Question 1

The nurse is planning care for a young child who is admitted with sickle cell crisis.The parents are with the child,and neither has much information about the disease.When planning care for this family,the nurse will set which goal with this family?
A)The child will drink adequate amounts of fluid each day.
B)The child will play outside in the sun.
C)The family will not have the child vaccinated.
D)The family will plan vacations in high-altitude areas.

Accepted Answer

The best goal for the nurse to set with this family is for the child to drink adequate amounts of fluid each day. This is because staying hydrated is crucial in managing sickle cell crisis and preventing complications. The other choices are not appropriate goals for this family - playing outside in the sun can increase the risk of dehydration and complications, not vaccinating the child can put them at risk for infections, and planning vacations in high-altitude areas can also increase the risk of complications.

Question 2

A nurse is planning care for a client with sickle cell disease and chooses "Acute Pain" as the nursing diagnosis.Which intervention is inappropriate for the nurse to include in this plan of care?
A)Administer prescribed analgesic medications around the clock.
B)Place client in position of comfort.
C)Use heat or cold packs as tolerated.
D)Support the client's joints and extremities with pillows.

Accepted Answer

A)The client with sickle cell disease who is in a sickle cell crisis will likely have extreme pain. To aid in caring for this client, the nurse will administer prescribed analgesic medications around the clock, place the patient in position of comfort, and support the client's joints and extremities with pillows. The use of heat or cold packs is contraindicated in the sickle cell client.
B)The client with sickle cell disease who is in a sickle cell crisis will likely have extreme pain. To aid in caring for this client, the nurse will administer ordered analgesic medications around the clock, place the patient in position of comfort, and support the client's joints and extremities with pillows. The use of heat or cold packs is contraindicated in the sickle cell client.
C)The client with sickle cell disease who is in a sickle cell crisis will likely have extreme pain. To aid in caring for this client, the nurse will administer ordered analgesic medications around the clock, place the patient in position of comfort, and support the client's joints and extremities with pillows. The use of heat or cold packs is contraindicated in the sickle cell client.
D)The client with sickle cell disease who is in a sickle cell crisis will likely have extreme pain. To aid in caring for this client, the nurse will administer ordered analgesic medications around the clock, place the patient in position of comfort, and support the client's joints and extremities with pillows. The use of heat or cold packs is contraindicated in the sickle cell client.

Question 3

During a routine physical examination of a client's lungs,the nurse notes a pink papule that is flat and erythematous with surface crusting on the client's upper chest.The nurse should notify the physician of this finding because the nurse suspects the papule might indicate what?
A)Squamous cell carcinoma
B)Basal cell carcinoma
C)Actinic keratosis
D)Malignant melanoma

Accepted Answer

A)Superficial basal cell carcinoma is often found on the trunk, and it manifests as a papule or plaque that is flat, pink, erythematous, and crusting. Squamous cell carcinoma is most often found on parts that are exposed to the sun, such as the face and hands. It usually appears as a small, firm, red nodule that may bleed as it grows. Malignant melanoma manifests as black, brown, or multicolored nodules or plaques. Actinic keratosis is a precancerous condition. The lesion appears as a shiny, rough macule.
B)Superficial basal cell carcinoma is often found on the trunk, and it manifests as a papule or plaque that is flat, pink, erythematous, and crusting. Squamous cell carcinoma is most often found on parts that are exposed to the sun, such as the face and hands. It usually appears as a small, firm, red nodule that may bleed as it grows. Malignant melanoma manifests as black, brown, or multicolored nodules or plaques. Actinic keratosis is a precancerous condition. The lesion appears as a shiny, rough macule.
C)Superficial basal cell carcinoma is often found on the trunk, and it manifests as a papule or plaque that is flat, pink, erythematous, and crusting. Squamous cell carcinoma is most often found on parts that are exposed to the sun, such as the face and hands. It usually appears as a small, firm, red nodule that may bleed as it grows. Malignant melanoma manifests as black, brown, or multicolored nodules or plaques. Actinic keratosis is a precancerous condition. The lesion appears as a shiny, rough macule.
D)Superficial basal cell carcinoma is often found on the trunk, and it manifests as a papule or plaque that is flat, pink, erythematous, and crusting. Squamous cell carcinoma is most often found on parts that are exposed to the sun, such as the face and hands. It usually appears as a small, firm, red nodule that may bleed as it grows. Malignant melanoma manifests as black, brown, or multicolored nodules or plaques. Actinic keratosis is a precancerous condition. The lesion appears as a shiny, rough macule.

