TestBankforEbersoleandHessGerontologicalNursingandHealthyAging1stEditionbyTouhyTestBank Chapter 11: Promoting Healthy Skin and Feet MULTIPLE CHOICE Which of the following is an important consideration regarding the skin of an older adult person? a Generous amounts of soap should be used for cleansing b Sweat glands increase in activity c The skin becomes more vulnerable to damage d The skin becomes darker in unexposed areas ANS: C Feedback A B C D Incorrect Because moisture is lost more rapidly from the skin of an older adult, excessive use of soap tends to dehydrate the skin more severely than in a younger person Incorrect Sweat gland activity does not increase in old age, but moisture is lost more rapidly because the skin is thinner and sebum secretion is reduced Correct Thinner skin, reduced sebaceous protection, vascular insufficiency, and longer periods in stationary positions promote skin damage for older adults Incorrect Changes of skin colour in areas exposed to the sun are of more concern than those in unexposed areas DIF: Knowledge REF: 169 TOP: CRNE: HW (Health & Wellness) OBJ: Which skin lesion on an older adult should be evaluated promptly by a dermatologist? a A circumscribed, raised area resembling a blob of brown wax b A multicoloured, raised lesion with an irregular border c A rough, scaly, pink to reddish-brown lesion d A brown spot on the skin with no raised area Test Bank: Chapter 11 TB 11-2 ANS: B Feedback A B C D Incorrect This lesion reflects seborrheic keratosis Correct This lesion is malignant melanoma Incorrect This lesion is an actinic keratosis Incorrect This lesion is lentigo DIF: Comprehension TOP: CRNE: HW (Health & Wellness) REF: 170 OBJ: Which of the following topical agents is safe to apply? a Corn starch, to absorb moisture in the groin area b Betadine, to disinfect a healing pressure ulcer c An over-the-counter preparation, to dissolve a corn d Zinc oxide ointment to an area of excoriation ANS: D Feedback A B C D Incorrect Corn starch is a substance that promotes fungal growth Incorrect Betadine, hydrogen peroxide, alcohol, and some soaps are damaging to newly formed skin Incorrect Corn preparations dissolve healthy tissue along with the corn Correct Zinc oxide is designed to coat the skin and replace the skin’s natural oil barrier DIF: Comprehension TOP: CRNE: HW (Health & Wellness) REF: 169 OBJ: A 70-year-old woman complains of dry skin and asks for advice Which advice should the nurse offer to this older adult for improving her dry skin? a Add oil to bath water to keep skin soft b Keep bath water between 32.2°C and 39.0°C c Move to a climate with lower humidity Test Bank: Chapter 11 TB 11-3 d Dry the skin vigorously with a rough towel after bathing ANS: B Feedback A B C D Incorrect Oil added to the bathtub increases the risk of slipping and falling, which can result in a catastrophic injury Oils should be applied directly to moist skin after bathing Correct Tepid bath water minimizes moisture loss from skin Incorrect Humidity should be maintained at about 60% The person may not be able to move to another location Incorrect Vigorous, rough towel drying increases skin irritation DIF: Application REF: 168 TOP: CRNE: HW (Health & Wellness) OBJ: Which of the following statements is true about impaired skin integrity? a A stage III pressure ulcer can regress to stage II as the subcutaneous tissues regenerate b Stasis ulcer is another term for pressure ulcer c An unstageable wound presents with redness and blistering d Anemia and poor nutritional status correlate with poor healing of pressure ulcers ANS: D Feedback A B C D Incorrect Because subcutaneous tissues such as muscle and fat are not regenerated but simply replaced by granular tissue, staging of pressure ulcers is never reversed Incorrect Stasis ulcers result from the leakage of blood from veins beneath the skin Pressure ulcers are caused when perfusion to the tissue is impaired by external pressure that causes tissue injury and death Incorrect An unstageable wound is covered with eschar or slough, preventing visualization of the wound The skin requires debriding before the wound can be staged Correct Anemia and poor nutritional status correlate with poor healing of pressure ulcers Test Bank: Chapter 11 TB 11-4 DIF: Knowledge REF: 179, Figure 11-3 TOP: CRNE: CH (Changes in Health) OBJ: An older adult female patient with mild peripheral vascular disease complains of foot pain from a corn After assessing the patient’s feet, which intervention should the nurse implement to safely alleviate her discomfort? a Cut out an oval corn pad to make a U shape b Use a corn pad slightly larger than the corn c Gently remove the corn with a sterile razor blade d Tape the toe with the corn to the other toes ANS: A Feedback A B C D Correct A corn pad that is altered in this way surrounds the corn without adding pressure over it Incorrect If an oval corn pad is used without being cut to a U shape, it aggravates pressure over the corn and can reduce circulation to the covered tissue Incorrect For surgical removal of a corn, the patient should be referred to a foot care specialist Incorrect Taping the toes replaces pressure