Medical Surgical Nursing An Integrated Approach 3rd Edition by Lois White – Test Bank

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Chapter 5—Inflammation and Infection

 

MULTIPLE CHOICE

 

1. The definition of inflammation is the:

a.	specific response to cellular injury
b.	nonspecific cellular response to tissue injury
c.	complex progression of tissue changes in response to injury
d.	invasion and multiplication of pathogenic microorganisms in body tissue

 

 

ANS:  B

Inflammation is a nonspecific cellular response to tissue injury. Tissue injury caused by bacteria, trauma, chemicals, heat, or any other occurrence releases substances, produces dramatic secondary changes in the injured tissue.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

2. What produces the characteristic redness and warmth associated with Stage 2 of the inflammatory response?

a.	release of chemicals (histamine, bradykinin, serotonin, prostaglandins, lymphokines)
b.	increased blood flow to the area
c.	plasma leaking into damaged tissue
d.	leukocytes infiltrating damaged tissue

 

 

ANS:  B

In Stage 2 of the Inflammatory Process, blood flow increases to the injured area causing the characteristic redness and warmth.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

3. What is typically ordered by a physician, for an area of inflammation, for 24-72 hours to control the inflammation, especially when pain and edema are present?

a.	compression	c.	dry heat
b.	warm, moist heat	d.	cold (ice)

 

 

ANS:  B

Heat, cold, or both may be applied to an inflamed area and need an order. Typically, physicians order cold (ice) on the affected area for 24-72 hours to control the inflammation, especially when pain and edema are present. After that time, heat is ordered to assist in quickly removing the accumulated waste products.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

4. Various agents are capable of causing disease. Heat is which type of agent?

a.	biological	c.	chemical
b.	physical	d.	environmental

 

 

ANS:  B

Physical agents are factors in the environment that are capable of causing disease, such as heat, light, noise, and radiation.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

5. Which of the following is a common bacterial infection?

a.	measles	c.	common cold
b.	urinary tract infection	d.	chickenpox

 

 

ANS:  B

Common bacterial infections include diarrhea, pneumonia, sinusitis, urinary tract infections, cellulitis, meningitis, gonorrhea, otitis media, and impetigo. Common viral infections include influenza, measles, common cold, chickenpox, hepatitis B, genital herpes, and HIV.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

6. Sexually transmitted diseases are transmitted by which type of contact?

a.	vector borne	c.	vehicle
b.	airborne	d.	direct contact

 

 

ANS:  D

The most important and frequent mode of transmission is contact transmission. This involves the transfer of an agent from an infected person to a host by direct contact with the infected person, indirect contact with the infected person through a fomite, or close contact with contaminated secretions. Sexually transmitted diseases are spread by direct contact.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

7. Lyme disease is spread by which type of transmission?

a.	direct contact	c.	vehicle
b.	airborne	d.	vector-borne

 

 

ANS:  D

Vector-borne transmission occurs when an agent is transferred to a susceptible host by animate means such as mosquitoes, fleas, ticks, lice, and other animals. Lyme disease, malaria, and West Nile virus are examples of diseases spread by vectors.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

8. A mother spreading HIV to a fetus is through which portal of entry?

a.	integumentary	c.	circulatory
b.	genitourinary	d.	transplacental

 

 

ANS:  D

A portal of entry is the route by which an infectious agent enters the host. A transplacental portal of entry is the transfer of microorganisms from mother to fetus via the placenta and umbilical cord (including HIV, and hepatitis B).

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

9. Which of these statements are true?

a.	As a person ages, immunity increases.
b.	Individuals who are not fully immunized are the same risk for infection.
c.	Lifestyle practices do not have an impact on an individual’s potential for illness.
d.	Individuals who maintain targeted weight for height and body frame are less prone to illness.

 

 

ANS:  D

Nutritional status does affect one’s susceptibility and severity of infection. Individuals who maintain the targeted weight for height and body frame are less prone to illness.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

10. The Centers for Disease Control and Prevention recommend which age group to receive the pneumococcal vaccine each year?

a.	children under age 1	c.	college age young adults
b.	individuals 65 and older	d.	elderly over 80

 

 

ANS:  B

The Centers for Disease Control and Prevention (CDC) (2010b) recommends that individuals 65 years of age and older receive the Influenza (flu) vaccine annually, the Pneumococcal vaccine, Tetanus (lockjaw), Herpes Zoster (shingles), and Diphtheria vaccine.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

11. What is the single most important practice in preventing the spread of infection?

a.	respiratory precautions	c.	using aseptic technique
b.	hand hygiene	d.	using bleach to break chain of infection

 

 

ANS:  B

Hand hygiene is the first line of defense against infection and is the single most important practice in preventing the spread of infection.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

12. What is the elimination of pathogens, except spores, from inanimate objects?

a.	antiseption	c.	sterilization
b.	disinfection	d.	cleansing

 

 

ANS:  B

Disinfection is the elimination of pathogens, except spores, from inanimate objects. Disinfectants are chemical solutions used to clean inanimate objects.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

13. Which are examples of barrier protection?

a.	hand cream	c.	gloves, gowns, goggles, and masks
b.	negative pressure rooms	d.	wound dressings

