CH. 65 Care for Skin, Hair, & Nail Disorders

While performing an initial assessment of a client admitted with appendicitis, the nurse observes an elevated blue-black lesion on the client's ear. The nurse knows that this lesion is consistent with what type of skin cancer?

- Malignant melanoma Explanation: A malignant melanoma presents itself as a superficial spreading melanoma which may appear in a combination of colors, with hues of: - tan, brown - black mixed with gray - blue-black, or white. The lesion tends to be circular, with irregular outer portions. BCC usually begins as a small, waxy nodule with rolled, translucent, pearly borders; telangiectatic vessels may be present. SCC appears as a rough, thickened, scaly tumor that may be asymptomatic or may involve bleeding. A dermatofibroma presents as a firm, dome-shaped papule or nodule that may be skin colored or pinkish brown.

A patient is diagnosed with seborrheic dermatitis on the face and is prescribed a corticosteroid preparation for use. What should the nurse educate the patient about regarding use of the steroid on the face?

- Avoid using the medication around the eyelids because it may cause cataracts and glaucoma. Explanation: Seborrheic dermatitis of the body and face may respond to a topically applied corticosteroid cream, which allays the secondary inflammatory response. However, this medication should be used with caution near the eyelids because it can lead to glaucoma and cataracts.

A nurse practitioner is seeing a 16-year-old client who has come to the dermatology clinic for treatment of acne. The nurse practitioner would know that the treatment may consist of which of the following medications?

- Benzoyl peroxide and erythromycin Explanation: Benzoyl peroxide and erythromycin gel is among the topical treatments available for acne. Acyclovir is used in the treatment of herpes zoster as an oral antiviral agent. Diphenhydramine is an oral antihistamine used in the treatment of pruritus. Intralesional injections of triamcinolone have been utilized in the treatment of psoriasis.

The nurse is conducting an admission history and physical examination of a client with a history of contact dermatitis. The nurse assesses whether the client uses which medication classification?

- Corticosteroids Explanation: Corticosteroids are used for contact dermatitis.

The nurse is caring for a client who is experiencing discomfort following a tongue piercing. Which instruction is most helpful?

- Eat soft foods. Explanation: The client is experiencing expected pain. Eating soft foods will help. Rinsing the mouth with antibacterial mouthwash helps to decrease the chance of infection. Providing oral care of brushing and flossing carefully is encouraged.

The nurse is providing instruction to a client with acne. The nurse promotes avoidance of which food(s)? Select all that apply.

- Explanation: The nurse should promote avoidance of foods associated with flare-up of acne, particularly those high in refined sugars: - chocolate - cola - ice cream

Which factor aggravates the condition caused by acne vulgaris?

- Friction Explanation: Acne vulgaris is aggravated by all forms of friction, including propping the hands against the face and rubbing the face. Any correlation with specific food items such as chocolate is more myth than fact. Sunlight does not aggravate the condition caused by acne vulgaris.

A 35-year-old kidney transplant client comes to the clinic exhibiting new skin lesions. The diagnosis is Kaposi sarcoma. The nurse caring for this client recognizes that this is what type of Kaposi sarcoma?

- Iatrogenic Explanation: Iatrogenic/organ transplant--associated Kaposi sarcoma occurs in transplant recipients and people with AIDS. This form of KS is characterized by local skin lesions and disseminated visceral and mucocutaneous diseases. Classic Kaposi sarcoma occurs predominantly in men of Mediterranean or Jewish ancestry between 40 and 70 years of age. Endemic KS affects people predominantly in the eastern half of Africa. AIDS-related KS is seen in people with AIDS.

The nurse is conducting a community education program on basal cell carcinoma (BCC). Which statement should the nurse make?

- It begins as a small, waxy nodule with rolled translucent, pearly borders. Explanation: BCC usually begins as a small, waxy nodule with rolled, translucent, pearly borders. It is less invasive than SCC. It does not metastasize through the blood or lymphatic system. SCC is a malignant proliferation arising from the epidermis.

Which statement is accurate regarding isotretinoin?

- It is teratogenic in humans. Explanation: Isotretinoin is teratogenic in humans, meaning that it can have an adverse effect on a fetus, causing central nervous system and cardiovascular defects, and structural abnormalities of the face. Contraceptives are needed during treatment. The client should not take vitamin A supplements while taking this drug. Side effects are reversible with the withdrawal of the medication.

