Chapter 61: Management of Patients with Dermatologic Problems

Which of the following medications is used to reduce turnover time of the psoriatic epidermis? 1- Methotrexate 2- Triamcinolone acetamide (Kenalog) 3- Tazarotene (Tazorac) 4- Acyclovir (Zovirax)

1- Methotrexate

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: 1- erythematous with raised papules. 2- dry and scaly with flaking skin. 3- inflamed with weeping and crusting lesions. 4- excoriated with multiple fissures.

1- erythematous with raised papules.

he nurse reinforces instructions to a client who has complained of chronic dry skin and episodes of pruritus. Which client statement indicates the need for further teaching?

"I should use a dehumidifier, especially during the winter months."

What advice should the nurse give a client with dermatitis until the etiology of the dermatitis is identified? 1- Use wool, synthetics, and other dense fibers. 2- Wear rubber gloves when in contact with soaps. 3- Rub the skin vigorously to dry. 4- Use hot water for bathing.

2- Wear rubber gloves when in contact with soaps.

A nurse is caring for a client experiencing an exacerbation of plaque psoriasis. The nurse assesses the area and documents a proliferation of which cell type? 1- Dermal 2- Epidermal 3- Endothelial 4- Epithelia

2- Epidermal

Which sedative medication is effective for treating pruritus? 1- Benzoyl peroxide 2- Hydroxyzine 3- Fexofenadine 4- Tetracycline

2- Hydroxyzine

The nurse is providing care for a young woman who has sought care because of signs and symptoms that are characteristic of psoriasis. When planning this woman's care, the nurse should be mindful of the fact that the etiology of the problem involves which of the following? 1- Chronic infection 2- Immune dysfunction 3- Persistent physical irritation 4- Benign neoplastic processes

2- Immune dysfunction

Photochemotherapy has been used as a treatment for which of the following skin disorders? 1- Shingles 2- Psoriasis 3- Allergic dermatitis 4- Rosacea

2- Psoriasis

The nurse inspects the appearance of a sacral ulcer and documents "a shallow open ulcer with a red-pink wound with partial thickness loss of dermis." The nurse knows to classify this ulcer as: 1- Stage I. 2- Stage II. 3- Stage III. 4- Stage IV.

2- Stage II.

A patient with an ulcer on his right leg is examined by the nurse practitioner. The nurse records the appearance of the ulcer as "ruddy" in color with poorly defined wound edges and moderate amounts of exudate. Based on this assessment, the ulcer is characterized as which of the following? 1- Arterial ulcer 2- Venous ulcer 3- Neuropathic ulcer 4- Pressure ulcer

2- Venous ulcer

Which individuals is least likely at risk for the development of psoriasis? a. A 32 year old African American b. A woman experiencing menopause c. A client with a family history of the disorder d. An individual who has experienced a significant amount of emotional distress

A 32-year-old African American Rationale: The incidence is lower in darker skinned races and ethnic groups.

21. A patient has just been diagnosed with psoriasis and frequently has lesions around his right eye. What should the nurse teach the patient about topical corticosteroid use on these lesions? A) Cataract development is possible. B) The ointment is likely to cause weeping. C) Corticosteroid use is contraindicated on these lesions. D) The patient may develop glaucoma.

A) Cataract development is possible.

5. When writing a plan of care for a patient with psoriasis, the nurse would know that an appropriate nursing diagnosis for this patient would be what? A) Impaired Skin Integrity Related to Scaly Lesions B) Acute Pain Related to Blistering and Erosions of the Oral Cavity C) Impaired Tissue Integrity Related to Epidermal Shedding D) Anxiety Related to Risk for Melanoma

A) Impaired Skin Integrity Related to Scaly Lesions

2. A nurse is caring for a patient who has been diagnosed with psoriasis. The nurse is creating an education plan for the patient. What information should be included in this plan? A) Use caution when taking nonprescription medications. B) Avoid public places until symptoms subside. C) Wash skin frequently to prevent infection. D) Liberally apply corticosteroids as needed.

A) Use caution when taking nonprescription medications.

The nurse is assigned to care for a client with herpes zoster. Which characteristics should the nurse expect to note when checking the lesions of this infection?