 

 

ANS:  C

To break the chain of infection between the mode of transmission and the portal of entry, asepsis must be ensured and barrier protection worn when the care of clients involves contact with body secretions. Gloves, masks, gowns, and goggles are barrier protection that can be used.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

14. Which of these statements are TRUE about antibiotics?

a.	Antibiotics are effective against viruses
b.	Antibiotics do not destroy normal flora
c.	Client should take all antibiotics prescribed
d.	Individuals can not develop resistance to antibiotics if they take a partial dose of the medication

 

 

ANS:  C

There are several key points when administering antibiotics. The physician or nurse practitioner should not be pressured to prescribe antibiotics for every illness. Antibiotics are not always appropriate. They are not effective against viruses. When antibiotics are prescribed, the client should take all of the medication as directed. Antibiotics taken only until the client feels better allow the microorganisms to become resistant to the antibiotic, and the antibiotic will no longer be effective. Antibiotics also destroy normal flora microorganisms, and other illnesses may ensue.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

15. Normal vaginal flora prevent the growth of several pathogens. What else prevents pathogenic growth of bacteria?

a.	monthly menses	c.	pubic hair
b.	endometriosis	d.	acidic environment of the vagina

 

 

ANS:  D

Normal vaginal flora prevent growth of several pathogens. At puberty, lactobacilli ferment and produce sugars in the vagina that lower the pH to an acidic range. The acidic environment of the vagina prevents pathogenic growth.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

16. What protects an individual against future invasions of already experienced antigens such as lethal bacteria, viruses, toxins and even foreign tissues?

a.	acquired immunity	c.	antibody immunity
b.	host immunity	d.	antioxidant immunity

 

 

ANS:  A

When the antigen enters the body again, the immune response occurs faster by rapidly producing antibodies. The formation of these antibodies is referred to as acquired immunity, which protects the individual against future invasions of already experienced antigens such as lethal bacteria, viruses, toxins, and even foreign tissues.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

17. Which stage in the infectious process can be characterized by the onset of nonspecific symptoms until specific symptoms begin to manifest?

a.	incubation	c.	illness
b.	prodromal	d.	convalescence

 

 

ANS:  B

The prodromal stage is the time from the onset of nonspecific symptoms until specific symptoms begin to manifest. The infectious agent continues to invade and multiply in the host. A client may also be infectious to other persons during this time period. In the client with chickenpox, a slight elevation in temperature will occur during this stage, followed within 24 hours by eruptions on the skin.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

18. A female client is being treated with an antibiotic for pneumonia. The antibiotic destroys normal flora of the genital tract and the client develops a vaginal yeast infection. This type of infection is called:

a.	ultra infection	c.	complementing infection
b.	type 2 infection	d.	super-infection

 

 

ANS:  D

A super-infection is an infection caused when the anti-infective used to treat the initial infectious process also destroys the body’s natural flora, that is present to protect against certain diseases.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

19. Which of the following are elevated with TB?

a.	neutrophils	c.	monocytes
b.	lymphocytes	d.	eosinophils

 

 

ANS:  C

Monocytes are increased in some protozoan and rickettsial infections as well as with tuberculosis.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

20. Which of the following is an infection control practice used to prevent the transmission of pathogens?

a.	aseptic technique	c.	sterile technique
b.	surgical asepsis	d.	medical asepsis

 

 

ANS:  A

Aseptic technique is the infection-control practice used to prevent the transmission of pathogens. The use of aseptic technique decreases the risk and spread of hospital-acquired infections.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

MULTIPLE RESPONSE

 

1. The primary signs of inflammation and infection are:

a.	redness	e.	loss of function
b.	heat	f.	loss of sensation
c.	pain	g.	purulent exudate
d.	swelling

 

 

ANS:  A, B, C, D, E, G

The primary signs of inflammation and infection are as follows: redness (erythema) results from increased blood flow to the area, heat results from increased blood flow and metabolism in the area, pain results from increased pressure on pain sensors in the area, swelling (edema, a detectable accumulation of increased interstitial fluid) results from fluid and leukocytes entering the tissues from the circulatory system, loss of function results from both pain and swelling and is the body’s way of resting the injured part, and pus (purulent exudate), resulting from infection, is a secretion made up of white blood cells, dead cells, bacteria, and other debris.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

2. The older adult may be at increased risk for infection because of the normal aging process.  Which of the following increase an older client’s risk for infection? (Select all that apply.)

a.	inadequate nutrition	e.	lethargy
b.	delayed inflammatory response	f.	nearsightedness
c.	malaise	g.	incontinence
d.	unsteadiness leading to falls

 

 

ANS:  A, B, D, E, G

The older adult may be at increased risk for infection because of the normal aging process.  As a person ages, the skin, respiratory tract, kidneys, immune system and GI system decrease in function. The systems function adequately during periods of homeostasis. However, when physiological stress is placed on the person, the systems are unable to adequately protect the person from an infection. Other factors that increase an older adults risk for infection include: inadequate nutrition (especially inadequate protein intake), a delayed inflammatory response, disorientation, agitation, incontinence, unsteadiness leading to falls, lethargy and general fatigue. An older adult client may present with acute confusion when infection is present. Additional factors include living in group settings where the older adult is exposed to many people who may have infections, and taking medications which may decrease the already-reduced immune system’s ability to respond adequately.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

