NUR 210 Pre lecture Quiz 2

The nurse notes the presence of white lesions that resemble milk curds in the back of a patient's throat. Which question by the nurse is appropriate at this time? "How often do you brush your teeth?" "Are you taking any medications at present?" "Do you have a productive cough?" "Have you ever hand an oral herpes infection?"

"Are you taking any medications at present?" The appearance of the lesions is consistent with an oral candidiasis (thrush) infection, which can occur in patients who are taking medications such as immunosuppressants or antibiotics. Candidiasis is not associated with poor oral hygiene or lower respiratory infections. The lesions do not look like an oral herpes infection.

A patient with atopic dermatitis has a new prescription for pimecrolimus (Elidel). After teaching the patient about the medication, which statement by the patient indicates that further teaching is needed? "If the medication burns when I apply it, I will wipe it off and call the doctor." "After I apply the medication, I can go ahead and get dressed as usual." "I will need to minimize my time in the sun while I am using the Elidel." "I will rub the medication gently into onto the skin every morning and night."

"If the medication burns when I apply it, I will wipe it off and call the doctor." The patient should be taught that transient burning at the application site is an expected effect of pimecrolimus and that the medication should be left in place. The other statements by the patient are accurate and indicate that patient teaching has been effective.

A young adult patient who is in the rehabilitation phase 6 months after a severe face and neck burn tells the nurse, "I'm sorry that I'm still alive. My life will never be normal again." Which response by the nurse is best? "Why do you feel that way? You will be able to adapt as your recovery progresses." It's is really too early to know how much your life will be changed by the burn." "It's true that your life may be different. What concerns you the most?" "Most people recover after a burn and feel satisfied with their lives."

"It's true that your life may be different. What concerns you the most?" This response acknowledges the patient's feelings and asks for more assessment data that will help in developing an appropriate plan of care to assist the patient with the emotional response to the burn injury. The other statements are accurate, but do not acknowledge the anxiety and depression that the patient is expressing.

The health care provider prescribes topical 5-FU for a patient with actinic keratosis on the left cheek. The nurse should include which statement in the patient's instructions? "Your cheek area will be painful and develop eroded areas that will take weeks to heal." "You need to avoid crowds because of the risk for infection caused by chemotherapy." "5-FU will shrink the lesion so that less scarring occurs once the lesion is excised." "You may develop nausea and anorexia, but good nutrition is is important during treatment."

"Your cheek area will be painful and develop eroded areas that will take weeks to heal." Topical 5-FU causes an initial reaction of erythema, itching, and erosion that lasts 4 weeks after application of the medication is stopped. The medication is topical, so there are no systemic effects such as increased infection risk, anorexia, or nausea.

A patient with severe burns has crystalloid fluid replacement ordered using the Parkland formula. The initial volume of fluid to be administered in the first 24 hours is 30,000 mL. The initial rate of administration is 1875 mL/hr. After the first 8 hours, what rate should the nurse infuse the IV fluids? (The Parkland formula for the total fluid requirement in 24 hours is as follows: 4ml x TBSA (%) x body weight (kg); 50% given in first eight hours; 50% given in next 16 hours.) 938 mL/hr 1250 mL/hr 350 mL/hr 523 mL/hr

938 mL/hr Half of the fluid replacement using the Parkland formula is administered in the first 8 hours and the other half over the next 16 hours. In this case, the patient should receive half of the initial rate, or 938 mL/hr.

Which activities can the nurse working in the outpatient clinic delegate to a licensed practical/vocational nurse (LPN/LVN) (select all that apply)? Apply a sterile dressing after the health care provider excises a mole. Administer patch testing to a patient with allergic dermatitis. Explain potassium hydroxide testing to a patient with a superficial skin infection. Teach a patient about site care after a punch biopsy of an upper arm lesion. Interview a new patient about chronic health problems and allergies.

Apply a sterile dressing after the health care provider excises a mole. Administer patch testing to a patient with allergic dermatitis. Skills such as administration of patch testing and sterile dressing technique are included in LPN/LVN education and scope of practice. Obtaining a health history and patient education require more critical thinking and registered nurse (RN) level education and scope of practice.

When taking the health history of an older adult, the nurse discovers that the patient has worked in the landscaping business for 40 years. The nurse will plan to teach the patient about how to self-assess for which clinical manifestations (select all that apply)? Erythema Alopecia Vitiligo Intertrigo Actinic keratosis

Erythema Actinic keratosis A patient who has worked as a landscaper is at risk for skin lesions caused by sun exposure such as erythema and actinic keratosis. Vitiligo, alopecia, and intertrigo are not associated with excessive sun exposure.

