Med Surg: Chapter 52: Nursing Management: Patients With Dermatologic Problems: PREPU
A patient is diagnosed with psoriasis after developing scales on the scalp, elbows, and behind the knees. The patient asks the nurse where this was "caught." What is the best response by the nurse? A Psoriasis is an inflammatory dermatosis that results from an overproduction of keratin. B Psoriasis comes from dermal abrasion. C Psoriasis is an inflammatory dermatosis that results from a superficial infection with Staphylococcus aureus. D Psoriasis results from excess deposition of subcutaneous fat.
A
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: A Avoid scratching the affected skin areas because this may exacerbate pruritus. B Take analgesics to achieve relief from pruritus. C Apply an over-the-counter corticosteroid ointment to the affected regions. D Use a moderately abrasive material to scratch the affected skin areas.
A
When performing a skin assessment, the nurse notes a localized skin infection of a single hair follicle. The nurse documents the presence of A a furuncle. B a carbuncle. C cheilitis. D a comedone.
A
occlusive dressing is?
An airtight dressing that protects a wound from air and bacteria; a commercial vented version allows air to passively escape from the chest, while an unvented dressing may be made of petroleum jelly-based (Vaseline) gauze, aluminum foil, or plastic.
A nurse is conducting a detailed skin assessment on an 80-year-old client. Which finding requires further investigation? A Bright red moles on the hands B Small, waxy nodule with pearly borders C Yellow, waxy deposits on the lower eyelids D Several areas of dry, scaly skin
B
The nurse is conducting a community education program on basal cell carcinoma (BCC). Which statement should the nurse make? A It is more invasive than squamous cell carcinoma (SCC). B It begins as a small, waxy nodule with rolled translucent, pearly borders. C It metastasizes through blood or the lymphatic system. D It is a malignant proliferation arising from the epidermis.
B
The nurse is instructing the parents of a child with head lice. Which statement should the nurse include? A Use shampoo with Kwell. B Use shampoo with piperonyl butoxide. C Disinfect brushes and combs with bleach. D Wash clothes in cold water.
B
The nurse working at a physician's office is providing teaching to the parent of a child diagnosed with Tinea capitis (ringworm of the head). How often should the nurse instruct the parent to shampoo the child's hair with ketoconazole or a selenium sulfide shampoo? A Weekly B Twice weekly C Daily D Once
B
Which statement indicates a characteristic of a basal cell carcinoma (BCC)? A It is a malignant proliferation arising from the epidermis. B It begins as a small, waxy nodule with rolled translucent, pearly borders. C It metastasizes through blood or the lymphatic system. D It is more invasive than squamous cell carcinoma (SCC).
B
Which term refers most precisely to a localized skin infection of a single hair follicle? A Carbuncle B Furuncle C Comedone D Cheilitis
B
While assessing the skin of a 45-year-old, fair-skinned female client, the nurse notes a lesion on the medial aspect of her lower leg. It has irregular borders, with various shades of black and brown. The client states that the lesion itches occasionally and bled slightly a few weeks ago. She also reveals a history of sunburns. Based on these signs and symptoms, the nurse suspects: A actinic keratoses. B melanoma. C basal cell carcinoma. D squamous cell carcinoma.
B
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: A "If someone develops symptoms, tell him to see a physician right away." B "All family members need to be treated." C "After you're treated, family members won't be at risk for contracting scabies." D "Just be careful not to share linens and towels with family members."
B
Which assessment finding indicates an increased risk of skin cancer? A A An irregular scar on the client's abdomen B A deep sunburn C A dark mole on the client's back D White irregular patches on the client's arm
B 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.
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? A Apply the medication every 2 hours. B Apply an occlusive dressing over the site after application. C Make sure that the skin is slightly dehydrated so that the medication can absorb through the skin cracks. D Apply a thick layer of cream over the lesions so that if some rubs off, there is more to absorb.
B Absorption of topical corticosteroids is enhanced when the skin is hydrated or the affected area is covered by an occlusive or moisture-retentive dressing
The nurse recommends which type of therapeutic bath for its antipruritic action? A Water B Colloidal (oatmeal) C Saline D Sodium bicarbonate (baking soda)
B 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.
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 A dermatitis. B lichenification. C pyodermas. D acantholysis.
B 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.
A nurse is aware that the incidence and prevalence of multiple melanoma are increasing. Which of the following individuals likely faces the greatest risk of developing the disease? A A person who is immunocompromised because of human immunodeficiency virus B A person who has a history of atopic dermatitis that has been unresponsive to treatment C A person who comes from a family whose members tend to have multiple changing moles D An African American person who has extensive keloid scarring
C As many as 10% of patients with melanoma are members of melanoma-prone families who have multiple changing moles (dysplastic nevi) that are susceptible to malignant transformation.
A client comes to the physician's office for treatment of severe sunburn. The nurse takes this opportunity to discuss the importance of protecting the skin from the sun's damaging rays. Which instruction best prevents skin damage? A "Use a sunscreen with a sun protection factor of 6 or higher." B "When at the beach, sit in the shade to prevent sunburn." C "Minimize sun exposure from 1 to 4 p.m., when the sun is strongest." D "Apply sunscreen even on overcast days."
