A nurse is providing teaching to a client who reports extremely dry skin. which of the following

Time to Read: About 3 minutes

This information describes skin reactions to look out for during your radiation therapy and how to manage them. 

Skin changes are common and expected during radiation therapy. Each person reacts to treatment in a different way.

The type of skin reaction that you may get depends on:

  • The part of your body that’s being treated.
  • The type and dose of radiation that you get.

Tell your doctor or nurse if you smoke or if you have:

  • High blood pressure
  • Diabetes
  • Any collagen vascular diseases, such as rheumatoid arthritis or dermatomyositis (a disease that causes a skin rash and muscle weakness)
  • A history of skin cancer in the area to be radiated

These conditions may affect how your wounds heal and how much of a reaction you have to radiation therapy.

Types of skin reactions during radiation therapy

During radiation therapy, your skin may become pink or tanned. at the treatment site. As your treatment continues, your skin may become bright red, or very dark, and may become swollen. Your skin may also feel dry, feel tight, be itchy, and look flaky.

Some people develop a rash or blisters in the area where they are getting radiation therapy. These blisters may open and peel. If you develop skin reactions, these will most likely peak up to 2 weeks after your last treatment. It may take several weeks for your skin to improve after you finish your radiation therapy.

While you’re receiving your treatments, you will be seen weekly by your radiation team. They will examine your skin and make recommendations for changes in your skin care, as needed.

Keep your skin clean

  • Bathe or shower daily using warm water and a mild unscented soap, such as Neutrogena®, Dove®, baby soap, Basis®, or Cetaphil®. Rinse your skin well and pat it dry with a soft towel.
  • When washing, be gentle with your skin in the area being treated. Don’t use a washcloth, scrubbing cloth, loofah or brush.
  • The tattoo marks you received before your treatment are permanent and won’t wash off. You may get other markings during treatment such as an outline of your treatment area with a purple felt-tipped marker. You can remove these markings with mineral oil when your radiation therapists say it’s okay.
  • Don’t use alcohol or alcohol pads on your skin in the area being treated.

Moisturize your skin often

  • Start using a moisturizer when you begin treatment. This can help to minimize any skin reaction. You can use an over-the-counter moisturizer. When choosing a moisturizer pick one that does not have any fragrances or lanolin. There are a number of products that are good to use, and your nurse may suggest one of these to you. Use only one at a time unless your nurse tells you to use more.
  • You may be prescribed a medication either at the start, or during, your radiation therapy to treat itchy skin. There are a number of products that are good to use, and your nurse may suggest one of these to you. Use only one at a time unless your nurse tells you to use more.
  • Apply the moisturizer 2 times a day.
  • Don’t apply moisturizers to open areas on your skin.

Avoid irritating your skin in the treatment area

  • Wear loose-fitting, cotton clothing over the treated area.
  • Use only the moisturizers, creams, or lotions that are recommended by your doctor or nurse.
  • Don’t use makeup, perfumes, powders, or aftershave in the area being treated.
  • You can use deodorant on intact skin in the area being treated. Stop using it if your skin becomes irritated.
  • Don’t shave the treated skin. If you must shave, use an electric razor and stop if the skin becomes irritated.
  • Don’t put any tape on the treated skin.
  • Don’t let your treated skin come into contact with extreme hot or cold temperatures. This includes hot tubs, water bottles, heating pads, and ice packs.
  • Don’t apply any patches to the treated area, including pain patches.
  • If your skin is itchy, don’t scratch it. Ask your nurse for recommendations on how to relieve the itching.
  • If you don’t have any skin reactions during the treatment, you can swim in a chlorinated pool. However, be sure to rinse off the chlorine right after getting out of the pool.
  • Avoid tanning or burning your skin during and after you’re finished with treatment. If you’re going to be in the sun, use a PABA-free sunblock with an SPF of 30 or higher. Also, wear loose-fitting clothing that covers you as much as possible.
  • A temperature of 100.4 °F (38 °C) or higher
  • Chills
  • Increasing pain or discomfort
  • Increased redness or swelling or skin that is hard or hot to the touch
  • A rash or blistering of your skin in the treated area
  • Drainage from your skin in the treated area
  • Any new open areas or changes to your skin
  • Any other new symptoms or problems

