Chapter 43: Care of Patients with Integumentary Disorders and Burns My Nursing Test Banks

Chapter 43: Care of Patients with Integumentary Disorders and Burns

MULTIPLE CHOICE

1. The nurse counsels a patient with poison ivy to decrease his discomfort by:

a.

bathing in warm water.

b.

maintaining an environment of 80 to 85 F.

c.

scrubbing skin to break the vesicles.

d.

patting skin dry.

ANS: D

Patting the skin dry will decrease irritation and will not break vesicles. The patient should bathe in tepid water and avoid getting hot as heat exacerbates the itching.

DIF: Cognitive Level: Application REF: 967 OBJ: 1 (theory)

TOP: Contact Dermatitis: Care Instruction

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

2. A patient with acne rosacea is sensitive about the facial erythema and telangiectases. The nurse recommends that she:

a.

drink 4 ounces of wine a day for vasodilation.

b.

cease smoking.

c.

avoid direct sunlight.

d.

forgo coffee and tea.

ANS: C

Avoiding direct sunlight will reduce the symptoms.

DIF: Cognitive Level: Application REF: 967 OBJ: 5 (theory)

TOP: Acne Rosacea: Exacerbation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

3. The nurse would question the order for isotretinoin (Accutane) that was prescribed for a:

a.

20-year-old man with nodular acne who is an epileptic.

b.

22-year-old woman with severe acne who is pregnant.

c.

46-year-old woman with cystic acne who is on oral contraceptive pills.

d.

50-year-old man with cystic acne who is on medication for hypertension.

ANS: B

Accutane is considered a teratogen and can cause fetal malformations. Patients of childbearing age must be on a contraceptive.

DIF: Cognitive Level: Analysis REF: 968 OBJ: 5 (theory)

TOP: Accutane: Contraindications KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

4. The nurse advises a 20-year-old college sophomore with acne vulgaris to:

a.

avoid all chocolate.

b.

wash the face gently with mild soap.

c.

scrub the face with soft brush.

d.

express clogged sebum from the pores.

ANS: B

Keeping the face clean and dry by washing with mild soap and not scrubbing is helpful to clear up clogged pores. Pustules should not be squeezed as this could lead to infection. Strict diet restrictions of the past are no longer observed as strenuously.

DIF: Cognitive Level: Application REF: 968 OBJ: 5 (theory)

TOP: Acne: Home Care KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

5. A patient with psoriasis is placed on PUVA therapy. The nurse clarifies that this therapy involves the combination of:

a.

radiation and corticosteroids.

b.

x-rays and methotrexate.

c.

artificial ultraviolet (UV) rays and a coal tar product.

d.

laser treatment and antimetabolites.

ANS: C

PUVA is a combination of artificial UV rays and psoralen, a coal tar product.

DIF: Cognitive Level: Application REF: 969 OBJ: 2 (theory)

TOP: Psoriasis Treatment: PUVA KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

6. The nurse recommends that the person who suffers with psoriasis can increase his comfort by:

a.

using drying solutions such as alcohol to clean psoriasis plaques.

b.

using a humidifier to keep psoriasis plaques moist.

c.

applying wet dressing to minimize proliferation.

d.

taking hot baths to reduce skin discomfort.

ANS: B

Humidification increases comfort. Heat and drying increase discomfort of psoriasis.

DIF: Cognitive Level: Application REF: 969 OBJ: 2 (theory)

TOP: Psoriasis: Increasing Comfort KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

7. An 84-year-old patient who has had a low-grade fever for 2 days complains of pain in the hip that travels down the leg along the sciatic nerve. The nurse assesses small groups of vesicles along the nerve path. These assessments lead the nurse to suspect that the patient is suffering from:

a.

herpes simplex.

b.

shingles.

c.

carbuncles.

d.

furuncles.

ANS: B

Herpes zoster (shingles) begins with vague symptoms of chills and low-grade fever and possibly some gastrointestinal disturbance. There may be only aching or discomfort along the nerve pathway with or without erythema. About 3 to 5 days after onset, small groups of vesicles appear on the skin. They usually are found on the trunk and spread halfway around the body, following the nerve pathways leading from the spinal nerve to the skin.

DIF: Cognitive Level: Application REF: 971 OBJ: 4 (theory)

TOP: Herpes Zoster: Shingles KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

8. The patient with shingles has been on an antiviral medication since the vesicles appeared. The nurse encourages the patient that such early treatment will probably prevent:

a.

postherpetic pain.

b.

outbreak of more vesicles.

c.

lesions attacking the eye.

d.

pain of the disease.