Question 4

A client presents to the primary care clinic for an annual physical.The nurse caring for the client notes that the client's healthcare provider uses the ABCD mnemonic to assess suspicious skin lesions.What does the "D" in ABCD represent?
A)Diameter of lesion greater than 8 mm
B)Distance of lesion to an additional lesion
C)Diameter of lesion greater than 6 mm
D)Depth of lesion

Accepted Answer

A) The ABCD rule is used to assess suspicious lesions:
Asymmetry (One half of the nevus does not match the other half.)
Border irregularity (Edges are ragged, blurred, or notched.)
Color variation or dark black color
Diameter greater than 6 mm (size of a pencil eraser)
B) The ABCD rule is used to assess suspicious lesions:
Asymmetry (One half of the nevus does not match the other half.)
Border irregularity (Edges are ragged, blurred, or notched.)
Color variation or dark black color
Diameter greater than 6 mm (size of a pencil eraser)
C) The ABCD rule is used to assess suspicious lesions:
Asymmetry (One half of the nevus does not match the other half.)
Border irregularity (Edges are ragged, blurred, or notched.)
Color variation or dark black color
Diameter greater than 6 mm (size of a pencil eraser)
D) The ABCD rule is used to assess suspicious lesions:
Asymmetry (One half of the nevus does not match the other half.)
Border irregularity (Edges are ragged, blurred, or notched.)
Color variation or dark black color
Diameter greater than 6 mm (size of a pencil eraser)

Question 5

Which race is at highest risk of inheriting sickle cell disease?
A)African American
B)Caucasian
C)Hispanic
D)Asian

Accepted Answer

Sickle cell disease is most commonly found in individuals of African descent, although it can also occur in individuals of Hispanic, Middle Eastern, and Mediterranean descent. Caucasian and Asian populations have a lower prevalence of sickle cell disease.

Question 6

The nurse is teaching a group of community members about preventing skin cancer.Which participant would be at the greatest risk for skin cancer?
A)A 25-year-old lifeguard at the community pool who wears sunscreen
B)A baby underneath a large beach umbrella
C)A 60-year-old farmer who wears a cap when working
D)A teenager who wears a ski outfit when skiing

Accepted Answer

The 60-year-old farmer is at the greatest risk for skin cancer because he is likely to spend long periods of time outdoors with his skin exposed to the sun. Although wearing a cap offers some protection, it is not enough to effectively prevent skin cancer. The other options either involve protective measures like sunscreen or clothing or are not exposed to the sun for extended periods of time.

Question 7

An emergency department nurse is caring for a child in sickle cell crisis.The nurse suspects the etiology of the crisis as being thrombotic in nature because of which clinical manifestations? Select all that apply.
A)The client has profound pallor and fatigue.
B)The client is in extreme pain.
C)The client has profound hypotension and shock.
D)The client has a fever.
E)The client's chest CT reveals a pulmonary infarct.

Accepted Answer

A)A thrombotic sickle cell crisis is manifested by extreme pain and fever. The client in profound hypotension and shock likely has splenic sequestration as the etiology, not thrombosis. The client with a pulmonary infarct likely has acute chest syndrome, not thrombosis. The client with profound pallor and fatigue likely is in an aplastic crisis, not thrombosis.
B)A thrombotic sickle cell crisis is manifested by extreme pain and fever. The client in profound hypotension and shock likely has splenic sequestration as the etiology, not thrombosis. The client with a pulmonary infarct likely has acute chest syndrome, not thrombosis. The client with profound pallor and fatigue likely is in an aplastic crisis, not thrombosis.
C)A thrombotic sickle cell crisis is manifested by extreme pain and fever. The client in profound hypotension and shock likely has splenic sequestration as the etiology, not thrombosis. The client with a pulmonary infarct likely has acute chest syndrome, not thrombosis. The client with profound pallor and fatigue likely is in an aplastic crisis, not thrombosis.
D)A thrombotic sickle cell crisis is manifested by extreme pain and fever. The client in profound hypotension and shock likely has splenic sequestration as the etiology, not thrombosis. The client with a pulmonary infarct likely has acute chest syndrome, not thrombosis. The client with profound pallor and fatigue likely is in an aplastic crisis, not thrombosis.
E)A thrombotic sickle cell crisis is manifested by extreme pain and fever. The client in profound hypotension and shock likely has splenic sequestration as the etiology, not thrombosis. The client with a pulmonary infarct likely has acute chest syndrome, not thrombosis. The client with profound pallor and fatigue likely is in an aplastic crisis, not thrombosis.

