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Which nursing instruction is most appropriate to convey to the client?
- A. Use hypoallergenic or glycerin soap for bathing.
- B. Apply lotion to the affected skin every other day.
- C. Take showers rather than tub baths.
- D. Rub the skin dry after bathing.
Correct Answer: A
Rationale: Hypoallergenic soap minimizes irritation in dry skin.
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Which immediate nursing interventions are appropriate for this client? Select all that apply.
- A. Place ice packs on the burned areas.
- B. Pour normal saline over the burned areas before dressing care.
- C. Begin an I.V. infusion of lactated Ringer's solution.
- D. Administer a tetanus injection.
- E. Administer pain medication.
- F. Administer oxygen therapy.
Correct Answer: B,C,D,E,F
Rationale: Ice packs can worsen tissue damage; other interventions address fluid loss, infection, pain, and oxygenation.
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.
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 writes the problem 'impaired skin integrity' for a client with stage IV pressure ulcers. Which interventions should be included in the plan of care? Select all that apply.
- A. Turn the client every three (3) to four (4) hours.
- B. Ask the dietitian to consult.
- C. Have the client sign a consent for pictures of the wounds.
- D. Obtain an order for a low air-loss bed.
- E. Elevate the head of the bed at all times.
Correct Answer: B,C,D
Rationale: Dietitian consult, wound photos (with consent), and low air-loss bed address stage IV ulcers. Turning every 3–4 hours is too infrequent, and constant head elevation increases coccyx pressure.
The public health nurse is providing a class on skin disorders in the African American community. Which information should the nurse include in the presentation?
- A. People with dark skin suffer the same skin conditions as people with light skin.
- B. African American men are more likely to have skin cancer than women.
- C. Dark-skinned individuals are less likely to form keloids after any type of surgery.
- D. Buccal mucosa of dark-skinned individuals is usually a bluish-tinged color.
Correct Answer: A
Rationale: Dark and light skin experience similar conditions, though presentation varies. Skin cancer risk is not gender-specific, keloids are more common in dark skin, and buccal mucosa is not bluish.