A patient has just arrived in the emergency department after an electrical burn from exposure to a high-voltage current. What is the priority nursing assessment? Extremity movement Peripheral pulses Pupil reaction to light Oral temperature

Extremity movement All patients with electrical burns should be considered at risk for cervical spine injury, and assessments of extremity movement will provide baseline data. The other assessment data are also necessary but not as essential as determining the cervical spine status.

When assessing a patient who spilled hot oil on the right leg and foot, the nurse notes that the skin is dry, pale, hard skin. The patient states that the burn is not painful. What term would the nurse use to document the burn depth? Deep partial-thickness skin destruction Full-thickness skin destruction Superficial partial-thickness skin destruction First-degree skin destruction

Full-thickness skin destruction With full-thickness skin destruction, the appearance is pale and dry or leathery and the area is painless because of the associated nerve destruction. Erythema, swelling, and blisters point to a deep partial-thickness burn. With superficial partial-thickness burns, the area is red, but no blisters are present. First-degree burns exhibit erythema, blanching, and pain.

The nurse instructs a patient about application of corticosteroid cream to an area of contact dermatitis on the right leg. Which patient action indicates that further teaching is needed? The patient covers the area with a dressing after applying the cream. The patient spreads the cream using a downward motion. The patient takes a tepid bath before applying the cream. The patient applies a thick layer of the cream to the affected skin.

The patient applies a thick layer of the cream to the affected skin. Creams and ointments should be applied in a thin layer to avoid wasting the medication. The other actions by the patient indicate that the teaching has been successful.

The nurse working in the dermatology clinic assesses a young adult female patient who is taking isotretinoin (Accutane) to treat severe cystic acne. Which assessment finding is most indicative of a need for further questioning of the patient? The patient has also used topical antibiotics to treat the acne. The patient already has some acne scaring on her forehead. The patient has s strong family history of rheumatoid arthritis. The patient recently had an intrauterine device removed.

The patient recently had an intrauterine device removed. Because isotretinoin is teratogenic, contraception is required for women who are using this medication. The nurse will need to determine whether the patient is using other birth control methods. More information about the other patient data may also be needed, but the other data do not indicate contraindications to isotretinoin use.

A patient with atopic dermatitis has been using a high-potency topical corticosteroid ointment for several weeks. The nurse should assess for which adverse effect? Dryness and scaling in the areas of treatment Alopecia of the affected area Thinning of the affected skin Reddish-brown discoloration of the skin

Thinning of the affected skin Thinning of the skin indicates that atrophy, a possible adverse effect of topical corticosteroids, is occurring. The health care provider should be notified so that the medication can be changed or tapered. Alopecia, red-brown discoloration, and dryness/scaling of the skin are not adverse effects of topical corticosteroid use.

A nurse is teaching a patient with contact dermatitis of the arms and legs about ways to decrease pruritus. Which information should the nurse include in the teaching plan (select all that apply)? Use of an over-the-counter (OTC) antihistamine can reduce scratching. Add oil to your bath water to aid in moisturizing the affected skin. Rub yourself dry with a towel after bathing to prevent skin maceration. Cool, wet cloths or dressings can be used to reduce itching. Take cool or tepid baths several times daily to decrease itching.

Use of an over-the-counter (OTC) antihistamine can reduce scratching. Cool, wet cloths or dressings can be used to reduce itching. Take cool or tepid baths several times daily to decrease itching. Cool or tepid baths, cool dressings, and OTC antihistamines all help reduce pruritus and scratching. Adding oil to bath water is not recommended because of the increased risk for falls. The patient should use the towel to pat (not rub) the skin dry.

What is the best method to prevent the spread of infection when the nurse is changing the dressing over a wound infected with Staphylococcus aureus? Change the dressing using sterile gloves. Soak the dressing in sterile normal saline. Wash hands and properly dispose of soiled dressings. Apply antibiotic ointment over the wound.

Wash hands and properly dispose of soiled dressings. Careful hand washing and the safe disposal of soiled dressings are the best means of preventing the spread of skin problems. Sterile glove and sterile saline use during wound care will not necessarily prevent spread of infection. Applying antibiotic ointment will treat the bacteria but not necessarily prevent the spread of infection.

While the patient's full-thickness burn wounds to the face are exposed, what is the best nursing action to prevent cross contamination? Wear gown, caps, masks, and gloves during all care of the patient. Administer IV antibiotics to prevent bacterial colonization of wounds. Turn the room temperature up to at least 70 F (20 C) Use sterile gloves when removing old dressings.

Wear gown, caps, masks, and gloves during all care of the patient. Use of gowns, caps, masks, and gloves during all patient care will decrease the possibility of wound contamination for a patient whose burns are not covered. When removing contaminated dressings and washing the dirty wound, use nonsterile, disposable gloves. The room temperature should be kept at approximately 85° F for patients with open burn wounds to prevent shivering. Systemic antibiotics are not well absorbed into deep burns because of the lack of circulation.