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NRNP 6540 LATEST EXAM WITH 350
QUESTIONS AND CORRECT ANSWERS
question- 1. The nurse practitioner is conducting patient rounds in a long-term care facility. As she talks with Mrs. Jones, she notices that her arms and elbows are excoriated and the skin is shearing. The nurse practitioner explains to the staff that Mrs. Jones needs frequent assessment of her skin and protection provided to prevent skin breakdown because:
- Her lack of activity causes the skin to tear.
- Fat has redistributed to the abdomen and thighs, leaving bony surfaces in areas such as the face, hands, and sacrum. This can result in injury.
- She has lost weight and is in jeopardy of falling.
- She picks at herself and causes skin breakdown. - answer-2. Answer: 2 Page: 96 Feedback
Lack of activity alone does not cause skin breakdown.
Fat is redistributed to the abdomen and thighs, leaving bony surfaces, such as the face, hands, and sacrum, exposed to potential injury, especially skin tears from shearing, friction forces and pressure ulcer development.
Although losing weight may be a risk factor for falling, it is not directly related to skin breakdown.
There is no evidence that she is picking at herself, as there is nothing reported anywhere else on her arms. question- 2. Mr. James is 91 years old. His daughter notices that he has bruises and lacerations on his arms and reports this to the nurse practitioner, who tells her that older people bruise easily due to their fragile blood vessels. The skin lacerations happen because he has thin skin. Even so, the nurse practitioner assures the daughter that she will investigate further to ensure that he is getting proper care. She says this because she understands that:
- These markings on the patient's skin are part of aging skin.
- Bruises and lacerations can indicate inadequate care.
- The daughter needs assurance that her father is okay.
- The patient is being abused. - answer-3. Answer: 2 Page: 97 Feedback
Markings on the skin may be signs of aging, a disease, or maltreatment.
Skin renewal turnover time increases to approximately 87 days in older adults, compared with 20 days during youth.
The perceived extended healing time is not related to diet.
This is false hope, as there is no medication that will heal this wound quickly.
Prophylactic antibiotics are not appropriate when there are no signs or symptoms of infection. question-4. The nurse practitioner assesses a patient's skin and finds an infectious lesion on the lower leg. The lesion is considered a secondary lesion. The nurse practitioner explains that a secondary lesion is one that:
- Arises from changes to a primary lesion.
- Is a complication of an underlying disease.
- Is difficult to treat.
- Is a normal sign of aging. - answer-4. Answer: 1 Page: 97 Feedback
Secondary lesions (infections) arise from changes to the primary lesion.
Secondary lesions are not necessarily the result of an underlying disease.
Secondary lesions can be treated with medications or surgery.
Secondary lesions arise as a condition not normal to aging. question-5. Ms. Rose, 88 years old, comes to the nurse practitioner with a complaint about a growth on her hand. She wants to have a biopsy done. The nurse practitioner asks the following question:
- Have you injured your hand recently?
- Are you using a different detergent?
- Has this growth changed, bled, or is it painful?
- Has this growth made it difficult to put on your rings? - answer-5. Answer: 3 Page: 97 Feedback
An injury would not stimulate growth.
A reaction to a detergent would more likely be a rash.
The patient presents with erythematous skin, painful with blisters, which indicates both first- and second-degree burn areas.
In third-degree burns there is no sensation when the wound is pinpricked. question-7. The nurse practitioner is concerned with primary prevention strategies. How can the nurse practitioner implement primary prevention strategies for an 80-year-old male patient who smokes?
- Review home fire safety protocols, including the proper use of smoke alarms, and discuss smoking cessation.
- Inform him that if he does not stop smoking, the nurse practitioner cannot see him again.
- Have a conference with his family about his smoking.
- Plan a family meeting with the patient to discuss benefits of his smoking cessation. - answer-7. Answer: 1 Page: 115, 116 Feedback
Primary prevention includes educational programs designed to educate the public on safety. For example, the individual smoking in bed would hopefully benefit from smoking cessation programs in the community, as well as instruction in safety precautions.
Threatening refusal of care is not ethical.
The patient is at risk, not the family.
The fact that the patient smokes is not the issue; safety is the issue. question-8. The nurse practitioner is conducting a safety class with community-living older adults. Which of the following should she include in her teaching of risks of burns for this population? Select all that apply.
- Thinner skin.
- Less vascularity.
- Diminished nerve function.
- A weakened immune system.
- The burden of various comorbidities leading to enhanced wound healing and reepithelialization after burn injury. - answer-8. Answer: 1, 2, 3, 4 Page: 98 Feedback
As one ages, there are significant changes in the skin, which becomes thinner, providing a less effective barrier to external stimuli.
With aging, there are fewer appendages and decreased vascularity.
Thinner skin and diminished nerve function often result in a higher incidence of deeper burns.
In these burns there is pain from exposed nerve endings, but by the second day, pain is often described more as pressure.
The first step in treatment is to stop the burn.
Destroyed nerves do not register pain.
Superficial dermal burns involve the dermis and are characterized by blisters. The underlying tissue is pink, moist, and hypersensitive to touch. question-10. Mrs. Thomas is 82 years old and burned her hand while cooking. The nurse practitioner assesses second- and third-degree burns over approximately half of the back of her hand. The nurse practitioner chooses which of the following for initial treatment? Select all that apply.
- Administer appropriate pain medication.
- Rinse with cool tap water.
- Clean with a strong detergent.
- Remove any loose tissue but allow the blisters to remain.
- Diagnose as first- and third-degree burns. - answer-10. Answer: 1, 2, 4 Page: 100
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After administration of appropriate pain medication, wound management can begin.
Burn wounds should be immediately doused in cool tap water to disperse any remaining heat in the tissue.