Which infecting agent causes scabies?

- Itch mite Explanation: Several skin disorders involve an infecting agent. Scabies is caused by Sarcoptes scabiei, an itch mite. Parasitic fungi cause dermatophytosis in skin, scalp, and nails. Shingles is caused by a reactivated virus.

A client comes to the dermatology clinic requesting the removal of epidermal nevi on his right cheek. The nurse knows that the procedure especially useful in treating such lesions is what?

- Laser treatment Explanation: Lasers are useful in treating cutaneous vascular lesions such as epidermal nevi.

A night-shift nurse receives a call from the emergency department about a client with herpes zoster who is going to be admitted to the floor. Based on this diagnosis, where should the nurse assign the client?

- Private room Explanation: Herpes zoster, a highly contagious infection, is transmitted by direct contact with vesicular fluid or airborne droplets from the infected host's respiratory tract. Placing the client with a client diagnosed with pneumonia places that client at risk for contracting herpes zoster. An isolation room with negative airflow isn't necessary for the client with herpes zoster. The nurse should assign the client to a private room. The client could safely room with the client who already had chickenpox; however, visitors might be unnecessarily exposed.

A patient is diagnosed with psoriasis after developing scales on the scalp, elbows, and behind the knees. The patient asks the nurse where this was "caught." What is the best response by the nurse?

- Psoriasis is an inflammatory dermatosis that results from an overproduction of keratin. Explanation: Current evidence supports an autoimmune basis for psoriasis (Porth & Matfin, 2009). Periods of emotional stress and anxiety aggravate the condition, and trauma, infections, and seasonal and hormonal changes may also serve as triggers. In this disease, the epidermis becomes infiltrated by activated T cells and cytokines, resulting in both vascular engorgement and proliferation of keratinocytes. Epidermal hyperplasia results.

What percent of those undergoing piercings suffer complications?

31%

The nurse should assess all possible causes of pruritus for a patient complaining of generalized pruritus. What does the nurse understand can be another cause for this condition?

End-stage kidney disease Explanation: Systemic disorders associated with generalized pruritus include chronic kidney disease.

While in a skilled nursing facility, a client contracts scabies, which is diagnosed the day after discharge. The client is living at her daughter's home with six other people. During her visit to the clinic, the client asks a staff nurse, "What should my family do?" The most accurate response from the nurse is:

- "All family members need to be treated." Explanation: When someone sharing a home with others contracts scabies, all individuals in the home need prompt treatment whether or not they're symptomatic. Towels and linens should be washed in hot water. Scabies can be transmitted from one person to another before symptoms develop.

A client has just undergone surgery for malignant melanoma. Which of the following nursing actions should be prioritized?

- Anticipate the need for, and administer, appropriate analgesic medications. Explanation: Nursing interventions after surgery for a malignant melanoma center on promoting comfort, because wide excision surgery may be necessary. Anticipating the need for and administering appropriate analgesic medications are important. Distraction techniques may be appropriate for some clients, but these are not a substitute for analgesia. Bed rest and a modified diet are not necessary.

The nurse caring for a client with repeated episodes of contact dermatitis is providing instruction to prevent future episodes. Which information should the nurse include?

- Avoid cosmetics with fragrance. Explanation: The nurse should teach the client to avoid: - cosmetics - soaps - laundry detergents that contain fragrance - avoidance of heat and fabric softeners - Gloves used for cleaning and washing dishes should be worn to no longer than 15 to 20 minutes/day, and cotton-lined gloves should be used.

A day care worker comes to the clinic for mild itching and rash of both hands. The nurse suspects contact dermatitis. The diagnosis is confirmed if the rash appears:

- erythematous with raised papules. Explanation: Contact dermatitis is caused by exposure to a physical or chemical allergen, such as skin care products, cleaning products, and latex gloves. Initial symptoms of itching, erythema, and raised papules occur at the site of exposure and can begin within 1 hour of exposure. Allergic reactions tend to be red, not scaly or flaky. Weeping, crusting lesions are also uncommon unless the reaction is severe or has been present for a long time. Excoriation is more common in skin disorders associated with a moist environment.

Which drug is an oral retinoid used to treat acne?

