters, hypersensitive to touch or air, blanching with pressure-- smoke inhalation Dry, leathery eschar; charred appearance; impaired sensation when touched-- thermal (partial thick, second degree)

The patient with acute angle-closure glaucoma is preparing for surgery. The nurse notes that the patient consented for a lens removal procedure. How should the nurse proceed?

Contact the surgeon for revision of the consent form. Either laser peripheral iridotomy or surgical iridectomy is the surgery of choice for acute angle-closure glaucoma. Lens removal is a surgery to correct cataracts. The nurse identifies this error and should consult the HCP to have the consent revised.

A nurse is caring for a patient with thermal burns. Which pathophysiologic reactions result in the patient being at risk for burn shock?

Decreased blood volume and increased systemic vascular resistance Fluids leak out of the intravascular space during a thermal burn injury. This results in a decrease in blood volume and a compensatory increase in systemic vascular resistance.

Which factors determine the severity of a burn? Select all that apply.

Depth of burn location of burn medical history of the patient extent of burn calculated as percentage of total body surface area

During an education session for a patient with a chronic visual sensory perception problem, which information should the nurse ensure the patient knows? Select all that apply.

Details of treatment regimen Long-term effects of the disease process How to recognize emergency care needs The food preferences and nutritional habits can affect eyesight

A nurse is caring for a patient with a chemical burn injury. Which symptom can the nurse expect to find on assessment?

Edema of surroundign tissue

The nurse is preparing a teaching plan for a patient with mild hearing loss who was fitted with an in-canal hearing aid. Which information should the nurse include in the teaching?

Ensure the hearing aid fits properly inside the ear canal.

Which practice should the nurse emphasize as being the single most important means of preventing secondary skin infections?

Hndwashing

Match the type of burn with the source of the burn injury.

Hydrochloric acid-- smoke inhalation boiling water-- radiation Exposed outlet wire-- chemical

A nurse is caring for a patient with burns in the rehabilitative phase. Which complication is the nurse most likely to see during this phase?

Hypertrophic scarring

A nurse is caring for a patient with a new diagnosis of primary open-angle glaucoma (POAG). When reviewing the health care provider's orders, which prescription should the nurse question?

Ibuprofen Nonsteroidal antiinflammatory drugs, such as ibuprofen, may be used preoperatively for patients undergoing cataract surgery, but they are not indicated for a patient with POAG.

A patient underwent an excisional biopsy 3 days ago. The patient calls the clinic and reports a scant amount of bleeding and "a little discomfort." What is the best action by the nurse?

Inform the patient that slight bleeding and discomfort are expected after an excisional biopsy

The nurse is developing a nutritional plan for a patient at risk for age-related macular degeneration (AMD). Which food item should the nurse encourage in the patient's diet?

Kale salad Eating dark-green and leafy vegetables, which are rich in lutein, may aid in reducing the risk of AMD in people at higher risk.

The nurse is caring for a patient with cataracts. The health care provider informs the nurse that the patient will be undergoing surgery to replace the affected lens. The nurse anticipates preparing the patient for which procedure?

Keratometry and A-scan ultrasound If surgery is planned, keratometry may be performed to assess the curvature of the cornea, and an A-scan ultrasound may be done to obtain measurements for an artificial replacement lens.

The nurse understands that which clinical manifestations are consistent with a diagnosis of shingles?

Linear rash with red pustules-- Shingles (herpes zoster) is a reactivation of the chicken pox virus with a characteristic linear distribution. Burning and itching on the trunk or lumbar area Shingles--(herpes zoster) is characterized by itching and/or burning pain on the trunk, face, and lumbosacral areas.

A nurse is caring for a patient who has prolonged pupil dilation related to ophthalmic medication usage. The nurse will monitor the patient for which signs of acute PACG?

Nausea, vomiting, and acute eye pain An acute attack of PACG can result in excruciating pain in or around the eye that may be accompanied by nausea and vomiting.

A patient has central and functional hearing loss. The nurse understands that which finding may have contributed to this disorder?

No physical reason for hearing loss can be identified

Which interventions should the care team implement during the acute phase of the burn injury?

Nutritional therapy graft donor site(s) care physical and occupational therapy

A nurse is caring for a newly admitted patient in the emergent phase after a severe electrical burn. Which provider orders should the nurse question?

Obtain an ECG in 8 hours Admin PO pain meds

What is the proper classification for a thermal burn involving only the epidermis and superficial structures of the dermis?

Partial-thickness burn A partial-thickness burn involves the epidermis and the superficial structures of the dermis.

A nurse is caring for a patient newly diagnosed with open-angle glaucoma. The patient asks, "How could I possibly have glaucoma? I haven't noticed a thing." What is an appropriate response by the nurse?

People with glaucoma often don't have symptoms right away, and are not aware of the disease until they are evaluated by a health care provider. Glaucoma develops slowly and without symptoms of pain or pressure and may not be noticed until there is visual field loss.

A patient arrives at the primary care clinic. The patient expresses concern about a "new mole" on the upper thigh. The nurse anticipates which initial order from the primary care provider?

