Question 1

The emergency nurse admits a client who was rescued from a burning building. The client's arms and chest are covered with dry, leathery, charred skin that does not blanch. Which new prescription should the nurse implement first?

Accepted Answer

11ecbb05_c9f7_97d4_b433_9fc439804754_MD0009_00 Burn injuries are caused by direct tissue damage from exposure to caustic (eg, thermal, chemical, electrical) sources. These injuries may be life-threatening, depending on the extent of tissue injury and organ damage. To prioritize the initial management of burn injuries, nurses should use the ABCs (ie, airway, breathing, circulation). Circulatory compromise is common after sustaining a burn, as extensive tissue injury combined with the systemic inflammatory response causes increased capillary permeability, fluid and electrolyte shifts, and decreased intravascular volume. These intravascular losses begin rapidly after a burn and may lead to hypovolemic shock and death. Therefore, the nurse should prioritize initiation of fluid resuscitation (Option C). (Option A) Although full-thickness burns destroy nerves and may be painless, clients with burns often have severe pain. However, pain is not life-threatening and may be treated after restoration of ABCs. (Option B) Burn injuries impair immune system function and skin integrity, increasing the risk for infection. Prevention of infection with topical antimicrobials (eg, bacitracin, silver sulfadiazine) is important. However, restoration of ABCs is the priority. (Option D) An escharotomy is a surgery involving incisions made through eschar (burned tissue) and is performed to prevent tissue ischemia and necrosis from impaired circulation. However, stabilizing circulatory status is the priority. Educational objective: Nurses should prioritize the initial management of burn injuries using the ABCs (ie, airway, breathing, circulation). Fluid administration, a life-saving measure for clients with burn injuries, stabilizes circulation and should be performed as soon as possible.

Question 2

A parent calls the nursing triage line during the evening. The parent says that a 7-year-old was found playing in an area with poison ivy and asks what to do. Which is the most important instruction to give the parent?

Accepted Answer

11ecbb05_c9fc_79d9_b433_0999f590f6ac_MD0009_00 Poison ivy can cause a contact dermatitis rash in those who are sensitive to the oily resin found on the leaves, stems, and roots of the plant. About 50% of people who come in contact with the plant develop a rash. It is often linear in appearance where the plant brushed against the skin. The rash develops 12-48 hours after exposure and can last for several weeks. The severity of the rash depends on the amount of resin on the skin. It is most important to first thoroughly wash the area to remove the resin and prevent its spread to other areas of the body. (Options A, B, and C) Applying cool, wet compresses; applying topical cortisone; and discouraging the child from scratching the area are all appropriate after the rash has developed. Washing the area has the highest priority and is most important immediately after exposure. Educational objective: Immediately after exposure to poison ivy, the client should be instructed to thoroughly wash the area to remove the oily resin, which is responsible for causing the rash that follows in 12-48 hours.

Question 3

A nurse is making a presentation on skin cancer prevention with special focus on melanoma at a community health forum. Which statements should the nurse include? Select all that apply.

Accepted Answer

Skin cancers are most often caused by damage to the skin's DNA. This damage is typically due to exposure to ultraviolet (UV) radiation, primarily from the sun but also from other sources (eg, tanning beds, sunlamps). The instructions to prevent sunburn and other sun-related damage include: Avoid the sun, if possible, especially between 10 AM and 4 PM. UV rays are not blocked by cloud coverage and can be reflected off water, sand, snow, and concrete. As a result, clients can burn in the shade or even during outdoor winter activities (eg, skiing) (Option D). Wear protective clothing (eg, long sleeves, wide-brimmed hats, umbrellas) when possible. Apply sunscreen: Use a broad-spectrum sunscreen to block both UVA and UVB rays. Choose a sunscreen with SPF ≥15 for daily use or SPF ≥30 for outdoor activities and sun-sensitive individuals. Sunscreen should be applied 15-30 minutes prior to sun exposure to allow the formation of a protective film on the skin. Regardless of the type of sunscreen used, it should be reapplied at least every 2 hours, or more often if possible (Options A and B). Because sunscreen is washed off with swimming and sweating, it should be reapplied, even for products labeled "water-resistant" or "very water-resistant" (Option C). Avoid the use of tanning beds as they emit UV radiation (Option E). Educational objective: To prevent sunburn, instruct clients to avoid sun exposure from 10 AM to 4 PM, wear protective clothing, use sunscreen properly (daily application; minimum SPF of 15-30; 15-30 minutes before going outside; reapplication when wet and every 2 hours), and avoid non-solar exposure to ultraviolet radiation (eg, tanning beds, sunlamps).

