Quiz: Chapter 42, Care of Patents With Integumentary Disorders and Burns EAQ

The nurse is caring for a patient with an electrical burn. What should be monitored on this patient? 1 The lungs 2 The heart 3 The kidneys 4 The gastric mucosa

The heart Electrical burns damage tissue deep within the body. The extent of damage is not always visible, and the entrance site and exit site may appear small. Cardiac monitoring should be initiated even if the patient does not complain of chest pain. The lungs, kidneys, and gastric mucosa should be monitored with other types of burns.

The nurse observes that a patient's nails are thick, brittle, and yellow-orange in color. What is this condition known as? 1 Pitting 2 Fissures 3 Koilonychia 4 Onychomycosis

Onychomycosis Onychomycosis is a fungal infection that causes the nail beds to thicken, become brittle, and discolor. The normal curvature of nails is slightly convex. The nails may become concave, or spoon-shaped, due to various factors, such as iron deficiency, diabetes, injury, psoriasis, or irritants. Pitting of nails is a condition in which multiple small pits develop on the nails. A fissure is a skin lesion caused by linear cracks in the epidermis. The spoon-shaped nail is known as koilonychia.

Which statement by a patient with psoriasis indicates that education about the condition has been effective? 1 "I should avoid even moderate sunlight and UV rays." 2 "Psoriasis can be cured with systemic steroids." 3 "I should practice good handwashing technique." 4 "I must cover up the affected areas to prevent spread to others."

"I should practice good handwashing technique." Skin irritation or breaks seem to stimulate the growth of psoriatic plaques. Therefore, handwashing is important in helping to prevent infection. Moderate sunlight and ultraviolet rays slow down the rate at which epithelial cells are produced. Psoriasis is not contagious, but it cannot be cured.

When a patient has psoriasis, the patient should be given which instruction? 1 "Keep out of the sun." 2 "Avoid wearing dark clothing." 3 "Avoid foods high in vitamin D."

"Keep the skin as moist as possible." Patients with psoriasis will need instruction about the nature of their disease, the purpose of the prescribed treatment, and information about ways to avoid aggravating it. The skin should be kept as moist and pliable as possible. It is not necessary to avoid the sun, vitamin D, or dark clothing.

The nurse is providing education to a patient recently diagnosed with psoriasis. The patient demonstrates understanding of the teaching by making which statement(s)? Select all that apply. 1 "I will go buy a humidifier for my bedroom." 2 "I will buy only the moisturizers my provider recommends." 3 "I should use a salicylic acid cleanser on my skin prior to applying the steroid cream." 4 "I should be careful to avoid scratches from my pets because this will stimulate plaque growth." 5 "My daughter loves to buy me fancy body washes and moisturizers; I will have to ask her to stop." 6 "I am so sad I won't be able to spend time in the sun any longer. Golf and swimming are my two favorite things."

1 "I will go buy a humidifier for my bedroom." 2 "I will buy only the moisturizers my provider recommends." I should be careful to avoid scratches from my pets because this will stimulate plaque growth." t5 "My daughter loves to buy me fancy body washes and moisturizers; I will have to ask her to stop." The patient should be instructed to use a humidifier, use only cleansers and moisturizers that are approved by the primary health care provider, and avoid injuries to the skin that stimulate plaque formation. It is not necessary to avoid sunlight; in fact, moderate sun exposure may be therapeutic. Salicylic acid cleanser would not be helpful for this patient because it is drying to the skin and may worsen symptoms.

Which risk categories are measured by the Braden Scale assessment tool? Select all that apply. 1 Mobility 2 Incontinence 3 Mental status 4 Nutritional status 5 Pressure distribution

1 Mobility 2 Incontinence 3 Mental status 4 Nutritional status The Braden Scale is the most commonly used skin risk assessment tool. This validated tool helps to assess various risk categories for pressure ulcer formation, including mobility, mental status, incontinence, and nutritional status. Pressure distribution can be measured by the pressure mapping process.

Pressure mapping is used to measure pressure distribution. What does the blue color indicate in a pressure map? 1 Pressure ulcer severity 2 Greater heat production 3 Most common ulcer areas 4 Cooler area under lower pressure

4 Cooler area under lower pressure The process of pressure mapping involves the use of a computerized tool that measures pressure distribution for a person sitting in a chair or lying on a mattress. The map is displayed as colored areas on the computer screen based on temperature differences. Shades of blue indicate cooler areas under lower pressure. Greater heat production is indicated by shades of red. Severity and the most common pressure ulcer areas are not indicated on a pressure map.

