Med-Surg: Dermatological
A nurse in a provider's office is caring for a client who has a new diagnosis of herpes zoster. The nurse should anticipate a prescription for which of the following medications? A. Zoster vaccine B. Acyclovir C. Amoxicillin D. Infliximab
B. Acyclovir The nurse should anticipate a prescription for acyclovir, an antiviral medication that inhibits replication of the virus that causes herpes zoster. - A: The zoster vaccine is to prevent herpes zoster - C: Amoxicillin is for a bacterial infection - D: Infliximab is for a client who has Crohn's disease
A nurse in an emergency department is assessing a client who has extensive burns, including on her face. Which of the following assessments should the nurse perform first? A. Estimation of burn injury B. Characteristics of cough and sputum C. Extent of peripheral edema D. Amount of urine output
B. Characteristics of cough and sputum A client who has burns to the face is at risk for pulmonary injury, and the development of a brassy cough can indicate an impending loss of airway.
A nurse is caring for a client whose wounds are covered with a heterograft dressing. In response to the client's questions about the dressing, the nurse explains that it is obtained from which of the following sources? A. Cadaver skin B. Pig skin C. Amniotic membranes D. Beef collagen
B. Pig skin Heterographs are obtained from an animal, usually a pig. - A: Homographs are obtained from cadaver skin - C: Human amniotic membranes are used to treat burns; however, they are not heterograft dressings - D: Artificial skin made from beef collagen is used to treat burns; however, it is not a heterograft dressing
A nurse is evaluating the laboratory values of a client who is in the resuscitation phase following a major burn. Which of the following laboratory findings should the nurse expect? A. Hemoglobin 10 g/dL B. Sodium 132 mEq/L C. Albumin 3.6 g/dL D. Potassium 4.0 mEq/dL
B. Sodium 132 mEq/L This laboratory finding is below the expected reference range. The nurse should anticipate a low sodium level because sodium is trapped in interstitial space. - A: This level is below the expected reference range. The nurse should anticipate an elevated hemoglobin level during the resuscitation phase due to the loss of fluid volume. - C: This laboratory value is within the expected reference range. The nurse should anticipate a low albumin level during the resuscitation phase. - D: This laboratory value is within the expected reference range. The nurse should anticipate an elevated potassium level during the resuscitation phase.
A nurse in a dermatology clinic is using the ABCDE method while screening several skin lesions for skin cancer on a client. Which of the following findings should the nurse report to the provider? A. Symmetric shape B. Border regularity C. Color variation within a lesion D. Diameter >4 mm
C. Color variation within a lesion - The C in the ABCDE method of screening for skin cancer stands for color variation within a lesion. - The A in the ABCDE method of screening for skin cancer stands for asymmetric shape. - The B in the ABCDE method of screening for skin cancer stands for border irregularity. - The D in the ABCDE method of screening for skin cancer stands for diameter >6mm. - The E stands for evolving or changing in any feature of the lesion.
A nurse is assessing a client who sustained partial-thickness and deep partial-thickness burns 72 hr ago. Which of the following findings should the nurse report to the provider? A. Edema in the burned extremities B. Severe pain at the burn sites C. Urine output of 30 mL/hr D. Temperature of 39.1c (102.4f)
D. Temperature of 39.1c (102.4f) An elevated temperature is an indication of infection, and the nurse should report this finding to the provider. Sepsis is a critical finding following a major burn injury. Initially, burn wounds are relatively pathogen-free. On approximately the third day following the injury, early colonization of the wound surface by gram-negative organisms changes to predominantly gram-positive opportunistic organisms. - A: Significant edema is expected when fluid shifts after a burn injury - B: Superficial partial-thickness and deep partial-thickness burns are painful throughout burn therapy - C: A urinary output of 30 mL/hr is within the expected reference range. A decreased urine output is expected with edema and fluid shifts around the fourth day following a major burn injury.