Question 4

For which client is it most important for the nurse to provide teaching on ways to prevent the spread of the condition?

Accepted Answer

11ecbb05_c9fc_c7fa_b433_d1b2f71e6bdd_MD0009_00 Tinea corporis (ringworm) is a fungal infection of the skin often transmitted from one person to another or from an infected animal to a human. It appears as a scaly, pruritic patch that is often circular or oval in shape. It is highly contagious and can be spread via items such as grooming tools, hats, towels, and bedding. Tinea corporis often spreads via shared athletic equipment or in athletic locker rooms due to the proximity of infected gear. This condition is treated with topical antifungals (eg, tolnaftate, haloprogin, miconazole, clotrimazole). (Option A) Eczema is a skin rash caused by an immune disorder that is often triggered by an allergy. Itching is common, but the rash is not contagious. (Option B) Oral candidiasis, or thrush, often occurs after a course of antibiotics or corticosteroids or can occur in infants with immature immune systems. An infant who is breastfed can transfer candidiasis to the mother's breast. There is also a small risk of transmission when infants place pacifiers or toys in their mouths and subsequently transfer these items to another child's mouth. However, oral candidiasis is significantly less contagious than tinea corporis. (Option C) Psoriasis is a chronic autoimmune disease that most often affects the skin by causing dry, scaly, red rashes. Psoriasis is not contagious. Educational objective: Tinea corporis (ringworm) is a highly contagious fungal skin infection. It is treated with topical antifungals. Clients should be instructed not to share items such as grooming tools, towels, bedding, and hats. Athletic equipment should be cleaned routinely.

Question 5

A nurse is reinforcing teaching with a client newly diagnosed with human immunodeficiency virus (HIV) about actions to prevent complications. Which of the following statements indicate that teaching was effective? Select all that apply.

Accepted Answer

Human immunodeficiency virus (HIV) is a viral infection of the CD4⁺ (helper T) cells, resulting in progressive immune system impairment. Clients with HIV are susceptible to opportunistic infections that typically occur during periods of low CD4⁺ counts. To reduce the risk of infection, nurses should educate clients with HIV to: Obtain and remain up to date on vaccinations, including the annual influenza vaccination (Option B). Avoid eating undercooked meats (eg, steak that is pink) and having contact with cat feces (eg, cat litter box) because both are sources of Toxoplasma gondii, an opportunistic parasite that causes encephalitis (Options A and C). Avoid drinking water from poorly sanitized (eg, developing countries) or potentially contaminated (eg, rivers, wells) sources because it may contain infectious pathogens (eg, Cryptosporidium, Isospora, Giardia). Instead, use bottled or purified water when drinking and brushing teeth (Option D). (Option E) Educate clients with HIV to always use synthetic barriers (eg, condoms) during sex to reduce the risk of transmitting HIV and being infected with additional HIV strains or other sexually transmitted infections. Clients with an undetectable viral load have a lower risk of transmitting HIV to a sexual partner but should still use barrier contraception. Educational objective: Clients with HIV should take precautions to prevent opportunistic infections, including: staying up to date on vaccinations, eating thoroughly cooked meat, avoiding changing cat litter boxes, and using bottled water to brush teeth when traveling to developing countries. Clients with HIV, even those with a low viral load, should always use condoms.

Question 6

A nurse is caring for a client admitted to the intensive care unit for toxic epidermal necrolysis. Which interventions should be included in this client's care plan? Select all that apply.

