exam 1

The nurse is caring for a client with cellulitis. Which of the following warrants a telephone call to the health-care provider? 1. Temperature 98.8° 2. Heart rate (HR) 74 3. Blood pressure 80/42 4. Respiratory rate of 20

3. Blood pressure 80/42

The nurse is caring for a client with chemical burns. Which of the following interventions should the nurse implement? 1. Tepid water lavage for 20 minutes 2. Neutralize the chemical 3. Apply ice to the area 4. Leave the client in their clothing

1.Tepid water lavage for 20 minutes

The nurse is caring for a client with superficial partial-thickness burns. Which clinical finding should the nurse expect to find? 1. Snowy white, gray skin 2. Pink to light red or white skin 3. Bright red to pink skin 4. Yellowish brown skin

3. Bright red to pink skin

The nurse witnesses a client collapsing onto the floor and hitting their head on a counter. The client is now conscious and bleeding profusely from a laceration on their head, and their left forearm is shorter, with an apparent open fracture. What is the priority intervention at this time? 1. Apply pressure to the head wound with a dressing 2. Immobilize the forearm from the wrist to the elbow 3. Obtain vital signs including an oxygen saturation 4. Complete a neurovascular assessment

1.Apply pressure to the head wound with a dressing

A patient recently had a malignant melanoma removed from her back. Which statement by the patient ensures she understood your instructions about preventing skin cancer and further skin care?* 1. "I will avoid sun exposure between 11 am to 3 pm." 2."I will wear a SPF of 15 sunscreen when going out in the boat with my bikini." 3. "I will make an appointment every 3 years for a skin cancer check." 4."Melanoma rarely metastasizes only squamous cell."

"I will avoid sun exposure between 11 am to 3 pm."

A patient presents with a skin infection caused by STREPTOCOCCUS PYOGENES. The patient's lower leg is infected from the deep dermis to the subcutaneous fat. What skin disorder does this describe?* 1.Psoriasis 2. Impetigo 3.Erysipelas 4.Cellulitis

.Cellulitis his key words in this question is STREPTOCOCCUS PYOGENES and the lower leg, deep dermis to the subcutaneous fat which is a hallmark of cellulitis.

The orthopedic health-care provider (HCP) has ordered a closed reduction of an oblique fracture of the right radius bone. The client asks the nurse why they will have a splint on their arm instead of a cast. Which of the following would be the most appropriate answer? 1. Because there is a cut close to the fracture site, the splint will be used to monitor healing of the skin wound while immobilizing the fracture. 2. A pain medication and sedative will be given prior to the procedure, and the HCP will manually pull on the limb to manipulate the ends into alignment. 3. The cast would not maintain proper alignment for this type of fracture. 4. The splint is easier to clean and keeps the arm cool during the summer months.

1. Because there is a cut close to the fracture site, the splint will be used to monitor healing of the skin wound while immobilizing the fracture.

The nurse is assessing a client's wound. Which tissue color should be of most concern to the nurse? 1. Black 2. Beefy red 3. Yellow 4. Pink

1. Black

Which of the following burn locations would lead the nurse to assess for inhalation injury? 1. Face 2. Hands 3. Back 4. Abdomen

1. Face

The nurse is reviewing orders for a client with psoriasis. Which medication should the nurse question? 1. Nadolol 2. Ceftriaxone 3. Levothyroxine 4. Furosemide

1. Nadolol

The nurse is assessing the skin of a Caucasian client. In which location will the nurse assess for cyanosis? 1. Nailbeds 2. Oral mucosa 3. Sclera 4. Tongue

1. Nailbeds

The client with a thyroid deficiency is at risk for which of the following musculoskeletal issues? 1. Osteoporosis 2. Deep vein thrombosis 3. Muscular atrophy 4. Fasciitis

1. Osteoporosis

The nurse is providing care to a client who sustained a traumatic amputation of their right arm via a leaf blower. The client is in otherwise excellent health, and the trauma team was able to retrieve the amputated limb for replantation. Which of the following actions by the team would facilitate a successful replantation of the limb? Select all that apply. 1. Rinsing the dirty limb immediately. 2. Placing the limb in a plastic bag and covering with ice. 3. Applying a tourniquet on the stump. 4. Applying oxygen to the client at the scene. 5. Administering an anticoagulant to the client.

1. Rinsing the dirty limb immediately. 2. Placing the limb in a plastic bag and covering with ice.

At which of the following locations are pressure injuries commonly seen? Select all that apply. 1. Sacrum 2. Knees 3. Heels 4. Scapulae 5. Greater trochanter

1. Sacrum 3. Heels 4. Scapulae 5. Greater trochanter

The nurse is teaching the client how to care for the saddle joint repair surgery. In which part of the body did the surgery occur? 1. The carpometacarpal of the thumb 2. The temporal bone and mandible 3. The joint space between the phalanges 4. The joint between the pubic bones

1. The carpometacarpal of the thumb

The nurse's assessment of a client who has sustained an injury after jumping and twisting their ankle reveals swelling, tenderness, and minor joint deformity. The client stated that they tried to jump from a step and slipped with one foot on the ground. An x-ray reveals a fractured tibia. What type of fracture is suspected at this time? 1. This describes how a spiral fracture would occur. 2. This describes how an avulsion fracture would occur. 3. This describes how a longitudinal fracture would occur. 4. This describes how a stress fracture would occur.

