ATI Med Surg Dermatological Dynamic Quizzes

A nurse in a provider's office is caring for a client who has a new diagnosis of herpes zoster. The nurse should anticipate a prescription for which of the following medications?

Acyclovir Correct Answer: B. Acyclovir The nurse should anticipate a prescription for acyclovir, an antiviral medication that inhibits replication of the virus that causes herpes zoster. Incorrect Answers: A. The nurse should anticipate a prescription for the zoster vaccine for an older adult client to prevent herpes zoster. C. The nurse should anticipate a prescription for amoxicillin for a client who has a bacterial infection. D. The nurse should anticipate a prescription for infliximab for a client who has Crohn's disease.

A nurse in an urgent care clinic is caring for a client who has a snakebite on her arm. Which of the following actions should the nurse take? ✔ A. Immobilize the limb at the level of the heart B. Apply a tourniquet to the affected limb C. Use a sterile scapula to incise the wound D. Apply ice to the skin over the snakebite wound

Correct Answer: A. Immobilize the limb at the level of the heart The emergency management of a client who has a snakebite involves limiting the spread of venom. Any constrictive clothing or jewelry should be removed before swelling worsens, and the affected limb should be immobilized at the level of the heart. Incorrect Answers: B. The nurse should not apply a tourniquet to the affected limb because this action is ineffective and can worsen the client's outcome. C. The nurse should not use a sterile scapula to incise the wound because this action is ineffective and can worsen the client's outcome. D. The nurse should not apply ice to the skin over the wound because this action is ineffective and can worsen the client's outcome.

A nurse is caring for a client who has been applying silver sulfadiazine cream to a deep partial-thickness arm burn for the past 2 weeks. The nurse should monitor the client for which of the following adverse effects? A. Hyponatremia ✔B. Leukopenia C. Hyperchloremia D. Elevated BUN

Correct Answer: B. Leukopenia Transient leukopenia is an adverse effect of silver sulfadiazine; therefore, the nurse should monitor the client for an allergic reaction that is causing a decrease in the client's WBC count. Incorrect Answers: A.Hyponatremia is an adverse effect of thiazide diuretics. C. Hyperchloremia is an adverse effect of mafenide acetate solution. D. Impaired kidney function is an adverse effect of gentamicin.

A nurse on a surgical unit is caring for 4 clients who have healing wounds. Which of the following wounds should the nurse expect to heal by primary intention? A. Partial-thickness burn B. Stage III pressure ulcer ✔C. Surgical incision D. Dehisced sternal wound

Correct Answer: C. Surgical incision With primary intention, a clean wound is closed mechanically, leaving well-approximated edges and minimal scarring. A surgical incision is an example of a wound that heals by primary intention. Incorrect Answers: A. A partial-thickness burn will heal by spontaneous re-epithelialization. Since it involves the uppermost layers of the dermis, scarring can be minimal or extensive, depending on the depth of the burn. B. A stage III pressure ulcer will heal by secondary intention. D. A dehisced sternal wound can either close by secondary or tertiary intention.

A nurse is collecting data from a client who has an arm lesion. Which of the following characteristics is a clinical manifestation of malignant melanoma? A. Rough, dry, and scaly (actinic keratosis) B. Firm nodule with crust (squamous cell carcinoma) C. Pearly papule with an ulcerated center (basal cell carcinoma) ✔D. Irregularly shaped with blue tones

Correct Answer: D. Irregularly shaped with blue tones Malignant melanomas are irregularly shaped and can be blue, red, or white in tone. They often occur on a client's upper back and lower legs. Incorrect Answers: A. This finding is a clinical manifestation of actinic keratosis. B. This finding is a clinical manifestation of squamous cell carcinoma. C. This finding is a clinical manifestation of basal cell carcinoma.

A nurse is assisting with planning care for a client who has deep partial-thickness and full-thickness thermal burns over 40% of his total body surface. The client is in the acute phase of burn injury. Which of the following interventions should the nurse include in the plan? ✔A. Initiate range-of-motion exercises. B. Use clean technique to provide wound care. C. Place the client on a low-protein diet. D. Maintain the client on bed rest.

Correct Answer: A. Initiate range-of-motion exercises. The nurse should begin performing active and passive range-of-motion exercises with the client to maintain mobility and prevent contractures. Incorrect Answers: B. The nurse should use sterile technique to provide wound care for the client to reduce the risk of infection. C. The nurse should place the client on a high-protein, high-calorie diet to promote wound healing. D. The nurse should encourage the client to ambulate frequently to promote mobility and improve ventilation.