ANS: A

Early treatment may avoid postherpetic pain syndrome, but it cannot assure that there will not be more vesicles or that the disease will not attack the eye. Pain with shingles is very hard to control.

DIF: Cognitive Level: Comprehension REF: 971 OBJ: 4 (theory)

TOP: Shingles: Treatment KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

9. The nurse is caring for a patient diagnosed with shingles. The patient has been complaining of constant pain along the sciatic nerve. What intervention by the nurse can best help to provide pain relief?

a.

Distract the patient with conversation.

b.

Massage the area of pain.

c.

Move the affected leg through range of motion (ROM).

d.

Change the patients position frequently.

ANS: A

Distraction, guided imagery, and deep muscle relaxation may help reduce pain. Massage to the affected area will result in disruption in the vesicles of the disease. This disruption will delay healing and cause further discomfort. ROM and changing of positions are needed for patients with shingles in the event they are not mobile, but these actions will not reduce the discomfort.

DIF: Cognitive Level: Application REF: 971 OBJ: 4 (theory)

TOP: Shingles: Care KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

10. The home health nurse instructs the family whose child came home from school with lice that the bed linens should be:

a.

thrown out in a sealed garbage bag.

b.

washed with strong bleach solution.

c.

washed and dried on the hottest setting.

d.

washed and dried at least through three cycles.

ANS: C

Washing in hot water with ordinary detergent and drying on the hottest cycle will kill lice. There is no need to completely discard the linens. Bleach is not needed. Multiple wash cycles will not be necessary.

DIF: Cognitive Level: Comprehension REF: 974 OBJ: 1 (clinical)

TOP: Pediculosis Capitis: Bed Linen Care

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

11. While bathing a patient, the nurse discovers a grayish black, nodular growth that resembles a blackberry in the middle of the patients back. The nurse should:

a.

encourage the patient to seek medical care as the findings are consistent with malignant melanoma.

b.

teach the patient how to assess for changes in the growth

c.

document finding an actinic keratoses on the back.

d.

suggest the patient get treatment for a growth that is consistent with squamous cell carcinoma.

ANS: A

These findings are consistent with a nodular malignant melanoma. It should be evaluated by the physician and removed immediately once the diagnosis is confirmed. Actinic keratoses occur very frequently on the skin of the elderly. They appear on fair-skinned people as a small, scaly, red or grayish papule particularly on areas of skin that are often exposed to the sun. Squamous cell carcinoma appears as a nodule that later becomes ulcerated.

DIF: Cognitive Level: Analysis REF: 974-975 OBJ: 6 (theory)

TOP: Skin Cancer: Malignant Melanoma

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

12. The nurse explains that the primary purpose of the whirlpool bath given to the patient with a stage III pressure ulcer is to:

a.

keep the patient clean.

b.

stimulate granulation tissue growth.

c.

improve circulation in surrounding skin.

d.

provide moisture to the ulcer.

ANS: B

The whirlpool acts as a type of dbridement. It gets rid of the necrotic debris and stimulates granulation tissue growth.

DIF: Cognitive Level: Application REF: 986 OBJ: 3 (clinical)

TOP: Pressure Ulcers: Dbridement KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

13. While bathing a patient, the nurse assesses a red, unblanchable area on the coccyx. The best dressing for this lesion is a ________ dressing.

a.

transparent film

b.

hydrocolloid

c.

fluffy absorbent

d.

wet-to-dry

ANS: A

A transparent film for a stage I pressure ulcer will protect it from shearing injury and will retain moisture. A hydrocolloid dressing would be appropriate for a larger, more advanced pressure ulcer. There is no discharge in a stage I pressure ulcer, making absorbent and wet-to-dry dressing options inappropriate.

DIF: Cognitive Level: Application REF: 978 OBJ: 8 (theory)

TOP: Pressure Ulcers: Dressings KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

14. The patient with a stage III pressure ulcer that will not heal is horrified about being hooked up to a unit providing voltage stimulus to the wound. The nurse explains that the electrical stimulation will:

a.

sterilize the wound.

b.

increase blood vessel growth.

c.

cause the ulcer to close by scabbing.

d.

coagulate the drainage.

ANS: B

The electrical stimulation will increase blood supply by stimulating vessel growth. The voltage unit will not cleanse the wound, cause scabbing, or coagulation of drainage.

DIF: Cognitive Level: Application REF: 981 OBJ: 3 (clinical)

TOP: Pressure Ulcers: Electrical Stimulation

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

15. In caring for a stage IV pressure ulcer, the nurse assesses the purulent drainage as creamy yellow with a necrotic odor. The nurse is aware that this type of exudate is probably caused by:

a.