A nurse is caring for a client who has burn injuries on his trunk. The nurse is explaining what to expect from the prescribed hydrotherapy. Which of the following statements by the client indicates an understanding of the teaching? A. I will be on a special shower table B. The water temperature will be very cool to ease my pain C. The nurse will use a firm-bristled brush to remove loose skin D. The nurse will use scissors to open small blisters
A. I will be on a special shower table The special shower table facilitates examination and debridement of the wound during hydrotherapy. An advantage of using the showering technique as opposed to a tub bath is that the water can be kept at a constant temperature; there is also a lower risk of wound infection. - B: The nurse should use warm water during hydrotherapy to help the client maintain adequate body temperature - C: The nurse should use soft washcloths or gauze to scrub and decried the wounds gently - D: The nurse should leave small blisters intact but open large blisters
A nurse in the emergency department is caring for a client who has a snakebite on her arm. Which of the following interventions should the nurse implement? A. Immobilie the limb at the level of the heart B. Apply a tourniquet to the affected limb C. Use a sterile scapula to incise the wound D. Apply ice to the skin over the snakebite wound
A. Immobilie the limb at the level of the heart The emergency management of a client who has a snakebite focuses on limiting the spread of venom. Any constrictive clothing or jewelry should be removed before swelling worsens, and the affected limb should be immobilized at the level of the heart. - B: Although the use of tourniquets was recommended in the past for the emergency management of snakebites, this is no longer an accepted treatment and is contraindicated. - C & D: These used to be treatments but are no longer used.
A nurse is planning care for a client who has deep partial-thickness and full-thickness thermal burns over 40% of his total body surface and is in the acute phase of burn injury. Which of the following interventions should the nurse include in the plan? A. Initiate range-of-motion exercises B. Use clean technique to provide wound care C. Place the client on a low-protein diet D. Maintain the client on bed rest
A. Initiate range-of-motion exercises The nurse should begin performing active and passive range-of-motion exercises with the client to maintain mobility and prevent contractors. - B: The nurse should use sterile technique to provide wound care for this client to reduce the risk of infection. - C: The nurse should place the client on a high-protein, high-calorie diet to promote wound healing - D: The nurse should encourage the client to ambulate frequently to promote mobility and improve ventilation.
A nurse is caring for an adolescent client who has burn wounds on her face and hands. Which of the following statements by the client indicates that she has adapted to her changed body image? A. May I go with my family to the visitor's lounge? B. I'll see my friends when I get home C. My dad is coming to visit. Can you fix my hair for me? D. I told my cousins I'm in protective isolation
A. May I go with my family to the visitor's lounge? This statement demonstrates a positive self-image since the client is asking to visit with her family in a public setting. - B: This statement indicates that the client does not feel comfortable being seen by her peer group. - C: Asking for assistance with her appearance indicates the client has not yet accepted or adapted to her changed body image. - D: This statement indicates that the client does not feel comfortable being seen by her extended family.
A nurse in a provider's office is assessing a client's skin lesions. The nurse notes that the lesions are 0.5cm (0.20in) in size, elevated, and solid with distinct borders. The nurse should document these findings as which of the following skin lesions? A. Papules B. Macules C. Wheals D. Vesicles
A. Papules A papule is a small, solid, elevated lesion with distinct borders. It is usually smaller than 10 mm in diameter. Papule are common lesions of warts and elevated moles. - B: A macule is a change in the color of the skin that is flat, variably shaped, discolored, and small (typically <10 mm in diameter). Freckles and the rash associated with rubella are types of macules. - C: Wheals (also known as hives) are transient, elevated, irregularly shaped lesions caused by localized edema. Wheals are a common manifestation of an allergic reaction. - D: A vesicle is a circumscribed, elevated lesion or blister containing serous fluid. Vesicles typically arise in herpes simplex, poison ivy, and chickenpox.
A nurse is providing discharge instructions to a client who is postoperative following surgical excision of a basal cell carcinoma. Which of the following findings should the nurse include as an indication of a mole's potential malignancy? A. Ulceration B. Blanching of surrounding skin C. Dimpling D. Fading of color
A. Ulceration Ulceration, bleeding, and exudation are indications of a mole's potential malignancy. Increasing size is also a warning sign. The nurse should emphasize the importance of lifetime follow-up evaluations and the proper techniques for self-examination of the skin every month.
