Deck 6: Skin and Lymphatic Disorders

Question 1

A 59-year-old female was admitted to the hospital for malaise, headache, fever, and flu-like symptoms.She has a decreased appetite and is having trouble sleeping.After a couple of days, she complains to the nurse practitioner of itching, burning, and tingling pain around her waist.The nurse practitioner advises the nursing staff to observe for vesicles for a few days.The patient asks why she is so sick.What would be the nurse practitioner's best response? Select all that apply.
1)We are not certain at this point, however, these symptoms often occur before a break-out of herpes zoster.
2)You have some very general systemic symptoms, so we are waiting for more specific symptoms to appear.
3)Because you had chicken pox as a child, and you now have a depressed immune system, the chance of developing herpes zoster is high.
4)These symptoms are probably a strong case of influenza.
5)Herpes zoster is more common in people 55 years old and older.

Answer 1

1, 3

Question 2

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 2

3

Question 3

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 3

1

Question 4

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

Question 5

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.

Question 6

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.

Question 7

Mr.Watson,75 years old, comes to the urgent care center with complaints of fever, fast heartbeat, a swollen gland under his right arm, and redness in his upper left arm that has hurt for 2 to 3 days.The patient says that he has had the redness in his arm for months without any difficulty.The nurse practitioner suspects which of the following? Select all that apply.
1)Influenza
2)Upper respiratory infection
3)Cellulitis of upper left arm
4)Necrotizing fasciitis
5)Lymphangitis

Question 8

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.

Question 9

Mrs.Thomas is 82 years old and burned her hand while cooking.The nurse practitioner assesses second- and third-degree burns over approximately half of the back of her hand.The nurse practitioner chooses which of the following for initial treatment? Select all that apply.
1)Administer appropriate pain medication.
2)Rinse with cool tap water.
3)Clean with a strong detergent.
4)Remove any loose tissue but allow the blisters to remain.
5)Diagnose as first- and third-degree burns.

Question 10

Mrs.Person, 82 years old, comes to the well clinic to see a nurse practitioner for a bump on her ear.This growth has been there for almost a year but has recently grown.The area around the growth appears inflamed.Why would the nurse practitioner suggest a biopsy? Select all that apply.
1)The growth is elevated and increasing in size.
2)The ear has high exposure to the sun.
3)There is inflammation around the growth.
4)The patient is 82 years old and reports having lived in the south of the United States for many years.
5)There is no concern about familial tendencies.

Question 11

The treatment for cellulitis includes which of the following? Select all that apply.
1)Patients with mild cellulitis may be given oral antibiotics.
2)One drug of choice is dicloxacillin, 500 mg four times a day.
3)Treatment is dependent on the culture of the cells affected.
4)The drug of choice is given for a minimum of 3 days.
5)Administration of a tetanus booster injection.

Question 12

Mr.Edwards is 76 years old and received a burn on his leg when he dozed off and dropped his cigarette.The nurse practitioner examines his leg for the degree of burn and classifies it as second degree with some third degree in the center.Mr.Edwards asks what that means and why it hurts so much.What is the best answer? Select all that apply.
1)It means that this is a serious, deep burn in the center, and a less deep burn around the sides.
2)It hurts because the nerve endings are exposed in the second-degree area.
3)It means that the burn is advancing and getting worse.
4)It hurts because the nerves are destroyed.
5)It hurts because the nerves in the second-degree areas are exposed to the outside and are stimulated.

Question 13

The nurse practitioner is making patient rounds in a long-term care facility and is visiting Mr.Smith, 95 years old, who has a large amount of fungus growing from his toenails.The staff nurse asks what can be done to help alleviate this nail fungus.What does the nurse practitioner advise? Select all that apply.
1)Wash and completely dry the feet and toes daily.
2)Keep the patient's feet cool and dry.
3)Use aluminum acetate solution (Burow's solution).
4)Have the patient wear occlusive footwear.
5)Use clotrimazole (ointment, cream, or lotion).

Question 14

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.

Question 15

The nurse practitioner is conducting a safety class with community-living older adults.Which of the following should she include in her teaching of risks of burns for this population? Select all that apply.
1)Thinner skin.
2)Less vascularity.
3)Diminished nerve function.
4)A weakened immune system.
5)The burden of various comorbidities leading to enhanced wound healing and reepithelialization after burn injury.