Prepare the patient for a biopsy The patient will be prepared for a biopsy to determine whether skin cancer is present whenever any abnormal or suggestive skin changes are noted on assessment.

A patient diagnosed with basal cell carcinoma is being treated with radiation therapy. The patient is complaining of a sore mouth. Which nursing actions are appropriate? Select all that apply.

Provide the patient with hard candies Encourage consumption of cool or cold food Teach the patient to avoid eating meat and spicy foods

A nurse is caring for a patient with severe burns to the face and chest who is preparing for discharge. Which action is appropriate by the nurse?

Provide the patient with information on support groups

While educating a patient with age-related macular degeneration (AMD), the nurse discusses modifiable risk factors. Which modifiable risk factor should the nurse include in the teaching?

SMOKING Smoking is a modifiable risk factor that is a predisposing factor for AMD. The patient should be educated on the importance of smoking cessation.

The nurse would anticipate a patient with leg and hand contact burns to need which diagnostic tests during the acute phase of burn management? Select all that apply.

Serum electrolytes complete blood count (CBC)

While caring for a patient with hearing loss, the nurse notes a deficit of 75 decibels on the audiogram. The nurse understands this is consistent with which type of hearing loss?

Severe impairment Severe impairment is represented by a loss of 71-90 decibels on the audiogram.

The nurse is assessing a patient with Ménière's disease. The patient presents with complaints of vertigo. What additional sign or symptom would the nurse suspect?

Significant inability to function Patients with Ménière's disease may experience significant instability because of sudden, severe attacks of vertigo.

The nurse knows that which bacteria are responsible for primary and secondary skin infections? Select all that apply

Staph aureus Group A B-hemolytic strepococci

The wife of an older adult patient states, "If I don't speak loudly to my husband, he can't hear me. It's been getting much worse these past few months." When planning care for this patient, which recommendation should the nurse include?

Suggest the patient have his hearing evaluated by his primary care provider immediately

A patient presents with mixed hearing loss. What should the nurse keep in mind when assessing the patient?

Take a careful medical and family history, especially assessing for deafness in the family

A patient with a visual impairment is being admitted to the hospital after abdominal surgery. As the nurse prepares the room for the patient, which action must be taken?

Take note of the furniture placement in the room. The nurse should implement fall precautions because the patient is at risk since he or she cannot see well. Part of the nursing interventions for a patient with visual impairment is to notify the patient if furniture or wastebaskets are moved. A careful review of the furniture placement can facilitate this action.

When calculating the total body surface area (TBSA) affected by a burn, the nurse knows that the Lund-Browder chart is considered more accurate than the rule of nines for which reason?

The Lund-Browder chart considers the age of the patient in calculation of TBSA. The Lund-Browder chart considers the age of the patient in calculation of TBSA. The rule of nines does not consider the age of the patient in the calculation.

The nurse is preparing to assess a patient with an eye condition. What is the primary reason for the nurse to include the patient's family in the assessment process?

The family may become the primary care provider. Ask about the patient's support system and always include the patient's caregiver in the assessment process, because some families may become the primary care providers

The nurse is preparing teaching materials for a patient who is newly diagnosed with glaucoma. What information is appropriate for this patient?

The importance of compliance with taking medications Being compliant with medications will assist with maintenance of a lower intraocular pressure. This should be included in the discharge teaching.

The student nurse is caring for a patient with an acute attack of Ménière's disease. Which finding indicates a need for further teaching of the student nurse?

The patient is placed in the dayroom to watch a favorite action movie. When caring for a patient with an acute attack of Ménière's disease, the nurse should plan interventions that minimize vertigo and provide for patient safety. Avoiding fluorescent or flickering lights or a television will minimize the attack and/or symptoms.

A patient has returned to the dermatology office to review results of a repeat skin biopsy. The provider is unable to determine the results of the biopsies on microscopic examination. Which data found in the patient's record would be most significant to report to the provider?

The patient is taking ibuprofen. Medications such as antiinflammatory agents may change the appearance of a biopsy specimen under microscopic examination. Ibuprofen is an antiinflammatory medication.

Most hospitalized patients with burns in the United States have which type of burn injury?

Thermal-- An annual review revealed that most hospitalized patients with burns have thermal burn injuries. Most thermal burns are caused by house fires.

A patient with a new diagnosis of actinic keratosis is admitted to the unit. On assessment, which clinical manifestations would the nurse expect to find?

Thickened papules on the skin Actinic keratosis is a precancerous lesion characterized by thickened hyperkeratotic papules and plaques on sun-exposed areas.

A nurse is caring for a patient who reports loss of peripheral vision that developed over time. Which diagnostic tests would the nurse anticipate the patient to undergo?

Tonometry Gonioscopy

The nurse is taking care of a patient with impetigo. Which methods are appropriate for management of the skin lesions and discomfort? select all that apply.

Topical antibiotics Warm Saline soaks

The nurse is preparing to administer psoralen to a patient diagnosed with cutaneous T-cell lymphoma. Which action should the nurse teach the patient to perform while taking this medication?

