Health Challenges: practice questions (Care for older adults & infection)

What does the acronym SCALES stand for in assessment of nutrition indicators in frail older adults?

sadness (mood) cholesterol (high) Albumin (low) Loss (or gain of weight) eating problems shopping (and food preparation problems )

the nurse provides home care instructions to the parent of a child with AIDS. Which statement by. the parent indicates the need for further teaching?

"I can send my child to day care if he has a fever, as long as it is a low-grade fever"

a client arriving at the ED has experienced frostbite to the right hand. Which finding would the nurse note on assessment of the clients hand? a. pink, edematous hand b. fiery red skin with edema in the nail beds c. black fingertips surrounded by an erythematous rash d. a white color to the skin, which is insensitive to touch

D

the Nurse is aware that the majority of older adults are... a. live alone b. live institutional settings c. are unable to care for themselves d. are actively involved in their community

D

the nurse manager is planning the clinical assignments for the day. Which staff members cannot be assigned to care for a client with herpes zoster? (SATA) a. the nurse who never had roseola b. the nurse who never had mumps c. the nurse who never had chickenpox d. the nurse who never had German measles e. the nurse who Never received the varicella-zoster vaccine

C, E

when developing the plan of care for an older adult who is hospitalized for an acute illness the nurse should... a. use a standardized geriatric nursing care plan b. plan for likely long-term care transfer to allow additional time for recovery c. consider the readmission functional abilities when setting patient goals d. minimize activity level during hospitalization

C.

among older Americans in the U.S.. a. more than 30% live in nursing homes b. the number of those who completed college is lower than in previous decades c. women are less likely to live in poverty d. those 85 years or older account for the fastest growing segment of the population

D

a mother and her two children have been diagnosed with pediculosis corporis at a health care center. an appropriate measure to treat this condition is

applying pyrethrins to the body

what should the nurse include in thee instructions for a patient with urticaria?

avoid contact with the causative agent

important patient teaching after a chemical peel includes

avoidance of sun exposure

which skin condition would be treated with laser surgery?

fine wrinkles reduction or facial lesions

a patient with psoriasis is being treated with psoralen plus ultraviolet A light phototherapy. During the course of therapy, for what duration should the nurse teach the patient to wear protective eyewear that blocks all UV rays?

for 24 hours following treatment when outdoors or when indoors near a bright window

the nurse determines that a patient with which disorder is MOST at risk for spreading the disease

impetigo

a patient with a contact dermatitis is treated with calamine lotion. What is the reason for using this base for a topical preparation?

insoluble powders suspended in water that leave residual powder on the skin

what characteristic is commonly seen with dysplastic nevus syndrome?

lesion has irregular color and asymmetric shape

According to the Corbin and Strauss chronic illness trajectory, which statement describes a patient with an unstable condition?

loss of control over symptoms and disease course

what is a mental status assessment of the older adult especially important in determining

potential for independent living

nursing interventions directed at health promotion in the older adult are primarily focused on ... a. disease management b. controlling symptoms of management c. teaching positive health behaviors d. teaching about nutrition to enhance longevity

teaching positive health behaviors

in a patient with leukocytosis with a shift to the left, what does the nurse recognize as causing this finding?

the demand for neutrophils causes the release of immature neutrophils from the bone marrow

the clinic nurse is instructing the parent of a child with HIV infection regarding immunizations. the nurse should provide which of the following instructions to the parent?

the inactivated influenza vaccine will be given yearly

what is characteristic of chronic inflammation?

the injurious agent persists or repeatedly injures tissue

when teaching a patient with melanoma about this disorder, the nurse recognizes that the patients prognosis is most dependent on

thickness of the lesion

an important nursing action to help a chronically ill older adult is to...

treat the patient as a competent manager of the disease

to prevent lichenification related to chronic skin problem, what does the nurse encourage the patient to do?

use measures to control itching

what is an appropriate intervention to promote debridement and removal of scales and crusts of skin lesions?

warm saline compresses

A patient is a 78 y/o woman who has had chronic respiratory disease for 30 years. She weighs 212 ills and is 5 ft tall he has recently completed corticosteroid and antibiotic treatment for an exacerbation of her respiratory disease. Identify 4 specific predisposing factors for bacterial skin infection in this patient.

chronic disease obesity recent antibiotic therapy recent corticosteroid therapy

what are the MOST appropriate compress to use to promote comfort for a patient with an inflamed, pruritic dermatitis?

cool tap water compresses

what is the leading cause of death in the US?

coronary artery disease

what invasive interventions are used to treat seborrheic keratoses

curettage, cryosurgery

what is a name for papillomavirus infection seen on the skin? a. furuncle b. carbuncle c. erysipelas d. plantar wart

d. plantar wart

The nurse identifies the presence of age-associated memory impairment in the older adult who states what?