1. This describes how a spiral fracture would occur.

A small blisterlike raised area of the skin that contains serous fluid up to 1cm in diameter (poison ivy.shingles,chinkenpox) 1. Vesicle 2. Macule 3. Papule 4. Pustule

1. Vesicle

Which of the following are methods to prevent complications from the effects on the musculoskeletal system and aging? Select all that apply. 1. Weight-bearing exercises 2. Strength training 3. A diet rich in vitamins A and C 4. Maintenance of immunizations 5. Adequate and consistent intake of calcium and phosphorus

1. Weight-bearing exercises 2. Strength training 3. A diet rich in vitamins A and C 5. Adequate and consistent intake of calcium and phosphorus

The nurse is providing care to the postmenopausal older adult. The nurse provides information on weight-bearing exercise. What is the reason for this information in regard to the musculoskeletal system? 1. Weight-bearing exercises decrease the effects of osteoporosis. 2. Weight-bearing exercises increase the synergistic effects of fine motor control and balance. 3. Weight-bearing exercises help with circulation. 4. Weight-bearing exercises decrease blood glucose levels.

1. Weight-bearing exercises decrease the effects of osteoporosis.

The nurse is attempting to assist a client who has an external fixation device to their lower leg to transfer from bed to bedside commode. Which of the following is the most appropriate method in doing this? 1. When moving a limb, grasp the device and lift, raise and move the limb as needed. 2. When moving the limb, grasp the area above the device to gently transfer the weight while the client stands on their unaffected limb. 3. When moving the limb, grasp the area above and below the device to steady the weight and promote balance to the transfer. 4. When moving the client, let the leg dangle to the floor while proving stability with a walker for the client.

1. When moving a limb, grasp the device and lift, raise and move the limb as needed.

The nurse is caring for a client with impetigo. Which of the following clinical manifestations can the nurse expect to find? 1. Honey-colored crusting 2. Red, scaly patches 3. White patches 4. Benign skin growth

1. Honey-colored crusting

A patient with herpes zoster is newly admitted. Based on your nursing knowledge of this disease, which statment is correct?* 1."If a person has not had chickenpox they could contract herpes zoster." 2."The virus is located in the basal nerve root ganglion." 3."Herpes zoster can only be diagnosed by skin stains." 4."Herpes zoster can appear in a healthy person at anytime."

1."If a person has not had chickenpox they could contract herpes zoster."Shingles is located in the DORSAL (not basal) nerve root. In addition, skin cultures and antinuclear antibody test can diagnose shingles. Lastly, it tends to appear in the IMMUNOCOMPROMISED who have had a history of chickenpox.

The nurse is caring for a client with scabies. Which of the following interventions should the nurse implement? 1. Apply permethrin as ordered. 2. Inform the client that itching may continue for 3-5 days after treatment. 3. Run the client a cool bath to remove scales and skin debris. 4. Encourage visitors to avoid feelings of isolation.

1.Apply permethrin as ordered.

The nurse is teaching client about avoiding malignant skin lesions. Which of the following should the nurse include in the teaching? 1. Avoid contact with allergens and irritants 2. Avoid overexposure to the sun 3. Shower with tepid water daily 4. Consume a diet high in protein

2. Avoid overexposure to the sun

The nurse witnesses a client that has fallen on the sidewalk and notes that there is an immediate loss of range of motion of the shoulder, and a joint deformity has occurred. The client instructs the nurse to "just pull it back into place because it hurts so much." What is the proper nursing intervention at this time? 1. Gently but firmly pull the shoulder until a "pop" is felt or heard 2. Immediately immobilize the joint, apply ice. and call for help 3. Immediately hyperextend the shoulder and apply ice 4. Keep the client comfortable until the ambulance arrives

2. Immediately immobilize the joint, apply ice. and call for help

The nurse is performing a skin assessment. What is the best location to assess for jaundice? 1. Nailbeds 2. Sclera 3. Mucous membranes 4. Earlobes

2. Sclera

The nurse is caring for a group of clients. Which client should the nurse see first? 1. A client with shingles complaining of itching 2. A client with burns who has developed stridor 3. A client with impetigo with honey-crusted lesions on the mouth 4. A client with cellulitis with localized edema

2. A client with burns who has developed stridor

The nurse is caring for a group of clients. Which client is at highest risk for developing skin cancer? 1. A dark-skinned client who is a surf instructor 2. A fair-skinned client who tans frequently 3. A fair-skinned client who tans weekly whose father had skin cancer 4. A dark skinned client who has been exposed to arsenic

3. A fair-skinned client who tans weekly whose father had skin cancer

A patient with acne vulargis is taking Accutane. Which statement by the patient is correct?* 1. "I scrub by face three times a day with over-the-counter cleansers." 2."I stopped taking my vitamin A supplement before I took my 1st dose of Accutane." 3."I love using oil-based cosmetics...it hides my pimples better." 4."I can't wait to start seeing results next week."