A 56-year-old patient is admitted to the hospital with pneumonia and shingles. The nurse is aware that shingles is caused by which occurrence? 1 Reactivation of herpes simplex 2 Compromised immune function 3 Exposure to individuals with genital herpes 4 Activation of varicella-zoster in individuals who have had varicella

4 Activation of varicella-zoster in individuals who have had varicella Shingles is an activation of the chickenpox virus in an adult. Although related to it, the herpes simplex virus does not cause chickenpox or shingles. Herpes simplex II does not cause chickenpox or shingles. A compromised immune system (such as might occur when a patient has pneumonia or another infection the immune system is fighting) does predispose an individual to opportunistic viruses, such as herpes zoster and herpes simplex, however.

The patient is diagnosed with a mild form of psoriasis. The nurse should plan to provide education regarding which treatment methods? Select all that apply. 1 Cyclosporine 2 Methotrexate 3 Metronidazole 4 Moderate ultraviolet (UV) exposure 5 Topical triamcinolone acetonide 6 Psoralen plus ultraviolet A (PUVA) therapy

4 Moderate ultraviolet (UV) exposure 5 Topical triamcinolone acetonide Moderate UV exposure and topical steroids such as triamcinolone acetonide are used to treat mild psoriasis. Moderate to severe psoriasis may be treated with PUVA therapy, cyclosporine, or methotrexate. Psoriasis is not caused by a bacterial infection, so metronidazole is not indicated.

When a patient with burns has a full-thickness wound, which of these tissues are involved? 1 The subcutaneous fat only 2 The entire dermis and muscles 3 The deeper layers of the dermis only 4 The entire dermis and subcutaneous tissue

4 The entire dermis and subcutaneous tissue A method to evaluate the depth of burns is based on the layers of skin that have been damaged. Full-thickness wounds involve all layers of skin and the destruction of the epidermal appendages. Wounds of this type will require grafting for the wound to heal and for optimal function to be restored. Partial-thickness wounds are those in which the epidermal appendages (sweat and oil glands and hair follicles) are not destroyed; these wounds will heal by themselves if no further injury occurs from either infection or inappropriate treatment for the phases of wound healing. Grafting may or may not be necessary.

The aging patient asks the nurse the best way to prevent shingles. In addition to the shingles vaccine, which intervention should the nurse recommend? 1 Begin a tai chi class. 2 Apply calamine lotion to the skin daily. 3 Request a prescription for prophylactic antivirals. 4 Avoid contact with cats, litter boxes, and gardening.

Begin a tai chi class. A study has shown that tai chi boosted the positive effects of the shingles vaccine. Calamine lotion is helpful after a shingles outbreak has occurred, but it would not prevent an outbreak. It is not necessary or helpful to take prophylactic antivirals or avoid contact with cats, litter boxes, or gardening.

The patient presents to the clinic with a firm, swollen, red mass that is painful to the touch on the inner thigh and has begun to drain through many openings on the mass. The nurse uses which term to document this assessment? 1 Boil 2 Cellulitis 3 Furuncle 4 Carbuncle

Carbuncle A carbuncle is a collection of infected hair follicles that become a reddened, swollen, painful mass that drains from many openings. Furuncles, or boils, are inflammations of hair follicles that are generally 1 to 5 cm in diameter. Cellulitis is an infection of the dermis and subcutaneous tissue.

The patient has been diagnosed with contact dermatitis. The nurse knows which mechanism caused this patient's symptoms? 1 Bacterial infection 2 Humoral immunity 3 Cell-mediated immunity 4 Contact with an exogenous toxin Contact dermatitis is caused by a cell-mediated immune r

Cell-mediated immunity Contact dermatitis is caused by a cell-mediated immune reaction to an allergen. It is not caused by a bacterial infection, humoral immune response, or contact with an exogenous toxin.

