Med/Surg

The nurse is assessing a client with a musculoskeletal system condition. Which statement indicates to the nurse that the client is experiencing bone pain?

"The pain feels deep in my legs and keeps me awake at night."

A physician orders 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?

"To prevent evaporation of water from the hydrated epidermis."

The nurse should determine the adult client's learning readiness by assessing________, followed by ___________, followed by ___________, and followed by ____________.

Cultural identification Personal values Physical status Emotions

Which health promotion model does the nurse identify is the reason some people choose actions to foster health and others refuse to participate?

Health-Belief Model

The nurse is assessing the integumentary system of a client with Cushing syndrome. The nurse anticipates which finding?

Hirsutism

A client has an elbow injury that involves the cartilage in that joint. The nurse understands that which type of cartilage has been affected?

Hyaline cartilage

Which of the following sedative medications is effective in treating pruritus?

Hydroxyzine (Atarax)

Production of melanin is controlled by a hormone secreted by which gland?

Hypothalamus

A patient with a history of chronic respiratory illness exhibits nail clubbing. The nurse interprets this finding as indicating which of the following?

Hypoxia

irregular bones include those in __________ and the ________

vertebrae jaw

The nurse is caring for a client with herpes zoster. The nurse documents the lesions as

vesicles

Ectoparasites

Lice: drink blood and inject waste and digestive juices into skin which causes itching

A patient has contact dermatitis on the hand, and the nurse observes an area that is thickened and rough between the thumb and forefinger. What does the nurse know that this is significant of related to repeated scratching and rubbing?

Lichenification

The nurse and nursing assistant are moving a client who slid down in the chair. What does the nurse encourage the assistant to avoid shearing when moving the client to a higher position in the chair?

Lift the client, do not slide them.

Which factor causes wrinkles among older adults?

Loss of subcutaneous tissue

If unable to locate a stroke using a CT scan, use ______

MRI.

Assessment of a patient reveals a flat and nonpalpable skin lesion that is 0.5 cm with a circumscribed border. The nurse documents this lesion as which of the following?

Macule

The nurse is preparing to assess the spine of an older adult. Which actions will the nurse take during this assessment? Select all that apply.

Measure Height Ask the client to bend backward Ask the client to bend forward at the waist

A nurse practitioner prescribes a therapeutic bath for a patient with an exacerbation of psoriasis. She tells the patient to make sure the bath area is well ventilated. Which of the following is the therapeutic bath solution prescribed by the nurse?

Medicated tars

Which of the following pigments influences hair color?

Melanin

Which procedure done for skin cancer conserves the most amount of normal tissue?

Mohs micrographic surgery

While examining a client's leg, a nurse notes an open ulceration with visible granulation tissue in the wound. Until a wound specialist can be contacted, which type of dressing should the nurse apply?

Moist sterile saline gauze

The nurse is caring for a client who may have a lice infestation. The nurse is using a bright light focused on an area of the head to confirm the presence of lice. In which manner is it easiest to differentiate nits from dandruff?

Nits are difficult to move from hair shafts.

Normal perspiration ___________. Odor comes from ______

No odor increase in bacteria on the skin's interaction with sweat chemicals

A young adult visits a health clinic for treatment of a severe case of eczema on his left leg. Which of the following is the preferred method for delivering medication in this scenario?

Ointment

A client is brought to the emergency department after injuring the right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean?

One side of the bone is broken and the other side is bent.

To detect cyanosis in clients with dark skin, it is most important that the nurse assess which area?

Oral mucosa

A nurse is caring for a client with an undiagnosed bone disease. When instructing on the normal process to maintain bone tissue, which process transforms osteoblasts into mature bone cells?

Ossification and calcification

An instructor is describing the process of bone development. Which of the following would the instructor describe as being responsible for the process of ossification?

Osteoblasts

Which serum level indicates the rate of bone turnover?

Osteocalcin

Which of the following is the most common and most fatal primary malignant bone tumor?

Osteogenic sarcoma (osteosarcoma)

5 P's of Compartment Syndrome

Pain/Swelling Pallor Paralysis Paresthesia Pulselessness

The nurse is performing an assessment for a patient who may have peripheral neurovascular dysfunction. What signs does the patient present with that indicate circulation is impaired? (Select all that apply.)

Pale, cyanotic, or mottled color Cool temperature of the extremity More than 3-second capillary refill

Which of the following are the major hormonal regulators of calcium homeostasis? Select all that apply.

Parathormone Calcitonin

A nurse is preparing a patient with a history of allergies for diagnostic testing. Which of the following would the nurse anticipate as being most likely?

Patch testing

What are the QSEN Competencies in Nursing?

Patient-centered care. Evidence-based practice. Teamwork and collaboration. Safety. Quality improvement. Informatics.

The nurse is assisting an older adult client with performing activities of daily living (ADL) and is brushing her hair. What does the nurse document as an abnormal finding?

Pearly white substance that is attached to the hair shaft that is not removed with brushing

The nurse notes several very small, round, red and purple macules on a patient's skin. The patient has a history of anticoagulant use. The nurse records this finding as which of the following?

Petechiae

Red bone marrow produces which of the following? Select all that apply.

Platelets White blood cells (WBCs) Red blood cells (RBCs)

What should we check before giving an MRI?

Presence of ANY metal. Nicotine patches contain metal! Check to see if they've been shot or work with metal, have a pacemaker, fillings, piercings, pins.

A nurse is admitting a client with toxic epidermal necrolysis. What is the nursing priority in preventing sepsis?

Preventing infection

A night-shift nurse receives a call from the emergency department about a client with herpes zoster who is going to be admitted to the floor. Based on this diagnosis, where should the nurse assign the client?

Private room

A nurse assesses a client with dry, rough, scaly skin without lesions on the legs. The client reports itching in the affected area. What skin assessment would the nurse document?

