A nurse is collecting data from a client who reports finding a new skin lesion. Which of the following actions is the nurse's priority?

Document the client's history of skin allergies.

Photograph the lesion for the client's medical record.

Identify when the client first noticed the lesion.

Instruct the client on the use of daily sunscreen products.

Answer and Explanation

The Correct Answer is C

A.   Document the client's history of skin allergies: While important for the client's overall care, documenting the history of skin allergies is not the priority when assessing a new skin lesion.
B.   Photograph the lesion for the client's medical record: Documenting the appearance of the lesion is important for the client's medical record, but it is not the priority when initially assessing the lesion.
C.   Identify when the client first noticed the lesion: The priority is to gather information about the onset and characteristics of the lesion to determine its potential severity and urgency of intervention.
D.   Instruct the client on the use of daily sunscreen products: While sun protection is important for skin health, it is not the priority when assessing a new skin lesion.

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Correct Answer is B

Explanation

A. A 49-year-old who works in food services: While individuals working in food services may be at risk of exposure to influenza, they are not in the highest priority group. Age and underlying health conditions are typically prioritized over occupational risk factors.

B. An 88-year-old who lives in an apartment for senior citizens: Older adults, especially those living in congregate settings like senior citizen apartments, are at higher risk of complications from influenza. Therefore, the 88-year-old should have the highest priority to receive the vaccine.

C. A 26-year-old with three young children: While having young children may increase the risk of exposure to influenza, younger adults without underlying health conditions are generally at lower risk of severe complications compared to older adults.

D. A 15-year-old who plays ice hockey: While participation in activities like ice hockey may increase the risk of exposure to respiratory infections, age and health status are more significant factors in determining priority for influenza vaccination.

A. Povidone-iodine B. Alcohol-based antiseptic C. Chlorhexidine D. Soap and water

Correct Answer is D

Explanation

A. Povidone-iodine: Povidone-iodine is an antiseptic agent used for skin disinfection but is not recommended for routine hand hygiene, especially in cases of Clostridium difficile infection.

B. Alcohol-based antiseptic: While alcohol-based hand sanitizers are effective for most routine hand hygiene situations, they may not be sufficient for removing spores of Clostridium difficile. Soap and water are preferred for hand hygiene in cases of C. difficile infection.
C. Chlorhexidine: Chlorhexidine is an antiseptic agent commonly used for skin disinfection, but like alcohol-based hand sanitizers, it may not effectively remove C. difficile spores. Soap and water are preferred.

D. Soap and water: Soap and water are recommended for hand hygiene in cases of Clostridium difficile infection because mechanical friction from hand washing helps physically remove
spores from the hands.

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A nurse is collecting data from a client who reports finding a new skin lesion. Which of the following actions is the nurse's priority?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is D

Explanation

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