When caring for a patient with pediculosis (lice) and scabies, the nurse would expect to implement which order? 1 Bed rest and parenteral antibiotics 2 Warm compresses and oatmeal baths 3 Administer oral and topical antibiotics 4 Contact isolation and administering permethrin and malathion

Contact isolation and administering permethrin and malathion In caring for a patient with lice and scabies, the nurse should expect to implement the order of placing the patient in contact isolation and treating the patient with the prescription drugs considered most effective against lice and scabies: permethrin, pyrethrins, and malathion. Bed rest and parenteral antibiotics, warm compresses and oatmeal baths, and administering oral and topical antibiotics are not treatments for lice and scabies.

The primary health care provider has prescribed cimetidine for a burn patient. The nurse informs the patient that this medication will help prevent development of which complication? 1 Hyperkalemia 2 Paralytic ileus 3 Curling's ulcer 4 Myoglobinuria

Curling's ulcer Curling's ulcer is a stress ulcer that occurs commonly in burn patients. Cimetidine is a histamine2 (H2) blocker and is effective in preventing ulcer formation. Cimetidine would not help prevent hyperkalemia, paralytic ileus, or myoglobinuria.

Tinea capitis, Microsporum audouinii, tinea corporis, and tinea pedis are examples of which type of infection? 1 Viral skin infections 2 Fungal skin infections 3 Bacterial skin infections 4 Infections acquired in restaurants

Fungal skin infections Tinea capitis, M. audouinii, tinea corporis, and tinea pedis are all examples of fungal skin infections. These dermatophytoses are superficial infections. These are not bacterial in origin; an example of a bacterial skin infection is cellulitis. These are not viral in nature; an example of a viral skin infection is herpes zoster. Fungal infections are not commonly acquired in restaurants. Tinea pedis, or athlete's foot, can be found between the toes of a person whose feet perspire heavily; it also can be spread from contaminated public bathroom facilities and swimming pools.

A patient who is recovering from a severe burn is permitted oral feedings. Which diet is most appropriate for this patient? 1 Low in protein and low in calories 2 Low in protein and high in calories 3 High in protein and low in calories 4 High in protein and high in calories

High in protein and high in calories A diet high in protein and calories is necessary for healing. The patient has increased metabolic needs directly proportional to the size of the burn area. Nutritional needs may be increased 50% to 150% above normal, and caloric requirements may be as high as 5000 calories per day. Caloric needs are calculated to include the patient's weight, age, and percentage of burn over total body surface.

The bed-ridden patient presents to the clinic with a crater-like ulcer on the right elbow. Subcutaneous fat can be seen in the wound base and there is a foul-smelling, purulent discharge. The nurse anticipates this pressure ulcer will be diagnosed at which stage? 1 I 2 II 3 III 4 IV

III Full-thickness loss of dermis into underlying tissue denotes a stage III pressure ulcer, and there is generally bacterial infection in the wound. Stage I pressure ulcers are areas of nonblanchable erythema over bony prominences. Stage II pressure ulcers have partial-thickness loss involving the epidermis and dermis. Stage IV pressure ulcers involve full-thickness loss and may involve the muscle and bone; necrotic tissue may be present.

The nurse is teaching a patient with loss of sensation and movement in the lower extremities secondary to spinal cord injury about protecting skin integrity. Which daily prevention strategy does the nurse include in the patient's teaching plan? 1 Eat a low-fat diet. 2 Massage reddened areas. 3 Complete a pressure map. 4 Lift hips off the chair at least every hour.

Lift hips off the chair at least every hour. Lifting the hips off the chair at least every hour relieves pressure and can prevent pressure ulcers. Eating a low-fat diet is not a daily prevention strategy for skin integrity. Reddened areas should never be massaged. Pressure mapping is not a daily activity and is not performed by the patient.

The patient presents to the clinic with silvery white, scaly lesions on the elbows, knees, and the base of the spine. The nurse anticipates which diagnosis? 1 Psoriasis 2 Acne rosacea 3 Seborrheic dermatitis 4 Systemic lupus erythematosus

Psoriasis Psoriasis is an autoimmune disease that presents with silvery white patches that generally occur on the elbows, knees, and the base of the spine. Acne rosacea is a redness on the cheeks and nose. Seborrheic dermatitis presents with yellow patches on the face and scalp. Lupus may present with a butterfly rash on the face.

