Chapter 61:Dermatology
When a patient has been diagnosed with scabies, if the infection has spread, family members may complain of pruritus within which time frame? 1 month 2 weeks 3 weeks 6 weeks
1 month Explanation: If the infection has spread, other members of the family and close friends also complain of pruritus about 1 month later.
A client has a rash on the arm that has been treated with an antibiotic without eradicating the rash. What type of examination can be used to determine if the rash is a fungal rash using ultraviolet light? Potassium hydroxide test Skin biopsy A Wood's light examination Fungal culture
A Wood's light examination Explanation: A Wood's light is also known as a black light and is a handheld device that can identify certain fungal infections that fluoresce under long-wave ultraviolet light. In a darkened room, when a physician or nurse aims the light at a lesion caused by a fungus that fluoresces, the lesion emits a blue-green color. It is the only test that uses a light, the others use skin scrapings.
Which assessment finding indicates an increased risk of skin cancer? A dark mole on the client's back An irregular scar on the client's abdomen A deep sunburn White irregular patches on the client's arm
A deep sunburn Explanation: A deep sunburn is a risk factor for skin cancer. A dark mole or an irregular scar is a benign finding. White irregular patches are abnormal but aren't a risk for skin cancer.
A client has been diagnosed with shingles. Which of the following medication classifications will reduce the severity and prevent development of new lesions? Antiviral Antipyretics Analgesics Corticosteroids
Antiviral Explanation: Oral acyclovir (Zovirax), when taken within 48 hours of the appearance of symptoms, reduces their severity, and prevents the development of additional lesions. Corticosteroids, analgesics,, and antipyretics are not used for this purpose.
The nurse is caring for a geriatric client with thin, chapped, itchy skin. Which nursing intervention should the nurse alter in the plan of care? Daily bathing with warm-hot water Maintenance of foam pad on wheelchair Use of a gait belt for ambulation Applying lanolin ointment
Applying lanolin ointment Explanation: Lanolin ointment is good to apply to dry skin because it helps moisturize. Bathing a geriatric client is unnecessary, and hot water will dry the skin further. Due to a decrease in epidermal replacement rates, excessive drying of an older person's skin can lead to pruritus, dryness, and infection. The nurse would not alter the plan of using a gait belt for ambulation or using a foam pad on the wheelchair.
Which of the following uses the body's own digestive enzymes to break down necrotic tissues? Autolytic debridement Enzymatic debridement Wet to dry dressings Wet dressings
Autolytic debridement Explanation: Autolytic debridement is a process that uses the body's own digestive enzymes to break down necrotic tissue. Application of enzymatic debriding agents speeds the rate at which necrotic tissues is removed. A form of mechanical debridement is a wet to dry dressing, which removes necrotic tissue and absorbs small to large amounts of exudates.
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. Wash skin in very hot water. Use a fabric softener. Wear gloves during the day.
Avoid cosmetics with fragrance. Explanation: The nurse should teach the client to avoid cosmetics, soaps, and laundry detergents that contain fragrance. Other prevention methods include 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.
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 Saline irrigations Antifungals Antivirals
Corticosteroids Explanation: Corticosteroids are used for contact dermatitis. Antifungals, antivirals, and saline irrigations are not used in the treatment of contact dermatitis.
Which medication classification may be used for contact dermatitis? Corticosteroids Saline irrigations Antifungals Antivirals
Corticosteroids Explanation: Corticosteroids are used for contact dermatitis. Antifungals, antivirals, and saline irrigations are not used in the treatment of contact dermatitis.
Which of the following aggravates the condition caused by acne vulgaris? Sunlight Chocolates High-fat diet Cosmetics
Cosmetics Explanation: Acne vulgaris is aggravated by cosmetics. 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 dermatologist recommends an over-the-counter suspension to relieve pruritus. The nurse advises the patient that the lotion should be applied: Hourly to prevent evaporation. Twice a day to prevent crusting on the skin. Overnight to enhance absorption. Every 3 to 4 hours for sustained effectiveness.