Proteus.

b.

Bacteroides.

c.

Staphylococcus.

d.

Pseudomonas.

ANS: C

Creamy yellow drainage is usually caused by Staphylococcus infections. Proteus is associated with a beige discharge having a fishy odor. Brown discharge having a fecal odor is seen in Bacteroides. Pseudomonas-containing wounds produce a green-blue discharge with a fruity odor.

DIF: Cognitive Level: Comprehension REF: 981 OBJ: 3 (clinical)

TOP: Pressure Ulcers: Drainage KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

16. The nurse admitting a patient with significant burns to the emergency department notes the presence of symptoms consistent with an inhalation burn. Which finding is the nurse most likely noting?

a.

Full-thickness burns to chest

b.

Hypotension

c.

Agitation

d.

Persistent coughing

ANS: D

Persistent coughing, particularly if black mucus is coughed up, is an indicator of an inhalation burn.

DIF: Cognitive Level: Comprehension REF: 984 OBJ: 9 (theory)

TOP: Burns: Inhalation Burns KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

17. The Parkland fluid resuscitation calculation calls for 8000 mL. The burn occurred at noon. The present time is 2:00 PM. The fluid should be set to deliver _____ mL by _____ PM.

a.

2000, 6:00

b.

3000, 7:00

c.

4000, 8:00

d.

7000, 9:00

ANS: D

According to the Parkland formula, one half of the fluid resuscitation load should be infused within 8 hours from the time of the burn. The burn occurred at noon, so by 8:00 PM, 4000 mL should have been infused of the 8000 mL calculated.

DIF: Cognitive Level: Analysis REF: 985 OBJ: 11 (theory)

TOP: Burns: Fluid Resuscitation KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

18. The nurse places a catheter drainage bag with a urometer on the catheter of the adult patient with a burn in order to measure hourly urine output. The nurse is aware that a minimum acceptable urine output is _____ mL/hr.

a.

10

b.

20

c.

30

d.

40

ANS: C

The minimum acceptable urine output for an adult is 30 mL/hr.

DIF: Cognitive Level: Knowledge REF: 985 OBJ: 11 (theory)

TOP: Burns: Urine Output KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

19. To prevent contractures in the burn patient, the nurse should:

a.

assist the patient to ambulate as soon as fluid shift has stabilized.

b.

leave the limbs in full extension.

c.

stop range-of-motion (ROM) exercises when the patient complains of pain.

d.

place the limbs in the flexion position.

ANS: A

Unless other injuries prevent it, the patient should be ambulated as soon as the fluid shift has stabilized in order to prevent contractures. Limbs should not be in static positions and should be put through ROM even when painful.

DIF: Cognitive Level: Comprehension REF: 988 OBJ: 12 (theory)

TOP: Burns: Prevention of Contractures KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

20. A 75-year-old patient questions the nurse about the need to consider a vaccine to prevent the development of shingles. What response by the nurse is most appropriate?

a.

The incidence of shingles in people your age is not overly common, making the need for vaccination unnecessary.

b.

The vaccination is still under study so I would not recommend you consider it.

c.

Considering the incidence of shingles in your age group taking the vaccination should be considered.

d.

The vaccination is considered a positive option for your age group and will provide for lifelong immunity.

ANS: C

The vaccination should be considered by high-risk populations. About 50% of individuals over age 80 years will have the disease. The vaccination has been approved for use. The immunity provided is anticipated to last for 6 years.

DIF: Cognitive Level: Application REF: 971 OBJ: 3 (theory)

TOP: Herpes Zoster: Elder Care Points KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

21. The mother of a 4-year-old child reports concerns about how to completely rid her home of lice. Which response by the patient indicates the need for further instruction?

a.

I will need to treat my bedding and furniture.

b.

A re-treatment will be needed about a week after the first one.

c.

I will need to discard my childs stuffed animals and dolls.

d.

I should avoid using Lindane.

ANS: C

For items that cannot be cleaned, such as some stuffed animals, sealing them in plastic bags with the air expelled for 14 days can be effective. The remaining statements are correct.

DIF: Cognitive Level: Application REF: 974 OBJ: 1 (theory)

TOP: Burn Assessment: Rule of Nines KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Health Promotion and Maintenance

22. The nurse read in the patients chart that the patient has a stage III pressure ulcer. Which assessment findings are consistent with this stage of ulcer?

a.

Damage to the subcutaneous tissue

b.

Unblanching skin

c.

Presence of mottled skin

d.