Accepted Answer

Toxic epidermal necrolysis is an acute skin disorder, most commonly associated with a medication reaction, that results in widespread erythema, blistering, epidermal shedding, keratoconjunctivitis, and skin erosion (ie, denuded skin). It is a severe form of Stevens-Johnson syndrome. The major cause of death related to toxic epidermal necrolysis is sepsis; therefore, infection prevention is critical. Basic supportive care includes: Wound care: Sterile, moist dressings are applied to open areas of skin (Option B). Infection prevention: Strict sterile technique and reverse isolation decrease infection risk. The nurse should also monitor for any signs of infection (eg, fever) (Option C). Fluids and nutrition: Vital signs and urine output are monitored for signs of hypovolemia. Oral feeding should be initiated early to promote wound healing; a nasogastric tube may be necessary. Hypothermia prevention: Maintain a room temperature of 85 F (29.4 C) or more, and use passive rewarming methods such as sterile, single-use warming blankets or digitally regulated warming pads (Option D). Pain management: Analgesics are administered around the clock and before painful procedures. Eye care: Sterile, cool compresses are applied to relieve discomfort. Lubricants may relieve dryness and prevent corneal abrasion (Option A). (Option E) Massage is inappropriate due to cutaneous tenderness and epidermal shedding. Educational objective: Toxic epidermal necrolysis is a life-threatening condition that causes large areas of denuded skin and mucosa. Nursing care focuses on preventing complications, including sepsis, fluid and electrolyte imbalance, hypothermia, and ophthalmic issues.

Question 7

When caring for a client with severe burns, the nurse can expect to administer pain medication via which route?

Accepted Answer

Burns cause large fluid shifts and can decrease perfusion to the gastrointestinal tract, resulting in inconsistent absorption of oral medications. Burns damage the muscle and subcutaneous tissue, causing generalized body edema and decreased circulating blood volume. These physiological changes reduce the absorption ability for the intramuscular and subcutaneous routes (Options A, C, and D). The best way to get medication into the system of a client with severe burns is to access the circulatory system directly via the intravenous route. Educational objective: In clients with severe burns, medications are best administered through the intravenous route given the possibility of reduced absorption from other routes (subcutaneous, intramuscular, oral).

Question 8

An obese client with diabetes who had a bowel resection 5 days ago says, "I felt like I split open when I was coughing." On assessment, the nurse notes that the incision edges are separated and a loop of bowel is protruding through the wound. Which nursing actions would be appropriate? Select all that apply.

Accepted Answer

11ecbb05_c9fa_a517_b433_a508bc65fa64_MD0009_00 Total separation of wound layers with protrusion of the internal viscera through the incision is known as evisceration. Evisceration is a medical emergency that can lead to localized ischemia, peritonitis, and shock. Emergency surgical repair is necessary. Clients at risk for poor wound healing (eg, obesity, diabetes mellitus) are at increased risk for evisceration. When an abdominal wound evisceration occurs, the nurse should take the following actions: Remain calm and stay with the client. Have someone notify the HCP immediately and bring sterile supplies. Instruct the client not to cough or strain. Place the client in low Fowler's position (no more than 20 degrees) with knees slightly flexed to relieve pressure on the abdominal incision and have the client maintain absolute bed rest to prevent tissue injury. Assess vital signs (and repeat every 15 minutes) to detect possible signs and symptoms of shock (eg, hypotension, tachycardia, tachypnea). Cover the viscera with sterile dressings saturated in NS solution to prevent bacterial invasion and keep the exposed viscera from drying out. Document interventions taken and the appearance of the wound and eviscerated organ (eg, color, drainage). If the blood supply is interrupted, the protruding organs can become ischemic (dusky) and necrotic (black). (Option A) This client should immediately be made NPO in preparation for possible emergency surgery. Only IV analgesics should be administered if the client is in pain. Educational objective: Emergency nursing management of wound evisceration includes the following: Stay with the client and have someone bring sterile supplies Notify the HCP and make the client NPO in preparation for emergency surgery Place the client in low Fowler's position with knees slightly flexed Cover viscera with sterile dressings saturated in NS solution Assess vital signs and monitor for signs of shock

Question 9

A nurse is teaching home management to a client newly diagnosed with severe psoriasis. Which client statement indicates that further teaching is needed?