2."I stopped taking my vitamin A supplement before I took my 1st dose of Accutane." -The patient should stopped taking any vitamin A supplement because this interacts with Accutane. In addition, the patient should be instructed that results will take 4 to 6 weeks to notice and that WATER based cosemetic should be used, and to avoid scrub the face with any type of OTC cleansers.

The nurse is caring for a client receiving balneotherapy. Which of the following interventions should the nurse implement? 1. Ensure the water is hot 2. Advise the client to wear loose clothes after the bath 3. Fill the tub to the brim 4. Encourage the client to bathe for 1-2 hours

2.Advise the client to wear loose clothes after the bath

The nurse is providing teaching for a client with tinea pedis. Which of the following statements made by the client indicates a need for further teaching? 1. "I need to wear cotton socks." 2. "I should wear water shoes in the shower." 3. "I will be sure to keep my feet moist." 4. "I am going to apply powder to my feet."

3. "I will be sure to keep my feet moist."

The nurse is providing teaching for a client with dermatitis. Which of the following statements made by the client indicates an understanding of the teaching? 1. "I should take short baths using hot water." 2. "I like to use deodorant soap because it smells good." 3. "I will lubricate my skin with unscented cream." 4. "When I have an itch, I scratch it until it stops."

3. "I will lubricate my skin with unscented cream."

A client arrives to their health-care provider's (HCP's) office with complaints of bilateral wrist pain. The client states that they recently found employment as an assembly line factory worker. The HCP notes that the client appears fatigued and has unintentionally lost 30 lb since their last examination. The client attributes the weight loss to their new diet that includes an increase in organ meats and shellfish.The HCP then performs a synovial biopsy that reveals cloudy, dark-yellow synovial fluid. The HCP obtains the client's latest laboratory results, which reveal decreased red blood cells, increased total cholesterol, and a positive C-reactive protein.Which of those signs and symptoms are indicative for rheumatoid arthritis?Select all that apply. 1. Repetitive motion with new employment at factory 2. Weight loss 3. Cloudy synovial fluid 4. Decreased red blood cells 5. Positive C-reactive protein

3. Cloudy synovial fluid 4. Decreased red blood cells 5. Positive C-reactive protein

The nurse is providing care to a client who is 5-days postoperative total hip arthroplasty. The client recently was diagnosed with a urinary tract infection secondary to the Foley catheter. The client complains of increased pain at the hip that is not managed with opioids. The nurse's assessment finds that the site is reddened, is warm to the touch, and has moderate swelling. What is the possible medical diagnosis for this client? 1. Compartment syndrome 2. Septic shock 3. Osteomyelitis 4. Rhabdomyolysis

3. Osteomyelitis

he nurse is assessing a client's pressure injury and notes wound exudate of creamy yellow pus. This finding can be indicative of which of the following? 1. Pseudomonas 2. Bacteroides 3. Staphylococcus 4. Proteus

3. Staphylococcus

The nurse is assessing a client with burns. For which of the following findings should the nurse notify the health-care provider? 1. Decreased facial swelling 2. Dry cough 3. Stridor 4. Urine output of 50 mL/hour

3. Stridor

Which of the following medications treat osteoporosis by increasing bone density? Select all that apply. 1. Prednisone 2. Nonsteroidal antiiflammatory drugs 3. Denosumab 4. Levothyroxine 5. Teriparatide

3.Denosumab 5. Teriparatide

A patient states they are having intense itching between their fingers with brown linear lines presenting. Based on your nursing knowledge this best describes what condition 1.Psorasis 2.Ringworm 3.Scabies 4.Ecemza

3.Scabies

The nurse is about to perform a dressing change for a client with a pressure injury. When should the nurse administer the ordered analgesic? 1. 2 hours before performing the dressing change 2. After beginning the dressing change 3. 30 minutes before performing the dressing change 4. Immediately following the dressing change

30 minutes before performing the dressing change

The nurse is caring for a group of clients. Which client is at high risk for impaired healing of a pressure injury? 1. A client with renal failure 2. A client with a fractured radius 3. A client who recently underwent an appendectomy 4. A client with quadriplegia

4. A client with quadriplegia

The nurse is preparing to administer enoxaparin to a client. Which of the following would be the recommended method of administering? 1. Draw up the medication and administer intramuscularly 2. Draw up the medication and administer subcutaneously 3. Dispose of the excess amount of medication and air bubble from the prefilled syringe 4. Administer the medication from the prefilled syringe with no alteration

