PREPU exam 7

When performing a skin assessment, the nurse notes a localized skin infection of a single hair follicle. The nurse documents the presence of

a furuncle.

A nurse is providing end-of-life care to a client who spends most of the time praying and talking about a "spiritual connection." The nurse interprets this as indicating which stage of grief?

acceptance

Which priority intervention should the nurse plan to implement to reduce a client's discomfort during terminal weaning?

administer sedation & analgesia

A client has recently lost a parent. The client spent about 6 months deeply mourning the loss and is just now able to function at the pre-loss level. During this process, a strong social support network was able to assist the client. What developmental stage of life does the nurse identify the client is in?

adult, they tend to grieve more intensely and more continuously, but for a relatively shorter period of time than children.

A client states, "My children still need me. Why did I get cancer? I am only 30." This client is exhibiting which stage, according to Kübler-Ross?

anger

The nurse is caring for a client terminally ill due to cancer whose family members have expressed profound sorrow over the forthcoming loss. Which nursing concern will the nurse apply to the family?

anticipatory grief due to upcoming loss of family member, evidenced by sorrow

A client is diagnosed with terminal kidney failure. The spouse demonstrates loss and grief behaviors. What type of loss is the spouse experiencing?

anticipatory loss

What is Kübler-Ross's third stage of grief?

bargaining

A nurse practitioner is seeing a 16-year-old client who has come to the dermatology clinic for treatment of acne. The nurse practitioner would know that the treatment may consist of which of the following medications?

benzoyl peroxide & erythromycin

According to the Harvard University Medical School committee, what function must be irreversibly lost to define death?

brain function

The nurse is providing instruction to a client with acne. The nurse promotes avoidance of which food(s)? Select all that apply.

chocolate & ice cream

Which primary lesions are associated with acne caused by sebum blockage in hair follicles?

comedomes

Upon admission, the nurse should give priority to addressing which need of a client who is displaying symptoms of dysfunctional grief?

coping strategies

The nurse is conducting an admission history and physical examination of a client with a history of contact dermatitis. The nurse assesses whether the client uses which medication classification?

corticosteroids

For which persons are death certificates necessary? Select all that apply.

death from an infectious disease death in an institutional setting unexpected death murder victims death before age 65 years U.S. law requires death certificates for all clients who die.

Which assessment finding indicates an increased risk of skin cancer?

deep sunburn

A terminally ill client is being cared for at home and receiving hospice care. The hospice nurse is helping the family cope with the client's deteriorating condition, educating them on the signs of approaching death. Which sign would the nurse include in this education plan?

difficulty swallowing

The nurse is providing care for a confused client who no longer is able to make health care decisions. Which document will the nurse review on the client's medical record to determine the designated person to make decisions on the client's behalf?

durable power of attorney form

A public health nurse is participating in a health promotion campaign that has the goal of improving outcomes related to skin cancer in the community. What action has the most potential to achieve this goal?

educating patients about early s/s of skin cancer

A day care worker comes to the clinic for mild itching and rash of both hands. The nurse suspects contact dermatitis. The diagnosis is confirmed if the rash appears:

erythematous with raised papules.

When preparing the care plan for a dying client, it is important for the nurse to include a goal that addresses which needs? Select all that apply.

expression of feelings management of pain use of coping strategies

A client is being discharged from the hospital with terminal brain cancer and a life expectancy of 1 month. When planning this client's discharge, it is most important for the nurse to include a referral to which agency?

hospice

The client is a young parent whose spouse died 3 months ago. The client is tearful and unkempt, eats a poor diet, and has lost 50 lb (22.6 kg) since the death of the spouse. The client states, "I cannot do this anymore." Which nursing concern is best supported by these data?

ineffective coping related to failure of previously used coping mechanisms

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

infection

Which infecting agent causes scabies?

itch mite

A client comes to the dermatology clinic requesting the removal of a port-wine stain on their right cheek. The nurse knows that which of the following is the procedure especially useful in treating cutaneous vascular lesions such as port-wine stains?

