Med Surg - Chapter 25 - Care of Patients with Skin Problems

A patient presents with a rash of red edematous papules. Which nursing instructions would be beneficial to the patient? Select all that apply. 1 "Refrain from being in warm environments." 2 "Refrain from overexertion and alcohol consumption." 3 "Use sleep-promoting herbal teas or sedating antihistamines at bedtime." 4 "Refrain from occluding treated areas unless prescribed by the health care provider." 5 "Keep your fingernails trim to reduce damage from scratching and secondary infections."

1 "Refrain from being in warm environments." 2 "Refrain from overexertion and alcohol consumption." A rash of red edematous papules is a clinical feature of urticaria. Overexertion, alcohol consumption, and warm environments should be avoided because these conditions may dilate blood vessels and make urticaria worse. Using of sleep promotion herbal teas or sedating antihistamines, preventing occlusion of treated areas unless prescribed by the health care provider, and keeping the fingernails trim are instructions given when histamines are prescribed to treat pruritus.

Which process involves the replacement of damaged tissue with scar tissue that aids in wound healing? 1 Granulation 2 Contraction 3 Resurfacing 4 Re-epithelialization

1 Granulation Granulation involves the replacement of dead tissue with scar tissue that aids in healing. Contraction involves pulling the wound edges along the path of least resistance with the help of fibroblasts. Resurfacing involves regrowth across the open area. Re-epithelialization involves the production of new skin cells by undamaged epidermal cells in the basal layer of the dermis.

The nurse is caring for a patient with a loss of tissue integrity. The diagnostic reports reveal damage to the dermis and subcutaneous tissue. What is the name of the process that will replace the damaged tissue? 1 Granulation 2 Contraction 3 Resurfacing 4 Re-epithelialization

1 Granulation Loss of tissue integrity that occurs due to damage to the deeper layers of dermis and subcutaneous tissue is a characteristic feature of a deep-partial and full-thickness wound. Granulation replaces damaged tissue with scar tissue and aids in wound healing. Contraction involves the pulling of wound edges inward along the path of least resistance. Resurfacing involves regrowth across the open area. Re-epithelialization involves the production of new skin cells by undamaged epidermal cells in the basal layer of the dermis.

Which is a common causative drug of toxic epidermal necrolysis (TEN)? 1 Pyrazolones 2 Tetracyclines 3 Opioid analgesics 4 Beta-blocking agents

1 Pyrazolones Pyrazolones are one of the most common drugs that can cause TEN. Tetracyclines and opioid analgesics may not cause TEN. Beta-blocking agents can aggravate psoriasis, but not TEN.

Which are common complications of pressure injuries? Select all that apply. 1 Sepsis 2 Uremia 3 Diabetes 4 Cirrhosis 5 Kidney failure

1 Sepsis 5 Kidney failure Pressure injuries may lead to sepsis because there is a possibility of infection through the wound. Pressure injuries may also affect kidney function, leading to kidney failure. Diabetes can put a patient at higher risk for the formation of injuries, but it is not a complication of pressure injuries. Uremia and cirrhosis are not complications associated with pressure injuries.

Which of the following fungal infections is associated with athlete's foot? 1 Tinea pedis 2 Tinea cruris 3 Tinea capitis 4 Tinea manus

1 Tinea pedis The term tinea is used to describe dermatophytoses; this term is then followed by the location description. For example, tinea pedis involves the foot (athlete's foot), tinea manus involves the hands, tinea cruris involves the groin (jock itch), tinea capitis involves the head, and tinea corporis involves the rest of the body (ringworm).

During the follow-up visit, a patient reports the spontaneous disappearance and reappearance of small maculae with dry, yellow adherent scales on the skin. Which type of skin cancer does the nurse suspect in this patient? 1 Melanoma 2 Actinic keratosis 3 Basal cell carcinoma 4 Squamous cell carcinoma

2 Actinic keratosis Actinic keratosis is characterized by small papule with dry, rough, adherent yellow or brown scales having an erythematous base. It may disappear spontaneously and reappear after the treatment. Melanoma involves the rapid invasion with metastasis of the pigmented papule and variegated colors with red tones. Basal cell carcinoma includes pearly papules with a central crater and rolled waxy borders on the sun exposed areas. Squamous cell carcinoma involves firm nodular lesions topped with a crust with a central area of ulceration.

How does the nurse measure a pressure injury that has formed in a patient's sacral area? 1 Trace the wound onto a plastic film daily. 2 Use a plastic tape for accurate measurement. 3 Measure the wound at the shortest width and length. 4 Assess the wound with 6 o'clock position in the direction of the head.

1 Trace the wound onto a plastic film daily. The nurse should trace the wound onto a piece of plastic film or sheeting daily to compare the wound size. This method is generally used for asymmetric injuries. The wound size is measured at the greatest length and width using a disposable paper tape. The length is always measured from the 12 o'clock position to the 6 o'clock position. The width is measured between the 9 o'clock position and the 3 o'clock position. The wound is assessed as a clock face with the 12 o'clock position in the direction of the patient's head. The 6 o'clock position is in the direction of the patient's feet.

A nurse is assessing a patient with incontinence. Which substances may be responsible for skin breakdown in the patient? Select all that apply. 1 Urea 2 Yeast 3 Nitrogen 4 Bacteria 5 Enzymes

1 Urea 2 Yeast 4 Bacteria 5 Enzymes Prolonged contact with urea, yeast, bacteria, and enzymes in an incontinent patient may increase the risk of skin breakdown. Such substances are irritants and can destroy the integrity of the skin barrier. Nitrogen is not an element responsible for skin breakdown in the patient who is incontinent.

In teaching a patient about skin cancer prevention, which instruction does the nurse include? 1 "If you feel you must tan, use a tanning bed." 2 "Avoid sun exposure between 11 AM and 3 PM." 3 "Wear transparent clothing to protect your skin from the sun." 4 "Examine your skin quarterly for possible cancerous or precancerous lesions."

2 "Avoid sun exposure between 11 AM and 3 PM." The sun's rays are strongest between 11 AM and 3 PM and can cause more damage during this time. Skin should be examined at least monthly. Opaque clothing should be worn to protect the skin from the sun. The rays in tanning beds are just as harmful to skin as the sun's rays and should be avoided.

A patient who is receiving drug therapy for urticaria reports an increasing sedative effect. The patient admits to consuming alcohol on a daily basis. Which category of medication could be the reason for this condition? 1 Antibiotics 2 Antihistamines 3 Cytotoxic drugs 4 Non-steroidal anti-inflammatory drugs

2 Antihistamines Antihistamines show increasing sedating effects when used concomitantly with alcohol due the depressant actions of both drugs on the central nervous system. Antihistamines such as diphenhydramine are prescribed to cure urticaria. Antibiotics such as topical bacterial agents are used to treat any debris in the wound. Cytotoxic drugs cause impaired cellular proliferation and are contraindicated in wound healing. Non-steroidal anti-inflammatory drugs cause an altered inflammatory response that may prolong the wound healing.

A patient has folliculitis caused by methicillin-resistant Staphylococcus aureus (MRSA). What does the nurse instruct the patient and family about preventing the spread of MRSA? 1 Bathe daily using a nonalkaline soap. 2 Change the bandage whenever drainage seeps through. 3 Wash the infected skin areas before washing uninfected areas. 4 Wash soiled clothing in warm water and dry outside in the sun.

2 Change the bandage whenever drainage seeps through. The patient and family should be taught to change the bandage whenever drainage seeps through to prevent the transfer of infection. The patient and family members should take a shower rather than bathe regularly with an antibacterial soap. The patient should wash all uninfected skin areas first and then wash the infected areas. It is preferable to wash uninfected areas with a fresh washcloth. All soiled clothing and linen should be washed with hot water and laundry detergent, and clothes should be dried either in a hot dryer or outside on a clothesline in the sun.

Which organism is associated with "hitch-hiking" infestation? 1 Scabies mite 2 Cimex lectularius 3 Pediculosis capitis 4 Bacillus anthracis

2 Cimex lectularius Cimex lectularius is the scientific name for a bedbug. This "hitch-hiking" bug is carried home from an infested environment and is the most common mode of infestation. Scabies mite infestations cause scabies. Pediculosis capitis is associated with pediculosis, an infestation of lice. The spores of Bacillus anthracis cause cutaneous anthrax. This is transmitted through contact with an infected animal.

Which clinical manifestation is observed during the inflammatory phase of wound healing? 1 Itching 2 Erythema 3 Injuries on the body surface 4 White edematous papules

2 Erythema Erythema is a clinical manifestation that occurs during the inflammatory phase of wound healing. It is characterized by redness or swelling of the skin that exists from skin trauma due to an aseptic surgical incision or a pressure injury. Itching is a clinical feature that occurs in pruritus. Injuries on body surfaces such as the sacrum, hips, and ankles are a characteristic feature in pressure injuries. A rash of white edematous papules or plaques occurs in urticaria.

What is the triggering factor for the recurrence of herpes simplex skin infection? 1 Cold 2 Fever 3 Cough 4 Headache

2 Fever Fever is a triggering factor for the recurrence of herpes simplex skin infections. Cold, cough, and headache may not be associated with herpes simplex infection.