A nurse is teaching a group of clients about skin cancer. The nurse should explain that basal cell carcinoma originates from which of the following tissues? A. Subcutaneous B. Epidermis C. Dermis D. Stratum corneum
B. Epidermis Basal cell carcinoma originates from the epidermal layer of the skin. It is the most common form of skin cancer. - A: Angiomas are an example of lesions that involve the skin and subcutaneous tissue, not basal cell carcinoma. - C: The dermis connects the epidermis to the subcutaneous tissue. Melanoma arises from this skin level, not basal cell carcinoma. - D: The stratum corneum layer is the outermost or topmost layer of the skin and is composed primarily of dead or peeling skin cells. Basal cell carcinoma does not arise from dead skin cells.
A nurse is caring for a client who has a prescription for silver sulfadiazine cream to be applied to her burn wounds. The nurse should evaluate the client for which of the following laboratory findings? A. Hyponatremia B. Leukopenia C. Hyperchloremia D. Elevated BUN
B. Leukopenia Transient leukopenia is an adverse effect of silver sulfadiazine. - A & C: Silver sulfadiazine does not cause electrolyte imbalances - D: Impaired kidney function is not an adverse effect of silver sulfadiazine
A nurse on a surgical unit is caring for 4 clients who have healing wounds. Which of the following wounds should the nurse expect to heal by primary intention? A. Partial-thickness burn B. Stage 3 pressure ulcer C. Surgical incision D. Dehisced sternal wound
C. Surgical incision With primary intention, a clean wound is closed mechanically, leaving well-approximated edges and minimal scarring. A surgical incision is an example of a wound that heals by primary intention. - A: A partial-thickness burn heals by spontaneous re-epithelialization. Since it involves the uppermost layers of the dermis, scarring can be minimal or extensive depending on the depth of the burn. - B: A stage 3 pressure ulcer will heal by secondary intention - D: A dehisced sternal wound can either close by secondary or tertiary intention
A nurse is assessing the abdominal incision of a client who is 3 days postoperative. The incision is slightly edematous and pink with crusting on the edges and is draining serosanguineous fluid. Which of the following assessments described the incision? A. The incision is showing early signs of infection B. The incision is showing early signs of dehiscence C. The incision is showing early signs of healing without complications D. The incision is showing signs of developing a fistula
C. The incision is showing early signs of healing without complications These assessment findings are consistent with appropriate healing without complications. - A: Signs of wound infection include warmth, erythema, and purulent drainage - B: Dehiscence is the separation of the layers of skin and tissue in a wound. Signs of dehiscence include the client's report of something moving apart, increased wound drainage, and a visually apparent separation. - D" A fistula is a complication of wound healing that involves the formation of an abnormal passageway within or from a wound. A common sign of fistula development is chronic drainage of fluids from the wound.
A nurse is assessing the skin of a client who has frostbite. The client has small blisters that contain blood, and the skin of the affected area does not blanch. The nurse should classify this injury as which of the following? A. First-degree frostbite B. Second-degree frostbite C. Third-degree frostbite D. Fourth-degree frostbite
C. Third-degree frostbite When a client has 3rd degree frostbite, the skin of the affected area has small blisters that are blood-filled, and the skin does not blanch. - A: When a client has 1st degree frostbite, the skin of the affected area is reddened and looks waxy - B: When a client has 2nd degree frostbite, the skin of the affected area has large, fluid-filled blisters - D: When a client has 4th degree frostbite, the skin of the affected area is frozen. Blisters do not appear, and the client's muscles and bones are affected.
A nurse is caring for a client who has a large wound healing by secondary intention. The nurse should inform the client that which of the following nutrients (in addition to protein) promotes wound healing? A. Vitamin B1 B. Calcium C. Vitamin C D. Potassium
C. Vitamin C A diet high in protein and vitamin C is recommended because these nutrients promote wound healing. - A: Vitamin B1 promotes the functioning of the nervous system. It does not specifically promote wound healing. - B: Calcium aids blood clotting and muscle contraction. It does not specifically promote wound healing. - D: Potassium is necessary for muscle activity and fluid balance. It does not specifically promote wound healing.