Every 3 to 4 hours for sustained effectiveness. Explanation: Lotions are frequently used to replenish lost skin oils or to relieve pruritus. They are usually applied directly to the skin, but a dressing soaked in the lotion can be placed on the affected area. Lotions must be applied every 3 or 4 hours for sustained therapeutic effect because if left in place for a long period, they may crust and cake on the skin.
Which of the following superficial fungal infections begins in the skin between the toes and spreads to the soles of the feet? Tinea corporis Tinea capitis Tinea pedis Tinea cruris
Explanation: Tinea pedis is an infection that begins in the skin between the toes and spreads to the soles of the feet. Tinea corporis is a skin infection of the body. Tinea capitis invades the hair shaft below the scalp. Tinea cruris is a skin infection of the groin.
Which of the following nonsedating antihistamines is appropriate for daytime pruritus? Diphenhydramine (Benadryl) Fexofenadine (Allegra) Lorazepam (Ativan) Hydroxyzine (Atarax)
Fexofenadine (Allegra) Explanation: Nonsedating antihistamine medications such as Allegra are more appropriate to relieve daytime pruritus. Benadryl or Atarax, when prescribed in a sedative dose at bedtime, may be beneficial in producing a restful and comfortable sleep. Ativan has sedating properties and is used as an antianxiety medication.
Which term refers most precisely to a localized skin infection of a single hair follicle? Furuncle Carbuncle Cheilitis Comedone
Furuncle Explanation: Furuncles occur anywhere on the body but are most prevalent in areas subjected to irritation, pressure, friction, and 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.
A client with scabies has been prescribed a scabicide. Which of the following advice should the nurse give the client before beginning the treatment? Wear clean clothing. Avoid contact with others who have scabies. Expect itching to continue for 2 to 3 weeks after the treatment. Have a thorough bath.
Have a thorough bath. Explanation: Before any treatment begins, the nurse advises the client to bathe thoroughly. Wearing clean clothing and avoiding contact with others who have scabies are essential in preventing a recurrence. As a part of client teaching, the nurse explains that itching may continue for 2 to 3 weeks after the treatment.
Which of the following reflect the pathophysiology of cutaneous signs of HIV disease? Genetic predisposition High CD4 count Decrease in normal skin flora Immune function deterioration
Immune function deterioration Explanation: Cutaneous signs may be the first manifestations of HIV, appearing in more than 90% of HIV-infected patients as immune function deteriorates. Common complaints include pruritus, folliculitis, and chronic actinic dermatitis. Cutaneous signs of HIV disease correlate to low CD4 counts. Cutaneous signs of HIV disease appear as immune function deteriorates.
Which skin condition is caused by staphylococci, streptococci, or multiple bacteria? Scabies Pediculosis capitis Impetigo Poison ivy
Impetigo Explanation: Impetigo is seen at all ages but is particularly common among children living under poor hygienic conditions. Scabies is caused by the itch mite. Pediculosis capitis is caused by head lice. Poison ivy is a contact dermatitis caused by the oleoresin given off by a particular form of ivy.
What is the major cause of death in toxic epidermal necrolysis (TEN)? Infection Hemorrhage Renal failure Liver failure
Infection Explanation: The major cause of death from TEN is infection, and the most common sites of infection are the skin and mucosal surfaces, lungs, and blood. Hemorrhage, renal failure, and liver failure are not the major causes of TEN.
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? A. Dry sterile dressing B. Sterile petroleum gauze C. Moist, sterile saline gauze D. Povidone-iodine-soaked gauze
Moist sterile saline gauze Explanation: Moist sterile saline dressings support wound healing and are cost-effective. Dry sterile dressings adhere to the wound and debride the tissue when removed. Petroleum supports healing but is expensive. Povidone-iodine is used as an antiseptic cleaning agent but because it can irritate epithelial cells, it shouldn't be left on an open wound.