"I forget movie stars' names more often now, but I can remember them later after the conversation is over."

which nursing actions would show the nurse's understanding of the concept of providing safe care without using restraints (SATA)

-placing patients with fall risk in low beds -asking the simple yes-or-no questions to clarify patient needs -making hourly rounds on patients to assess for pain and toileting needs

nurses instruction to the patient when receiving the medications for dermatologic problems 1. topical antibiotics 2. topical corticosteroids 3. systemic antihistamines 4. topical flurouracil 5. topical immunomodulators

1. clean skin.. thin film, dry dressings 2. diagnosis of the lesion first. Thin layers. massage in at prescribed frequency. occlusive dressing 3. advise of side effects and potential risks associated with driving or operating heavy machinery 4. avoid sunlight. causes photosensitivity. warn patient that it will cause painful eroded dermatitis before healing 5. heat may be felt at application site. Red, swelling, blistering, excoriation, itching, peeling, and burning may occur

An 80-year old woman is brought to the ED by her daughter, who says her mother has refused to eat for 6 days. The mother says she stays in her room all the time because the family is mean to her when she eats or watched TV with them. she says her daughter bringers her only 1 meal a day, and that the meal is cold leftovers from the family meal days before. 1. what types of elder mistreatment may be present in this situation? 2. how would the nurse assess the situation to determine whether abuse is present? the daughter says her mother is too demanding and she just cannot cope with caring for her mother 24 hours a day 1. what may be an appropriate nursing diagnosis for the daughter? 2. what resources can thee nurse suggest to the daughter?

1. physiologic abuse, psychologic neglect, physical neglect, and perhaps violation of personal rights 2. perform very careful medical history and screening for mistreatment; interview the mother alone; use assessment tool designed specifically for elder mistreatment: specifically assess for depression, dehydration, malnutrition, pressure ulcers, and poor personal hygiene 1. caregiver role strain, spiritual distress, or dysfunctional family process 2. community care giver support group; and to help care for her mother, formal support system for respite care, adult day care, Programs for All-Inclusive Care for the Elderly (PACE)

the nurse is providing instructions to the assistive personnel regarding care of an older adult client with hearing loss. What should the nurse tell the AP about older clients with hearing loss? a. they respond to low-pitched sounds b. they are often distracted c. they have middle ear changes d. they develop moist cerumen production

A

the patient has developed scaly, crusty areas non their lower leg. They tell you that "the itching is driving me batty" the nurse suspects which of the following a. eczama b. psoriasis c. impetigo d. shingles

A

An ethnic older adult may feel a loss of self worth when the nurse: (SATA) a. prohibits visits from a faith leader b. informs the patient about ethnic support services c.. allows a patient to rely on ethnic health beliefs and practices d. has to use an interpreter to provide explanations and teaching e. emphasizes that a therapeutic diet does not allow ethnic foods

A, E

when teaching a 69 y/o patient about self care, what will promote health (SATA) a. proper diet b. immunizations c. teaching chair yoga d. demonstrating balancing techniques e. participation in health promotion activities

A,B,C,D,E (ALL)

you are helping in an elementary school and the parents want to know what you are looking for when you are looking for parasitic skin infections. You would tell them.. (SATA) a. scabies b. carbuncles c. lice d. keloids e. bed bugs

A,C,E keloids- raised type of scar carbuncles- bacterial skin infection

The nurse plans care for a patient with a newly diagnosed malignant melanoma based on the knowledge that initial treatment may involve? (SATA) a. shave biopsy b. 5-FU c. surgical excision d. localized radiation e. Mohs surgery f. topical nitrogen mustard

C, E

a client is being admitted to the hospital for treatment of acute cellulitis of the lower left leg. during the admission assessment, the nurse expects to note which finding? a. an inflammation b. a skin infection of the dermis and underlying hypodermis c. an acute superficial infection of the dermis and lymphatics d. an epidermal and lymphatic infection caused by staphylococcus

B

the clinic nurse notes that the health care provider has documented a diagnoses of herpes zoster (shingles) in the clients chart. Based on an understanding of the cause of this disorder, the nurse determines that this definitive diagnosis was made by which of the following diagnostic tests a. positive patch test b. positive culture results c. abnormal biopsy results d. Woods light examination indicative of infection