A burn victim with second- and third-degree burns of the left arm is brought to the emergency department via ambulance. The nurse knows a major early concern in the care of this patient is the prevention of which complication? 1 Shock 2 Infection 3 Hemorrhage 4 Circulatory overload

Shock When a burn area is large, the inflammatory response can result in a massive shift of water, electrolytes, and protein into the tissues; this causes severe edema. Evaporation from denuded areas is four times higher than that from intact skin. Hyperkalemia occurs when potassium is released from the damaged cells. Hyponatremia is caused by the stress response and potassium shifts. Metabolic acidosis develops. The loss of fluids from the vascular space leads to hypovolemia with low blood pressure and, therefore, possible hypovolemic shock.

Which assessment is the nurse's highest priority in caring for a patient in the acute phase of burn injury? 1 Urine output 2 Bowel sounds 3 Muscle strength 4 Signs of infection

Signs of infection The patient with burn injury is at risk for infection as a result of open wounds and reduced immune function. Burn wound sepsis is a serious complication of burn injury, and infection is the leading cause of death during the acute phase of recovery. Assessing bowel sounds, muscle strength, and urine output are not the priority during the acute phase of burn injury.

he nurse is caring for a patient with an electrical burn. What should be monitored on this patient? 1 The lungs 2 The heart 3 The kidneys 4 The gastric mucosa

The heart Electrical burns damage tissue deep within the body. The extent of damage is not always visible, and the entrance site and exit site may appear small. Cardiac monitoring should be initiated even if the patient does not complain of chest pain. The lungs, kidneys, and gastric mucosa should be monitored with other types of burns.

A patient with herpes zoster is asking the nurse about her condition. What knowledge does the nurse base patient education on? 1 There is usually a rash that occurs in the thoracic region. 2 Herpes zoster usually is permanently disabling to healthy adults. 3 The pain experienced by most patients is typically described as "mild." 4 Steroids are usually avoided because of the immune system suppression.

There is usually a rash that occurs in the thoracic region. The rash usually occurs in the thorax region; vesicles erupt in a line along the involved nerve. The pain experienced by most patients is typically described as very severe. Herpes zoster usually is not permanently disabling to healthy adults. The greatest risk occurs to patients who have had a lower resistance to infection, such as those on chemotherapy or patients receiving large doses of prednisone, in whom the disease could be fatal because of the patient's compromised immune system. Analgesics often are prescribed for pain, including opioid analgesics. Steroids may be given to decrease inflammation and edema. Lotions may be used to relieve pruritus, and corticosteroids may be used to relieve pruritus and inflammation.

The home health nurse is caring for an older patient who is confined to bed. What interventions does the nurse take to prevent pressure ulcers in the patient? Select all that apply. 1 Do not massage bony prominences. 2 Place a bed pillow under the ankles. 3 Massage bony prominences twice a day. 4 Keep the head of the bed elevated to 40 degrees. 5 Perform a weekly assessment of the patient's skin.

1 Do not massage bony prominences. 2 Place a bed pillow under the ankles. The older patient confined to bed is predisposed to the formation of pressure ulcers. Massaging bony prominences must be avoided to prevent tearing the fragile skin. A pillow should be placed under the patient's ankles to prevent the heels from rubbing on the bed surface. 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 primary health care provider.

A nursing student is caring for a patient with open wound burns. Which interventions does the nursing student provide for this patient? Select all that apply. 1 Provides high-calorie meals 2 Performs frequent handwashing 3 Performs gloved dressing changes 4 Assists with weekly dressing changes 5 Assigns the patient to a semi-private room

1 Provides high-calorie meals 2 Performs frequent handwashing 3 Performs gloved dressing changes High-calorie intake promotes wound healing. Handwashing is the most effective technique for preventing infection. Gloves should be worn when changing dressings to reduce the risk for infection. Dressing changes are performed daily to several times a day. The patient should be assigned a private room.

The patient has been diagnosed with acne rosacea. The nurse should educate the patient to avoid which substances? Select all that apply. 1 Tea 2 Milk 3 Beer 4 Juice 5 Wine 6 Coffee

1 Tea 3 Beer 5 Wine 6 Coffee Caffeine-containing drinks (e.g., tea and coffee) and foods, alcoholic drinks (including beer and wine), and spicy foods cause flare-ups of rosacea. Milk and juice do not cause rosacea flare-up.

