Midterm Exam: NRNP 6645 Psychotherapy with
Multiple Modalities (Grade A) | Questions and
Answers
1. Mrs. Williams is 76 years old and comes in to have a wound checked on her right
leg. She fell a month ago and the wound has not healed. She is concerned that
something is wrong. The nurse practitioner examines the wound and sees that it has
been cleaned properly and has no signs of infection. The edges are approximated, but
the skin around the wound is red and tender to touch. The best response regarding Mrs.
Williams' concern is:
1. Wound healing for older people may take up to four times longer than it does for
younger people.
2. Let us talk about what you are eating.
3. Had you come in earlier, I would have ordered medicine that would have healed that
right up.
4. I will order an antibiotic to prevent infection. - ANSWER: 1. Answer: 1
Page: 96
Feedback
1.
Skin renewal turnover time increases to approximately 87 days in older adults,
compared with 20 days during youth.
2.
The perceived extended healing time is not related to diet.
3.
This is false hope, as there is no medication that will heal this wound quickly.
4.
Prophylactic antibiotics are not appropriate when there are no signs or symptoms of
infection.
2. The nurse practitioner is conducting patient rounds in a long-term care facility. As she
talks with Mrs. Jones, she notices that her arms and elbows are excoriated and the skin
is shearing. The nurse practitioner explains to the staff that Mrs. Jones needs frequent
assessment of her skin and protection provided to prevent skin breakdown because:
1. Her lack of activity causes the skin to tear.
2. Fat has redistributed to the abdomen and thighs, leaving bony surfaces in areas such
as the face, hands, and sacrum. This can result in injury.
3. She has lost weight and is in jeopardy of falling.
4. She picks at herself and causes skin breakdown. - ANSWER: 2. Answer: 2
Page: 96
,Midterm Exam: NRNP 6645 Psychotherapy with
Multiple Modalities (Grade A) | Questions and
Answers
Feedback
1.
Lack of activity alone does not cause skin breakdown.
2.
Fat is redistributed to the abdomen and thighs, leaving bony surfaces, such as the face,
hands, and sacrum, exposed to potential injury, especially skin tears from shearing,
friction forces and pressure ulcer development.
3.
Although losing weight may be a risk factor for falling, it is not directly related to skin
breakdown.
4.
There is no evidence that she is picking at herself, as there is nothing reported
anywhere else on her arms.
3. Mr. James is 91 years old. His daughter notices that he has bruises and lacerations
on his arms and reports this to the nurse practitioner, who tells her that older people
bruise easily due to their fragile blood vessels. The skin lacerations happen because he
has thin skin. Even so, the nurse practitioner assures the daughter that she will
investigate further to ensure that he is getting proper care. She says this because she
understands that:
1. These markings on the patient's skin are part of aging skin.
2. Bruises and lacerations can indicate inadequate care.
3. The daughter needs assurance that her father is okay.
4. The patient is being abused. - ANSWER: 3. Answer: 2
Page: 97
Feedback
1.
Markings on the skin may be signs of aging, a disease, or maltreatment.
2.
Poorly healing wounds or chronic pressure ulcers may signal a problem not only with
the patient but with the caregiver's ability to provide adequate care. Welts, lacerations,
burns, and distinctive markings may indicate a need for intervention.
3.
This is a result of the nurse practitioner addressing it further rather than the reason for
addressing it.
4.
A professional cannot assume abuse without good reason.
,Midterm Exam: NRNP 6645 Psychotherapy with
Multiple Modalities (Grade A) | Questions and
Answers
4. The nurse practitioner assesses a patient's skin and finds an infectious lesion on the
lower leg. The lesion is considered a secondary lesion. The nurse practitioner explains
that a secondary lesion is one that:
1. Arises from changes to a primary lesion.
2. Is a complication of an underlying disease.
3. Is difficult to treat.
4. Is a normal sign of aging. - ANSWER: 4. Answer: 1
Page: 97
Feedback
1.
Secondary lesions (infections) arise from changes to the primary lesion.
2.
Secondary lesions are not necessarily the result of an underlying disease.
3.
Secondary lesions can be treated with medications or surgery.
4.
Secondary lesions arise as a condition not normal to aging.