A nurse is reinforcing discharge teaching with a client who is postoperative following surgical excision of a basal cell carcinoma. Which of the following findings should the nurse include as an indication of malignancy of a mole? ✔A. Ulceration B. Blanching of surrounding skin C. Dimpling D. Fading of color

Correct Answer: A. Ulceration Ulceration, bleeding, or exudation are indications of a mole's potential malignancy. Increasing size is also a warning sign. The nurse should emphasize the importance of lifetime follow-up evaluations and review the proper techniques for self-examining the skin every month. Incorrect Answers: B. Redness or swelling of the skin around a mole, not blanching, is an indication of potential malignancy. C. Dimpling is not an indication of a mole's potential malignancy. D. Darkening of a mole, not fading, is associated with potential malignancy.

A nurse is caring for a client whose wounds are covered with a heterograft dressing. In response to the client's questions about the dressing, the nurse explains that it is obtained from which of the following sources? A. Cadaver skin ✔B. Pig skin C. Amniotic membranes D. Beef collagen

Correct Answer: B. Pig skin Heterografts are obtained from an animal, usually a pig. Incorrect Answers: A. Homographs are obtained from cadaver skin. C. Human amniotic membranes are used to treat burns; however, they are not heterograft dressings. D. Artificial skin made from beef collagen is used to treat burns; however, it is not a heterograft dressing.

A nurse is reinforcing teaching with a client who has a large wound healing by secondary intention. The nurse should instruct the client that which of the following nutrients promotes wound healing? A. Vitamin B1 B. Calcium ✔C. Vitamin C D. Potassium

Correct Answer: C. Vitamin C A diet high in protein and vitamin C is recommended because these nutrients promote wound healing. Incorrect Answers: A. Vitamin B1 promotes the functioning of the nervous system; however, it does not specifically promote wound healing. B. Calcium aids in blood clotting and muscle contraction; however, it does not specifically promote wound healing. D. Potassium is necessary for muscle activity and fluid balance; however, it does not specifically promote wound healing.

A nurse is reinforcing teaching with a client who is wheelchair-bound and his caregiver about ways to reduce the risk of pressure ulcer formation. Which of the following instructions should the nurse include? A. "Move between the bed and the wheelchair once every 2 hours." B. "Make sure that your caregiver massages your skin daily." C. "Use a rubber ring when sitting in the wheelchair." ✔D. "Shift your weight in the wheelchair every 15 minutes."

Correct Answer: D. "Shift your weight in the wheelchair every 15 minutes." This response addresses the safety issue of pressure ulcer risk. Pressure ulcers are most likely to develop if the client does not shift position frequently to relieve pressure. Incorrect Answers: A. The nurse should instruct wheelchair-bound clients at risk for pressure ulcer formation to change position at least once every hour. B. The nurse should instruct the client and his caregiver to avoid massaging the skin, especially over bony prominences; this can further traumatize fragile tissues. C. The nurse should instruct the client and his caregiver to avoid using a rubber ring while sitting because it reduces circulation to the client's skin.

A nurse is caring for a client who has regular occupational exposure to sunlight and presentA nurse is caring for a client who has regular occupational exposure to sunlight and presents to the clinic for evaluation of several skin lesions. Which of the following findings should alert the nurse to the possibility of malignant melanoma? A. A pearly papule that is 0.5 cm (0.20 in) wide with raised, indistinct borders on the upper right shoulder (basal cell carcinoma) B. Several flat, pigmented, circumscribed areas of various sizes over the bridge of the nose (freckle) C. A raised, circumscribed lesion on the face that contains yellow-white purulent material (pustle such as acne) ✔Correct answer D D. An irregularly shaped brown lesion with light blue areas on the necks to the clinic for evaluation of several skin lesions. Which of the following findings should alert the nurse to the possibility of malignant melanoma?

D. An irregularly shaped brown lesion with light blue areas on the neck Correct Answer: D. An irregularly shaped brown lesion with light blue areas on the neck Malignant melanoma, the leading cause of skin cancer death, is a neoplasm of dermal or epidermal cells. Exposure to sunlight increases the risk, with fair-skinned people at the greatest risk. Malignant melanoma commonly starts in exposed skin areas like the back, scalp, face, and neck and metastasizes readily to other areas. Manifestations include a change in the color, size, or shape of a skin lesion and irregular borders in hues of tan, black, or blue. Incorrect Answers: A. This describes basal cell carcinoma, a slow-growing skin tumor that results from sun exposure in clients who have fair skin. Basal cell carcinomas are usually pale in color and either pearly or flaky in appearance. B. This describes macules such as freckles. C. This describes a pustule such as acne lesions.

