Integumentary Practice Questions

A patient presents with a new-onset, erythematous rash that contains intact pustules. Subjective symptoms include itching and burning. Which diagnostic evaluation is most helpful in determining the underlying etiology? A. Excisional biopsy B. Skin scraping C. Sterile collection of pustule roof D. Cryosurgery

C

The nurse correlates the use of KOH testing with the definitive diagnosis of which skin disorder? A. Bacterial infections B. Herpes simplex C. Fungal infections D. Psoriasis

C

The nurse correlates which clinical manifestation with superficial partial-thickness burns? A. Eschar B. Dry, leathery appearance C. Blisters D. Waxy appearance

C

Using the parkland formula, calculate the hourly rate of fluid replacement with lactated ringers solution during the first 8 hours for a client weighing 75 kg with total body surface area burn of 40%. Record your answer using a whole number: ___________

6000mL

The nurse correlates which zone of burn injury as the most susceptible to sustained injury because of insufficient fluid resuscitation? A. Zone of stasis B. Zone of conversion C. Zone of hyperemia D. Zone of coagulation

A

The nurse is assessing a client who is immobile and notes that an area of sacral skin is reddened, but not broken. The reddened area continues to blanch and refill with fingertip pressure. What is the most appropriate nursing action? a. Reposition the client off the reddened skin and reassess in a few hours b. Apply a moist to moist dressing, being careful to pack just the wound bed c. Consult with a wound-ostomy-continence nurse specialist d. Complete and document a Braden skin breakdown risk score for the client

A

The nurse is instructing the client about postoperative care following cataract removal. What position should the nurse teach the client to use? a. Remain in a semi-fowlers position b. Position the feet higher than the body c. Lie on the operative side d. Place the head in a dependent position

A

The nurse correlates which clinical manifestations with the possibility of an inhalation injury? (Select all that apply.) A. Facial burns B. Singed nasal hairs C. Soot in the sputum D. Hoarseness E. Eschar

ABCD

The nurse is teaching skin care guidelines to the caretaker of a 79-year-old incontinent female who has a total Braden score of 14 with a score of 2 in the mobility category. What are appropriate educational priorities? (Select all that apply.) A. Gently cleanse and dry the skin immediately after an incontinence episode B. Use a toileting schedule to minimize episodes of incontinence C. Aggressively clean the patient's skin after an incontinence episode D. Assist the patient with repositioning at least every 2 hours E. Use diapers for stool and urine containment

ABD

The nurse anticipates supplementary feeding via a nasogastric tube in a patient for which reasons? (Select all that apply.) A. Hypermetabolic state. B. Multiple open wounds. C. Increased heat loss. D. Increased caloric needs. E. Burn greater than 20% TBSA.

ABDE

Which properties of the epidermal and dermal layers contribute to wound healing? (Select all that apply.) A. The 30-day maturation time of epidermal keratinocytes B. Eccrine gland sweat production C. Melanocytes in a 1:36 ratio with keratinocytes D. Presence of Langerhans cells, macrophages, and mast cells E. Blood vessels in the dermis and subcutaneous tissue

ACDE

A 75-year-old client who has been taking furosemide regularly for 4 months tells the nurse about having trouble hearing. What should the nurse do? a. Tell the client that at age 75 years, it is inevitable that there will be hearing loss b. Report the hearing loss to the healthcare provider c. Schedule the client for audiometric testing and a hearing aid d. Tell the client that the hearing loss is only temporary; when the body adjusts to the furosemide, hearing will improve

B

Eardrops have been prescribed to be instilled in the adult client's left ear to soften cerumen. To position the client, what should the nurse do? a. Have the client lie on the left side b. Pull the auricle lobe up and back c. Pull the ear lobe down and back d. Chill the eardrops prior to administering

B

In completing a skin assessment, the nurse correlates erythema, redness, and warmth with which phase of wound healing? A. Hemostasis B. Inflammatory C. Proliferative D. Maturation

B

In the acute phase of burn injury, which pain medication would most likely be given to the client to decrease the perception of the pain? a. Oral analgesics such as ibuprofen or acetaminophen b. Intravenous opioids c. Intramuscular opioids d. Oral antianxiety agents such as lorazepam

B

The nurse is admitting a patient to the unit who is a paraplegic and has a history of healed sacral pressure injuries, verified by the large scars on the sacrum. What action should the nurse take first? A. Apply a moisturizing lotion to the sacrum. B. Place a dressing such as a silicone foam dressing over the scars. C. Place the patient in a sitting position to keep pressure off the sacrum. D. Help the patient choose the most nutritious foods on the menu.

