Nokea
The female teacher comes to the school nurse’s office and shows the nurse a rash on her hands. The nurse tells the teacher she has probably contracted impetigo from one of the students. Which intervention should the nurse implement?
- A. Instruct the teacher to go to her HCP today.
- B. Tell the teacher to wash her hands with soap and water.
- C. Encourage the teacher to rub vitamin E oil on the lesions.
- D. Explain that the rash will go away in a few days.
Correct Answer: A
Rationale: Impetigo requires HCP evaluation for antibiotics. Handwashing is preventive, vitamin E is ineffective, and spontaneous resolution is unlikely.
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When the client asks the nurse about the purpose of the eye shield, which explanation is best?
- A. The shield keeps foreign substances out of the eye.
- B. The shield protects the eye from accidental trauma.
- C. The shield reduces rapid eye movement when dreaming.
- D. The shield promotes dilation of the pupil at night.
Correct Answer: B
Rationale: The shield prevents accidental trauma to the healing eye during sleep.
The client sustained a hot grease burn to the right hand and calls the emergency department for advice. Which information should the nurse provide to the client?
- A. Apply an ice pack to the right hand.
- B. Place the hand in cool water.
- C. Be sure to rupture any blister formation.
- D. Go immediately to the doctor’s office.
Correct Answer: B
Rationale: Cool water reduces burn progression and pain without tissue damage. Ice causes frostbite, rupturing blisters risks infection, and immediate doctor visits depend on severity.
The nurse is providing postoperative care for the client with a split-thickness skin graft on the burn wound at the sole of the right foot. Which is appropriate care for this client?
- A. Immobilization of the graft site
- B. Weight-bearing exercises to the graft site
- C. Assist client out of bed as much as tolerated
- D. Maintain right leg in a dependent position
Correct Answer: A
Rationale: The graft must be immobilized so that it can remain in place and be able to revascularize. The client cannot place weight on the graft site. Bearing weight causes trauma. A dependent position impairs circulation and may cause further tissue injury.
Which health teaching information is most appropriate for a client with a herpes simplex virus type 1 infection?
- A. Apply petroleum jelly to the lesions to prevent spreading the virus to adjacent areas.
- B. Use good personal hygiene to prevent spreading the virus to other body parts.
- C. Avoid using soap and water on open lesions.
- D. Remove the scabs daily by soaking with hot compresses.
Correct Answer: B
Rationale: Good hygiene prevents viral spread to other areas.
A young man has extensive burns on the front and back of the chest. His treatment includes the use of Sulfamylon to the burned areas. How should the nurse apply this medication?
- A. With a sterile, gloved hand
- B. With a sterile applicator
- C. With sterile 4x4's
- D. By aerosol spray
Correct Answer: C
Rationale: Sulfamylon is applied using sterile 4x4 gauze pads to ensure even coverage and maintain sterility while minimizing pain.