Nokea
When planning the skin care of a patient with decreased mobility, the nurse is aware of the varying thickness of the epidermis. At what location is the epidermal layer thickest?
- A. The scalp
- B. The elbows
- C. The palms of the hands
- D. The knees
Correct Answer: C
Rationale: The epidermis is the thickest over the palms of the hands and the soles of the feet.
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Assessment findings that would alert the nurse that a client might be at greater risk for deep vein thrombosis include:
- A. Varicose veins and obesity
- B. Client is 35 years old
- C. Client is on an anticoagulant medication
- D. All of the above
Correct Answer: A
Rationale: The development of a blood clot is an increased risk in clients with an impaired circulatory system (e.g., varicose veins), obesity, and age over 40. Anticoagulant medications reduce clot risk.
A female client sees a dermatologist for a skin problem. Later, the nurse reviews the client's chart and notes that the chief complaint was intertrigo. This term refers to which condition?
- A. Dry, scaly skin patches
- B. Irritation of opposing skin surfaces caused by friction
- C. Blisters from an allergic reaction
- D. Red, inflamed hair follicles
Correct Answer: B
Rationale: Intertrigo is inflammation caused by friction and moisture between opposing skin surfaces, often in skin folds.
Following myringotomy for acute otitis media, which topic would be appropriate for teaching about home management by the nurse?
- A. Ear irrigations should be placed on the wall of the external canal, and not on the tympanic membrane.
- B. Air travel and sudden barometric shifts will not affect the surgical procedure.
- C. Sterile cotton-tipped swabs can be used to clean the ear drainage.
- D. Shampooing and swimming are not restricted after a couple of weeks.
Correct Answer: B
Rationale: Air travel should not cause pressure buildup post-myringotomy due to tube equalization. Irrigations, swabs, and water exposure are contraindicated to prevent contamination.
The nurse describes several types of burn treatment. Which statement best describes a xenograft?
- A. Incision into subcutaneous tissue to increase circulation
- B. Biologic dressing obtained from a cadaver
- C. Wound covered with ointment, then covered with layers of gauze saturated with topical medication
- D. Biologic dressing obtained from a pig
Correct Answer: D
Rationale: A xenograft is a biologic dressing sourced from pig skin.
During skin inspection of a client, a nurse observes lesions with wavy borders that are widespread across the client's chest. Which descriptors should the nurse use to document these observations?
- A. Clustered and annular
- B. Linear and circinate
- C. Diffuse and serpiginous
- D. Coalesced and circumscribed
Correct Answer: C
Rationale: Diffuse is used to describe lesions that are widespread. Serpiginous describes lesions with wavy borders.