The nurse notes darker skin pigmentation in the skin folds of a patient who has a body mass index of $40 \mathrm{kg} / \mathrm{m}^2$. Which of the following topics would the nurse include in patient teaching?
- A. Teach the patient about the risk for type 2 diabetes.
- B. Educate the patient about treatment of fungal infection.
- C. Discuss the use of drying agents to minimize infection risk.
- D. Instruct the patient about use of mild soap to clean skin folds.
Correct Answer: A
Rationale: Obesity and the presence of acanthosis nigricans in skin folds suggest an increased risk for type 2 diabetes. The description of the patient's skin does not indicate problems with fungal infection, poor hygiene, or the need to dry the skin folds better.
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Which of the following actions would the nurse take when applying a wet dressing to an inflamed and pruritic area of skin on a patient's ankle?
- A. Use a cool solution to wet the dressing.
- B. Change the dressing using sterile gloves.
- C. Soak the dressing in sterile normal saline.
- D. Apply the dressing from the knee to the foot.
Correct Answer: A
Rationale: Cool solutions are used when wet dressings are applied to inflamed areas. Wet dressings do not require sterile technique; tap water is the most common solution used. To avoid maceration of healthy skin, wet dressings should only be applied over the affected area.
The nurse is caring for a patient who has basal cell carcinoma (BCC) of the face. Which of the following information should the nurse include when teaching this patient?
- A. Treatment plans include watchful waiting.
- B. Screening for metastasis will be important.
- C. Low-dose systemic chemotherapy is used to treat BCC.
- D. Minimizing sun exposure will reduce risk for future BCC.
Correct Answer: D
Rationale: BCC is frequently associated with sun exposure. BCC spread locally, but do not metastasize to distant tissues. Since BCC can cause local tissue destruction, treatment is indicated. Local chemotherapy may be used to treat BCC.
The nurse is assessing a patient who has just arrived in the postanesthesia recovery area (PACU) after a blepharoplasty. Which of the following assessment data is a priority?
- A. The patient complains of incisional pain.
- B. The patient 's heart rate is 110 beats/minute.
- C. The patient is unable to detect when the eyelids are touched
- D. The skin around the incision is pale and cold when palpated.
Correct Answer: D
Rationale: Pale, cool skin indicates a possible decrease in circulation, so the surgeon should be notified immediately. Warm, pink skin that blanches with pressure indicates that adequate circulation is present in the surgical area. The other assessment data indicate a need for ongoing assessment or nursing action. A heart rate of 110 may be related to the stress associated with surgery, assessment of other vital signs and continued monitoring are appropriate. Because local anaesthesia would be used for the procedure, numbness of the incisional area is expected immediately after surgery. The nurse should monitor for return of feeling.
After the nurse has finished teaching a patient about application of corticosteroid cream to an area of contact dermatitis on the right leg, which of the following patient actions indicates that more teaching is needed?
- A. The patient spreads the cream using a downward motion.
- B. The patient takes a tepid bath before applying the cream.
- C. The patient applies a thick layer of the cream to the affected skin.
- D. The patient covers the area with a dressing after applying the cream.
Correct Answer: C
Rationale: Creams and ointments should be applied in a thin layer to avoid wasting the medication. The other actions by the patient indicate that the teaching has been successful.
A patient who has severe refractory psoriasis on the face, neck, and extremities has quit working and withdrawn from social activities because of the appearance of the lesions. Which of the following actions should the nurse take first?
- A. Discuss the possibility of enrolling in a worker-retraining program.
- B. Encourage the patient to volunteer to work on community projects.
- C. Suggest that the patient use cosmetics to cover the psoriatic lesions
- D. Ask the patient to describe the impact of psoriasis on quality of life.
Correct Answer: D
Rationale: The nurse's initial actions should be to assess the impact of the disease on the patient's life and to allow the patient to verbalize feelings about the psoriasis. Depending on the assessment findings, other actions may be appropriate.
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