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NRNP 6645 MIDTERM AND FINAL EXAM 2025 (5 DIFFERENT
VERSIONS 500 QS & ANS) /NRNP6645 PSYCHOTHERAPY WITH
MULTIPLE MODALITIES
- Mrs. Williams is 76 years old and comes in to have a wound checked on her right leg. She fell a month ago and the wound has not healed. She is concerned that something is wrong. The nurse practitioner examines the wound and sees that it has been cleaned properly and has no signs of infection. The edges are approximated, but the skin around the wound is red and tender to touch. The best response regarding Mrs. Williams' concern is:
a) Wound healing for older people may take up to four times longer than it does for younger people. b) Let us talk about what you are eating. c) Had you come in earlier, I would have ordered medicine that would have healed that right up. d) 4. I will order an antibiotic to prevent infection.
- Answer: a Page: 96
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a) Skin renewal turnover time increases to approximately 87 days in older adults, compared with 20 days during youth. b) The perceived extended healing time is not related to diet. c) This is false hope, as there is no medication that will heal this wound quickly. d) Prophylactic antibiotics are not appropriate when there are no signs or symptoms of infection.
- The nurse practitioner is conducting patient rounds in a long-term care facility. As she talks with Mrs. Jones, she notices that her arms and elbows are excoriated and the skin is shearing. The nurse practitioner explains to the staff that Mrs. Jones needs frequent assessment of her skin and protection provided to prevent skin breakdown because:
a) Her lack of activity causes the skin to tear. b) Fat has redistributed to the abdomen and thighs, leaving bony surfaces in areas such as the face, hands, and sacrum. This can result in injury.
daughter that she will investigate further to ensure that he is getting proper care. She says this because she understands that:
a) These markings on the patient's skin are part of aging skin. b) Bruises and lacerations can indicate inadequate care. c) The daughter needs assurance that her father is okay. d) 4. The patient is being abused.
- Answer: b Page: 97
Feedback a) Markings on the skin may be signs of aging, a disease, or maltreatment. b) Poorly healing wounds or chronic pressure ulcers may signal a problem not only with the patient but with the caregiver's ability to provide adequate care. Welts, lacerations, burns, and distinctive markings may indicate a need for intervention. c) This is a result of the nurse practitioner addressing it further rather than the reason for addressing it. d) A professional cannot assume abuse without good reason.
- The nurse practitioner assesses a patient's skin and finds an infectious lesion on the lower leg. The lesion is considered a secondary lesion. The nurse practitioner explains that a secondary lesion is one that:
a) Arises from changes to a primary lesion. b) Is a complication of an underlying disease. c) Is difficult to treat. d) Is a normal sign of aging.
- Answer: a Page: 97
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Secondary lesions (infections) arise from changes to the primary lesion.
Secondary lesions are not necessarily the result of an underlying disease.
Secondary lesions can be treated with medications or surgery.
Lesions that warrant biopsy are those that have changed, bleed, or are painful.
The ability to put on her ring is not the problem.
- A 60-year-old male enters the burn center for triage and treatment due to a burn he received at a campfire. His left arm has an area that is erythematous and painful, and another area has a blister. What does the nurse practitioner record as the degree of burn?
- First degree
- Second degree
- First and second degree
- Second and third degree 6. Answer: 3 Page: 98
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First-degree burns involving the epidermis are erythematous and painful but do not blister.
Second-degree burns involve the dermis and are characterized by blisters.
The patient presents with erythematous skin, painful with blisters, which indicates both first- and second-degree burn areas.
In third-degree burns there is no sensation when the wound is pinpricked.
- The nurse practitioner is concerned with primary prevention strategies. How can the nurse practitioner implement primary prevention strategies for an 80-year-old male patient who smokes?
- Review home fire safety protocols, including the proper use of smoke alarms, and discuss smoking cessation.
- Inform him that if he does not stop smoking, the nurse practitioner cannot see him again.
- Have a conference with his family about his smoking.
- Plan a family meeting with the patient to discuss benefits of his smoking cessation. 7. Answer: 1 Page: 115, 116
- Diminished nerve function.
- A weakened immune system.
- The burden of various comorbidities leading to enhanced wound healing and reepithelialization after burn injury. 8. Answer: 1, 2, 3, 4 Page: 98
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As one ages, there are significant changes in the skin, which becomes thinner, providing a less effective barrier to external stimuli.
With aging, there are fewer appendages and decreased vascularity.
Thinner skin and diminished nerve function often result in a higher incidence of deeper burns.