- Isotretinoin Explanation: Isotretinoin, an oral retinoid, is used in clients diagnosed with nodular cystic acne that does not respond to conventional therapy.

A nurse assesses a client with dry, rough, scaly skin without lesions on the legs. The client reports itching in the affected area. What skin assessment would the nurse document?

- Pruritus Explanation: Pruritus (itching) is one of the most common symptoms of patients with dermatologic disorders. Itch receptors are unmyelinated, penicillate (brush-like) nerve endings that are found exclusively in the skin, mucous membranes, and cornea. Shingles presents with lesions. Candidiasis presents with reddened skin and is often found in the folds of skin. Seborrhea refers to dry, scaly patches usually located on the scalp.

A patient has a moisture-retentive dressing for the treatment of a sacral decubitus ulcer. How long should the nurse leave the dressing in place before replacing it?

- 12 to 24 hours Explanation: Depending on the product used and the type of dermatologic conditions encountered, most moisture-retentive dressings may remain in place from 12 to 24 hours

A client underwent a nipple piercing one month ago and exhibits several signs and symptoms of infection at the piercing site. During a client education session, the nurse indicates a body piercing site can develop infection until it completely heals. How long does the nurse say this piercing site takes to completely heal?

- 6 months Explanation: Nipple piercings can take up to 6 months to heal.

A nurse is planning the care of a client with herpes zoster. What medication, if given within the first 24 hours of the initial eruption, can arrest herpes zoster?

- Acyclovir Explanation: Acyclovir, if started early, is effective in significantly reducing the pain and halting the progression of the disease. There is evidence that infection is arrested if oral antiviral agents are given within the first 24 hours. Prednisone is an anti-inflammatory agent used in a variety of skin disorders, but not in the treatment of herpes. Azathioprine is an immunosuppressive agent used in the treatment of pemphigus. Triamcinolone is utilized in the treatment of psoriasis.

The nurse is caring for a patient with extensive bullous lesions on the trunk and back. Prior to initiating skin care, what is a priority for the nurse to do?

- Administer analgesic pain medication. Explanation: The patient with painful and extensive lesions should be premedicated with analgesic agents before skin care is initiated.

The nurse is instructing the patient in how to apply a corticosteroid cream to lesions on the arm. What intervention can the nurse instruct the patient to do to increase the absorption of the medication?

- Apply an occlusive dressing over the site after application. Explanation: Corticosteroids are widely used in treating dermatologic conditions to provide: - anti-inflammatory - antipruritic - vasoconstrictive effects The patient is educated to apply this medication according to strict guidelines, using it sparingly but rubbing it into the prescribed area thoroughly. Absorption of topical corticosteroids is enhanced when the skin is hydrated or the affected area is covered by an occlusive or moisture-retentive dressing

A nurse is providing care for a client who has psoriasis. Following the appearance of skin lesions, the nurse should prioritize what assessment?

- Assessment of the client's joints for pain and decreased range of motion Explanation: Asymmetric rheumatoid factor-negative arthritis of multiple joints occurs in up to 42% of people with psoriasis, most typically after the skin lesions appear. The most typical joints affected include those in the hands or feet, although sometimes larger joints such as the elbow, knees, or hips may be affected. As such, the nurse should assess for this musculoskeletal complication. GI, cardiovascular, and neurologic function are not affected by psoriasis.

A client has recently been diagnosed with advanced malignant melanoma and is scheduled for a wide excision of the tumor on her chest. In writing the plan of care for this client, what major nursing diagnosis should the nurse include?

- Deficient Knowledge about Early Signs of Melanoma Explanation: The fact that the client's disease was not reported until an advanced stage suggests that the client lacked knowledge about skin lesions. Excision does not result in chronic pain, though it causes acute pain. Reconstructive surgery is not a certainty, and will not necessarily lead to depression. Anxiety is likely, but this may or may not be related to a lack of social support.

The nurse is caring for a client with a blistering disease. Which action will the nurse take to relieve this client's discomfort?

- Dry the skin carefully after bathing. - Apply warmed blankets as necessary. - Premedicate with analgesics before skincare. Explanation: Clients with blistering disorders may experience significant disability. There is constant itching and possible pain in the denuded areas of the skin. After the skin is bathed, it is to be dried carefully. Hypothermia is common and measures to keep the client warm, such as using warmed blankets, should be used. The client with painful and extensive lesions should be premedicated with analgesic agents before skin care is done. Measuring temperature every 4 hours assesses for the development of an infection. Tape should never be used because it could produce more blisters.

