Nokea
A patient is ending the first year of recovery after having burns to both legs. Which observation indicates that the patient needs to be encouraged to wear the pressure garment?
- A. Skin warm and moist
- B. Pedal pulses present but faint
- C. Scattered areas of scarring noted
- D. Nonpitting edema of both ankles
Correct Answer: C
Rationale: Pressure garments reduce scarring; scattered scarring suggests inadequate use, indicating a need for encouragement to wear them.
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After completing data collection the nurse determines that an older patient is experiencing the death of melanocytes. What observation did the nurse use to make this determination?
- A. Dry skin
- B. Wrinkled skin
- C. Thin and gray hair
- D. Thin and fragile skin
Correct Answer: C
Rationale: Death of melanocytes leads to gray hair due to loss of pigment, and hair thins with inactive follicles.
Which information should the nurse include when teaching a patient who has just received a prescription for ciprofloxacin (Cipro) to treat a urinary tract infection?
- A. Use a sunscreen with a high SPF when exposed to the sun.
- B. Sun exposure may decrease the effectiveness of the medication.
- C. Photosensitivity may result in an artificial-looking tan appearance.
- D. Wear sunglasses to avoid eye damage while taking this medication.
Correct Answer: A
Rationale: The patient should stay out of the sun. If that is not possible, teach them to wear sunscreen when taking medications that can cause photosensitivity. The other statements are not accurate.
The outer layer of the epidermis provides the most effective barrier to penetration of the skin by environmental factors. Which of the following is an example of penetration by an environmental factor?
- A. An insect bite
- B. Dehydration
- C. Sunburn
- D. Excessive perspiration
Correct Answer: A
Rationale: The stratum corneum, the outer layer of the epidermis, provides the most effective barrier to both epidermal water loss and penetration of environmental factors, such as chemicals, microbes, insect bites, and other trauma.
A male client comes to the physician's office for treatment of severe sunburn. The nurse takes this opportunity to discuss the importance of protecting the skin from the sun's damaging rays. Which instruction would best prevent skin damage?
- A. Wear protective clothing only.
- B. Use a tanning bed instead of sun exposure.
- C. Apply sunscreen even on overcast days.
- D. Avoid sunscreen on cloudy days.
Correct Answer: C
Rationale: UV rays penetrate clouds, so applying sunscreen even on overcast days is essential to prevent skin damage.
A nurse is reviewing the medical record of a male client to be admitted to the nursing unit and notes documentation of reticular skin lesions. The nurse expects that these lesions will appear to be:
- A. Net-like appearance
- B. Circular patches
- C. Linear streaks
- D. Small, raised bumps
Correct Answer: A
Rationale: Reticular lesions have a net-like or lace-like pattern, often due to vascular or pigment changes.