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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: The correct answer is a because refusing to look at the dressing or surgical incision can indicate that the client is having difficulty accepting the loss of her breast. This behavior may suggest that the client is struggling with body image issues, grief, or denial about the changes to her body.
Choice B reason: Requesting pain medication every 3 hours is a common postoperative behavior to manage pain and does not necessarily indicate difficulty adjusting to the loss of a breast. Pain management is a normal part of recovery.
Choice C reason: Asking questions about the information on the postoperative care pamphlet demonstrates an interest in understanding and managing her care. This behavior indicates that the client is engaged in her recovery process, rather than struggling to adjust.
Choice D reason: Performing arm exercises once or twice each day shows that the client is following postoperative care instructions and is actively participating in her rehabilitation. This behavior does not suggest difficulty adjusting to the loss of her breast.
Correct Answer is C
Explanation
Choice A reason: Stating that "This type of surgery is very easy and should not cause a major disruption in your activities" minimizes the client's concerns and may not be accurate for every individual. Each person's experience with surgery and recovery is unique, and it is important to acknowledge and address the client's specific concerns and reasons for delaying the surgery.
Choice B reason: Saying "Most women don't have any problems during their recovery" is a generalization that may not apply to every client. It does not address the client's individual fears or concerns and may come across as dismissive of their feelings.
Choice C reason: The correct answer is c because asking, "Can you tell me your reasons for delaying the surgery?" shows empathy and allows the client to express their concerns. This opens a dialogue where the nurse can provide information, support, and address any specific issues the client may have about the surgery and recovery process.
Choice D reason: Telling the client, "If this happened to one of my family members, I would tell them to go ahead and not wait," inserts the nurse's personal opinion and may not be helpful to the client. It is important to focus on the client's feelings and concerns rather than offering personal anecdotes or advice.
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