Damage limited to the epidermis

ANS: A

A stage III pressure ulcer presents as a crater-like ulcer. The underlying subcutaneous tissue is involved in the destructive process. The ulcer may or may not be infected. Bacterial infection is almost always present at this stage. Unblanching skin and mottled skin are consistent with a stage I pressure ulcer. Damage to the epidermis is noted with a stage II pressure ulcer.

DIF: Cognitive Level: Comprehension REF: 980 OBJ: 3 (clinical)

TOP: Pressure Ulcers KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

MULTIPLE RESPONSE

23. The home health nurse gives instructions to a patient in avoiding recurrence of athletes foot, which includes: (Select all that apply.)

a.

wear clean cotton socks.

b.

wear shoes that allow ventilation.

c.

use only clean towels.

d.

wash and dry feet daily.

e.

apply antibacterial medication to feet.

ANS: A, B, C, D

Tinea pedis is a common fungal infection. All options listed will be helpful in avoiding a recurrence of the infection except application of an antibacterial medication. An antifungal medication should be used.

DIF: Cognitive Level: Comprehension REF: 973 OBJ: 3 (theory)

TOP: Tinea Pedis: Home Care KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

24. An 86-year-old resident struck her forearm on a table, causing a category I L-shaped skin tear 6 cm 2 cm. The nurse should: (Select all that apply.)

a.

clean the tear with alcohol.

b.

approximate the edges of the tear.

c.

secure the skin flap with Steri-Strips.

d.

cover with a nonadherent dressing.

e.

assess closely for 5 days for signs of infection.

ANS: B, C, D, E

Alcohol would act as an irritant to the skin tear and should be avoided. Cleansing with normal saline is recommended. The remaining options are appropriate for the management of the skin tear.

DIF: Cognitive Level: Application REF: 981 OBJ: 7 (theory)

TOP: Skin Tear: Interventions KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

25. The interventions for a burn patient newly admitted to the emergency department include: (Select all that apply.)

a.

covering the burn with sterile salinesaturated towel.

b.

removing clothing stuck to burn.

c.

taking care not to disturb blisters.

d.

removing jewelry from injured limbs.

e.

assessing the cause of the burn.

ANS: A, C, D, E

Clothing stuck to a burned area should not be removed.

DIF: Cognitive Level: Comprehension REF: 983-984 OBJ: 10 (theory)

TOP: Burns: Admission Interventions KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

26. The nurse is providing education about dietary selections that will promote wound healing. The selection of which menu options should be included? (Select all that apply.)

a.

Tofu

b.

Wheat bread

c.

Lean beef

d.

Citrus fruits

e.

Leafy green vegetables

ANS: A, C, D, E

Protein, zinc, and vitamins A, C, and E are shown to reduce pressure ulcers in high-risk patients. Tofu and lean beef are sources of protein. Citrus fruits are high sources of vitamin C. Leafy green vegetables are sources of vitamin A.

DIF: Cognitive Level: Application REF: 978 OBJ: 8 (theory)

TOP: Pressure Ulcers: Wound and Wound Healing

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

COMPLETION

27. An adult male patient enters the emergency department with full- and partial-thickness burns on the entire right leg, front of the right arm, and one half of the front torso. The nurse, using the rule of nines, assesses the burn as ____%.

ANS:

31

31.5

32

Right leg = 18%, front of arm = 4.5%, and half of front torso = 9%; 18 + 4.5 + 9 = 31.5%.

DIF: Cognitive Level: Application REF: 982 OBJ: 10 (theory)

TOP: Burn Assessment: Rule of Nines KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

28. Using the Parkland formula, the fluid needed for a person weighing 140 pounds with a 25% burn would be _____ mL.

ANS:

6360

4 mL 25% (percentage burn) 63.6 (weight in kilograms) = 6360 mL.

DIF: Cognitive Level: Application REF: 985 OBJ: 10 (theory)

TOP: Burns: Fluid Resuscitation Calculation

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

MATCHING

The nurse differentiates the various type of dermatitis. Match each option with the characteristics that best describe it. (Options may be used once, more than once, or not at all.)

a.

Contact dermatitis

b.

Atopic dermatitis

c.

Stasis dermatitis

d.

