Exam 28: Integumentary Function

An older adult patient has an open,draining wound on the lower medial aspect of the right leg.The skin surrounding the wound is reddish brown with surrounding erythema and edema.Based on this information,the nurse edits the patient's care plan to include impaired skin integrity:

A patient has a wound that is a shallow crater with surrounding erythema and warmth.What stage pressure ulcer does the nurse chart?

The presence of which skin assessment finding,if noted on an older adult patient,should cause the nurse to suspect a premalignancy?

A patient has a purulent,foul-smelling leg wound.What wound care practice is most appropriate?

An older adult patient reports simple xerosis with mild pruritus.The nurse educates her on the importance of:

The nurse explains that the plan of care for an older adult patient with seborrheic dermatitis of the scalp should include:

An older adult patient newly diagnosed with peripheral vascular disease (PVD)is being educated on the possibility of developing a foot ulcer.What assessment finding indicates the patient may have an ulcer resulting from this disease?

An older patient has been treated for a small basal cell carcinoma on the face.What assessment finding indicates to the nurse that the goals for a priority diagnosis have been met?

The nurse plans to assess for candidiasis as a priority intervention for a:

An older adult patient has been taught measures to prevent the development of skin cancer.Which statement,if made by the patient,indicates the need for more teaching?

When assessing the older adult patient's skin for indications of melanoma,the nurse should inspect for a(n):

When assessing for squamous cell cancer (SCC),a home health nurse is particularly concerned about a suspicious lesion on the:

The nurse of a bedridden 74-year-old woman is evaluating whether the family members understand how to position the patient correctly.The nurse is confident the family is capable of effective positioning when it is observed that the patient's:

An older diabetic patient has impaired mobility and decreased vision.The nurse examines the patient's feet at each clinical visit.The patient asks why this is necessary.What response by the nurse is best?

For which patient does the nurse add compression therapy to the nursing care plan?

An 87-year-old patient developed herpes zoster after surgical repair of a hip fracture.The priority nursing diagnosis is:

The nurse knows that several age-related changes in the integumentary system increase older adults' risk for pressure ulcers.Which factors does this include? (Select all that apply. )

An older diabetic patient reports a candidiasis infection.When asked,the patient states all blood sugars have been within the target range.What action by the nurse is best?

In creating community education on various types of skin cancer,the nurse places the highest priority on early diagnosis of melanoma because:

A 65-year-old man is seen in the outpatient clinic for treatment of psoriasis.The nurse educates the patient to the possibility of developing: