Integumentary Disorders Comprehensive Examination

The nurse is caring for a client preoperative for facial reconstruction. Which client problem should the nurse include in the preoperative plan of care? 1. Loss of self-esteem. 2. Alteration in comfort. 3. Ineffective airway clearance. 4. Impaired communication.

Answer: 1 1. A loss of self-esteem can occur after a change in facial appearance through injury, disease, or age-related changes. 2. Edema and pain would be appropriate postoperatively. 3. The airway has not been compromised preoperatively. 4. Communication may be a problem postoperatively but not before surgery.

The nurse is working with clients in an aesthetic surgery center. Which intervention should the nurse implement for a client undergoing a chemical peel? 1. Teach the client to expect extreme swelling after the procedure. 2. Apply the chemical mixture directly to the skin after the face is cleansed. 3. Administer general anesthesia to the client before the procedure. 4. Explain that there will be no pain or discomfort during the procedure.

Answer: 1 1. After the first 6 to 8 hours, the client will have extreme edema, causing the eyes to swell. This is expected. 2. The dermatologist will apply the chemical to begin the peeling procedure. 3. The client will be awake during the procedure, but an analgesic and a tranquilizer can be administered for sedation. Only certified registered nurse anesthetists (CRNAs) administer general anesthesia. 4. There is a sensation of burning during the application of the chemical and for several days after the procedure.

Which client's clinical manifestations indicate contact dermatitis to the nurse? 1. Erythema and oozing vesicles. 2. Pustules and nodule formation. 3. Varicosities and edema. 4. Telangiectasia and flushing.

Answer: 1 1. Contact dermatitis presents with erythema and small oozing vesicles. 2. Pustules and nodule formation indicate acne. 3. Stasis dermatitis presents with varicosities and edema. 4. Clients diagnosed with rosacea present with telangiectasia and periodic flushing.

The nurse is assessing the client diagnosed with psoriasis. Which data would support that diagnosis? 1. Appearance of red, elevated plaques with silvery-white scales. 2. A burning, prickling row of vesicles located along the torso. 3. Raised, flesh-colored papules with a rough surface area. 4. An overgrowth of tissue with an excessive amount of collagen.

Answer: 1 1. Most clients diagnosed with psoriasis have red, raised plaques with silvery-white scales. 2. A burning, prickling row of vesicles located along the torso is the description of herpes zoster. 3. Raised, flesh-colored papules with a rough surface area is a description of warts. 4. An overgrowth of tissue with an excessive amount of collagen is the definition of a keloid.

The nurse is caring for a male client diagnosed with folliculitis barbae. Which information should the nurse teach to prevent a reoccurrence? 1. Tell the client to not shave the face. 2. Instruct the client to rub on astringent aftershave lotion. 3. Recommend the client apply hot packs for 20 minutes before shaving. 4. Teach the client to use an antibacterial soap on the face.

Answer: 1 1. Shaving is the cause of this condition, and refraining from shaving and lotions is the only cure. Special brushes are used. If the client must shave, he should use a depilatory cream or electric razor. 2. Aftershave will not prevent folliculitis. 3. Hot packs will not prevent folliculitis. 4. Antibacterial soap is too strong for use on the face. Shaving is the cause of folliculitis.

The nurse is teaching the client diagnosed with atopic dermatitis. Which information should the nurse include in the teaching? 1. Discuss skincare using hydrating lotions and minimal soap. 2. Tell the client the methods of treating secondary infection. 3. Explain there are no adverse effects to using topical corticosteroids daily. 4. Instruct the client that inhaled allergens have never been linked to exacerbations.

Answer: 1 1. Skincare must be meticulous. Minimal soap and tepid water should be used when showering or bathing. Lotions that do not irritate should be used to keep the skin hydrated. 2. The client needs to know the clinical manifestations indicating the need to notify the HCP, not the methods of treatment. 3. There are adverse effects of the topical use of corticosteroids. 4. Research supports a link between inhaled allergens and atopic dermatitis exacerbations.

