Protection- Anaphylaxis and melanoma (CA)

39. The school nurse is discussing impetigo with the teachers in an elementary school. One of the teachers asks the nurse, "How can I prevent getting impetigo?" Which statement would be the most appropriate response? 1. "Wash your hands after using the bathroom." 2. "Do not touch any affected areas without gloves." 3. "Apply a topical antibiotic to your hands." 4. "Keep the child with impetigo isolated in the room."

2. Lesions are extremely contagious and should not be touched, except when wearing gloves.

4. A patient is diagnosed with herpes simplex viral encephalitis. Which medication should the nurse prepare to administer to this patient? 1) Acyclovir 2) Famciclovir 3) Valacyclovir 4) Parenteral acyclovir

4. Because the bioavailability of IV acyclovir is greater than the oral route, IV acyclovir is utilized for patients with severe disease or those who encounter complications of HSV such as encephalitis.

On the second day following an abdominal perineal resection, the nurse notes that the wound edges aren't approximated and one half the incision has torn apart. The nurse should immediately take what action? 1.Flush the wound with sterile water. 2.Apply an abdominal binder. 3.Cover the wound with a sterile dressing moistened with normal saline. 4.Apply strips of tape.

3. When dehiscence occurs, the nurse should immediately cover the wound with a sterile dressing moistened with normal saline. If the dehiscence is extensive, the incision must be resutured in surgery. Later, after the sutures are removed, additional sup- port may be provided to the incision by applying strips of tape as directed by institutional policy or by the surgeon. An abdominal binder may also be utilized for additional support.

36. The nurse participating in a health fair is discussing malignant melanoma with a group of clients. Which information regarding the use of sunscreen is important to include? 1. Sunscreen is only needed during the hottest hours of the day. 2. Toddlers should not have sunscreen applied to their skin. 3. Sunscreen does not help prevent skin cancer. 4. The higher the number of the sunscreen, the more it blocks UV rays.

4. Sunscreen products range in numerical value from 4 to 50; the higher the number of the sunscreen, the greater the UV protection.

The client is admitted to the outpatient surgery center for removal of a malignant melanoma. Which assessment data indicate the lesion is a malignant melanoma? A. The lesion is asymmetrical and has irregular boarders B. The lesion has a waxy appearance with pearl-like boarders C. The lesion has a thickened and scaly appearance D. The lesion appeared as a thickened area after injury

A. The lesion is asymmetrical and has irregular boarders

A client with severe cellulitis is starting intravenous antibiotic treatment. The nurse is explaining situations that should be reported to the healthcare provider. Which situation should the nurse​ describe? (Select all that​ apply.) A. Increase in lethargy B. Decrease in pain of affected area C. Temperature over 38.3°C ​(101°​F) D. Spread of infected area in the next 24 dash-48 hours E. Decrease in edema of affected area in the next 24-48 hours

A. Increase in lethargy C. Temperature over 38.3degrees°C ​(101 degrees°​F) D. Spread of infected area in the next 24-48 hours

What is the criteria for detecting melanoma?

ABCDE criteria Asymmetry BorderirregularityColor Diameter (<6 mm or 1/4 in) Evolution (changing)

The nurse is describing some of the major characteristics of cancer to a patient who has recently received a diagnosis of malignant melanoma. When differentiating between benign and malignant cancer cells, the nurse should explain differences in which of the following aspects? Select all that apply. A) Rate of growth B) Ability to cause death C) Size of cells D) Cell contents E) Ability to spread

ANS: A,B,E Benign and malignant cells differ in many cellular growth characteristics, including the method and rate of growth, ability to metastasize or spread, general effects, destruction of tissue, and ability to cause death. Cells come in many sizes, both benign and malignant. Cell contents are basically the same, but they behave differently.

A patient with a suspected malignant melanoma is referred to the dermatology clinic. The nurse knows to facilitate what diagnostic test to rule out a skin malignancy? A)Tzanck smear B)Skin biopsy C)Patch testing D)Skin scrapings

ANS: B A skin biopsy is done to rule out malignancies of skin lesions. A Tzanck smear is used to examine cells from blistering skin conditions, such as herpes zoster. Patch testing is performed to identify substances to which the patient has developed an allergy. Skin scrapings are done for suspected fungal infections.

