NRNP 6645 MIDTERM AND FINAL EXAM
2023 (5 DIFFERENT VERSIONS 500 QS &
ANS) /NRNP6645 PSYCHOTHERAPY
WITH MULTIPLE MODALITIES
1. 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:
1. Wound healing for older people may take up to four times longer than it does for younger
people.
2. Let us talk about what you are eating.
3. Had you come in earlier, I would have ordered medicine that would have healed that right
up.
4. I will order an antibiotic to prevent infection. - answer✔1. Answer: 1
Page: 96
ALL RIGHTS RESERVED.
Skin renewal turnover time increases to approximately 87 days in older adults, compared with
20 days during youth.
2.
The perceived extended healing time is not related to diet.
3.
This is false hope, as there is no medication that will heal this wound quickly.
4.
Prophylactic antibiotics are not appropriate when there are no signs or symptoms of infection.
2. 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:
1. Her lack of activity causes the skin to tear.
2. 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.
3. She has lost weight and is in jeopardy of falling.
4. She picks at herself and causes skin breakdown. - answer✔2. Answer: 2
Page: 96
Feedback
1.
Lack of activity alone does not cause skin breakdown.
2.
Fat is redistributed to the abdomen and thighs, leaving bony surfaces, such as the face, hands,
and sacrum, exposed to potential injury, especially skin tears from shearing, friction forces and
pressure ulcer development.
3.
ALL RIGHTS RESERVED.
Although losing weight may be a risk factor for falling, it is not directly related to skin
breakdown.
4.
There is no evidence that she is picking at herself, as there is nothing reported anywhere else
on her arms.
3. Mr. James is 91 years old. His daughter notices that he has bruises and lacerations on his
arms and reports this to the nurse practitioner, who tells her that older people bruise easily due
to their fragile blood vessels. The skin lacerations happen because he has thin skin. Even so, the
nurse practitioner assures the daughter that she will investigate further to ensure that he is
getting proper care. She says this because she understands that:
1. These markings on the patient's skin are part of aging skin.
2. Bruises and lacerations can indicate inadequate care.
3. The daughter needs assurance that her father is okay.
4. The patient is being abused. - answer✔3. Answer: 2
Page: 97
Feedback
1.
Markings on the skin may be signs of aging, a disease, or maltreatment.
2.
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.
3.
This is a result of the nurse practitioner addressing it further rather than the reason for
addressing it.
4.
ALL RIGHTS RESERVED.
A professional cannot assume abuse without good reason.
4. 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:
1. Arises from changes to a primary lesion.
2. Is a complication of an underlying disease.
3. Is difficult to treat.
4. Is a normal sign of aging. - answer✔4. Answer: 1
Page: 97
Feedback
1.
Secondary lesions (infections) arise from changes to the primary lesion.
2.
Secondary lesions are not necessarily the result of an underlying disease.
3.
Secondary lesions can be treated with medications or surgery.
4.
Secondary lesions arise as a condition not normal to aging.
5. Ms. Rose, 88 years old, comes to the nurse practitioner with a complaint about a growth on
her hand. She wants to have a biopsy done. The nurse practitioner asks the following question:
1. Have you injured your hand recently?
2. Are you using a different detergent?
3. Has this growth changed, bled, or is it painful?
4|Page
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