A 35-year-old man is seen in the clinic for an \"infection in my left foot\". Wh

Question

A 35-year-old man is seen in the clinic for an "infection in my left foot". Which of the following would the nurse expect to find during an assessment of this client? . a. Hard and fixed cervical nodes b. Enlarged and tender inguinal nodes c. Bilateral enlargement of the occipital nodes d. "Pellet-like" nodes in the supraclavicular region The nurse has just completed a lymph assessment on a 60-year-old healthy female client. The nurse knows that most lymph nodes in healthy adults are normally: 2. a. Shotty b. Not palpable c. Large, firm, and fixed to the tissue d. Rubbery, discrete, and mobile The nurse observes yellow-tinged sclera on a client with dark skin. Based on this observation, what is the nurse's best action? 3. a. b. c. d. Evaluate the client further for cardiac disease Examine the soles of the client's feet Inspect the client's oral palate Place the client on contact isolation A client has two skin lesions, each the size of a nickel on his chest. Both lesions are flat and are a darker color than the rest of the client's skin. How does the nurse document this finding? 4. a. Two 2-cm hyperpigmented patches b. Two 1-inch erythematous plaques c. Two 2-mm pigmented papules d. Two 1-inch moles 5. Which client does the nurse assess to be at greatest risk for pressure ulcer development? a. Client who has pneumonia b. Client who uses a crutch to ambulate c. Client with hypertension on multiple medications d. Incontinent client with limited mobility The nurse is assessing a client and observes multiple fingernails. The nurse suspects that the client may have which condition? 6. small pits in all of the client's a. Cystic fibrosis b. Iron deficiency anemia c. Isolated of severe malnutrition d. Psoriasis

Explanation / Answer

1. If any infection in the lower extremities there will be a enlargement of inguinal nodes which are present in groins. So the correct answer is option b

2. In healthy adults lymph nodes are normally not palpable. So the correct answer is option b

3. In sclera there may be a subconjunctival fat deposition, that show a yellow hue and in dark skin patients assessing jaundice in other body areas is hard. So in order to confirm the jaundice the nurse has to inspect the client's oral palate. So the correct answer is option c.

4. Skin lesions are abnormal growth or appearance of the skin. Hyperpigmented patches only will be flat darker in color than the rest of the skin due to high melanin deposition. So the correct answer is option a.

5. Patients who have incontinent with limited mobility will do bed wetting. So they will be lying in the same wetted bed till the care givers change the position. They are more prone to develop pressure ulcer. So the correct answer is option d.

6. People who have psoriasis will have multiple small pits in finger nails. Psoriasis is a common skin condition which causes inflammation of the skin. So the correct answer is option d.

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