Review for the nclex-rn® Examination, 6



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Silvestri: Saunders Comprehensive Review for the NCLEX-RN® Examination, 6th Edition

Adult Health

Test Bank

MULTIPLE CHOICE

1. The nurse reviews the health record of a client with melasma. The nurse would anticipate that this client will exhibit:



1.

Skin that is uniformly dark in color

2.

Very pale skin with little pigmentation

3.

Patches of skin that have loss of pigmentation

4.

Blotchy brown macules across the cheeks and forehead

ANS: 4

Rationale: Melasma is a condition caused by hormonal influences on melanin production and is noted by the appearance of blotchy brown macules across the cheeks and forehead. “Skin that is uniformly dark in color” describes vitiligo. “Very pale skin with little pigmentation” and “patches of skin that have loss of pigmentation” refer to normal variations in skin color.

Test-Taking Strategy: To answer this question correctly, you must be familiar with the various terms used when discussing skin structures and functions. “Skin that is uniformly dark in color” describes vitiligo. “Very pale skin with little pigmentation” and “patches of skin that have loss of pigmentation” refer to normal variations in skin color. Review the description of melasma if you had difficulty with this question.

PTS: 1


DIF: Level of Cognitive Ability: Understanding

REF: Black, J., & Hawks, J. (2009). Medical-surgical nursing: clinical management for positive outcomes (8th ed.). St. Louis: Saunders.

OBJ: Client Needs: Physiological Integrity

TOP: Content Area: Adult Health/Integumentary

MSC: Integrated Process: Nursing Process—Assessment

2. The client with cellulitis of the lower leg has had cultures done on the affected area. The nurse reviewing the results of the culture report interprets that which of the following organisms is not part of the normal flora of the skin?



1.

Escherichia coli

2.

Candida albicans

3.

Staphylococcus aureus

4.

Staphylococcus epidermidis

ANS: 1

Rationale: E. coli is normally found in the intestines and is a common source of infection of wounds and the urinary system. C. albicans, S. aureus, and S. epidermis are part of the normal flora of the skin.

Test-Taking Strategy: To answer this question correctly, you must be familiar with the normal microorganisms that inhabit the skin. Note that the question asks for the organism that is not part of normal flora. Remember that E. coli is normally found in the intestines. Review basic skin structures if you had difficulty with this question.

PTS: 1


DIF: Level of Cognitive Ability: Understanding

REF: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: patient-centered collaborative care (6th ed.). St. Louis: Saunders.

OBJ: Client Needs: Physiological Integrity

TOP: Content Area: Adult Health/Integumentary

MSC: Integrated Process: Nursing Process—Assessment

3. The client complains of chronic pruritus. Which of the following diagnoses would the nurse expect to support this client’s complaint?



1.

Anemia

2.

Renal failure

3.

Hypothyroidism

4.

Diabetes mellitus

ANS: 2

Rationale: Clients with renal failure often have pruritus, or itchy skin. This is because of impaired clearance of waste products by the kidneys. The client who is markedly anemic is likely to have pale skin. Hypothyroidism may lead to complaints of dry skin. Clients with diabetes mellitus are at risk for skin infections and skin breakdown.

Test-Taking Strategy: Focus on the subject, chronic pruritus. Remember that clients with renal failure often experience this problem. If this question was difficult, review the common causes of pruritus.

PTS: 1


DIF: Level of Cognitive Ability: Understanding

REF: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: patient-centered collaborative care (6th ed.). St. Louis: Saunders.

OBJ: Client Needs: Physiological Integrity

TOP: Content Area: Adult Health/Integumentary

MSC: Integrated Process: Nursing Process—Assessment

4. A client being seen in an ambulatory clinic for an unrelated complaint has a butterfly rash noted across the nose. The nurse interprets that this finding is consistent with early manifestations of which of the following disorders?



1.

Hyperthyroidism

2.

Pernicious anemia

3.

Cardiopulmonary disorders

4.