4. Administer the medication from the prefilled syringe with no alteration

The nurse is caring for a client with contact dermatitis. Which of the following is the most likely cause? 1. Seasonal allergies 2. Hay fever 3. Asthma 4. Perfume

4. Perfume

The nurse is caring for a client with cellulitis of the right lower leg. Which of the following clinical manifestations can the nurse expect to find? 1. Cool skin 2. Itching 3. Hypertension 4. Redness

4. Redness

The nurse is caring for a client with burns on the lower part of both arms, the chest, and both legs (upper and lower). Using the rule of nines, the client has which percentage of burns? 1. 18 2. 24 3. 36 4. 54

54%

. Which patients below are at risk for developing osteoarthritis? Select-all-that-apply:* A. A 65 year old male with a BMI of 35. B. A 59 year old female with a history of taking long term doses of corticosteroids. C. A 55 year old male with a history of repeated right knee injuries. D. A 60 year old female with high uric acid levels.

A 55 year old male with a history of repeated right knee injuries.

The nurse is caring for a client with burns to the entire chest, abdomen, back, and lower extremities. Using the rule of nines, the nurse would document what approximate percentage of burns? Enter the numeral only.

72 The back is 18%, the entire front (chest and abdomen) is 18%, and each leg is 18%. 18+18+18+18=72%.

Which patient below is NOT at risk for osteoporosis?* A. A 50 year old female whose last menstrual period was 7 years ago. B. A 45 year old male patient who has been taking glucocorticoids for the last 6 months. C. A 30 year old male who drinks alcohol occasionally and has a BMI of 28. D. A 35 year old female who has a history of seizures and takes Dilantin regularly.

A 30 year old male who drinks alcohol occasionally and has a BMI of 28. -Remember the risk factors include: older age (45+), being a woman, Caucasian or Asian, post-menopause, glucocorticoids therapy, anticonvulsants (Dilantin), REGULAR alcohol usage, smoking, sedentary lifestyle, BMI <19, family history.

While in a skilled nursing facility, a male client contracted scabies, which is diagnosed the day after discharge. The client is living at her daughter's home, where six other persons are living. During her visit to the clinic, she asks a staff nurse, "What should my family do?" The most accurate response from the nurse is: A. "All family members will need to be treated." B. "If someone develops symptoms, tell him to see a physician right away." C. "Just be careful not to share linens and towels with family members." D. "After you're treated, family members won't be at risk for contracting scabies."

A. "All family members will need to be treated." -When someone in a group of persons sharing a home contracts scabies, each individual in the home needs prompt treatment whether he's symptomatic or not. Scabies is a contagious skin condition caused by the mite Sarcoptes scabiei which burrows into the skin and causes severe itching. Scabies is transmitted by direct skin-to-skin contact or indirectly by contact with contaminated material (fomites).

. A 63 year old patient has severe osteoarthritis in the right knee. The patient is scheduled for a knee osteotomy. You are providing pre-op teaching about this procedure to the patient. Which statement made by the patient is correct about this procedure?* A. "This procedure will realign the knee and help decrease the amount of weight experienced on my right knee." B. "A knee osteotomy is also called a total knee replacement." C. "A knee osteotomy is commonly performed for patients who have osteoarthritis in both knees." D. "This procedure will realign the unaffected knee and help alleviate the amount of weight experienced on the right knee."

A. "This procedure will realign the knee and help decrease the amount of weight experienced on my right knee."

In a female client with burns on the legs, which nursing intervention helps prevent contractures? A. Applying knee splints. B. Elevating the foot of the bed. C. Hyperextending the client's palms. D. Performing shoulder range-of-motion exercises.

A. Applying knee splints. -Applying knee splints prevents leg contractures by holding the joints in a position of function. Maintain proper body alignment with supports or splints, especially for burns over joints. Promotes functional positioning of extremities and prevents contractures, which are more likely over joints.

Your patient is scheduled for a DEXA scan this morning. The patient is having heartburn and requests a PRN medication to help with relief. Which medications can the patient NOT have at this time?* A. Calcium Carbonate B. Bismuth Salicylate C. Milk of Magnesia D. Famotidine

A. Calcium Carbonate -Before a DEXA scan, which is a bone density test, the patient should not take any type of calcium supplements

A female client with second- and third-degree burns on the arms receives autografts. Two days later, the nurse finds the client doing arm exercises. The nurse knows that this client should avoid exercise because it may: A. Dislodge the autografts. B. Increase edema in the arms. C. Increase the amount of scarring. D. Decrease circulation to the fingers.

A. Dislodge the autografts. Because exercising the autograft sites may dislodge the grafted tissue, the nurse should advise the client to keep the grafted extremity in a neutral position. Patients who suffer hand burns are at a high contracture risk, partly due to numerous cutaneous functional units, or contracture risk areas, located within the hand. Patients who undergo split-thickness skin grafting are often immobilized postoperatively for graft protection.