B

the nurse is providing medication instructions to an older adult client who is taking digoxin daily. The nurse explains to the client that decreased lean body mass and decreased glomerular filtration rate, which are age-related body changes, could place the client at risk for which complication with medication therapy? a. decreased absorption of digoxin b. increased risk for digoxin therapy c. decreased therapeutic effect of digoxin d. increased risk for side effects related to digoxin

B

the long-term care nurse is performing assessments on several of the residents. Which are normal age-related physiological changes the nurse should expect to note? a. increased heart rate b. decline in visual activity c. decreased respiratory rate d. decline inn long-term memory e. increased susceptibly to infections f. increased incidence of awakening after sleep onset

B,E,F

which statements describe malignant melanomas? (SATA) a. related to chemical exposure b. neoplastic growth of melanocytes c. skin cancer with highest mortality rate d. irregular color and asymmetric shape e. frequently occurs on previously damaged skin

B, C, D

which skin conditions are more common in immunosuppressed patients? (SATA) a. acne b. herpes simplex 1 c. Kaposi sarcoma d. lentigo e. herpes zoster f. candidiasis

B, C, F

a client returns to the clinic for follow-up treatment after a skin biopsy of a suspicious lesion performed 1 week ago. the biopsy report indicates that the lesion is melanoma. The nurse understands that melanoma has which characteristics? (SATA) a. lesion is painful to touch b. lesion s highly metastatic c. lesion is a nevus that has changes in color d. skin under the lesion is reddened and warm to touch e. lesion occurs in body areas exposed to outdoor sunlight

B,C

the home care nurse is visiting an older client whose spouse died 6 months ago. Which behaviors by the client indicates effective coping? (SATA) a. neglecting personal grooming b. looking at old snapshots of family c. participating in a senior citizens program d. visiting the spouses grave once a month e. decorating a wall with the spouses pictures and awards received

B,C,D,E

which of the following infections would antibiotics help treat? (SATA) a. influenza b. impetigo c. carbuncle d. measles e. cellulitis f. rubella

B,C,E

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? a. avoid antibiotic ointment usage for 72 hours b. keep dressing in place for 8 hours and then clean daily c. remove the dressing every 1-2 hours and let air dry d. if redness occurs and yellow exudate present this is normal for 7 days

B.

which description characterizes seborrheic keratosis? a. white, patchy yeast infection b. warty, irregular papules or plaques c. excessive turnover of epithelial cells d. deep inflammation of subcutaneous tissue

B.

a patient who had abdominal surgery 3 months ago calls the clinic reporting severe abdominal pain and cramping, vomiting, and bloating. What should the nurse suspect when assessing the patient? a. infection b. adhesion c. contracture d. evisceration

B. adhesion

what is the most common skin cancer and has pearly borders?

Basal cell carcinoma

a characteristic of a chronic illness is that it (SATA) a. has reversible pathological changes b. has a consistent, predictable clinical course c. results in a permanent deviation from normal d. is associated with many stable and unstable phases e. always starts with an acute illness and progresses slowly

C, D

which skin condition occurs as an allergic reaction to mite eggs? a. impetigo b. folliculitis c. scabies d. pediculosis

C. scabies

which nutrients aid in capillary synthesis and collagen production by the fibroblasts in wound healing? a. fats b. proteins c. vitamin c d. vitamin A

C. vitamin C

the clinic nurse assesses the skin of a client with psoriasis after the client has used a new topical treatment for 2 months. The nurse identifies which characteristics as improvement in the manifestations of psoriasis? (SATA) a. presence of striae b. palpable radial pulses ' c. absence of any ecchymosis on the extremities d. thinner and decrease in number of reddish papules e. scarce amount of slivery white scaly patches on the arms

D, E

when assessing a lesion diagnosed as basal cell carcinoma, the nurse most likely expects to note which findings? (SATA) a. an irregularly shaped lesion b. a small papule with a dry, rough scale c. a firm, nodular lesion topped with crust d. a pearly papule with a central crater and a waxy border e. location in the bald spot atop the head that is exposed to outdoor sunlight

D, E

a 66-year old black patient is scheduled to have a basal cell carcinoma on his cheek excised in his health care provider office. What discharge teaching is most important for the nurse to include for this patient? a. you will probably need radiation as well after the excision b. it is good you are having it removed to avoid massive tissue destruction c. it is too bad you can't have this done by laser b/c it leaves less scarring d. Using the prescribed ointment and an adhesive bandage will promote the healing with less scarring

D.

what is the MOST important nursing measure in the rehab of an older adult to prevent loss of function form inactivity and immobility