Accepted Answer

Psoriasis is a chronic autoimmune disease that causes a rapid turnover of epidermal cells. Characteristic silver plaques on reddened skin may be found bilaterally on the elbows, knees, scalp, lower back, and/or buttocks. The goal of therapy is to slow epidermal turnover, heal lesions, and control exacerbations. There is no cure for psoriasis; disease management includes avoidance of triggers (eg, stress, trauma, infection), topical therapy (eg, corticosteroids, moisturizers), phototherapy (eg, ultraviolet light), and systemic medications, including cytotoxic (eg, methotrexate) and biologic (eg, infliximab) agents (Options C and D). The client should avoid alcohol as it can worsen psoriasis (Option B). In addition, the liver, kidneys, and bone marrow are specifically affected by the systemic medications commonly used to control psoriasis. (Option A) Exposure to ultraviolet light (eg, phototherapy, sunlight) can help slow epidermal turnover and decrease exacerbations; however, there is a greater long-term risk of skin cancer. Therefore, frequent skin examinations by a health care provider are important. Educational objective: Psoriasis is a chronic autoimmune condition characterized by exacerbations of silver plaques on reddened skin. Although there is no cure, management includes topical and systemic medications, phototherapy, and avoidance of triggers.

Question 10

The nurse assesses a client with a burn on the arm and finds that the area is red, moist, and covered in shiny, fluid-filled vesicles.  Which burn stage does the nurse document?

Accepted Answer

11ecbb05_c9fc_2bb8_b433_7f99aeafa34d_MD0009_00 Second-degree (partial-thickness) burns appear as moist or weeping wounds with blisters and shiny, fluid-filled vesicles, and clients have moderate to severe pain. Both the epidermis and dermis are damaged. Second-degree Immediate care of minor burn injuries involves removal of clothing and debris from the affected area, cooling and cleansing of the wound, and pain management. Minor burn injuries can be treated on an outpatient basis with wound care and dressing changes. Major burn injuries require hospitalization and emergency interventions (eg, airway management, fluid resuscitation). (Option A) First-degree (superficial) burns are dry with blanchable redness. They usually damage the epidermis only. (Options C and D) Third-degree (full-thickness) burns are dry and inelastic with waxy white, leathery, or charred black color. They destroy the dermis and may involve subcutaneous tissue. Fourth-degree (full-thickness) burns have the same appearance as third-degree burns, with additional involvement of fascia, muscle, and/or bone tissue. Due to nerve damage, pain is not the major feature, unlike with second-degree burns. Educational objective: Second-degree (partial-thickness) burns damage both the epidermis and the dermis, and appear as moist or weeping wounds with redness, blisters, shiny fluid-filled vesicles, and moderate to severe pain.

Question 11

The nurse is providing discharge teaching for a client who suffered full-thickness burns. Which statement by the client demonstrates a need for further instruction on the rehabilitation phase of a burn injury?

Accepted Answer

The rehabilitation phase begins after the client's wounds have fully healed and lasts about 12 months. The initiation of this phase depends on the extent of the burns and the client's ability to care for themselves. Interventions in the rehabilitation phase are aimed at improving mobility and independence and minimizing the potential for long-term complications. These interventions include: Counseling or other psychosocial support Gentle massage with water-based lotion to alleviate itching and minimize scarring Planning for reconstructive surgery Pressure garments to prevent hypertrophic scars and promote circulation (Option D) Range-of-motion exercises to prevent contractures (Option B) Sunscreen and protective clothing to prevent sunburns and hyperpigmentation (Option C) (Option A) Daily application of water-based lotion is necessary to minimize scar formation and alleviate itching. Infection is not likely as the rehabilitation phase begins after the wounds are fully healed. Educational objective: The rehabilitation phase begins after the client's wounds are healed. The goals of this phase are to increase the client's ability to perform activities of daily living and prevent long-term complications.

