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A nurse is caring for a client who has a nonpalpable skin lesion that is less than 0.5 cm (0.2 In) in diameter. Which of the following terms should the nurse use to document this finding?

Papule

Vesicle

Nodule

Macule

Answer and Explanation

The Correct Answer is D

A. Papule – A papule is a raised, solid lesion (e.g., a mole) and is palpable, not flat.

B. Vesicle – A vesicle is a fluid-filled blister (e.g., herpes, chickenpox), which is not the case here.

C. Nodule – A nodule is a deep, raised lesion that extends into the dermis or subcutaneous tissue.

D. Macule – A macule is a flat, nonpalpable skin discoloration that is less than 1 cm (e.g., a freckle or petechiae).

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Correct Answer is D

Explanation

A. Presence of WBCs in urine : This suggests a possible infection, not necessarily a blockage.

B. Cloudy urine : This may indicate an infection but is not specific for occlusion.

C. Urinary urgency: A client with a catheter should not experience urgency since urine continuously drains.

D. Bladder distention: If the catheter is occluded, urine will accumulate in the bladder, leading to distention.

A. “I'm sure your situation will get better with time." B. "It must be terrible to be in this situation." C. "If I were you, I would talk with the hospital chaplain." D. “Tell me what you have done in the past to cope with your problems.”

Correct Answer is D

Explanation

A. “I'm sure your situation will get better with time." This response is dismissive and does not acknowledge the client’s feelings. It provides false reassurance rather than support.

B. "It must be terrible to be in this situation." While this statement attempts empathy, it may sound judgmental or patronizing rather than encouraging meaningful discussion.

C. "If I were you, I would talk with the hospital chaplain." This response assumes what the client should do rather than exploring their current coping mechanisms. It does not encourage self-reflection.

D. “Tell me what you have done in the past to cope with your problems.” This response uses therapeutic communication by allowing the client to reflect on past coping strategies and explore potential solutions.

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A nurse is caring for a client who has a nonpalpable skin lesion that is less than 0.5 cm (0.2 In) in diameter. Which of the following terms should the nurse use to document this finding?

Nursing Test Bank

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Correct Answer is D

Explanation

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Correct Answer is D

Explanation

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