Pruritus

Photochemotherapy has been used as a treatment for which of the following skin disorders?

Psoriasis

The nurse is caring for a client who experienced a crushing injury of the lower extremities. Which of the following symptoms is essential to be reported to the physician?

Pulselessness

A patient's skin is examined and the nurse notes the presence of herpes simplex/zoster skin lesions. The nurse describes the lesions as:

Pus-filled vesicles; circumscribed and elevated masses >0.5 cm.

A client has a boil that is located in the left axillary area and is elevated with a raised border, and filled with pus. How would the nurse document this type of lesion?

Pustule

What does QSEN stand for?

Quality and Safety Education for Nursing

A patient has a fracture of the right femur sustained in an automobile accident. What process of fracture healing does the nurse understand will occur with this patient?

Reactive phase, reparative phase, remodeling phase

Which of the following is the final stage of fracture repair?

Remodeling

A patient is scheduled for Mohs microscopic surgery for removal of a skin cancer lesion on his forehead. The nurse knows to prepare the patient by explaining that this type of surgery requires:

Removal of the tumor, layer by layer.

Symptoms of _________ include acute heel pain experienced when getting up in the morning

plantar fasciitis

The nurse is conducting a medication reconciliation with a client admitted with a fracture. What medication predisposes a client for a risk for fractures?

prednisone

Secondary skin infections

preexisting skin conditions, injury or surgery, several microorganisms, like staph or strep

A client is undergoing photochemotherapy involving a combination of a photosensitizing chemical and ultraviolet light. What health problem does this client most likely have?

psoriasis

Which term refers to a disease of a nerve root?

radiculopathy

A 1-year-old client has a localized rash and is miserably itchy. The client's mother indicates having just started to use a new skin cream and that the rash developed within 12 hours of the first dose. What treatments would pediatrician prescribe? Select all that apply.

remove allergen cool baths without soap twice daily apply hydrogen peroxide to dry rash

acantholysis

separation of epidermal cells from each other due to damage or abnormality of the intracellular substance

fracture pain

sharp and piercing and is relieved by immobilization

The nurse is assigned to a client admitted with advanced Parkinson's disease. What type of gait correlates with Parkinson's disease?

shuffling

When conducting a skin assessment, the nurse notes a purple macular lesion on the client's right upper extremity. The nurse differentiates the lesion as a petechia or ecchymosis based on

size

An example of a flat bone is the

sternum

Flat bones include the _______ and ________

sternum skull

Vigilance

sustained concentration, ability to maintain concentrated attention over prolonged periods of time

Sweat glands on the trunk respond to _______, while glands on the hands and feet respond to __________, and armpits and forehead respond to _________

temperature nervousness both

A client experiences a musculoskeletal injury that involves the structure that connects a muscle to the bone. The nurse understands that this injury involves which structure?

tendon

Failure to Rescue

the inability to save a patient's life after the development of a complication (complication occurring after the 2nd day in hospital) not recognizing deterioration in a patient's status and taking steps to reverse the changes, lack of managing complications resulting in death

The nurse teaches the client who demonstrates herpes zoster (shingles) that

the infection results from reactivation of the chickenpox virus.

lichenification

thickening of the horny layer of the skin (synonym: scaling)

A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include?

use the large muscles in the leg when lifting and object

Which order of activities is accurate when making a home visit?

Review agency policies regarding visits, ask permission to enter home, perform hand hygiene, and document care provided.

The diagnosis of a skin disorder is made chiefly by which of the following?

Visual inspection

The nurse is teaching a client about a vitamin that supports calcium's absorption. What vitamin is the nurse teaching the client about?

Vitamin D

Which term refers to a condition characterized by destruction of melanocytes in circumscribed areas of the skin?

Vitiligo

Which may occur if a client experiences compartment syndrome in an upper extremity?

Volkmann's contracture

What advice should the nurse give a client with dermatitis until the etiology of the dermatitis is identified?

Wear rubber gloves when in contact with soaps.

The nurse documenting an acute open wound should include which characteristic(s)? Select all that apply.

Wound size Periwound skin Wound bed

Which term refers to yellowish waxy deposits on the upper and lower eyelids?

Xanthelasma

The nurse is reading the physician's report of an elderly client's physical examination. The client demonstrates xanthelasma, which refers to which symptom?

Yellowish waxy deposits on the eyelids

osteophytes

a bony outgrowth associated with the degeneration of cartilage at joints. AKA bone spur

strain

a musculotendinous stress injury

While reading a client's chart, the nurse notices that the client is documented to have paresthesia. The nurse plans care for a client with

abnormal sensations.

Low Back Pain Causes

acute lumbosacral strain unstable lumbosacral ligaments weak muscles intervertebral disc problems unequal leg length (comorbidities: depression, alcohol use, smoking, stress, obesity)

Vigilant

alertly watchful, especially to avoid danger carefully noticing problems or signs of danger

disarticulation

amputation through a joint

sprain

an injury to ligaments and muscles and other soft tissues at a joint

The nurse notes that the client demonstrates generalized pallor and recognizes that this finding may be indicative of

anemia

short bones are found in the __________ and ________

ankle hand

Which medication taken by the client in the previous 24 hours would be of greatest concern to the nurse caring for a client undergoing a bone biopsy?

aspirin

sharp pain may also result from

bone infection with muscle spasm

Bone pain

boring, not related to movement, interferes with sleep

What food can the nurse suggest to the client at risk for osteoporosis?

broccoli

A client with diabetes punctured the foot with a sharp object. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics?

>4 weeks

The classic lesions of impetigo manifest as

honey-yellow crusted lesions on an erythematous base.