Which processes are required for restoring skin integrity? Select all that apply. 1 Maturation 2 Granulation 3 Inflammation 4 Re-epithelialization 5 Wound contraction

2 Granulation 4 Re-epithelialization 5 Wound contraction After injury, the body restores skin integrity through three processes - granulation, re-epithelialization, and wound contraction. In granulation, the damaged tissue is removed and filled with scar tissue. In re-epithelialization, the production of new skin takes place. In wound contraction, the wound size decreases and fibroblasts deposit new collagen to replace the damaged tissue. Closing of the wound occurs in wound contraction. Maturation and inflammation are phases of wound healing and not the processes involved in wound healing.

Which skin infection would cause a patient to report facial drooping? 1 Candidiasis 2 Herpes zoster 3 Herpes simplex 4 Dermatophytosis

2 Herpes zoster Facial drooping is the clinical sign of Bell's palsy, a complication of herpes zoster infection. This is seen when the trigeminal nerve is infected by the varicella-zoster virus. Candidiasis is a fungal infection and is not associated with Bell's palsy. Herpes simplex is a viral infection; this may not cause Bell's palsy. Dermatophytosis is also a fungal infection and is not associated with Bell's palsy.

A patient with chronic wounds is worried about treatment costs. What nursing tips for home care may be of help to the patient? Select all that apply. 1 "Buy only sterile products." 2 "Never reuse any kinds of supplies." 3 "You can use clean tap water and nonsterile supplies." 4 "You may reuse nonsterile items without cleaning them." 5 "Thoroughly wash your hands before touching any supplies.

3 "You can use clean tap water and nonsterile supplies." 5 "Thoroughly wash your hands before touching any supplies. Because caring for a chronic wound can be expensive, the nurse can tell the patient and his or her caregiver to use clean tap water and nonsterile supplies and to thoroughly wash their hands before touching supplies. Buying only sterile products is costly and unnecessary. If supplies are reusable, it would be too costly and wasteful to discard them after one use. Nonsterile items may be reused but need to be properly cleaned before the reuse.

A patient with a skin infection in the axilla reports a small, red lesion filled with pus. Upon assessment, the nurse notices the area to be erythematous and tender on palpation with noticeable lymphadenopathy. What could be the possible diagnosis? 1 Shingles 2 Cellulitis 3 Furuncle 4 Folliculitis

3 Furuncle A furuncle is a skin infection seen in the axilla. It is characterized by a small erythematous lesion, filled with pus, and tender on percussion. Lymphadenopathy in the axilla is termed as regional lymphadenopathy. This is also associated with furuncle. Shingles do not have small, red, pus-filled lesions. Cellulitis is a local inflammatory reaction associated with skin trauma and does not have small, red, pus-filled lesions. Folliculitis presents with hair in the center of the lesion.

An older adult patient with a skin infection reports itching at the infection site, along with fever and malaise. Upon assessment, the nurse finds the patient to be immunosuppressed. Which drug does the nurse expect the primary health care provider to prescribe? 1 Topical clindamycin 2 Topical ketoconazole 3 Intravenous acyclovir 4 Intravenous vancomycin

3 Intravenous acyclovir Fever and malaise are the systemic manifestations of shingles. Intravenous acyclovir is the drug of choice in immunosuppressed patients with systemic infections. Mild bacterial infections are treated with topical antibacterial ointment such as topical clindamycin. In fungal infections such as dermatophytosis and candidiasis, topical ketoconazole is used. Intravenous vancomycin is used to treat methicillin-resistant Staphylococcus aureus infections.

A patient with a pediculosis skin infection reports itching and skin abrasions from scratching. What would be the drug of choice? 1 Acyclovir 2 Penicillin 3 Malathion 4 Ketoconazole

3 Malathion In pediculosis, itching is a common manifestation, and skin abrasions (excoriation) from scratching may also be seen. Malathion is the drug used to treat pediculosis. Acyclovir is used to treat viral infections. Penicillin is used to treat bacterial infections. Ketoconazole is an antifungal agent.

Which process promotes the healing of partial-thickness wounds? 1 Granulation 2 Maturation 3 Re-epithelialization 4 Wound contraction

3 Re-epithelialization Partial-thickness wounds are more superficial. In a partial-thickness wound, only the epidermis and upper layers of the dermis are damaged. Such wounds heal by re-epithelialization. Granulation is a major process for deep wounds. Maturation is not involved in the healing of partial-thickness wounds. In wound contraction, the size of the wound decreases and the wound finally closes.

