Nokea
A 30-year-old African American had surgery 6 months ago and the incision site is now raised, indurated, and shiny. This is most likely which type of tissue growth?
- A. Angioma
- B. Keloid
- C. Melanoma
- D. Nevus
Correct Answer: B
Rationale: Keloids, which originate in scars, are hard and shiny and are seen more often in African Americans than in Whites. An angiomas resembles a birthmark. A melanoma is a serious form of skin cancer. A nevus is commonly referred to as a mole.
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Which is the greatest concern during the emergent phase of a burn injury?
- A. joint contractures
- B. Fluid overload
- C. hypovolemic shock.
- D. adrenal failure.
Correct Answer: C
Rationale: Hypovolemic shock is frequently lethal in the emergent period of a severe burn because of the transfer of fluids into the interstitial tissue from the circulating volume. Joint contractures and fluid overload occur during later phases of the burn injury. Adrenal failure is not associated with the emergent period of a severe burn.
When providing the open method of treatment for a patient who is 52 years old with burns to the lower extremities, which does the nurse expect to see included in the nursing plan?
- A. Change the dressing using good medical asepsis.
- B. Provide an analgesic immediately after the dressing change.
- C. Perform circulation checks every 2 to 4 hours.
- D. Keep the room temperature at 85°F (29.4°C) to prevent chilling.
Correct Answer: D
Rationale: Chilling may be controlled by keeping the room temperature at 85°F (29.4°C). The open method of burn injury treatment does not involve dressings; the wound is left undressed. Strict surgical protocol is observed and analgesia should be given before the treatment. Circulation is not restricted if the wound area is left open.
Which is the initial intervention for relief of the pruritus of dermatitis venenata?
- A. Apply baking soda to lesions.
- B. Wash area with copious amounts of water.
- C. Apply cool compresses continuously.
- D. Expose area to air.
Correct Answer: B
Rationale: In dermatitis venenata (poison oak or ivy), the patient should wash the affected part immediately after contact with the offending allergen. Applying baking soda is not effective. Cool compresses and air exposure are not the initial intervention.
Which will a patient be assessed for upon the diagnosis of genital herpes?
- A. Hepatitis B
- B. Syphilis
- C. Human immunodeficiency virus (HIV).
- D. Cirrhosis
Correct Answer: C
Rationale: Persons with genital herpes should be assessed for HIV because the therapy for herpes is suppressive; persons with HIV are not candidates for suppressant therapy. Hepatitis B, syphilis and cirrhosis are not associated with genital herpes.
Which patient statement indicates that more teaching is needed regarding antibiotic therapy for the treatment of cellulitis?
- A. My skin is cleared up. I don't think I need the medication anymore.'
- B. Cellulitis can come back at any time.'
- C. If I had washed that scratch with soap and water, I probably would not have gotten cellulitis.'
- D. Cellulitis is contagious.'
Correct Answer: A
Rationale: The entire amount of antibiotic medication should be completed even if the symptoms have abated to ensure the eradication of the infectious agent. Cellulitis can return if untreated or undertreated. Washing wounds with soap and water can prevent many infections, but this is not related to the discussion of antibiotics. Cellulitis can spread, however this is not related to the discussion of antibiotics.