During an outpatient visit you are assessing the patient's understanding about the signs and symptoms associated with osteoporosis. Select all of the signs and symptoms stated by the patient that are correct:* A. Dowager's Hump B. Loss of 0.5 inches in height compared to young adult height C. Swelling and warmth at the bone site D. Some patients are asymptomatic E. Fractures most commonly in the hips, wrist, and spine

A. Dowager's Hump D. Some patients are asymptomatic E. Fractures most commonly in the hips, wrist, and spine

A male client is diagnosed with herpes simplex. Which statement about herpes simplex infection is true? A. During early pregnancy, herpes simplex infection may cause spontaneous abortion or premature delivery. B. Genital herpes simplex lesions are painless, fluid-filled vesicles that ulcerate and heal in 3 to 7 days. C. Herpetic keratoconjunctivitis usually is bilateral and causes systemic symptoms. D. A client with genital herpes lesions can have sexual contact but must use a condom.

A. During early pregnancy, herpes simplex infection may cause spontaneous abortion or premature delivery. Herpes simplex may be passed to the fetus transplacentally and, during early pregnancy, may cause spontaneous abortion or premature delivery. Both primary and recurrent HSV infections in pregnant women can lead to intrauterine transmission and resultant congenital HSV infection.

The orthopedic office nurse is providing care to a client who has been injured in a fall onto an icy patch of sidewalk a year ago. The client states that they still cannot move their knee due to the pain and swelling. The nurse anticipates that the health-care provider will use which of the following diagnostic procedures? 1. Arthroscopy 2. Bone biopsy 3. Arthrocentesis 4. Serum alkaline phosphatase assessment

Arthroscopy

When planning care for a male client with burns on the upper torso, which nursing diagnosis should take the highest priority? A. Ineffective airway clearance related to edema of the respiratory passages B. Impaired physical mobility related to the disease process C. Disturbed sleep pattern related to facility environment D. Risk for infection related to breaks in the skin

A. Ineffective airway clearance related to edema of the respiratory passages -When caring for a client with upper torso burns, the nurse's primary goal is to maintain respiratory integrity. Therefore, option A should take the highest priority. Immediately assess the patient's airway, breathing, and circulation.

Following a full-thickness (third-degree) burn of his left arm, a male client is treated with artificial skin. The client understands postoperative care of artificial skin when he states that during the first 7 days after the procedure, he will restrict: A. Range of motion B. Protein intake C. Going outdoors D. Fluid ingestion

A. Range of motion To prevent disruption of the artificial skin's adherence to the wound bed, the client should restrict range of motion of the involved limb. Skin grafting is the transfer of cutaneous tissue from one portion of the body to another, often used to cover large wounds. The rationale of skin grafts is to take skin from a donor site that will heal and transfer the skin to an area of need. After incorporation, skin grafts provide wounds with protection from the environment, pathogens, temperature, and excessive water loss like normal skin.

A male client who has suffered a cerebrovascular accident (CVA) is too weak to move on his own. To help the client avoid pressure ulcers, the nurse should: A. Turn him frequently. B. Perform passive range-of-motion (ROM) exercises. C. Reduce the client's fluid intake. D. Encourage the client to use a footboard.

A. Turn him frequently.

A male client with psoriasis visits the dermatology clinic. When inspecting the affected areas, the nurse expects to see which type of secondary lesion? A. Scale B. Crust C. Ulcer D. Scar

A. scale -Psoriasis is a chronic proliferative and inflammatory condition of the skin. It is characterized by erythematous plaques covered with silvery scales particularly over the extensor surfaces, scalp, and lumbosacral region.

Parathyroid hormone plays an important role in bone health. When the parathyroid gland secretes PTH (parathyroid hormone) it causes:* A. the body to increase the calcium levels by stimulating the osteoclast activity. B. the body to decrease the calcium levels by inhibiting osteoclast activity. C. the body to increase the calcium levels by stimulating osteoblast activity. D. the body to decrease the calcium levels by inhibiting osteoblast activity.

A. the body to increase the calcium levels by stimulating the osteoclast activity. -When the calcium levels are low this stimulates the parathyroid gland to secrete PTH, which stimulates osteoCLAST activity. Remember osteoCLASTS break down the bone matrix within the spongy bone. This will cause calcium to enter the blood stream, hence increasing calcium levels.

You are developing a care plan for a patient with psoriasis. What would you include in your nursing interventions?* 1. Place the patient in contact isolation. 2. Administer daily soaks with tepid, wet compresses to affected area of the skin. 3.Keep blisters intact and protected. 4.Apply acetic acid compresses as prescribed.

Administer daily soaks with tepid, wet compresses to affected area of the skin.

Dr. Martinez prescribes an emollient for a client with pruritus of recent onset. The client asks why the emollient should be applied immediately after a bath or shower. How should the nurse respond? A. "This makes the skin feel soft." B. "This prevents evaporation of water from the hydrated epidermis." C. "This minimizes cracking of the dermis." D. "This prevents inflammation of the skin."