Which problem should the nurse identify for the client recently diagnosed with leprosy (Hansen's disease)? 1. Social isolation. 2. Altered body image. 3. Potential for infection. 4. Alteration in comfort.

Answer: 1 1. The client diagnosed with leprosy (Hansen's disease) may feel ostracized because of the stigma of the disease. Historically, people have been isolated from society when diagnosed. Leprosy colonies were sites of treatment for those diagnosed. Today much of the public is unaware of the presence of the disease. Clients are treated on an outpatient basis by health departments. 2. Altered body image would occur in the late stages of leprosy and may not occur at all if treated in the early stages. 3. The client diagnosed with leprosy already has an infection, so it is not potential. 4. Clients diagnosed with leprosy have a decreased sensation from peripheral nerve damage and have no discomfort.

The nurse is preparing the plan of care for a client diagnosed with Stevens-Johnson syndrome. Which interventions should the nurse include? Select all that apply. 1. Monitor intake and output every 8 hours. 2. Assess breath sounds and rate every 4 hours. 3. Assess vesicles, erosions, and crusts frequently. 4. Perform the whisper test for auditory changes daily. 5. Assess orientation to person, place, and time every shift.

Answer: 1, 2, 3 1. The client diagnosed with Stevens-Johnson syndrome must be assessed for fluid volume deficit, the need for fluid replacement, and renal failure. Intake and output monitor both. 2. Breath sounds and respiratory status should be assessed because many clients develop respiratory failure and require mechanical ventilation. 3. The client diagnosed with Stevens-Johnson syndrome has a combination of vesicles, erosions, and crusts at the same time. The skin should be assessed every 8 hours. 4. Hearing is not affected by Stevens-Johnson syndrome, but blindness can be a complication; vision should be assessed for any changes. 5. Neurological status is not compromised.

The older client diagnosed with poison ivy is prescribed a methylprednisolone dose pack. Which intervention should the nurse teach the client? 1. Tell the client to return to the office in 1 week for blood levels. 2. Instruct the client to take the medication exactly as prescribed. 3. Explain the medication should be taken on an empty stomach. 4. Teach to stop the medication immediately if side effects occur.

Answer: 2 1. Clients taking a steroid dose pack do not require laboratory testing for a therapeutic level. 2. The client should take the methylprednisolone (Solu-Medrol), a steroid, exactly as instructed. The number of pills should be taken in a descending (tapering) manner. 3. Steroids by mouth can cause gastrointestinal bleeding. They should be taken with food or after eating. 4. Steroids should not be stopped suddenly; they need to be tapered off.

The nurse is preparing the plan of care for a client diagnosed with psoriasis. Which intervention should the nurse include in the plan of care? 1. Apply a thin dusting with nystatin powder over the area. 2. Cover the area with an occlusive dressing after applying a steroid cream. 3. Administer acyclovir to the affected areas six times a day. 4. Teach the client the risks and hazards of implanted radiation therapy.

Answer: 2 1. Nystatin (Mycostatin), an antifungal powder, would not be useful to treat psoriasis. 2. Covering the affected area with an occlusive dressing enhances the steroid's effectiveness. This intervention should be limited to 12 hours to reduce systemic and local side effects. 3. Acyclovir is an antiviral medication and is used for viral diseases. It would not be used for psoriasis. 4. Implanted radiation is a treatment for some forms of cancer but not for psoriasis. Radiation in the form of UV light therapy is sometimes used to treat psoriasis.

The nurse is planning the care of a client diagnosed with psoriasis. Which psychosocial problem should be included in the plan? 1. Alteration in comfort. 2. Altered body image. 3. Anxiety. 4. Altered family processes.

Answer: 2 1. Psoriasis can cause discomfort, itching, and pain, but it is not a psychosocial issue. 2. Altered body image is a problem the nurse should assess in clients diagnosed with psoriasis. Any chronic skin disease affecting appearance can cause psychosocial problems. 3. Anxiety is not usually a problem in a client diagnosed with psoriasis. The main concern is body image and discomfort. 4. The condition of psoriasis does not affect family processes.

