A nurse is collecting data from a client who has scleroderma. Which of the following findings should the nurse expect?

A dry raised rash

Excessive salivation

Periorbital edema

Hardened skin

Answer and Explanation

The Correct Answer is D

Choice A reason: A dry raised rash is not a typical finding in scleroderma. Scleroderma primarily affects the skin and connective tissues, leading to hardening and tightening of the skin.

Choice B reason: Excessive salivation is not associated with scleroderma. Clients with scleroderma may experience dry mouth (xerostomia) instead.

Choice C reason: Periorbital edema is not a characteristic feature of scleroderma. Scleroderma involves systemic sclerosis that affects the skin, blood vessels, and internal organs.

Choice D reason: The correct answer is d because hardened skin is a hallmark of scleroderma. This autoimmune disease causes the skin to become thickened, tight, and stiff due to excessive collagen deposition.

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Correct Answer is B

Explanation

Choice A reason: While a healthy diet is important, avoiding fried foods alone is not sufficient for managing hepatitis A. This statement does not fully address the necessary precautions to prevent transmission.

Choice B reason: The correct answer is b because abstaining from sexual intercourse is essential to prevent the spread of hepatitis A. The virus can be transmitted through close personal contact, including sexual activity.

Choice C reason: Refraining from international travel may be advisable in some cases, but it is not a specific requirement for managing hepatitis A. This statement does not directly address transmission prevention.

Choice D reason: Avoiding salads in restaurants can help reduce the risk of foodborne transmission of hepatitis A, but it is not as comprehensive as abstaining from sexual intercourse, which directly prevents person-to-person transmission.

A. Massage erythematous bony prominences. B. Implement a turning schedule every 4 hr. C. Use pillows to keep heels off the bed surface. D. Keep environmental humidity less than 30%. E. Minimize skin exposure to moisture.

Correct Answer is ["C","E"]

Explanation

Choice A reason: Massaging erythematous bony prominences can actually cause further damage to the skin and underlying tissues. It is better to relieve pressure and monitor the skin closely for any signs of breakdown.

Choice B reason: Implementing a turning schedule every 4 hours is not frequent enough. Clients with spinal cord injuries should be repositioned every 2 hours to prevent prolonged pressure on any one area and reduce the risk of skin breakdown.

Choice C reason: The correct answer is c because using pillows to keep the heels off the bed surface helps prevent pressure ulcers on the heels, which are common sites of skin breakdown in immobilized clients. This technique helps distribute pressure more evenly and reduces the risk of ulcers.

Choice D reason: Keeping environmental humidity less than 30% is not recommended, as low humidity can lead to dry and cracked skin, increasing the risk of skin breakdown. Maintaining a moderate humidity level helps keep the skin hydrated and intact.

Choice E reason: The correct answer is e because minimizing skin exposure to moisture, such as sweat, urine, or wound exudate, helps prevent maceration and skin breakdown. Using moisture-wicking materials and keeping the skin dry and clean are important measures in skin care for paralyzed clients.

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A nurse is collecting data from a client who has scleroderma. Which of the following findings should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reinforcing discharge instructions with a client who has hepatitis

Correct Answer is B

Explanation

A nurse is contributing to the plan of care for a client who has a spinal cord injury and paralysis. Which of the following actions should the nurse include in the plan to decrease the client’s risk of skin breakdown? (Select all that apply.)

Correct Answer is ["C","E"]

Explanation

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