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WALDEN NRNP 6540 FINAL EXAM
QUESTIONS AND ANSWERS GRADED A+
- Mrs. .Williams .is. 76 .years .old .and .comes .in .to .have .a .wound .checked .on .her right .leg. .She .fell .a .month .ago .and .the .wound .has .not .healed. .She .is .concerned .that .something .is .wrong. .The .nurse .practitioner .examines .the .wound .and .sees .that .it .has .been .cleaned .properly .and .has .no .signs .of .infection. .The .edges .are .approximated, .but .the .skin .around .the .wound .is .red .and .tender .to .touch. .The .best .response .regarding .Mrs. .Williams' .concern .is:
- Wound .healing .for .older .people .may .take .up .to .four .times .longer .than .it .does .for .younger .people.
- Let .us .talk .about .what .you .are .eating.
- Had .you .come .in .earlier, .I .would .have .ordered .medicine .that .would .have .healed .t
XC.^1 hat .right .up.
- I .will .order .an .antibiotic .to .prevent .infection. .- .ANSWER- .1. .Answer: . 1 .Page:. 96
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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.
.3.
This .is .false .hope, .as .there .is .no .medication .that .will .heal .this .wound .quickly.
.4.
Prophylactic .antibiotics .are .not .appropriate .when .there .are .no .signs .or .symptoms .of .infection.
- .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
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.1.
Lack .of .activity .alone .does .not .cause .skin .breakdown.
Poorly .healing .wounds .or .chronic .pressure .ulcers .may .signal .a .problem .not .only .with .the .patient .but .with .the .caregiver's .ability .to .provide .adequate .care. .Welts, .lacerations, .burns, .and .distinctive .markings .may .indicate .a .need .for .intervention.
This .is .a .result .of .the .nurse .practitioner .addressing .it .further .rather .than .the .reason .for .addressing .it.
A .professional .cannot .assume .abuse .without .good .reason.
- 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
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.1.
Secondary .lesions .(infections) .arise .from .changes .to .the .primary .lesion.
.2.
Secondary .lesions .are .not .necessarily .the .result .of .an .underlying .disease.
.3.
Secondary .lesions .can .be .treated .with .medications .or .surgery.
.4.
Secondary .lesions .arise .as .a .condition .not .normal .to .aging.
- 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
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.1.
An .injury .would .not .stimulate .growth.
.2.
A .reaction .to .a .detergent .would .more .likely .be .a .rash.
.3.
Lesions .that .warrant .biopsy .are .those .that .have .changed, .bleed, .or .are .painful.
.4.
The .ability .to .put .on .her .ring .is .not .the .problem.
- 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
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.1.
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.
.3.
The .patient .is .at .risk, .not .the .family.
.4.
The .fact .that .the .patient .smokes .is .not .the .issue; .safety .is .the .issue.
- 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
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.1.
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.
.3.
Thinner .skin .and .diminished .nerve .function .often .result .in .a .higher .incidence .of .deeper .burns.
Advanced .age .results .in .a .weakened .immune .system.
.5.
Along .with .the .burden .of .various .comorbidities, .the .fragility .of .older .skin .leads .to .delayed .wound .healing .and .reepithelialization .after .burn .injury.
- Mr. .Edwards .is. 76 .years .old .and .received .a .burn .on .his .leg .when .he .dozed .off .and .dropped .his .cigarette. .The .nurse .practitioner .examines .his .leg .for .the .degree .of .burn .and .classifies .it .as .second .degree .with .some .third .degree .in .the .center. .Mr. .Edwards .asks .what .that .means .and .why .it .hurts .so .much. .What .is .the .best .answer? .Select .all .that .apply.
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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.1.
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.
- 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
- Lymphangitis .- .ANSWER- .11. .Answer:. 3
Page:. 103
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.1.
Influenza .is .systemic .and .not .localized .in .any .one .area.
.2.
The .patient .has .no .respiratory .symptoms.
.3.
Signs .of .cellulitis .include .worsening .of .erythema, .edema, .tenderness, .and .pain .that .has .occurred .for .a .few .days. .Symptoms .are .usually .sudden. .Systemic .symptoms .which .indicate .serious .toxicity .include .fever, .hypotension, .and .tachycardia.