B

The nurse recognizes which etiology as consistent with a thermal burn? A. Direct current B. Scalding C. Exposure to organic compounds D. Ionizing radiation

B

The nurse in the emergency department is triaging patients. Which patient requires immediate attention? A. A 16-year-old with a laceration that was sutured closed 3 days ago and now has erythema extending 2 cm beyond the suture line B. A 30-year-old patient with an open sacral pressure injury with exposed bone with purulent exudate C. A 48-year-old patient with an indurated, erythematous area on his thigh who is complaining of 10/10 pain and has had a fever for 24 hours D. A 60-year-old patient with diabetes mellitus who has a nail embedded in his foot because he could not feel it in his shoe

C

The nurse is assessing an 80-year-old client who has scald burns on the hands and both forearms (first and second degree burns on 10% of the body surface area). What should the nurse do first? a. Clean the wounds with warm water b. Apply antibiotic cream c. Refer the client to a burn center d. Cover the burns with a sterile dressing

C

The nurse is caring for a client with severe burns who is receiving fluid resuscitation. Which finding indicates that the client is responding? a. Pulse rate of 112 bpm b. Blood pressure of 94/64 mm Hg c. Urine output of 30 mL/h d. Serum sodium level of 136 mEq/L

C

A client has a wound on the ankle that is not healing. The nurse should assess the client for which risk factors for delayed wound healing? Select all that apply. a. Atrial fibrillation b. Advancing age c. Type 2 diabetes mellitus d. Hypertension e. Smoking

CBE

After cataract removal surgery, the client is instructed to report sharp pain in the operative eyes because this could indicate which postoperative complication? a. Detached retina b. Prolapse of the iris c. Extracapsular erosion d. Intraocular hemorrhage

D

The client is diagnosed with a detached retina in the right eye. What should the nurse do first? a. Apply compresses to the eye b. Instruct the client to lie prone c. Remove all bed pillows d. Promote measures that limit mobility

D

What should the nurse teach the patient to expect during and following cryosurgery for the removal of a basal cell carcinoma? A. "You may experience some discomfort during and immediately after the procedure. Local wound care may be required because of minor skin sloughing in the next few days." B. "You will not have any pain with this procedure and need to see your provider only if complications develop." C. "You may experience some discomfort during the procedure, but there is no follow-up care required." D. "You will receive a local anesthetic just prior to the procedure. In the next few days, you may experience burning and itching at the site."

A

When hemodynamic status is monitored in a patient with a burn injury, what amount of urine output indicates adequate fluid resuscitation? A. 0.5 mL/kg/hr B. 1 mL/kg/hr C. 2 mL/kg/hr D. 3 mL/kg/hr

A

Which statement made by a patient who is currently asymptomatic with an HSV-2 infection indicates the need for more education about the disease? A. "It's okay to have intercourse with my partner as long as we use a barrier method of protection and I take my antiviral medications." B. "It's more likely that I could spread the HSV-2 infection if I have sexual relations when I have open ulcers and pain." C. "When I get pregnant, I will be certain to tell my gynecologist about my HSV-2 infection." D. "I understand that I could still transmit the virus if I don't have symptoms."

A

The nurse recognizes that burns to which body areas meet the criteria for referral to a burn center because of the increased risk of functional changes? (Select all that apply.) A. Chest B. Perineum C. Elbows D. Face E. Hands

BCDE

A 78-year-old patient fractured a hip 1 week ago and is now being admitted to a rehabilitation facility for physical therapy because of difficulty ambulating. During the admission skin assessment, the nurse notes an area of nonblanchable erythema on the sacrum. What is the nursing priority at this time? A. Order a redistributing mattress for the patient's bed. B. Consult the nutritionist for a complete nutritional assessment. C. Perform and document the admission skin and risk assessments. D. Apply a hydrocolloid dressing over the area to protect it from further trauma.

C

A client uses timolol maleate eyedrops. The expected outcome of this drug is to control glaucoma by: a. Constricting the pupils b. Dilating the canals of Schlemm c. Reducing aqueous humor formation d. Improving the ability of the ciliary muscle to contract

C

A mother brings in her 8-year-old child because of a new rash of annular patches, raised borders, and central clearing. What should be done first? A. Obtain a scraping of the rash for KOH microscopy. B. Explain to the mother that this is probably tinea corporis and an antifungal ointment will successfully treat it. C. Obtain a focused history to include medications, activities in which the patient partakes, and any history of skin disorders or fungal rashes. D. Explain to the mother that the rash will subside on its own.

