NSG 233 P & D Integumentary System with 100% correct answers 2023

The nurse takes the health history of a patient who has been admitted to the same-day surgery unit for elective facial dermabrasion. Which information is most important to convey to the plastic surgeon? A. The patient takes 325 mg of aspirin daily. B. The patient has not eaten anything for 8 hours. C. The patient has a family history of melanoma. D. The patient does not routinely use sunscreen. A. The patient takes 325mg of aspirin daily. Rational: Because aspirin affects platelet aggregation, the patient is at an increased risk for postprocedural bleeding, and the surgeon may need to reschedule the procedure. The other information is also pertinent but will not affect the scheduling of the procedure. The nurse has just received a change-of-shift report for the burn unit. Which patient should be assessed first? A. Patient who has just been transferred from the postanesthesia care unit after having skin grafts applied to the anterior chest . B. Patient with deep partial-thickness burns on both legs who reports severe and continuous leg pain . C. Patient admitted 3 weeks ago with full-thickness leg and buttock burns who has been waiting for 3 hours to receive discharge teaching D. Patient who has just arrived from the emergency department with facial burns sustained in a house fire . D. Patient who has just arrived from the emergency department with facial burns sustained in a house fire. Rational: Facial burns are frequently associated with airway inflammation and swelling, so this patient re-quires the most immediate assessment. The other patients also require rapid assessment or interventions, but their situations are not as urgent as that of the patient with facial burns. A patient admitted to the emergency department reports new onset itching of the trunk and groin. The nurse notes multiple reddened wheals on the chest, back, and groin. Which question should the nurse ask next? A. "How do you usually manage stress?" B. "Have you been using sunscreen regularly?" C. "Do you have a family history of eczema?" D. "Are you taking any new medications?" D. "Are you taking any new medications?" Rational: Wheals are frequently associated with allergic reactions, so asking about exposure to new medications is the most appropriate question for this patient. The other questions would be useful in assessing the skin health history but do not directly relate to the patient's symptoms. A 22-year-old woman who has been taking isotretinoin to treat severe cystic acne makes all these statements while being seen for a follow-up examination. Which statement is of most concern? A. "I don't think there has been much improvement in my skin." B. "I have been experiencing a lot of muscle aches and pains." C. "My husband and I are thinking of starting a family soon." D. "Sometimes I get nauseated after taking the medication." C. "My husband and I are thinking of starting a family soon" Rational: Because isotretinoin is associated with a high incidence of birth defects, it is important that the patient stop using the medication at least 1 month before attempting to become pregnant. Nausea and muscle aches are possible adverse effects of isotretinoin that would require further assessment but are not as urgent as discussing the fetal risks associated with this medication. The patient's concern about whether treatment is effective should be addressed, but this is a lower priority intervention. At the beginning of the shift, an assistive personnel tells the nurse, "I have several patients today who have wound infections. I will do my best, but if I put on a gown and gloves every time I go into their rooms, I will never get all the care done!" Which response by the nurse is best? A. "Let's look at the patient assignments for today and make changes so that you can give the needed care and maintain good infection control." B. "I know you are busy, but please try to comply with the standard infection control measures because these patients have serious infections." C. "If you are unable to follow infection control standards, perhaps you need a review class in correct use of personal protective equipment." D. "Tell me what you think are the most important times to use personal protective equipment to pre-vent infections from spreading." A. "Let's look at the patient assignments for today and make changes so that you can give the needed care and maintain good infection control." Rational: Seeking the AP's input into changes is respectful and helps with team dynamics. This response also most directly addresses the AP's concern about difficulties with time management. Asking the AP to try to comply suggests that noncompliance with needed infection control actions is an option. The suggestion that the AP will have to attend a class is dis-respectful because it sounds like a threat, and there is no indication