A patient who is scheduled for a skin test informs the nurse that he has been taking corticosteroids to help control his allergy symptoms. What nursing intervention should the nurse implement? A) The patient should take his corticosteroids regularly prior to testing. B)The patient should only be tested for grass, mold, and dust initially. C)The nurse should have an emergency cart available in case of anaphylaxis during the test. D)The patients test should be cancelled until he is off his corticosteroids.

ANS: D Corticosteroids and antihistamines, including over-the-counter allergy medications, suppress skin test reactivity and should be stopped 48 to 96 hours before testing, depending on the duration of their activity. Emergency equipment must be at hand during allergy testing, but the test would be postponed.

A patient has a bacterial infection, but the causative organism is not known. Which type of antibacterial drug will most likely be prescribed? a. Narrow-spectrum b. Limited-spectrum c. Extended-spectrum d. Broad-spectrum

ANS: D - A broad-spectrum antibacterial drug is effective against a wide range of bacteria, both gram-positive and gram-negative. Narrow-spectrum drugs are effective against a few bacteria, while extended-spectrum drugs are effective against several types of bacteria.

A patient has been admitted to the emergency department with signs of anaphylaxis following a bee sting. The nurse knows that if this is a true allergic reaction the patient will present with what alteration in laboratory values? A) Increased eosinophils B) Increased neutrophils C) Increased serum albumin D) Decreased blood glucose

Ans: A Feedback: Higher percentages of eosinophils are considered moderate to severe eosinophilia. Moderate eosinophilia is defined as 15% to 40% eosinophils and is found in patients with allergic disorders. Hypersensitivity does not result in hypoglycemia or increased albumin and neutrophil counts.

An office worker takes a cupcake that contains peanut butter. He begins wheezing, with an inspiratory stridor and air hunger and the occupational health nurse is called to the office. The nurse should recognize that the worker is likely suffering from which type of hypersensitivity? A) Anaphylactic (type 1) B) Cytotoxic (type II) C) Immune complex (type III) D) Delayed-type (type IV)

Ans: A Feedback: The most severe form of a hypersensitivity reaction is anaphylaxis. An unanticipated severe allergic reaction that is often explosive in onset, anaphylaxis is characterized by edema in many tissues, including the larynx, and is often accompanied by hypotension, bronchospasm, and cardiovascular collapse in severe cases.

A nurse has asked the nurse educator if there is any way to predict the severity of a patients anaphylactic reaction. What would be the nurses best response? A) The faster the onset of symptoms, the more severe the reaction. B) The reaction will be about one-third more severe than the patients last reaction to the same antigen. C) There is no way to gauge the severity of a patients anaphylaxis, even if it has occurred repeatedly in the past. D) The reaction will generally be slightly less severe than the last reaction to the same antigen.

Ans: A Feedback: The time from exposure to the antigen to onset of symptoms is a good indicator of the severity of the reaction: the faster the onset, the more severe the reaction. None of the other statements is an accurate description of the course of anaphylactic reactions.

A patient is brought to the emergency department (ED) in a state of anaphylaxis. What is the ED nurses priority for care? A) Monitor the patients level of consciousness. B) Protect the patients airway. C) Provide psychosocial support. D) Administer medications as ordered.

Ans: B Feedback: Anaphylaxis severely threatens a patients airway; the nurses priority is preserving airway patency and breathing pattern. This is a higher priority than other valid aspects of care, including medication administration, psychosocial support, and assessment of LOC.

A nurse knows of several patients who have achieved adequate control of their allergy symptoms using over-the-counter antihistamines. Antihistamines would be contraindicated in the care of which patient? A) A patient who has previously been treated for tuberculosis B) A pregnant woman at 30 weeks gestation C) A patient who is on estrogen-replacement therapy D) A patient with a severe allergy to eggs

Ans: B Feedback: Antihistamines are contraindicated during the third trimester of pregnancy. Previous tuberculosis, hormone therapy, and food allergies do not contraindicate the use of antihistamines.

