Skin Disorders
The clinic nurse notes that the health care provider has documented a diagnosis of herpes zoster (shingles) in the client's chart. Based on an understanding of the cause of this disorder, the nurse determines that this definitive diagnosis was made by which diagnostic test?
A. Positive patch test
B. Positive culture results
C. Abnormal biopsy results
D. Wood's light examination indicative of infection
B. Positive culture results
Rationale:
With the classic presentation of herpes zoster, the clinical examination is diagnostic. However, a viral culture of the lesion provides the definitive diagnosis.
A patch test is a skin test that involves the administration of an allergen to the surface of the skin to identify specific allergies. A biopsy would provide a cytological examination of tissue. In a Wood's light examination, the skin is viewed under ultraviolet light to identify an organism.
A patient with rheumatoid arthritis (RA) is prescribed Methotrexate. What is the most important teaching point for this medication?
A. Avoid taking with dairy products
B. Take with a full glass of water
C. Report any signs of infection immediately
D. Limit intake of green leafy vegetables
C. Report any signs of infection immediately
Rationale:
Methotrexate is an immunosuppressant, and patients are at increased risk for infections.
Reporting signs of infection is critical. While taking with water is a good practice, it is not as crucial as infection monitoring. Avoiding dairy or green leafy vegetables is not specifically related to methotrexate.
A patient is diagnosed with a urinary tract infection (UTI). Which symptoms is most commonly associated with this condition?
A. Dysuria
B. Bradycardia
C. Hyperglycemia
D. Hypertension
A. Dysuria
Rationale:
Dysuria, or painful urination, is a common symptom of UTIs. The other options are not typically associated with UTIs.
A patient with Systemic Lupus Erythematosus (SLE) is admitted with severe joint pain and fatigue. Which laboratory test result is most indicative of a lupus flare?
A. Elevated erythrocyte sedimentation rate (ESR)
B. Positive antinuclear antibody (ANA) titer
C. Increased Creatinine level
D. Low complement levels (C3 and C4)
D. Low complement levels (C3 and C4)
Rationale:
Low complement levels (C3&C4) are indicative of active lupus because they are consumed during the inflammatory process. Elevated ESR and positive ANA are common in many autoimmune disorders and are not specific to lupus flares.
Increased creatinine may indicate renal involvement but does not directly indicate a flare.
A patient with autoimmune hemolytic anemia is being treated with corticosteroids. Which laboratory result would indicate a positive response to treatment?
A. Decreased reticulocyte count
B. Increased hemoglobin level
C. Elevated bilirubin level
D. Low haptoglobin test
B. Increased hemoglobin level
Rationale:
An increase in hemoglobin levels would indicate a positive response to treatment as it suggests a reduction in hemolysis.
The staff nurse reviews the nursing documentation in a client's chart and notes that the wound care nurse has documented that the client has a stage II pressure injury in the sacral area. Which finding would the nurse expert to note on assessment of the client's sacral area?
A. Intact skin
B. Full-thickness skin loss
C. Exposed bone, tendon, or muscle
D. Partial-thickness skin loss of the dermis
D. Partial-thickness skin loss of the dermis
Rationale:
In stage 2 pressure injury, the skin is not intact. Partial thickness skin loss of the dermis has occurred. It presents as a shallow open ulceration with a red-pink wound bed without slough. It may also present as an intact or open/ruptured serum-filled blister. The skin is intact in stage one period full thickness skin loss occurs in stage 3. Exposed bone, tending, or muscle is present in stage 4.
A patient with systemic lupus erythematosus (SLE) is experiencing pericarditis. What is the most appropriate initial intervention?
A. Administer NSAIDs
B. Start antibiotic therapy
C. Initiate corticosteroid treatment
D. Begin anticoagulant therapy
A. Administer NSAIDs
Rationale:
NSAIDs are often the first line of treatment for pericarditis to reduce inflammation and pain.
Corticosteroids may be used if NSAIDs are not effective, but antibiotics and anticoagulants are not indicated for pericarditis unless there are specific indications.