A public health nurse is participating in a health promotion campaign that has the goal of improving outcomes related to skin cancer in the community. What action has the greatest potential to achieve this goal?

- Educating participants about the early signs and symptoms of skin cancer Explanation: The best hope of decreasing the incidence of skin cancer lies in educating clients about the early signs. There is a relationship between general health and skin cancer, but teaching individuals to identify the early signs and symptoms is more likely to benefit overall outcomes related to skin cancer. Teaching about treatment options is not likely to have a major effect on outcomes of the disease. Smoking is not among the major risk factors for skin cancer.

A client has received a diagnosis of irritant contact dermatitis. What action should the nurse prioritize in the client's subsequent care?

- Helping the client identify and avoid the offending agent Explanation: A focus of care for clients with irritant contact dermatitis is identifying and avoiding the offending agent. Immunosuppressants are not used to treat eczema and wound care is not normally required, except in cases of open lesions. Poor hygiene has no correlation with contact dermatitis.

An older adult client, who is bedridden, is admitted to the unit because of a pressure injury that can no longer be treated in a community setting. During assessment, the nurse finds that the ulcer extends into the muscle and bone. At what stage should the nurse document this injury?

- IV Explanation: In addition to the interventions listed for stage I, these advanced draining, necrotic pressure injuries must be cleaned (débrided) to create an area that will heal. Stage I is an area of erythema that does not blanch with pressure. Stage II involves a break in the skin that may drain. Stage III is an ulcer that extends into the subcutaneous tissue. With this type of ulcer, necrosis of tissue and infection may develop. Stage IV is an ulcer that extends to underlying muscle and bone.

A patient is being evaluated for nodular cystic acne. What systemic pharmacologic agent may be prescribed for the treatment of this disorder?

- Isotretinoin (Accutane) Explanation: Synthetic vitamin A compounds (i.e., retinoids) are used with dramatic results in patients with nodular cystic acne unresponsive to conventional therapy. One compound is isotretinoin, which is used for active inflammatory popular pustular acne that has a tendency to scar. Isotretinoin reduces sebaceous gland size and inhibits sebum production. It also causes the epidermis to shed (epidermal desquamation), thereby unseating and expelling existing comedones.

A school nurse has sent home four children who show evidence of pediculosis capitis. What is an important instruction the nurse should include in the note being sent home to parents?

- Nits may have to be manually removed from the child's hair shafts. Explanation: Treatment for head lice should begin promptly and may require manual removal of nits following medicating shampoo. Head lice are not related to a lack of hygiene. Treatment is necessary because the condition will not likely resolve spontaneously within 1 week.

A client's blistering disorder has resulted in the formation of multiple lesions in the client's mouth. What intervention should be included in the client's plan of care?

- Provide chlorhexidine solution for rinsing the client's mouth. Explanation: Frequent rinsing of the mouth with chlorhexidine solution is prescribed to rid the mouth of debris and to soothe ulcerated areas. A hypertonic solution would be likely to cause pain and further skin disruption. Meticulous mouth care should be provided and there is no reason to provide nutrition parenterally.

The nurse is caring for a client who developed a pressure injury as a result of decreased mobility. The nurse on the previous shift has provided client teaching about pressure injuries and healing promotion. The nurse determines that the client has understood the teaching by observing the client:

- avoid placing body weight on the healing site. Explanation: The major goals of pressure injury treatment may include: - relief of pressure - improved mobility - improved sensory perception - improved tissue perfusion - improved nutritional status - minimized friction and shear forces - dry surfaces in contact with skin - healing of pressure ulcer, if present.

A client with a history of diabetes mellitus has recently developed furunculosis. What is causing the client's condition?

- infection Explanation: Furuncles and carbuncles are caused by skin infections with organisms that usually exist harmlessly on the skin surface.