Which condition is an autoimmune disease involving immunoglobulin G? Stevens-Johnson syndrome (SJS) Toxic epidural necrolysis (TEN) Pemphigus Bullous pemphigoid
Pemphigus Explanation: Pemphigus is an autoimmune disease involving immunoglobulin G. TEN, SJS, and bullous pemphigoid do not involve immunoglobulin G.
Which drug is a topical corticosteroid used to treat psoriasis? Triamcinolone Coal tar Neutrogena Methotrexate
Triamcinolone Explanation: Triamcinolone is a topical corticosteroid used to treat psoriasis. Coal tar is used for mild to moderate lesions of psoriasis. Neutrogena is a medicated shampoo. Methotrexate is a systemic therapy for psoriasis.
A patient is being evaluated for nodular cystic acne. What systemic pharmacologic agent may be prescribed for the treatment of this disorder? Isotretinoin (Accutane) Benzoyl peroxide Retin-A Salicylic acid
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, and 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.
A client with a history of diabetes mellitus has recently developed furunculosis. What is causing the client's condition? infection diet hygiene unknown
infection Explanation: Furuncles and carbuncles are caused by skin infections with organisms that usually exist harmlessly on the skin surface.
Which is not a category of medications used for treatment of the skin? inhaled steroids topical corticosteroids antihistamines antibiotics
inhaled steroids Explanation: Inhaled steroids are not used for skin disorders. Topical corticosteroids, antihistamines, and antibiotics are all used in the treatment of skin disorders.
A patient is being evaluated for nodular cystic acne. What systemic pharmacologic agent may be prescribed for the treatment of this disorder? Isotretinoin (Accutane) Benzoyl peroxide Retin-A Salicylic acid
sotretinoin (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.
Which statement is accurate regarding isotretinoin? It is teratogenic in humans. Contraceptives are not needed during treatment. To achieve the full effect of the medication, the client should take vitamin A supplements. The side effects are irreversible.
t 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.
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: "Just be careful not to share linens and towels with family members." "All family members need to be treated." "If someone develops symptoms, tell him to see a physician right away." "After you're treated, family members won't be at risk for contracting scabies."
"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.
The nurse is caring for a client diagnosed with herpes zoster. Which statement by the client needs further clarification by the nurse? "Herpes zoster is a reactivation of the varicella virus." "Even though this is from a childhood disease, I am still contagious." "Once I get the infection, I cannot get it again." "Herpes zoster is caused by a viral infection."
"Once I get the infection, I cannot get it again." Explanation: The nurse is correct to clarify that even though the client has herpes zoster, the client can get herpes zoster again. The virus is contagious and can reoccur. All of the other options are correct.
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? Use very warm water to clean the face prior to applying the medication. Wash the face several times a day and reapply the medication. Scrape the scaly patches off prior to applying the medication. Avoid using the medication around the eyelids because it may cause cataracts and glaucoma.
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 patient has developed a boil on the face and the nurse observes the patient squeezing the boil. What does the nurse understand is a potential severe complication of this manipulation? Scarring Brain abscess Erythema Cellulitis
Brain abscess Explanation: Nurses must take special precautions in caring for boils on the face because the skin area drains directly into the cranial venous sinuses. Sinus thrombosis with fatal pyemia can develop after manipulating a boil in this location. The infection can travel through the sinus tract and penetrate the brain cavity, causing a brain abscess.
The nurse is providing instruction to a client with acne. The nurse promotes avoidance of which food(s)? Select all that apply. Chocolate Onions Bananas Ice cream
Chocolate Ice cream Explanation: The nurse should promote avoidance of foods associated with flare-up of acne, particularly those high in refined sugars, including chocolate, cola, and ice cream.
The nurse recommends which type of therapeutic bath for its antipruritic action? Sodium bicarbonate (baking soda) Colloidal (oatmeal) Water Saline
Colloidal (oatmeal) Explanation: Colloidal oatmeal baths are recommended to decrease itching associated with a dermatologic disorder such as psoriasis. Baking soda baths are cooling but dangerous because the tub gets very slippery and a bath mat must be used in the tub. Water and saline baths have the same effect as wet dressings and are not known to counteract itching.
