When inspecting the client's skin, the nurse observes several areas of ecchymosis on the trunk and extremities. Which information in the client's history requires additional follow-up by the nurse?

Takes an oral anticoagulant.

Works in a day care center.

Adheres to a gluten free diet.

Recently had dental surgery.

Answer and Explanation

The Correct Answer is A

A. Takes an oral anticoagulant. Ecchymosis, or bruising, can be a side effect of anticoagulant therapy and may indicate potential bleeding issues that require further assessment.

B. Works in a day care centre. While exposure to children might increase the risk of minor injuries, it is less likely to be directly related to the ecchymosis observed.

C. Adheres to a gluten-free diet. This dietary preference is not likely to be directly related to the ecchymosis observed.

D. Recently had dental surgery. While recent surgery might be relevant, it is less likely to cause widespread ecchymosis unless there were complications.

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Correct Answer is D

Explanation

A. Needle aspiration of the synovial space: Needle aspiration of the synovial space is a diagnostic procedure used to collect synovial fluid for analysis. It is not directly related to crepitation.

B. Knee arthroplasty surgery: Knee arthroplasty (joint replacement surgery) involves replacing damaged knee joint components with artificial ones. While it can improve joint function, it is not directly related to crepitation.

C. History of a fractured patella: A fractured patella (kneecap) can lead to altered joint mechanics and abnormal wear. This might lead to long-term issues but isn't directly associated with crepitation unless it caused secondary degenerative changes in the knee joint.

D. Degenerative disease: Degenerative joint diseases like osteoarthritis often involve changes in the cartilage, leading to rough surfaces within the joint. When these rough surfaces rub against each other during movement, crepitation can occur.

A. Multiple maculopapular pustules over forehead and chin on an adolescent student. B. Red, swollen, painful nodule located on the upper back of a school aged student. C. Small, white flecks on the hair shafts throughout scalp on a school aged child. D. Bilateral patellar abrasions with eschar formation on a preschool aged student.

Correct Answer is B

Explanation

A. Multiple maculopapular pustules over forehead and chin on an adolescent student: These pustules could be indicative of an infectious process, such as acne or impetigo. While not necessarily an emergency, it’s important to assess and potentially treat these skin lesions promptly. The school nurse should report this to the healthcare provider for further evaluation.

B. Red, swollen, painful nodule located on the upper back of a school-aged student: This finding raises concern for an abscess or localized infection. The pain, redness, and swelling suggest an inflammatory process. The nurse should promptly report this to the healthcare provider for assessment and appropriate management.

C. Small, white flecks on the hair shafts throughout the scalp on a school-aged child: These white flecks are likely nits (lice eggs). While not an emergency, they do require attention. The nurse should inform the parents or guardians and recommend appropriate treatment. However, this finding does not necessitate immediate reporting to the healthcare provider.

D. Bilateral patellar abrasions with eschar formation on a preschool-aged student: Abrasions with eschar (dead tissue) formation can indicate a deeper injury. The nurse should report this to the healthcare provider promptly for assessment and wound care recommendations.

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When inspecting the client's skin, the nurse observes several areas of ecchymosis on the trunk and extremities. Which information in the client's history requires additional follow-up by the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

When assessing a client's range of motion, the nurse notes crepitation with movement of the left knee. Which information in the client's history is most likely related to this finding?

Correct Answer is D

Explanation

Which finding, obtained during a skin assessment of a student, should the school nurse report to the healthcare provider?

Correct Answer is B

Explanation

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