Clustered skin vesicles

The nurse manager is planning the clinical assignments for the day and avoids assigning which staff member to the client with herpes zoster? a. The nurse who never had roseola b. The nurse who never had mumps c. The nurse who never had chickenpox d. The nurse who never had German measles

c. The nurse who never had chickenpoxRationale: Caused by a reativation of the varicella-zoster virus. It is very contagious to those who has not has the virus(responsible for chickenpox)

The evening nurse reviews the clients documentation in the chart and notes that the day nurse has documented that the client has stage II pressure ulcer in the sacral area. Which of the following would the nurse expect to note on assessment of the client's sacral area? a. Intact skin b. Full thickness skin loss c. Expose bone, tendons, or muscle d. Partial-thickness skin loss of the dermis

d. Partial-thickness skin loss of the dermisRationale: Stage I(skin intact), stage III (full-thickness skin loss occurs), and Stage IV (expose bone, tendons, or muscle)

25. When caring for a patient with toxic epidermal necrolysis (TEN), the critical care nurse assesses frequently for high fever, tachycardia, and extreme weakness and fatigue. The nurse is aware that these findings are potential indicators of what? Select all that apply. A) Possible malignancy B) Epidermal necrosis C) Neurologic involvement D) Increased metabolic needs E) Possible gastrointestinal mucosal sloughing

B) Epidermal necrosis D) Increased metabolic needs E) Possible gastrointestinal mucosal sloughing

18. A patient has received a diagnosis of irritant contact dermatitis. What action should the nurse prioritize in the patients subsequent care? A) Teaching the patient to safely and effectively administer immunosuppressants B) Helping the patient identify and avoid the offending agent C) Teaching the patient how to maintain meticulous skin hygiene D) Helping the patient perform wound care in the home environment

B) Helping the patient identify and avoid the offending agent

14. A patient with a chronic diabetic wound is being discharged after receiving a skin graft to aid wound healing. What direction should the nurse include in home care instructions? A) Gently massage the graft site daily to promote perfusion. B) Protect the graft from direct sunlight and temperature extremes. C) Protect the graft site from any form of moisture for at least 12 weeks. D) Apply antibiotic ointment to the graft site and donor site daily.

B) Protect the graft from direct sunlight and temperature extremes.

After 7 days of wound care, a client who has a well-granulated pressure ulcer reports to the nurse, "I'm feeling better overall." Which nursing intervention most likely contributed to the client's feelings?

Ambulation three times daily

The nurse is caring for a postoperative client. The nurse knows that the primary processes of normal wound healing include which phases? Select all that apply.

Inflammatory or (lag) phaseMaturation or (remodeling) phaseProliferative or (connective tissue repair) phase

16. A nurse is providing care for a patient who has psoriasis. The nurse is aware of the sequelae that can result from this health problem. Following the appearance of skin lesions, the nurse should prioritize what assessment? A) Assessment of the patients stool for evidence of intestinal sloughing B) Assessment of the patients apical heart rate for dysrhythmias C) Assessment of the patients joints for pain and decreased range of motion D) Assessment for cognitive changes resulting from neurologic lesions

C) Assessment of the patients joints for pain and decreased range of motion

38. An older adult resident of a long-term care facility has been experiencing generalized pruritus that has become more severe in recent weeks. What intervention should the nurse add to this residents plan of care? A) Avoid the application of skin emollients. B) Apply antibiotic ointment as ordered following baths. C) Avoid using hot water during the patients baths. D) Administer acetaminophen 4 times daily as ordered.

C) Avoid using hot water during the patients baths.

39. A patient has a diagnosis of seborrhea and has been referred to the dermatology clinic, where the nurse contributes to care. When planning this patients care, the nurse should include which of the following nursing diagnoses? A) Risk for Deficient Fluid Volume Related to Excess Sebum Synthesis B) Ineffective Thermoregulation Related to Occlusion of Sebaceous Glands C) Disturbed Body Image Related to Excess Sebum Production D) Ineffective Tissue Perfusion Related to Occlusion of Sebaceous Glands

C) Disturbed Body Image Related to Excess Sebum Production

12. A patient diagnosed with a stasis ulcer has been hospitalized. There is an order to change the dressing and provide wound care. Which activity should the nurse first perform when providing wound care? A) Assess the drainage in the dressing. B) Slowly remove the soiled dressing. C) Perform hand hygiene. D) Don non-latex gloves.

C) Perform hand hygiene.