that the AP needs more training on infection control. Asking the AP to clarify when personal protective equipment is needed may lead to useful discussion about infection control but should be done when more time is available for discussion. The nurse obtains this information about a 60-year-old patient who has a shingles infection. Which finding is of most concern? A. The patient has not had the herpes zoster vaccination. B. The patient has had symptoms for about 2 days. C. The patient has severe burning-type discomfort. D. The patient's spouse is currently receiving cancer chemotherapy. D. The patient's spouse is currently receiving cancer chemotherapy. Rational: Because exposure to patients with shingles may cause herpes zoster infection (including systemic infection) in individuals who are immune suppressed, teaching about how to prevent transmission and possible evaluation and treatment of the patient's spouse is needed. Antiviral treatment is most effective when started within 72 hours of symptom development. The patient will need analgesics to treat the pain associated with shingles and may receive vaccination, but the biggest concern is possible infection of the patient's spouse. The nurse assigns a dressing change to the LPN/LVN on a stage III pressure injury that is draining large amounts of purulent serosanguinous fluid. Which type of dressing should the nurse instruct the LPN/ LVN to utilize? A. A hydrophobic dressing B. A transparent dressing C. Wet to damp saline moistened gauze D. A hydrophilic dressing D. A hydrophilic dressing Rational: A hydrophilic dressing will draw the fluid material away from the surface of the wound, preventing the skin surrounding the wound from breaking down. A hydrophobic dressing is used for dry wounds or those with little drainage. In the past when wet to dry dressings were removed, new tissue growth was disrupted. The current practice is to remove dressings while they are damp. This spares the new growth but mechanically removes necrotic tissue. A transparent dressing is used to easily monitor a dry healing wound. Scenario: A 50-year-old patient with no known allergies has sustained 30% partial and full thickness burns. The patient's blood pressure has dropped significantly since admission 18 hours ago. The significant decrease in blood pressure after major burns is due to __________. His arterial blood gases indicate a metabolic acidosis. Metabolic acidosis in burn victims and is caused by _________. First line treatment of metabolic acidosis includes administration of ___________. ___________ will be administered to prevent infection with Clostridium tetani. To prevent hypertrophic scars and contractures, compression dressings or garments are applied. The patient must wear the compression garments for at least 23 hours a day for ___________ in order to be effective. A. Septicemia; Hypoventilation; High flow oxygen; Piperacillin-tazobactam; 3 months to 6 months. B. Capillary leak syndrome; Decreased tissue perfusion; Intravenous fluids; Tetanus Toxoid; 1-2 years. C. Insufficient fluid replacement; High bicarbonate; Sodium Bicarbonate; Vancomycin; 6 months to a year. D. Patient controlled analgesia with Morphine; Hypoxia; antibiotics; Amphotericin B; 3 to 4 years. B. Capillary leak syndrome; Decreased tissue perfusion; Intravenous fluids; Tetanus Toxoid; 1-2 years. Rational: After a major burn blood pressure initially increases due to vasoconstriction; however, within 12 hours, the BP will decrease due to capillary leak syndrome (third spacing), caused by dilation of the blood vessels that are near the burns. Morphine, in-sufficient fluid and septicemia can also lower blood pressure but are not unique to the physiology of major burns. Metabolic acidosis occurs as fluid, protein and electrolytes leak out of the vascular space. This action leads to decreased tissue perfusion which releases acids. Hyperkalemia worsens the acidosis as potassium from inside the destroyed cells is lost. In order to treat the metabolic acidosis intravenous fluids are given according to burn protocols in order to maintain urine output at 0.5mg/kg. Fluid resuscitation is necessary to maintain tissue perfusion in order to lessen the acidosis. Adequate renal function is necessary to excrete excess acid. Usually, sodium bicarbonate is administered only if the pH is less than 7.0 and is controversial. Fluids are first line therapy. Clostridium tetani is the bacteria that causes tetanus. The correct treatment for tetanus is tetanus toxoid. Vancomycin and Piperacillin-tazobactam are broad spectrum antibiotics that may be given to cover for septicemia, but they do not treat tetanus and Amphotericin B is an anti-fungal. Compression garments must be worn for 1-2 years for the full benefit to be realized. Which assessment finding calls for the most immediate action by the nurse? A. Yellow color of the skin and sclera. B. Bluish