Question 1

A client is returning to the nursing unit after an intermaxillary wiring to treat a facial fracture. What equipment is vital for the nurse to have at the bedside? (Select all that apply)
A) Scale
B) Suction set-up
C) Thermometer
D) Wire cutters

Accepted Answer

Airway problems can lead to life-threatening situations for the client whose jaws are wired shut. Suction equipment must be readily available. If the client has an airway problem that cannot be cleared with suctioning, the nurse must cut the wires holding the jaw together. A thermometer is also needed shortly after the client returns to the nursing unit, but is not the priority over equipment to protect the airway.

Question 2

The nurse would record the assessment of a nonblanching reddened area on an older client's sacrum as
A) atopic dermatitis.
B) intertrigo.
C) stage 1 pressure ulcer.
D) xerotic eczema.

Accepted Answer

A reddened area that cannot be blanched, especially if it is on a bony prominence, is indicative of a stage 1 ulcer. Precautions should be taken at this point so that the ulcer does not progress.

Question 3

Activities related to skin care the registered nurse can delegate to an unlicensed assistive personnel (UAP) include which of the following? (Select all that apply.)
A) Applying over-the-counter lotions to skin that is not broken
B) Assisting the client with frequent turning to prevent pressure ulcers
C) Covering the client who complains of being cold with more blankets
D) Placing a sterile gauze pad over broken skin to contain drainage
E) Treating a new rash with topical antihistamines if ordered

Accepted Answer

All the above options can be delegated to a UAP except option e. Prescription medications need to be applied by the registered nurse. The nurse needs to investigate a new rash for the possibility of an allergic reaction.

Question 4

A nurse is working with a client suffering from chronic pruritus. The client is angry and frustrated. The nurse should incorporate actions into the care plan that acknowledge
A) multiple treatments may be tried before finding one that works.
B) the lack of any effective treatments for pruritus.
C) the major impact pruritus has on quality of life.
D) that pruritus is very expensive to treat.

Accepted Answer

Pruritus is challenging because of its common occurrence, detrimental effect on skin health, and the major effect it may have on quality of life.

Question 5

When teaching a client with intermaxillary wiring, the nurse would instruct the client to avoid
A) carbonated beverages.
B) thick drinks.
C) using a water irrigation device.
D) vitamin supplements.

Accepted Answer

Alcoholic and carbonated beverages should be avoided because they can cause nausea and create fizz and foam in the back of the throat, leading to airway problems.

Question 6

Oral antiviral therapy is prescribed for a client with herpes zoster. The nurse would explain to the client that the medication is used to decrease (Select all that apply)
A) itching.
B) pain.
C) postherpetic neuralgia.
D) recurrence.
E) spreading.

Accepted Answer

When antivirals are started early in the disease, they can reduce pain and accelerate healing. They also seem to have a role in reducing the incidence of postherpetic neuralgia. Pain relief can also be obtained through analgesics and sedatives.

Question 7

Before plastic surgery, the nurse would help the client develop (Select all that apply)
A) a good body image.
B) a positive attitude.
C) plans for payment.
D) realistic expectations.
E) satisfactory motivation.

Accepted Answer

Preoperative teaching includes helping the client develop realistic postoperative expectations. Working with clients to bolster their body image is also important.

Question 8

The nurse would reinforce to a client who is about to undergo liposuction for removal of excess fatty tissue that
A) bed rest is required for 24 hours after suction lipectomy.
B) final results may take up to 6 months to appear.
C) only small amounts of tissue can be removed at one time.
D) the client cannot receive analgesics after liposuction for several days.

Accepted Answer

Usually up to 6 months is required for the final results of liposuction to be apparent, after edema subsides and subcutaneous tissue heals. Clients need to be aware of this so their expectations are not unrealistically high preoperatively. Clients gradually resume normal activities, although it may take up to 6 weeks before the client can engage in strenuous activity. Large amounts of fat can be removed, but the nurse must assess the client for hypovolemia. Oral analgesics are effective for pain.

Question 9

The nurse would counsel a client with eczema that the condition that might preclude the use of PUVA, or at least would require extra precautions, is
A) age over 60.
B) cataracts in development.
C) long-term cortisone therapy.
D) presence of open lesions.

Accepted Answer

A history of cataract formation is a potential contraindication for PUVA. Clients who exhibit cataract formation need extra eye protection and more frequent ophthalmologic exams.

Question 10

The nurse would explain to a client that effective treatments for severe pruritus include (Select all that apply)
A) oral corticosteroids.
B) sealing emollients.
C) tricyclic antidepressants.
D) topical antihistamines.
E) topical corticosteroids.

Accepted Answer

Sealing emollients, applied immediately after a warm bath or soak, can be used with or without other topical medications. Tricyclic antidepressants can be used as they have a high binding capacity for H? receptors and are especially useful in clients who would benefit from both the antidepressant and the antihistaminic effect.

Question 11

A nurse is caring for a client who had a musculocutaneous flap reconstruction. The nurse assesses the flap to be cool with dark dermal blood on lancing. The most appropriate action by the nurse is to
A) document the findings and continue care.
B) elevate the affected body part if possible.
C) notify the surgeon immediately.
D) rewrap the pressure dressing.

Accepted Answer

The major concern with flap reconstruction is establishing and/or maintaining the blood flow to the flap. A cool, pale flap with decreased capillary refill, or dark dermal blood on lancing, indicate perfusion problems and the surgeon should be notified at once. The body part should already be elevated if possible unless that interferes with arterial flow.