A nurse is reinforcing teaching with a group of clients about skin cancer. The nurse should explain that basal cell carcinoma originates from which of the following tissues?

Epidermis Correct Answer: B. Epidermis Basal cell carcinoma originates from the epidermal layer of the skin. It is the most common form of skin cancer. Incorrect Answers: A. Angiomas, not basal cell carcinomas, are an example of lesions that involve the skin and subcutaneous tissue. C. The dermis connects the epidermis with the subcutaneous tissue. Melanoma, not basal cell carcinoma, arises from this skin layer. D. The stratum corneum layer is the outermost or topmost layer of skin and is composed primarily of dead or peeling skin cells. Basal cell carcinoma does not arise from dead skin cells.

A nurse is reinforcing teaching with a client who has burn injuries to his trunk about what to expect from the prescribed hydrotherapy. Which of the following statements by the client indicates an understanding of the teaching?

I will be on a special shower table Correct Answer: A. "I will be on a special shower table." Hydrotherapy involves a special shower table that facilitates examination and debridement of the wound. By using the showering technique as opposed to a tub bath, the water can be kept at a constant temperature, and there is a lower risk of wound infection. Incorrect Answers: B. The nurse should use warm water during the hydrotherapy treatment to help the client maintain adequate body temperature. C. The nurse should use soft washcloths or gauze to gently scrub and debride the wounds. D. The nurse should leave small blisters intact but will open large blisters.

A nurse is assisting with the admission of a client who is bedridden and was admitted from home. The nurse notes a shallow crater in the epidermis of the client's sacral area. The nurse should document that the client has a pressure ulcer at which of the following stages?

II Correct Answer: D. II With a stage II pressure ulcer, there is partial-thickness skin loss involving the epidermis and the dermis. The ulcer is visible and superficial and can appear as an abrasion, blister, or shallow crater. Edema persists, and the ulcer can become infected. The client might report pain, and there might be a small amount of drainage. Incorrect Answers: A. With a stage IV pressure ulcer, the client has full-thickness tissue loss with destruction, tissue necrosis, and visible damage to muscle, bone, or supporting structures. Sinus tracts, deep pockets of infection, tunneling, and undermining can also occur. B. With a stage I pressure ulcer, the skin is intact with an area of persistent, nonblanchable redness, usually over a bony prominence that might feel warm or cool when touched. The tissue is swollen and congested, and the client might report discomfort at the site. In clients with darker skin tones, the ulcer can appear blue or purple and different from other skin areas. C. With a stage III pressure ulcer, there is full-thickness tissue loss with damage to or necrosis of subcutaneous tissue. The ulcer might extend down to, but not through, the underlying fascia. The ulcer appears as a deep crater with or without undermining of adjacent tissue and without exposed muscle or bone. Drainage and infection are common.

A community health nurse is reinforcing teaching about melanoma with a group of clients. Which of the following characteristics of lesions associated with melanoma should the nurse include in the teaching?

Irregular border Correct Answer: D. Irregular border The nurse should identify that skin cancer lesions, including melanoma, are expected to exhibit border irregularity. The nurse should reinforce teaching with clients about the appearance of melanoma lesions, including asymmetry of shape, border irregularity, color variation within a single lesion, diameter greater than 6 mm, and evolving or changing in any feature. Incorrect Answers: A. The nurse should identify that skin cancer lesions, including melanoma, are expected to exhibit color variation. B. The nurse should identify that skin cancer lesions, including melanoma, are expected to exhibit asymmetry in shape. C. The nurse should identify that skin cancer lesions, including melanoma, are expected to exhibit a diameter greater than 6 mm.

A nurse in a provider's office is collecting data from a client who has skin lesions. The nurse notes that the lesions are 0.5 cm (0.20 in) in size, elevated, and solid with distinct borders. The nurse should document these findings as which of the following skin lesions?