C

The nurse questions which intervention in the stable patient with the nursing diagnosis "Impaired skin integrity related to draining skin lesions on right lower extremity"? A. Place patient on isolation precautions B. Obtain a swab specimen from wound bed after cleansing with a non-antiseptic solution C. Educate patient about wound and skin treatment regimen D. Administer broad-spectrum antibiotic before obtaining a culture

C

Which statement accurately describes the skin's protective capabilities? A. The epidermis can resist damage when exposed to continuous moisture. B. Melanocytes always provide adequate protection to underlying structures from UV exposure. C. Langerhans cells, located in the epidermis, often provide the initial signal to the immune system that pathogen invasion has occurred. D. Temperature is regulated by blood vessels and sweat glands.

C

An 18-year-old with psoriatic plaques on the elbows, knees, and legs has been successfully treated with a combination of therapies including phototherapy. Because the patient is an avid soccer player and expects to receive a college scholarship next year, which information is the most important aspect to teach at this time? A. The importance of knowing the clinical manifestations of PsA (soft tissue swelling, limitations of movement) because as many as 30% of those who have psoriasis develop PsA B. The importance of adhering to the medication regimen C. The importance of finding a support group to help cope with stress and anxiety that can develop as a response to treatment and can exacerbate the disease D. The importance of using sunscreen while outside

D

The nurse recognizes that pressure injury is most probable in which areas in the patient positioned in a supine position? (Select all that apply.) A. Occiput B. Nares C. Behind the knees D. Sacrum E. Heels

ADE

The nurse is discharging a client who just had cataract removal and intraocular lens implantation. The nurse is condiment the client understands discharge instructions when the client states the following. Select all that apply a. I understand the schedule for my eyedrops and will use the medications b. I feel good and am ready to drive home now c. I will call in the morning if I cannot see clearly d. I will wear the eye shield at night to protect my eye e. I will avoid lifting or pulling anything over 10 lbs f. I will call if I still have eye pain after taking acetaminophen

ADEF

The nurse recognizes which diagnostic test as most sensitive in a patient with a suspected electrical burn injury? A. Arterial blood gas B. CK-MB levels C. Echocardiogram D. Serum carboxyhemoglobin

B

Using the resuscitation guidelines, the nurse determines that a patient requires a total of 12 L of fluid in the first 24 hours post-injury. How much of the total volume needs to be given within the first 8 hours? A. 4,000 mL lactated Ringer's B. 6,000 mL lactated Ringer's C. 8,000 mL lactated Ringer's D. 10,000 mL lactated Ringer's

B

Which clinical finding requires additional investigation by the nurse? A. CRT less than 2 seconds B. New-onset petechial rash C. A macule with symmetrical shape, regular border, and uniform color D. Pale or cyanotic nail bed after exposure to cold temperatures

B

Which individual is at greatest risk for developing skin cancer? A. A fair-skinned, blue-eyed teenager who works outside in the summers, uses sunscreen with sun protection factor (SPF) of 50, and wears long-sleeved dark shirts B. A woman with a medium to dark complexion who applies sunscreen once in the midmorning and afternoon while she is playing tennis C. A 10-year-old child who plays outside in the early morning and late afternoons and uses SPF 30 D. A surfer who wears a wet suit with long sleeves and legs and applies sunscreen to his face periodically throughout the day

B

Which intervention is the priority for the patient during the emergent phase of burn management? A. Application of silver sulfadiazine cream B. Use of clean, dry sheets and warm blankets C. Initiation of wet normal saline dressings D. Maintaining the injured area open to air

B

The risk for injury during an attack of Meniere's Disease is high. The nurse should instruct the client to take which immediate action when experiencing vertigo? a. Place you r head between your knees b. Concentrate on rhythmic deep breathing c. Close your eyes tightly d. Assume a reclining or flat position

D

To approach a deaf client, what should the nurse do first? a. Knock on the room's door loudly b. Close and open the vertical blinds rapidly c. Talk while walking into the room d. Get the client's attention

D

Which position is best to reduce the risk of skin tears in an immobile, older adult patient? A. In a side-lying position B. Foot of the bed elevated to no greater than 15 degrees C. In a chair with feet on the floor D. Head of the bed elevated no greater than 30 degrees

D