A junior nursing student is having an observation day in the operating room. Early in the day, the student tells the OR nurse that her eyes are swelling and she is having trouble breathing. What should the nurse suspect? A) Cytotoxic reaction due to contact with the powder in the gloves B) Immune complex reaction due to contact with anesthetic gases C) Anaphylaxis due to a latex allergy D) Delayed reaction due to exposure to cleaning products

Ans: C Feedback: Immediate hypersensitivity to latex, a type I allergic reaction, is mediated by the IgE mast cell system. Symptoms can include rhinitis, conjunctivitis, asthma, and anaphylaxis. The term latex allergy is usually used to describe the type I reaction. The rapid onset is not consistent with a cytotoxic reaction, an immune complex reaction, or a delayed reaction.

A nurse is aware of the need to assess patients risks for anaphylaxis. What health care procedure constitutes the highest risk for anaphylaxis? A) Administration of the measles-mumps-rubella (MMR) vaccine B) Rapid administration of intravenous fluids C) Computed tomography with contrast solution D) Administration of nebulized bronchodilators

Ans: C Feedback: Radiocontrast agents present a significant threat of anaphylaxis in the hospital setting. Vaccinations less often cause anaphylaxis. Bronchodilators and IV fluids are not implicated in hypersensitivity reactions.

A patient has just been told that he has malignant melanoma. The nurse caring for this patient should anticipate that the patient will undergo what treatment? A) Chemotherapy B) Immunotherapy C) Wide excision D) Radiation therapy

Ans: C Feedback:Wide excision is the primary treatment for malignant melanoma, which removes the entire lesion and determines the level and staging. Chemotherapy may be used after the melanoma is excised. Immunotherapy is experimental and radiation therapy is palliative.

You're providing an in-service on skin cancer prevention to a local group seniors. One topic you discuss is the identification of melanoma. Select all the characteristics of this type of skin cancer you will educate the participants about: A. Diameter of 10 mm or higher B. Red, purple, and black color C. Dissimilar borders D. Uniform appearance E. Increase in size, shape, color

B,C,E When educating about how to identify melanoma using the ABCDE acronym. A: asymmetrical, B: borders uneven (dissimilar), C: color dark or multiple colors, D: diameter greater than 6 mm (NOT 10 mm). E: evolution (lesion increases in size, shape, color).

Which medication is administered intravenously for anaphylaxis when it occurs under general anesthesia?a.Sodium bicarbonate b.Dopamine c.Albuterol d.Benadryl

B. Dopamine

After surgery the patient with a closed abdominal wound reports a sudden "pop" after coughing. When the nurse examines the surgical wound site, the sutures are open, and pieces of small bowel are noted at the bottom of the now-opened wound. Which corrective intervention should the nurse do first? A. Allow the area to be exposed to air until all drainage has stopped B. Place several cold packs over the area, protecting the skin around the wound C. Cover the area with sterile, saline-soaked towels and immediately notify the surgical team; this is likely to indicate a wound evisceration D. Cover the area with sterile gauze, place a tight binder over it, and ask the patient to remain in bed for 30 minutes because this is a minor opening in the surgical wound and should reseal quickly (Potter: Fundamentals of Nursing, 8th Edition, Chapter 48)

C. Cover the area with sterile, saline-soaked towels and immediately notify the surgical team; this is likely to indicate a wound evisceration

The most common symptom of malignant melanoma is a smooth growth that is symmetrical inflammation and bleeding of a skin lesion hard-surfaced nodules with visible scales a change in a new or existing pigmented lesion or mole

a change in a new or existing pigmented lesion or mole

All of the following statements apply to malignant melanoma EXCEPT: a. The malignant cell is a melanocyte. b. They present as non-pruritic purplish macules. c. The neoplasm grows rapidly and metastasizes early. d. The lesion is usually dark or multicolored with an irregular border.

b. They present as non-pruritic purplish macules.

The most serious type of skin cancer is squamous cell carcinoma basal cell carcimona malignant melanoma actinic keratosis

malignant melanoma