VSim Case 1- Josephine Morrow Questions With All Correct Answers!!

The nurse is assessing a patient's nails. Which techniques should the nurse consider using when performing this assessment? (Select all that apply.) - Answer-clubbing, capillary refill, hygiene, texture The nurse has completed a skin assessment and is now documenting using the Braden Scale. Which areas are assessed using this tool? (Select all that apply.) - Answer-mobility, nutrition The nurse is assessing for skin texture, thickness, and moisture. Which technique would the nurse use to perform these assessments? - Answer-palpation A patient with a history of skin cancer reports an "itchy mole" on the back. Which characteristics should the nurse inspect for when evaluating the lesion? (Select all that apply.) - Answer-asymmetry, borders, color The nurse is inspecting a patient's cheek and finds a palpable, 0.4-cm mass containing clear fluid. How would the nurse document this finding? - Answer-vesicle Upon inspection of a patient's lower extremity, the nurse suspects venous insufficiency. Which assessment findings would support this conclusion? (Select all that apply.) - Answer-reddish-bluish discoloration, thickened, tough skin, moderate leg edema The nurse is interviewing a patient who is reporting itching and a rash. Which question(s) would be appropriate for the nurse to include in the nursing health history? (Select all that apply). - AnswerHow much does it bother you? When did it begin? What other symptoms occur with it? The nurse is assessing a shallow, open ulcer with a red-pink wound bed that is located on a patient's sacrum. How would the nurse document this wound? - Answer-Stage II The nurse is preparing to complete a skin, hair, and nail examination. What equipment should the nurse gather before beginning the assessment? (Select all that apply.) - Answer-magnifying glass, centimeter ruler, penlightThe nurse is providing patient teaching about prevention of pressure ulcers. Which statement, if made by the patient, indicates that the teaching was successful? - Answer-Because I have dry skin, I should avoid cold air and use moisturizers The nurse is educating Ms. Morrow and her daughter on food choices that will promote wound healing. Which diet choices should be included in the teaching session? - Answer-meats, cheeses, and beans The nurse is inspecting Ms. Morrow's skin. To which areas should the nurse pay extra attention during the assessment? (Select all that apply.) - Answer-under the breasts, limbs, groin The nurse is inspecting Ms. Morrow's leg for the development of additional venous stasis ulcers. Which findings would alert the nurse to the possible development of an additional venous wound? - Answer-leg pain and brownish or blue skin discoloration The nurse is assessing a wound on a patient's lower extremity that has a mottled, bluish appearance and localized edema. How should the nurse describe this type of wound? - Answer-venous stasis ulcer