1. The nurse is caring for a male client with a chest tube. If the chest drainage system is accidentally disconnected, what should the nurse plan to do? a. Place the end of the chest tube in a container of sterile saline. b. Apply an occlusive dressing and notify the physician. c. Clamp the chest tube immediately.

d. Secure the chest tube with tape.

2. A male elderly client is admitted to an acute care facility with influenza. The nurse monitors the client closely for complications. What is the most common complication of influenza? a. Septicemia b. Pneumonia c. Meningitis

d. Pulmonary edema

3. A female client has a tracheostomy but doesn't require continuous mechanical ventilation. When weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for: a. 15 to 60 seconds. b. 5 to 20 minutes. c. 30 to 40 minutes.

d. 45 to 60 minutes.

4. Gina, a home health nurse is visiting a home care client with advanced lung cancer. Upon assessing the client, the nurse discovers wheezing, bradycardia, and a respiratory rate of 10 breaths/minute. These signs are associated with which condition? a. Hypoxia b. Delirium c. Hyperventilation

d. Semiconsciousness

5. A male client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?

a. pH, 5.0; PaCO2 30 mm Hg b. pH, 7.40; PaCO2 35 mm Hg c. pH, 7.35; PaCO2 40 mm Hg

d. pH, 7.25; PaCO2 50 mm Hg

6. A female client with interstitial lung disease is prescribed prednisone (Deltasone) to control inflammation. During client teaching, the nurse stresses the importance of taking prednisone exactly as prescribed and cautions against discontinuing the drug abruptly. A client who discontinues prednisone abruptly may experience: a. hyperglycemia and glycosuria. b. acute adrenocortical insufficiency. c. GI bleeding.

d. restlessness and seizures.

7. A male client is admitted to the health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this client? a. Activity intolerance related to fatigue b. Anxiety related to actual threat to health status c. Risk for infection related to retained secretions

d. Impaired gas exchange related to airflow obstruction

8. A male client abruptly sits up in bed, reports having difficulty breathing and has an arterial oxygen saturation of 88%. Which mode of oxygen delivery would most likely reverse the manifestations? a. Simple mask b. Non-rebreather mask c. Face tent

d. Nasal cannula

9. A male adult client with cystic fibrosis is admitted to an acute care facility with an acute respiratory infection. Prescribed respiratory treatment includes chest physiotherapy. When should the nurse perform this procedure? a. Immediately before a meal b. At least 2 hours after a meal c. When bronchospasms occur

d. When secretions have mobilized

10. On arrival at the intensive care unit, a critically ill female client suffers respiratory arrest and is placed on mechanical ventilation. The physician orders pulse oximetry to monitor the client's arterial oxygen saturation (SaO2) noninvasively. Which vital sign abnormality may alter pulse oximetry values? a. Fever b. Tachypnea c. Tachycardia

d. Hypotension

11. The nurse is caring for a male client who recently underwent a tracheostomy. The first priority when caring for a client with a tracheostomy is: a. helping him communicate. b. keeping his airway patent. c. encouraging him to perform activities of daily living.

d. preventing him from developing an infection.

12. For a male client with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent airway? a. Restricting fluid intake to 1,000 ml/day b. Enforcing absolute bed rest c. Teaching the client how to perform controlled coughing

d. Administering prescribed sedatives regularly and in large amounts

13. The amount of air inspired and expired with each breath is called: a. tidal volume. b. residual volume. c. vital capacity.

d. dead-space volume.