 

 

 

Chapter 31—Caring for the Client with Diabetes Mellitus

 

MULTIPLE CHOICE

 

1. What is the primary function of insulin?

a.	to stimulate active transport of glucose into muscle and adipose tissue cells
b.	to convert glycogen to glucose
c.	to stimulate breakdown of adipose tissue
d.	to increase breakdown of protein into amino acids

 

 

ANS:  A

Insulin is a hormone produced and secreted by the pancreas. Insulin stimulates the active transport of glucose into muscle and adipose tissue cells, making it available for cell use.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

2. When the body produces an excess amount of insulin, the nurse should monitor for signs and symptoms of:

a.	diabetes insipidus	c.	hyperglycemia
b.	diabetes mellitus	d.	hypoglycemia

 

 

ANS:  D

Hypoglycemia, or low blood glucose, results when the body produces an excess amount of insulin.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

3. Symptoms of glycosuria, polyuria, polydipsia, and ketoacidosis are indicative of which of these conditions?

a.	gestational diabetes mellitus
b.	idiopathic diabetes mellitus
c.	impaired glucose tolerance
d.	non-insulin-dependent diabetes mellitus

 

 

ANS:  B

Manifestations of type 1 diabetes typically include abrupt onset of glycosuria (glucose in the urine), polydipsia (excessive thirst), polyuria (increased urination), and polyphagia (increased hunger); ketonuria (ketones in the urine) may develop as fat stores are metabolized for energy.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

4. Which forms of type 1 diabetes are characterized by an absolute insulin deficiency requiring management with insulin injections?

a.	gestational diabetes mellitus
b.	impaired glucose tolerance
c.	immune-mediated or idiopathic diabetes mellitus
d.	chemical-induced diabetes mellitus

 

 

ANS:  C

Immune-mediated or idiopathic diabetes mellitus are two forms of diabetes resulting from pancreatic beta-cell destruction or primary defect in beta-cell function. They are characterized by an absolute insulin deficiency requiring management with insulin injections.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

5. The nurse is caring for a client who has a family history of diabetes, is obese, and is aging. Which type of diabetes would the nurse suspect this client has?

a.	gestational diabetes mellitus	c.	type 1 diabetes mellitus
b.	immune-mediated diabetes mellitus	d.	type 2 diabetes mellitus

 

 

ANS:  D

Type 2 diabetes mellitus initially begins with insulin resistance, where the cells are not able to use the insulin properly. As it progresses, the pancreas gradually loses the ability to produce adequate qualities of insulin. Risk factors include family history, age, obesity, ethnicity, and a history of gestational diabetes.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

6. Which person would be MOST likely to develop type 2 diabetes?

a.	a 20-year-old white athlete with a family history of diabetes
b.	a 30-year-old black athlete with a family history of diabetes
c.	a 40-year-old black female who is 50 pounds overweight
d.	a 50-year-old white male who is 10 pounds overweight

 

 

ANS:  C

The primary risk factor for developing type 2 diabetes is obesity; other risk factors include age, insufficient exercise, hypertension, dyslipidemia, history of gestational diabetes mellitus, ethnic background, and family history of diabetes.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

7. What is the cornerstone of treatment for the person who has type 2 diabetes?

a.	blood glucose monitoring
b.	medication with oral hypoglycemic agents
c.	nutritional therapy
d.	weight loss

 

 

ANS:  C

Medical management of type 2 diabetes focuses on dietary management, particularly for weight control, and exercise. If diet and exercise do not adequately control blood sugar levels, oral hypoglycemic medications or parenteral administration of insulin may be prescribed.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

8. When a client’s glucose level drops below 70 mg/dL, often before meals or when insulin action is peaking, the client is experiencing:

a.	diabetic ketoacidosis
b.	diabetic neuropathy
c.	hyperosmolar hyperglycemic nonketotic syndrome
d.	hypoglycemia

 

 

ANS:  D

Hypoglycemia (insulin reaction) is a complication of type 1 diabetes that can be fatal unless it is recognized and treated promptly. While hypoglycemia can occur at any time of day, clients experience it most frequently before meals or when their prescribed insulin action peaks. Causes of hypoglycemia include skipping meals, eating late, engaging in unplanned exercise, and administering excess insulin.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

9. Subcutaneous insulin absorption occurs MOST quickly when injected into which area?

a.	abdomen	c.	hips
b.	arms	d.	thighs

 

 

ANS:  A

Factors affecting absorption should be considered when selecting an injection site. Absorption occurs most quickly in the abdomen, followed by the arms, thighs, hips, and subscapular regions.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

10. In which situation would a client possibly require glucose management by sliding scale insulin?

a.	clients with type 1 diabetes mellitus experiencing illness, stress, or surgery
b.	clients with type 1 or type 2 diabetes mellitus experiencing illness, stress, or surgery
c.	clients newly diagnosed with type 2 diabetes mellitus
d.	clients participating in a rigorous sport or activity

 

 

ANS:  B

During times of surgery, illness, or stress, clients may have their glucose levels maintained with an insulin sliding scale in lieu of their regular treatment.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