laser treatment

While performing an initial assessment of a client admitted with appendicitis, the nurse observes an elevated blue-black lesion on the client's ear. The nurse knows that this lesion is consistent with what type of skin cancer?

malignant melanoma

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

Which of the following persons is responsible for handling and filing a death certificate with proper authorities?

mortician

A client has been declared brain dead following a motor vehicle accident. What assessment data would the nurse anticipate?

no ocular movement

A client has developed cancer within 8 months of their spouse's death. The nurse will consider the possibility of what cause?

physical effects of bereavement People experiencing bereavement are known to be at greater risk for mortality and morbidity than are comparable people not experiencing bereavement

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

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?

pruritis (itching)

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

The nurse is talking with the adult child of a client with end-stage acute kidney injury and late-stage dementia. The client can no longer live at home, and the child states, "I live 500 miles away. I do not know what to do." About which type of living arrangement will the nurse teach the child?

residential care

Which care environment would the nurse suggest to a client with no family nearby who is diagnosed with end-stage lung disease?

residential care

A nurse is caring for a client whose skin cancer will soon be removed by excision. Which of the following actions should the nurse perform?

teach the client self-care after treatment

A client visits the health care facility for a regular check-up. The nurse is aware that the client lost his wife 2 months earlier. What would lead the nurse to suspect dysfunctional grief?

the client begins abusing alcohol

An 81-year-old client is exhibiting many characteristic signs and symptoms of imminent death. What individual should the nurse first inform of the client's change in status?

the client's healthcare provider

A client has been diagnosed with shingles. Which is an assessment finding the nurse would expect to see?

vesicles

A client's blistering disorder has resulted in the formation of multiple lesions in the client's mouth. What intervention should be included in the client's plan of care?

Provide chlorhexidine solution for rinsing the client's mouth.

The nurse is preparing a care plan for a client with dysfunctional grief. Which nursing intervention(s) should the nurse include? Select all that apply.

Provide the client with information regarding a grief support group. Encourage the client to have regular check-ups with the health care provider. Refer the client to a grief specialist.

The parents of an adolescent who is being maintained on life support after a motorcycle crash tell the nurse, "We would like to donate his organs if he dies." What is the nurse's role in organ donation?

Review options and provide consent forms to the family.

A nurse is caring for a client admitted to the medical unit with a diagnosis of pemphigus. When writing the care plan for this client, what issues should be included? Select all that apply.

Risk for infection Impaired skin integrity Disturbed body image Acute pain

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 has just undergone surgery for malignant melanoma. Which of the following nursing actions should be prioritized?

Anticipate the need for, and administer, appropriate analgesic medications.

An older adult client experiences the death of a spouse. Which behavior by the client exemplifies Parkes' grief stage of reorganization?

Appears sad and reaches out to adult children for support.

A client with a terminal diagnosis states, "I am so glad I had a good life. I am ready to die." How will the nurse assist the client to communicate this acceptance of death to the family?

Ask the client how the nurse can best support the discussion with family

A nurse providing care for a client diagnosed with psoriasis is aware of the sequelae that can result from this health problem. Following the appearance of skin lesions, the nurse should prioritize what assessment?

Assessment of the client's joints for pain and decreased range of motion

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 client has recently been diagnosed with advanced malignant melanoma and is scheduled for a wide excision of the tumor on her chest. In writing the plan of care for this client, what major nursing diagnosis should the nurse include?

Deficient Knowledge about Early Signs of Melanoma The fact that the client's disease was not reported until an advanced stage suggests that the client lacked knowledge about skin lesions

A client has a diagnosis of seborrhea and has been referred to the dermatology clinic, where the nurse contributes to care. When planning this client's care, the nurse should prioritize which issue?

Disturbed body image

A client has undergone dermabrasion to decrease scarring from severe acne as a teen. After completion of the procedure, the nurse reviews the client's home care instructions. Which instruction is appropriate for this client?

Don't touch the area treated

A client who is terminally ill states to the nurse, "My situation is hopeless; I have no control over anything." The nurse implements which interventions to enable hope for the client? Select all that apply.

Encourage the client to discuss feelings. Sit in a chair next to the client. Hold the client's hand.