Detergents and antibacterial soaps are not indicated. Burn wounds should be cleaned with mild soap and rinsed.
For small surface area burns, it is good to remove any loose tissue during cleansing and allow intact blisters to remain.
First-degree burns do not exhibit blisters, and third-degree burns do not exhibit pain. question-11. Mr. Watson,75 years old, comes to the urgent care center with complaints of fever, fast heartbeat, a swollen gland under his right arm, and redness in his upper left arm that has hurt for 2 to 3 days. The patient says that he has had the redness in his arm for months without any difficulty. The nurse practitioner suspects which of the following? Select all that apply.
- Influenza
- Upper respiratory infection
- Cellulitis of upper left arm
- Necrotizing fasciitis
- Treatment is dependent on the culture of the cells affected.
- The drug of choice is given for a minimum of 3 days.
- Administration of a tetanus booster injection. - answer-12. Answer: 1, 2 Page: 103 Feedback
Oral antibiotics are sufficient for mild cellulitis and IV antibiotics for organisms such as MRSA.
There are several drugs effective with cellulitis; dicloxacillin is one of them.
Treatment of MRSA should be guided by wound culture results, but not cellulitis.
The drug of choice is typically given for 7 days.
If the wound is grossly contaminated and the patient's last tetanus booster was 5 to 10 years ago, the practitioner should consider giving another booster at this time. question-13. A 59-year-old female was admitted to the hospital for malaise, headache, fever, and flu-like symptoms. She has a decreased appetite and is having trouble sleeping. After a couple of days, she complains to the nurse practitioner of itching, burning, and tingling pain around her waist. The nurse practitioner advises the nursing staff to observe for vesicles for a few days. The
patient asks why she is so sick. What would be the nurse practitioner's best response? Select all that apply.
- We are not certain at this point, however, these symptoms often occur before a break-out of herpes zoster.
- You have some very general systemic symptoms, so we are waiting for more specific symptoms to appear.
- Because you had chicken pox as a child, and you now have a depressed immune system, the chance of developing herpes zoster is high.
- These symptoms are probably a strong case of influenza.
- Herpes zoster is more com - answer-13. Answer: 1, 3 Page: 106 Feedback
Patients usually experience itching, burning, or tingling pain at the site 4 to 5 days before the eruption appears.
Although there are general systemic symptoms, there is also itching, burning, and pain in the waist, which is leading to a herpes zoster diagnosis.
The patient has initial contact with VZV in the form of chicken pox. Individuals who are immunosuppressed are more likely to develop herpes zoster.
Common locations for skin cancers are the scalp, ears, lower lip, and dorsal side of the hands.
Signs of malignancy include inflammation of the lesion.
The incidence of all types of skin cancers increases with age and the degree and intensity of sun exposure.
Certain genetic predispositions can contribute to the development of skin cancer, and there is a familial tendency to develop melanoma. question-15. The nurse practitioner is making patient rounds in a long-term care facility and is visiting Mr. Smith, 95 years old, who has a large amount of fungus growing from his toenails. The staff nurse asks what can be done to help alleviate this nail fungus. What does the nurse practitioner advise? Select all that apply.
- Wash and completely dry the feet and toes daily.
- Keep the patient's feet cool and dry.
- Use aluminum acetate solution (Burow's solution).
- Have the patient wear occlusive footwear.
- Use clotrimazole (ointment, cream, or lotion). - answer-15. Answer: 1, 2, 3 Page: 123
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The key to prevention of recurrence is to keep the area dry. Use a hairdryer to thoroughly dry the area after bathing.
The key to prevention of all types is to keep the skin cool and dry.
The use of aluminum acetate solution (Burow's) and the application of antifungal or absorbent powder have all been shown to prevent recurrence.
Avoiding occlusive footwear, wearing absorbent materials, and practicing good hygiene offer the best primary prevention.
Newer agents are more likely to cure tinea pedis than the older generation of antifungals, including clotrimazole, which is fungistatic, whereas terbinafine is fungicidal. question-1. In the assessment for peripheral vascular disorders, the clinician should begin with which of the following after the general history and physical examination?
- Auscultation of the carotid arteries bilaterally.
- Palpation of the carotid arteries bilaterally.
- Inspection of the carotid arteries bilaterally.
- Order diagnostic testing. - answer-1. Answer: 1
Page: 218 Feedback
AAA presents the signal symptoms of persistent or intermittent pain in the middle or lower abdomen, radiating to the lower back.
Venous leg ulcers present signal symptoms of swelling that subside with elevation of lower extremities, eczematous skin changes, dull ache in lower extremities, and presence of varicosities.
PVD is a disease that alters blood flow to or from the extremities and vital organs other than the heart. It presents signal symptoms of pain, intermittent claudication of the feet, and tissue loss in affected leg/arm.
Lymphedema presents the signal symptoms of swelling of the affected body part, usually the limb, because of impaired flow of lymph fluid. question-3. In the initial screening for a diagnosis of AAA, which of the following is the best screening test?
- CT scan
- Complete blood count (CBC)
- Ultrasound in the abdominal area
- Angiography - answer-3. Answer: 3 Page: 216 Feedback
CT screening is indicated when surgery is planned.
CBC may be a secondary screening when surgery is planned.
Ultrasound in the abdominal area is the best initial screening test for AAA.
Angiography screening is indicated when surgery is planned. question-4. Mrs. Prentiss is diagnosed with symptomatic AAA. The initial treatment is aggressive blood pressure control. At which of the following readings should mean arterial pressure be maintained?
- Between 100 and 120 mm Hg.
- Between 90 and 120 mm Hg.
- Between 60 and 70 mm Hg.
- Between 80 and 100 mm Hg. - answer-4. Answer: 3