Systemic lupus erythematosus (SLE)

ANS: 4

Rationale: An early sign of SLE is the appearance of a butterfly rash across the nose. Hyperthyroidism often leads to moist skin and increased perspiration. Pernicious anemia is exhibited by pale skin. Severe cardiopulmonary disorders may lead to clubbing of the fingers.

Test-Taking Strategy: To answer this question accurately, you must be familiar with the impact of systemic conditions on the skin. Remember that SLE causes a characteristic butterfly rash. If this question was difficult, review the disorders identified in the options and the associated skin conditions that occur in each disorder.

PTS: 1


DIF: Level of Cognitive Ability: Understanding

REF: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: patient-centered collaborative care (6th ed.). St. Louis: Saunders.

OBJ: Client Needs: Physiological Integrity

TOP: Content Area: Adult Health/Integumentary

MSC: Integrated Process: Nursing Process—Assessment

5. The nurse notes that the older adult client has a number of bright, ruby-colored, round lesions scattered on the trunk and thighs. The nurse correctly interprets the finding as alterations in blood vessels of the skin and defines them as:



1.

Purpura

2.

Venous star

3.

Cherry angioma

4.

Spider angioma

ANS: 3

Rationale: A cherry angioma occurs with increasing age and has no clinical significance. It is noted by the appearance of small, bright, ruby-colored round lesions on the trunk and/or extremities. Purpura results from hemorrhage into the skin. A venous star results from increased pressure in veins, usually in the lower legs, and has an irregularly shaped bluish center with radiating branches. Spider angiomas have a bright red center, with legs that radiate outward. These are commonly seen in those with liver disease or vitamin B deficiency, although they can occur occasionally without underlying pathology.

Test-Taking Strategy: To answer this question accurately, you must be familiar with the various alterations in vascularity that can occur in the skin. Note the relationship of the words “ruby” in the question and “cherry” in the correct option. If you had difficulty with this question, review the various skin alterations identified in each of the options.

PTS: 1


DIF: Level of Cognitive Ability: Understanding

REF: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: patient-centered collaborative care (6th ed.). St. Louis: Saunders.

OBJ: Client Needs: Physiological Integrity

TOP: Content Area: Adult Health/Integumentary

MSC: Integrated Process: Nursing Process—Assessment

6. The client has been diagnosed with paronychia. The nurse understands that this is a disorder of the:



1.

Nails

2.

Hair follicles

3.

Pilosebaceous glands

4.

Epithelial layer of skin

ANS: 1

Rationale: Paronychia is a fungal infection that is most often caused by Candida albicans. This results in inflammation of the nail fold, with separation of the fold from the nail plate. The area is generally tender to touch, with purulent drainage. Disorders of the hair follicles include folliculitis, furuncles, and carbuncles. Disorders of the pilosebaceous glands include acne vulgaris and seborrheic dermatitis. There are a variety of disorders involving the epithelial skin.

Test-Taking Strategy: To answer this question accurately, you must be familiar with a variety of skin disorders and their causes. Remember that paronychia is a nail disorder. If this question was difficult, review the characteristics of paronychia.

PTS: 1


DIF: Level of Cognitive Ability: Understanding

REF: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: patient-centered collaborative care (6th ed.). St. Louis: Saunders.

OBJ: Client Needs: Physiological Integrity

TOP: Content Area: Adult Health/Integumentary

MSC: Integrated Process: Nursing Process—Assessment

7. The client is diagnosed with a full-thickness burn. The nurse understands that which of the following structural areas of the skin is involved?



1.

Epidermis only

2.

Epidermis and deeper dermis

3.

Epidermis and upper layer of dermis

4.

Epidermis, entire dermis, and epithelial portion of subcutaneous fat

ANS: 4

Rationale: A full-thickness burn involves the epidermis, entire dermis, and epithelial portion of subcutaneous fat layer. “Epidermis only” describes a superficial burn. “Epidermis and deeper dermis” describes a partial-thickness burn, and “epidermis, entire dermis, and epithelial portion of subcutaneous fat” describes a deep partial-thickness burn.

