module 7 ch 56 (2nd-17) test bank

A patient's blistering disorder has resulted in the formation of multiple lesions in the patient's mouth. What intervention should be included in the patient's plan of care?

• Provide chlorhexidine solution for rinsing the patient's mouth.

• Avoid providing regular mouth care until the patient's lesions heal.

• Liaise with the primary care provider to arrange for parenteral nutrition.

• Encourage the patient to gargle with a hypertonic solution after each meal.

When caring for a patient with toxic epidermal necrolysis (TEN), the critical care nurse assesses frequently for high fever, tachycardia, and extreme weakness and fatigue. The nurse is aware that these findings are potential indicators of what? Select all that apply.

• Possible malignancy

• Epidermal necrosis

• Neurologic involvement

• Increased metabolic needs

• Possible gastrointestinal mucosal sloughing

A nurse is assessing a teenage patient with acne vulgaris. The patient's mother states, 'I keep telling him that this is what happens when you eat as much chocolate as he does.' What aspect of the pathophysiology of acne should inform the nurse's response?

• A sudden change in patient's diet may exacerbate, rather than alleviate, the patient's symptoms.

• Chocolate is not among the foods that are known to cause acne.

• Elimination of chocolate from the patient's diet will likely lead to resolution within several months.

• Diet is thought to play a minimal role in the development of acne.

A nurse is providing self-care education to a patient who has been receiving treatment for acne vulgaris. What instruction should the nurse provide to the patient?

• Wash your face with water and gentle soap each morning and evening.

• Before bedtime, clean your face with rubbing alcohol on a cotton pad.

• Gently burst new pimples before they form a visible head.

• Set aside time each day to squeeze blackheads and remove the plug.

A nurse is caring for a patient whose skin cancer will soon be removed by excision. Which of the following actions should the nurse perform?

• Teach the patient about early signs of secondary blistering diseases.

• Teach the patient about self-care after treatment.

• Assess the patient's risk for recurrent malignancy.

• Assess the patient for adverse effects of radiotherapy.

A patient has just undergone surgery for malignant melanoma. Which of the following nursing actions should be prioritized?

• Maintain the patient on bed rest for the first 24 hours postoperative.

• Apply distraction techniques to relieve pain.

• Provide soft or liquid diet that is high in protein to assist with healing.

• Anticipate the need for, and administer, appropriate analgesic medications.

A patient has recently been diagnosed with advanced malignant melanoma and is scheduled for a wide excision of the tumor on her chest. In writing the plan of care for this patient, what major nursing diagnosis should the nurse include?

• Deficient Knowledge about Early Signs of Melanoma

• Chronic Pain Related to Surgical Excision and Grafting

• Depression Related to Reconstructive Surgery

• Anxiety Related to Lack of Social Support

A nurse educator is teaching a group of medical nurses about Kaposi's sarcoma. What would the educator identify as characteristics of endemic Kaposi's sarcoma? Select all that apply.

• Affects people predominantly in the eastern half of Africa

• Affects men more than women

• Does not affect children

• Cannot infiltrate

• Can progress to lymphadenopathic forms

A 35-year-old kidney transplant patient comes to the clinic exhibiting new skin lesions. The diagnosis is Kaposi's sarcoma. The nurse caring for this patient recognizes that this is what type of Kaposi's sarcoma?

• Classic

• AIDS-related

• Immunosuppression-related

• Endemic

A 65-year-old man presents at the clinic complaining of nodules on both legs. The man tells the nurse that his son, who is in medical school, encouraged him to seek prompt care and told him that the nodules are related to the fact that he is Jewish. What health problem should the nurse suspect?

• Stasis ulcers

• Bullous pemphigoid

• Psoriasis

• Classic Kaposi's sarcoma