B. "This prevents evaporation of water from the hydrated epidermis." -Applying an emollient immediately after taking a bath or shower prevents evaporation of water from the hydrated epidermis, the skin's upper layer. T

At what age does osteoarthritis primarily begins? A. 20 years oldB. 30 years oldC. 60 years oldD. 40 years old

B. 30 years old

The most common type of disabling connective tissue disease in the United States is: A. Carpal tunnel syndrome .B. Degenerative joint disease. C. Fibrositis. D. Polymyositis.

B. Degenerative joint disease.

Nurse Harry documents the presence of a scab on a client's deep wound. The nurse identifies this as which phase of wound healing? A. Inflammatory B. Migratory C. Proliferative D. Maturation

B. Migratory scab formation is found in the migratory phase. It is accompanied by migration of epithelial cells, synthesis of scar tissue by fibroblasts, and development of new cells that grow across the wound.

. You receive your patient back from radiology. The patient had an x-ray of the hips and knees for the evaluation of possible osteoarthritis. What findings would appear on the x-ray if osteoarthritis was present? Select-all-that-apply:* A. Increased joint space B. Osteophytes C. Sclerosis of the bone D. Abnormal sites of hyaline cartilage

B. Osteophytes C. Sclerosis of the bone The joint space would be DECREASED not increased in OA. In addition, an x-ray cannot show hyaline cartilage...therefore, the cartilage cannot be assessed on an x-ray. The radiologist would be looking for osteophytes (bone spurs), sclerosis of the bone (abnormal hardening of the bones), and decreased joint space.

The nurse is providing home care instructions to a client who has recently had a skin graft. It's most important that the client remember to: A. Use cosmetic camouflage techniques. B. Protect the graft from direct sunlight. C. Continue physical therapy. D. Apply lubricating lotion to the graft site.

B. Protect the graft from direct sunlight -To avoid burning and sloughing, the client must protect the graft from direct sunlight. Protect the grafted area and the donor site from direct exposure to sunlight. Keep it covered for the first year and then protect it with a sunblock thereafter.

5. A patient with osteoarthritis has finished their first physical therapy session. As the nurse you want to evaluate the patient's understanding of the type of exercises they should be performing regularly at home as self-management. Select all the appropriate types of exercise stated by the patient:* A. Jogging B. Water aerobics C. Weight Lifting D. Tennis E.Walking

B. Water aerobics C. Weight Lifting E.Walking

During a full body skin assessment of a patient you see the following lesion with these characteristics: waxy border, red papule with a central crater. This describes what type of lesion?* 1. Melonoma 2. Normal, benign mole 3.Basal cell 4.Squamous cell

Basal cell

Pathophysiologic changes seen with osteoarthritis include: A. Joint cartilage degeneration.B. The formation of bony spurs at the edges of the joint surfaces.C. Narrowing of the joint space.D. All of the above.

C. Narrowing of the joint space.

A patient newly diagnosed with osteoarthritis asks about the medication treatments for their condition. Which medication is NOT typically prescribed for OA?* A. NSAIDs B. Topical Creams C. Oral corticosteroids D. Acetaminophen (Tylenol)

C. Oral corticosteroids

A female adult client with atopic dermatitis is prescribed a potent topical corticosteroid, to be covered with an occlusive dressing. To address a potential client problem associated with this treatment, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement, the nurse should add which "related-to" phrase? A. Related to potential interactions between the topical corticosteroid and other prescribed drugs B. Related to vasodilatory effects of the topical corticosteroid C. Related to percutaneous absorption of the topical corticosteroid D. Related to topical corticosteroid application to the face, neck, and intertriginous sites

C. Related to percutaneous absorption of the topical corticosteroid -A potent topical corticosteroid may increase the client's risk for injury because it may be absorbed percutaneously, causing the same adverse effects as systemic corticosteroids. Corticosteroids are better absorbed and more permeable in regions of thin epidermis, such as the eyelid, compared to thicker regions of epidermis, such as the sole.

1. Bones play an important role in the body. Which of the following in NOT a function performed by the bones?* A. Provide protection and support for the organs. B. Give the body shape. C. Secrete the hormone calcitonin and store blood cells. D. Store calcium and phosphorus.

C. Secrete the hormone calcitonin and store blood cells. -Bones (specifically bone marrow) are responsible for red blood cell, platelet, and white blood cell production. In addition, it stores blood cells and minerals, such as calcium and phosphorous. Calcitonin is secreted by the thyroid gland NOT the bones. However, calcitonin causes osteoclast activity to be inhibited, but is not secreted by the bone.

During discharge teaching to a patient at risk for developing osteoporosis, you discuss the types of exercise the patient should perform. Which type of exercise is not the best to perform to prevent osteoporosis?* A. Tennis B. Weight-lifting C. Walking D. Hiking

C. Walking

. The diagnostic test that reveals the narrowing of the joint space is: A. MRIB. CT ScanC. X-rayD. Physical assessment

C. X-ray

A female client is brought to the emergency department with second-and third-degree burns on the left arm, left anterior leg, and anterior trunk. Using the Rule of Nines, what is the total body surface area that has been burned? A. 18% B. 27% C. 30% D. 36%

D. 36% -The Rule of Nines divides body surface area into percentages that, when totaled, equal 100%. According to the Rule of Nines, the arms account for 9% each, the anterior legs account for 9% each, and the anterior trunk accounts for 18%. Therefore, this client's burns cover 36% of the body surface area.