Test-Taking Strategy: To answer this question accurately, you must be familiar with the classification of burn depth and the associated skin structures affected. Noting the words “full-thickness” will direct you to “epidermis, entire dermis, and epithelial portion of subcutaneous fat.” If this question was difficult, review the types of burn injuries.

PTS: 1


DIF: Level of Cognitive Ability: Understanding

REF: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: patient-centered collaborative care (6th ed.). St. Louis: Saunders.

OBJ: Client Needs: Physiological Integrity

TOP: Content Area: Adult Health/Integumentary

MSC: Integrated Process: Nursing Process—Assessment

8. A client who suffered carbon monoxide poisoning from working on an automobile in a closed garage has a carbon monoxide level of 15%. The nurse would anticipate observing which sign or symptom?



1.

Coma

2.

Flushing

3.

Dizziness

4.

Tachycardia

ANS: 2

Rationale: The signs and symptoms worsen as the carbon monoxide level rises in the bloodstream. Impaired visual acuity occurs at 5% to 10%, whereas flushing and headache are seen at 11% to 20%. Nausea and impaired dexterity appear at levels of 21% to 30%, and a 31% to 40% level is accompanied by vomiting, dizziness, and syncope. Levels of 41% to 50% cause tachypnea and tachycardia, and those higher than 50% result in coma and death.

Test-Taking Strategy: Knowledge of the various manifestations of carbon monoxide poisoning is needed to answer this question. Remember that flushing is noted at levels of 11% to 20%. If you had difficulty with this question, review the manifestations associated with carbon monoxide poisoning.

PTS: 1


DIF: Level of Cognitive Ability: Analyzing

REF: Black, J., & Hawks, J. (2009). Medical-surgical nursing: clinical management for positive outcomes (8th ed.). St. Louis: Saunders.

OBJ: Client Needs: Physiological Integrity

TOP: Content Area: Adult Health/Integumentary

MSC: Integrated Process: Nursing Process—Assessment

9. A client is admitted to the hospital with cellulitis of the lower leg. The nurse would anticipate which of the following therapies to be prescribed?



1.

Intermittent heat lamp treatments

2.

Alternating hot and cold compresses

3.

Warm compresses to the affected area

4.

Cold compresses to the affected area

ANS: 3

Rationale: Warm compresses may be used to decrease the discomfort, erythema, and edema that accompany cellulitis. Definitive treatment includes antibiotic therapy after appropriate cultures have been done. Other supportive measures are also used to manage such symptoms as fatigue, fever, chills, headache, or myalgia. Heat lamps are not used because of the risk of burns, and moist heat is most useful in treating this disorder.

Test-Taking Strategy: Use knowledge of the disease process and concepts related to heat and cold therapy to answer this question. Eliminate “alternating hot and cold compresses” and “cold compresses to the affected area” first, because cold therapy would cause vasoconstriction rather than vasodilation. Choose correctly between “intermittent heat lamp treatments” and “warm compresses to the affected area,” knowing that moist heat decreases the discomfort, erythema, and edema that accompanies cellulitis. If you had difficulty with this question, review the treatment associated with cellulitis.

PTS: 1


DIF: Level of Cognitive Ability: Analyzing

REF: Monahan, F., Sands, J., Marek, J., Neighbors, M., & Green, C. (2007). Phipps' medical-surgical nursing: health and illness perspectives (8th ed.). St. Louis: Mosby.

OBJ: Client Needs: Physiological Integrity

TOP: Content Area: Adult Health/Integumentary

MSC: Integrated Process: Nursing Process—Planning

10. The nurse has instructed the client in the correct technique for breast self-examination (BSE). For a portion of the examination, the client will lie down. If the client were to examine the right breast, the nurse would tell the client to place a pillow:



1.

Under the left scapula

2.