Papules Correct Answer: A. Papules A papule is a small, solid, elevated lesion with distinct borders. It is usually <10 mm in diameter. Warts and elevated moles are examples of papules. Incorrect Answers: B. A macule is flat, variably shaped, discolored, and small—typically <10 mm in diameter. A macule is a change in the color of the skin. Freckles and the rash associated with rubella are types of macules. C. Wheals, also known as hives, are transient, elevated, irregularly shaped lesions caused by localized edema. Wheals are a common manifestation of an allergic reaction. D. A vesicle is a circumscribed, elevated lesion or blister containing serous fluid. Vesicles typically arise with herpes simplex, poison ivy, and chickenpox.

A nurse is assisting with the care of a client who is in the resuscitation phase following a major burn. Which of the following laboratory findings should the nurse expect?

Sodium 132 mEq/L Correct Answer: B. Sodium 132 mEq/L The nurse should anticipate a client who is in the resuscitation phase of a burn injury to have a low sodium level because sodium is trapped in interstitial space. Incorrect Answers: A. Hemogloibin 10 g/dl; This laboratory value is below the expected reference range. The nurse should anticipate an elevated hemoglobin level during the resuscitation phase due to loss of fluid volume. C. Albumin 3.6 g/dl; This laboratory finding is within the expected reference range. The nurse should anticipate a low albumin level during the resuscitation phase. D. Potassium 4.0 mEq/dl; This laboratory finding is within the expected reference range. The nurse should anticipate an elevated potassium level during the resuscitation phase.

A nurse is contributing to the plan of care for a client who has been admitted for the treatment of a malignant melanoma of the upper leg without metastasis. The nurse should expect the provider to perform which of the following procedures?

Surgical excision Correct Answer: D. Surgical excision The therapeutic approach to malignant melanoma depends on the level of invasion and the depth of the lesion. Surgical excision is the treatment of choice for small, superficial lesions. Deeper lesions require wide, local excision followed by skin grafting. Incorrect Answers: A. Curettage is used for small lesions that are not melanomas. B. Melanoma is resistant to radiation therapy. However, radiation along with corticosteroids might be helpful to clients who have metastatic disease. C. Regional chemotherapy is the treatment for localized tumors and superficial basal cell carcinomas without metastasis.

A nurse is collecting data from a client who sustained superficial partial-thickness and deep partial-thickness burns 72 hours ago. Which of the following findings should the nurse report to the provider?

Temperature of 39.1° C (102.4°F) Correct Answer: D. Temperature of 39.1° C (102.4°F) An elevated temperature is an indication of infection, and the nurse should report this finding to the provider. Sepsis is a critical finding following a major burn injury. Initially, burn wounds are relatively pathogen-free. On approximately the third day following the injury, early colonization of the wound surface by gram-negative organisms changes to predominantly gram-positive opportunistic organisms. Incorrect Answers: A. Significant edema is expected when fluid shifts after a burn injury. B. Superficial partial-thickness and deep partial-thickness burns are painful throughout burn therapy. C. A urinary output of 30 mL/hr is within the expected reference range. A decrease in urine output is expected with edema and fluid shifts on or about the fourth day following a major burn injury.

A nurse is collecting data from a client who is 3 days postoperative following abdominal surgery. The client's incision is slightly edematous, appears pink with crusting on the edges, and is draining serosanguinous fluid. Which of the following statements describes this incision?

The incision is showing signs of healing without complications Correct Answer: C. The incision is showing signs of healing without complications. The nurse's findings are consistent with appropriate healing without complications. Incorrect Answers: A. Signs of wound infection include warmth, erythema, and purulent drainage. B. Dehiscence is the separation of the layers of skin and tissue in a wound. Signs of dehiscence include the client's report of something moving apart, increased wound drainage, and a visually apparent separation. D. A fistula is a complication of wound healing that involves the formation of an abnormal passageway within or from a wound. A common sign of fistula development is chronic drainage of fluids from the wound.

A nurse is observing the skin of a client who has frostbite. The client has small blisters that contain blood, and the skin of the affected area does not blanch. The nurse should classify this injury as which of the following?

Third-degree frostbite Correct Answer: C. Third-degree frostbite When a client has third-degree frostbite, the skin of the affected area has small blisters that are blood-filled, and the skin does not blanch. Incorrect Answers: A. When a client has first-degree frostbite, the skin of the affected area is reddened and looks waxy. B. When a client has second-degree frostbite, the skin of the affected area has large, fluid-filled blisters. D. When a client has fourth-degree frostbite, the skin of the affected area is frozen. Blisters do not appear. The client's muscles and bones are affected.