11. Which complication of insulin therapy is characterized by a rapid decrease in serum glucose, usually at night, causing the release of glucose-elevating hormones and an elevated glucose level in the morning, which may be inadvertently treated with an increased insulin dose?

a.	dawn phenomenon	c.	lipodystrophy
b.	insulin resistance	d.	Somogyi phenomenon

 

 

ANS:  D

The Somogyi phenomenon occurs when a rapid decrease in serum glucose, usually at night, causes the release of glucose-elevating hormones and an elevated glucose level in the morning. Adjusting insulin dosing to avoid the peaking of insulin during the night will correct this effect.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

12. When mixing two different types of insulin in the same syringe, which type is always drawn up first?

a.	lente, intermediate acting	c.	regular, short acting
b.	NPH, intermediate acting	d.	ultra lente, long acting

 

 

ANS:  C

When mixing insulins, remember the memory trick of “RNs do it correctly!”

R–Draw up regular (short acting) into the syringe first.

N–Draw up the NPH (intermediate acting) insulin into the same syringe second.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

13. Which nursing intervention would minimize a client’s risk of developing lipodystrophies?

a.	administering insulin intramuscularly	c.	using human insulin
b.	rotating sites of administration	d.	using insulin at room temperature

 

 

ANS:  B

Failure to rotate injection sites may cause a complication known as lipodystrophy, a change in the subcutaneous fat that decreases the absorption of the insulin.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

14. In caring for a client who is taking oral hypoglycemic agents, the nurse recognizes these medications are used in the treatment of which type of diabetes?

a.	gestational, requiring therapy for a very short time
b.	type 1, not stable with insulin administration only
c.	type 2, not controlled with diet and exercise
d.	type 1 and type 2, not controlled by diet and exercise

 

 

ANS:  C

Oral hypoglycemic agents are used to treat persons with type 2 diabetes that is not controlled with diet and exercise. These agents are meant to supplement diet and exercise, not replace them.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

15. What is the advantage of giving metformin, a biguanide, to a client requiring oral hypoglycemic agents?

a.	It can be administered on a more flexible schedule.
b.	It does not have the major side effects of nausea, abdominal discomfort, and diarrhea.
c.	It does not increase insulin release or produce hypoglycemic episodes.
d.	It does not tend to react with other medications.

 

 

ANS:  C

Metformin (Glucophage), a biguanide, does not increase insulin but works by making existing insulin more effective at the cellular level.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

16. The major goal of medical nutrition therapy for clients with diabetes mellitus is to:

a.	reduce serum lipid levels
b.	improve health through optimal nutrition
c.	maintain as near-normal a blood glucose level as possible
d.	wean insulin-dependent clients with diabetes from insulin through diet control

 

 

ANS:  C

The goals of nutrition therapy are to maintain as near-normal a blood glucose level as possible, achieve optimal serum lipid levels, provide adequate calories to maintain or attain a reasonable weight, prevent complications of diabetes, and improve overall health.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

17. The nurse should instruct clients with diabetes about “sick day management” of their disease by emphasizing which action?

a.	Report blood glucose lower than 100 mg/dL to the health care provider.
b.	Continue taking the scheduled insulin or oral hypoglycemic agent.
c.	Use sliding scale insulin to manage hypoglycemia.
d.	Increase intake of carbohydrates for the duration of the illness.

 

 

ANS:  B

It is important that persons with diabetes have a plan for maintaining their diabetes in the event of illness. It is important that they continue taking the scheduled insulin or oral hypoglycemic agent when they are experiencing illness, because illness and fever can increase blood glucose and the need for insulin.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

18. A client tells the nurse about experiencing symptoms of a hypoglycemic insulin reaction. Which action should the nurse take FIRST?

a.	Assess the blood glucose level, and administer glucose in the most appropriate form.
b.	Call the health care provider.
c.	Give the client juice or hard candy immediately.
d.	Have the client lie down and see if symptoms subside.

 

 

ANS:  A

Nursing care of clients who have hypoglycemia focuses on assessing symptoms, checking blood glucose level, and administering glucose in the most appropriate form. Teaching clients and their families how to prevent hypoglycemic reactions is also important, and clients should be encouraged to wear medical identification bracelets or tags that state they have type 1 diabetes.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

19. A client who has diabetes begins to experience nausea, vomiting, weakness, fatigue, and blurred vision. The nurse observes the client’s skin is warm and flushed and notes a fruity odor to the client’s breath. The nurse should anticipate the client will be treated for:

a.	hypoglycemia
b.	diabetic ketoacidosis
c.	hyperosmolar hyperglycemic nonketotic syndrome
d.	insulin resistance

 

 

ANS:  B

Diabetic ketoacidosis (DKA) occurs predominantly in clients who have type 1 diabetes and can be precipitated by factors such as stress, illness, or surgery. DKA may occur gradually or suddenly, and manifestations are similar to those of hyperglycemia (polyuria, polyphagia, and polydipsia); other symptoms may include nausea and vomiting, abdominal pain, headache, weakness, fatigue, blurred vision, skin that is hot and of poor turgor, Kussmaul’s respirations, and fruity breath odor.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