Which expected outcome should the nurse include in the plan of care for the client diagnosed with seborrheic dermatitis? 1. The client will have no further outbreaks. 2. The client will follow medical protocol. 3. The client will shampoo three times a week. 4. The client will apply bacitracin twice daily.

Answer: 2 1. Seborrheic dermatitis is a chronic skin disorder with remissions and exacerbations. To have an expected outcome of no further outbreaks would not be realistic. 2. To control the disorder by following the medical protocols would be realistic and appropriate. 3. The client needs to shampoo daily or a minimum of three times each week for treatment. This is an intervention, not an outcome. 4. To apply bacitracin would treat a bacterial infection. This is an intervention, not a goal or expected outcome.

The nurse is caring for the client diagnosed with contact dermatitis. Which collaborative intervention should the nurse implement? 1. Encourage the use of support stockings. 2. Administer a topical anti-inflammatory cream. 3. Remove scales frequently by shampooing. 4. Shampoo with pyrethrin weekly.

Answer: 2 1. Support stockings are used for stasis dermatitis, which is caused by impaired circulation. 2. Topical corticosteroids are administered to treat contact dermatitis, which comes from an allergic response to irritants. The irritant should be eliminated and topical anti-inflammatory creams should be administered. 3. Seborrheic dermatitis is treated by frequent cleaning with medicated shampoos and soaps to remove the yellow scales. 4. Pyrethrin (Rid) shampoo is used to treat lice. The client shampoos the hair and rinses after 10 minutes.

The nurse is teaching clients at a community center about skin diseases. Which information about pruritus should the nurse include? Select all that apply. 1. Cool environments increase itching. 2. Using soap increases itching. 3. Use hot water to rinse off the soap. 4. Apply mild skin lotion for hydration. 5. Blot gently, but completely dry the skin.

Answer: 2, 4, 5 1. A cool environment makes itching decrease, not increase. 2. Soaps cause itching to increase. The client should avoid soap when experiencing pruritus. 3. Tepid, cool water is better for the client with itching. 4. Mild lotion can help the skin stay hydrated. 5. The client should dry off completely after bathing and blot gently rather than rub vigorously.

The home health nurse is visiting an older client with concern for an area of rough skin having a greasy feel and multiple papules. Which information should the nurse provide the client? 1. Contact the HCP immediately for an appointment. 2. Tell the client this is a normal aging change and no action should be taken. 3. Tell the client to discuss this with the HCP at the next appointment. 4. Have the client buy a wart remover kit at the store.

Answer: 3 1. An area that has a greasy, rough feel and multiple papules does not require an immediate appointment with the HCP. 2. Seborrheic keratosis is a common occurrence in the elderly, but the skin lesion should be assessed by an HCP. 3. The client should discuss any suspicious area with the HCP. This is not an emergency, but it should be assessed. 4. An area wartlike in appearance, varying in color from flesh tones to black, and having a greasy, rough feel is probably a seborrheic keratosis. The home health nurse does not have the authority to diagnose as an HCP, and, therefore, the nurse should not encourage the client to self-treat.

The client had an allergic reaction to poison oak 2 weeks ago. He has returned to the clinic with severe itching and weeping vesicles on the arms and legs. Which intervention should the nurse implement? 1. Obtain a sample of the drainage for culture and sensitivities. 2. Determine any allergic reactions to any medications taken recently. 3. Inquire how the poison ivy or oak plants were destroyed. 4. Assess for any temperature elevation since the last visit to the clinic.

Answer: 3 1. Collecting a sample for culture does not diagnose poison oak or ivy. This is a reoccurrence of the allergic reaction to the poison oak. 2. These are the clinical manifestations of exposure to poison oak, not to medication. 3. Many people dispose of the poison oak plant in ways that spread the sap. Burning or pulling the plant without gloves can cause another allergic reaction. Pets can spread the allergen on fur. Tools should be cleaned before touching the skin. 4. Clients do not have temperature elevation unless there is a secondary infection present.

