Integumentary System Questions

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A nurse is caring for a client who has a disturbed body image as a result of a burn injury. Which is an important initial nursing intervention for this client?

Conveying a positive attitude toward the client

A registered nurse teaches a client about the functions of the integumentary system. Which statement made by the client indicates the need for further teaching?

"Epidermis of the skin will protect from trauma by providing a cushioning effect."

A nurse is teaching a client with pruritus about personal care interventions. Which statement made by the client indicates the nurse needs to intervene?

"I will not file the edges of fingernails."

A client with scleroderma reports numbness and tingling in the hands followed by blanching of the fingers. The nurse concludes that the client has Raynaud phenomenon. How should the nurse advise the client?

"Keep the hands warm by wearing gloves."

The registered nurse asked the student nurse to care for a client whose dermal-epidermal junction is flattened. On assessing the client, the registered nurse observes that the risk for skin tears is increased. Which action of the student nurse may have resulted in this condition?

Assisting the client to change positions at 4-hour intervals

A client experiences a traumatic brain injury. Which finding identified by the nurse indicates damage to the upper motor neurons?

Babinski response

A client has undergone surgery for bags under the eyes. What could be the common complications seen in this client? Select all that apply.

Ectropion Hematoma Corneal injury

Which drugs used for the treatment of plaque psoriasis will the nurse administer subcutaneously?

Etanercept Adalimumab Ustekinumab

As part of the teaching plan for a client with scleroderma, the nurse addresses the need for special skin care. Which instructions will the nurse provide to the client?

Keep the hands warm

What is the function of a client's cranial nerve VI?

Movement of the eye with lateral rectus muscles

During a seizure, a client had sudden loss of muscle tone that lasted for a few seconds followed by confusion. Which statement about this type of seizures is true? Select all that apply.

These seizures increase the risk of injuries due to fall. These seizures are most resistant to drug therapy.

Apregnant client is noted to have a yellow-orange discoloration of the ears and nose. On reviewing the laboratory reports, the nurse finds an increase in levels of serum carotene. Which significant condition might be affecting the client?

Thyroid deficiency

A nurse is performing a neurologic assessment of a client. Which equipment is required when preparing to assess the vagus nerve (cranial nerve X) of the client?

Tongue depressor

The nurse is advising an older adult client to apply moisturizer when the skin is moist. Which physical change in the client is associated with this advice?

Decreased dermal blood flow

After assessing a dark-skinned client, the nurse concludes that the client has cyanosis. Which assessment color variation helped the nurse reach this conclusion?

Grey color

The nurse is caring for a client with burns receiving opioid analgesics and who is sedated. Which medications should the nurse anticipate to be prescribed by the primary healthcare provider to overcome this side effect of the opioid analgesics? Select all that apply.

Pregabalin Gabapentin

Which area in a client is most commonly affected by a furuncle?

Buttocks

Which nursing action would be most effective in reducing complications in an older client who has decreased cell division in the epidermal layer of the skin? Select all that apply.

Advising the client to prevent skin trauma Advising the client to protect open areas

A client who sustained a head injury reports bland taste of food. Upon examination, the nurse finds that there is loss of taste perception from the anterior two-thirds region of the tongue. What is the origin of the involved nerve?

Inferior pons

After assessing the integumentary system of a client, the healthcare provider diagnoses the condition as telangiectasia. The nurse will anticipate which etiologies for this condition?

Liver failure Sun exposure

A nurse is caring for a client with glaucoma. Which rationale associated with the need for treatment of this condition should the nurse include in a teaching program?

Lost vision cannot be restored.

The nurse is caring for a client two days after the client had a brain attack (cerebrovascular accident, CVA). To prevent the development of plantar flexion, which action should the nurse take?

Maintain the feet at right angles to the legs.

A state's Nurse Practice Act (Canada: Provincial/Territorial Registered Nurse Act) does not allow a registered nurse (RN) to suture wounds. The primary healthcare provider offers to teach the RN how to suture and tells the RN that minor wounds may be sutured without supervision. Which action should the nurse take?

Refuse to suture wounds

A client is admitted with severe burns, is obese, and has pre-existing respiratory problems. Which complication should the nurse anticipate?

Venous thromboembolism

The nurse is preparing to insert an intravenous (IV) catheter in a client who is being admitted for uncontrolled diabetes. Upon assessment of the client's forearm for a potential insertion site, the nurse notes that the client has an excessive amount of hair. What should the nurse do to properly prepare the site for insertion?

Clip the hair.

A nurse is caring for two clients. One has Parkinson disease, and the other has myasthenia gravis. For which common complication associated with both disorders should the nurse assess these clients?

Difficulty swallowing

The nurse is evaluating the condition of a client with burns of the upper body. Which finding will alert the nurse of a potential respiratory obstruction?

Hoarse quality to the voice

The nurse is caring for a client with a spinal cord injury. Which assessment findings alert the nurse that the client is developing autonomic hyperreflexia (autonomic dysreflexia)?

Hypertension and bradycardia

A nurse is assessing a client whose mouth is drooping over to the left. Which cranial nerve should the nurse assess further?

Left facial nerve

A client is admitted to the hospital after sustaining serious burns that involve a large surface of the skin. The nurse is caring for the client during the emergent phase after the injury. Which nursing objective is the priority during this phase?

Restoring fluid volume

While completing an assessment, the nurse finds that a client has decreased thickness and excessive dryness of the epidermis. Which clinical finding is associated with this skin assessment?

Skin fragility


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