20. What is the MOST common chronic complication of diabetes mellitus?

a.	blindness	c.	morbid obesity
b.	renal failure	d.	neuropathy

 

 

ANS:  D

Neuropathies are the most common chronic complication of diabetes; they occur more frequently with age and duration of the disease. While all types of nerves can be affected, sensorimotor polyneuropathy (peripheral neuropathy), involving the lower extremities, and autonomic neuropathy, involving virtually any organ system, occur most frequently.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

21. The nurse should teach the client to monitor for which complication of diabetic neuropathy?

a.	arthrosclerosis	c.	injury and undetected foot injury
b.	diabetic retinopathy	d.	kidney failure

 

 

ANS:  C

The incidence of neuropathy increases with age and duration of the disease. Decreased sensations in the lower extremities and decreased pain and temperature sensations coupled with decreased circulation places the client at risk for undetected foot injury.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

22. A client newly diagnosed with type 2 diabetes mellitus has a nursing diagnosis of Knowledge deficit: diabetes, medical regimen, diet, exercise, and self-care management skills. Which nursing goal is appropriate for this client?

a.	to maintain current weight
b.	to maintain vital signs within normal limits
c.	to use the food pyramid for meal planning
d.	to relate the importance of an exercise program

 

 

ANS:  D

The goals of exercise and nutrition therapy are to maintain as near-normal a blood glucose level as possible, achieve optimal serum lipid levels, provide adequate calories to maintain or attain a reasonable weight, to prevent complications of diabetes, and to improve overall health. Oral hypoglycemic agents are used to treat persons with type 2 diabetes that is not controlled with diet and exercise. These agents are meant to supplement diet and exercise, not replace them.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

MULTIPLE RESPONSE

 

1. The nurse is reviewing a client’s medical history. Which factors would indicate that client is at risk for the development of diabetes? (Select all that apply.)

a.	triglyceride level of 199 mg/dL	d.	blood pressure of 138/78
b.	first child weighed 9 lbs 3 oz	e.	taking antihypertensive medications
c.	body mass index of 32	f.	great uncle who was diabetic

 

 

ANS:  B, C, E

The criteria for those who should be screened for diabetes include triglyceride level of 250 mg/dL or greater, hypertension, gestational diabetes, having a child weighing over 9 lbs, immediate family history, at-risk ethnic group, high-density lipoprotein (HDL) of 35 mg/dL or less, and having one of the two precursors of diabetes.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

2. A teenaged client appears to have developed hybrid diabetes. The nurse is aware that this type of diabetes causes the client to have which of the following? (Select all that apply.)

a.	insulin resistance associated type 1 diabetes
b.	antibodies against pancreatic islet cells associated with autoimmunity
c.	antibodies against pancreatic islet cells associated with type 1 diabetes
d.	insulin resistance associated with obesity
e.	insulin resistance associated type 2 diabetes
f.	antibodies against pancreatic islet cells associated with type 2 diabetes

 

 

ANS:  B, C, D, E

Youth with hybrid or mixed diabetes typically have insulin resistance associated with obesity and type 2 diabetes and antibodies against pancreatic islet cells associated with autoimmunity and type 1 diabetes.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

 

 

 

Chapter 57—Caring for Clients with Integumentary Disorders

 

MULTIPLE CHOICE

 

1. Which phase of wound healing lasts the longest period of time?

a.	initial	c.	reconstructive
b.	defensive	d.	maturation

 

 

ANS:  D

In the maturation phase, which begins about three weeks after the initial injury and may continue indefinitely if the wound in extensive and deep, the process of scar tissue remodeling occurs.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

2. A wound that involves minimal tissue loss with well-approximated edges will heal by which of these methods?

a.	primary intention	c.	tertiary intention
b.	secondary intention	d.	quartile intention

 

 

ANS:  A

Wound healing may take place by primary intention when tissue loss is minimal, edges are closely approximated, and scarring is minimal; by secondary intention when tissue loss is extensive and edges cannot be approximated, resulting in longer time for repair and possible scarring; and by tertiary intention when primary closure of the wound is unsuitable (e.g., when circulation is inadequate or infection is present).

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

3. Which of these factors is the MOST common cause of altered wound healing?

a.	advanced age	c.	hemorrhage
b.	smoking	d.	infection

 

 

ANS:  D

Factors that may adversely affect wound healing by reducing local blood supply include client age, oxygenation, smoking, drug therapy, and disease (e.g., diabetes mellitus). A nurse must also carefully monitor the wound for evidence of hemorrhage and infection, which can interfere with healing. The client’s nutritional status can also affect wound healing, either positively or negatively.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

4. Which of these statements about the cause of significant skin damage is TRUE?

a.	It results from cumulative sun exposure.
b.	It is genetically inherited.
c.	It results from ingesting carcinogenic foods and other substances.
d.	It results from tanning bed usage.

 

 

ANS:  A

Malignant melanoma, the most dangerous type of skin neoplasm, may begin in a preexisting mole and metastasize to every body organ via the blood and lymphatic systems; its incidence is accelerating as the result of increased sun exposure. Preventive measures, such as limiting sun exposure and using appropriate sunscreens, reduce the risk for developing malignant melanoma.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

5. When teaching a client about basal cell carcinoma, the nurse would be sure to include which of the following?

a.	It appears as a nodular lesion in the epidermis.
b.	It is the most frequent type of skin cancer.
c.	It usually begins in a preexisting mole (nevus).
d.	It can metastasize to other body tissues.