5. Ms. Rose, 88 years old, comes to the nurse practitioner with a complaint about a
growth on her hand. She wants to have a biopsy done. The nurse practitioner asks the
following question:
1. Have you injured your hand recently?
2. Are you using a different detergent?
3. Has this growth changed, bled, or is it painful?
4. Has this growth made it difficult to put on your rings? - ANSWER: 5. Answer: 3
Page: 97
Feedback
1.
An injury would not stimulate growth.
2.
A reaction to a detergent would more likely be a rash.
3.
Lesions that warrant biopsy are those that have changed, bleed, or are painful.
4.
The ability to put on her ring is not the problem.
, Midterm Exam: NRNP 6645 Psychotherapy with
Multiple Modalities (Grade A) | Questions and
Answers
6. A 60-year-old male enters the burn center for triage and treatment due to a burn he
received at a campfire. His left arm has an area that is erythematous and painful, and
another area has a blister. What does the nurse practitioner record as the degree of
burn?
1. First degree
2. Second degree
3. First and second degree
4. Second and third degree - ANSWER: 6. Answer: 3
Page: 98
Feedback
1.
First-degree burns involving the epidermis are erythematous and painful but do not
blister.
2.
Second-degree burns involve the dermis and are characterized by blisters.
3.
The patient presents with erythematous skin, painful with blisters, which indicates both
first- and second-degree burn areas.
4.
In third-degree burns there is no sensation when the wound is pinpricked.
7. The nurse practitioner is concerned with primary prevention strategies. How can the
nurse practitioner implement primary prevention strategies for an 80-year-old male
patient who smokes?
1. Review home fire safety protocols, including the proper use of smoke alarms, and
discuss smoking cessation.
2. Inform him that if he does not stop smoking, the nurse practitioner cannot see him
again.
3. Have a conference with his family about his smoking.
4. Plan a family meeting with the patient to discuss benefits of his smoking cessation. -
ANSWER: 7. Answer: 1
Page: 115, 116
Feedback
1.
Primary prevention includes educational programs designed to educate the public on
safety. For example, the individual smoking in bed would hopefully benefit from smoking
cessation programs in the community, as well as instruction in safety precautions.
2.
Multiple Modalities (Grade A) | Questions and
Answers
1. Mrs. Williams is 76 years old and comes in to have a wound checked on her right
leg. She fell a month ago and the wound has not healed. She is concerned that
something is wrong. The nurse practitioner examines the wound and sees that it has
been cleaned properly and has no signs of infection. The edges are approximated, but
the skin around the wound is red and tender to touch. The best response regarding Mrs.
Williams' concern is:
1. Wound healing for older people may take up to four times longer than it does for
younger people.
2. Let us talk about what you are eating.
3. Had you come in earlier, I would have ordered medicine that would have healed that
right up.
4. I will order an antibiotic to prevent infection. - ANSWER: 1. Answer: 1
Page: 96
Feedback
1.
Skin renewal turnover time increases to approximately 87 days in older adults,
compared with 20 days during youth.
2.
The perceived extended healing time is not related to diet.
3.
This is false hope, as there is no medication that will heal this wound quickly.
4.
Prophylactic antibiotics are not appropriate when there are no signs or symptoms of
infection.
2. The nurse practitioner is conducting patient rounds in a long-term care facility. As she
talks with Mrs. Jones, she notices that her arms and elbows are excoriated and the skin
is shearing. The nurse practitioner explains to the staff that Mrs. Jones needs frequent
assessment of her skin and protection provided to prevent skin breakdown because:
1. Her lack of activity causes the skin to tear.
2. Fat has redistributed to the abdomen and thighs, leaving bony surfaces in areas such
as the face, hands, and sacrum. This can result in injury.
3. She has lost weight and is in jeopardy of falling.
4. She picks at herself and causes skin breakdown. - ANSWER: 2. Answer: 2
Page: 96
,Midterm Exam: NRNP 6645 Psychotherapy with
Multiple Modalities (Grade A) | Questions and
Answers
Feedback
1.
Lack of activity alone does not cause skin breakdown.
2.
Fat is redistributed to the abdomen and thighs, leaving bony surfaces, such as the face,
hands, and sacrum, exposed to potential injury, especially skin tears from shearing,
friction forces and pressure ulcer development.