17. A patient is admitted to the intensive care unit with what is thought to be toxic epidermal necrolysis (TEN). When assessing the health history of the patient, the nurse would be alert to what precipitating factor? A) Recent heavy ultraviolet exposure B) Substandard hygienic conditions C) Recent administration of new medications D) Recent varicella infection

C) Recent administration of new medications

A client with psoriasis has been prescribed coal tar for use in the treatment of the disorder. In reinforcing instructions to the client about the medication, the nurse incorporates which aspect of this medication?

Can stain the skin and hair

An older client is transferred to the nursing unit following a graft to a stage 4 pressure ulcer. Which combination of dietary items should the nurse encourage the client to eat to promote wound healing?

Chicken breast, broccoli, strawberries, milk

The nurse is assessing the skin on a client who is immobile and notes the presence of a stage 2 pressure ulcer in the sacral area. Which nursing actions will encourage healing of a stage 2 pressure ulcer? Select all that apply.

Clean with mild soap and water. Encourage adequate nutritional intake. Apply a dressing that allows oxygen to pass through.

A client is receiving topical corticosteroid therapy in the treatment of psoriasis. The nurse expects the health care provider to prescribe which measure to maximize the effectiveness of this therapy?

Covering the application with a warm, moist dressing and an occlusive outer wrap

The health care provider suspects a client has herpes zoster. To confirm the diagnosis of herpes zoster, for which diagnostic test does the nurse gather equipment?

Culture of the lesion

3. A nurse is planning the care of a patient with herpes zoster. What medication, if administered within the first 24 hours of the initial eruption, can arrest herpes zoster? A) Prednisone (Deltasone) B) Azanthioprine (Imuran) C) Triamcinolone (Kenalog) D) Acyclovir (Zovirax)

D) Acyclovir (Zovirax)

13. A patient comes to the clinic complaining of a red rash of small, fluid-filled blisters and is suspected of having herpes zoster. What presentation is most consistent with herpes zoster? A) Grouped vesicles occurring on lips and oral mucous membranes B) Grouped vesicles occurring on the genitalia C) Rough, fresh, or gray skin protrusions D) Grouped vesicles in linear patches along a dermatome

D) Grouped vesicles in linear patches along a dermatome

19. A nurse is caring for a patient whose chemical injury has necessitated a skin graft to his left hand. The nurse enters the room and observes that the patient is performing active range of motion (ROM) exercises with the affected hand. How should the nurse best respond? A) Liaise with the physical therapist to ensure that the patient is performing exercises safely. B) Validate the patients efforts to increase blood perfusion to the graft site. C) Remind the patient that ROM exercises should be passive, not active. D) Remind the patient of the need to immobilize the graft to facilitate healing.

D) Remind the patient of the need to immobilize the graft to facilitate healing.

The nurse is caring for a client on transmission-based precautions who has herpes zoster or shingles. Which are some of the most important skin issues associated with this condition? Select all that apply.

Full-thickness skin necrosis can result. Lesions are very contagious when they are fluid-filled blisters. Eruptions can last several weeks, and the severe pain (postherpetic neuralgia) often persists after the lesions have resolved. To reduce the risk of transmitting the virus to others, keep clients with lesions separated from other clients until lesions have crusted.

During the inspection of a client's skin, the nurse notes redness and an abrasion type wound on the sacrum area. The nurse determines that this finding is indicative of which stage of pressure ulcer?

stage 2

The evening nurse reviews the nursing documentation in the client's chart and notes that the day nurse has documented that the client has a stage 2 pressure ulcer in the sacral area. Which should the nurse expect to find when checking the client's sacral area?

Partial-thickness skin loss of the epidermis

A client with jaundice is complaining of pruritus. Which strategy should the nurse institute to help control the problem and prevent injury?

Pat the skin dry after bathing.

The nurse inspects the skin of a client who is suspected of having psoriasis. Which finding should the nurse note if this disorder is present?

Silvery-white scaly lesions

The nurse inspects a pressure ulcer on a client's sacrum and notes that the ulcer has partial-thickness skin loss and the formation of a blister. The nurse should document the ulcer as which category?

Stage 2

n older client is complaining of chronic dry skin and occasional pruritus. The nurse reinforces instructions for the client to avoid which skin care regimen that will aggravate the condition?