Question 12

When caring for a client after a chemical peel procedure to the face, the nurse would
A) apply skin moisturizer.
B) cleanse the client's face with an astringent.
C) maintain the client in a head-down position.
D) use abrasive cleaning agents.

Accepted Answer

Care after chemical peel includes application of skin moisturizers, gentle cleansing, use of sunscreen, and avoidance of abrasive agents. Abrasives and astringents would dry and damage the fragile skin. The head-down position would encourage edema formation.

Question 13

A client is expressing great disappointment that the plastic surgery did not turn out as well as expected. The client is distressed over visible scarring and lingering edema. The most appropriate nursing diagnosis for this client is
A) Altered Coping
B) Disturbed Body Image
C) Fear
D) Situational Low Self Esteem

Accepted Answer

The most appropriate diagnosis is Disturbed Body Image since the client is complaining about the way his/her body looks postoperatively. If the client made negative comments about him/herself, the diagnosis would be Situational Low Self-Esteem. The client made no comments that would lead the nurse to choose either of the other two options.

Question 14

The nursing care for a client after rhinoplasty would include
A) administering aspirin to decrease inflammation.
B) changing nasal packing daily to prevent infection.
C) maintaining the client flat in bed to reduce edema.
D) observing for excessive swallowing to assess for bleeding.

Accepted Answer

Postoperatively, the nurse should assess for bleeding. While the client is sleepy from the anesthetic, excessive swallowing may be the only indication of bleeding.

Question 15

To prevent pressure ulcers in a frail elderly client, the nurse would (Select all that apply)
A) bathe and dry the skin vigorously to stimulate circulation.
B) keep the head of the bed elevated 30 degrees.
C) offer nutritional supplements and frequent snacks.
D) turn the client at least every 2 hours.

Accepted Answer

Clients should be turned at least every 2 hours as permanent damage can occur in 2 hours or less. If skin assessment reveals a stage I ulcer while on a 2-hour turning schedule, the client must be turned more frequently. Protein-calorie malnutrition is another major risk factor for developing pressure ulcers. Additional supplements boost nutritional status, which is essential to healthy skin. Use of doughnuts, elevated head of beds, and overstimulation of skin may all stimulate, if not actually encourage, dermal decline.

Question 16

The nurse working with a UAP can delegate all of the following activities related to care of the client with a pressure ulcer except
A) assessing the client's skin using a standardized tool.
B) turning and repositioning the client according to a schedule.
C) keeping the client's skin clean and dry.
D) reporting any red areas that do not disappear after pressure relief.

Accepted Answer

Options b, c, and d are all activities that can be delegated to the UAP. Assessment remains the responsibility of the professional nurse.

Question 17

A nurse is working with a client who has a disfigured face and who is undergoing a series of reconstructive operations. The nurse has formulated the diagnosis: Disturbed Body Image related to perceived disfigurement as a primary problem. The least helpful intervention by the nurse would be to
A) present reality in a kind and compassionate manner.
B) refer the client to a licensed aesthetician to help with makeup.
C) say "I know how you feel" while sitting with the client.
D) tell the client s/he has to look in a mirror to get used to the facial appearance.

Accepted Answer

This statement is a communication barrier. Better statements include "You seem depressed" and "You are angry." These statements provide openings for communication.

Question 18

After abdominoplasty, the nurse would place the client in the
A) low-Fowler position.
B) mid-Fowler position with knees bent.
C) side-lying position.
D) supine position with knees bent.

Accepted Answer

The post-abdominoplasty client needs to lie in a contouring position (i.e., mid-Fowler position with knees bent) when in bed to decrease tension on the suture lines.

Quiz 49: Management of Clients with Integumentary Disorders

A client is returning to the nursing unit after an intermaxillary wiring to treat a facial fracture. What equipment is vital for the nurse to have at the bedside? (Select all that apply)

The nurse would record the assessment of a nonblanching reddened area on an older client's sacrum as

Activities related to skin care the registered nurse can delegate to an unlicensed assistive personnel (UAP) include which of the following? (Select all that apply.)

A nurse is working with a client suffering from chronic pruritus. The client is angry and frustrated. The nurse should incorporate actions into the care plan that acknowledge

When teaching a client with intermaxillary wiring, the nurse would instruct the client to avoid

Oral antiviral therapy is prescribed for a client with herpes zoster. The nurse would explain to the client that the medication is used to decrease (Select all that apply)

Before plastic surgery, the nurse would help the client develop (Select all that apply)

The nurse would reinforce to a client who is about to undergo liposuction for removal of excess fatty tissue that

The nurse would counsel a client with eczema that the condition that might preclude the use of PUVA, or at least would require extra precautions, is

The nurse would explain to a client that effective treatments for severe pruritus include (Select all that apply)

A nurse is caring for a client who had a musculocutaneous flap reconstruction. The nurse assesses the flap to be cool with dark dermal blood on lancing. The most appropriate action by the nurse is to

When caring for a client after a chemical peel procedure to the face, the nurse would

A client is expressing great disappointment that the plastic surgery did not turn out as well as expected. The client is distressed over visible scarring and lingering edema. The most appropriate nursing diagnosis for this client is

The nursing care for a client after rhinoplasty would include

To prevent pressure ulcers in a frail elderly client, the nurse would (Select all that apply)

The nurse working with a UAP can delegate all of the following activities related to care of the client with a pressure ulcer except

A nurse is working with a client who has a disfigured face and who is undergoing a series of reconstructive operations. The nurse has formulated the diagnosis: Disturbed Body Image related to perceived disfigurement as a primary problem. The least helpful intervention by the nurse would be to

After abdominoplasty, the nurse would place the client in the