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NUR352 exam questions and answers

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Integument Physical Assessment Techniques - Correct Ans--Inspection -Palpaiton Integument health promotion - Correct Ans--Sunscreen -Monthly self-checks -diet (avoiding saturated fats and processed foods) Braden Scale - Correct Ans-A tool for predicting pressure ulcer risk -Out of 23, the lower the score the higher the risk ABCDE - Correct Ans-skin cancer screening asymmetry, border, color, diameter, evolving Expected skin color + temp findings - Correct Ans--color variation (scars, genetic, age, sun damage, pregnancy) -temperature (environmental or chronic perfusion issue) Unexpected skin color +temp findings - Correct Ans--Color (pallor, cyanosis, jaundice, erythema, ecchymosis, hematoma, petechiae) -hypo or hyperthermia Skin integrity expected - Correct Ans--scars -good hygiene -chart the beginning of any sores Skin integrity unexpected - Correct Ans--Lesions; need investigation -Primary lesions are the direct result of something (a burn) -Secondary lesions occur when a primary is untreated -Obtain subjective history of new changes -ABCDE -infestation Pressure wound risk factors - Correct Ans-- location -mobility -age -weight -nutrition -chronic conditions (diabetes) -moisture/friction -Braden scale! Braden scale categories - Correct Ans-sensory perception, moisture, activity, mobility, nutrition, friction and shear Pressure wound staging - Correct Ans-1. Nonblanchable; intact skin with redness 2. Partial loss on outermost layers; shiny 3.Full thickness loss through subQ 4.Full thickness loss with necrosis or damage to bone/muscle -nurses cannot stage, and they cannot be staged if the bottom is not visible Pressure wound care - Correct Ans--Advocate for pain control -Administer pain meds before wound changes Primary pressure wound interventions - Correct Ans--Turn every 2 hours -Can be delegated after inspection -Maintain diet and hygiene Secondary pressure wound interventions - Correct Ans-- wound care -gel pads -pillows Pressure wound documentation - Correct Ans--time noticed -care received -depth/ size Integument expected moisture/turgor/texture - Correct Ans--Age/genetics/weight change variations -Trauma/procedures -Age can contribute to dryness and decreased elasticity Integument unexpected moisture/turgor/texture - Correct Ans--Profound dryness, flaking, roughness -Velvety /thickening texture (thyroid) -Diaphoresis -Tenting -Edema hair expected findings - Correct Ans--evenly distributed -adequate quantity -good hygiene hair unexpected findings - Correct Ans--hair loss; alopecia -uneven distribution nails expected findings - Correct Ans--symmetrical -smooth -color appropriate for ethnicity

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NUR352 exam questions and answers
2024-2025
Integument Physical Assessment Techniques - Correct Ans--Inspection
-Palpaiton

Integument health promotion - Correct Ans--Sunscreen
-Monthly self-checks
-diet (avoiding saturated fats and processed foods)

Braden Scale - Correct Ans-A tool for predicting pressure ulcer risk
-Out of 23, the lower the score the higher the risk

ABCDE - Correct Ans-skin cancer screening
asymmetry, border, color, diameter, evolving

Expected skin color + temp findings - Correct Ans--color variation (scars, genetic, age,
sun damage, pregnancy)
-temperature (environmental or chronic perfusion issue)

Unexpected skin color +temp findings - Correct Ans--Color (pallor, cyanosis, jaundice,
erythema, ecchymosis, hematoma, petechiae)
-hypo or hyperthermia

Skin integrity expected - Correct Ans--scars
-good hygiene
-chart the beginning of any sores

Skin integrity unexpected - Correct Ans--Lesions; need investigation
-Primary lesions are the direct result of something (a burn)
-Secondary lesions occur when a primary is untreated
-Obtain subjective history of new changes
-ABCDE
-infestation

Pressure wound risk factors - Correct Ans-- location
-mobility
-age
-weight
-nutrition
-chronic conditions (diabetes)
-moisture/friction
-Braden scale!

,Braden scale categories - Correct Ans-sensory perception, moisture, activity, mobility,
nutrition, friction and shear

Pressure wound staging - Correct Ans-1. Nonblanchable; intact skin with redness
2. Partial loss on outermost layers; shiny
3.Full thickness loss through subQ
4.Full thickness loss with necrosis or damage to bone/muscle
-nurses cannot stage, and they cannot be staged if the bottom is not visible

Pressure wound care - Correct Ans--Advocate for pain control
-Administer pain meds before wound changes

Primary pressure wound interventions - Correct Ans--Turn every 2 hours
-Can be delegated after inspection
-Maintain diet and hygiene

Secondary pressure wound interventions - Correct Ans-- wound care
-gel pads
-pillows

Pressure wound documentation - Correct Ans--time noticed
-care received
-depth/ size

Integument expected moisture/turgor/texture - Correct Ans--Age/genetics/weight
change variations
-Trauma/procedures
-Age can contribute to dryness and decreased elasticity

Integument unexpected moisture/turgor/texture - Correct Ans--Profound dryness,
flaking, roughness
-Velvety /thickening texture (thyroid)
-Diaphoresis
-Tenting
-Edema

hair expected findings - Correct Ans--evenly distributed
-adequate quantity
-good hygiene

hair unexpected findings - Correct Ans--hair loss; alopecia
-uneven distribution

nails expected findings - Correct Ans--symmetrical
-smooth
-color appropriate for ethnicity

, - <3s cap refill

nail unexpected findings - Correct Ans--broken/missing
-clubbing (hypoxia)
->3s cap refill
-loosely attached
-color not appropriate
-brittle/thick

expected skin changes with age - Correct Ans--consider psychological impacted of
visible changes
-sun exposure= skin cancer
-less elasticity- skin tears
-collagen fibers stiffen; less fatty acids in the epidermis
-decreased sebum= dryness
-uneven pigmentation
-slower hair + nail growth
-nail discoloration (yellowing)/ changes in thickness
- decreased SUBQ tissues (loss of warmth and cushioning)
-wrinkling from UV exposure

health promotion for skin - Correct Ans--hygiene
-wound care
-balanced diet (protein and vitamin D)
-address skin breakdown (acne, dryness)
-sun exposure (avoid 10-)
-monthly self-checks
-1-2 years derm vists

lateral flexion - Correct Ans-

neck rotation - Correct Ans-

Shoulder Abduction - Correct Ans-

shoulder adduction - Correct Ans-

shoulder flexion - Correct Ans-

shoulder hyperextension - Correct Ans-

finger extension - Correct Ans-

finger adduction - Correct Ans-

finger abduction - Correct Ans-

Información del documento

Subido en
13 de noviembre de 2024
Número de páginas
17
Escrito en
2024/2025
Tipo
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