Skin & Mobility Care Quiz

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Essential topics on burns, wounds, and mobility.

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Kay

Estados Unidos

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Skin & Mobility Care Quiz


Skin & Mobility Care QuizVersión en línea Essential topics on burns, wounds, and mobility. por Kay 1 A nurse is caring for a client who has sustained an electrical burn. Which of the following actions should the nurse take? (Select all that apply.) Choose one or more answers a Ensure the power source is turned off b Touch the client to assess responsiveness immediately c Monitor cardiac rhythm d Assess for internal injuries e Delay treatment until visible burns appear 2 A nurse is assessing a client who has a first-degree burn. Which of the following findings should the nurse expect? (Select all that apply.) Choose one or more answers a Blister formation b Redness of the skin c Damage to the dermis d Mild pain e Absence of scarring 3 What best describes a first-degree burn? a Nerve damage causing loss of pain sensation b Blisters form and severe pain persists c Affects all skin layers with white charred tissue d Affects only the epidermis with redness and mild pain 4 Second-degree burns typically cause? a Dry, non-blanching skin b Blisters and more pronounced pain c No tissue damage at all d Only redness with no pain 5 Third-degree burns are often? a Mild redness and itching b Painful, sensitive, with scabbing c White or charred skin with often no pain d Red, swollen, with blisters 6 Gasoline burns covering 25% of body require priority concern for? a Gastric ulcers b Airway obstruction c Hypertension d Hair loss at the burn site 7 Wound healing stage described by warmth and edema due to immune activity is? a Proliferation phase b Maturation phase c Hemostatic phase d Inflammatory phase 8 Openings: Stage 1 pressure injury manifests as? a Blister formation b Necrotic tissue present c Pus drainage d Non-blanchable erythema with intact skin 9 Urine output target during burn fluid resuscitation for adults is? a At least 2 mL/kg/hr b At least 0.5 mL/kg/hr c 1 mL/kg/hr d 0.05 mL/kg/hr 10 Which skin layer provides pigmentation and protection? a Subcutaneous fascia b Hypodermis c Dermis d Epidermis 11 Peripheral artery disease (PAD) signs include? a Excess hair growth and swelling only b Warm, flushed skin with strong pulses c Decreased or absent pulses and cool skin d Pain-free extremities at rest 12 Infection risk with an open ulna fracture is reduced by? a Prompt antibiotics and surgical irrigation b Waiting 48 hours before care c Oral antibiotics only without surgery d Raising the limb and applying ice 13 A nurse is caring for a client who has gasoline burns covering 25% of the body. Which of the following is the priority action? a Initiate wound care b Assess pain level c Ensure a patent airway d Administer IV fluids 14 A nurse is providing care for a client who has severe burns. Which of the following interventions should the nurse include? (Select all that apply.) Choose one or more answers a Maintain airway patency b Initiate fluid resuscitation c Restrict fluid intake d Monitor urine output e Implement infection control measures 15 A nurse is assessing a client who has burns over 50% of their body. Which of the following physiological changes should the nurse expect? (Select all that apply.) Choose one or more answers a Increased risk for infection b Hyperkalemia c Decreased metabolic demands d Fluid volume deficit e Organ dysfunction 16 A nurse is evaluating the effectiveness of fluid resuscitation in a burn client. Which of the following findings indicate adequate perfusion? (Select all that apply.) Choose one or more answers a Urine output of 0.5 mL/kg/hr b Elevated lactate levels c Stable vital signs d Cool extremities e Adequate peripheral circulation 17 A nurse is caring for a client at risk for moisture-related skin damage. Which of the following clients are at risk? (Select all that apply.) Choose one or more answers a Client with urinary incontinence b Client with excessive diaphoresis c Ambulatory client with no comorbidities d Client with wound drainage e Immobile client 18 A nurse is planning care to prevent friction injuries. Which of the following interventions should the nurse include? (Select all that apply.) Choose one or more answers a Reposition the client every 2 hr b Use lift devices when moving the client c Drag the client during repositioning d Maintain dry linens e Use proper body mechanics 19 A nurse is assessing a wound during the inflammatory phase of healing. Which of the following findings should the nurse expect? (Select all that apply.) Choose one or more answers a Warmth b Edema c Pale wound bed d Increased redness e Absence of drainage 20 A nurse is caring for a client with a wound infection. Which findings indicate a local infection? (Select all that apply.) Choose one or more answers a Redness at wound site b Drainage c Fever and