from the shoe with pressure from the tape DIF: Application REF: 181 TOP: CRNE: CH (Changes in Health) OBJ: Which of the following statements is true about foot care for older adults with diabetes? a A health care aide is qualified to care for the feet of a diabetic patient, including trimming the patient’s nails b Onychomycosis is eradicated quickly with antifungal creams or powders c Toenails should be cut to give a smooth, rounded edge d Tinea pedis is treated with topical application of antifungal powders ANS: D Feedback Test Bank: Chapter 11 A B C D Incorrect Diabetic foot care should be performed only by a nurse with special training, a nurse practitioner, or a podiatrist Incorrect Treatment of onychomycosis is very difficult because of the limited blood supply to the nails Oral medications are expensive and toxic Incorrect A toenail should be cut flat across Rounding can lead to ingrown toenails Correct Tinea pedis is treated similarly to any other fungal infections Feet, especially between the toes, should be kept dry and clean and should be regularly exposed to sun and air Topical application of antifungal powders, in addition to the hygiene measures already noted, is the usual treatment DIF: Knowledge REF: 182 TOP: CRNE: CH (Changes in Health) TB 11-5 OBJ: The nurse plans care to protect the skin covering an older adult’s greater trochanter What is the nurse’s priority intervention when the older adult is positioned on the side? a Turn the patient at least once every hour b Place a cushion between the patient’s knees c Keep the patient’s skin clean and dry d Use the Sims’ position ANS: A Feedback A B C Correct The most important nursing intervention when an older adult is positioned on the side is to relieve pressure on the head of the femur, the greater trochanter, because it is the most prominent bony projection on the side of a body By turning the older adult at one-hour intervals or more frequently, the nurse helps to maintain tissue perfusion, thus providing oxygenation to tissues and allowing the removal of waste from vulnerable skin Incorrect The nurse places a pillow between the knees to help maintain physiological body alignment and prevent strain on the hips and spine, and if positioned properly, the pillow can help to maintain tissue integrity of the medial malleolus and ankle by elevating them off the mattress However, because the nurse’s priority is to maintain tissue oxygenation, preventing muscle and joint strain is not as important Incorrect The nurse keeps the skin clean and dry to help maintain skin integrity, but this is not as important as maintaining tissue oxygenation Test Bank: Chapter 11 D Incorrect The nurse uses the Sims’ position to supplement turning, because in Sims’ position, the patient is on the side but rotated slightly forward, allowing the chest and abdomen to fall forward and relieve some of the pressure on the patient’s side DIF: Analysis REF: 175 TOP: CRNE: CH (Changes in Health) TB 11-6 OBJ: An older adult has a vitamin deficiency Which of the following does the nurse provide to the older adult to supply the missing vitamin important for maintaining healthy skin and enhancing tissue repair? a Carrot sticks b Non-fat milk c Orange slices d Unsalted nuts ANS: C Feedback A B C D Incorrect Carrots sticks are a good source of beta carotene, fibre, and vitamin A, important in the formation of epithelial tissue Incorrect Milk provides calcium for bone strength and protein for tissue repair, but these not address a vitamin deficiency Correct Orange slices provide vitamin C, which is important forhealthy tissues and gums, tissue repair and healing, and maintenance of blood vessels Incorrect Unsalted nuts provide healthy fats, fibre, and other nutrients, but not vitamins DIF: Application REF: 168 TOP: CRNE: HW (Health & Wellness) OBJ: 10 The nurse monitors for which of the following clinical indicators when an older adult complains of pruritus? a Dry, flaky skin b Brown macule c Brownish skin d Regional edema Test Bank: Chapter 11 TB 11-7 ANS: A Feedback A Correct The nurse is alert for rough, dry, flaky skin when an older adult complains of pruritus, to be able to prevent linear excoriation leading to skin breaks, excoriation, inflammation, and infection B Incorrect A brown macule is a freckle or a liver spot, an indication of sun exposure Incorrect Brownish skin is a clinical indicator of venous insufficiency Incorrect Regional edema is a sign of fluid overload and venous insufficiency; localized edema is a sign of infection C D DIF: Comprehension TOP: CRNE: CH (Changes in Health) REF: 168 OBJ: 11 The nurse cares for an older male adult who has a malignant melanoma Which intervention should the nurse implement for this man, to prevent a recurrence or advancement of this condition in the future? a Place posters about sunscreen in the halls of his apartment building b Promote application of sunscreen at his neighbourhood health fair c Tell him to schedule all outdoor activities after P.M daily d Instruct him to wear sun-protective clothing and a hat at all times ANS: D Feedback A B C D Incorrect Placing posters is an intervention for a community nurse