The nurse is assisting with creation of patient assignments for the day. Which staff member is most appropriate to care for a patient with an active shingles infection? 1 The 64-year-old female nurse who had shingles last year 2 The 27-year-pregnant nurse who had chickenpox as a child 3 The 24-year-old male nurse who has never had chickenpox 4 The 24-year-old female nurse who had chickenpox as a child

1 The 64-year-old female nurse who had shingles last year The 64-year-old female nurse is not likely to be pregnant and has been exposed to the herpes zoster virus. The 27-year-old pregnant nurse and the male nurse who never had chickenpox should avoid contact with this patient because the virus can harm the fetus, and it is very contagious and dangerous for individuals who have never been exposed. The 24-year-old female nurse, although she had chickenpox as a child, may be pregnant and is therefore not the best choice to be this patient's caregiver.

When the nurse is assessing the skin of an older patient, which data will be most important to report to the primary health care provider? 1 Liver spots are present on both hands. 2 The skin on the extremities is paper thin. 3 A multicolored lesion is present on the patient's thigh. 4 Cherry red hemangiomas are scattered on the patient's back.

A multicolored lesion is present on the patient's thigh. Color variation within a lesion is associated with skin cancer; the primary health care provider should be informed so that the lesion can be further assessed. Liver spots, cherry red hemangiomas, and loss of skin elasticity are findings that are associated with aging and are normal for the older adult.

The patient is taking oral antifungal medication for treatment of onychomycosis. Which laboratory tests are most important for this patient? Select all that apply. 1 Creatinine 2 Hemoglobin A1c 3 Blood urea nitrogen (BUN) 4 High-density lipoprotein (HDL) 5 Alanine aminotransferase (ALT) 6 Aspartate aminotransferase (AST)

Alanine aminotransferase (ALT) 6 Aspartate aminotransferase (AST) Systemic antifungal medications are highly hepatotoxic; therefore liver function tests (ALT and AST) should be monitored closely. It is less important to monitor the patient's cholesterol levels (HDL), kidney function (BUN and creatinine), and hemoglobin A1c.

A patient with burn injuries states, "I feel so helpless." Which nursing intervention is most helpful for this patient? 1 Encourage visitors. 2 Encourage participation in wound care. 3 Tell the patient that these feelings are normal. 4 Reassure the patient that he or she will be fine.

Encourage participation in wound care. Encouraging participation in wound care will offer the patient some sense of control. Encouraging visitors may be a good distraction but will not help the patient achieve a sense of control. Telling the patient that his or her feelings are normal may be reassuring but does not address the patient's issue of feeling helpless. Reassuring the patient that he or she will be fine is neither helpful nor therapeutic.

A patient's burns have become infected with Pseudomonas. The nurse should anticipate using which topical dressing? 1 Silver nitrate 2 Povidone-iodine 3 Mafenide acetate 4 Silver sulfadiazine

Mafenide acetate Mafenide acetate is effective against a Pseudomonas infection. The patient should also receive pain medication before dressing changes; this medication produces a burning sensation when applied to wounds. Silver nitrate, silver sulfadiazine, and povidone-iodine are not the best options for a Pseudomonas infection.

A patient is in the resuscitation phase of burn injury. Which route does the nurse use to administer pain medication to the patient? 1 Topical 2 Sublingual 3 Intravenous (IV) 4 Intramuscular (IM)

Intravenous (IV) During the resuscitation post-burn phase, the IV route is used for administering opioid drugs because of problems with absorption from the muscle and stomach. When these agents are given by the IM or subcutaneous route, they remain in the tissue spaces and do not relieve pain. In addition, when edema is present, all doses are rapidly absorbed at once when the fluid shift is resolving. This delayed absorption can result in lethal blood levels of analgesics. Because the skin is too damaged, the sublingual route and the topical route are not indicated for administering drugs to the patient in the resuscitation phase of burn injury.

A patient with extensive burns experiences pain when admitted to the emergency department. The LPN/LVN should anticipate that pain medication at this time should be given via which route? 1 Orally 2 Subcutaneously 3 Intramuscularly 4 Intravenously

Intravenously As soon as IV lines are established and fluid resuscitation is begun, pain control can begin. Measures to relieve pain include the IV administration of morphine or hydromorphone hydrochloride. Oral, subcutaneous, and intramuscular administration of pain medication are not the most effective for control of the severe acute pain that occurs with extensive burns.