Question 12

A client is brought to the emergency department after sustaining third-degree burns over 50% of the body. Which solution is the best choice for fluid resuscitation in this client?

Accepted Answer

The greatest immediate threat to a client with severe and extensive burn injuries is hypovolemic shock and electrolyte imbalance. This is due to cellular damage and increased capillary permeability caused by direct thermal trauma, which result in fluid loss. In the emergent phase of burn management, it is critical to establish an airway and replenish lost intravascular fluid, proteins, and electrolytes. Lactated Ringer's (LR), also known as Ringer's lactate, is the solution of choice for fluid resuscitation of a burned client due to its similarity in chemical composition to human plasma (Option D). LR remains in the intravascular space longer than other solutions, which helps to stabilize blood pressure and avert shock. (Option A) Hypotonic solutions (eg, 0.45% normal saline) quickly leave the intravascular space and are not useful in replacing intravascular volume. They may also contribute to peripheral and interstitial edema, which can lead to pulmonary complications. (Option B) Hypertonic solutions (eg, 5% dextrose in 0.9% normal saline [D5NS], 3% saline) can cause further electrolyte imbalances in a client with severe burns, resulting in hypernatremia, hyperchloremia, and arrhythmias. (Option C) Although technically an isotonic solution, 5% dextrose in water (D5W) behaves as a hypotonic solution when dextrose is metabolized by the body and free water is released to the tissues rather than remaining in the intravascular space. Educational objective: Lactated Ringer's is the standard for fluid resuscitation in burn clients due to its similarity in chemical composition to human plasma. Hypotonic, hypertonic, and dextrose-containing solutions should not be used for fluid resuscitation.

Question 13

The nurse is caring for a client in the intensive care unit who suffered partial-thickness burns to 36% of the body.  During the first 24 hours, the nurse would anticipate which of the following assessments?

Accepted Answer

11ecbb05_c9f9_4585_b433_c9606fff2768_MD0009_00 Burn injuries cause tissue damage that leads to increased vascular permeability and fluid shifts (eg, second and third spacing). In the emergent phase after a burn (first 24-72 hours), fluid, proteins, and intravascular components leak into the surrounding interstitium, causing decreased intravascular oncotic pressure and decreased intravascular volume, and resulting in fluid shifts and hypovolemia. Potassium, the predominant intracellular cation, is released when cellular damage occurs, resulting in hyperkalemia (potassium >5.0 mEq [5.0 mmol/L]). Clients with hyperkalemia experience muscle weakness, ECG changes (tall, peaked T waves, shortened QT interval), and cardiac arrhythmias (Option D). (Option A) Hematocrit and hemoglobin values will be elevated due to hypovolemia (hemoconcentration). (Option B) The sympathetic nervous system is activated in response to a burn, causing decreased peristalsis. Nausea, vomiting, gastric distension, and paralytic ileus may occur. (Option C) Sodium is the most abundant extracellular cation. Hyponatremia (sodium <135 mEq/L [135 mmol/L]) occurs as sodium is lost via fluid shifts and insensible losses. Educational objective: Burn injuries cause cellular destruction, capillary leaking, and fluid shifts. Fluids are lost during the emergent phase (first 24-72 hours), resulting in hypovolemia and hyponatremia. The blood becomes more viscous and increased hematocrit and hemoglobin values result. Cellular damage releases potassium, which causes hyperkalemia.

Question 14

The nurse is participating in a staff presentation to review risk factors for skin cancer. Which of the following risk factors should the nurse include? Select all that apply.

