When assessing a client diagnosed with basal cell carcinoma, which of the following findings will the nurse expect?
A blister-like pustule on the face that oozes clear fluid
A dark brown lesion that is flat
A small scaly, dry lesion on the elbow
Location on the top of the head where exposed frequently to sunlight
The Correct Answer is C
Choice A Reason: This is incorrect because a blister-like pustule on the face that oozes clear fluid may indicate impetigo, which is a bacterial skin infection, not basal cell carcinoma. Basal cell carcinoma is a type of skin cancer that arises from the basal layer of the epidermis, which is the outermost layer of the skin. Basal cell carcinoma lesions are usually not blistered or pustular, but rather smooth, shiny, or waxy.
Choice B Reason: This is incorrect because a dark brown lesion that is flat may indicate a mole, which is a benign growth of melanocytes, which are cells that produce pigment, not basal cell carcinoma. Basal cell carcinoma lesions are usually not dark brown or flat, but rather flesh-colored, pink, or red, and may have a raised or indented center.
Choice C Reason: This is correct because a small scaly, dry lesion on the elbow may indicate basal cell carcinoma. Basal cell carcinoma lesions are often small, scaly, and dry, and may bleed or crust over. They can occur anywhere on the body, but are more common on areas that are exposed to the sun, such as the face, neck, arms, or legs.
Choice D Reason: This is incorrect because location on the top of the head where exposed frequently to sunlight may indicate squamous cell carcinoma, which is another type of skin cancer that arises from the squamous layer of the epidermis, not basal cell carcinoma. Squamous cell carcinoma lesions are usually rough, scaly, or crusted, and may have a firm or hard texture. They can also occur anywhere on the body, but are more common on areas that are exposed to the sun.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","D","E"]
Explanation
Choice A reason: This is correct because avoiding swimming underwater can help prevent the worsening of Meniere's disease. Meniere's disease is a disorder of the inner ear that causes episodes of vertigo, tinnitus, hearing loss, and fullness in the ear. Swimming underwater can increase pressure in the ear and trigger an attack. The nurse should advise the client to avoid activities that involve changes in altitude or pressure, such as flying, diving, or climbing.
Choice B reason: This is incorrect because wearing earphones when in crowded places can worsen Meniere's disease. Earphones can increase noise exposure and damage hearing, which is already impaired by Meniere's disease. The nurse should advise the client to avoid loud noises and use hearing aids if needed.
Choice C reason: This is incorrect because keeping eyes open during an acute attack can increase vertigo and nausea. Vertigo is a sensation of spinning or moving when still, which can be caused by Meniere's disease. Keeping eyes open can make vertigo worse by creating a visual mismatch with vestibular signals from the inner ear. The nurse should advise the client to close their eyes or focus on a stationary object during an attack.
Choice D reason: This is correct because sitting or lying down if whirling occurs can help prevent falls or injuries due to vertigo. Whirling is another term for vertigo, which can affect balance and coordination. Sitting or lying down can reduce movement and stabilize posture during an attack. The nurse should advise
the client to avoid driving or operating machinery when experiencing vertigo.
Choice E reason: This is correct because we do not know the exact cause of Meniere's disease. Meniere's disease is thought to be related to abnormal fluid balance or pressure in the inner ear, but what triggers this condition is unknown. The nurse should educate the client about possible risk factors, such as genetics, infections, allergies, autoimmune disorders, or head trauma, but also acknowledge the uncertainty and variability of the disease.
Choice F reason: This is incorrect because damage to the ear from excess noise is not the cause of Meniere's disease. Damage to the ear from excess noise can cause noise-induced hearing loss, which is a type of sensorineural hearing loss that affects the cochlea or the auditory nerve. Meniere's disease is a type of mixed hearing loss that affects both the cochlea and the middle ear. The nurse should not confuse or misinform the client about the cause of their condition.
Correct Answer is D
Explanation
Choice A Reason: Decreased thickness of tympanic membranes is not a physiological change to hearing in older adult clients. The tympanic membranes are thin and flexible structures that vibrate in response to sound waves. The thickness of the tympanic membranes does not change significantly with age.
Choice B Reason: Decreased tinnitus is not a physiological change to hearing in older adult clients. Tinnitus is a ringing or buzzing sound in the ears that may be caused by various factors, such as noise exposure, ear infections, medications, or aging. Tinnitus may increase or decrease with age, depending on the underlying cause.
Choice C Reason: Decreased ear wax is not a physiological change to hearing in older adult clients. Ear wax is a natural substance that lubricates and protects the ear canal from dust, bacteria, and insects. Ear wax production may vary with age, but it does not affect hearing unless it accumulates and blocks the ear canal.
Choice D Reason: Decreased ability to hear high-frequency sounds is a physiological change to hearing in older adult clients. This is also known as presbycusis, which is a gradual loss of hearing that occurs as part of aging. Presbycusis affects the ability to hear high-pitched sounds, such as consonants, birdsong, or alarms.
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