 

 

ANS:  B

Basal cell carcinoma, the most common type of skin cancer, is associated with prolonged sun exposure, poor tanning ability, and previous X-ray therapy for facial acne. Surgical removal of the lesion(s) is the treatment of choice.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

6. Which of these therapies is used in the medical treatment of squamous cell carcinoma?

a.	chemosurgery	c.	electrosurgery
b.	chemotherapy	d.	radiation therapy

 

 

ANS:  A

Squamous cell carcinoma is associated with prolonged exposure to sun and exposure to gamma radiation and X-rays. Surgical excision and chemosurgery are treatment options.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

7. Which of these statements about the characteristics of malignant melanoma is TRUE?

a.	It begins as a preexisting mole or nevus.
b.	The nevus is regular in shape.
c.	The nevus is a uniform light-brown color.
d.	The nevus is smaller than 6 millimeters in diameter.

 

 

ANS:  A

Malignant melanoma, the most dangerous type of skin neoplasm, may begin in a preexisting mole and metastasize to every body organ via the blood and lymphatic systems; its incidence is accelerating as the result of increased sun exposure.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

8. In addition to malignant melanoma, which of these skin disorders may metastasize to other body tissues and cause death?

a.	squamous cell carcinoma	c.	lipoma
b.	basal cell carcinoma	d.	angioma

 

 

ANS:  A

Squamous cell carcinoma and malignant melanoma are associated with prolonged exposure to sun and may metastasize to other body tissues and cause death.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

9. A client who has AIDS develops cutaneous T-cell lymphoma, which is characterized by:

a.	ready susceptibility to treatment and cure
b.	initial appearance of moles that are irregular in shape
c.	superficial infection of the dermis and epidermis
d.	metastasis to vital organ systems, even if treatment improves the skin’s condition

 

 

ANS:  D

Cutaneous T-cell lymphoma is a malignant disease involving the T-helper cells that has both skin manifestations and multiple organ system manifestations.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

10. Surgical removal is recommended for which type of benign skin tumor if it causes pressure on surrounding nerves or interferes with normal body function?

a.	angioma	c.	lipoma
b.	keloid	d.	nevi

 

 

ANS:  C

Nonmalignant skin neoplasms include skin tags, lipomas, keloids, sebaceous cysts, nevi, and angiomas. These lesions usually require no medical or nursing intervention unless the client experiences pressure on surrounding nerves or continuous irritation that may result in impaired skin integrity or infection.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

11. What is considered the BEST treatment for a port-wine angioma?

a.	surgical debridement	c.	radical surgical excision
b.	cosmetics	d.	skin grafting over the lesion

 

 

ANS:  B

Nonmalignant skin neoplasms include skin tags, lipomas, keloids, sebaceous cysts, nevi, and angiomas. These lesions usually require no medical or nursing intervention unless the client experiences pressure on surrounding nerves or continuous irritation that may result in impaired skin integrity or infection. Cosmetic products can be useful in camouflaging lesions such as birthmarks.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

12. A basic rule for the nurse when caring for clients who are experiencing impaired skin integrity related to an infectious disorder of the skin would be to:

a.	avoid the use of soaps due to their drying effect
b.	cleanse the skin with comfortably hot water to facilitate removal of crusts and ointment residues
c.	massage the skin in an outward circle to facilitate healing
d.	wear gloves

 

 

ANS:  D

Nurses should wear gloves when caring for the client with skin lesions.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

13. A client who has diabetes and is overweight develops a carbuncle at the nape of the neck, which is incised and drained. The client asks the nurse what caused the carbuncle to grow. Which of these responses is the MOST appropriate response?

a.	“Your diabetes probably increased your susceptibility to infection.”
b.	“It’s the result of poor hygiene.”
c.	“The staphylococcus organism is present on the skin, and a hair follicle probably became infected.”
d.	“Your obesity and constant perspiration may have caused it.”

 

 

ANS:  A

A carbuncle begins as an infected hair follicle. Persons who are obese or malnourished with poor hygiene as well as people who are diabetic are most susceptible to carbuncles.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

14. A client has clusters of small vesicles over the thoracic region and describes severe pain and itching of the affected areas. Herpes zoster is diagnosed, and the client will be treated with which of these medications?

a.	acyclovir (Zovirax)	c.	miconazole nitrate (Micatin)
b.	lindane (Kwell)	d.	nitric acid

 

 

ANS:  A

Herpes zoster is treated with acyclovir (Zovirax) in clients with severe pain or to clients who are immunosuppressed.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

15. Which of these statements about a nurse who has never had chickenpox caring for a client with herpes zoster during the draining, open lesions phase of the illness is TRUE?

a.	The nurse is at risk of contracting herpes zoster.
b.	The nurse could contract herpes simplex virus type 1 or 2.
c.	The nurse may develop chickenpox as a result of this exposure.
d.	The nurse would not be at risk for developing any condition if consistently using universal precautions.