Accepted Answer

Skin cancers are most often linked to damage of skin cells' DNA by overexposure to ultraviolet radiation (eg, sunlight, tanning beds). The three most common types of skin cancer are squamous cell carcinoma, basal cell carcinoma, and melanoma. Melanomas grow rapidly and are highly metastatic, making them the deadliest form of skin cancer. Basal cell and squamous cell carcinomas generally have a much lower risk of metastasis. Risk factors for skin cancer include: Family or personal history of skin cancer (Option A) Celtic ancestry traits (eg, light skin, red or blond hair, blue or green eyes, many freckles) Aging Atypical or high number of moles because some skin cancers develop from pre-existing moles (Option B) Immunosuppression (eg, immunosuppressant medications, HIV), which lowers the body's ability to defend against cancerous mutations (Option D) Ultraviolet light exposure (eg, chronic sun exposure, outdoor occupation, tanning bed use, history of severe sunburns) (Option E) Clients should be taught to avoid overexposure to sunlight, perform monthly skin checks with the ABCDE assessment, and immediately report any abnormal findings to their health care provider. Early detection and treatment significantly improve outcomes. (Option C) Acne is not a known risk factor for skin cancer. Educational objective: Risk factors for skin cancer include family or personal history of skin cancer, Celtic ancestry traits (eg, light skin, blue eyes), aging, atypical or high number of moles, immunosuppression, and ultraviolet light exposure (eg, chronic sun exposure, outdoor occupation).

Question 15

The nurse is caring for an adult client at the clinic who asks the nurse to look at a "black skin lesion." What assessment findings would be a classic indication of a potential malignant skin neoplasm? Select all that apply.

Accepted Answer

The examination for skin cancer follows the ABCDE rule: Asymmetry (eg, one half unlike the other) (Option B) Border irregularity (eg, edges are notched or irregular) Color changes and variation (eg, different brown or black pigmentation) (Option E) Diameter of 6 mm or larger (about the size of a pencil eraser) (Option D) Evolving (eg, appearance is changing in shape, size, color) (Option A) Normal variations in skin will blanch with manual pressure. Failure to blanch is typically an indication that there is blood beneath the skin, as in petechiae and/or purpura. (Option C) Pus or purulent drainage is usually indicative of an infectious process, not cancer. Educational objective: Examination of a skin lesion for malignancy should include ABCDE: Asymmetry, Border irregularity, Color change and variation, Diameter of 6 mm or more, and Evolving in appearance.

Question 16

The nurse is conducting an educational community outreach program on melanoma screening. Which statement by a resident would indicate the need for further education?

Accepted Answer

Client education on early detection of skin cancer is important as most cases of malignant melanoma are discovered by the client. A full medical workup of every mole is unnecessary. Routine self-evaluation followed by medical assessment of questionable growths is sufficient. Clients with advanced age or reduced mobility may need to see a dermatologist for a full-body skin survey. (Option A) Rapid changes in a mole should be evaluated immediately. (Option C) Amelanotic melanomas are pink growths similar to basal cell carcinomas of the skin. Blue, white, and red colorations can occur in melanoma. (Option D) Malignant expansions of previous growths (moles, nevi) are common. Educational objective: Skin cancer screening should cover the basics - uneven, large, blotchy moles, or any sudden changes in mole size or color need to be checked out by a health care provider.

Question 17

The nurse cares for a client admitted with severe burns who is now on fluid resuscitation therapy. Which assessment findings would best indicate that fluid resuscitation has been successful?

Accepted Answer

After a burn injury, increased capillary permeability leads to third spacing (fluid shifts to areas where normally minimal or absent), allowing proteins, plasma, and electrolytes to leave the vascular space and occupy other spaces and tissues. This creates a state of hypovolemic shock, which poses the highest risk of mortality in the initial phase of the burn process. Therefore, aggressive fluid resuscitation to correct hypovolemia is a priority. Adequate urine output (at least 30 mL/hr, or 0.5 mL/kg/hr) depends on adequate renal perfusion and is the greatest indicator that fluid resuscitation therapy has effectively restored tissue perfusion. (Option A) Although stable vital signs (eg, systolic blood pressure ≥90 mm Hg, mean arterial pressure ≥65 mm Hg, heart rate <120/min) indicate client improvement, urine output is the greatest indicator of adequate fluid resuscitation. (Option B) A decrease in serum potassium from 5.7 mEq/L to 5.0 mEq/L (5.7 mmol/L to 5.0 mmol/L) indicates that hyperkalemia is resolving but is not an indicator of tissue perfusion. (Option D) Rapid increase in weight indicates that fluid shifts continue to occur and the kidneys are not eliminating properly. This could be a sign of fluid overload. Educational objective: Aggressive fluid resuscitation is essential to correct hypovolemia in a client with severe burns. Urine output ≥30 mL/hr or 0.5 mL/kg/hr, systolic blood pressure ≥90 mm Hg, and heart rate <120/min indicate adequate perfusion to vital organs.