Moisture retentive dressings

hydrogels, hydrocolloids, foam dressings, calcium alginates

It is best to do migraine teaching

in a quiet room

A client with a history of diabetes mellitus has recently developed furunculosis. What is causing the client's condition?

infection

Signs of osteomyelitis

infection of the bone; fever, redness at the site, pain, signs of cardiac adjustment such as tachycardia

sciatica

inflammation of the sciatic nerve, resulting in pain along the nerve in the thigh and leg

pain that is the worst in the morning

inflammatory rhuematic disorders, tendonitis

fasciculation

involuntary twitch of muscle fibers

Health education of a client by the nurse

is an independent function of nursing practice.

Pain That Increases With Usage

joint/muscle sprain, compartment syndrome or infection

Which of the following is the most common site of joint effusion?

knee

Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely?

long bone bowing

Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes?

lower lumbar

While assessing the skin of a 45-year-old, fair-skinned female client, the nurse notes a lesion on the medial aspect of her lower leg. It has irregular borders, with various shades of black and brown. The client states that the lesion itches occasionally and bled slightly a few weeks ago. She also reveals a history of sunburns. Based on these signs and symptoms, the nurse suspects:

melanoma

Heterotropic ossification

misplaced formation of bone

isotonic contraction

muscle is shortened without a change in its tension; a joint is moved as a result

isometric contraction

muscle tension is increased without changing its length; there is no associated joint motion

A nurse is caring for a client following foot surgery. Which nursing intervention is most important for the nurse to include in the nursing care plan?

neuromuscular assessments every hour

Involucrum

new bone growth around a sequestrum

A client with carpal tunnel syndrome has had limited improvement with the use of a wrist splint. The nurse knows that which procedure will show the greatest improvement in treatment for this client?

open nerve release

pain that worsens as the day progresses

osteoarthritis

A client is being treated for acne vulgaris. What contributes to follicular irritation?

overproduction of sebum

subluxation

partial dislocation of a joint

A client has a rash on the arm that has been treated with an antibiotic without eradicating the rash. What type of examination can be used to determine if the rash is a fungal rash using ultraviolet light?

A Wood's light examination

PVD peripheral vascular disease

A circulatory condition in which narrowed blood vessels reduce blood flow to the limbs. Peripheral vascular disease is a sign of fatty deposits and calcium building up in the walls of the arteries (atherosclerosis). Risk factors include aging, diabetes, and smoking. Symptoms may include leg pain, particularly when walking. Tobacco cessation, exercise, and a healthy diet are often successful treatments. When these changes aren't enough, medications or surgery can help.

The nurse is caring for a patient with extensive bullous lesions on the trunk and back. Prior to initiating skin care, what is a priority for the nurse to do?

Administer analgesic pain medication.

The nurse is providing care to a client following a knee arthroscopy. What would the nurse expect to include in the client's plan of care?

Administering the prescribed analgesic.

The nurse is caring for a client with a hip fracture. The physician orders the client to start taking a bisphosphonate. Which medication would the nurse document as given?

Alendronate

A client is experiencing muscle weakness in the upper extremities. The client raises an arm above the head but then loses the ability to maintain the position. Muscular dystrophy is suspected. Which diagnostic test would evaluate muscle weakness or deterioration?

An electromyography

A client has been diagnosed with shingles. Which of the following medication classifications will reduce the severity and prevent development of new lesions?

Antiviral

Which term refers to a grating or crackling sound or sensation?

Crepitus

Parasitic Infections

Lice (pediculosis) scabies (itch mite)

Which of the following information regarding the transmission of lice would the nurse identify as a myth?

Lice can jump from one individual to another.

While in a skilled nursing facility, a client contracts scabies, which is diagnosed the day after discharge. The client is living at her daughter's home with six other people. During her visit to the clinic, the client asks a staff nurse, "What should my family do?" The most accurate response from the nurse is:

"All family members need to be treated."

Choose the nursing statement that would best reflect the final component of the "Ask-Tell-Ask-Close" technique of communication and demonstration.

"Can you repeat for me the information I just reviewed about weighing food portions?"

A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching?

"I should use my heating pad this evening to reduce some of the pain in my knee."

A client with a sports injury undergoes a diagnostic arthroscopy of the left knee. What comment by the client following the procedure will the nurse address first?

"My toes are numb."

The nurse is preparing the client for computed tomography. Which information should be given by the nurse?

"You must remain very still during the procedure."

A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching?

"You will receive IV antibiotics for 3 to 6 weeks."

The nurse is collaborating with the health care provider on a plan of care for a 54-year-old male client with osteomyelitis of the left femur secondary to uncontrolled type 1 diabetes.

*Perform neurovascular checks of lower extremities every 8 hours. *Administer IV antibiotic based on culture and sensitivity report. *Encourage ambulation with weight-bearing on the left leg. *Administer ibuprofen 400 mg orally three times daily, as needed for pain. *Make referral to dietitian to discuss nutrition for healing and blood glucose control. *Provide education on self-blood glucose monitoring and insulin administration.

Seborrheic Dermatitis

- caused by: genetic/stress/diet/infection/hormones - chronic inflammatory disorder caused by excessive production of sebum -can be wet or dry form -dry form is dandruff -wet form looks greasy -may be a manifestation of Parkinsons or HIV -no known cure, use dandruff shampoo and rotate; keep on head for 5-10 min -keep skin clean and dry and avoid sweating, heat, scratching, irritants

Tinea Pedis

-"ATHLETES FOOT" -soles have scaling and maceration between toes -acute infections have vesicles -avoid contaminating other areas of skin and other people -antifungal powder

Tinea Crusis

-"JOCK ITCH" -begins with scaling patches that spread and form pustules -same treatment as corposis, antifungals

Stevens-Johnson Syndrome

-A severe, possibly fatal reaction to meds: antibiotics, nsaids, anticonvulsants -necrotic sloughing -starts with conjuctiva burning, fever, sore throat, malaise, skin tenderness -looks like full body burn -sepsis and multiple organ dysfunction syndrome can cause death -biopsy and cbc -treated in burn center, IVIG, immunosuppressant, temporary biological dressings