What is a characteristic of herpes simplex type 2? 1 It is commonly known as a cold sore and generally occurs near the lips. 2 It usually affects the tongue in women and near the nose in men. 3 It is characterized by a vesicle at the corner of the mouth, lips, or nose. 4 It is accompanied by flulike symptoms 3 to 4 days after the vesicles erupt.

It is accompanied by flulike symptoms 3 to 4 days after the vesicles erupt. Herpes simplex type 2 is accompanied by flulike symptoms 3 to 4 days after the vesicles erupt. Headache, fatigue, myalgia, elevated temperature, and anorexia are common. It usually affects the cervix in women and the penis in men. Herpes simplex type 2 causes lesions in the genital area and is commonly known as genital herpes. The primary mode of transmission is through sexual contact. Herpes simplex type 1 is commonly known as a cold sore and is characterized by a vesicle at the corner of the mouth, lips, or nose.

The nurse is preparing to care for a patient with psoriasis. The nurse should anticipate which skin assessment? 1 Fluid-filled blisters 2 Patches covered with silvery scales 3 Zigzag lesions that are slightly raised 4 An area of local swelling and redness

Patches covered with silvery scales Psoriasis is a noncontagious, chronic, and recurring skin disorder that typically appears as inflamed, edematous skin lesions covered with adherent silvery-white scales. These scales are the result of an abnormally rapid rate of proliferation of skin cells. Zigzag lesions, fluid-filled blisters, or an area of local swelling and redness are not anticipated assessment data in a patient with psoriasis.

A patient in the long-term care unit has an erosion in the skin. The lesion involves the epidermis, dermis, and a portion of the subcutaneous tissue. What should the nurse document this lesion as? 1 Bullae 2 Plaque 3 Macule 4 Pressure ulcer

Pressure ulcer Pressure ulcers are depressions in the skin that develop when the patient remains immobile for a long period of time. Pressure ulcers extend to the subcutaneous tissue and are graded according to their depth; the one described would be considered a stage III ulcer. A bullae is a vesicle filled with clear fluid and having a diameter more than 1 cm. Plaques are elevated patches that are greater than 1 cm in diameter. Macules are flat lesions that are less than 1 cm in diameter.

What is the best way for the nurse to prevent a patient's stage I pressure ulcer from advancing to stage II? 1 Pad the ulcer. 2 Massage the reddened areas. 3 Suggest an egg crate foam mattress. 4 Promote mobility and/or frequent repositioning.

Promote mobility and/or frequent repositioning. Frequent repositioning and/or promoting mobility is the best way to prevent further deterioration of this patient's pressure ulcer. Reddened areas should never be massaged. Padding the ulcer may not be appropriate. An egg crate foam mattress may be suggested but is not the best option.

The nurse observes multiple small pits in all of a patient's fingernails. The nurse suspects that the patient may have which condition? 1 Psoriasis 2 Cystic fibrosis 3 Iron deficiency anemia 4 Severe malnutrition

Psoriasis Pitting of the nails may be associated with psoriasis. Late clubbing of the fingernails is a sign of cystic fibrosis. Spoon nails (koilonychia) are a sign of iron deficiency anemia. Beau's grooves are a sign of isolated periods of severe malnutrition.

What does the nurse tell an older patient and the patient's family about preventing skin cancer? Report any changes in lesions. 2 Keep track of spots on the arms and legs. 3 Wear warm protective clothing during the day. 4 Avoid exposure to the sun early in the morning.

Report any changes in lesions. Any changes in existing lesions should be reported to the primary health care provider, such as changes in color, size, shape, sensation, or character of the lesion. The patient should avoid exposure to the sun between 11 a.m. and 3 p.m. when ultraviolet light is at its strongest. The patient should wear a hat, sunglasses, and opaque clothing when going out in the sun. The patient should also keep a body map of all spots, scars, or lesions.