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? Semi-private room with a client diagnosed with pneumonia Isolation room with negative airflow Semi-private room with a client who had chickenpox and was admitted with a GI bleed Private room
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.
Dry, rough, scaly skin with the presence of itching is best described as: Candidiasis Shingles Pruritus Seborrhea
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.
With repeated reactions of contact dermatitis, which of the following can occur? Pain along the sensory nerve Sepsis Secondary bacterial infection Hemorrhage
Secondary bacterial infection Explanation: If repeated reactions occur, or if the patient continually scratches the skin, lichenification (thickening of the horny layer of the skin) and pigmentation occur. Secondary bacterial invasion may follow. During shingles, there will be pain along the sensory nerve. Sepsis and hemorrhage would not occur from repeated bouts of contact dermatitis.
What advice should the nurse give a client with dermatitis until the etiology of the dermatitis is identified? Rub the skin vigorously to dry. Wear rubber gloves when in contact with soaps. Use hot water for bathing. Use wool, synthetics, and other dense fibers.
Wear rubber gloves when in contact with soaps. Explanation: The nurse should advise the client to wear rubber gloves when coming in contact with any substance such as soap or solvents. The client should avoid wool, synthetics, and other dense fibers. The client should use tepid bath water and should pat rather than rub the skin dry.
A nurse discovers scabies when assessing a client who has just been transferred to the medical-surgical unit from the day surgery unit. To prevent scabies infection in other clients, the nurse should: wash her hands, apply a pediculicide to the client's scalp, and remove any observable mites. isolate the client's bed linens until the client is no longer infectious. notify the nurse in the day surgery unit of a potential scabies outbreak. place the client on enteric precautions.
isolate the client's bed linens until the client is no longer infectious. Explanation: To prevent the spread of scabies to other hospitalized clients, the nurse should isolate the client's bed linens until the client is no longer infectious — usually 24 hours after treatment begins. Other required precautions include using good hand-washing technique and wearing gloves when applying the pediculicide and during all contact with the client. Although the nurse should notify the nurse in the day surgery unit of the client's condition, a scabies epidemic is unlikely because scabies is spread through skin or sexual contact. This client doesn't require enteric precautions because the mites aren't found in feces.
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: prevent the spread of the infection. debride the wound. keep the wound moist. reduce pain.
keep the wound moist. Explanation: Wet-to-damp dressings keep the wound bed moist, which helps promote the growth of granulation tissue. Because dead tissue adheres to a dry dressing, wet-to-dry dressings are used for debriding wounds. Wet-to-damp dressings don't prevent the spread of infection. Although these dressings provide a soothing, cool feeling, they don't relieve pain.
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 dermatitis. acantholysis. lichenification. pyodermas.
lichenification. Explanation: The nurse should note this as being lichenification, also called scaling. Dermatitis is an inflammation of the skin. Acantholysis is a separation of the epidermal cells from each other, and pyodermas is a bacterial skin infection.
The nurse teaches the client who demonstrates herpes zoster (shingles) that once the client has had shingles, they will not have it a second time. a person who has had chickenpox can contract it again upon exposure to a person with shingles. the infection results from reactivation of the chickenpox virus. no known medications affect the course of shingles.
the infection results from reactivation of the chickenpox virus. Explanation: It is assumed that herpes zoster represents a reactivation of latent varicella (chickenpox) virus and reflects lowered immunity. It is believed that the varicella zoster virus lies dormant inside nerve cells near the brain and spinal cord and is reactivated with weakened immune systems and cancers. A person who has had chickenpox is immune and therefore not at risk of infection after exposure to a client with herpes zoster. Some evidence indicates that infection is arrested if oral antiviral agents are administered within 24 hours of the initial eruption.