Generalized Exfoliative Dermatitis

-AKA erythroderma -involves 90% of skin -skin gets red with fever, malaise, chills -skin changes from pink to dark red -heat and hair loss -can be secondary to psoraisis or eczema or disease -electrolyte and fluid balance because patients lose protein and water -may be hospitalized -prevent sepsis and hypothermia -corticosteroids, antihistamines before bed, warm compresses, lubrication, baths

Preventing Failure to Rescue

-Assess patient frequently -Attend to cues/signs/symptoms -Recognize deviation from normal complications -Identify that there is a problem, call for help

Eczema

-Atopic dermatitis -chronic -unknown cause, thought to be r/t allergic hypersensitivity to environmental substance -pathophysiology: aggravated by stress and fatigue -s/s: erythema, scaly, dry, thickened, may crack and bleed

Arterial Ulcers

-Between toes, tips of toes, over phalangeal heads, around lateral malleolus, sites subjected to trauma or rubbing of footwear, mid tibia -EVEN wound margins, oval or round -Deep, pale, necrotic, granulation tissue -Blanched, purpuric, thin, SHINY, dry, hairless -SEVERE PAIN, minimal drainage, decreased temperature, absent or diminished pulses, cyanosis, thickened toenails, gangrene

Impetigo

-Bullous impetigo: caused by S. aureous, large fluid filled blisters which rupture -Non-bullous: 70% of cases; caused by S. aureous (MRSA), strep, to skin that has had trauma -Contagious, spreads to others and affects face, hands, neck, extremities -More common in warmer climates, malnourished, children, poor hygiene -Red macules turn into vesicles which rupture and a yellow crust forms over it -Clean and remove crust before giving topical antibiotics for mild cases -Systemic antibiotics (for wide spread or cases with fever) like amoxicillin when mrsa is present -bactericidal soap

Bullous Pemphigoid

-Chronic autoimmune blistering disease of the skin & mucous membranes -Can be fatal, MC in 65+y/o -MC at flexor surfaces of arms -IgG and complement C3 at the junction of the epidermis and dermis -corticosteroids, immunosuppression, anti-inflammatory

Dermatitis herpetiformis

-Chronic blistering disease. Appearance of herpes simplex, intensely pruritic papules and vesicles -defect in gluten metabolism -common on back, elbows, knees -avoid gluten

Lice

-Head: Pediculus human capitis: mom lays eggs (nits) close to scalp and hatch in a week, mature in a week -Body: corpus: spread by living in close contact -Groin: Pthriasis Pubis, aka crabs: sexual contact -can cause impetigo and furuncles -found on the back of the head and behind the ears for head -shampoo with pyrethrin, remove eggs

How to find the Post Tib Pulse

-Locate medial malleolus -2 - 3cm below and behind it you should find the posterior tibial pulse.

Cellulitis

-MC cause of infectious limb swelling -strep or staph enters through a break in the skin -redness, warmth, pain, fever, chills, sweating -orange peel pitting appearance -antibiotics -elevate, cool packs, then warm packs

Hiddradenitis Suppurativa AKA acne inversa

-More common among black people -Genetic, caused by occluded follicles -Pea-sized nodules that rupture deeply and spread, can cause abcesses and scarring -Warm compresses and loose-fitting clothing, antibiotics, NSAIDs -CO2 laser surgery is more effective than surgery that excises the entire area

Venous Ulcers

-On medial lower leg and ankle, superior to medial malleolus, SELDOM noted on the foot or above the knee -IRREGULAR wound margins -Shallow, partial-thickness, ruddy red, granular, necrotic tissue common -SCALY, pruritic, weepy, brown staining, dermatitis, firm edema -Moderate to large amount of drainage, pain levels vary, ankle flare, lipodermatosclerosis (hard fibrosis of surrounding tissue), dilated superficial veins

How to find Dorsalis Pedis Pulse

-Place your fingers half way down the dorsum of the foot on the bony area in the line between the first and second toes. -The bones you can feel are the dorsal aspect of the navicular and the intermediate cuneiform bones. -The pulse is palpated where the artery passes over this area.

Neuropathic (Diabetic) Ulcers

-Plantar aspect of foot, over metatarsal heads, under heel -EVEN wound margins -Deep, granular, red or pale, yellow slough common -Hyperkeratotic tissue, callus, cellulitis -Low to moderate drainage, foot deformities, diminished or absent sensation in foot, palpable pulses, osteomyelitis, usually PAINLESS

Arterial Ulcers Characteristics

-Pulses ABSENT or WEAK -SHARP & SEVERE pain -Cool, shiny, hairless skin -DEEP, circular -Tip of toes, webbing, heel, pressure points -MINIMAL EDEMA -Base of ulcer is pale to black, wet to dry gangrene

Venous Ulcers Characteristics

-Pulses PRESENT, may be hard to feel through edema -Found near malleolus or anterior tibial area -ACHING pain -Skin is reddish/blue, looks like dermatitis -SUPERFICIAL depth with irregular border -Beefy red to yellow granulation tissue -Moderate to SEVERE EDEMA In legs

Tinea Corposis

-Starts with red macule that spreads into a ring of papules or vesicles with central clearing -itchy -lesions found in clusters and can spread to scalp and nails -topical/oral antifungal creams

Herpes Simplex

-Type 1: mouth -Type 2: genitals -can be found in both places

Herpes Zoster AKA Shingles

-VZV lays dormant by brain and spinal cord, when immune system is weakened it comes back and forms fluid-filed blisters (preerruptive phase) -Vesicles and pain in acute phase -postherpetic pain can last up to 60 days -if it's in the eye it can cause blindness -antiviral agents can be given if caught within 72 hours of symptom onset, may continue for 21 days -there's a vaccine now -pain management

