Which term is used to describe the following condition in a patient’s medical record: perineal skin breakdown after sitting in wet underclothes for many hours?

Debridement.

Evisceration.

Maceration.

Dehiscence.

Answer and Explanation

The Correct Answer is C

Choice A rationale:

Debridement refers to the removal of dead, damaged, or infected tissue to promote healing. It is not a term used to describe skin breakdown caused by moisture.

Choice B rationale:

Evisceration is the protrusion of internal organs through a wound or surgical incision. It is not relevant to the condition of perineal skin breakdown due to wetness.

Choice D rationale:

Dehiscence is the separation of a surgical wound. It is not applicable in this case, as there is no mention of a surgical wound.

Choice C rationale:

Maceration is a term used to describe skin that has become softened and broken down due to prolonged exposure to moisture. This is the most accurate term to describe the condition of perineal skin breakdown after sitting in wet underclothes for many hours.

Key features of maceration:

Skin softening: The skin becomes white and wrinkled, resembling a prune.

Epidermal loss: The outer layer of skin (epidermis) may slough off, leaving the underlying tissue exposed. Redness: The affected area may become red and inflamed.

Pain or tenderness: The area may be painful or tender to the touch.

Increased risk of infection: Macerated skin is more susceptible to infection due to the breakdown of the skin barrier. Causes of maceration:

Prolonged exposure to moisture: This can include sweat, urine, feces, wound drainage, or excessive bathing. Friction: Rubbing or chafing of the skin can also contribute to maceration.

Impaired circulation: Poor blood flow to the area can make it more vulnerable to maceration. Prevention of maceration:

Keep skin clean and dry: This is the most important step in preventing maceration. Change wet or soiled clothing or dressings promptly.

Apply barrier creams or ointments: These can help to protect the skin from moisture.

Use incontinence products: These can help to keep the skin dry if the patient is incontinent. Reposition the patient frequently: This helps to reduce pressure and friction on the skin.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is C

Explanation

Choice A rationale:

Side effect: A side effect is an effect of a drug that is secondary to the main intended effect. It is usually predictable and may be either beneficial or harmful. However, constipation is not a common or expected side effect of iron supplements. It is more likely to be an adverse reaction.

Choice B rationale:

Therapeutic effect: The therapeutic effect is the intended effect of a drug, the one that is desired to treat the condition. In this case, the therapeutic effect of the iron supplement would be to increase the patient's iron levels. Constipation is not the desired effect of the iron supplement, so it is not a therapeutic effect.

Choice C rationale:

Adverse reaction: An adverse reaction is an unwanted or harmful reaction to a drug that is not necessarily predictable. It can range from mild to severe. Constipation is a common adverse reaction to iron supplements. It is thought to be caused by the iron binding to undigested food in the intestines, making it harder to pass stool.

Choice D rationale:

Toxicity: Toxicity refers to a poisonous or harmful effect of a drug. It is usually caused by taking too much of a drug or by a drug interacting with another drug or substance. Constipation is not a sign of iron toxicity. Iron toxicity can cause symptoms such as nausea, vomiting, abdominal pain, and diarrhea.

A. A superficial 3-inch x 3-inch abrasion has no active bleeding, drainage, or debris. B. The 4-inch incision edges are well approximated with intact sutures. C. An ulcerated 3-inch x 1-inch area has thick yellow slough present in the center. D. The incision is 5 inches long x 1 inch deep x 1 inch wide with granulation tissue present.

Correct Answer is B

Explanation

Choice A rationale:

A superficial abrasion heals by secondary intention, not primary intention.

In secondary intention healing, the wound is left open to heal from the inside out. This type of healing is typically slower and results in more scar tissue formation.

The absence of active bleeding, drainage, or debris is a positive sign, but it does not guarantee that the wound is healing by primary intention.

Choice C rationale:

The presence of thick yellow slough indicates that the wound is infected and not healing properly. This is a sign of delayed healing, not primary intention healing.

Choice D rationale:

The presence of granulation tissue is a sign of healing, but it does not indicate whether the wound is healing by primary or secondary intention.

Granulation tissue is a type of new tissue that forms during the healing process. It is composed of blood vessels, collagen, and fibroblasts.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

Which term is used to describe the following condition in a patient’s medical record: perineal skin breakdown after sitting in wet underclothes for many hours?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient develops constipation after taking a daily iron supplement prescribed by the physician. Which term best describes the patient’s reaction to the supplement?

Correct Answer is C

Explanation

Which assessment charting indicates that the wound is healing by primary intention?

Correct Answer is B

Explanation

Which assessment finding indicates that the patient is not a candidate for acupuncture therapy?

If a patient opts for an herbal supplement over a prescribed medication, what would be the nurse’s best response?

The nurse notes a reddened area on the right heel that does not turn lighter in color when pressed with a finger.Which term will the nurse use to describe this area?

Which medication order is written appropriately?

The nurse is caring for a patient with shallow respirations and diminished breath sounds following abdominal surgery yesterday.Which are the appropriate actions of the nurse? (Select all that apply.)

The patient is scheduled to receive insulin aspart and insulin detemir.What is the correct procedure for the nurse to draw up the insulins for administration?

The nurse is to administer 10 mg/kg of acetaminophen to a patient who weighs 70 pounds (32 kg). The acetaminophen elixir is 160 mg per 5 mL. How many mL of medication will be given to the patient for each dose?

The post-anesthesia care unit nurse receives a patient from the operating room. Which assessment will the nurse perform first?