Question 18

The nurse is preparing educational materials about histoplasmosis for a group of nursing students.  Which teaching point is appropriate for the nurse to include?

Accepted Answer

11ecbb05_c9f6_fb93_b433_a190df4c9c5a_MD0009_00 Histoplasmosis is an opportunistic fungal infection that most commonly occurs in clients with compromised immunity due to medical conditions (eg, HIV, malnutrition) or immunosuppressant medications (eg, TNF-α inhibitors [infliximab], corticosteroids [prednisone]) (Option D). Histoplasmosis infection results from inhaling Histoplasma capsulatum spores that are typically found in soil that contains bird or bat droppings. In most clients, histoplasmosis infection is either asymptomatic or results in mild, pneumonialike symptoms (eg, fatigue, fever, dyspnea, cough). However, clients with substantial or recurrent exposure to Histoplasma capsulatum spores or who are immunocompromised may develop chronic pulmonary infection or disseminated infection, which requires treatment and/or hospitalization. (Option A) Kaposi sarcoma, not histoplasmosis, is a form of cancer typically affecting immunocompromised clients who are infected with human herpesvirus 8. Kaposi sarcoma is commonly identified when immunocompromised clients develop pink or purple lesions all over the skin. (Option B) Histoplasmosis infection is typically asymptomatic or self-limiting and usually does not require treatment. (Option C) Unlike tuberculosis and other airborne infectious diseases (eg, measles, varicella, herpes zoster), histoplasmosis is not spread by breathing microbes expelled into the air by infected individuals. Educational objective: Histoplasmosis is an opportunistic fungal infection that results when fungal spores from soil that contains bird or bat droppings is inhaled. Histoplasmosis is usually asymptomatic or mild, but can result in widespread, life-threatening infections in immunocompromised individuals.

Question 19

The nurse is reinforcing education about home and lifestyle alterations to a client recently diagnosed with HIV. Which of the following statements by the client indicates a need for further education? Select all that apply.

Accepted Answer

Human immunodeficiency virus (HIV) is a viral infection of the CD4⁺ (helper T) cells, resulting in progressive immune system impairment. When educating clients with HIV, the nurse should discuss health promotion and infection transmission prevention strategies, particularly safe sex practices. Unprotected sex increases the risk of transmitting HIV and other sexually transmitted infections (STIs). Protected sex is important even with HIV-positive partners as HIV has multiple strains and coinfection results in HIV superinfection, which may hasten progression to AIDS (Option A). Clients with HIV should use latex or synthetic condoms and/or dental dams during sexual activity involving mucous membrane exposure (ie, oral, vaginal, anal) to semen or vaginal secretions. Natural barriers (eg, lambskin) do not prevent transmission of STIs due to the presence of small pores (Option D). (Option B) Sharing personal hygiene devices that may have been exposed to blood (eg, toothbrushes, razors) increases HIV transmission risk and should be avoided. (Option C) Immunosuppressed clients should be educated to avoid raw or undercooked foods (eg, eggs, meats, seafood) to avoid foodborne illnesses. (Option E) To prevent transmission of HIV, hepatitis B virus, and other bloodborne diseases, IV drug users should be taught to avoid reusing or sharing needles or syringes. Educational objective: Clients with HIV are educated to use latex or synthetic barriers during all sexual encounters (ie, oral, vaginal, anal) in which nonintact skin or mucous membranes are exposed to semen or vaginal secretions. Unprotected sex increases the risk of transmitting HIV and other sexually transmitted infections, as well as HIV coinfection/superinfection.

