A nurse is assessing the skin of a client who has worked outdoors for the past 20 years. Which of the following findings is the nurse's priority?
Skin tags noted in the neck region
A change in appearance of a mole on the shoulder
Atrophic wart on the left index finger
A flat, nonpalpable, discolored area of skin on the trunk
The Correct Answer is B
Choice A reason:
Skin tags noted in the neck region: Skin tags are generally benign and not typically a cause for immediate concern. While they can be removed if desired, they are not as urgent as assessing potential changes in moles for skin cancer.
Choice B reason:
A change in appearance of a mole on the shoulder is the appropriate answer. The nurse's priority should be a change in the appearance of a mole on the shoulder. Changes in the colour, size, shape, or texture of a mole can indicate potential skin cancer, especially malignant melanoma. Timely assessment and appropriate follow-up are crucial to catch any skin cancer early and ensure effective treatment.
Choice C reason:
The atrophic wart on the left index finger is incorrect. An atrophic wart is a benign skin condition and is not typically associated with skin cancer or immediate danger. It may not require urgent assessment.
Choice D reason:
A flat, nonpalpable, discoloured area of skin on the trunk: While any change in skin appearance should be assessed, a nonpalpable, discoloured area may not present an immediate concern unless it shows signs of growth, change, or other concerning features.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason:
Mixing medications together in a single syringe is not recommended unless specifically approved by a pharmacist or healthcare provider, as some medications may interact with each other and cause adverse effects or reduced efficacy.
Choice B reason:
Medications should not be combined with the formula in the feeding bag. This can alter the effectiveness of both the medications and the feeding formula.
Choice C reason:
Flushing the NG tube with 5 mL of sterile water is generally not enough. The tube should be flushed with a sufficient amount of water (usually 15-30 mL) before and after administering medications to ensure that the medications are delivered properly and to prevent clogging.
Choice D reason:
Each medication should be diluted with sterile water to ensure it can pass through the NG tube without clogging and to facilitate proper absorption.
Correct Answer is C
Explanation
Choice A reason:
ALT is not primarily used to check kidney function. Kidney function is typically assessed through other tests, such as blood urea nitrogen (BUN) and creatinine levels.
Choice B reason:
ALT is not used to assess the risk of blood clots. It is specifically related to liver function.
Choice C reason:
Alanine aminotransferase (ALT) is an enzyme found primarily in the liver. An elevated ALT level in the blood can indicate potential liver damage or disease, so the ALT test is used to assess the function of the liver.
Choice D reason:
ALT is not a test to determine heart performance. Heart function is evaluated using tests such as electrocardiograms (ECGs) or cardiac enzymes.
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