ATI LPN
Test Bank for Medical Surgical Nursing: Concepts for Interprofessional Collaborative Care 10th Edition
Chapter 24 Questions
Question 1 of 5
A nurse assesses an older adult client with a skin disorder shown in the image. How should the nurse document this finding?
Correct Answer: A
Rationale: Petechiae are small, reddish-purple, non-raised lesions that do not fade or blanch with pressure. Ecchymoses are larger areas of hemorrhaging (bruising), actinic lentigo presents as paper-thin, transparent skin, and senile angiomas are red, raised lesions.
Question 2 of 5
A nurse assesses a client who is admitted with inflamed soft-tissue folds around the nail plates. Which question should the nurse ask to elicit information about this possible condition?
Correct Answer: A
Rationale: The condition chronic paronychia is common in people with frequent intermittent exposure to water, such as homemakers, bartenders, and laundry workers. The other questions would not provide information specifically related to the assessment finding.
Question 3 of 5
A nurse assesses a client and identifies that the client has pallor conjunctivae. Which focused assessment should the nurse complete next?
Correct Answer: B
Rationale: Pallor conjunctivae may indicate anemia, so the nurse should assess hemoglobin and hematocrit levels next to evaluate for possible anemia.
Question 4 of 5
A nurse assesses an older adult's skin. Which findings require immediate referral? (Select all that apply.)
Correct Answer: D,F
Rationale: Skin lesions with various colors and an asymmetric 6-mm dark lesion fit two of the American Cancer Society's hallmark signs for cancer according to the ABCD method. Other manifestations are variants of normal seen in various age groups.
Question 5 of 5
A nurse assesses a client who has two skin lesions on his chest. Each lesion is the size of a dime and has irregular borders. How should the nurse document this finding?
Correct Answer: B
Rationale: Diffuse is used to describe lesions that are widespread. The description of two lesions with irregular borders does not fit annular (circular), clustered (grouped together), or linear (in a straight line).