When educating a patient about preventing catheter-associated urinary tract infections (CAUTIs), what is the most important advice?
A. "Drink cranberry juice daily"
B. "Ensure proper catheter care and hygiene."
C. "Take prophylactic antibiotics"
D. "Needs to be discontinued with sterile technique"
B. "Ensure proper catheter care and hygiene."
Rational:
Proper care and hygiene of the catheter are critical in preventing CAUTIs. This includes regular cleaning of the catheter and the area around the urethra.
The nurse is admitting a patient positive for human immunodeficiency virus (HIV). A fellow nurse states, "This patient is on contact precautions for his HIV status. You need to wear an isolation gown in addition to your gloves." Which response by the nurse is most appropriate?
A. "Thank you for reminding me, I'll put on my gown now."
B. "The patient only requires standard precautions."
C. "Actually, I only need to wear gloves if I have open cuts on my hand."
D. "HIV is only spread by eating infected meat and vegetables."
B. "The patient only requires standard precautions."
Rational:
HIV is one of the blood-borne pathogens that universal precautions protect against. The nurse should wear gloves when coming in contact with any bodily fluids, not when the nurse has a break in the skin. HIV is spread by contact with infected bodily fluids, not by eating infected meat and vegetables.
The nurse provides care for a pediatric client who is postoperative for kidney transplantation and prescribed immunosuppressant therapy to decrease the risk for organ rejection. The child is prescribed neutropenic precautions due to significantly decreased absolute neutrophil count. Which action by the unlicensed assistive personnel (UAP) requires intervention by the nurse to decrease the child's risk for infection?
A. The UAP dons gloves to empty the child's bed pan
B. The UAP performs hand hygiene before taking vital signs
C. The UAP provides fresh fruit for the child's bedtime snack.
D. The UAP dons a gown when assisting the child with bathing
C. The UAP provides fresh fruit for the child's bedtime snack.
Rationale:
Fresh fruit may harbor infection-causing bacteria thus it is contraindicated for a pediatric client who is immunocompromised due to neutropenia; therefore, this UAP action requires intervention by the nurse to decrease the child's risk for infection.
The nurse manager is planning the clinical assignments for the day. Which staff members cannot be assigned to care for a client with herpes zoster? Select all that apply.
A. The nurse who never had roseola
B. The nurse who never had mumps
C. The nurse who never had chicken pox
D. The nurse who never had German measles
E. The nurse who never received the varicella-zoster vaccine
C. The nurse who never had chicken pox
E. The nurse who never received the varicella-zoster vaccine
Rationale:
The nurses who have not had chicken pox or did not receive the varicella-zoster vaccine are susceptible to the herpes zoster virus and should not be assigned to care for the client with herpes zoster. Nurses who have not contracted roseola, mumps, or rubella are not necessarily susceptible to herpes zoster.
Which statement by a patient indicates a need for further education about antibiotic therapy?
A. "I should stop taking the antibiotic as soon as I feel better."
B. "I need to take the antibiotics until they are all gone, even if I feel better."
C. "I should take the antibiotics at evenly spaced intervals."
D. "I will call my doctor if I experience any severe side effects."
A. "I should stop taking the antibiotic as soon as I feel better."
Rational:
This statement is incorrect. Patients should complete the full course of antibiotics to prevent the development of antibiotic-resistant bacteria.
The nurses working in the emergency department is assessing a client who recently returned from Nigeria and presented complaining of a fever at home, fatigue, muscle pain, and abdominal pain. What action would the nurse take next?
1. Check the client's temperature
2. Isolate the client in a private room
3. Check a complete set of vital signs
4. Contact the primary health care provider
2. Isolate the client in a private room
Rationale:
The nurse would suspect the potential for Ebola virus disease (EVD) because of the clients recent travel to Nigeria. The nurse needs to consider the symptoms that the client is reporting, and clients who meet the exposure criteria need to be isolated in a private room before other treatment measures are taken. Exposure criteria include a fever reported at home or in the ED of 38.0 C (100.4) or a headache, fatigue, weakness, muscle pain, vomiting, diarrhea, abdominal pain, or signs of bleeding. After isolating the client, it would be acceptable to then collect further data and notify the Primary Health care provider and other state and local authorities of the clients signs and symptoms.