Advanced age results in a weakened immune system.
Along with the burden of various comorbidities, the fragility of older skin leads to delayed wound healing and reepithelialization after burn injury.
- Mr. Edwards is 76 years old and received a burn on his leg when he dozed off and dropped his cigarette. The nurse practitioner examines his leg for the degree of burn and classifies it as second degree with some third degree in the center. Mr. Edwards asks what that means and why it hurts so much. What is the best answer? Select all that apply.
- It means that this is a serious, deep burn in the center, and a less deep burn around the sides.
- It hurts because the nerve endings are exposed in the second-degree area.
- It means that the burn is advancing and getting worse.
- It hurts because the nerves are destroyed.
- It hurts because the nerves in the second-degree areas are exposed to the outside and are stimulated. 9. Answer: 1, 2 Page: 98
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Clean with a strong detergent.
Remove any loose tissue but allow the blisters to remain.
Diagnose as first- and third-degree burns. 10. Answer: 1, 2, 4 Page: 100
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After administration of appropriate pain medication, wound management can begin.
Burn wounds should be immediately doused in cool tap water to disperse any remaining heat in the tissue.
Detergents and antibacterial soaps are not indicated. Burn wounds should be cleaned with mild soap and rinsed.
For small surface area burns, it is good to remove any loose tissue during cleansing and allow intact blisters to remain.
First-degree burns do not exhibit blisters, and third-degree burns do not exhibit pain.
- Mr. Watson,75 years old, comes to the urgent care center with complaints of fever, fast heartbeat, a swollen gland under his right arm, and redness in his upper left arm that has hurt for 2 to 3 days. The patient says that he has had the redness in his arm for months without any difficulty. The nurse practitioner suspects which of the following? Select all that apply.
- Influenza
- Upper respiratory infection
- Cellulitis of upper left arm
- Necrotizing fasciitis
- Lymphangitis 11. Answer: 3 Page: 103
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Influenza is systemic and not localized in any one area.
Page: 103
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Oral antibiotics are sufficient for mild cellulitis and IV antibiotics for organisms such as MRSA.
There are several drugs effective with cellulitis; dicloxacillin is one of them.
Treatment of MRSA should be guided by wound culture results, but not cellulitis.
The drug of choice is typically given for 7 days.
If the wound is grossly contaminated and the patient's last tetanus booster was 5 to 10 years ago, the practitioner should consider giving another booster at this time.
- A 59-year-old female was admitted to the hospital for malaise, headache, fever, and flu-like symptoms. She has a decreased appetite and is having trouble sleeping. After a couple of days, she complains to the nurse practitioner of itching, burning,
and tingling pain around her waist. The nurse practitioner advises the nursing staff to observe for vesicles for a few days. The patient asks why she is so sick. What would be the nurse practitioner's best response? Select all that apply.
- We are not certain at this point, however, these symptoms often occur before a break-out of herpes zoster.
- You have some very general systemic symptoms, so we are waiting for more specific symptoms to appear.
- Because you had chicken pox as a child, and you now have a depressed immune system, the chance of developing herpes zoster is high.
- These symptoms are probably a strong case of influenza.
- Herpes zoster is more com 13. Answer: 1, 3 Page: 106
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The growth is elevated and increasing in size.
The ear has high exposure to the sun.
There is inflammation around the growth.
The patient is 82 years old and reports having lived in the south of the United States for many years.
There is no concern about familial tendencies. 14. Answer: 1, 2, 3, 4 Page: 118
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Signs of malignancy include elevation; the original lesion may also have enlarged in size.
Common locations for skin cancers are the scalp, ears, lower lip, and dorsal side of the hands.
Signs of malignancy include inflammation of the lesion.
The incidence of all types of skin cancers increases with age and the degree and intensity of sun exposure.
Certain genetic predispositions can contribute to the development of skin cancer, and there is a familial tendency to develop melanoma.
- The nurse practitioner is making patient rounds in a long-term care facility and is visiting Mr. Smith, 95 years old, who has a large amount of fungus growing from his toenails. The staff nurse asks what can be done to help alleviate this nail fungus. What does the nurse practitioner advise? Select all that apply.
- Wash and completely dry the feet and toes daily.
- Keep the patient's feet cool and dry.
- Use aluminum acetate solution (Burow's solution).
- Have the patient wear occlusive footwear.
- Use clotrimazole (ointment, cream, or lotion). 15. Answer: 1, 2, 3 Page: 123
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