The nurse is evaluating a group of student nurses after teaching them about wound healing in older adults. Which statements made by a student nurse indicate the need for further teaching? Select all that apply. 1 "The process of wound healing is less efficient in older adults." 2 "The strength of a healed wound is reduced in older adults." 3 "Replacement of connective tissue is reduced in older adults." 4 "Re-epithelialization and wound dilation is slower in older adults." 5 "Incontinence or immobility in older adults lowers the risk of chronic wound development."

4 "Re-epithelialization and wound dilation is slower in older adults." 5 "Incontinence or immobility in older adults lowers the risk of chronic wound development." Re-epithelialization and wound contraction, not dilation, is slower in older adults. This phenomenon happens because of an improper release of inflammatory factors for the regrowth of epithelial tissues on the wound surface. Incontinence, malnutrition, or immobility in older adults increases the risk of chronic wound development because of impaired cellular proliferation and decreased collagen synthesis. The strength of a healed wound is reduced in older adults because of reduction in the replacement of connective tissue. The process of wound healing is less efficient in older adults because of the increased development of bacterial infections. Tissues are replaced at a slower rate in an older adult.

Which category of medications can aggravate psoriasis? 1 Antibiotics 2 Barbiturates 3 Sulfonamides 4 Beta-blocking agents

4 Beta-blocking agents Beta-blocking agents can make psoriasis worse. Antibiotics, barbiturates, and sulfonamides can cause toxic epidermal necrolysis and do not make psoriasis worse.

Which skin infection is characterized by a painless lesion and formation of eschar regardless of treatment? 1 Scabies 2 Shingles 3 Candidiasis 4 Cutaneous anthrax

4 Cutaneous anthrax The two clinical features that distinguish cutaneous anthrax from other skin infections include painless lesions and formation of eschar even after treatment is provided. Due to scabies, a patient experiences intensive itching, which is unbearable mostly at nights. In shingles, painful burning lesions may be seen. In candidiasis, burning and itching may be observed.

A pregnant patient presents to the clinic with a skin infection and reports itching and swelling on the arm. While assessing the patient, the nurse finds the infected area to be elevated and hemorrhagic, edematous, and tender. The patient also presents with fever, chills, and enlarged lymph nodes. Which is the most suitable drug for this patient? 1 Oral ciprofloxacin 2 Oral ketoconazole 3 Intravenous vancomycin 4 Intravenous ciprofloxacin

4 Intravenous ciprofloxacin Itching and swelling on the arm is a clinical sign of cutaneous anthrax. Fever, chills, and enlarged lymph nodes are the systemic symptoms of cutaneous anthrax. During pregnancy and in patients who present with a fever, intravenous ciprofloxacin is the most suitable drug therapy. This is followed by oral antibiotics for the next 60 days. Oral ciprofloxacin is prescribed when there is no evidence of systemic symptoms. Oral ketoconazole is prescribed for fungal infections. Intravenous vancomycin is used to treat methicillin-resistant Staphylococcus aureus and drug-resistant bacterial infections.

The nurse instructs a patient at high risk for pressure injuries to avoid having any reddened areas massaged. Why does the nurse recommend this? 1 It may cause irritation. 2 It may produce inflammation. 3 It may cause severe bleeding. 4 It may damage capillary beds.

4 It may damage capillary beds. Massage to reddened skin areas can damage capillary beds and increase tissue necrosis. Massage does not cause irritation, bleeding, or inflammation.

A patient with a skin infection reports recurrence of the infection after treatment with topical antifungal therapy. While assessing the patient, the nurse notices erythematous macular eruptions in the infected area. Which drug would be beneficial for the patient? 1 Penicillin 2 Acyclovir 3 Tetracycline 4 Ketoconazole

4 Ketoconazole Erythematous macular eruption is a clinical sign of candidiasis. As a result of the continuous use of topical antifungal agents, the infection may become resistant. Systemic antifungal agents such as ketoconazole may be used to treat resistant fungal infections. Penicillin and tetracycline are used to treat bacterial infections. Acyclovir is used to treat viral infections.

The nurse is caring for a patient with a surgical incision. Which process of wound healing is affected if there is damage to the hair follicles and sweat glands? 1 Contraction 2 Resurfacing 3 Granulation 4 Re-epithelialization

4 Re-epithelialization Re-epithelialization involves the production of undamaged epidermal cells in the basal layer of the dermis, which also lines the hair follicles and sweat glands. Resurfacing involves regrowth of the tissue across the open area. Contraction involves pulling of the wound edges inward along the path of least resistance. Granulation involves the filling in of damaged tissue with scar tissue for healing to occur.

A patient has a chronic pressure injury with a cavity-like defect. Which type of intention helps in healing the wound? 1 First 2 Third 3 Fourth 4 Second

4 Second A chronic pressure injury requires gradual filling of the dead space with connective tissue. This healing occurs by second intention. A wound without tissue loss, such as a clean laceration or a surgical incision, can heal by first intention. Wounds at high risk for infection can heal by third intention. Fourth intention is not a phase of wound healing.

A patient tells the nurse, "My skin always looks dry even after I apply lotion." How should the nurse respond? 1 "Bathe in lukewarm water to prevent your skin from drying." 2 "Avoid wearing nylon stockings for more than 2 hours at a time." 3 "Leave oil-based soap on the skin while bathing instead of rinsing it off." 4 "Wear full-length pajamas instead of nightgowns while sleeping to protect the skin."

1 "Bathe in lukewarm water to prevent your skin from drying." Bathing in lukewarm water helps stimulate the release of oils from the sebaceous glands. This will help keep the skin moist and prevent dryness. Avoiding nylon stockings helps reduce the perspiration in the feet, legs, and genital area, thereby preventing bacterial infections and a bad odor. Leaving oil from soap on the skin will increase skin dryness. Wearing full-length pajamas during sleep may decrease the likelihood of the patient scratching the skin because of dryness; however, it will not address the dry skin itself.

What is the duration of the first phase of wound healing? 1 3 to 5 days 2 5 to 7 days 3 2 to 4 weeks 4 3 weeks or longer

1 3 to 5 days The first phase of wound healing is the inflammatory phase; this phase begins at the time of injury or cell death and lasts for 3 to 5 days. The duration of wound healing that occurs in partial wound thickness is 5 to 7 days. The duration of wound healing that occurs in the proliferative phase is 2 to 4 weeks. Wound healing lasts for 3 weeks or longer in the maturation phase.

A patient with chronic skin disorders complains of loss of vision. Which assessment finding made by the nurse confirms this diagnosis? Select all that apply. 1 Crusts 2 Vesicles 3 Erythema 4 Drug-induced reaction 5 Immunological reaction

1 Crusts 2 Vesicles Crusts and vesicles are the typical clinical features of Stevens-Johnson syndrome. Loss of vision is seen in severe conditions of Stevens-Johnson syndrome. Erythema is associated with toxic epidermal necrolysis (TEN). Both TEN and Stevens-Johnson syndrome are drug-induced and immunological reactions, so these findings cannot confirm the diagnosis.

A patient with psoriasis who is on biologic therapy has developed an infection. What would be the priority nursing interventions to treat this patient? Select all that apply. 1 Discontinuing the medication 2 Advising the patient to use antibiotics 3 Notifying the primary health care provider 4 Performing physical examination of the patient 5 Advise the patient to have a complete blood test

1 Discontinuing the medication 3 Notifying the primary health care provider The nurse should discontinue the medication and notify the primary health care provider if the patient develops an infection during treatment with biologic therapy. The nurse should not advise the patient to use antibiotics and to undergo complete blood test. These interventions should be performed by the primary health care provider. Physical examination may or may not be performed by the primary health care provider, but it is not a priority nursing intervention.

Which process occurs in the third intention of wound healing? 1 Removal of debris 2 Elimination of dead space 3 Inward pulling of wound edges 4 Replacement of dead tissue with scar tissue

1 Removal of debris Removal of debris and exudate is done in third intention with healing after a reduction in inflammation; the wound is then closed surgically. The elimination of dead space in a closed wound is done in first intention wound healing, which would shorten the phase of tissue repair. The inward pulling of wound edges that occurs along the path of least resistance is called contraction, which occurs in second intention. The replacement of dead tissue with scar tissue represents granulation; this occurs in second intention.

What should the nurse include in the plan of care when a patient reports itching? 1 Keep the patient's room warm. 2 Keep the patient's fingernails trimmed and filed. 3 Advise the patient to take a shower on a daily basis. 4 Advise the patient to drink iced tea at bedtime to promote sleep.

2 Keep the patient's fingernails trimmed and filed. Itching occurs when chemical agents or chemical mediators such as histamine act on itch receptors. Therefore, the nurse should implement measures to prevent dry skin, protect skin integrity, and promote sleep. This would include keeping the fingernails trimmed and filed to prevent skin tearing from scratching. The room should be kept cool to promote comfort and decrease itching. Patients with dry skin should shower every other day to prevent skin dryness. Herbal teas (not iced tea) can be used at bedtime to promote sleep and decrease itching.

What is the dosage frequency of adalimumab? 1 Infusions at 0, 2, and 6 weeks, then every 8 weeks 2 Loading dose followed by maintenance dose every other week 3 Twice weekly for 3 months followed by once-a-week injections 4 Once a week for 12 weeks followed by a 12-week drug-free interval

2 Loading dose followed by maintenance dose every other week Adalimumab is administered through the subcutaneous route with the loading dose followed by a maintaining dose every other week that is started 1 week after the loading dose. IV infusions of infliximab are administered at 0, 2, and 6 weeks and then every 8 weeks. Etanercept is administered through the subcutaneous route twice weekly for 3 months, followed by once-a-week injections. Alefacept is administered through the intramuscular route once a week for 12 weeks followed by a 12-week drug-free interval.

The nurse assesses a patient's leg ulcer and notices redness, pain, and swelling around the wound along with fever and lymphadenopathy. The patient's medical record reveals an allergy to penicillin. What would be effective medications to treat this infection? Select all that apply. 1 Acyclovir 2 Macrolide 3 Tetracycline 4 Ketoconazole 5 Aminoglycoside

2 Macrolide 3 Tetracycline 5 Aminoglycoside Cellulitis is a bacterial infection characterized by redness, pain, swelling, warmth, and tenderness. Fever and lymphadenopathy are also associated with cellulitis. Macrolides, tetracyclines, and aminoglycosides are the antibacterial drugs used to treat cellulitis if the patient is allergic to penicillin. Acyclovir is used to treat viral infections. Ketoconazole is used to treat fungal infections such as dermatophytosis and candidiasis.

A patient with contact dermatitis reports redness in the earlobes. What could be the reason for this? 1 Latex allergy 2 Nickel allergy 3 Cosmetic allergy 4 Airborne contact allergy

2 Nickel allergy Nickel allergy is most commonly seen in patients who are exposed to nickel. If the earlobes are red, the nurse should ask about earrings that might cause inflammation of the ears. A latex allergy will manifest when a person comes into contact with latex. Cosmetic allergies involve the head and neck. Airborne contact allergy is seen in patients who come into contact with paint or ragweed.

Which type of allergy is associated with linear streaks of vesicles? 1 Latex 2 Plants 3 Nickel 4 Toothpaste

2 Plants Having an allergy to plants such as poison ivy is associated with linear streaks of vesicles. Latex, nickel, and toothpaste allergies are associated with localized eczematous eruptions that have well-defined, geometric margins.

What is the nurse's primary focus in the management of urticaria? 1 Increased patient comfort 2 Removal of triggering substance 3 Prevention of skin injury with loss of tissue integrity 4 Checking for the presence of necrotic tissue and amount of exudates

2 Removal of triggering substance Removal of the triggering substance and the relief of its manifestations are important nursing interventions in the management of urticaria. Increasing patient comfort and preventing skin injury with loss of tissue integrity are the interventions used in the management of pruritus. Checking for the presence of necrotic tissue and amount of exudates is an intervention used to manage pressure injuries.

While assessing a patient, the nurse identifies that there is no change in the size of the wound. Which category of medications could be the reason for this condition? 1 Antibiotics 2 Antihistamines 3 Cytotoxic drugs 4 Non-steroidal anti-inflammatory drugs

3 Cytotoxic drugs The wound size decreases at a uniform rate of 0.6 to 0.75 mm/day due to the inward pulling of the wound edges by fibroblasts. Cytotoxic drugs impair cellular regulation and collagen synthesis, and thus decrease wound contraction. Antibiotics, antihistamines, and nonsteroidal anti-inflammatory drugs will have no effect on the size of the wound.

Which nursing interventions can the nurse working in a long-term care facility delegate to a nursing assistant? 1 Use the Braden scale to determine pressure injury risk for a newly admitted patient. 2 Complete daily sterile dressing changes for a patient with a venous leg ulcer. 3 Every 2 hours, reposition a patient who has had a stroke and is incontinent. 4 Admit a newly transferred patient who had pedicle flap surgery 1 week ago.

3 Every 2 hours, reposition a patient who has had a stroke and is incontinent. The nursing assistant has the education and scope of practice to reposition a patient. Using the Braden scale, changing a sterile dressing, and patient admissions are actions that should be done by licensed nursing staff who have broader education and scope of practice.

The nursing instructor reviews instructions with the nursing student on caring for an older adult patient with a pressure injury. What action by the nursing student indicates a need for further instruction about proper skin care for this patient? 1 Avoids reddened areas 2 Uses a moisturizing lotion 3 Massages bony prominences 4 Repositions the patient every 1 to 2 hours

3 Massages bony prominences Massaging bony prominences should be avoided in older adult patients because they are at high risk for skin tears. Reddened areas should not be directly massaged because this can damage capillary beds and increase tissue necrosis. The patient should be repositioned at least every 1 to 2 hours to prevent injury extension and the generation of additional pressure injuries. Using a moisturizing lotion is appropriate.