Necrotizing .fasciitis .exhibits .diffuse .swelling .of .an .arm .or .leg .with .bullae.
.5.
- 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
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.1.
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.
Herpes .zoster .is .characterized .by .pain .along .the .dermatomes .and .vesicles, .which .is .not .symptomatic .of .influenza.
This .infection .is .most .common .in .adults .over. 55 .years .old. .The .risk .of .herpes .zoster .increases .with .age.
- Mrs. .Person,. 82 .years .old, .comes .to .the .well .clinic .to .see .a .nurse .practitioner .for .a .bump .on .her .ear. .This .growth .has .been .there .for .almost .a .year .but .has recently .grown. .The .area .around .the .growth .appears .inflamed. .Why .would .the .nurse .practitioner .suggest .a .biopsy? .Select .all .that .apply.
- The .growth .is .elevated .and .increasing .in .size.
- The .ear .has .high .exposure .to .the .sun.
- There .is .inflammation .around .the .growth.
- The .patient .is. 82 .years .old .and .reports .having .lived .in .the .south .of .the .United .States .for .many .years.
- There .is .no .concern .about .familial .tendencies. .- .ANSWER- .14. .Answer: .1, .2, .3, 4
Page:. 118
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.1.
Signs .of .malignancy .include .elevation; .the .original .lesion .may .also .have .enlarged .in .size.
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.
.3.
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.
- 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:. 215
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The .clinician .should .begin .with .auscultation .of .the .carotid .arteries .bilaterally .because .cardiac .murmurs .will .usually .radiate .into .the .carotid .arteries.
After .auscultation .of .the .carotid .and .subclavian .arteries, .the .clinician .should .proceed .to .palpation .of .the .brachial, .radial, .and .ulnar .arteries.
After .auscultation .and .palpation, .careful .inspection .should .be .performed .of .the .distal .fingers .and .the .nail .beds.
Diagnostic .testing .is .usually .ordered .when .areas .of .concern .are .found.
- Which .of .the .following .conditions .is .signaled .by .symptoms .of .swelling .of .the .affected .body
part, .usually .the .limb, .because .of .impaired .flow .of .lymph .fluid?
- Abdominal .aortic .aneurysm .(AAA)
- Venous .ulcers
- Peripheral .vascular .disease .(PVD)
- Lymphedema .- .ANSWER- .2. .Answer:. 4
Page:. 218
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.1.
AAA .presents .the .signal .symptoms .of .persistent .or .intermittent .pain .in .the .middle .or .lower .abdomen, .radiating .to .the .lower .back.
Ultrasound .in .the .abdominal .area .is .the .best .initial .screening .test .for .AAA.
.4.
Angiography .screening .is .indicated .when .surgery .is .planned.
- .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
Page:. 217
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.1.
A .reading .of. 100 .to. 120 .mm .Hg .is .too .high.
.2.
A .reading .of. 90 .to. 120 .mm .Hg .is .too .high.
.3.
Good .arterial .pressure .for .those .with .AAA .should .fall .between. 60 .and. 70 .mm .Hg.
.4.
A .reading .of. 80 .to. 100 .mm .Hg .is .too .high.
- Which .medical .specialist .is .the .best .referral .for .patients .with .symptomatic .AAA?
- Vascular .surgeon
- Neurosurgeon
- Cardiologist
- Internist .- .ANSWER- .5. .Answer:. 1
Page:. 217
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.1.
A .vascular .surgeon .is .a .specialist .who .is .highly .trained .to .treat .diseases .of .the .vascular .system.
A .neurosurgeon .is .a .physician .who .specializes .in .the .diagnosis .and .surgical .treatment .of .disorders .of .the .central .and .peripheral .nervous .system.
A .cardiologist .is .a .doctor .who .specializes .in .the .study .or .treatment .of .heart .diseases .and .heart .abnormalities.
Internists .are .specialists .who .apply .scientific .knowledge .and .clinical .expertise .to .the .diagnosis, .treatment, .and .compassionate .care .of .adults .across .the .spectrum, .from .health .to .complex .illness.