Question 8

A dark-skinned client tells the nurse of plans to bask in the sun on an upcoming vacation.The nurse questions the client about sunscreen use.Which response indicates the client needs further education?
A)"I don't need sunscreen because I am dark-skinned already."
B)"I will avoid the sun between the peak hours of 10 a.m.and 4 p.m."
C)"I can still experience sun damage despite my dark skin tones."
D)"The melanocytes in my skin provide me with increased protection from the sun."

Accepted Answer

The response "I don't need sunscreen because I am dark-skinned already" indicates a lack of understanding about the importance of sunscreen for all skin types, regardless of skin color. Dark-skinned individuals can still experience sun damage and should use sunscreen to protect their skin. Choices B, C, and D all demonstrate an understanding of the need for sunscreen and sun protection.

Question 9

The nurse is talking to a group of young adults about decreasing the risk for skin cancer.A young woman asks the nurse about the safety of ultraviolet light tanning salons.Which response by the nurse is most appropriate?
A)"Using tanning beds without clothing contaminates skin and leads to infections."
B)"Tanning from ultraviolet light is safer than sunshine."
C)"Using sunscreen will prevent skin cancers,even in tanning beds."
D)"Exposure to ultraviolet light used in tanning beds can cause skin cancer."

Accepted Answer

Exposure to ultraviolet light used in tanning beds can cause skin cancer. It is important for the nurse to convey to the young adults that tanning beds are not a safe alternative to natural sunlight exposure and can contribute to an increased risk of skin cancer. The nurse should also discuss the importance of using sunscreen and protective clothing when outdoors to decrease the risk of skin cancer.

Question 10

The nurse is reviewing the medical records for several clients who will be seen in the clinic today.According to the ABCD rule,which client may require removal of the skin lesion?
A)A client with a lesion that is symmetrical with an irregular border,a single color,and diameter change from 4 mm to 5 mm
B)A client with a lesion that is symmetrical,with a smooth border,a single color,and diameter that has stayed the same
C)A client with a lesion that is asymmetrical with a regular border,two colors,and diameter change from 4 mm to 3 mm
D)A client with a lesion that is asymmetrical with an irregular border,two colors,and diameter change from 5 mm to 7 mm

Accepted Answer

The ABCD rule stands for Asymmetry, Border irregularity, Color variation, and Diameter greater than 6 mm. The lesion described in option D is asymmetrical, has an irregular border, two colors, and has increased in diameter from 5 mm to 7 mm, which meets two of the ABCD criteria (asymmetry and border irregularity). This client may require removal of the skin lesion for biopsy to rule out skin cancer.

Question 11

A client is scheduled to have a suspected cancerous lesion removed from the arm.When planning care for this client,which outcome would be a priority?
A)The client will make nutritional changes.
B)The client will experience minimal pain after healing.
C)The client will heal without signs of infection.
D)The client will not need to make lifestyle changes.

Accepted Answer

The priority outcome for a client with a suspected cancerous lesion being removed from the arm would be to heal without signs of infection. This is because infection can delay healing and cause complications, potentially leading to further treatment or hospitalization. While nutritional changes may be important for overall health, it is not the priority outcome in this situation. Similarly, while minimizing pain is desirable, it is not as essential as preventing infection. Lifestyle changes may or may not be necessary depending on the type and severity of the cancer, but it is not the priority outcome for this client.

Question 12

A nurse working in an outpatient dermatology clinic is caring for a client who has been diagnosed with a lentigo maligna.Which statement is inappropriate for the nurse to include in the client's teaching plan?
A)The lesion is also called Robertson freckle.
B)The lesion is a precursor to melanoma.
C)The lesion is a tan or black patch on the skin that looks like a freckle.
D)The lesion grows slowly,becoming mottled,dark,thick,and nodular.