hypotension d Pain at wound site e Infection confined to wound 21 A nurse is teaching a client about the effects of smoking on wound healing. Which of the following statements should the nurse include? (Select all that apply.) Choose one or more answers a Smoking increases oxygen delivery b Smoking causes vasoconstriction c Smoking delays healing d Smoking improves immune response e Smoking increases infection risk 22 A nurse is assessing a client who has an arterial ulcer. Which of the following findings should the nurse expect? (Select all that apply.) Choose one or more answers a Located on the toes b Pale wound bed c Irregular borders d Painful e Associated with poor circulation 23 A nurse is assessing a client for a stage 1 pressure injury. Which of the following findings should the nurse expect? (Select all that apply. Choose one or more answers a Non-blanchable erythema b Open ulcer c Intact skin d Blister formation e Persistent redness 24 A nurse is implementing interventions to reduce the risk of pressure injuries. Which of the following actions should the nurse take? (Select all that apply.) Choose one or more answers a Reposition every 2 hr b Keep skin clean and dry c Massage bony prominences d Provide adequate nutrition e Use lift devices 25 A nurse is assessing a client for inhalation injury. Which of the following findings should the nurse identify as manifestations? (Select all that apply.) Choose one or more answers a Hoarseness b Brassy cough c Stridor d Oxygen saturation of 98% e Soot in sputum 26 A nurse is caring for a client who is immobile. Which of the following complications should the nurse monitor for? (Select all that apply.) Choose one or more answers a Deep vein thrombosis b Pressure injuries c Improved lung expansion d Respiratory complications e Muscle atrophy 27 A nurse is teaching a client about ice therapy for a soft-tissue injury. Which of the following instructions should the nurse include? (Select all that apply.) Choose one or more answers a Apply ice within 48 hr b Apply ice directly to skin c Use for 15–20 min intervals d Apply every 1–2 hr e Use a barrier between ice and skin 28 A nurse is providing discharge teaching for a client with a walking boot for an ankle fracture. Which of the following instructions should the nurse include? (Select all that apply.) Choose one or more answers a Wear the boot snugly b Remove boot when ambulating c Monitor skin for irritation d Keep the boot dry e Follow weight-bearing instructions 29 A nurse is assessing a client who has peripheral artery disease. Which findings indicate impaired circulation? (Select all that apply.) Choose one or more answers a Decreased pulses b Cool extremities c Redness with elevation d Pain with limb elevation e Muscle atrophy 30 A nurse is teaching a client with diabetes about foot care. Which of the following instructions should the nurse include? (Select all that apply.) Choose one or more answers a Inspect feet daily b Walk barefoot at home c Wear closed-toe shoes d Report wounds promptly e Maintain blood glucose control Feedback 1 Safety first (turn off power), monitor heart, assess internal injuries. Never touch client before ensuring safety. 2 First-degree burns affect only epidermis → redness, mild pain, no blistering, no scarring. 3 First-degree burns involve only the epidermis. 4 Blisters and significant pain are characteristic of second-degree burns. 5 Nerve damage can reduce pain in third-degree burns. 6 Airway safety is critical due to inhalation risk. 7 Inflammation involves warmth and edema from immune response. 8 Stage 1: persistent redness without skin break. 9 Monitor urine output to assess perfusion. 10 Epidermis contains keratin and melanocytes. 11 PAD shows reduced pulses and cool skin. 12 Infection risk requires prompt antibiotics and irrigation. 13 Airway is priority (ABCs)**, especially with gasoline/inhalation risk. 14 Fluid resuscitation, airway, infection prevention, and monitoring are critical. Fluids are NOT restricted. 15 Severe burns → infection, hyperkalemia, dehydration, organ failure, hypermetabolic (not decreased). 16 Adequate perfusion = good urine output, stable vitals, good circulation. Elevated lactate = poor perfusion. 17 Moisture risks: incontinence, sweat, drainage, immobility. 18 Never drag a client—causes friction/shear. 19 Inflammatory phase = warmth, redness, edema. 20 Local infection stays at wound. Systemic = fever, hypotension. 21 Smoking ↓ oxygen, causes vasoconstriction, delays healing, ↑ infection risk. 22 Arterial ulcers = toes, pale, painful, ischemic. Borders are regular (not irregular). 23 Stage 1 = intact skin + non-blanchable redness. 24 Do NOT massage bony prominences. 25 Classic inhalation signs. O2 sat 98% is normal. 26 Immobility causes multiple complications, not improvement. 27 Never apply ice directly to skin. 28 Boot stays on during ambulation unless instructed otherwise 29 PAD = poor circulation signs. Elevation worsens pallor, not redness. 30 Never walk barefoot due to injury risk.