Wear protective eyewear

A patient just underwent a surgical dermatologic procedure. Which statements indicate the nurse fully understands the foundations of proper healing when providing patient teaching? Select all that apply.

Your sutures will be removed in 4 to 14 days." "Topical antibiotics will help prevent infection while promoting healing." "Be sure to let me know if you are having pain or discomfort, and I can give you some ibuprofen."

Which patient does the nurse identify as being at risk for developing cataracts?

a 20 year old who sustained an injurt to the right eye after a car accident. Risk factor for devloping cataracts.

A patient presents to the emergency department with a small, plaque-like lesion on the right arm. The patient states, "I don't know what this is, but I want it removed." Which order by the health care provider should the nurse anticipate?

a kin scraping

A patient is admitted to the burn center with burns to the neck and chest after a gasoline explosion at work. Emergency transport reported wheezing in the upper lung fields. Upon initial assessment, the nurse notes no current wheezing and diminished breath sounds throughout. What is the appropriate action for the nurse to take?

Contact the health care provider and prepare for emergency intubation. The patient is likely to have inhalation burn injuries, and intubation is necessary to maintain oxygenation and ventilation.

A nurse is providing nutritional support to a patient with severe burns. The nurse anticipates the patient will receive which type of diet?

High protein, high carbohydrate A high-protein, high-carbohydrate diet promotes tissue healing.

What is the total 24-hour fluid requirement in milliliters for a 55-kg adult patient with 75% TBSA burned?

16,500 4 mL lactated Ringer's solution per kilogram (kg) of body weight per percent of total body surface area (% TBSA) burned = Total fluid requirements for first 24 hours after burn4 mL × 55 kg × 75 = 16500 mL

The nurse is most concerned about the administration of psoralen to which patient?

A patient with alcohol-related liver disease Psoralen should be used with extreme caution in patients with liver and/or renal disease.

A patient recently admitted to the oncology unit is diagnosed with actinic keratosis. Which provider order should the nurse question?

A skin excision to determine tumor depth Actinic keratoses are rough, dry, patchy areas of the skin, not deep tumors. Aggressive nonsurgical treatment is the initial intervention for actinic keratosis. The nurse would be correct to question this provider order.

The nurse is preparing a patient for surgery to correct an age-related cataract of the left eye. Which nursing assessments are appropriate for this patient? SELECT ALL THAT APPLY

Anxiety levels, visual acuity in the right eye, Knwoledge of different therapeutic options

The nurse is caring for a patient diagnosed with melanoma. The nurse is aware that which areas are common sites for this cancer? Select all that apply.

Back, scalp, trunk, lower legs

A nurse is caring for a patient with a first-degree thermal burn injury. Which symptom can the nurse expect to see on assessment?

Blanching with pressure Blanching with pressure is an expected clinical manifestation of a partial-thickness superficial (first-degree) thermal burn injury.

A patient with psoriasis of the upper arms is being treated while in the hospital with a diagnosis of lupus. Which medication order should the nurse question?

Ceftriaxone

A patient presents to the clinic with welts on both arms and itchy, watery eyes and is diagnosed with allergic contact dermatitis. The patient receives a prescription but a few days later complains of feeling drowsy with the medication and requests a different prescription. Which medications would be appropriate for the patient? Select all that apply.

Cetirizine Loratadine Fexofenadine Hydrocortisone

A patient has been diagnosed with malignant melanoma. The health care provider orders adjuvant therapy after surgery for this patient. Which medication does the nurse anticipate administering to the patient?

Cisplatin Cisplatin is a chemotherapy medication used in the treatment of malignant melanomas

Which nursing interventions are most appropriate for a patient receiving psoralen therapy? Select all that apply.

Provide skin moisturizers, admin ondansetron as ordered, Recommend the use of an emollient

The nurse caring for a patient diagnosed with squamous cell carcinoma knows that which patient findings are risk factors for the development of skin cancer? Select all that apply.

inability to tan celtic ancestry infrequent use of sunscreen

Phototherapy for a patient with atopic dermatitis has been effective when the nurse notes which assessment finding?

itching has resolved

The nurse suspects a patient receiving topical immunomodulatory therapy is experiencing a side effect of the treatment if which finding is noted?

itching, burning or feeling of warmth

The nurse is caring for a patient who was just transported by EMS to the hospital for burns to the legs, chest, arms, and face. Which nursing interventions are appropriate at this time? Select all that apply.

prepare to initiate tube feeding as indicated Insert urinary catheter to monitor intake and output monitor oxygen status and provide supplemental oxygen as needed

A nurse is caring for a patient with a chemical burn to the left extremity who is in the rehabilitative phase of burn management. Which order would the nurse anticipate from the health care provider?

provide patient education on wound care The rehabilitation phase begins when the patient's wounds are healed and he or she is engaging in some form of self-care. It is appropriate to provide the patient with education on wound care during this phase.

A nurse is caring for a patient who spilled boiling soup on her legs. Which type of burn will the nurse see?

thermal

The nurse is concerned that a patient is experiencing complications of long-term oral corticosteroid use. Which finding indicates a possible complication?

wt loss of 2 lbs