Accepted Answer

Including the statement that the lesion is also called Robertson freckle is inappropriate as it does not provide any useful information for the client's understanding and management of the condition. The other statements are important for the client to know, such as the fact that the lesion is a precursor to melanoma and its characteristic appearance and progression.

Question 13

The nurse is providing care to a 3-year-old client who is receiving treatment for sickle cell disease.The client is at risk for infection.Which medication does the nurse expect to administer to this client?
A)Acetaminophen
B)Penicillin
C)Morphine sulfate
D)Tamoxifen

Accepted Answer

Penicillin is commonly administered prophylactically to clients with sickle cell disease to prevent infections, particularly pneumococcal infections. Acetaminophen is a pain reliever and fever reducer. Morphine sulfate is an opioid analgesic used to relieve severe pain. Tamoxifen is a medication used to treat breast cancer.

Question 14

The nurse is caring for an older adolescent client diagnosed with malignant melanoma.Which nursing diagnoses would be appropriate when planning this client's care? Select all that apply.
A)Impaired Skin Integrity
B)Risk for Compromised Human Dignity
C)Anxiety
D)Risk for Acute Confusion
E)Disturbed Body Image

Accepted Answer

A) Impaired Skin Integrity is appropriate because malignant melanoma can lead to skin breakdown and ulceration.
C) Anxiety is appropriate because a diagnosis of malignant melanoma can be very stressful and cause anxiety.
E) Disturbed Body Image is appropriate because a diagnosis of malignant melanoma can affect the client's physical appearance and self-esteem. However, Risk for Compromised Human Dignity and Risk for Acute Confusion are not appropriate nursing diagnoses for this client.

Question 15

The nurse is caring for a client who has recently been diagnosed with skin cancer.The client is tearful and states,"How did I get skin cancer? I don't believe in tanning!" Which response by the nurse is indicated at this time?
A)"Can you tell me more about your feelings?"
B)"This is unusual,as skin cancer normally only occurs in sunbathers."
C)"Sun exposure can happen as we carry out our daily activities."
D)"We frequently never find out why cancer strikes."

Accepted Answer

This response acknowledges the client's concern while providing information about how sun exposure can occur in everyday life, such as during activities like walking or driving. It also avoids making an inaccurate statement that skin cancer only occurs in sunbathers, as this is not necessarily true.

Question 16

The nurse is caring for a client who was admitted to a medical-surgical unit in sickle cell crisis.Which medication should the nurse expect to administer to this client?
A)Acetaminophen (Tylenol)
B)Ibuprofen (Advil)
C)Meperidine (Demerol)
D)Hydroxyurea

Accepted Answer

A)Hydroxyurea decreases production of abnormal blood cells and leads to a lesser amount of pain being experienced. Meperidine is not used for pain control for clients in sickle cell crisis because it can cause seizures. Acetaminophen or ibuprofen is used for mild pain, but they would not be effective for the severe pain experienced by a client in sickle cell pain crisis.
B)Hydroxyurea decreases production of abnormal blood cells and leads to a lesser amount of pain being experienced. Meperidine is not used for pain control for clients in sickle cell crisis because it can cause seizures. Acetaminophen or ibuprofen is used for mild pain, but they would not be effective for the severe pain experienced by a client in sickle cell pain crisis.
C)Hydroxyurea decreases production of abnormal blood cells and leads to a lesser amount of pain being experienced. Meperidine is not used for pain control for clients in sickle cell crisis because it can cause seizures. Acetaminophen or ibuprofen is used for mild pain, but they would not be effective for the severe pain experienced by a client in sickle cell pain crisis.
D)Hydroxyurea decreases production of abnormal blood cells and leads to a lesser amount of pain being experienced. Meperidine is not used for pain control for clients in sickle cell crisis because it can cause seizures. Acetaminophen or ibuprofen is used for mild pain, but they would not be effective for the severe pain experienced by a client in sickle cell pain crisis.

Question 17

A pediatric nurse is educating the client with sickle cell disease and the client's family regarding the genetic implications of the disease.Which information is inappropriate for the nurse to share with the client's family?
A)If both parents have the trait,then with each pregnancy,the risk of having a child with the disease is 50%.
B)The disorder is transmitted as an autosomal recessive genetic defect.
C)The sickle cell gene may have originated to protect against lethal forms of malaria.
D)In African Americans,sickle cell disease occurs in 1 of every 365 births.