While assessing the skin of a 45-year-old, fair-skinned female client, the nurse notes a lesion on the medial aspect of her lower leg. It has irregular borders, with various shades of black and brown. The client states that the lesion itches occasionally and bled slightly a few weeks ago. She also reveals a history of sunburns. Based on these signs and symptoms, the nurse suspects:

- melanoma. Explanation: The "ABCDs" of melanoma are - Asymmetry of the lesion - Borders that are irregular - Colors that vary in shades - increased Diameter. Fair skin with a history of sunburn and the location of the lesion on the leg (the most common site in women) suggest melanoma. Squamous cell carcinoma commonly develops on the skin of the face, the ears, the dorsa of the hands and forearms, and other sun-damaged areas. Early lesions appear as opaque, firm nodules with indistinct borders, scaling, and ulceration. Actinic keratosis is a premalignant skin lesion. Basal cell carcinoma presents as lesions that are lightly pigmented. As they enlarge, their centers become depressed and their borders become firm and elevated.

A client is being treated for acne vulgaris. What contributes to follicular irritation?

- overproduction of sebum Explanation: The overproduction of sebum provides an ideal environment for bacterial growth within the irritated follicle. The follicle becomes further distended and irritated, causing a raised papule in the skin.

A client is undergoing photochemotherapy involving a combination of a photosensitizing chemical and ultraviolet light. What health problem does this client most likely have?

- psoriasis Explanation: Photochemotherapy is used to treat psoriasis.

A nurse is assessing a client with a new skin disorder. Which 4 questions would the nurse include when asking the client about the change in skin condition?

1. When did the disorder first begin, and where did it first appear? 2. Where are the lesions located? 3. Has the problem spread? 4. Have you tried to treat the lesions?

Define the Following Terms: - acne vulgaris - alopecia - alopecia areata - androgenetic alopecia - body piercing - carbuncle - comedone - dandruff - dermabrasion - dermatitis - dermatome - dermatophytes - dermatophytoses - erythema - furuncle - furunculosis - granuloma - herpes zoster - keloids - nits - onychocryptosis - onychomycosis - pediculosis - photochemotherapy - podiatrist - pruritus - psoriasis - rhinophyma - rosacea - scabies - seborrhea - seborrheic dermatitis - shingles - tattoo - telangiectases

acne vulgaris - inflammatory disorder that affects the sebaceous glands and hair follicles alopecia - condition that affects the hair follicles and results in partial or total hair loss alopecia areata - autoimmune disorder causing patchy areas of hair loss that can progress to total hair loss and even loss of hair from the entire body androgenetic alopecia - genetically acquired condition referred to by many as male-pattern baldness, but also affects women albeit to a milder degree body piercing - act of inserting a metal ring or barbell, which is a straight or curved rod, into the lips, ear cartilage, cheeks, nose, tongue, eyebrows, navel, nipples, or genital area carbuncle - deep skin and subcutaneous abscess from which pus drains comedone - skin condition commonly called a blackhead; formed when sebum, keratin, and bacteria accumulate and dilate a hair follicle dandruff - loose, scaly material of dead, keratinized epithelium shed from the scalp dermabrasion - method of removing surface layers of scarred skin using sandpaper, a rotating wire brush, chemicals, or a diamond wheel dermatitis - general term that refers to an inflammation of the skin dermatome - skin area supplied by a nerve dermatophytes - parasitic fungi that invade the skin, scalp, and nails dermatophytoses - superficial fungal infections erythema - redness of the skin furuncle - skin infection commonly called a boil furunculosis - condition of having multiple furuncles or boils granuloma - inflammatory nodular lesion herpes zoster - skin disorder (shingles) that develops later after an infection with varicella (chickenpox) due to an acute reactivation of the varicella-zoster virus, which lies dormant in nerve roots keloids - overgrowth of scar tissue especially among those with darkly pigmented skin nits - eggs laid by adult female lice that are tightly cemented to the side of hair shafts onychocryptosis - ingrown toenail onychomycosis - fungal infection of the fingernails or toenails pediculosis - infestation with lice. photochemotherapy - combination of ultraviolet light therapy and a photosensitizing drug to destroy cells podiatrist - practitioner who specializes in the care for feet pruritus - itching psoriasis - chronic, noninfectious inflammatory disorder of the skin in which the cells of the epidermis proliferate so quickly that the upper layer of cells cannot be shed fast enough to make room for the newly produced cells. rhinophyma - skin condition of inflamed tissue that causes the nose to become permanently enlarged, red, nodular, and bulbous rosacea - chronic skin disorder characterized by a "rosy" appearance; generally affects fair-skinned people 30 to 60 years old scabies - skin disorder caused by infestation with the itch mite seborrhea - dermatologic condition associated with excessive production of secretions from the sebaceous glands seborrheic dermatitis - skin condition that appears as red areas covered by yellowish, greasy-appearing scales shingles - skin disorder that develops years after an infection with varicella (chickenpox) tattoo - pigmentation of the dermal layer of skin with injection of needles containing dye Telangiectases - chronically dilated blood vessels appearing as visible linear streaks on the skin with a spidery appearance.