The community health nurse is conducting a research study and is identifying clients in the community at risk for latex allergy. Which client population is most at risk for developing this type of allergy?
A. Hairdressers
B. The homeless
C. Children in day care centers
D. Individuals living in a group home
A. Hairdressers
Rationale:
Individuals most at risk for developing a latex allergy include healthcare workers; individuals who work in the rubber industry; or those who have had multiple surgeries, have spina bifida, wear gloves frequently or are allergic to Kiwis, bananas, pineapples, tropical fruits, grapes, avocado, potatoes, hazelnuts, or water chestnuts
The patient with Type 1 diabetes mellitus has contracted influenza A. Which lab must be most closely monitored in this patient to prevent a life-threatening complication?
A. Sodium
B. Calcium
C. Potassium
D. White blood cell count
C. Potassium
Rationale
The patient with type 1 diabetes mellitus who falls ill is at risk for diabetic ketoacidosis. The resulting osmotic diuresis and acidosis result in hypokalemia which can lead to fatal cardiac dysrhythmias. DKA can also lead to hyponatremia which can cause cerebral edema if untreated for an extended period of time. It is important to monitor the sodium level, but it is less deadly than hypokalemia. DKA can cause alterations in several other electrolyte levels, including calcium, but it is less of a concern than hypokalemia. The patient will likely have elevated white blood cell count related to the influenza A, however, it is not considered to be life-threatening complication.
The 8-year-old presents with a generalized rash. The patient's mother reports that some areas of the rash have developed into pimples that are oozing clear fluid. The nurse places this patient on which type of precaution(s)? Select all that apply.
A. Contact
B. Airborne
C. Droplet
D. Standard
E. Neutropenic
A, B, D
Rational:
The patient's presentation is suspicious for varicella (chicken pox) infection. The correct precautions for a patient with varicella who has draining lesions or contact and airborne precautions; all patients require standard precautions. Droplet precautions are used for patients with respiratory viruses such as rhinovirus. Neutropenic precautions are appropriate for severely immuno-compromised patients.
A nurse is preparing to administer medication to a patient with acne. Which medication requires the nurse to advise the patient to avoid pregnancy due to teratogenic effects?
A. Tretinoin
B. Isotretinoin
C. Clindamycin
D. Benzoyl peroxide
B. Isotretinoin
Rationale:
Isotretinoin, an oral retinoid, has significant teratogenic effects and women of childbearing age must avoid pregnancy while on this medication. A pregnancy test and enrollment in a risk management program are required before initiation.
The community health nurse is providing a teaching session about anthrax to members of the community and asks the participants about the methods of transmission. What answers by the participants would indicate that teaching was effective? Select all that apply?
1. Bites from ticks or deer flies
2. Inhalation of bacterial spores
3. Through a cut or abrasion in the skin
4. Direct contact with an infected individual
5. Sexual contact with an infected individual
6. Ingestion of contaminated undercooked meat
2, 3, 6
Rational:
Anthrax is caused by Bacillus anthracis and can be contracted through the digestive system or abrasions in the skin or inhaled through the lungs. It cannot be spread from person to person, and it is not contracted via bites from ticks or deer flies.
The nurse provides care for a client who is postoperative for a heart transplant and is prescribed immunosuppressant therapy to decrease the likelihood of rejection. Which precaution should the nurse implement in the provision of care for this client to decrease the risk for infection that is associated with immunosuppressant therapy?
A. Droplet
B. Contact
C. Reverse
D. Airborne
C. Reverse
Rationale:
Reverse precautions are implemented to decrease the immunocompromised patient risk for infection when hospitalized.
A nurse is assessing a patient with cellulitis. Which finding is most consistent with this diagnosis?
