med surg chp. 22 quiz

general appraisal overview (GAO)

a working form that allows clinicians the opportunity to document their thinking about a study - provides an overview to get appraisers to start thinking about a study to be appraised - A GAO is not Rapid Critical Appraisal (RCA) ; it is a preliminary step to RCA

4 phases to critical appraisal of quantitative studies

1. rapid critical appraisal 2. evaluation 3. synthesis 4. recommendation

The nurse is instructing a client about skin and sun protection. Which statement by the client indicates a need for further nursing teaching? A. "I use a tanning bed to avoid the sun's harmful rays." B. "My sunglasses are UVA and UVB protected." C. "I am better protected from the sun because I am dark skinned." D. "Sunscreen should be applied liberally."

ans: A rationale: The client who reports using a tanning needs further teaching. Tanning beds are just as damaging to the skin as the sun's rays.Individuals with dark skin are better protected from the sun than people with light skin. Regular use of sunscreen helps protect skin from the sun. Sunglasses with UVA- and UVB-protected lenses help shield the eyes from the sun's harmful rays.

The home health nurse is doing an intake assessment on a client who had a recent punch biopsy of a basal cell carcinoma on the left cheek. Which client statement requires further nursing teaching? A. "I expect to have a large scar as a result of this procedure." B. "Every morning, I check my cheek for signs of infection." C. "No harsh chemicals should be used on my skin." D. "I have been cleaning my face with soap and water."

ans: A rationale: The client's comment about expecting a large scar after a skin punch biopsy indicates a need for client teaching. Punch and shave biopsies cause little or no scarring. The nurse should further assess the client for knowledge about the association between sun exposure and skin cancers and for use of sunscreens.The client should check the biopsy site daily for signs of infection. Cleaning the face with soap and water helps to prevent infection. Harsh chemicals should not be used.

A client with a stage 1 pressure injury has slipped to the bottom of the bed. What action does the nurse take first? A. Get help to lift the client. B. Assess for broken skin areas. C. Pad the bony prominences. D. Move the client gently upward.

ans: A rationale: The first action by the nurse would be to get help, and then and gently lift the client with a sheet.Pulling or dragging the client should be avoided. Looking for broken skin areas or padding bony prominences are not the priorities of care, and can be accomplished after the client is positioned appropriately.

The nurse is educating a client who is to undergo a Wood Lamp examination. What teaching will the nurse provide? (Select all that apply.) A. "You will be in a darkened room while the provider uses the lamp." B. "Take ibuprofen before the examination to minimize pain." C. "Certain kinds of skin infections can be visualized." D. "This examination requires a small injection of lidocaine." E. "An antibiotic ointment needs to be applied after the exam."

ans: A, C rationale: Certain skin infections can be seen using a Wood Lamp, which produces a specific color, such as blue-green or red, that can be used to identify infection. Hypopigmented skin is more prominent when it is viewed under black light, making evaluation of pigment changes in lighter skin easier. This examination is carried out in a darkened room and does not cause discomfort. Lidocaine, ibuprofen, and an antibiotic ointment are not needed.

What teaching will the nurse provide to the client who just had a skin biopsy taken and sutures placed to close the wound? Select all that apply. A. Use antibiotic ointment as prescribed B. Return for suture removal in 2-3 days C. Report redness to the healthcare provider D. Keep dressing moist so skin does not dry out E. Use tap water or saline to remove any crusting

ans: A, C, E rationale: Following a biopsy, the nurse will teach the client to care for the wound to reduce the risk for infection. Teaching includes using antibiotic ointment as prescribed, returning for suture removal in 7-10 days, reporting redness or excessive drainage to the healthcare provider, keeping the dressing dry, and using tap water or saline to remove dried blood or crusting.