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

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 Suspensions consist of either a powder in water that requires shaking before application, or clear solutions, which contain completely dissolved active ingredients. A suspension such as calamine lotion provides a rapid cooling and drying effect as it evaporates, leaving a thin, medicinal layer of powder on the affected skin.

A client has received a diagnosis of irritant contact dermatitis. What action should the nurse prioritize in the client's subsequent care?

Helping the client identify and avoid the offending agent

A 35-year-old kidney transplant client comes to the clinic exhibiting new skin lesions. The diagnosis is Kaposi sarcoma (KS). The nurse caring for this client recognizes that this is what type of KS?

Immunosuppression-related

Which drug is an oral retinoid used to treat acne?

Isotretinoin

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.

Which of the following medications is used to reduce turnover time of the psoriatic epidermis?

Methotrexate

A school nurse has sent home four children who show evidence of pediculosis capitis. What is an important instruction the nurse should include in the note being sent home to parents?

Nits may have to be manually removed from the child's hair shafts.

The nurse is caring for a client whose spouse died 6 days ago. What assessment finding suggests that the client is in the first stage of Engel's model of grief?

The client has difficulty believing the spouse is actually deceased.

Which does not coincide with Kübler-Ross's stages related to a dying client?

The dying client usually exhibits anger first.

Hospice nurses provide care in a variety of settings, including clients' homes, long-term-care facilities, and hospice residences. After the client dies, what happens next?

The hospice nurse continues to care for the client's family for up to 1 year

Which are signs of a "good death"? Select all that apply.

The person dies with dignity. The person is prepared for death. The person has a sense of completion of life.

Ch 65 (skin diseases) A client has had a surgical procedure to correct an ingrown toenail. What would the nurse advise the client to do in order to prevent recurrences?

Use nail clippers to trim toenails.

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

Use shampoo with piperonyl butoxide.

The nurse is taking care of a client who was hospitalized for an ulcerative colitis exacerbation. Recently, the client's parent died from colon cancer. Which question would be essential to ask this client at the start of the assessment of their loss reaction?

What type of relationship did you have with your parent?

A client has been receiving dialysis for years and now states, "I have been thinking about this for a long time. I no longer wish to continue dialysis. I just want to die." What is the most appropriate statement by the nurse?

"Can you tell me about why you've made this decision?"

Which priority intervention should the nurse plan to implement to reduce a client's discomfort during terminal weaning?

Administer sedation and analgesia.

The admission department at a local hospital is registering an older adult man for an outpatient test. The admissions nurse asks the man if he has an advance directive. The man responds that he does not want to complete an advance directive because he does not want anyone controlling his finances. What would be appropriate information for the nurse to share with this client?

Advanced directives are limited only to healthcare instructions and directives.

A nurse educator is teaching a group of medical nurses about Kaposi sarcoma (KS). What would the educator identify as characteristics of endemic KS? Select all that apply.

Affects people predominantly in the eastern half of Africa Affects men more than women Can progress to lymphadenopathic forms

A client has been declared brain dead following a fall from a roof. The client's advance directives state they do not wish to have prolonged life measures, and that only the heart, kidneys, and liver should be donated. The client's spouse wants to also donate the client's corneas. What is the appropriate nursing action?

Contact the organ procurement team to discuss organ donation with the spouse.

The condition of a client with a traumatic brain injury continues to deteriorate despite medical efforts. The decision is made to terminally wean the client from mechanical ventilation. Which statement by the nurse is most significant in educating the family regarding terminal weaning?

"All efforts will be taken to make sure your loved one is comfortable and out of pain."

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." When someone sharing a home with others contracts scabies, all individuals in the home need prompt treatment whether or not they're symptomatic. Towels and linens should be washed in hot water. Scabies can be transmitted from one person to another before symptoms develop.

A nurse is caring for a client whose spouse died more than 4 years ago. What assessment question will the nurse ask to determine if the client is experiencing abnormal grief?

"Have you gone through and donated your spouse's clothing?"

A nurse is talking to a client who was just informed of a terminal illness and is responding in an angry manner. What statement by the nurse would best facilitate better client outcomes?