Rosacea

-a red, enlarged nose may occur in severe cases, rhinophyma -cause is unknown -may worsen: in heat, sunlight, cold, spicy food, alcohol, menopause, psychological stress, steroid cream -not curable, but treatable: metronidazole, doxycycline, tetracycline -caucasians are more frequently affected

Carbuncle

-abscess of skin caused by a deep furuncle that spread to several follicles -purulent may be absorbed which can cause sepsis, high fever, leukocytosis -hot climates, diabetics, immunosuppressed -common on neck and back -antibiotics and cutting lesions -CAREFUL on the face, drains into cranial venous sinuses. It can drain and cause an abscess in the brain

Pemphigus vulgaris

-acantholysis: separation of epidermis caused by rubbing of the skin -blisters -autoimmune disease -present with oral lesions -odor from bullae and serum -corticosteroids, immunosuppression, IV immunoglobulin -Most commonly affects Jewish and Mediterranean people

Irritant Contact Dermatitis

-aka eczema -primary: nonallergic -affects women more than men -continuous scratching leads to lichenification

Acne Vulgaris

-chronic -affects hair follicles and sebaceous glands on the face, neck, torso, and upper arms -comedones (primary acne lesions), cysts, white/black heads, papules, pustules, nodules -80% of people get it, more likely in females -caused by genetics, bacteria, hormones, puberty -androgens cause enlarged and more active sebum glands which get plugged and inflammed -avoid sugar and use oil-free products to wash (benzoyl peroxide and salicyclic acid) -antibiotics & BPeroxide for severe cases, corticosteroid injection, phototherapy for antibiotic resistant

psoraisis

-chronic, autoimmune -worse when stressed -can affect mouth, eyes, skin, joints (negative arthritis of multiple joints) -silvery plaques -elbows, knees, lower back, butt -pitting nails -topical corticosteroids and phototherapy for mild cases -^plus systemic treatment methotrexate, for severe

Scabies

-contagious skin disease transmitted by the itch mite, commonly through sexual contact -takes a month to appear -permethrin, to whole body except face, which scabies don't live on

Furuncle (boil)

-deep form of folliculitis -starts as a pimple -infection spreads to subcutaneous -usually caused by staph -has a point, center turns yellow or black "comes to a head" -common in hot climates, diabetics, immunosuppressed

Fungal/Mycotic Infections

-eukaryotic organisms -tinea is most common: AKA ringworm; head, body, nails, feet, groin -wood's light: infected hair is flourescent

Stasis Dermatitis/Stasis Ulcers

-occurs in venous insufficiency -common in diabetics -large vessels are damaged, compromising circulation in lower left legs -Skin becomes dry, fragile, ulcers form easily -starts as a erythema, scale, and itching -chronically leads to change in skin color

Folliculitis

-pseudofolliculitis barbae: shaving bumps, most commonly affects black men -caused by fungal, viral, parasitic, bacterial

tinea barbae

-red, inflamed, absecesslike lesions, pustules or crusting -may develop secondary infection -griseofulvin 4-6 weeks, terbinafide 2-4 weeks -shampoo beard with selenium sulfide for 2 weeks -"barbers itch"

Tinea Capitis

-scalp/eyebrows -contagious infection of hair shaft -scaling, oval, red patches -small papules or pustules on scalp or eyebrows -brittle hair that breaks easily, alopecia -same treatment as tinea barbae: griseofulvin 4-6 weeks, terbinafide 2-4 weeks -shampoo beard with selenium sulfide for 2 weeks

Assessment

-should NOT involve assessment, interpretation, or decision making

tinea unguium

-toe nails/onychomycosis -nails thicken and break easily and lack luster -whole nail can be destroyed -oral anitfungal or surgery

Psoriasis

-unknown cause, thought to be autoimmune (T-lymphocyte mediated immune response, often has a family history -chronic inflammatory skin disorder -lesions are white-ish -scaly plaques on scalp, knees, elbows -skin cells grow 10x faster -silvery scales

Viruses that cause dermatological disorders

-varicella-zoster VZV -herpes simplex -severe acute respiratory syndrome covid 2 SARS-Co-V-2

A client has undergone arthroscopy. After the procedure, the site where the arthroscope was inserted is covered with a bulky dressing. The client's entire leg is also elevated without flexing the knee. What is the appropriate nursing intervention required in caring for a client who has undergone arthroscopy?

Apply a cold pack at the insertion site.

The nurse is instructing the patient in how to apply a corticosteroid cream to lesions on the arm. What intervention can the nurse instruct the patient to do to increase the absorption of the medication?

Apply an occlusive dressing over the site after application.

A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem?

Apply lotions and take warm baths or soaks.

The nurse is preparing the client with a right neck mass for magnetic resonance imaging (MRI). Which question should the nurse ask? Select all that apply.

Are you wearing any jewelry?" "Have you removed your hearing aid?" "Do you have a pacemaker?"

___________ is the chief cause of musculoskeletal-related disability in the US

Arthritis

Which is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or wrist?

Arthrography

A patient is scheduled for a procedure that will allow the physician to visualize the knee joint in order to diagnose the patient's pain. What procedure will the nurse prepare the patient for?

Arthroscopy

The nurse documents the skin color change of a dark-skinned African American patient in cardiogenic shock as:

Ashen gray and dull.

The nurse is performing a neurological assessment. What will this assessment include?

Ask the client to plantar flex the toes.

Which of the following uses the body's own digestive enzymes to break down necrotic tissues?

Autolytic debridement

A patient is diagnosed with seborrheic dermatitis on the face and is prescribed a corticosteroid preparation for use. What should the nurse educate the patient about regarding use of the steroid on the face?

Avoid using the medication around the eyelids because it may cause cataracts and glaucoma.