The nurse is preparing the client scheduled for a dermabrasion. Which information should the nurse include while teaching the client? 1. Erythema will go away within 24 hours. 2. Do not change the dressing until seen by the HCP. 3. Stay out of extreme cold or heat situations. 4. Avoid direct sunlight for 3 days.

Answer: 3 1. Erythema can last from 1 week to a month. 2. After 24 hours, the serum oozes from the dressing, and the client needs to apply a prescribed ointment to keep the area soft and flexible. 3. Extreme cold and heat and straining and lifting heavy objects should be avoided. 4. Direct sunlight should be avoided for 3 to 6 months. Clients should be taught to wear sunscreen.

Which laboratory test should the nurse monitor to identify an allergic reaction for the client diagnosed with contact dermatitis? 1. IgA. 2. IgD. 3. IgE. 4. IgG.

Answer: 3 1. Immunoglobulin A (IgA) protects against respiratory, gastrointestinal, and genitourinary infections. 2. IgD is a protein that is activated in collagen disease. 3. IgE is a protein responsible for allergic reactions. 4. IgG is the major antibody for viruses, bacteria, and toxins.

The health department nurse is caring for the client diagnosed with leprosy (Hansen's disease). Which assessment data indicate the client is experiencing a complication of the disease? 1. Elevated temperature at night. 2. Brownish-black discoloration to the skin. 3. Reduced skin sensation in the lesions. 4. A high count of mycobacteria in the culture.

Answer: 3 1. The client does not usually have an elevated temperature. 2. A side effect of the medication dapsone is a discoloration of the skin from pink to brownish-black. 3. The decrease in sensation of the lesions is the result of peripheral nerve damage. Leprosy is a peripheral nervous system disease. 4. A high mycobacterium count would be expected from the disease but would not be a complication.

The nurse is caring for a client 1 day postoperative for facial reconstruction. Which intervention should the nurse implement? 1. Provide all activities of daily living. 2. Allow the client to voice fears and concerns. 3. Monitor nutritional food and fluid intake. 4. Assess clinical manifestations of infection.

Answer: 3 1. The client should be able to perform most activities of daily living. The nurse must encourage independence in the client. 2. On the first day postoperative, the nurse's priority would be physiological needs. 3. Monitoring the client's nutritional intake and fluid balance is important for healing. 4. Assessing for infection is the responsibility of the nurse but would occur later than 1 day postoperative. This is an elective procedure, which means the client would not have had an infection before surgery.

The public health nurse is caring for a client diagnosed with leprosy (Hansen's disease). Which intervention should the nurse implement? 1. Explain the need for admission to the hospital. 2. Administer dapsone for 1 month only. 3. Instruct to use skin moisturizing lotion to control the symptoms. 4. Discuss the ways leprosy is transmitted to other individuals.

Answer: 4 1. Clients are treated on an outpatient basis by specialized clinics. In the United States, it is the health department's responsibility to care for these clients and ensure that the clients are taking their medications. 2. Dapsone, a sulfone, will be used to treat leprosy for several years up to the remainder of the client's life. 3. Moisturizing lotions will not treat the infectious process and therefore cannot control the symptoms. 4. Contrary to popular thought, leprosy, although contagious, usually requires prolonged exposure for the infection to spread to another person. Directly touching the lesions will increase the potential for infection.

The nurse is caring for a client with reports of a rash and itching on the face for 1 week. Which intervention should the nurse implement first? 1. Check for the presence of hirsutism on the face. 2. Use the ultraviolet examination light to visualize the rash under the black light. 3. Determine what OTC medications the client has used on the rash. 4. Ask the client to describe when the rash first appeared.