 

 

ANS:  C

Persons who have not had chickenpox risk contracting the disease if they care for clients with herpes zoster with open lesions.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

16. An older adult client develops herpes zoster and asks the nurse how this can happen, having had chickenpox as a child. What is the nurse’s MOST appropriate response?

a.	“Have you been exposed to chickenpox recently?”
b.	“Herpes zoster is related to the chickenpox virus, and you have just caught shingles.”
c.	“You only developed partial immunity to the virus that causes it.”
d.	“You must not have actually had chickenpox as a child.”

 

 

ANS:  C

Persons who previously had chickenpox but developed only partial immunity to it, still may be susceptible to herpes zoster.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

17. For a client who has herpes simplex virus type 2 with painful genital lesions, oral administration of which medication helps shorten an acute episode and prevent recurrence of this illness?

a.	lindane (Kwell)	c.	nitric acid
b.	miconazole nitrate (Micatin)	d.	acyclovir (Zovirax)

 

 

ANS:  D

Herpes zoster is treated with acyclovir (Zovirax) in clients with severe pain or to clients who are immunosuppressed.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

18. A client shows the nurse a “ringworm” on the left forearm. What over-the-counter topical antifungal drug could the nurse recommend to the client to treat this lesion?

a.	acyclovir	c.	miconazole nitrate (Micatin)
b.	lindane (Kwell)	d.	nitric acid

 

 

ANS:  C

Treat mild infections with an over-the-counter topical antifungal drug such as miconazole nitrate (Micatin) or tolnaftate (Aftate).

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

19. A client develops a severe case of generalized scabies. The nurse should instruct the client to:

a.	apply lindane (Kwell) topically to the entire body at bedtime
b.	change bed linens daily
c.	treat only those family members who have symptoms
d.	use cold water to wash all underclothing, bed linens, and bath linens

 

 

ANS:  A

Apply the scabicide lindane (Kwell) topically to the entire body at bedtime so that the medication remains on the skin 8 to 12 hours.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

20. A client has contracted pediculosis capitis. Which of these aspects would the nurse include in client teaching?

a.	Apply an antibiotic ointment to the affected area twice a day.
b.	Comb the nits out of the scalp, and discard them in the trash.
c.	Discard any clothing worn since the infection developed.
d.	Shampoo the hair with Kwell now, and repeat in 10 days.

 

 

ANS:  D

Lindane (Kwell) is applied topically to the hair as a shampoo and repeated again in 8 to 10 days. Wash or dry-clean clothing and bedding.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

21. Contact dermatitis can be caused by which of the following substances?

a.	oral penicillin	c.	aluminum
b.	topical antibiotics	d.	cosmetics

 

 

ANS:  D

Dermatitis, inflammation of the skin, can be caused by a number of substances. Contact dermatitis, an acute skin reaction to substances such as poison ivy, cosmetics, harsh chemicals, or metals, creates erythema, burning, pruritus, and rash.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

22. Which of the following is a major symptom of contact dermatitis?

a.	scaling	c.	loss of skin surface
b.	blanching of skin	d.	pruritus

 

 

ANS:  D

Contact dermatitis, an acute skin reaction to substances such as poison ivy, cosmetics, harsh chemicals, or metals, creates erythema, burning, pruritus, and rash.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

23. Which of these statements about exfoliative dermatitis is TRUE?

a.	Overwhelming systemic infections or massive loss of body fluids and electrolytes can cause death.
b.	Severe pruritus can be controlled with oral antihistamines.
c.	Skin inflammation will gradually heal.
d.	Systemic symptoms include weight loss.

 

 

ANS:  A

Exfoliative dermatitis, a chronic skin inflammation, affects the entire body; localized manifestations include erythema, severe pruritus, extensive scaling, and loss of skin surface, while systemic manifestations include chills, fever, and malaise. Because of associated systemic infections and fluid and electrolyte imbalances, exfoliative dermatitis can be fatal. The cause of exfoliative dermatitis is usually unknown.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

24. A client develops large, red patches covered with thick, silvery scales on the arms and knees, and psoriasis is diagnosed. Client teaching about this disease should include which of these aspects?

a.	Its exact cause is unknown.
b.	After initial symptoms are treated, they will not recur.
c.	The disease is progressive and fatal.
d.	Psychotherapy can alleviate its symptoms.

 

 

ANS:  A

Psoriasis, a chronic inflammatory, noninfectious skin disease, affects primarily scalp, hands, arms, knees, lower back, and genitalia. Although the specific cause is unknown, emotional stress, infections, trauma, and seasonal and hormonal changes can aggravate psoriasis. Periods of remission and exacerbation are characteristic.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

25. Photochemotherapy (PUVA) is used to treat severe psoriasis by combining the use of methotrexate with ultraviolet A light waves to:

a.	cause remission of the disease
b.	cure the disease
c.	result in the full-blown recurrence of the disease, which may then be surgically removed
d.	slow cell division, which relieves symptoms

 

 

ANS:  D

Medical management of clients with psoriasis focuses on slowing the rate of epidermal cell formation or altering abnormal keratinization; the condition cannot be cured, only controlled with prescribed medications such as keratolytic agents, corticosteroids, and methotrexate, and with photochemotherapy to slow cell division, which relieves symptoms.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

26. Etretinate (Tegison) is used to treat clients who have severe psoriasis that is not amenable to other therapies. Which of these statements should the nurse include when teaching the client about this medication?

a.	“Effective contraception is a must during treatment and for at least one month after treatment.”
b.	“Expect drowsiness after each dose.”
c.	“Nausea should be reported to your health care provider.”
d.	“Your urine may normally be colored orange from this medication.”