Performance of active and passive ROM

the patient has diabetes mellitus and chronic obstructive pulmonary disease that has been treated with high dose corticosteroids for the past several years, which dermatologic manifestations could be related to these systemic problems? (SATA) a. acne b. increased sweating c. dry, coarse, brittle hair d. impaired wound healing e. erythematous plaques of the shins f. decreased subcutaneous fat over extremities

a. acne d. impaired wound healing e. erythematous plaques of the shins f. decreased subcutaneous fat over extremities

an appropriate care of choice for an older adult who lives with an employee daughter but need help with activities of daily living is a. adult day care b. long-term care c. a retirement center d. an assisted living facility

a. adult day care

An infant of a mother infected with HIV is seen in the clinic each month and is being monitored for symptoms indicative of human immunodeficiency virus (HIV) infection. The nurse assesses the infant, knowing that which infection is the most common opportunistic infection of children infected with HIV? a. cough b. liver failure c. watery stool d. nuchal rigidity

a. cough

Which safe sun practices would the nurse include in the teaching care plan for a patient who has photosensitivity (select all that apply)? a. wear protective clothing b. apply sunscreen liberally and often c. emphasize the short-term use of a tanning booth d. avoid sun exposure to the sun, especially during midday e. wear any sunscreen as long as it is bought at a drugstore

a. wear protective clothing b. apply sunscreen liberally and often d. avoid sun exposure to the sun, especially during midday

which statements about older people are only myths and illustrate thee concept of agesim? (SATA) a. you can't teach an old dog new tricks b. old people are not sexually driven c. most old people live independently d. most older adults can no longer learn new information e. most older people lose interest in life and wish they would die

a. you can't teach an old dog new tricks b. old people are not sexually driven d. most older adults can no longer learn new information e. most older people lose interest in life and wish they would die

what skin condition has hyperkeratotic scaly lesions, is a precursor of squamous cell carcinoma, and may be treated with topical fluorouracil (5-FU)?

actinic keratosis

assessment findings that follow the criteria for frailty

age unplanned weight loss (> 10 lb in a year) self-reported exhaustion weakness (measured in grip strength) slow walking speed low level of physical activity

the nurse is caring for an older adult client in a long-term care facility. which action contributes to encouraging autonomy in the client?

allowing thee client to choose social activities

common site for the lesions associated with atopic dermatitis is the

antecubital space

a 58 y/o male patients will be transferred from the acute care clinical unit of the hospital to another care area. The patient needs complicated dressing changes for several months. To which practice settings could the patient be transferred? (SATA) a. acute rehab b. long-term care unit c. intermediate care facility d. transitional subacute care e. programs fo All-Inclusive Care for the Elderly (PACE)

b. long-term care unit e. programs fo All-Inclusive Care for the Elderly (PACE)

A 78 y/o female patient is admitted with N/V, anorexia, diarrhea, and dehydration. She has a history of diabetes and 2 years ago had a stroke with residual right-sided weakness. Identify which characteristics of chronic illness the nurse will probably find in the patient (select all that apply). a. self-limiting b. residual disability c. infrequent complications d. permanent impairments e. need for long-term management f. nonreversible pathologic changes

b. residual disability d. permanent impairments e. need for long-term management f. nonreversible pathologic changes

in teaching a patient who is using topical corticosteroids to treat acute dermatitis, the nurse should tell the patient that (SATA) a. the cream form is the most efficient system of delivery b. short-term use of topical corticosteroids usually does not cause systemic side effects c. use a glove to apply small amounts of creams or ointments to prevent further infection d. abruptly stopping the use of topical corticosteroids may cause the dermatitis to reappear e. systemic side effects from topical corticosteroids are likely if the patient is malnourished

b. short-term use of topical corticosteroids usually does not cause systemic side effects d. abruptly stopping the use of topical corticosteroids may cause the dermatitis to reappear

older adults who become ill are more likely than younger adults to a. report symptoms to their health care providers b. refuse to carry out lifestyle changes to promote recovery c. seek medical attention because of limitations on their lifestyle d. alter their daily living activities to accommodate new symptoms

d. alter their daily living activities to accommodate new symptoms

what invasive interventions are used to treat telangiectasia

electrodessication or electrocoagulation

what invasive interventions are used to treat lesions involving dermis

excision

what invasive interventions are used to treat malignant melanoma

excision, Mohs surgery

what invasive interventions are used to treat basal and squamous cell carcinoma

excision, Mohs surgery, curettage, cryosurgery

what invasive interventions are used to treat common and genital warts

excision, curettage, cryosurgery