The nurse plans care for a client who is diagnosed with atopic dermatitis.

The nurse provides teaching to the client who is diagnosed with atopic dermatitis regarding the importance of skin hydration. Appropriate teaching points include: - application of an emollient that contains glycerol to the skin immediately after bathing because the oil seals water into the skin - use of a mild soap, which acts as a natural moisturizer, thus keeping the skin hydrated - Dry, itchy skin often occurs due to inflammation that is associated with atopic dermatitis - encouraging the use of emollients, which decrease inflammation; - The use of cotton fabrics, which allow the skin to breathe - using a mild detergent to wash clothing to decrease the risk for a reaction and inflammation - taking an antihistamine before bed.

A 30-year-old client has just returned from the operating room after having a "flap" done following a motorcycle accident. The client's spouse asks the nurse about the major complications following this type of surgery. What would be the nurse's best response?

- "The major complication is when the blood supply fails and the tissue in the flap dies." Explanation: The major complication of a flap is necrosis of the pedicle or base as a result of failure of the blood supply. This is more likely than tearing of the pedicle and chronic pain and is more serious than loss of sensation.

A 10-year-old child is brought to the office with complaints of severe itching in both hands that's especially annoying at night. On inspection, the nurse notes gray-brown burrows with epidermal curved ridges and follicular papules. The physician performs a lesion scraping to assess this condition. Based on the signs and symptoms, what diagnosis should the nurse expect?

- Scabies Explanation: Signs and symptoms of scabies include: - gray-brown burrows - epidermal curved or linear ridges - Follicular papules - severe itching that usually occurs at night - commonly occurs in school-age children. The most common areas of infestation are the: - finger webs - flexor surface of the wrists - antecubital fossae Impetigo is a contagious, superficial skin infection characterized by a small, red macule that turns into a vesicle, becoming pustular with a honey-colored crust. Contact dermatitis is an inflammation of the skin caused by contact with an irritating chemical or allergen. Dermatophytosis, or ringworm, is a disease that affects the scalp, body, feet, nails, and groin. It's characterized by erythematous patches and scaling.

A client with squamous cell carcinoma has been scheduled for treatment of this malignancy. The nurse should anticipate that treatment for this type of cancer will primarily consist of what intervention?

- Surgical excision Explanation: The primary goal of surgical management of squamous cell carcinoma is to remove the tumor entirely. Radiation therapy is reserved for older clients, because x-ray changes may be seen after 5 to 10 years, and malignant changes in scars may be induced by irradiation 15 to 30 years later. Obtaining a biopsy would not be a goal of treatment; it may be an assessment. Chemotherapy and radiation therapy are generally reserved for clients who are not surgical candidates.

A nurse is working with a family whose 5-year-old child has been diagnosed with impetigo. What educational intervention should the nurse include in this family's care?

- Teaching about the importance of maintaining high standards of hygiene Explanation: Impetigo is associated with unhygienic conditions; educational interventions to address this are appropriate. The disease is contagious, thus vesicles should not be manually burst. Because of the bacterial etiology, corticosteroids are ineffective.

Which term describes a fungal infection of the scalp?

- Tinea capitis Explanation: Tinea capitis is a fungal infection of the scalp. Tinea corporis involves fungal infections of the body. Tinea cruris describes fungal infections of the inner thigh and inguinal creases. Tinea pedis is the term for fungal infections of the foot.

A nurse receives a report on a client who has circular lesions on his neck. Which condition is the client most likely to have?