What are the classifications of osteoarthritis? A. IdiopathicB. PrimaryC. SecondaryD. All of the above

D. All of the above

A female client sees a dermatologist for a skin problem. Later, the nurse reviews the client's chart and notes that the chief complaint was intertrigo. This term refers to which condition? A. Spontaneously occurring wheals. B. A fungus that enters the skin's surface, causing infection. C. Inflammation of a hair follicle. D. Irritation of opposing skin surfaces caused by friction.

D. Irritation of opposing skin surfaces caused by friction Intertrigo refers to irritation of opposing skin surfaces caused by friction. Intertrigo is a superficial inflammatory skin condition of the skin's flexural surfaces, prompted or irritated by warm temperatures, friction, moisture, maceration, and poor ventilation.

________ are found within the spongy bone and are responsible for building up the bone matrix. While ________, which are also found in the spongy bone, breakdown the bone matrix.* A. Osteocytes, osteoclasts B. Osteoclasts, osteoblasts C. Osteocytes, osteoblasts D. Osteoblasts, osteoclasts

D. Osteoblasts, osteoclasts OsteoBLASTS are found within the spongy bone and are responsible for building up the bone matrix, while osteoCLASTS, which are also found in the spongy bone as well, breakdown the bone matrix.

A male client with a solar burn of the chest, back, face, and arms is seen in urgent care. The nurse's primary concern should be: A. Fluid resuscitation B. Infection C. Body image D. Pain management

D. Pain management With a superficial partial-thickness burn such as a solar burn (sunburn), the nurse's main concern is pain management. Pain is nearly always present to some degree because of the varying severity of tissue involvement and destruction but is usually most severe during dressing changes and debridement.

You're caring for a patient who has a health history of severe osteoporosis. On assessment you note the patient has severe kyphosis of the upper back. Which nursing diagnosis takes priority for this patient's care?* A. Risk for skin breakdown B. Knowledge deficient regarding disease process C. Limited mobility D. Risk for falls

D. Risk for falls

The nurse is teaching a 75-year-old client about immunizations. Which of the following should the nurse include in the teaching? 1. Instruct the client to receive the varicella vaccine. 2. Encourage the client to receive the shingles vaccination. 3. Encourage the client to receive the human papilloma virus (HPV) vaccine. 4. Instruct the client in the need to receive a rotavirus vaccination.

Encourage the client to receive the shingles vaccination.

True or False: Osteoporosis is a disease process that results in the thinning of the matrix of pore-like structures within the compact bone.* True False

FALSE: Osteoporosis is a disease process that results in the thinning of the matrix of pore-like structures within the SPONGY (not compact) bone. The compact bone is the outside part of the bone, and the spongy bone is found inside the compact bone. It contains a matrix of pore-like components such as protein and minerals...this starts to thin and becomes more porous in osteoporosis.

A patient with osteoarthritis is describing their signs and symptoms. Which signs and symptoms below are NOT associated with osteoarthritis? Select-all-that-apply:* A. Morning stiffness greater than 30 minutes B. Experiencing grating during joint movement C. Fever and Anemia D. Symmetrical joint involvement E. Pain and stiffness tends to be worst at the end of the day

Fever and Anemia

During a head-to-toe assessment of a patient with osteoarthritis, you note bony outgrowths on the distal interphalangeal joints. You document these findings as:* A. Bouchard's Nodes B. Heberden's Nodes C. Neurofibromatosis D. Dermatofibromas

Heberden's Nodes -ony outgrowths found on the DISTAL interphalangeal joint (closest to the fingernail and furthest away from the body) is called Heberden's Node. If the bony outgrowth was found on the PROXIMAL interphalangeal joint (middle joint of the finger...closest to the body) it is called Bouchard's Node.

A client arrives to the orthopedic office for their second hylan g-f 20 injection for their osteoarthritis. What is the purpose of this injection? 1. Hylan g-f 20 provides a replacement for the cushioning synovial fluid for pain control and increased flexibility. 2. Hylan g-f 20 provides temporary pain relief due to its antiinflammatory properties. 3. Hylan g-f 20 provides a replacement of the cartilage lost due to osteoarthritis. 4. Hylan g-f 20 prepares the client for total joint replacement.

Hylan g-f 20 provides a replacement for the cushioning synovial fluid for pain control and increased flexibility.

Which statement by a patient with scabies causes concern and that they should be re-educated by the nurse?* 1. "I'm going on vacation next week with my bowling team." 2."I will wash my clothing only in cold water with bleach." 3,."I will apply anti-scabies medication thickly to my face and scalp." 4. I will avoid using soap and water while using antiscabies treatment."