3.
Although losing weight may be a risk factor for falling, it is not directly related to skin
breakdown.
4.
There is no evidence that she is picking at herself, as there is nothing reported
anywhere else on her arms.
3. Mr. James is 91 years old. His daughter notices that he has bruises and lacerations
on his arms and reports this to the nurse practitioner, who tells her that older people
bruise easily due to their fragile blood vessels. The skin lacerations happen because he
has thin skin. Even so, the nurse practitioner assures the daughter that she will
investigate further to ensure that he is getting proper care. She says this because she
understands that:
1. These markings on the patient's skin are part of aging skin.
2. Bruises and lacerations can indicate inadequate care.
3. The daughter needs assurance that her father is okay.
4. The patient is being abused. - ANSWER: 3. Answer: 2
Page: 97
Feedback
1.
Markings on the skin may be signs of aging, a disease, or maltreatment.
2.
Poorly healing wounds or chronic pressure ulcers may signal a problem not only with
the patient but with the caregiver's ability to provide adequate care. Welts, lacerations,
burns, and distinctive markings may indicate a need for intervention.
3.
This is a result of the nurse practitioner addressing it further rather than the reason for
addressing it.
4.
A professional cannot assume abuse without good reason.
,Midterm Exam: NRNP 6645 Psychotherapy with
Multiple Modalities (Grade A) | Questions and
Answers
4. The nurse practitioner assesses a patient's skin and finds an infectious lesion on the
lower leg. The lesion is considered a secondary lesion. The nurse practitioner explains
that a secondary lesion is one that:
1. Arises from changes to a primary lesion.
2. Is a complication of an underlying disease.
3. Is difficult to treat.
4. Is a normal sign of aging. - ANSWER: 4. Answer: 1
Page: 97
Feedback
1.
Secondary lesions (infections) arise from changes to the primary lesion.
2.
Secondary lesions are not necessarily the result of an underlying disease.
3.
Secondary lesions can be treated with medications or surgery.
4.
Secondary lesions arise as a condition not normal to aging.
5. Ms. Rose, 88 years old, comes to the nurse practitioner with a complaint about a
growth on her hand. She wants to have a biopsy done. The nurse practitioner asks the
following question:
1. Have you injured your hand recently?
2. Are you using a different detergent?
3. Has this growth changed, bled, or is it painful?
4. Has this growth made it difficult to put on your rings? - ANSWER: 5. Answer: 3
Page: 97
Feedback
1.
An injury would not stimulate growth.
2.
A reaction to a detergent would more likely be a rash.
3.
Lesions that warrant biopsy are those that have changed, bleed, or are painful.
4.
The ability to put on her ring is not the problem.
, Midterm Exam: NRNP 6645 Psychotherapy with
Multiple Modalities (Grade A) | Questions and
Answers
6. A 60-year-old male enters the burn center for triage and treatment due to a burn he
received at a campfire. His left arm has an area that is erythematous and painful, and
another area has a blister. What does the nurse practitioner record as the degree of
burn?
1. First degree
2. Second degree
3. First and second degree
4. Second and third degree - ANSWER: 6. Answer: 3
Page: 98
Feedback
1.
First-degree burns involving the epidermis are erythematous and painful but do not
blister.
2.
Second-degree burns involve the dermis and are characterized by blisters.
3.
The patient presents with erythematous skin, painful with blisters, which indicates both
first- and second-degree burn areas.
4.
In third-degree burns there is no sensation when the wound is pinpricked.
7. The nurse practitioner is concerned with primary prevention strategies. How can the
nurse practitioner implement primary prevention strategies for an 80-year-old male
patient who smokes?
1. Review home fire safety protocols, including the proper use of smoke alarms, and
discuss smoking cessation.
2. Inform him that if he does not stop smoking, the nurse practitioner cannot see him
again.
3. Have a conference with his family about his smoking.
4. Plan a family meeting with the patient to discuss benefits of his smoking cessation. -
ANSWER: 7. Answer: 1
Page: 115, 116
Feedback
1.
Primary prevention includes educational programs designed to educate the public on
safety. For example, the individual smoking in bed would hopefully benefit from smoking
cessation programs in the community, as well as instruction in safety precautions.
2.