Using astringents to clean the skin

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? 1- 4 to 6 hours 2- 8 hours 3- 12 to 24 hours 4- 24 to 36 hours

3- 12 to 24 hours

A client with chronic dermatitis has decided to receive testing to determine the cause of the condition. A patch test will be performed at the scheduled clinic visit in 2 weeks. The nurse reinforces instructions to the client regarding preparation for the test. Which statement by the client indicates an understanding regarding the preparation for this procedure?

"I need to stop taking my antihistamine 2 days before I come to the clinic for the test."

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? 1- Apply an occlusive dressing over the site after application. 2- Make sure that the skin is slightly dehydrated so that the medication can absorb through the skin cracks. 3- Apply a thick layer of cream over the lesions so that if some rubs off, there is more to absorb. 4- Apply the medication every 2 hours.

1- Apply an occlusive dressing over the site after application.

The nurse is teaching a client about the correct use of topical concentrated corticosteroids. The nurse includes which statement(s)? Select all that apply. 1- Avoid applying to the face. 2- Avoid prolonged use. 3- Apply to intertriginous areas. 4- Hypertrichosis is normal.

1- Avoid applying to the face. 2- Avoid prolonged use.

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? 1- Avoid cosmetics with fragrance. 2- Wash skin in very hot water. 3- Use a fabric softener. 4- Wear gloves during the day.

1- Avoid cosmetics with fragrance.

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? 1- Corticosteroids 2- Saline irrigations 3- Antifungals 4- Antivirals

1- Corticosteroids

The nurse should assess all possible causes of pruritus for a patient complaining of generalized pruritus. What does the nurse understand can be other causes for this condition? 1- End-stage kidney disease 2- Hypothyroidism 3- Pneumonia 4- Myasthenia gravis

1- End-stage kidney disease

The most important principle of psoriasis treatment is which of the following? 1- Gentle removal of scales 2- Application of emollient creams 3- Establishment of regular skin care routine 4- Dressing changes

1- Gentle removal of scales

What is the major cause of death in toxic epidermal necrolysis (TEN)?1- Infection 2- Hemorrhage 4- Renal failure 5- Liver failure

1- Infection

A client is undergoing photochemotherapy involving a combination of a photosensitizing chemical and ultraviolet light. What health problem does this client most likely have? 1- psoriasis 2- plantar warts 3- undesired tattoo 4- dandruff

1- psoriasis

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? 1- Use very warm water to clean the face prior to applying the medication. 2- Avoid using the medication around the eyelids because it may cause cataracts and glaucoma. 3- Wash the face several times a day and reapply the medication. 4- Scrape the scaly patches off prior to applying the medication.

2- Avoid using the medication around the eyelids because it may cause cataracts and glaucoma.

The nurse recommends which type of therapeutic bath for its antipruritic action? 1- Sodium bicarbonate (baking soda) 2- Colloidal (oatmeal) 3- Water 4- Saline

2- Colloidal (oatmeal)

A male patient is being treated in the hospital for the effects of a debilitating ischemic stroke that he experienced 2 weeks ago. The patient's plan of care identifies a risk of skin breakdown due to the cognitive, sensory, and motor effects of the stroke. What intervention should the nurse prioritize in an effort to reduce the patient's risk of pressure ulcers? 1- Turn the patient at least twice between 2200 and 0600 each night. 2- Ensure that the patient's heels are elevated off the surface of his bed. 3- Avoid seating the patient in a chair until his rehabilitation has been completed. 4- Provide relevant health education to the patient about the management of pressure ulcers.

2- Ensure that the patient's heels are elevated off the surface of his bed.

An older adult patient's skin has become progressively drier in recent years, and the patient now describes many of her skin surfaces as being "incredibly itchy, all the time." The nurse who is contributing to this patient's care should encourage the patient to: 1- Use a moderately abrasive material to scratch the affected skin areas. 2- Apply an over-the-counter corticosteroid ointment to the affected regions. 3- Avoid scratching the affected skin areas because this may exacerbate pruritus. 4- Take analgesics to achieve relief from pruritus.

3- Avoid scratching the affected skin areas because this may exacerbate pruritus.

