Which is important for the nurse to assess when inspecting the skin of a patient?

Wear gloves only if the skin appears broken or inflamed.

Ask the patient about personal skin care.

Avoid potentially embarrassing questions about rashes or scars.

Have artificial, preferably fluorescent, lighting for proper illumination of the skin.

Answer and Explanation

The Correct Answer is B

A. Wear gloves only if the skin appears broken or inflamed. Gloves should be worn to protect both the patient and the nurse from infection regardless of the appearance of the skin.
B. Ask the patient about personal skin care. Understanding the patient's personal skin care practices can provide insight into potential issues and areas needing attention.
C. Avoid potentially embarrassing questions about rashes or scars. Addressing rashes or scars is crucial for proper assessment and treatment, despite potential embarrassment.
D. Have artificial, preferably fluorescent, lighting for proper illumination of the skin. Proper lighting is important, but asking about personal skin care can provide additional context and help with a thorough assessment.

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Correct Answer is C

Explanation

A. Osteomyelitis: Osteomyelitis is an infection of the bone and does not directly impact the skeletal changes affecting lung function.

B. Osteoporosis: While osteoporosis affects bone density and may cause fractures, it is not specifically linked to changes in lung function related to skeletal changes.

C. Kyphosis: Kyphosis, or excessive curvature of the thoracic spine, can compress the thoracic cavity and reduce lung expansion, which impacts effective air exchange in COPD patients.

D. Arthritis: Arthritis affects joint function but does not have a direct impact on the skeletal changes that alter lung function like kyphosis does.

A. personality disorder. B. dementia. C. delirium. D. sundowning syndrome.

Correct Answer is D

Explanation

A. Personality disorder. Personality disorders are long-term patterns of behaviour and inner experiences that deviate significantly from the expectations of the individual's culture. The described behaviour is a specific pattern related to the time of day, not indicative of a personality disorder.
B. Dementia. While dementia is the underlying condition, the specific worsening of symptoms in the evening is known as sundowning syndrome. Dementia alone does not specify the time-related pattern of increased confusion and agitation.
C. Delirium. Delirium is an acute, often sudden change in cognition and attention, usually caused by an underlying medical condition or substance use. The described behavior follows a regular daily pattern, indicating a different issue.
D. Sundowning syndrome. Sundowning syndrome refers to increased confusion and agitation in the late afternoon and evening, commonly seen in individuals with Alzheimer's disease or other forms of dementia.

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Which is important for the nurse to assess when inspecting the skin of a patient?

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Naxlex Comprehensive Predictor Exams

The nurse recognizes that an older adult patient with COPD has a higher incidence of developing which age-related skeletal change that will alter the ability to exchange air effectively?

Correct Answer is C

Explanation

A nurse is caring for an older adult who lives in a long-term care facility on the Alzheimer unit. Every evening around 5:00 p.m., the resident becomes increasingly agitated and more confused, a state that lasts throughout the evening. The nurse recognizes this behaviour as:

Correct Answer is D

Explanation

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What should the entire health team focus on during the rehabilitation phase?

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