An older patient suffering from stasis dermatitis comes to the clinic for a checkup. What signs/symptoms will the nurse expect to see with stasis dermatitis? 1 Facial redness 2 Red, rough skin 3 White and yellow plaques 4 Scaling and hyperpigmentation

Scaling and hyperpigmentation Stasis dermatitis is seen on the patient's legs with signs/symptoms of scaling, hyperpigmentation, erythema, and pruritus. It is generally seen with venous stasis in conjunction with varicosities, phlebitis, and vascular trauma. Red, rough skin and facial redness are not part of stasis dermatitis. White and yellow plaques are seen with seborrheic dermatitis.

The patient presents to the clinic with white and yellow scaly plaques on the scalp, eyelids, upper lip, axillae, and back. The nurse anticipates which diagnosis? 1 Stasis dermatitis 2 Atopic dermatitis 3 Contact dermatitis 4 Seborrheic dermatitis

Seborrheic dermatitis Seborrheic dermatitis appears as scaly, yellow and white plaques that itch. Stasis dermatitis is common in patients with venous stasis and edema (as in congestive heart failure) and begins as erythema and pruritus, which changes to petechiae, scaliness, and excessive pigmentation. Atopic dermatitis is eczema. Contact dermatitis is caused when an irritant touches the skin.

When a patient has herpes zoster (shingles), the LPN/LVN should expect the patient to report which symptom? 1 Severe, persistent pain 2 A rash on the arms 3 Pustules on the legs 4 Respiratory involvement

Severe, persistent pain Shingles begins with vague symptoms of chills and low-grade fever and possibly some gastrointestinal disturbance. There may be only aching or discomfort along the nerve pathway with or without erythema. About 3 to 5 days after onset, small groups of vesicles appear on the skin. They are usually found on the trunk and spread halfway around the body, following the nerve pathways leading from the spinal nerve to the skin. Rash on the extremities and respiratory involvement are not expected.

A patient with congestive heart failure and peripheral edema comes to the clinic complaining of a history of redness and itching on the bilateral lower legs, which have turned dark and scaly. The nurse anticipates which diagnosis? 1 Stasis dermatitis 2 Atopic dermatitis 3 Contact dermatitis 4 Seborrheic dermatitis

Stasis dermatitis Stasis dermatitis is common in patients with venous stasis and edema (as in congestive heart failure). It begins as erythema and pruritus, which changes to petechiae, scaliness, and excessive pigmentation. Atopic dermatitis is eczema. Contact dermatitis is caused when an irritant touches the skin. Seborrheic dermatitis appears as scaly, yellow and white plaques that itch.

An LPN/LVN has just taken the health history of a frail older patient. Which finding best supports the admitting diagnosis of a stage III pressure ulcer over the presacral region? 1 The patient lives alone on a fixed income without assistance to perform bathing. She is not able to cook her own meals. 2 The skin is dry with loose skinfolds. The patient has lost 3 pounds over the past year, due to chronic poor appetite. 3 The patient has been diabetic for more than 20 years, follows the American Diabetes Association diet, and takes oral metformin as prescribed. 4 The patient fell 2 weeks ago and has been resting in bed because movement is painful. The patient is having difficulty getting to the bathroom in time.

The patient fell 2 weeks ago and has been resting in bed because movement is painful. The patient is having difficulty getting to the bathroom in time. Immobility and lying in bed puts increased pressure on bony prominences. Not getting to the bathroom in time leads to incontinence, which affects skin integrity. All of these findings place this patient at risk for a pressure ulcer. A history of diabetes is less likely than immobility and incontinence to contribute to the formation of pressure ulcers. Dry skin in loose folds would suggest dehydration rather than pressure ulcers. The patient's economic background is less likely than immobility and incontinence to contribute to the formation of pressure ulcers.

An older patient is suffering from a decreased rate of toenail growth. What does the nurse instruct the patient regarding how to protect the toenails from infection? 1 Wear wool socks. 2 Wear cotton socks. 3 Keep the feet uncovered. 4 Keep the toenails bandaged

Wear cotton socks. An older patient who has a decreased rate of nail growth is prone to develop fungal infections. To protect against this, the patient should keep the feet and toes clean and hygienic and wear cotton socks. If the feet are kept uncovered, the chance of developing infection is greater. Wearing woolen socks may be uncomfortable for the patient, and excessive sweating may lead to infection. Bandaging the toenails is an impractical and unnecessary approach, and may be very uncomfortable.