A 52-year-old client asks the nurse for interventions for the treatment and prevention of actinic ketatosis. The client is a construction foreman and has actinic ketatosis that is noted only on the right side of the face next to the nose. Which recommendation is appropriate for this client?

Avoidance of direct sunlight with protective clothing measures should be discussed with the client.

Which of the following causes odor in perspiration?

Bacteria on the skin

X-rays give a _______ view of soft tissues

Basic

During a routine examination of a client's fingernails, the nurse notes a horizontal depression in each nail plate. When documenting this finding, the nurse should use which term?

Beau's line

Functional PVD

Blood vessels can widen and narrow in spasms caused by other factors, such as stress, smoking, cold temperatures, or work involving vibrating machinery. -Chronic venous insufficiency (CVI): When the valves in the veins do not work properly, they can prevent blood from the legs from returning to the heart, causing blood to pool in the legs. CVI does not pose a serious health treat, but left untreated, it can cause pain, swelling, and leg ulcers. -Raynaud's disease: With this disorder, exposure to cold temperatures or emotional upset causes decreased blood flow to the fingers, and sometimes the ears, toes, nipples, knees, or nose. -Varicose veins: Caused by venous insufficiency, varicose veins are enlarged, twisted veins that are visible under the skin. They are usually blue and occur in the legs but can also be red and occur in other parts of the body. Pregnancy, obesity, and extended periods of standing can lead to this mostly cosmetic issue.

A patient diagnosed with Addison's disease would be expected to have which of the following skin pigmentations?

Bronze (darkening of skin)

Which hormone inhibits bone resorption and increases the deposit of calcium in the bone?

Calcitonin

The nurse assesses a dark-skinned patient who has cherry-red nail beds, lips, and oral mucosa. What does this assessment data indicate the patient may be experiencing?

Carbon monoxide poisoning

A nurse is caring for a client with eczema. Which medication would be prescribed when an allergy is a factor causing the skin disorder?

Chlorpheniramine

What is the term for a rhythmic contraction of a muscle?

Clonus

The nurse is caring for a client scheduled to have magnetic resonance imaging (MRI). The nurse contacts the health care provider to cancel the MRI when the nurse reads which element in the client's medical history?

Cochlear implant

Which of the following is the primary lesion associated with acne, caused by sebum blockage in hair follicles?

Comedone

Which is a neurovascular problem caused by pressure within a muscle area that increases to such an extent that microcirculation diminishes?

Compartment syndrome

Two days after application of a cast to treat a fractured femur, the client reports severe, deep, and constant pain in the leg. What will the nurse suspect?

Compartment syndrome.

inpingement syndrome

Condition that occurs when tendons of the shoulder/rotator cuff become impinged, or compressed, by the bones of the shoulder

The nurse is applying a cold towel to a patient's neck to reduce body heat. How does the nurse understand that the heat is reduced?

Conduction

Which is a circulatory indicator of peripheral neurovascular dysfunction?

Cool skin

Which medication classification may be used for contact dermatitis?

Corticosteroids

Choose the correct statement about the endosteum, a significant component of the skeletal system:

Covers the marrow cavity of long bones

What should we always check before giving an MRI?

Creatinine levels & pregnancy test

After teaching a group of students about the structure of the skin, the nursing instructor determines that the teaching was successful when the group identifies which of the following as the true skin?

Dermis

What term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia?

Dupuytren contracture

The nurse is performing a neurovascular assessment of a client's injured extremity. Which would the nurse report?

Dusky or mottled skin color

Which diagnostic test would the nurse expect to be ordered for a client with lower extremity muscle weakness?

Electromyograph (EMG)

The nurse should assess all possible causes of pruritus for a patient complaining of generalized pruritus. What does the nurse understand can be another cause for this condition?

End-stage kidney disease

A nurse is caring for a client experiencing an exacerbation of plaque psoriasis. The nurse assesses the area and documents a proliferation of which cell type?

Epidermal

Which group is at the greatest risk for osteoporosis?

European American women

A nurse is preparing a presentation for a group of high school athletes about temperature regulation during activity such as practice. When describing the mechanisms of heat loss, which of the following would the nurse identify as primarily responsible when environmental temperatures are very high?

Evaporation

The patient is advised to apply a suspension-type lotion to a dermatosis site. The nurse should advise the patient to apply the lotion how often to be effective?

Every 3 hours

Which of the following nonsedating antihistamines is appropriate for daytime pruritus?

Fexofenadine (Allegra)

After bone fracture, fibrocartilaginous callus formation normally occurs at the same time as which process?

Fibroblast migration

During a routine checkup, a nurse observes the client's skin to be tight and shiny. Which of the following is the correct indication of this sign?

Fluid retention

The nurse is developing a plan of care for a client with toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome. Which action should the nurse include?

Frequently inspect the oral cavity.

Which term refers most precisely to a localized skin infection of a single hair follicle?

Furuncle

When writing a plan of care for a client with psoriasis, the nurse would know that an appropriate nursing diagnosis for this client would be what?

Impaired Skin Integrity Related to Scaly Lesions

Which skin condition is caused by staphylococci, streptococci, or multiple bacteria?

Impetigo

Which capability corresponds with home health care?

Improvises when providing care

A weight-loss and exercise program is recommended for a client with type 2 diabetes. When teaching the client about lifestyle changes, what type of assessment would the nurse prioritize?

Individual cultural assessment

cheilitis

Inflammation and cracking of the lips and corners of the mouth due to infection, allergies, or nutritional deficiency

A client is scheduled for a bone scan. A bone scan may be ordered to detect metastatic bone lesions, fractures, and certain types of inflammatory disorders. Which nursing considerations are correct in preparing a client for a bone scan? Select all that apply.

Inform the client that the radiopaque isotope will be administered intravenously. Ensure that the client does not have any allergies to the isotope. Encourage the client to drink fluids to help distribute and eliminate the isotope.