I will avoid using soap and water while using antiscabies treatment." -The face and scalp are not affected by scabies. The patients bedding and clothes should be wash in HOT water. Also, the patient should remove medication prior to reapplication of medication with soap and water.

Nurse Bea plans to administer dexamethasone cream to a client who has dermatitis over the anterior chest. How should the nurse apply this topical agent? A. With a circular motion, to enhance absorption. B. With an upward motion, to increase blood supply to the affected area. C. In long, even, outward, and downward strokes in the direction of hair growth. D. In long, even, outward, and upward strokes in the direction opposite hair growth.

In long, even, outward, and downward strokes in the direction of hair growth. -When applying a topical agent, the nurse should begin at the midline and use long, even, outward, and downward strokes in the direction of hair growth. This application pattern reduces the risk of follicle irritation and skin inflammation.

A client calls the Ask a Nurse line and describes the symptoms of frostbite. How would you assist the caller?* 1. Instruct the patient to massage the affected area to increase blood flow. 2. Instruct the patient to rewarm the affected part with warm water for 15 to 20 minutes until the skin flushes. 3. Instruct the patient to immediately cover the exposed area and let it air dry. 4.Instruct the patient to attempt to debride the blisters so new skin can form.

Instruct the patient to rewarm the affected part with warm water for 15 to 20 minutes until the skin flushes.

A patient is being discharged from having a skin biopsy of a lesion on the right thigh. What would you include in the discharge instructions?* 1.If redness and yellow exudate present this is normal for 7 days. 2. Avoid antibiotic ointments usage for 72 hours. 3.Keep dressing in place for 8 hours and then clean daily. 4. Remove the dressing every 1 to 2 hours and let air dry.

Keep dressing in place for 8 hours and then clean daily. After a skin biopsy the dressing should be kept in place for 8 hours and then clean daily. Antibiotic ointment is usually prescribed by the doctor and should be used as directed.

he nurse is assessing pulses on a burn victim and notes a diminished pedal pulse. Which action should the nurse take? 1. Increase the rate of IV fluid. 2. Notify the health-care provider. 3. Administer an opioid analgesic. 4. Elevate the client's legs.

Notify the health-care provider.

The doctor orders a skin culture and antiobiotic therapy on your newly admitted patient. Which of the following sequence of nursing interventions is correct?* 1. Obtain skin culture and then administer antibiotic therapy 6 hours from skin culture collection. 2.Start antibiotic therapy and then immediately collect culture. 3. Obtain skin culture and then administer antibiotic therapy. 4.Administer antibiotic therapy and then in 1 hour obtain skin culture.

Obtain skin culture and then administer antibiotic therapy

The nurse is providing care to an elderly client who has sustained a hip fracture. The client asks why the surgeon recommends an open reduction internal fixation. What would be an appropriate response to the client? 1. Open reduction and internal fixation of the hip allows early ambulation while the bone is healing. 2. Open reduction and internal fixation of the hip allows the health-care provider to visualize signs of osteoporosis. 3. Open reduction and internal fixation of the hip is contraindicated for elderly clients due to the complexity of surgery. 4. Open reduction and internal fixation of the hip is less harmful to the client than an external fixture.

Open reduction and internal fixation of the hip allows early ambulation while the bone is healing.

The nurse is caring for a client with silvery scales on the knees and elbows. The nurse suspects the client has which of the following conditions? 1. Dermatitis 2. Herpes 3. Psoriasis 4. Impetigo

Psoriasis

Which of the following is the most common type of cancer in the United States? 1. Breast 2. Lung 3. Colon 4. Skin

Skin

Which of the following are age-related changes of the integumentary system? 1. Elasticity increases 2. Skin becomes thin 3. Activity of sweat glands increases 4. Skin becomes less fragile

Skin becomes thin

A patient with impetigo would have which of the following psychosocial issues?* 1.Social isolation with restrictions with physical activity 2. None of the options are correct 3.Increased risk for radiation exposure 4.Decreased personal hyigene

Social isolation with restrictions with physical activity -Patient with impetigo are placed in contact isolation for the bacterial infection is highly contagious. Therefore, the patient would have to be isolated from people and activities and social contact will impact them psychosocially.

Which stage of a pressure injury is shown here? 1. Stage I 2. Stage II 3. Stage III 4. Stage IV

Stage II

The nurse is providing information to a client who has been diagnosed with avascular necrosis of the right femoral head. Which of the following components of the client's health history would have caused this musculoskeletal issue? 1. The client is a retired physical education teacher for an elementary school. 2. The client has a 10-yr history of steroid use for severe allergies. 3. The client is a thin postmenopausal vegetarian. 4. The client has a history of long-term use of antibiotics.

The client has a 10-yr history of steroid use for severe allergies.

. Osteoarthritis develops due to the deterioration of the synovium within the joint that can lead to complete bone fusion.* True False

True