Accepted Answer

A)In educating the client and the client's parents regarding sickle cell disease, the nurse will state that the disorder is transmitted as an autosomal recessive genetic defect. If both parents have the trait, then with each pregnancy, the risk of having a child with the disease is 25%, not 50%. The sickle cell gene may have originated to protect against lethal forms of malaria. In African Americans, sickle cell disease occurs in 1 of every 365 births.
B)In educating the client and the client's parents regarding sickle cell disease, the nurse will state that the disorder is transmitted as an autosomal recessive genetic defect. If both parents have the trait, then with each pregnancy, the risk of having a child with the disease is 25%, not 50%. The sickle cell gene may have originated to protect against lethal forms of malaria. In African Americans, sickle cell disease occurs in 1 of every 365 births.
C)In educating the client and the client's parents regarding sickle cell disease, the nurse will state that the disorder is transmitted as an autosomal recessive genetic defect. If both parents have the trait, then with each pregnancy, the risk of having a child with the disease is 25%, not 50%. The sickle cell gene may have originated to protect against lethal forms of malaria. In African Americans, sickle cell disease occurs in 1 of every 365 births.
D)In educating the client and the client's parents regarding sickle cell disease, the nurse will state that the disorder is transmitted as an autosomal recessive genetic defect. If both parents have the trait, then with each pregnancy, the risk of having a child with the disease is 25%, not 50%. The sickle cell gene may have originated to protect against lethal forms of malaria. In African Americans, sickle cell disease occurs in 1 of every 365 births.

Quiz 2: Cellular Regulation

The nurse is planning care for a young child who is admitted with sickle cell crisis.The parents are with the child,and neither has much information about the disease.When planning care for this family,the nurse will set which goal with this family?

A nurse is planning care for a client with sickle cell disease and chooses "Acute Pain" as the nursing diagnosis.Which intervention is inappropriate for the nurse to include in this plan of care?

During a routine physical examination of a client's lungs,the nurse notes a pink papule that is flat and erythematous with surface crusting on the client's upper chest.The nurse should notify the physician of this finding because the nurse suspects the papule might indicate what?

A client presents to the primary care clinic for an annual physical.The nurse caring for the client notes that the client's healthcare provider uses the ABCD mnemonic to assess suspicious skin lesions.What does the "D" in ABCD represent?

Which race is at highest risk of inheriting sickle cell disease?

The nurse is teaching a group of community members about preventing skin cancer.Which participant would be at the greatest risk for skin cancer?

An emergency department nurse is caring for a child in sickle cell crisis.The nurse suspects the etiology of the crisis as being thrombotic in nature because of which clinical manifestations? Select all that apply.

A dark-skinned client tells the nurse of plans to bask in the sun on an upcoming vacation.The nurse questions the client about sunscreen use.Which response indicates the client needs further education?

The nurse is talking to a group of young adults about decreasing the risk for skin cancer.A young woman asks the nurse about the safety of ultraviolet light tanning salons.Which response by the nurse is most appropriate?

The nurse is reviewing the medical records for several clients who will be seen in the clinic today.According to the ABCD rule,which client may require removal of the skin lesion?

A client is scheduled to have a suspected cancerous lesion removed from the arm.When planning care for this client,which outcome would be a priority?

A nurse working in an outpatient dermatology clinic is caring for a client who has been diagnosed with a lentigo maligna.Which statement is inappropriate for the nurse to include in the client's teaching plan?

The nurse is providing care to a 3-year-old client who is receiving treatment for sickle cell disease.The client is at risk for infection.Which medication does the nurse expect to administer to this client?

The nurse is caring for an older adolescent client diagnosed with malignant melanoma.Which nursing diagnoses would be appropriate when planning this client's care? Select all that apply.

The nurse is caring for a client who has recently been diagnosed with skin cancer.The client is tearful and states,"How did I get skin cancer? I don't believe in tanning!" Which response by the nurse is indicated at this time?

The nurse is caring for a client who was admitted to a medical-surgical unit in sickle cell crisis.Which medication should the nurse expect to administer to this client?

A pediatric nurse is educating the client with sickle cell disease and the client's family regarding the genetic implications of the disease.Which information is inappropriate for the nurse to share with the client's family?