During a routine assessment of a client, the nurse notes that the client's nails are concave. Which condition is indicated by this finding?

Iron deficiency anemia

The nurse is providing information to a client about the safe use of a newly prescribed medication. The first question the nurse should ask is

Is the client ready to learn?

Which drug is an oral retinoid used to treat acne?

Isotretinoin

A patient is being evaluated for nodular cystic acne. What systemic pharmacologic agent may be prescribed for the treatment of this disorder?

Isotretinoin (Accutane)

An older adult asks about a red papule that is on the right arm that loses color when pressure is applied. In which way will the nurse interpret this finding?

It is a cherry angioma that is a normal age-related skin alteration.

The nurse is providing teaching to a client with acne who is using isotretinoin therapy. Which statement should the nurse make?

It is teratogenic in humans.

Which infecting agent causes scabies?

Itch mite

A patient has a serum bilirubin concentration of 3 mg/100 mL. What does the nurse observe when performing a skin assessment on this patient?

Jaundice

The nurse assesses the client and observes reddish-purple to dark blue macules, plaques, and nodules. The nurse recognizes that these manifestations are associated with which condition?

Kaposi sarcoma

The nurse is performing a physical examination of a patient and observes a well-healed old scar on the right shoulder. The scar is hypertrophied, elevated, and irregular without any redness or irritation. The patient states, "I had shoulder surgery about 5 years ago." The nurse documents this finding as which of the following?

Keloid

A client visits an orthopedic specialist because of pain beginning in the low back and radiating behind the right thigh and down below the right knee. The doctor suspects a diagnosis of sciatica. The nurse knows that the origin of the pain is between which intervertebral disks?

L4, L5, and S1

A 10-year-old child is brought to the office with complaints of severe itching in both hands that's especially annoying at night. On inspection, the nurse notes gray-brown burrows with epidermal curved ridges and follicular papules. The physician performs a lesion scraping to assess this condition. Based on the signs and symptoms, what diagnosis should the nurse expect?

Scabies

A client with psoriasis visits the dermatology clinic. When inspecting the affected areas, the nurse expects to see which type of secondary lesion?

Scale

What is the term for a lateral curving of the spine?

Scoliosis

Which statement reflects the progress of bone healing?

Serial x-rays are used to monitor the progress of bone healing.

A client undergoes an invasive joint examination of the knee. What will the nurse closely monitor the client for?

Serous drainage

Which laboratory study indicates the rate of bone turnover?

Serum osteocalcin

Biopsies are performed on which of the following? Select all that apply.

Skin nodules Plaques Ulcers Blisters

A group of students are studying for an examination on joints. The students demonstrate understanding of the material when they identify which of the following as an example of a synarthrodial joint?

Skull at the temporal and occipital bones

The nurse is assessing the client for scoliosis. What will the nurse have the client do to perform the assessment?

Stand behind the client and ask the client to bend forward at the waist.

The most common causative organism of osteomyelitis is

Staphylococcus aureus

The health care team is caring for a client with osteomalacia. It has been determined that the osteomalacia is caused by malabsorption. What treatment should the nurse anticipate?

Supplemental calcium and increased doses of vitamin D

A client with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. The wound appearance has not improved. What action would the nurse anticipate to promote healing?

Surgical debridement

Sudoriferous glands secrete which type of substance?

Sweat

Morton neuroma is exhibited by which clinical manifestation?

Swelling of the third (lateral) branch of the median plantar nerve

A patient is diagnosed with severe psoriasis. The health care provider prescribes a popular topical non-steroid. The nurse knows to prepare health teaching information for which of the following drugs?

Tazorac

A client has been treated for migraine headaches for several months and comes to the clinic reporting no improvement. The nurse is talking with the client and hears an audible click when the client is moving the jaw. What does the nurse suspect may be happening?

Temporomandibular disorder

A nurse is caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and the immune system is currently depressed. Which assignment is the most appropriate for the nurse caring for this client?

patient should be in the icu

When providing discharge instructions, the nurse recognizes that which client is most likely to comply with the therapeutic treatment regimen?

The client with pneumonia who requires 1 week of oral antibiotics

The emergency room nurse is reporting the location of a fracture to the client's primary care physician. When stating the location of the fracture on the long shaft of the femur, the nurse would be most correct to state which terminology locating the fractured site?

The fracture is on the diaphysis.

The nurse assesses soft subcutaneous nodules along the line of the tendons in a patient's hand and wrist. What does this finding indicate to the nurse?

The patient has rheumatoid arthritis.

Occlusive PVD

The types of PVD that stem from a blockage of the vessels are called occlusive. -Atherosclerosis: Thickening or hardening of the arteries over time can also lead to heart attack or stroke if not treated. -Buerger's disease: This chronic inflammatory condition in the minor arteries of the extremities can lead to blood clots and blockages in the arms or legs. -Carotid artery disease: Also called carotid artery stenosis, this condition occurs when the carotid arteries, the main blood vessels that carry oxygenated blood to the brain, become narrowed. Carotid artery disease results from atherosclerosis and may lead to heart attack or stroke. -Deep vein thrombosis (DVT): Blood clots can develop in a vein within a muscle (deep vein) and can dislodge and travel to the lungs, causing pulmonary embolism (blockage of the lung artery). DVT most commonly occurs after extended periods of inactivity, such as a long flight or prolonged bed rest. -Lymphedema: This chronic condition causes parts of the body to swell because lymph (fluid in the lymphatic system that travels through the body to fight disease and infection) builds up. People who have cancer treatment, such as surgery or radiation therapy, that affects the lymph nodes are at higher risk of developing the condition.

Petechiae are associated with which of the following disorders?

Thrombocytopenia

To treat a client with acne vulgaris, the physician is most likely to order which topical agent for nightly application?

Tretinoin (retinoic acid [Retin-A])

Which diagnostic test is used to examine cells from herpes zoster?