14. A male client with pneumonia develops respiratory failure and has a partial pressure of arterial oxygen of 55 mm Hg. He's placed on mechanical ventilation with a fraction of inspired oxygen (FIO2) of 0.9. The nursing goal should be to reduce the FIO2 to no greater than: a. 0.21 b. 0.35 c. 0.5

d. 0.7

15. Nurse Mickey is administering a purified protein derivative (PPD) test to a homeless client. Which of the following statements concerning PPD testing is true? a. A positive reaction indicates that the client has active tuberculosis (TB). b. A positive reaction indicates that the client has been exposed to the disease. c. A negative reaction always excludes the diagnosis of TB.

d. The PPD can be read within 12 hours after the injection.

16. Before weaning a male client from a ventilator, which assessment parameter is most important for the nurse to review? a. Fluid intake for the last 24 hours b. Baseline arterial blood gas (ABG) levels c. Prior outcomes of weaning

d. Electrocardiogram (ECG) results

17. Which of the following would be most appropriate for a male client with an arterial blood gas (ABG) of pH 7.5, PaCO2 26 mm Hg, O2 saturation 96%, HCO3 24 mEq/L, and PaO2 94 mm Hg? a. Administer a prescribed decongestant. b. Instruct the client to breathe into a paper bag. c. Offer the client fluids frequently.

d. Administer prescribed supplemental oxygen.

18. A female client is receiving supplemental oxygen. When determining the effectiveness of oxygen therapy, which arterial blood gas value is most important? a. pH b. Bicarbonate (HCO3-) c. Partial pressure of arterial oxygen (PaO2)

d. Partial pressure of arterial carbon dioxide (PaCO2)

19. Nurse Julia is caring for a client who has a tracheostomy and temperature of 103° F (39.4° C). Which of the following interventions will most likely lower the client's arterial blood oxygen saturation? a. Endotracheal suctioning b. Encouragement of coughing c. Use of cooling blanket

d. Incentive spirometry

20. For a male client who has a chest tube connected to a closed water-seal drainage system, the nurse should include which action in the plan of care? a. Measuring and documenting the drainage in the collection chamber b. Maintaining continuous bubbling in the water-seal chamber c. Keeping the collection chamber at chest level

d. Stripping the chest tube every hour

21. Nurse Eve formulates a nursing diagnosis of Activity intolerance related to inadequate oxygenation and dyspnea for a client with chronic bronchitis. To minimize this problem, the nurse instructs the client to avoid conditions that increase oxygen demands. Such conditions include: a. drinking more than 1,500 ml of fluid daily. b. being overweight. c. eating a high-protein snack at bedtime.

d. eating more than three large meals a day.

22. A black male client with asthma seeks emergency care for acute respiratory distress. Because of this client's dark skin, the nurse should assess for cyanosis by inspecting the: a. lips. b. mucous membranes. c. nail beds.

d. earlobes.

23. A female client with asthma is receiving a theophylline preparation to promote bronchodilation. Because of the risk of drug toxicity, the nurse must monitor the client's serum theophylline level closely. The nurse knows that the therapeutic theophylline concentration falls within which range? a. 1 to 2 mcg/ml b. 2 to 5 mcg/ml c. 5 to 10 mcg/ml

d. 10 to 20 mcg/ml

24. A male client is to receive I.V. vancomycin (Vancocin). When preparing to administer this drug, the nurse should keep in mind that: a. vancomycin should be infused over 60 to 90 minutes in a large volume of fluid. b. vancomycin may cause irreversible neutropenia. c. vancomycin should be administered rapidly in a large volume of fluid.

d. vancomycin should be administered over 1 to 2 minutes as an I.V. bolus.

25. Before seeing a newly assigned female client with respiratory alkalosis, the nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis? a. Myasthenia gravis b. Type 1 diabetes mellitus c. Extreme anxiety

d. Narcotic overdose

26. At 11 p.m., a male client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He's anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-medrol) I.V. At 11:30 p.m., the client's arterial blood oxygen saturation is 86% and he's still wheezing. The nurse should plan to administer: a. alprazolam (Xanax). b. propranolol (Inderal) c. morphine.

d. albuterol (Proventil).