A nurse is caring for a client who has regular occupational exposure to sunlight and presents for evaluation of several skin lesions. Which of the following findings should alert the nurse to the possibility of malignant melanoma? A. A pearly papule that is 0.5cm (0.20in) wide with raises, indistinct borders on the upper right shoulder B. Several flat, pigmented, circumscribed areas of various sizes over the bridge of the nose C. A raised, circumscribed lesion on the face that contains yellow-white purulent drainage D. An irregularly shared brown lesion with light blue areas on the neck
D. An irregularly shared brown lesion with light blue areas on the neck Malignant melanoma (the leading cause of death from skin cancer) is a neoplasm of dermal or epidermal cells. Exposure to sunlight increases the risk, and fair-skinned people have the highest risk. Malignant melanoma commonly starts in exposed skin areas like the back, scalp, face, and neck and metastasizes readily to other areas. Manifestations include a change in the color, size, or shape of a skin lesion with irregular borders in hues of blue, white, and red tones. - A: This describes basal cell carcinoma, a slow-growing skin tumor that results from sun exposure in clients who have fair skin. Basal cell carcinomas are usually pale in color and either pearly or flaky in appearance. - B: This describes macule such as freckles - C: This describes a pustule such as acne lesions
A nurse is assessing a client who is bedridden and was admitted from home. The nurse notes a shallow crater in the epidermis of the client's sacral area. The nurse should document that the client has a pressure ulcer at which of the following stages? A. IV B. I C. III D. II
D. II A stage 2 pressure ulcer involves partial-thickness skin loss of the epidermis and the dermis. The ulcer is visible and superficial and can look like an abrasion, blister, or shallow crater. Edema persists, and the ulcer might become infected. The client might report pain, and there might be a small amount of drainage. - A: With a stage 4 pressure ulcer, the client has full-thickness tissue loss, in addition to destruction, tissue necrosis, and visible damage to muscle, bone, or supporting structures. Sinus tracts, deep pockets of infection, tunneling, and undermining can occur. - B: With a stage 1 pressure ulcer, the skin is intact with an area of persistent, nonblanchable redness, usually over a bony prominence that might feel warm or cool when touched. The tissue is swollen and congested, and the client might report discomfort at the site. With darker skin tones, the ulcer can appear blue or purple and different from other skin areas. - C: A stage 3 pressure ulcer involves full-thickness tissue loss with damage to or necrosis of subcutaneous tissue. The ulcer might extend down to but not through the underlying fascia. The ulcer looks like a deep crater with or without undermining of adjacent tissue and without exposed muscle or bone. Drainage and infection are common.
A nurse is providing teaching to a client who is wheelchair-bound and his caregiver about ways to reduce the risk of pressure ulcer formation. Which of the following instructions should the nurse include? A. Move between the bed and the wheelchair once every 2 hr B. Make sure that your caregiver massages your skin daily C. Use a rubber ring when sitting on the bedside D. Shift your weight in the wheelchair every 15 min
D. Shift your weight in the wheelchair every 15 min This response addresses the safety issue of pressure ulcer risk. Pressure ulcer are most likely to develop if the client does not shift position frequently to relive pressure. - A: The nurse should instruct wheelchair-bound clients who are at risk for pressure ulcer formation to change position at least every hour - B: The nurse should instruct the client and his caregiver to avoid massaging the skin, especially over bony prominences, as this can further traumatize fragile tissue. - C: The nurse should instruct the client and his caregiver to avoid using a rubber ring for sitting because it reduces circulation to the client's skin.
A nurse is planning care for a client who has been admitted for the treatment of a malignant melanoma of the upper leg without metastasis. The nurse should plan to prepare the client for which of the following procedures? A. Curettage B. External radiation therapy C. Regional chemotherapy D. Surgical excision
D. Surgical excision The therapeutic approach to malignant melanoma depends on the level of invasion and the depth of the lesion. Surgical excision is the treatment of choice for small, superficial lesions. Deeper lesions require wide local excision, followed by skin grafting. - A: Curettage is used for small lesions that are not melanomas - B: Melanoma is resistant to radiation therapy. However, radiation along with corticosteroids might be helpful to clients who have metastatic disease. - C: Regional or topical chemotherapy is the treatment of choice for localized tumors and superficial basal cell carcinomas but not for malignant melanoma, which has an extremely high incidence of metastasis.