Answer: 4 1. Hirsutism is an excessive amount of hair growth in unexpected areas. This is not associated with itching or a rash. 2. An ultraviolet examination light (Wood's light) or black light is used to examine certain infections. This would be used during the physical examination portion of the assessment. 3. The nurse should determine the previous treatment the client used, but it is not the first intervention. 4. It is important to assess the rash as it appeared. If the client treated the rash with an ointment or cream, its appearance might have changed. Many times the appearance has changed from the first onset and from the treatment. Assessment is the first part of the nursing process.

The nurse has completed the teaching plan for the client diagnosed with psoriasis. Which statement indicates the need for further teaching? 1. "I will check my skin every day for redness with tenderness." 2. "I must take my psoralen medication 2 hours before my treatment." 3. "I will wear dark glasses during my treatment and the rest of the day." 4. "The coal tar ointments and lotions will not stain my clothes."

Answer: 4 1. The client needs to perform a complete inspection of the skin to identify clinical manifestations of generalized redness and tenderness. Treatments will be discontinued if they occur. The client understands the teaching. 2. Psoralen, a photosensitizing agent, is administered 2 hours before the ultraviolet light therapy to enhance the effects. The client understands the teaching. 3. The client will wear dark glasses to protect the eyes during the treatments and for the remainder of the day. Before the treatment, dark glasses are not needed. The client understands the teaching. 4. Coal tar comes in lotions, ointments, shampoos, and gels. They are used more in the hospital setting than in home settings because of the staining and mess associated with their use. The client needs more teaching.

The RN and a UAP are caring for a client diagnosed with a stage IV pressure injury. Which action by the UAP warrants intervention by the RN? 1. The UAP turns the client every 2 hours. 2. The UAP keeps the sheets wrinkle-free. 3. The UAP encourages the client to drink high-protein drinks. 4. The UAP places multiple diapers on the client.

Answer: 4 1. The client should be turned every 2 hours, so this would not warrant intervention by the nurse. 2. Keeping the sheets wrinkle-free helps with preventing skin breakdown. This would not warrant intervention by the nurse. 3. Protein is needed for wound healing, so this intervention is appropriate for the UAP. 4. Placing extra diapers saves the UAP from changing the linens, but it keeps wet plastic against the skin, leading to further skin breakdown. This action would warrant intervention by the RN.

The client is reporting severe itching following a course of antibiotics. Which independent nursing action should the nurse implement? 1. Refer to an allergy specialist to begin desensitization. 2. Use a tar-preparation gel after each shower or bath. 3. Keep the covers tightly around the client at night. 4. Take baths with an OTC colloidal oatmeal preparation.

Answer: 4 1. There is no indication of the need for the client to be desensitized to the medication. The client should inform HCPs of any previous reactions to medications before taking any medication. 2. Tar solutions are used for psoriasis, not pruritus. The use of tar solutions would be a collaborative intervention rather than an independent intervention. 3. Cool sleeping environments decrease itching. Warmth increases itching and should be avoided. 4. Soothing baths, such as colloidal baths or emollient baths, are helpful in treating pruritus. Balneotherapy is a term used to refer to therapeutic baths.

The ED nurse is caring for a client admitted with extensive, deep partial-thickness and full-thickness burns. Which interventions should the nurse implement? Rank in order of priority. 1. Estimate the amount of burned area using the rule of nines. 2. Insert two 18-gauge catheters and begin fluid replacement. 3. Apply sterile saline dressings to the burned areas. 4. Determine the client's airway status. 5. Administer morphine sulfate, IV.

Answer: 4, 2, 3, 1, 5 4. The airway is always the first priority for any process in which the airway might be compromised. 2. The nurse should start fluid resuscitation as soon as possible before the client's blood pressure makes it more difficult to establish an IV route. 3. Covering the open burns will prevent further intrusion of bacteria. 1. Estimating the extent of the burned area should be done but does not have priority over the airway, fluid replacement, and the prevention of infection. 5. Pain is a priority but not over determining the airway and fluid status and prevention of infection.