 

 

ANS:  A

Etretinate (Tegison) has numerous adverse reactions including liver damage and severe birth defects. Women of childbearing age must use effective contraception during treatment and for at least one month after treatment.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

27. Which of these foods would the nurse recommend to a client to assist healing of a stasis ulcer?

a.	pasta with cheese	c.	flounder with rice
b.	sausage and red beans	d.	roast beef and baked potato

 

 

ANS:  D

A diet high in protein and vitamin C is needed for tissue regeneration. If a client is anemic; lean meats; whole grains; and green, leafy vegetables should be encouraged.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

28. Which of these intrinsic factors contributes to development of pressure ulcers?

a.	impaired mobility	c.	friction
b.	shearing	d.	moisture

 

 

ANS:  A

Risk factors for development of pressure ulcers include intrinsic factors such as impaired mobility, incontinence, poor nutritional status, and altered consciousness, and external factors such as pressure, shearing, friction, and moisture.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

29. An older adult client is admitted to a long-term care facility. The nurse should automatically place which of these support surfaces on the client’s bed?

a.	air-filled mattress	c.	waterproof draw sheet
b.	eggcrate mattress	d.	electric warming blanket

 

 

ANS:  B

Commercial products may be prescribed to prevent further ulcer development, and wound cleansing may be prescribed, including normal saline or medicated solutions; specific wound dressings are also prescribed. Special support surfaces (e.g., egg-crate mattresses or air-filled mattresses) or special beds (e.g., Clinitron, Kin Air) can be used to reduce skin pressure and shear and friction forces.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

30. What is the single MOST effective way to prevent a client from developing pressure ulcers?

a.	diet rich in vitamin C and protein	c.	frequent repositioning
b.	massage of bony prominences	d.	use of pillows

 

 

ANS:  C

Nursing care of clients who are at risk for pressure ulcers focuses on prevention: frequently assessing skin condition, frequently changing position, using pressure-reducing surfaces, encouraging intake of foods high in vitamin C and protein, and encouraging activity or passive range-of-motion exercise if active exercise is not possible.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)

 

31. The nurse is caring for a client who has an ulceration appearing as a deep crater with undermining of adjacent tissue loss. The nurse recognizes that this client has which type of ulcer present?

a.	stage I	c.	stage III
b.	stage II	d.	stage IV

 

 

ANS:  C

The degree of tissue damage in pressure ulcers has been classified into four stages. In stage I pressure ulcers, skin is intact and nonblanchable erythema is present. In stage II, a superficial ulcer (abrasion, blister, or shallow crater) is present and there is partial-thickness skin loss. In stage III, a deep crater with or without undermining of adjacent tissue loss is present and there is full-thickness skin loss. In stage IV, there is extensive destruction; tissue necrosis; damage to muscle, bone, or supporting structures; and full-thickness skin loss.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

MULTIPLE RESPONSE

 

1. Management of a client with a stage III ulceration would include which of the following? (Select all that apply.)

a.	frequently assessing lung sounds
b.	frequently changing position
c.	air-filled mattress
d.	debridement of the wound bed
e.	encouraging intake of foods high in vitamin C and protein

 

 

ANS:  B, C, D, E

Medical management of clients who have pressure ulcers depends on the stage of the ulcer(s). Commercial products may be prescribed to prevent further ulcer development, and wound cleansing may be prescribed, including normal saline or medicated solutions; specific wound dressings are also prescribed. Special support surfaces (e.g., egg-crate mattresses or air-filled mattresses) or special beds (e.g., Clinitron, Kin Air) can be used to reduce skin pressure and shear and friction forces. Surgical debridement may be indicated for some pressure ulcers. Nursing care of clients who are at risk for pressure ulcers focuses on prevention: frequently assessing skin condition, frequently changing position, using pressure-reducing surfaces, encouraging intake of foods high in vitamin C and protein, and encouraging activity or passive range-of-motion exercise if active exercise is not possible.

 

PTS:   1                    DIF:    Application    REF:   White (2013)

 

2. The physician orders a dressing for a client with a wound. The student nurse is aware that the purpose of applying dressings includes which of the following? (Select all that apply.)

a.	to promote homeostasis
b.	to promote thermal insulation of the wound
c.	to promote healing by reflecting light
d.	to promote splinting or support for the wound
e.	to provide concealment from the client
f.	to promote retention of bacterial contamination

 

 

ANS:  A, B, D, E

A dressing serves several purposes: to promote homeostasis, to promote thermal insulation of the wound, to promote splinting or support for the wound, to provide concealment from the client, to protect the wound from bacterial contamination, to provide a moist environment to enhance epithelialization, to support healing by absorbing drainage, and to enhance debridement of the wound.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2013)