1|Page
NRNP 6560 - Week 9 i-Human Case Study: Advanced
Clinical Assessment, Differential Diagnosis, and
Evidence-Based Management of Abdominal Pain in a
48-Year-Old Female.
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
Feedback
1.
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.
,2|Page
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.
Although losing weight may be a risk factor for falling, it is not directly
related to skin breakdown.
4.
,3|Page
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.
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:
, 4|Page
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. Has this growth made it difficult to put on your rings? - ANSWER-5.
Answer: 3
Page: 97
Feedback
1.
An injury would not stimulate growth.
2.
A reaction to a detergent would more likely be a rash.
NRNP 6560 - Week 9 i-Human Case Study: Advanced
Clinical Assessment, Differential Diagnosis, and
Evidence-Based Management of Abdominal Pain in a
48-Year-Old Female.
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
Feedback
1.
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.
,2|Page
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.
Although losing weight may be a risk factor for falling, it is not directly
related to skin breakdown.
4.
,3|Page
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.
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:
, 4|Page
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. Has this growth made it difficult to put on your rings? - ANSWER-5.
Answer: 3
Page: 97
Feedback
1.
An injury would not stimulate growth.
2.
A reaction to a detergent would more likely be a rash.