27. Pulmonary disease (COPD), which nursing action best promotes adequate gas exchange? a. Encouraging the client to drink three glasses of fluid daily b. Keeping the client in semi-Fowler's position c. Using a high-flow Venturi mask to deliver oxygen as prescribed

d. Administering a sedative as prescribed

28. Nurse Joana is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide? a. It helps prevent early airway collapse. b. It increases inspiratory muscle strength c. It decreases use of accessory breathing muscles.

d. It prolongs the inspiratory phase of respiration.

29. A male client who takes theophylline for chronic obstructive pulmonary disease is seen in the urgent care center for respiratory distress. Once the client is stabilized, the nurse begins discharge teaching. The nurse would be especially vigilant to include information about complying with medication therapy if the client's baseline theophylline level was: a. 10 mcg/mL b. 12 mcg/mL c. 15 mcg/mL

d. 18mcg/mL

30. Nurse Kim is caring for a client with a pneumothorax and who has had a chest tube inserted notes continuous gentle bubbling in the suction control chamber. What action is appropriate? a. Do nothing, because this is an expected finding. b. Immediately clamp the chest tube and notify the physician. c. Check for an air leak because the bubbling should be intermittent.

d. Increase the suction pressure so that bubbling becomes vigorous.

31. A nurse has assisted a physician with the insertion of a chest tube. The nurse monitors the adult client and notes fluctuation of the fluid level in the water seal chamber after the tube is inserted. Based on this assessment, which action would be appropriate? a. Inform the physician. b. Continue to monitor the client. c. Reinforce the occlusive dressing.

d. Encourage the client to deep-breathe.

32. The nurse caring for a male client with a chest tube turns the client to the side, and the chest tube accidentally disconnects. The initial nursing action is to: a. Call the physician. b. Place the tube in a bottle of sterile water. c. Immediately replace the chest tube system.

d. Place the sterile dressing over the disconnection site.

33. Nurse Paul is assisting a physician with the removal of a chest tube. The nurse should instruct the client to: a. Exhale slowly. b. Stay very still. c. Inhale and exhale quickly.

d. Perform the Valsalva maneuver.

34. While changing the tapes on a tracheostomy tube, the male client coughs and the tube is dislodged. The initial nursing action is to: a. Call the physician to reinsert the tube. b. Grasp the retention sutures to spread the opening. c. Call the respiratory therapy department to reinsert the tracheotomy.

d. Cover the tracheostomy site with a sterile dressing to prevent infection.

35. A nurse is caring for a male client immediately after removal of the endotracheal tube. The nurse reports which of the following signs immediately if experienced by the client? a. Stridor b. Occasional pink-tinged sputum c. A few basilar lung crackles on the right

d. Respiratory rate of 24 breaths/min

36. An emergency room nurse is assessing a female client who has sustained a blunt injury to the chest wall. Which of these signs would indicate the presence of a pneumothorax in this client? a. A low respiratory b. Diminished breathe sounds c. The presence of a barrel chest

d. A sucking sound at the site of injury

37. A nurse is caring for a male client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client? a. Hypocapnia b. A hyperinflated chest noted on the chest x-ray c. Increase oxygen saturation with exercise

d. A widened diaphragm noted on the chest x-ray

38. A community health nurse is conducting an educational session with community members regarding tuberculosis. The nurse tells the group that one of the first symptoms associated with tuberculosis is: a. Dyspnea b. Chest pain c. A bloody, productive cough

d. A cough with the expectoration of mucoid sputum

39. A nurse performs an admission assessment on a female client with a diagnosis of tuberculosis. The nurse reviews the results of which diagnostic test that will confirm this diagnosis?

a. Bronchoscopy b. Sputum culture c. Chest x-ray

d. Tuberculin skin test