Skin & Mobility Care Quiz

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Skin & Mobility Care QuizVersión en línea

por Kay

A nurse is caring for a client who has sustained an electrical burn. Which of the following actions should the nurse take? (Select all that apply.)

A nurse is assessing a client who has a first-degree burn. Which of the following findings should the nurse expect? (Select all that apply.)

What best describes a first-degree burn?

Second-degree burns typically cause?

Third-degree burns are often?

Gasoline burns covering 25% of body require priority concern for?

Wound healing stage described by warmth and edema due to immune activity is?

Openings: Stage 1 pressure injury manifests as?

Urine output target during burn fluid resuscitation for adults is?

Which skin layer provides pigmentation and protection?

Peripheral artery disease (PAD) signs include?

Infection risk with an open ulna fracture is reduced by?

A nurse is caring for a client who has gasoline burns covering 25% of the body. Which of the following is the priority action?

A nurse is providing care for a client who has severe burns. Which of the following interventions should the nurse include? (Select all that apply.)

A nurse is assessing a client who has burns over 50% of their body. Which of the following physiological changes should the nurse expect? (Select all that apply.)

A nurse is evaluating the effectiveness of fluid resuscitation in a burn client. Which of the following findings indicate adequate perfusion? (Select all that apply.)

A nurse is caring for a client at risk for moisture-related skin damage. Which of the following clients are at risk? (Select all that apply.)

A nurse is planning care to prevent friction injuries. Which of the following interventions should the nurse include? (Select all that apply.)

A nurse is assessing a wound during the inflammatory phase of healing. Which of the following findings should the nurse expect? (Select all that apply.)

A nurse is caring for a client with a wound infection. Which findings indicate a local infection? (Select all that apply.)

A nurse is teaching a client about the effects of smoking on wound healing. Which of the following statements should the nurse include? (Select all that apply.)

A nurse is assessing a client who has an arterial ulcer. Which of the following findings should the nurse expect? (Select all that apply.)

A nurse is assessing a client for a stage 1 pressure injury. Which of the following findings should the nurse expect? (Select all that apply.

A nurse is implementing interventions to reduce the risk of pressure injuries. Which of the following actions should the nurse take? (Select all that apply.)

A nurse is assessing a client for inhalation injury. Which of the following findings should the nurse identify as manifestations? (Select all that apply.)

A nurse is caring for a client who is immobile. Which of the following complications should the nurse monitor for? (Select all that apply.)

A nurse is teaching a client about ice therapy for a soft-tissue injury. Which of the following instructions should the nurse include? (Select all that apply.)

A nurse is providing discharge teaching for a client with a walking boot for an ankle fracture. Which of the following instructions should the nurse include? (Select all that apply.)

A nurse is assessing a client who has peripheral artery disease. Which findings indicate impaired circulation? (Select all that apply.)

A nurse is teaching a client with diabetes about foot care. Which of the following instructions should the nurse include? (Select all that apply.)