While examining a client's leg, a nurse notes an open ulceration with visible granulation tissue in the wound. Until a wound specialist can be contacted, which type of dressing should the nurse apply? 1- Dry sterile dressing 2- Sterile petroleum gauze 3- Moist sterile saline gauze 4- Povidone-iodine-soaked gauze

3- Moist sterile saline gauze

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? 1- Semi-private room with a client diagnosed with pneumonia 2- Semi-private room with a client who had chickenpox and was admitted with a GI bleed 3- Private room 4- Isolation room with negative airflow

3- Private room

A physician has ordered a wet-to-damp dressing for an infected pressure ulcer. The nurse knows that the primary reason for this treatment is to: 1- prevent the spread of the infection. 2- debride the wound. 3- keep the wound moist. 4- reduce pain.

3- keep the wound moist.

The nurse notes that the client's lower extremities are covered with very dry skin and that the horny layer of the skin has become thickened. The nurse notes the finding as 1- dermatitis. 2- acantholysis. 3- lichenification. 4- pyodermas.

3- lichenification.

The pharmacology class is learning about herpes zoster and medications that are used to treat this disease process. When planning care for a patient with herpes zoster what medications, if administered within the first 24 hours of the initial eruption, can arrest herpes zoster? 1- Deltasone (Prednisone) 2- Azathioprine (Imuran) 3- Triamcinolone (Kenalog) 4- Acyclovir (Zovirax)

4- Acyclovir (Zovirax)

A patient comes to the clinic complaining of a red rash of small, fluid-filled blisters. The patient is suspected of having herpes zoster. What should the nurse know about the distribution of lesions of herpes zoster? 1- Grouped vesicles occurring on lips and oral mucous membranes 2- Grouped vesicles occurring on the genitalia 3- Rough, fresh, or gray skin protrusions 4- Grouped vesicles in linear patches along a dermatome

4- Grouped vesicles in linear patches along a dermatome

nurse is caring for a patient with a stage IV ulcer. When considering treatment options, the nurse knows that: 1- The draining ulcer would need debridement. 2- A moist environment should be provided to aid wound healing. 3- Moisture to the skin should be avoided. 4- Surgical intervention may be necessary.

4- Surgical intervention may be necessary.

The nurse is providing morning hygiene for an older adult patient who requires total care due to late-stage Alzheimer's disease. In recent weeks, the patient has shown signs of dermatitis on various skin surfaces. When providing a bed bath for this patient, the nurse should do which of the following? 1- Use only water to wash and rinse the patient's skin surfaces. 2- Utilize a deodorant soap to reduce the risk of skin breakdown due to excessive perspiration. 3- Avoid using a towel to dry the patient's skin. 4- Use a mild soap or a soap substitute when washing the patient's skin.

4- Use a mild soap or a soap substitute when washing the patient's skin.

Ultraviolet light therapy is prescribed as a component of the treatment plan for a client with psoriasis and the nurse provide instructions to the client regarding the treatment. Which statement by the client indicate a need for further instructions? a. Treatments are limited to two or three times a week b. The ultraviolet light treatments are given on consecutive days c. Eye goggles need to be worn to prevent exposure to ultraviolet light d. Just the area requiring treatment should be exposed to the ultraviolet light

b. The ultraviolet light treatments are given on consecutive daysRationale: Treatments are limited to two or three times a weekand ultraviolet light treatments are NOT given on consecutive days. Safety precautions are required during therapy

The clinic nurse notes that the physician has documented a diagnosis of of herpes zoster (shingles) in the client's chart. Based on an understanding of the cause of this disorder, the nurse determines that this definitive diagnosis was made following which diagnostic test? a. Patch test b. Skin biopsy c. Culture of the lesion d. Wood's light examination

c. Culture of the lesionRationale: A viral cultural of the lesion provides the definitive diagnosis. Patch test(allergies), Biopsy (tissue), and Wood's light (identify superficial infection of the skin)

The clinic nurse assesses the skin of a white client diagnosis of psoriasis. The nurse understands that which characteristic is associated with this skin disorder?a. Clear, thin nail beds b. Red-purplish scaly lesions c. Oily skin and no episodes of pruritus d. Silvery-white scaly patches on the scalp, elbows, knees, and sacral regions

d. Silvery-white scaly patches on the scalp, elbows, knees, and sacral regionsRationale: Psoriatic patches are covered with silvery-white scales. Affected areas include the scalp, elbows, knees, shins, trunk, and sacral area