Which intervention will the nurse delegate to an unlicensed assistive personnel (UAP) for a client who has poor personal hygiene? Select all that apply. A. Obtain a social history. B. Assist the client with bathing. C. Help the client with brushing of teeth. D. Tell the client that he or she smells bad. E. Consult social services to assess the client's living conditions. F. Teach client and family members how to help with personal hygiene. G. Notify the healthcare provider of any suspected drug or alcohol addiction. H. Assess for cognitive function or physical limitations that can interfere with grooming.

ans: B, C rationale: Nurses can delegate tasks to unlicensed assistive personnel (UAP) that are within the scope, understanding, and training of the UAP. The nurse always remains responsible to supervise the delegated task. The UAP is able to help the client bathe and brush teeth. Assessment in the form of taking a history and determining cognitive function or physical limitations is within the scope of the nurse, not the UAP. The nurse's role - not the UAP's - also includes interventions such as consulting with members of the interprofessional team and teaching the client and family members.

Which assessment data regarding a lesion found on a 39-year old client who uses a tanning bed requires nursing intervention? Select all that apply. A. Symmetrical and light pink B. Brownish-purple with irregular borders C. Changed in shape since last appointment D. 8 mm wide and described as itching often E. Regular border with fixed size and elevation

ans: B, C, D rationale: · Asymmetry of shape · Border irregularity · Color variation within one lesion · Diameter greater than ¼ of an inch or 6 mm · Evolving or changing in any feature (shape, size, color, elevation, itching, bleeding, or crusting)

Which characteristic of a skin lesion will the nurse report to the health care provider? (Select all that apply.) A. Dark red color B. Irregular border C. Asymmetry D. Round and raised appearance E. Size increase from last month F. 1-mm ecchymotic area on the upper extremity

ans: B, C, E rationale: A lesion with one or more of the ABCDE (asymmetry, border irregularity, color variation, diameter, evolving) features should be evaluated by a dermatologist or a surgeon. Therefore, the nurse will report these findings to the health care provider.Ecchymosis is a bruise and is not necessarily problematic; it is common after minor trauma. A dark red color or a round and raised appearance is not necessarily problematic.

The nurse is caring for a client with hypoxia. Which assessment finding in the fingernails does the nurse anticipate? (Select all that apply.) A. Yellowish color B. Early clubbing C. Beau lines D. Blue discoloration E. Koilonychias F. Pitting

ans: B, D rationale: Blue discoloration and early clubbing are findings associated with hypoxia.Yellowish color is often seen in clients with jaundice, or bacterial or fungal infection of the nails. Koilonychias are found in clients with iron deficiency, poorly controlled diabetes, and psoriasis. Beau lines are found in clients with an acute, severe illness, prolonged febrile state, or isolated periods of severe nutrition. Pitting is found in clients with psoriasis or alopecia areata.

The nurse notices yellowing at the corners of the sclera in an African-American client. What further assessment will the nurse perform? A. Gently percuss the liver. B. Examine the feet soles. C. Check the oral mucosa. D. Assess the palms of the hands.

ans: C rationale: After assessing an African-American client's sclera for jaundice, the nurse would then check for a yellow tinge to the oral mucous membranes, especially the hard palate.The nurse does not percuss the liver; this will be done by the health care provider. The feet soles and palms of the hands of a client with dark skin may appear yellow, even if jaundice is not present. Therefore, these are not areas of assessment that will be useful in determining if the client has jaundice.

The nurse is caring for a client with skin breakdown due to inadequate hygiene. Which intervention is appropriate for the RN to delegate to the nursing assistant? A. Teach the client and family about the importance of good hygiene in skinfolds. B. Evaluate the client's ability to provide skin hygiene independently. C. Bathe the client, and apply a protective barrier to skinfolds and perineum. D. Check the client's skin weekly for areas of redness or breakdown.

ans: C rationale: Assisting clients with bathing and personal hygiene is included in nursing assistant education.Assessment, teaching, and evaluation are more skills that require the education and scope of practice of licensed nursing staff.