Incorrect Promoting sunscreen at a health fair is an intervention for a community nurse Incorrect Scheduling activities after a specific time can be impractical or impossible Correct The nurse caring for an older adult instructs him to wear sun-protective garments at all times as well as an effective sunscreen to protect his skin against ultraviolet light to help prevent additional skin cancers Test Bank: Chapter 11 TB 11-8 DIF: Application REF: 172, Box 11-4 TOP: CRNE: CH (Changes in Health) OBJ: 12 Which infection-control practice should the nurse implement when caring for an older adult who has active herpes zoster? a Wear a face shield and gown for all patient contact b Instruct staff and visitors to wear a mask of the respirator type c Use a hospital room that has negative airflow circulation d Cover ruptured skin lesions with a nonabsorbent dressing ANS: D Feedback A B C D Incorrect A face shield is not necessary when caring for an adult with herpes zoster; however, a gown can be necessary during dressing changes or any time that splashing can occur Incorrect Airborne precautions and the respirator type of mask are indicated for infections transmitted through the air Incorrect Because active herpes zoster in an older adult is transmitted through contact, negative airflow is not indicated Correct Herpes zoster in an adult is spread through contact, so the nurse applies the principles of contact precautions when caring for an older adult with active herpes zoster; thus, to reduce the transmission of the virus through contact, the nurse keeps the ruptured lesions covered DIF: Comprehension TOP: CRNE: CH (Changes in Health) REF: 169–170 OBJ: 13 An older adult sleeps in a recliner with his cool, greyish-coloured feet on the floor What should the nurse investigate to assess the vascular status of this older adult? a Ability to stand during activities of daily living b Lateral ulcerations with brownish discoloration c Complaints of dull aching and peripheral edema d History of dyslipidemia and hypertension ANS: D Test Bank: Chapter 11 TB 11-9 Feedback A B C D Incorrect To assess an older adult with signs of arterial insufficiency, the nurse examines the distance the adult can walk without pain The older adult with peripheral arterial disease can stand without pain because dependent positioning of the feet helps to perfuse hypoxic tissues Incorrect Lateral ulcerations are clinical indicators of venous insufficiency Incorrect Dull aching and peripheral edema are clinical indicators of venous insufficiency Correct The nurse examines the older adult’s history of a dyslipidemia and hypertension to help determine the vascular status because histories of these disorders are risk factors for peripheral arterial disease DIF: Application REF: 172 TOP: CRNE: CH (Changes in Health) OBJ: 14 An older male adult has peripheral edema and brownish skin below the knees bilaterally Which goal does the nurse use specifically in this older adult’s plan of care, to manage his condition? a Promote perfusion to the periphery b Maintain dependent positioning c Protect skin from ultraviolet rays d Promote lower extremity compression ANS: D Feedback A B C D Incorrect Perfusion to the peripheral tissues is not this older adult’s problem Incorrect Dependent positioning uses gravity to pull fluid from higher to lower places; for this patient, the nursing care needs to counteract the gravity pull of fluids, so dependent positioning is contraindicated Incorrect Protecting skin from the sun is suitable care for all skin and not specifically related to his condition Correct An older adult with brownish skin and peripheral edema has clinical indicators of venous insufficiency; therefore the basis of nursing care for this older adult is compression because compression helps to prevent venous pooling and fluid accumulation in dependent interstitial spaces and, thus, prevent edema The nurse should request that a referral be made to a vascular surgeon DIF: Application REF: 172 OBJ: Test Bank: Chapter 11 TB 11-10 TOP: CRNE: CH (Changes in Health) 15 Which nursing intervention is most likely to prevent the creation of an environment that is conducive to fungal growth? a Provide oral care with soft-bristled brush b Apply nystatin powder to reddened tissue c Use mild skin cleansing agents and blot dry d Apply gauze soaked with antifungal lotion ANS: C Feedback A B C D Incorrect Providing oral care with a soft-bristled brush is ineffective therapy for preventing an oral Candida infection (thrush) Besides, thrush is usually an opportunistic infection, caused by immunosuppression Incorrect Reddened tissue can be infected already; nonetheless, applying an antifungal agent is an indicated treatment for a fungal infection Correct Fungal infections are most likely to begin in moist, dark areas of the body such as under the breasts and at the perineum; thus the nurse works to keep the skin of these areas, and all skin, clean and dry and to prevent tissue irritation from harsh drying Incorrect Applying antifungal lotion and keeping an area moist can contribute to fungal overgrowth DIF: Comprehension TOP: CRNE: CH (Changes in Health) REF: 175 OBJ: