Question 1

A nurse is assessing the skin of an older patient with dry skin and notices several areas of scratches and abrasion. Interventions should be implemented to meet what goal?&#10;A) investigate the possibility of elder abuse&#10;B) decrease the risk of infection&#10;C) promote safety during daily hygiene&#10;D) increase the patient's self-esteem

Accepted Answer

Scratches and abrasions can increase the risk of infection, especially in older adults with dry skin that may be more prone to cracking. Therefore, interventions should focus on decreasing the risk of infection through proper wound care and education on preventing further skin trauma. Investigating elder abuse, promoting safety during daily hygiene, and increasing self-esteem may also be important goals, but they are not directly related to the skin assessment findings in this scenario.

Question 2

What physical changes during adolescence predispose the adolescent to body odor and acne?&#10;A) growth of long bones&#10;B) loss of calcium from bones&#10;C) hormonal changes&#10;D) decreased skin secretions

Accepted Answer

Hormonal changes during adolescence, including an increase in androgens, stimulate the sebaceous glands in the skin to produce more oil, which can lead to acne. This increase in oil production can also contribute to body odor as bacteria break down the excess oil and sweat on the skin. Growth of long bones (A) and loss of calcium from bones (B) are changes associated with growth during adolescence but do not directly contribute to body odor or acne. Decreased skin secretions (D) would actually lead to less body odor, as there would be less sweat and oil for bacteria to break down.

Question 3

An 80-year-old woman tells the nurse that she just itches all the time and her skin seems very dry. How do these symptoms relate to aging skin?&#10;A) activity of the glands in the skin lessens&#10;B) the symptoms are indicators of a disease&#10;C) skin gland activity increases, leading to acne&#10;D) the symptoms are unrelated to aging skin

Accepted Answer

As people age, the activity of glands in the skin, which normally produce oils to keep the skin moist, lessens. This can lead to dry, itchy skin.

Question 4

A patient has had food poisoning with severe vomiting and diarrhea. What would this acute illness most likely cause?&#10;A) edema&#10;B) dehydration&#10;C) jaundice&#10;D) eczema

Accepted Answer

Severe vomiting and diarrhea can lead to significant fluid loss and dehydration.

Question 5

A home health nurse is visiting a patient who is receiving chemotherapy for cancer treatment. What condition may result from chemotherapy?&#10;A) changes in skin color&#10;B) excess hair growth&#10;C) loss of hair&#10;D) dry, brittle nails

Accepted Answer

Chemotherapy can cause damage to rapidly dividing cells, including hair follicles, resulting in hair loss. A, B, and D are not directly associated with chemotherapy.

Question 6

A nurse is developing a plan of care for an older adult who is malnourished and on bed rest. Which of the following interventions would be included to prevent skin alterations?&#10;A) turn and reposition every 2 hours&#10;B) limit fluids to 500 mL every 24 hours&#10;C) do not use lotions or creams on skin&#10;D) assess vital signs every 4 hours

Accepted Answer

Turning and repositioning every 2 hours helps to prevent pressure ulcers, which can occur due to prolonged pressure on the skin. Limiting fluids and avoiding lotions/creams do not directly relate to preventing skin alterations. Assessing vital signs is important for overall monitoring of the patient's health, but does not specifically address skin alterations.

Question 7

Which of the following statements by a patient would alert the nurse to an increased risk for skin cancer?&#10;A) &#34;I take a shower three times a day.&#34;&#10;B) &#34;This wart has changed color.&#34;&#10;C) &#34;My skin is just so dry and it itches.&#34;&#10;D) &#34;My cast is rubbing a blister.&#34;

Accepted Answer

A change in the color or shape of a wart can be a sign of skin cancer, specifically melanoma. Patients should be advised to see a healthcare provider for further evaluation. The other statements do not necessarily indicate an increased risk for skin cancer.

Question 8

Which of the following is one of the most important benefits of a nurse helping with bathing?&#10;A) The patient sees professional staff.&#10;B) The nurse improves technical skills.&#10;C) Staff-nurse relationships are more collegial.&#10;D) Nurse-patient relationships are facilitated.

Accepted Answer

When a nurse helps with bathing, it allows for a more intimate interaction with the patient and can facilitate the development of a trusting relationship with the nurse. This can improve patient satisfaction and contribute to better outcomes.

Question 9

A patient tells a nurse that he always uses boric acid solution to wash out his eyes. What would the nurse teach the patient?&#10;A) &#34;Boric acid should not be used; it is toxic when absorbed.&#34;&#10;B) &#34;Good work! Continue with your cleansing routine.&#34;&#10;C) &#34;Why in the world would you do such a thing?&#34;&#10;D) &#34;Maybe you should try something a little stronger.&#34;

Accepted Answer

Boric acid can be toxic when absorbed and is not recommended for eye washing. The nurse should educate the patient on safer alternatives for eye washing.

Question 10

A nurse is caring for a patient with long hair. The patient asks if something could be done about her hair to be more comfortable. How would the nurse respond?&#10;A) &#34;Yes, I can braid it for you if you want me to.&#34;&#10;B) &#34;Well I guess I could just cut it all off.&#34;&#10;C) &#34;You will have to ask your family to do that.&#34;&#10;D) &#34;No, that is not a part of my job as a nurse.&#34;

Accepted Answer

As a nurse, it is within the scope of practice to assist patients with grooming and personal hygiene. Braiding the patient's hair is a reasonable request and can improve their comfort level. Option B is not an appropriate response as it is not the nurse's decision to make regarding the patient's hair. Option C is also not appropriate as the responsibility falls on the nurse to provide care for the patient while in their care. Option D is incorrect as grooming and personal hygiene are part of a nurse's responsibilities.

Question 11

A nurse is helping an older woman undress and notices the woman's knee-high hose have left deep indentations. The woman has diabetes. Does this pose a risk to the patient?&#10;A) No, the indentations will go away.&#10;B) No, knee-high hose are more comfortable.&#10;C) Yes, these are a safety hazard and should not be worn.&#10;D) Yes, these can obstruct lower extremity circulation.

Accepted Answer

The answer of A nurse is helping an older woman...

Question 12

The family of a patient being discharged home has arranged to rent a hospital bed. What should the nurse teach the family about safety when using the bed?&#10;A) how to apply the bed linens&#10;B) proper maintenance&#10;C) how to move the patient in bed&#10;D) advisable positions and controls

Accepted Answer

The answer of The family of a patient being discharged...

Question 13

A nurse is making a bed occupied by a patient. Which of the following is a recommended step for this procedure?&#10;A) Lower side rail on opposite side of you.&#10;B) Discard soiled linen onto the floor.&#10;C) Fan-fold soiled linens as close to patient as possible.&#10;D) Place the drawsheet under the patient's knees.

Accepted Answer

The answer of A nurse is making a bed occupied...

Question 14

A nurse is teaching an adolescent patient how to care for her acne. Which of the following is a recommended guideline?&#10;A) Squeeze infected areas to prevent infection.&#10;B) Rigorously cleanse the acne with soap and hot water.&#10;C) Use water-based moisturizers and make-up.&#10;D) Use sun-tanning booths to dry up pustules.

Accepted Answer

The answer of A nurse is teaching an adolescent patient...

Question 15

A nurse is shaving the facial hair of a bed-ridden patient. Which of the following is a recommended guideline for this procedure?&#10;A) Fill bath basin with cool water.&#10;B) Apply shaving cream approximately 1 inch thick.&#10;C) Shave with the direction of hair growth in downward, short strokes.&#10;D) Do not use aftershave or lotion on area shaved.

Accepted Answer

The answer of A nurse is shaving the facial hair...

Deck 22: Self-Concept