Nokea
The nurse who documents the burn injury is accurate in identifying the full-thickness burns as having what appearance?
- A. White and leathery
- B. Pink and blistered
- C. Red and painful
- D. Mottled and wet
Correct Answer: A
Rationale: Full-thickness burns appear white, leathery, and painless due to nerve destruction.
You may also like to solve these questions
After cleaning a client's prescription eyeglasses with soap and warm water or a commercial glass cleaner, which nursing action is best for drying the moist lenses?
- A. Rub the lenses with a paper tissue.
- B. Wipe the lenses with a soft cloth.
- C. But the lenses with a paper towel.
- D. Blow on the lenses to promote air drying.
Correct Answer: B
Rationale: A soft cloth prevents scratches and effectively dries the lenses.
Which finding of the client's biographical data most likely contributed to developing skin cancer?
- A. The client is a chronic cigarette smoker.
- B. The client has male pattern baldness.
- C. The client works for a drug manufacturer.
- D. The client bathes with a deodorant soap.
Correct Answer: B
Rationale: Baldness increases scalp sun exposure, a risk factor for skin cancer.
When examining the client's skin, which finding would the nurse expect to observe?
- A. Weeping skin lesions on the trunk of the body.
- B. Red skin patches covered with silvery scales.
- C. A red rash containing raised pustules.
Correct Answer: B
Rationale: Psoriasis presents with red patches and silvery scales.
When developing nursing care plans, the nurse is careful to classify which type of wound as a chronic wound?
- A. A gunshot wound with tissue damage
- B. A slow-healing diabetic foot ulcer
- C. A stage I pressure ulcer on the coccyx
- D. A 7-day-old infected surgical wound
Correct Answer: B
Rationale: Diabetic foot ulcers heal slowly, classifying them as chronic.
The long-term care nurse has received the a.m. shift report. Which client should the nurse assess first?
- A. The client who has not had a bowel movement today.
- B. The client who needs the indwelling catheter changed.
- C. The client with periorbital skin lesions.
- D. The client with a stage I pressure ulcer.
Correct Answer: C
Rationale: Periorbital skin lesions (e.g., herpes zoster ophthalmicus) risk eye complications, requiring urgent assessment. Constipation, catheter changes, and stage I ulcers are less acute.