Under the left shoulder

3.

Under the right shoulder

4.

Under the small of the back

ANS: 3

Rationale: The nurse would instruct the client to lie down and place a towel or pillow under the shoulder on the side of the breast to be examined. If the right breast is to be examined, the pillow would be placed under the right shoulder, and vice versa. Therefore “under the left scapula,” “under the left shoulder,” and “under the small of the back” are incorrect.

Test-Taking Strategy: Use the process of elimination, and visualize this procedure. This will direct you to “under the right shoulder.” If you are unfamiliar with the procedure for performing BSE, review this important self-examination.

PTS: 1


DIF: Level of Cognitive Ability: Applying

REF: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: patient-centered collaborative care (6th ed.). St. Louis: Saunders.

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Content Area: Adult Health/Oncology

MSC: Integrated Process: Teaching and Learning

11. The nurse would identify that which of the following foods should be increased in the diet to help decrease the risk of cancer development?



1.

Bacon

2.

Broccoli

3.

Bologna

4.

Broiled beef

ANS: 2

Rationale: Broccoli is a cruciferous vegetable, which is helpful in reducing the risk of cancer. Other cruciferous vegetables are cauliflower, Brussels sprouts, and cabbage. Red meat (“bacon”) and meats with nitrites (“bologna” and “broiled beef”) can increase the risk of developing cancer.

Test-Taking Strategy: Remember that options that are comparable or alike are not likely to be correct. With this in mind, note that each incorrect option lists a meat, whereas the correct choice is a cruciferous vegetable. Review dietary risk factors for cancer if you had difficulty with this question.

PTS: 1


DIF: Level of Cognitive Ability: Applying

REF: Nix, S. (2009). Williams’ basic nutrition and diet therapy (13th ed.). St. Louis: Mosby.

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Content Area: Adult Health/Oncology

MSC: Integrated Process: Nursing Process—Implementation

12. The nurse would include which of the following in a list of the most helpful foods for the vegan client wishing to increase foods high in vitamin A?



1.

Peas

2.

Carrots

3.

Potatoes

4.

Green beans

ANS: 2

Rationale: Foods that are high in vitamin A include carrots, green leafy vegetables, and yellow vegetables. The other vegetables are high in vitamins but do not necessarily have the highest amount of vitamin A.

Test-Taking Strategy: Note the strategic words “most helpful.” To answer this question accurately, you must be aware of the type of foods that are naturally high in vitamin A. Remember that carrots are high in vitamin A. If you had difficulty with this question, review foods that are in this vitamin group.

PTS: 1


DIF: Level of Cognitive Ability: Applying

REF: Peckenpaugh, N. (2010). Nutrition essentials and diet therapy (11th ed.). St. Louis: Saunders.

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Content Area: Adult Health/Oncology

MSC: Integrated Process: Nursing Process—Implementation

13. According to the American Cancer Society, fecal occult blood testing should be done annually after the age of _____ years.



1.

30

2.

40

3.

50

4.

60

ANS: 3

Rationale: Fecal occult blood testing for colorectal cancer should be done annually for both men and women after the age of 50 years. The other options are incorrect.

Test-Taking Strategy: To answer this question correctly, you must be familiar with the recommendations for cancer screening published by the American Cancer Society. This would allow you to eliminate each of the incorrect options easily. Review these cancer prevention guidelines.

PTS: 1


DIF: Level of Cognitive Ability: Applying

REF: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: patient-centered collaborative care (6th ed.). St. Louis: Saunders.

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Content Area: Adult Health/Oncology

MSC: Integrated Process: Nursing Process—Implementation

14. A 27-year-old female client is undergoing evaluation of lumps in her breasts. In determining whether the client could have fibrocystic breast disorder, the nurse should ask the client whether the breast lumps seem to become more prominent or troublesome at which of the following times?



1.

After menses

2.

Before menses

3.

During menses

4.

At any time, regardless of the menstrual cycle

ANS: 2




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