Seborrheic dermatitis

29. Cell-mediated immunity resulting in inflammatory response

30. Erythema and pruritus with scaling associated with phlebitis

31. Appearance of vesicular lesions following inflammatory response

32. Scaly lesions on scalp, ear canals, and eyebrows

33. Rash associated with poison ivy

34. Mast cellstimulated release of histamine

35. Lesions may become ulcerated

29. ANS: A DIF: Cognitive Level: Comprehension REF: 966-967

OBJ: 1 (theory) TOP: Skin Disorders: Cause KEY: Nursing Process Step: NA

MSC: NCLEX: NA

30. ANS: C DIF: Cognitive Level: Comprehension REF: 967

OBJ: 1 (theory) TOP: Skin Disorders: Cause KEY: Nursing Process Step: NA

MSC: NCLEX: NA

31. ANS: A DIF: Cognitive Level: Comprehension REF: 966-967

OBJ: 1 (theory) TOP: Skin Disorders: Cause KEY: Nursing Process Step: NA

MSC: NCLEX: NA

32. ANS: D DIF: Cognitive Level: Comprehension REF: 967

OBJ: 1 (theory) TOP: Skin Disorders: Cause KEY: Nursing Process Step: NA

MSC: NCLEX: NA

33. ANS: A DIF: Cognitive Level: Comprehension REF: 966-967

OBJ: 1 (theory) TOP: Skin Disorders: Cause KEY: Nursing Process Step: NA

MSC: NCLEX: NA

34. ANS: B DIF: Cognitive Level: Comprehension REF: 967

OBJ: 1 (theory) TOP: Skin Disorders: Cause KEY: Nursing Process Step: NA

MSC: NCLEX: NA

35. ANS: C DIF: Cognitive Level: Comprehension REF: 967

OBJ: 1 (theory) TOP: Skin Disorders: Cause KEY: Nursing Process Step: NA

MSC: NCLEX: NA

The nurse describes common complications that burn patients may experience. Match the burn complication with the description that best fits it.

a.

Edema

b.

Hyperkalemia

c.

Hypovolemia

d.

Tissue hypoxia

e.

Hypermetabolism

36. Potassium released from damaged cells

37. Increased viscosity of blood slowing blood flow to small vessels

38. Negative nitrogen balance

39. Inflammatory response causing fluid shift

40. Loss of fluid from vascular space

36. ANS: B DIF: Cognitive Level: Analysis REF: 982

OBJ: 6 (theory) TOP: Burn Pathophysiology KEY: Nursing Process Step: NA

MSC: NCLEX: NA

37. ANS: D DIF: Cognitive Level: Analysis REF: 982

OBJ: 6 (theory) TOP: Burn Pathophysiology KEY: Nursing Process Step: NA

MSC: NCLEX: NA

38. ANS: E DIF: Cognitive Level: Analysis REF: 982

OBJ: 6 (theory) TOP: Burn Pathophysiology KEY: Nursing Process Step: NA

MSC: NCLEX: NA

39. ANS: A DIF: Cognitive Level: Analysis REF: 982

OBJ: 6 (theory) TOP: Burn Pathophysiology KEY: Nursing Process Step: NA

MSC: NCLEX: NA

40. ANS: C DIF: Cognitive Level: Analysis REF: 982

OBJ: 6 (theory) TOP: Burn Pathophysiology KEY: Nursing Process Step: NA

MSC: NCLEX: NA

The nurse describes several types of burn treatment. Match the burn treatment to the statement that best describes it.

a.

Open technique

b.

Closed technique

c.

Escharotomy

d.

Allograft

e.

Xenograft

41. Incision into subcutaneous tissue to increase circulation

42. Biologic dressing obtained from a cadaver

43. Wound covered with ointment, then covered with layers of gauze saturated with topical medication

44. Biologic dressing obtained from a pig

45. Wound covered with ointment, and additional environmental warmth provided

41. ANS: C DIF: Cognitive Level: Analysis REF: 986

OBJ: 8 (theory) TOP: Burns: Treatments KEY: Nursing Process Step: NA

MSC: NCLEX: NA

42. ANS: D DIF: Cognitive Level: Analysis REF: 986

OBJ: 8 (theory) TOP: Burns: Treatments KEY: Nursing Process Step: NA

MSC: NCLEX: NA

43. ANS: B DIF: Cognitive Level: Analysis REF: 986

OBJ: 8 (theory) TOP: Burns: Treatments KEY: Nursing Process Step: NA

MSC: NCLEX: NA

44. ANS: E DIF: Cognitive Level: Analysis REF: 986

OBJ: 8 (theory) TOP: Burns: Treatments KEY: Nursing Process Step: NA

MSC: NCLEX: NA

45. ANS: A DIF: Cognitive Level: Analysis REF: 986

OBJ: 8 (theory) TOP: Burns: Treatments KEY: Nursing Process Step: NA

MSC: NCLEX: NA

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