The nurse observes multiple small pits in all of a client's fingernails. The nurse suspects that the client may have which condition? A. Prolonged febrile illness B. Cystic fibrosis C. Psoriasis D. Iron deficiency anemia

ans: C rationale: Pitting of the fingernails may be seen in clients with psoriasis and alopecia areata. It can involve several or all of the fingernails and also be associated with plate thickening and onycholysis.Late clubbing of the fingernails is a sign of cystic fibrosis. Spoon nails (koilonychias) are a sign of iron deficiency anemia. Beau grooves are a sign of prolonged febrile illness.

When the nurse is assessing the skin of an older adult client, which finding must be reported to the health care provider (HCP)? A. Cherry hemangiomas are scattered on the back. B. The skin on the extremities is paper-thin. C. A multicolored lesion is present on the thigh. D. Liver spots are present on both hands

ans: C rationale: The multicolored lesion on the client's thigh must be reported to the health care provider. Color variation within a lesion is associated with skin cancer; the health care provider should be informed so that the lesion can be further assessed.Liver spots, cherry hemangiomas, and loss of skin elasticity are findings that are associated with aging and are normal for an older adult. They will be documented, but are not reportable to the health care provider.

A client just had an excisional skin lesion biopsy as an outpatient procedure. Which intervention will the nurse assign to an LPN/LVN? A. Teach about signs of incisional infection. B. Complete the written discharge instructions. C. Apply an antibiotic ointment and place a sterile dressing on the incision. D. Instruct about how to do dressing changes.

ans: C rationale: Wound care is included in practical nursing education.Client teaching and instruction and completing discharge teaching are within the RN's scope of practice.

How will the nurse describe a shave biopsy to a client? A. "A scalpel will be used to remove a deep sample of skin." B. "A small plug of tissue will be removed by a circular cutting instrument." C. "A deep specimen of skin will be taken, and the area will be sutured closed." D. "A razor blade will be gently moved across the skin's surface to obtain a sample."

ans: D rationale: A shave biopsy is accomplished by taking a razor blade and moving it across the skin's surface gently to obtain a sample. An excisional biopsy is done by using a scalpel to remove a deep sample of skin which is then sutured closed. A punch biopsy involves the use of a circular cutting instrument to remove a small plug of tissue.

The staff mix available for the medical-surgical unit includes RNs, LPN/LVNs, and nursing assistants. Which client does the nurse plan to assign to an experienced LPN/LVN? A. Client with a stage I pressure injury who requires turning every 2 hours. B. Client who needs grafting of a second-degree burn on the right leg. C. Client who needs discharge teaching after receiving steroids for Stevens-Johnson syndrome. D. Client with a sutured facial tear after falling off a bike.

ans: D rationale: An LPN/LVN is an appropriate choice to care for an adult client with a facial suture. This nurse would be familiar with wound monitoring for potentially contaminated wounds and would recognize signs of infection.Conducting discharge teaching is a more complex nursing action that requires RN-level education and scope of practice. The client with stage I pressure injuries who needs to be turned every 2 hours could be cared for by a nursing assistant.

Which method does the nurse use to assess skin lesions for cancer? A. Wood's light examination for fluorescence B. Size and location of lesions C. Presence of inflammation or exudate D. Asymmetry, border, color, diameter, evolving

ans: D rationale: The ABCDE (asymmetry, border, color, diameter, evolving) method is the appropriate technique for assessing skin lesions.Inflammation and exudate indicate infection. A Wood's light examination is not necessary to use to assess a lesion; it is used to see skin infections. Size and location of lesions is not specific for cancer screening.

critical appraisal of quantitative studies

encompasses identifying a study's place on levels of evidence hierarchy and answers three broad questions: 1. Are the results of the study valid? (Validity) 2. What are the results? (Reliability) 3. Will the results help me in caring for my patients? (Applicability)

levels of evidence hierarchies

provide guidance about the types of research studies, if well done, that are more likely to provide reliable answers to clinical questions.

validity

whether or not results of a study were obtained by sound scientific methods Key questions: - Can the results of the study be "believed"? (Internal validity) - Can the results of the study be generalized to other settings/patient populations? (External validity) - Study bias and/or confounding study results can impact study validity.