What condition can greatly increase the risk of accelerated tissue destruction in a patient with pressure injuries? 1 Mechanical obstacles 2 Decrease in skin moisture 3 Negative nitrogen balance 4 Exposure to ultraviolet light

3 Negative nitrogen balance Skin and wound healing depend on a positive nitrogen balance and adequate serum protein levels. A negative nitrogen balance slows down the healing mechanism and increases the risk for accelerated tissue destruction. Mechanical obstacles and a decrease in skin moisture may hamper the wound healing process, but do not cause accelerated tissue destruction. Exposure to ultraviolet light causes sunburn.

A patient has had a melanoma lesion removed. For secondary prevention, what is important for the nurse to teach the patient? 1 Avoid sun exposure. 2 Perform a total skin self-examination monthly. 3 Perform a total skin self-examination monthly with a partner. 4 Ensure that all lesions are reviewed by a dermatologist or a surgeon.

3 Perform a total skin self-examination monthly with a partner. Performing a monthly total skin self-examination with another person is the best secondary preventive measure. If the patient is taught to use the ABCDE ( asymmetry, border, color, diameter, and evolving) method of lesion assessment, the patient will know whether a lesion warrants assessment by a specialist. Avoiding sun exposure is primary prevention. It is difficult for a person to assess all of the skin surfaces of his or her body by him- or herself, even with the use of mirrors. It is better to involve a partner with the assessment.

Which medication acts as a strong irritant and causes chemical burns in patients with psoriasis? 1 Anthralin 2 Calcitriol 3 Tazarotene 4 Calcipotriene

1 Anthralin Anthralin is used to treat psoriasis and is a strong irritant, which can cause chemical burns. Calcitriol, tazarotene, and calcipotriene are not skin irritants; hence, these will not cause chemical burns in a patient with psoriasis.

Which systemic drug is most commonly used to treat psoriasis? 1 Bexarotene 2 Azathioprine 3 Cyclosporine 4 Methotrexate

1 Bexarotene Systemic therapy is used in the treatment of psoriasis, when the patient does not respond to topical therapies. Bexarotene is a vitamin A derivative that is most commonly used to treat psoriasis. Azathioprine, cyclosporine, and methotrexate are less commonly used systemic drugs for psoriasis.

Which disease may cause urticaria? 1 Cancer 2 Vasculitis 3 Lymphedema 4 Diabetes mellitus

1 Cancer Cancer is one of the causative factors of urticaria. It occurs due to the exposure to allergens, which release histamines into the skin. Vasculitis, lymphedema, and diabetes mellitus cause altered inflammatory responses in wound healing.

During morning rounds, the nurse discovers that an older adult patient has been incontinent during the night. To protect the skin, what does the nurse do first? 1 Clean the patient. 2 Apply a barrier cream. 3 Assess the area for skin breakdown. 4 Place the patient in a side-lying position.

1 Clean the patient. Cleaning and drying the patient to prevent skin breakdown is the first priority for skin protection. Applying a barrier cream, assessing the area, and placing the patient in a side-lying position can all be done after the patient has been cleaned.

Which body area is most commonly affected by psoriasis? 1 Neck 2 Chest 3 Elbow 4 Facial skin

3 Elbow The elbow is commonly affected by psoriasis. Neck, chest, and facial skin are rarely affected with psoriasis.

What is the underlying cause of urticaria? 1 Exposure to allergens 2 Aseptic surgical incision 3 Compression of underlying soft tissue 4 Distress caused by stimulation of itch-specific receptors

1 Exposure to allergens Urticaria is a rash of white or edematous papules or plaques caused by exposure to allergens. An aseptic surgical incision may cause skin trauma by affecting the tissue integrity. The compression of underlying soft tissue between a bony prominence over an extended period may cause deep pressure injuries by causing a loss of tissue integrity. Pruritus causes distress due to stimulation of the itch-specific receptors.

Which condition may trigger recurrence of herpes simplex virus (HSV) infection in an otherwise healthy male? 1 Fatigue 2 Menses 3 Bell's palsy 4 Eye infection

1 Fatigue Fatigue is a stressor that may trigger recurrence of HSV infection in an otherwise healthy male. Menses is a stressor for HSV infection for healthy female. Bell's palsy and eye infections are complications of Herpes zoster but not triggering factors.

Which factor may cause a systemic altered inflammatory response? 1 Leukemia 2 Heart failure 3 Hypovolemia 4 Lymphedema

1 Leukemia Leukemia may cause a systemic altered inflammatory response by systemic inhibition of the leukocytic response, which results in an impaired host resistance to infection. Heart failure and hypovolemia may cause impaired cellular proliferation. Lymphedema may cause a local altered inflammatory response.

