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Which statement would the nurse expect the client to report when looking at an object without wearing corrective glasses or contact lenses?
- A. I see near objects more clearly.
- B. I see a blurry area in front of me.
- C. I see far objects more clearly.
- D. I see two of the same object.
Correct Answer: B
Rationale: Astigmatism causes blurry or distorted vision due to irregular corneal curvature.
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The nurse is assessing the client with atopic dermatitis. Which finding should the nurse expect?
- A. Patchy loss of skin pigmentation called vitiligo.
- B. Trichotillomania, a type of hair loss from compulsive pulling and/or twisting of the hair.
- C. Blistering, redness, and a white patch between the fingers, characteristic of candidiasis.
- D. Atopic dermatitis, which is characterized by redness and irregular, scaly lesions.
Correct Answer: D
Rationale: Atopic dermatitis is characterized by redness and irregular, scaly lesions. Vitiligo shows patchy loss of pigmentation. Trichotillomania involves hair loss from compulsive pulling. Candidiasis shows blistering, redness, and white patches.
The client is diagnosed with disseminated herpes zoster secondary to AIDS. Which interventions should the nurse implement? Select all that apply.
- A. Place the client in contact isolation.
- B. Administer a corticosteroid IVP.
- C. Assess the client’s pain on a 1-to-10 scale.
- D. Request that the client not have any visitors.
- E. Ensure that only nurses who have had chickenpox care for this client.
Correct Answer: A,C,E
Rationale: Contact isolation, pain assessment, and assigning immune nurses prevent transmission and manage disseminated zoster. Corticosteroids are contraindicated, and visitor bans are excessive.
Which action is most appropriate to include in the postoperative care plan when a client has skin grafts?
- A. Minimize movement to prevent graft disruption.
- B. Change the dressing over the graft every 8 hours.
- C. Reinforce the graft dressing if drainage occurs.
- D. Apply wet soaks to the graft every 4 hours.
Correct Answer: A
Rationale: Minimizing movement ensures graft adherence and healing.
The nurse is caring for the client diagnosed with contact dermatitis. Which collaborative intervention should the nurse implement?
- A. Encourage the use of support stockings.
- B. Administer a topical anti-inflammatory cream.
- C. Remove scales frequently by shampooing.
- D. Shampoo with lindane 1%, an antiparasitic, weekly.
Correct Answer: B
Rationale: Topical anti-inflammatory cream (e.g., steroids) treats contact dermatitis. Stockings, scale removal, and lindane are irrelevant.
The nurse is assessing the client newly diagnosed with psoriasis. Which findings should the nurse expect? Select all that apply.
- A. Pruritus at the affected areas
- B. Nailbeds that are pink and clear
- C. Stringy, oily hair that falls out in clumps
- D. Lesions appear as red plaques with silvery scales
- E. Affected areas at elbows, knees, scalp, palms, or soles
Correct Answer: A,D,E
Rationale: Itching is a common symptom of psoriasis. Psoriatic patches are red, scaly plaques with silvery scales and occur most often on elbows, knees, scalp, palms, and soles. Nail involvement may include thickening, discoloration, and pitting; pink and clear describes normal nailbeds. Hair is dry and brittle, not oily.