Question 20

A client who suffered a burn injury has received fluid resuscitation and is now diuresing, indicating the end of the emergency phase. Which prescription is the highest priority at this time?

Accepted Answer

11ecbb05_c9f9_bab6_b433_c1dcf000d69b_MD0009_00 The nurse should consider Maslow's Hierarchy of Needs to determine the importance of various interventions. This client in the acute phase of burn management continues to have increased physiological needs. Clients with burns have increased metabolism and calorie requirements that must be met for healing to occur. The nutrition needed for healing increases proportionally with the percentage of burned tissue. Therefore, providing proper nutrition as soon as possible is the highest priority (Option A). (Option B) Although it is important to promote activities of daily living, physiological needs such as nutrition are priorities. (Option C) Psychological and spiritual needs are important but do not take precedence over the client's physiological needs. (Option D) Physiological needs include direct care for the burned area, infection prevention, and giving the client prescribed medications for healing. Education of the family comes after meeting any type of physiological need. Educational objective: Consider Maslow's Hierarchy of Needs when prioritizing nursing concerns. Physiological needs should be met first (eg, oxygen, fluids, nutrition). Proper nutrition is vital for healing to occur after a burn injury.

Exam 1: Adult Health

The emergency nurse admits a client who was rescued from a burning building. The client's arms and chest are covered with dry, leathery, charred skin that does not blanch. Which new prescription should the nurse implement first?

A parent calls the nursing triage line during the evening. The parent says that a 7-year-old was found playing in an area with poison ivy and asks what to do. Which is the most important instruction to give the parent?

A nurse is making a presentation on skin cancer prevention with special focus on melanoma at a community health forum. Which statements should the nurse include? Select all that apply.

For which client is it most important for the nurse to provide teaching on ways to prevent the spread of the condition?

A nurse is reinforcing teaching with a client newly diagnosed with human immunodeficiency virus (HIV) about actions to prevent complications. Which of the following statements indicate that teaching was effective? Select all that apply.

A nurse is caring for a client admitted to the intensive care unit for toxic epidermal necrolysis. Which interventions should be included in this client's care plan? Select all that apply.

When caring for a client with severe burns, the nurse can expect to administer pain medication via which route?

A nurse is teaching home management to a client newly diagnosed with severe psoriasis. Which client statement indicates that further teaching is needed?

The nurse assesses a client with a burn on the arm and finds that the area is red, moist, and covered in shiny, fluid-filled vesicles. Which burn stage does the nurse document?

The nurse is providing discharge teaching for a client who suffered full-thickness burns. Which statement by the client demonstrates a need for further instruction on the rehabilitation phase of a burn injury?

A client is brought to the emergency department after sustaining third-degree burns over 50% of the body. Which solution is the best choice for fluid resuscitation in this client?

The nurse is caring for a client in the intensive care unit who suffered partial-thickness burns to 36% of the body. During the first 24 hours, the nurse would anticipate which of the following assessments?

The nurse is participating in a staff presentation to review risk factors for skin cancer. Which of the following risk factors should the nurse include? Select all that apply.

The nurse is caring for an adult client at the clinic who asks the nurse to look at a "black skin lesion." What assessment findings would be a classic indication of a potential malignant skin neoplasm? Select all that apply.

The nurse is conducting an educational community outreach program on melanoma screening. Which statement by a resident would indicate the need for further education?

The nurse cares for a client admitted with severe burns who is now on fluid resuscitation therapy. Which assessment findings would best indicate that fluid resuscitation has been successful?

The nurse is preparing educational materials about histoplasmosis for a group of nursing students. Which teaching point is appropriate for the nurse to include?

The nurse is reinforcing education about home and lifestyle alterations to a client recently diagnosed with HIV. Which of the following statements by the client indicates a need for further education? Select all that apply.

A client who suffered a burn injury has received fluid resuscitation and is now diuresing, indicating the end of the emergency phase. Which prescription is the highest priority at this time?