Nokea
Which action will the nurse take when administering a therapeutic bath to a patient who has severe pruritus from contact dermatitis?
- A. Use Burow's solution to help promote healing.
- B. Rub the skin briskly to decrease pruritus.
- C. Limit bathing to three times a week.
- D. Ensure that bath area is at least 85 degrees and dehumidified.
Correct Answer: A
Rationale: Pruritus is responsible for most of the discomfort. Wet dressings and using Burow's solution help promote the healing process. Rubbing the skin would increase pruritis. Give daily baths with an application to cleanse the skin. A cool environment with increased humidity decreases the pruritus.
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Melanocytes give rise to the pigment melanin, which is responsible for skin color. Where can the melanocytes be found?
- A. Dermis
- B. Superficial fascia
- C. Epidermis
- D. Loose connective tissue
Correct Answer: C
Rationale: A layer in the epidermis contains highly specialized cells called melanocytes.
A patient, age 37, sustained partial- and full-thickness burns to 26% of the body surface area. When would the greatest fluid loss resulting from the burns occur?
- A. Within 12 hours after burn trauma
- B. 24 to 36 hours after burn trauma
- C. 36 to 48 hours after burn trauma
- D. 48 to 72 hours after burn trauma
Correct Answer: A
Rationale: In a burn injury, usually the greatest fluid loss occurs within the first 12 hours.
Which is a major function of the skin?
- A. Excretion of wastes
- B. Protection
- C. Vitamin C synthesis
- D. Temperature regulation
- E. Prevention of dehydration
Correct Answer: A,B,D,E
Rationale: Functions of the skin include protection from the environment (pathogenic organisms, foreign substances, natural barrier against infection), temperature regulation, prevention of dehydration, excretion of waste products, and vitamin D synthesis.
Which is the greatest concern during the emergent phase of a burn injury?
- A. joint contractures
- B. Fluid overload
- C. hypovolemic shock.
- D. adrenal failure.
Correct Answer: C
Rationale: Hypovolemic shock is frequently lethal in the emergent period of a severe burn because of the transfer of fluids into the interstitial tissue from the circulating volume. Joint contractures and fluid overload occur during later phases of the burn injury. Adrenal failure is not associated with the emergent period of a severe burn.
A patient with severe eczema is starting a coal tar derivative treatment. Which will the nurse include in the teaching plan for the patient relative to this treatment?
- A. Drink at least 1000 mL of fluid daily.
- B. Avoid exposure to sunlight for 72 hours after use.
- C. Bathe with an astringent soap.
- D. Reduce intake of high calcium foods.
Correct Answer: B
Rationale: Persons using coal tar derivatives should avoid exposure to sunlight for 72 hours after use. The product stains clothes and bathroom fixtures. There is no need to drink additional fluids, bathe with astringent soaps or reduce calcium rich foods.