A. A hard, raised lesion with clear borders
B. A warm, red, swollen area with diffuse borders
C. A cluster of fluid-filled blisters
D. Dry, scaly patches of skin
B. A warm, red, swollen area with diffuse borders
Rationale:
Cellulitis typically presents as a warm, red, swollen area with diffuse borders, often accompanied by fever and malaise. This bacterial skin infection requires prompt treatment with antibiotics.
The nurse is performing a skin assessment on a patient and notes an area of full-thickness loss of skin on the sacrum. Adipose tissue and granulation tissue are present with no visible muscle, tendon ligament, cartilage, or bone. How would the nurse classify this pressure injury?
A. Stage 1 pressure injury
B. Stage 2 pressure injury
C. Stage 3 pressure injury
D. Stage 4 pressure injury
C. Stage 3 pressure injury
Rationale:
A stage 3 pressure injury is characterized by full thickness skin loss in which adipose tissue is apparent with slough or eschar. There may also be granulation tissue and rolled wound edges. There is no exposed fascia, muscle, tendon, ligament, cartilage, or bone; This would be noted in a stage 4 pressure injury
A 6-day-old neonate in the newborn intensive care unit has been prescribed oxacillin for a suspected central line-associated bloodstream infection. The nurse receives the following order: oxacillin IV 50mg/kg/day, divided q12hr. The neonate weights 2lb. 11oz and the pharmacy dispenses the medication in a concentration of 20mg/ml. How many milliliters will the nurse administer for each dose? Round your answer to the nearest tenth decimal place.
A. 1.5ml
B. 1ml
C. 2ml
D. 1.2ml
A. 1.5ml
Rational:
The 2lb. 11oz (2.7lb) neonate weighs 1.2kg. 50mg/kg/day means that the patient will receive 60mg/day (50mg x 1.2kg) divided into two doses, which is 30mg/dose. With concentration of 20mg/ml, the nurse would administer 1.5ml of oxacillin q12h intravenously.
The nurse is assigned to a 45-year-old HIV-positive male patient who is admitted with a MRSA skin infection on his right arm secondary to intravenous drug use. The patient is prescribed intravenous vancomycin. Twenty minutes after starting the vancomycin infusion, the patient develops a mild erythematous macular rash on the face, trunk and extremities. Which action is performed first?
A. Administer topical hydrocortisone cream
B. Give Benadryl IV
C. Stop the infusion
D. Slow the infusion rate
C. Stop the infusion
Rational:
The patient presents with signs and symptoms of red man's syndrome, a drug reaction associated with vancomycin. If patients who acutely developed red man syndrome during the infusion of the medication, stopping the infusion is the first recommended treatment step. Slowing the infusion rate would be appropriate if there was no concern for anaphylaxis, but it can sometimes be difficult to distinguish between red man syndrome and anaphylaxis. Red man syndrome is related to rate of infusion however so if anaphylaxis is ruled out, the drug can be restarted at a slower infusion rate. Topical hydrocortisone cream and Prednisone can be used for symptomatic treatment, but they are not alternatives to temporary or permanent stopping the medication.
A patient with chronic idiopathic urticaria is not responding to standard antihistamine treatment. What additional medication might be considered?
A. Beta-blockers
B. Leukotriene receptor antagonists
C. Calcium channel blockers
D. ACE inhibitors
B. Leukotriene receptor antagonists
Rationale:
Leukotriene receptor antagonists, such as montelukast, can be used as an adjunct therapy in chronic idiopathic urticaria when antihistamines alone are insufficient.
Beta-blockers, calcium channel blockers, and ACE inhibitors are not indicated for this condition.
The nurse reviews the client's chart and notes that the physician has documented a diagnosis of paronychia. Based on this diagnosis, which of the following would the nurse expect to note during the assessment?
A. Red shiny around the nail bed
B. White taut skin in the popliteal area
C. White silvery patches on the elbows
D. Swelling of the skin near the parotid gland.
A. Red shiny around the nail bed
Rationale:
Paronychia or infection around the nail, is characterized by red, shiny skin often associated with painful swelling. These infections frequently result from trauma, picking at the nail, or disorder such as dermatitis. Often these become secondarily infected with bacteria or fungus.