Tzanck smear

A dermatologist has asked the nurse to assist with examination of a client's skin using a Wood light. This test will allow the health care provider to assess for which of the following?

Unusual patterns of pigmentation on the client's skin

A client recently received lip and tongue piercings and subsequently developed a superinfection of candidiasis from the antibacterial mouthwash. What would the nurse recommend for this client?

Use an antifungal mouthwash or salt water.

A client is being treated for acne vulgaris. What warning must be given to this client regarding the application of benzoyl peroxide?

Use gloves with application.

The nurse is instructing the parents of a child with head lice. Which statement should the nurse include?

Use shampoo with piperonyl butoxide.

Which of the following inhibits bone resorption and promotes bone formation?

calcitonin

________bone is found where hematopoiesis and bone formation occurs

cancellous

Primary bacterial skin infections

caused by a single organism on previously normal skin IMPETIGO FOLLICULITIS

dislocation

complete separation of joint surfaces

________ bone is found where support is needed

cortical

muscle pain

cramps, soreness

ganglion cyst

cyst near tendon sheaths or joints

sequestrum

dead bone in abscess cavity

avascular necrosis

death of tissue due to insufficient blood supply

What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years?

decreased height

A nurse is assessing a patient's nails and observes Beau's lines. Which of the following depicts this condition?

defined dips in the nails

The shaft, or ________ of long bones are primarily made of ____________ bone.

diaphysis cortical/compact

radiculopathy

disease of the spinal nerve roots

The client diagnosed with osteosarcoma is scheduled for a surgical amputation. Which nursing diagnosis would be a priority for this client compared with other surgical clients?

disturbed body image

A client is diagnosed with a fracture of a diarthrosis joint. What is an example of this type of joint?

elbow

To help minimize calcium loss from a hospitalized client's bones, the nurse should:

encourage ambulation

The end of long bones are called _________ and are made of _____________

epiphyses cancellous/trabecular

FRAX predicts

fall risk within the next ten years given current PHI and behaviors, injuries, alcohol use, smoking, BMI, etc.

The nurse is assessing the skin of a client with tinea pedis and notes a linear crack. The nurse documents this as

fissure

Loose bodies (joint mice)

fragments in a joint space that lock the joint

Which of the following was formerly called a bunion?

hallux valgus

A client has come to the clinic with foot pain. The physician has described the client's condition as a flexion deformity of the proximal interphalangeal joint. What is the name of this disorder?

hammer toe

Staff at the local public health department have generated a list of topics that were identified by community members. Which location(s) will the staff identify to hold educational programs for the participants? Select all that apply.

high school health clinic recreation center community college place of worship

A patient sustained an open fracture of the femur 24 hours ago. While assessing the patient, the nurse observes the patient is having difficulty breathing, and oxygen saturation decreases to 88% from a previous 99%. What does the nurse understand is likely occurring with this patient?

Fat emboli

A patient has had a stroke and is unable to move the right upper and lower extremity. During assessment the nurse picks up the arm and it is limp and without tone. How would the nurse document this finding?

Flaccidity

Dupuytren contracture causes flexion of which area(s)?

Fourth and fifth fingers

A client with diabetes mellitus has impaired skin integrity due to an injury. Which skin disorder is the client likely to develop?

Furuncle

A client with a cognitive disability needs discharge instructions prior to leaving the hospital. Which educational strategy will the nurse implement that will best promote learning for this client?

Give clear, written information.

The nurse is reporting on the results of client blood work to the oncoming nurse. Upon reviewing the data, it is noted that the client has an elevated uric acid level. Which inflammatory process would the nurse screen for on shift rounds?

Gout

The nurse is conducting a community education program on basal cell carcinoma (BCC). Which statement should the nurse make?

It begins as a small, waxy nodule with rolled translucent, pearly borders.

What is the most prevalent bone disease in the world?

Osteoporosis

____________ frequently results in compression fractures of the spine, neck, femur, and wrist

Osteoporosis

The nurse is caring for a 12-year-old client. When teaching the client, what tone of teaching should the nurse implement?

Relevant

A client has just undergone arthrography. What is the most important instruction for the nurse to include in the teaching plan?

Report joint crackling or clicking noises occurring after the second day.

Which of the following is an appropriate priority nursing diagnosis for the client following an arthrocentesis?

Risk for infection

A 42-year-old client displays symptoms that indicate a risk for developing hypertension. Which immediate measures would the nurse recommend?

Routine screening and follow-up appointments

A nurse is caring for a patient who is experiencing fear, anxiety, and feelings of powerlessness after receiving a diagnosis of cancer. The nurse develops a teaching plan focusing on the patient's diagnosis and treatment options to promote the patient's sense of control over the situation. Using Maslow's Hierarchy of Human Needs, which of the following categories is the nurse attempting to meet?

Safety and security

A nurse practitioner assesses a patient's movement in his left hand after a cast is removed. The nurse asks the patient to turn his wrist so the palm of his hand is facing up. This movement is known as:

Supination

Skull sutures are an example of which type of joint?

Synarthrosis

The nurse working in the orthopedic surgeon's office is asked to schedule a shoulder arthrography. The nurse determines that the surgeon suspects which finding?

Tear in the joint capsule

What symptoms of a fractured clavicle does the nurse recognize?

The shoulder slopes downward and droops inward.

indications of a genetic musculoskeletal disorder

bone pain, enlarged hands and feet, excessive or decrease in height, short stature, flat/highly arched feet, frequency of bone-related injuries or fractures, hypermobility of joints, large/small head circumference, protruding jaw/forehead, unexplained changes in muscle tone (hypertonia)

A client is seen in the emergency room for a knee injury that happened during a basketball game. Diagnostic tests reveal torn cords of fibrous connective tissue that connect muscles to bones. What type of tear has this client sustained?

tendon