LPN exams medical-surgical practice questions set 4

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The integumentary system, primarily the skin, performs several critical physiological roles. It prevents dehydration by acting as a barrier, thanks to the waterproof keratin in the epidermis, which limits water loss. It regulates body fluids indirectly through sweat production and prevents excessive fluid loss. Temperature regulation occurs via sweating and blood vessel dilation or constriction in the dermis. However, the skin does not synthesize vitamin A. Instead, it synthesizes vitamin D when exposed to ultraviolet light, using cholesterol precursors in the epidermis. Vitamin A, essential for skin health and vision, is obtained from the diet (e.g., through beta-carotene) and not produced by the integument. This distinction is key: while the skin processes certain vitamins, its synthetic capacity is limited to vitamin D, not A. Misattributing vitamin A synthesis to the skin overlooks its actual metabolic role and dietary dependency, making this the function it does not perform among the listed options.

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The correct answer is B: "Have you been camping in the last month?" This question is the first one to ask because the client presenting with a ring-like rash on the upper leg suggests a possible exposure to ticks, which are commonly found in outdoor environments like camping areas. Ticks can transmit Lyme disease, which often presents with a characteristic rash called erythema migrans. By asking about recent camping activities, the nurse can gather crucial information to assess the likelihood of a tick bite and the need for further evaluation or treatment. Choices A, C, and D are incorrect because they do not directly address the potential exposure to ticks from outdoor activities like camping. Asking about cats in the home (choice A) is more relevant for conditions like cat scratch fever. Inquiring about flu-like symptoms (choice C) and physical contact with others with a similar rash (choice D) may be important but are not as pertinent as determining outdoor activities that could lead to a tick bite.

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The correct answer is C: 'The odor is an expected reaction to the pressure dressing.' The rationale is that in the scenario provided, the male client is being treated with an occlusive dressing for the pressure ulcer. Occlusive dressings can sometimes lead to a foul odor due to the accumulation of exudate and bacteria under the dressing, which is a normal part of the healing process. The nurse's response should reassure the wife that the odor is expected and not necessarily indicative of an infection. Option A: 'I will contact your husband's doctor when he makes rounds.' This response does not address the wife's concern about the foul odor and delays providing necessary information. Option B: 'The odor is secondary to an infection and he is taking antibiotics.' This response assumes an infection without proper assessment and may mislead the wife about the cause of the odor. Option D: 'I am sorry the odor bothers you. We will bathe your husband.' This response does not address the underlying cause

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The correct answer is D: Artificial passive. Plasma therapy involves administering preformed antibodies to provide immediate protection against a specific pathogen. This is considered artificial passive immunity because the antibodies are obtained from an external source rather than being produced by the individual's immune system. Explanation: 1. Natural active immunity (Choice A) is when the body produces its antibodies after exposure to a pathogen, which is not the case in plasma therapy. 2. Natural passive immunity (Choice B) is when antibodies are passed from mother to fetus or through breast milk, not obtained through plasma therapy. 3. Artificial active immunity (Choice C) involves vaccination to stimulate the body's immune response, which is different from plasma therapy. In summary, the correct answer is D (Artificial passive) because plasma therapy provides immediate immunity through externally sourced antibodies, distinguishing it from the other types of immunological protection.

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Immobilizing the right arm with a splint or sling is the correct answer, as it promotes graft adherence by preventing movement and shear forces that could dislodge the newly placed skin graft. Stability is critical in the initial days post-grafting to allow the graft to establish blood supply from the wound bed, ensuring survival and integration. Elevation may reduce edema but isn't the primary intervention for adherence, though it can aid comfort and swelling control. Applying negative pressure wound therapy is contraindicated for grafts, as suction could disrupt fragile tissue, cause bleeding, or lift the graft, undermining its purpose. Irrigation with saline twice daily risks disturbing the graft's attachment and introduces infection risk, countering sterile post-op protocols that favor minimal interference. Immobilization directly addresses the mechanical stability needed for graft take, making it the most effective nursing action in this scenario, supported by standard wound care principles.