D
A dermatologist recommends an over-the-counter suspension to relieve pruritus. The nurse advises the patient that the lotion should be applied: A Overnight to enhance absorption. B Twice a day to prevent crusting on the skin. C Hourly to prevent evaporation. D Every 3 to 4 hours for sustained effectiveness.
D
A nurse in a health care provider's office teaches a patient how to apply an occlusive dressing (using plastic film) to cover a medicated ointment applied to her arm. An important teaching point would be to tell the patient to: A Place heat on top of the dressing to increase skin temperature. B Immobilize her arm when it is wrapped. C Cover the dressing with an elastic wrap so she can continue her daily activities during a treatment. D Limit use of the dressing to 12 hours.
D
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? A 8 hours B 4 to 6 hours C 24 to 36 hours D 12 to 24 hours
D
A patient with a history of human immunodeficiency virus (HIV) has just been diagnosed with toxic epidermal necrolysis (TEN) and admitted to the regional burn unit for treatment. The nurses who will be providing direct care for this patient should prioritize which of the following practices? A Continuous monitoring of blood glucose levels B Intermittent urinary catheterization C Provision of enteral nutritional supplements D Vigilant application of standard infection control precautions
D
A patient with squamous cell carcinoma has been scheduled for treatment of this malignancy. The nurse knows that the primary method of treatment in this type of cancer is what? A Radiation therapy B Biopsy of sample tissue C Chemotherapy D Surgical excision
D
The most important principle of psoriasis treatment is which of the following? A Establishment of regular skin care routine B Dressing changes C Application of emollient creams D Gentle removal of scales
D
The nurse is assessing a patient for psoriatic lesions after treatment with a nonsteroidal cream. What type of lesion does the nurse know is characteristic of psoriasis? A Cluster of pustules B Group of raised vesicles C Pattern of bullae that rupture and form a scaly crust D Red, raised patch covered with silver scales
D
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? A Use of a gait belt for ambulation B Maintenance of foam pad on wheelchair C Daily bathing with warm-hot water D Applying lanolin ointment
D
Which of the following nonsedating antihistamines is appropriate for daytime pruritus? A Lorazepam (Ativan) B Hydroxyzine (Atarax) C Diphenhydramine (Benadryl) D Fexofenadine (Allegra)
D
Which of the following reflect the pathophysiology of cutaneous signs of HIV disease? A Decrease in normal skin flora B High CD4 count C Genetic predisposition D Immune function deterioration
D
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 Povidone-iodine-soaked gauze D Moist sterile saline gauze
D
While performing an initial assessment of a patient, the nurse observes an elevated blue-black lesion on the patient's ear. The nurse knows that this is indicative of what type of skin cancer? A Basal cell carcinoma B Dermatofibroma C Malignant melanoma D Squamous cell carcinoma
C
Dermatophytes (also called tinea) are parasitic fungi that invade the skin, scalp, and nails. How is a diagnosis made for this condition? Select all that apply. A excoriation from scratching B visual examination C intense itching, especially at night D Wood's light
B, D Diagnosis is based on visual examination; the lesions are scraped and examined microscopically. When a Wood's light is used, the affected areas fluoresce a green-yellow color. Intense itching at night and excoriation from scratching are symptoms of scabies.
A client has been diagnosed with shingles. Which of the following medication classifications will reduce the severity and prevent development of new lesions? A Corticosteroids B Antipyretics C Antiviral D Analgesics
C
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? A Turn the patient at least twice between 2200 and 0600 each night. B Avoid seating the patient in a chair until his rehabilitation has been completed. C Ensure that the patient's heels are elevated off the surface of his bed. D Provide relevant health education to the patient about the management of pressure ulcers.
C
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? A Epithelia B Endothelial C Epidermal D Dermal
C
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? A Grouped vesicles occurring on the genitalia B Rough, fresh, or gray skin protrusions C Grouped vesicles in linear patches along a dermatome D Grouped vesicles occurring on lips and oral mucous membranes
C
A patient is being evaluated for nodular cystic acne. What systemic pharmacologic agent may be prescribed for the treatment of this disorder? A Benzoyl peroxide B Retin-A C Isotretinoin (Accutane) D Salicylic acid
C
The nurse is caring for a client diagnosed with herpes zoster. Which statement by the client needs further clarification by the nurse? A "Herpes zoster is a reactivation of the varicella virus." B "Even though this is from a childhood disease, I am still contagious." C "Once I get the infection, I cannot get it again." D "Herpes zoster is caused by a viral infection."
C
The nurse is caring for a client with questionable lice infestation. The nurse is using a bright light focused on an area of the head to confirm the presence of lice. In which manner is it easiest to differentiate nits from dandruff? A Dandruff is throughout the hair. B Nits are located near the scalp. C Nits are difficult to move from hair shafts. D Dandruff looks white and flakey.
C
Which of the following uses the body's own digestive enzymes to break down necrotic tissues? A Enzymatic debridement B Wet to dry dressings C Autolytic debridement D Wet dressings
C