- Tinea corporis Explanation: Tinea corporis, or ringworm, is a flat, scaling, papular lesion with raised borders. Candidiasis is a fungal infection of the skin or mucous membranes commonly found in the oral, vaginal, and intestinal mucosal tissue. Molluscum contagiosum is a viral skin infection with small, red, papular lesions. Tinea pedis is a superficial fungal infection on the feet, commonly called athlete's foot, that causes itching, sweating, and a foul odor.

Which of the following is also known as "jock itch"?

- Tinea cruris Explanation: Tinea cruris is also known as "jock itch." Tinea corporis is ringworm affecting the body. Tinea pedis is "athlete's foot." Tinea unguium is a type of ringworm that affects the toenails.

To treat a client with acne vulgaris, the physician is most likely to order which topical agent for nightly application?

- Tretinoin (retinoic acid [Retin-A]) Explanation: Tretinoin is a topical agent applied nightly to treat acne vulgaris. Minoxidil promotes hair growth. Zinc oxide gelatin treats stasis dermatitis on the lower legs. Fluorouracil is an antineoplastic topical agent that treats superficial basal cell carcinoma.

A client is being treated for acne vulgaris. What warning must be given to this client regarding the application of benzoyl peroxide?

- Use gloves with application. Explanation: Warn clients using acne preparations containing benzoyl peroxide that this ingredient is an oxidizing agent and may remove the color from clothing, rugs, and furniture. Thorough handwashing after drug use may not remove all the drug and permanent fabric discoloration may still occur. Users of products containing benzoyl peroxide should wear disposable plastic gloves when applying the drug.

A client has had a surgical procedure to correct an ingrown toenail. Which care recommendation would not help to prevent recurrences?

- Use scissors to trim toenails. Explanation: Use nail clippers rather than scissors to trim toenails. Toenails should be trimmed so that they are slightly longer than the end of the toes, without rounding off of the corners. Wear wide shoes and loose socks with sufficient room for the toes. Keep the feet clean and dry. Avoid physical activities that involve sudden stops which jam the toes into the front of the shoe.

The nurse is instructing the parents of a child with head lice. Which statement should the nurse include?

- Use shampoo with piperonyl butoxide. Explanation: The nurse's instructions should include: - shampooing with piperonyl butoxide - washing clothes in hot water - disinfecting brushes and combs with piperonyl butoxide shampoo

When performing a skin assessment, the nurse notes a localized skin infection of a single hair follicle. The nurse documents the presence of

- a furuncle. Explanation: Furuncles are localized skin infections of a single hair follicle. They can occur anywhere on the body but are most prevalent in areas subjected to: - irritation - pressure, friction - excessive perspiration, such as the back of the neck, the axillae, or the buttocks. A carbuncle is a localized skin infection involving several hair follicles. Cheilitis refers to dry cracking at the corners of the mouth. Comedones are the primary lesions of acne, caused by sebum blockage in the hair follicle.

Onychomycosis is a fungal dermatophyte infection of the fingernails or toenails. Which is not a factor for promotion of this infection?

- alternating pairs of shoes daily Explanation: Alternating pairs of shoes daily helps to decrease incidence. Contributing factors include: - warm, dark, moist environments - artificial nails - going barefoot

There is an increase in the incidence of skin cancer being reported. Which have been identified as factors that predispose to malignant changes in the skin?

Explanation: Contributing factors include: - the thinning ozone layer - residence in high-altitude areas where the atmosphere is thinner than at sea level - prolonged, repeated exposure to UV rays in those who do farming, fishing, road construction, etc. Use of sunblock is a protector from UV rays.

What should the nurse assess for to determine if a patient using corticosteroids for a dermatologic condition is having local side effects? Select all that apply.

Explanation: Local side effects of topical corticosteroids may include: - skin atrophy and thinning - striae (bandlike streaks) - telangiectasias (small, red lesions caused by dilation of blood vessels).

The nurse notes that a client who uses a wheelchair for long periods after recovering from an amputation has a reddened area over the coccyx. Which teaching will the nurse provide to the client to relieve the pressure?

For the client who spends long periods of time in a wheelchair, pressure can be relieved by: - performing push-ups or pushing down on armrests and raising the buttocks off the seat of the chair - moving from side to side while sitting in the chair - Shifting weight in the chair by bending forward with the head down between the knees if able and constantly moving in the chair - Complete one half of a push-up by completing a push-up on the right side and then the left side by pushing down on the armrest