Correct answer:

Immobilizing the right arm with a splint or sling is the correct answer, as it promotes graft adherence by preventing movement and shear forces that could dislodge the newly placed skin graft. Stability is critical in the initial days post-grafting to allow the graft to establish blood supply from the wound bed, ensuring survival and integration. Elevation may reduce edema but isn't the primary intervention for adherence, though it can aid comfort and swelling control. Applying negative pressure wound therapy is contraindicated for grafts, as suction could disrupt fragile tissue, cause bleeding, or lift the graft, undermining its purpose. Irrigation with saline twice daily risks disturbing the graft's attachment and introduces infection risk, countering sterile post-op protocols that favor minimal interference. Immobilization directly addresses the mechanical stability needed for graft take, making it the most effective nursing action in this scenario, supported by standard wound care principles.

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The correct answer is D. The nurse should assess the patient with a repaired right femoral shaft fracture complaining of tightness in the calf first. This could indicate a potential complication like deep vein thrombosis (DVT), which is a serious condition requiring immediate attention to prevent further harm. Assessing for DVT is crucial as it can lead to pulmonary embolism if left untreated. Choice A is incorrect as facial pain in a patient with a repaired mandibular fracture, while important, does not pose an immediate life-threatening risk. Choice B is incorrect as an externally rotated leg in a patient with an unrepaired intracapsular left hip fracture may indicate a hip dislocation, but it is not as urgent as assessing for a potential DVT. Choice C is incorrect as wrist swelling and deformity in a patient with an unrepaired Colles’ fracture, while concerning, does not require immediate attention compared to the potential complication of DVT in the patient with the femoral shaft

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Rationale for Correct Answer (E): E: Surgery is the correct answer. Surgery is not typically used as a primary therapy for autoimmune diseases. Autoimmune diseases are usually treated with medications such as immuno-suppressive drugs (A), anti-inflammatory drugs (B), and targeted therapies like anti-TNF (C) and anti-CD20 (D) to manage symptoms and control the immune response. Surgery is only considered in specific cases when other treatments have failed or for complications related to the autoimmune disease. Therefore, surgery is not a standard therapy for autoimmune diseases. Summary of Incorrect Choices: A: Immuno-suppressive drugs like cortisone are commonly used in autoimmune disease treatment. B: Aspirin is an anti-inflammatory drug that can help manage symptoms in some autoimmune diseases. C: Anti-TNF therapy targets specific molecules involved in the immune response in autoimmune diseases. D: Anti-CD20 therapy targets B cells to modulate the immune response in autoimmune diseases.

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The correct answer is D: Prepare his room before his arrival so that he feels expected and welcome. This is the best choice because it demonstrates a proactive and thoughtful approach to welcoming the new resident. By preparing the room in advance, the nursing assistant shows consideration and care for the resident's comfort and well-being. This action helps create a positive first impression by making the resident feel valued and welcomed. Incorrect choices: A: Placing personal items where the NA thinks they look best may not align with the resident's preferences and could make the resident feel uncomfortable. B: Completing the admission process quickly may prioritize efficiency over the resident's emotional needs, potentially leading to a rushed and impersonal interaction. C: Allowing the resident to introduce himself to everyone in the facility puts the burden of initiating social interactions on the resident, which may not be ideal for someone new and unfamiliar with the environment.

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Acne arises from multiple factors, but excess sebum is a primary cause. Sebaceous glands produce sebum, an oil that lubricates skin and hair. Overproduction, often triggered by hormonal changes (e.g., androgens in puberty), clogs hair follicles, creating a breeding ground for Propionibacterium acnes bacteria. This leads to inflammation, forming pimples. Hypersecretion of hormones, like testosterone, drives this excess sebum, making it a linked cause, though the question allows single selection, prioritizing sebum's direct role. Excess carotene affects skin color, not oil production or acne. Poor hygiene ('wash your face') can worsen acne by allowing bacterial buildup, but it's not the root cause overwashing may even irritate skin. Bacterial infection is a secondary factor after sebum clogs pores. Dermatological consensus highlights sebum's role in acne pathogenesis, with hormonal influence as a trigger, distinguishing it from dietary pigments or hygiene alone as the most immediate explanation.