The home health nurse is caring for an older patient confined to bed. What interventions does the nurse take to prevent pressure injuries in the patient? Select all that apply. 1 Place a bed pillow under the ankles. 2 Massage bony prominences twice a day. 3 Keep the head of the bed elevated to 40 degrees. 4 Perform a weekly assessment of the patient's skin. 5 Keep the patient's skin directly off plastic surfaces.

1 Place a bed pillow under the ankles. 5 Keep the patient's skin directly off plastic surfaces. The older patient confined to bed is predisposed to the formation of pressure injuries. A pillow should be placed under the patient's ankles to prevent the heels from rubbing on the bed surface, and the nurse should ensure that the patient's skin is not irritated by plastic surfaces. The head of the patient's bed should not be elevated more than 30 degrees because the patient is likely to experience shearing forces pulling the skin away from deeper tissues in this position. The nurse must perform a daily assessment of the patient's skin and report any manifestations of infection to the health care provider. Massaging bony prominences must be avoided to prevent tearing the fragile skin.

A patient has been ordered anthralin treatment for psoriasis. What does the nurse teach the patient about self-management of this drug? 1 Prevent drug contact with uninvolved skin. 2 Apply to the lesion for not more than 3 hours. 3 Apply the drug with care as it causes staining. 4 Place warm, moist dressings over the application.

1 Prevent drug contact with uninvolved skin. The patient should apply the drug carefully in the affected areas and avoid uninvolved skin because the drug is a strong irritant and can cause chemical burns. Warm, moist dressings are placed over corticosteroid applications for inflamed skin. Tar preparations cause staining and have an unpleasant odor. Anthralin is applied for not more than 2 hours to prevent chemical burns.

Which condition will occur from stimulation of the itch-specific nerve fibers? 1 Pruritus 2 Cellulitis 3 Urticaria 4 Pressure ulcer

1 Pruritus Pruritus occurs when the itch-specific nerve fibers are stimulated. Cellulitis occurs due to inflammation or infection of the skin and subcutaneous tissue. Urticaria is caused by exposure to allergens, which releases histamine into the skin. Pressure injuries occur when the skin and underlying soft tissue are compressed between a bony prominence and an external surface for an external period.

A patient with a skin infection reports intense itching that is unbearable at night. Which drug may be beneficial for this patient? 1 Penicillin 2 Ivermectin 3 Permethrin 4 Ketoconazole

3 Permethrin In scabies, the itching is very intense and becomes unbearable at night. Permethrin is used to treat scabies. Penicillin is used to treat bacterial infections. Ivermectin is used to treat pediculosis. Ketoconazole is used to treat fungal infections.

Which event takes place during the maturation phase of wound healing? 1 Fibrin strands form a scaffold or framework. 2 White blood cells migrate into the wound. 3 Epithelial cells grow over the granulation tissue bed. 4 Collagen is reorganized to provide greater tensile strength.

4 Collagen is reorganized to provide greater tensile strength. The maturation phase is the third phase of wound healing. It begins as early as 3 weeks after injury and may continue for a year. In the maturation phase, collagen is reorganized to provide greater tensile strength. In the proliferative (second) phase of wound healing, fibrin strands form a scaffold or framework, and later, epithelial cells grow over the granulation tissue bed. The inflammatory (first) phase of wound healing is marked by white blood cells (especially macrophages) migrating to the wound.

A patient with a skin infection on the neck reports itching, swelling, and a history of contact with an infected animal. Upon assessment, the nurse finds the infected area to be edematous and tender. The patient also has fever, chills, and enlarged lymph nodes. What could be the possible diagnosis? 1 Cellulitis 2 Furuncle 3 Athlete's foot 4 Cutaneous anthrax

4 Cutaneous anthrax A patient who reports with itching and swelling from a skin infection and who has been in contact with an infected animal is showing the clinical signs of cutaneous anthrax. Fever, chills, and enlarged lymph nodes are the typical systemic manifestations that differentiate cutaneous anthrax from cellulitis and furuncle. Though fever, edema, tenderness, and lymphadenopathy are also associated with cellulitis and furuncles, chills are not. Athlete's foot is a fungal infection of the foot.

Which is a risk factor for candidial infection? 1 Pregnancy 2 Weight loss 3 Hypertension 4 Diabetes mellitus

4 Diabetes mellitus Diabetes mellitus is a risk factor for candidial infection. In pregnancy, drugs should be used with caution; therefore, it is not associated with candidial infections. Weight loss can happen with anthrax. Hypertension is not a risk factor for candidial infections.