After completing an integument physical examination, the nurse is documenting information concerning observed lesions. What characteristics will the nurse include in this documentation? (Select all that apply.)

Location

Color

Condition of surrounding skin

Elevation

Distribution pattern

Answer and Explanation

Correct Answer : A,B,C,D,E

A) Location: Documenting the exact location of lesions is crucial for monitoring changes over time, assessing potential spread or resolution, and providing accurate information for future reference. This information helps in the diagnosis and in tracking the effectiveness of treatments.

B) Color: The color of lesions can provide important clues about their nature and cause. For example, red or inflamed lesions might indicate infection or irritation, while darker lesions could suggest malignancy or chronicity. Color changes can also signify healing or worsening of the lesion.

C) Condition of surrounding skin: Noting the condition of the skin around the lesions helps assess whether there is additional inflammation, infection, or other skin conditions that may be related to the primary lesion. This provides a more comprehensive understanding of the patient’s skin health and any secondary complications.

D) Elevation: Elevation refers to whether the lesion is raised, flat, or depressed compared to the surrounding skin. This characteristic helps in identifying the type of lesion, such as a papule, plaque, or ulcer. Elevated lesions might suggest certain dermatological conditions, while depressed lesions might indicate scarring or loss of tissue.

E) Distribution pattern: The pattern of how lesions are distributed on the body can provide diagnostic clues. For example, a linear distribution might suggest contact dermatitis, while a symmetrical distribution could indicate a systemic condition. Understanding the distribution pattern helps in identifying the underlying cause and planning appropriate treatment.

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Correct Answer is A

Explanation

A) Facial edema: Myxedema is a severe form of hypothyroidism that is often characterized by the accumulation of mucopolysaccharides in the skin and other tissues, leading to facial and peripheral edema. This is a classic symptom of myxedema and is expected in clients with this condition.

B) Diarrhea: Diarrhea is more commonly associated with hyperthyroidism rather than hypothyroidism. Clients with myxedema typically experience constipation due to slowed gastrointestinal motility.

C) Tachycardia: Tachycardia is associated with hyperthyroidism. In contrast, myxedema is associated with bradycardia or a slow heart rate because of the overall slowing of the body's metabolic processes.

D) Heat intolerance: Heat intolerance is a symptom of hyperthyroidism. Clients with myxedema usually experience cold intolerance due to decreased metabolic activity and impaired thermoregulation.

A. Electrical cords are placed along the walls. B. Handrails are present in the bathroom. C. Uses a microwave for cooking. D. Scatter rugs are present in the kitchen.

Correct Answer is D

Explanation

A) Electrical cords are placed along the walls: While it is important to ensure that electrical cords are safely managed, cords placed along the walls are less likely to pose a tripping hazard compared to those that are left loose or run across walking paths. This setup, in itself, is generally not a significant safety risk if managed properly.

B) Handrails are present in the bathroom: Handrails in the bathroom are actually a safety feature, not a risk. They provide necessary support for older adults with decreased vision or mobility issues, helping to prevent falls when using the toilet or getting in and out of the bathtub or shower.

C) Uses a microwave for cooking: Using a microwave for cooking is generally considered safe for individuals with decreased vision, as it minimizes the risk of burns and other injuries associated with using a stove or oven. The microwave can be a safer cooking method if the client is familiar with its operation.

D) Scatter rugs are present in the kitchen: Scatter rugs are a significant safety risk, especially for older adults with decreased vision. These rugs can easily cause trips and falls, leading to potentially serious injuries. Removing scatter rugs or securing them with non-slip backing can help mitigate this risk and create a safer home environment.

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After completing an integument physical examination, the nurse is documenting information concerning observed lesions. What characteristics will the nurse include in this documentation? (Select all that apply.)

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Explanation

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