color around the lips and earlobes. C. Bilateral erythema of the face and neck. D. Dark brown spotting on the chest and back. B. Bluish color around the lips and earlobes. Rational: A blue color or cyanosis may indicate that the patient has significant problems with circulation or ventilation. Further assessment of respiratory and circulatory status is needed immediately to determine if actions such as administration of oxygen or medications are appropriate. The other data may also indicate health problems in major body systems, but potential respiratory or circulatory abnormalities are the priority. After the nurse performs a skin assessment on a 70-year-old new resident in a long-term care facility, which finding is of most concern? A. All the toenails are thickened and yellow. B. An irregular border is seen on a black mole on the scalp. C. Silver scaling is present on the elbows and knees. D. Numerous striae are noted across the abdomen and buttocks. B. An irregular border is seen on a black mole on the scalp. Rational: Irregular borders and a black or variegated color are characteristics associated with malignant skin lesions. Striae and toenail thickening or yellowing are common in older adults. Silver scaling is as-sociated with chronic conditions such as psoriasis and eczema, which may need treatment but are not as urgent a concern as the appearance of the mole. A patient is scheduled for patch testing to determine allergies to several substances. Which action associated with this test should the nurse delegate to assistive personnel (AP) working in the allergy clinic? A. Monitoring the patient for anaphylactic reactions to the testing B. Examining the patch area for evidence of a reaction. C. Scheduling a follow-up appointment for the patient in 2 days D. Explaining the purpose of the testing to the patient. C. Scheduling a follow-up appointment for the patient in 2 days Rational: Scheduling a follow-up appointment for the patient is within the legal scope of practice and training for the AP role. Patient teaching, assessment for positive skin reactions to the test, and monitoring for serious allergic reactions are appropriate to the education and practice role of licensed nursing staff Which of these actions will the nurse take first for a patient who has arrived in the emergency department with sudden onset urticaria and intense itching? A. Administer the prescribed cetirizine. B. Auscultate the patient's breath sounds. C. Apply topical corticosteroid cream. D. Ask the patient about any new medications. B. Auscultate the patient's breath sounds. Rational: Because urticaria can be associated with anaphylaxis, assessment for clinical manifestations of anaphylaxis (e.g., respiratory distress, wheezes, or hypotension) should be done immediately. The other actions are also appropriate, but therapy will change if an anaphylactic reaction is occurring. The nurse is planning hospital discharge teaching for four patients. For which patient is it most important to instruct about the need to use sunscreen? A. A 78-year-old patient with a red, pruritic rash caused by an allergic reaction to penicillin . B. A 32-year-old patient with pneumonia who has a new prescription for doxycycline . C. A dark-skinned 62-year-old patient who has had keloids injected with hydrocortisone . D. A fair-skinned 55-year-old patient with psoriasis who works outside for 8 hours daily . B. A 32-year-old patient with pneumonia who has a new prescription for doxycycline. Rational: Systemic use of tetracyclines such as doxycycline is associated with severe photosensitivity reactions to ultraviolet (UV) light. All individuals should be taught about the potential risks of overexposure to sunlight or other UV light, but the patient taking doxycycline is at the most immediate risk for severe adverse effects. The charge nurse is supervising a newly hired RN. Which action by the new RN requires the most immediate action by the charge nurse? A. Obtaining an anaerobic culture specimen from a superficial burn wound. B. Teaching a newly admitted burn patient about the use of pressure garments. C. Discussing the use of herpes zoster vaccine with a 25-year-old patient . D. Giving doxycycline with a glass of milk to a patient with cellulitis. D. Rational: Dairy products inhibit the absorption of doxycycline, so this action would decrease the effectiveness of the antibiotic. The other activities are not appropriate but would not cause as much potential harm as the administration of doxycycline with milk. Anaerobic bacteria would not be likely to grow in a superficial wound. The herpes zoster vaccine is recommended for patients who are 60 years or older. Pressure garments may be used after graft wounds heal and during the rehabilitation period after a burn injury, but this should be discussed when the patient is ready for rehabilitation, not when the patient is admitted.