"How much do you know, and what do you want to know?"

A middle-age client is caring for an older adult parent who has end-stage kidney injury. Which statement by the client indicates to the nurse that the client is experiencing anticipatory loss?

"I am feeling so sad when I should be enjoying the time we have remaining."

The nurse is caring for a client who is making a decision about whether to consent to treatment that carries a high level of risk. The client tells the nurse "I do not know what decision to make." What is the nurse's best response?

"I am here to support you; however, the decision is yours to make."

A client with end-stage chronic obstructive pulmonary disease (COPD) has reached the end of the 6-month period for hospice services and the family caregiver states, "I don't know what we will do if they cut off our hospice services." What is the best response by the hospice nurse?

"I will contact the health care provider to extend services since your family member meets the criteria."

The nurse is talking with the family after their loved one died. What words of support and comfort would be most therapeutic for the nurse to say after this event?

"I would like to sit here with you and listen."

A nurse has just finished a presentation on hospice and palliative care. Which statement by a participant would indicate a need for further education?

"In hospice care, nurses take on the responsibility of making care decisions for clients."

The nurse is trying to help the client cope with the dying process. Which nursing statement is most appropriate?

"It must be very difficult for you."

Which phrase can do much to instill hope in the dying client?

"Let me tell you about your illness"

Ch 38 (end of life) During an interview of the client at the community clinic, the nurse finds that the client is providing care for a parent, who is terminally ill. Which statement by the client indicates anticipatory grieving?

"My parent is suffering with cancer and death will be a relief of the pain."

When preparing for palliative care with the dying client, the nurse should provide the family with which explanation?

"The goal of palliative care is to give clients the best quality of life by the aggressive management of symptoms."

"My father has been dead for over a year and my mother still cannot talk about them without crying. Is that normal?" How should the nurse respond?

"The inability to talk about one's spouse without crying, even after a year, is still considered normal."

The nurse is caring for a client who recently experienced the death of the spouse. The client states, "I am so frustrated with myself because I feel like I should be back to my normal self by now but I am not." How should the nurse respond? Select all that apply.

"You have come a long way in your process. Let's look at all of the progress you have had already." "It would be helpful to discuss what supports you have in your life right now. Please share this information with me." "It is really beneficial to talk about how you are feeling. Tell me more about how you are feeling frustrated." "There are many resources in the community that can be beneficial during this time. I can share these with you."

A patient has a moisture-retentive dressing for the treatment of a sacral decubitus ulcer. How long should the nurse leave the dressing in place before replacing it?

12 to 24 hours

What percent of those undergoing piercings suffer complications?

31%

Which assessment finding would best support a nursing concern of disordered grieving?

A client is unable to return to work after their sibling's death 18 months ago.

Which situation is most likely to warrant an autopsy?

A client's death involves an allegation of a medical error.

A nurse is planning the care of a client with herpes zoster. Which medication(s), if administered within the first 24 hours of the initial eruption, can arrest herpes zoster? Select all that apply.

Acyclovir & valacyclovir

A client has responded to a recent diagnosis of lung cancer by making extensive plans for overseas travel with family, despite the extremely poor prognosis. The client is adamant about not discussing cancer and is identified by the nurse as experiencing the denial stage of grief. How can the nurse best facilitate the client's healthy grieving?

Address the client's diagnosis and prognosis at a later time or date.

A patient has developed a boil on the face and the nurse observes the patient squeezing the boil. What does the nurse understand is a potential severe complication of this manipulation?

Brain abscess Nurses must take special precautions in caring for boils on the face because the skin area drains directly into the cranial venous sinuses. The infection can travel through the sinus tract and penetrate the brain cavity, causing a brain abscess.

A 65-year-old presents at the clinic reporting nodules on both legs. The client tells the nurse that their son, who is in medical school, encouraged them to seek prompt care because the nodules may be related to their Mediterranean heritage. What health problem should the nurse suspect?

Classic Kaposi sarcoma (KS)

A client with squamous cell carcinoma is scheduled for treatment. The nurse should anticipate that treatment for this type of cancer will primarily consist of what intervention?

Surgical excision