Skin Cancer Med Surg Success & Test Bank

32. The client is admitted to the outpatient surgery center for removal of a malignant melanoma. Which assessment data indicate the lesion is a malignant melanoma? 1. The lesion is asymmetrical and has irregular borders. 2. The lesion has a waxy appearance with pearl- like borders. 3. The lesion has a thickened and scaly appearance. 4. The lesion appeared as a thickened area after an injury.

1. Malignant melanomas are the most deadly of the skin cancers. Asymmetry, irregu- lar borders, variegated color, and rapid growth are characteristic of them.

33. The client has had a squamous cell carcinoma removed from the lip. Which discharge instructions should the nurse provide? 1. Notify the HCP if a nonhealing lesion develops around the mouth. 2. Squamous cell carcinoma tumors do not metastasize. 3. Limit foods to liquid or soft consistency for one (1) month. 4. Apply heat to the area for 20 minutes every four (4) hours.

1. The client should be aware of symptoms that indicate development of another skin cancer. Squamous cell carcinoma can develop in areas of the skin and mucous membranes.

27. The nurse is caring for clients in an outpatient surgery clinic. Which client should be assessed first? 1. The client scheduled for a skin biopsy who is crying. 2. The client who had surgery three (3) hours ago and is sleeping. 3. The client who needs to void prior to discharge. 4. The client who has received discharge instructions and is ready to go home.

1. This client has an unexpected situation occurring and should be assessed before any stable client.

26. The female client admitted for an unrelated diagnosis asks the nurse to check her back because "it itches all the time in that one spot." When the nurse assesses the client's back, the nurse notes an irregular-shaped lesion with some scabbed-over areas surrounding the lesion. Which action should the nurse implement first? 1. Notify the HCP to check the lesion on rounds. 2. Measure the lesion and note the color. 3. Apply lotion to the lesion. 4. Instruct the client to make sure the HCP checks the lesion.

2. This is part of assessing the lesion and should be completed. The ABCDs of skin cancer detection include the following: (1) Asymmetry—Is the lesion balanced on both sides with an even surface? (2) Borders—Are the borders rounded and smooth or notched and indistinct? (3) Color—Is the color a uniform light brown or is it variegated and darker or reddish purple? (4) Diameter—A diameter exceed- ing 4 to 6 mm is considered suspicious.

35. The male client diagnosed with acquired immunodeficiency syndrome (AIDS) states that he has developed a purple-brown spot on his calf. Which action should the nurse do first? 1. Refer the client to an HCP for a biopsy of the area. 2. Assess the lesion for size, color, and symmetry. 3. Discuss end-of-life decisions with the client. 4. Report the sexually transmitted illness to the health department.

2. This is the first step in deciding how to help the client. The nurse should assess the lesion to determine if it could be a Kaposi's sarcoma tumor or a healing contusion.

30. The nurse is caring for a client diagnosed with squamous cell skin cancer and writes a psychosocial problem of "fear." Which nursing interventions should be included in the plan of care? 1. Explain to the client that the fears are unfounded. 2. Encourage the client to verbalize the feeling of being afraid. 3. Have the HCP discuss the client's fear with the client. 4. Instruct the client regarding all planned procedures.

2. This is the most commonly written therapeutic communication goal. This ad- dresses the client's concerns.

34. Which client physiological outcome (goal) is appropriate for a client diagnosed with skin cancer who has had surgery to remove the lesion? 1. The client will express feelings of fear. 2. The client will ask questions about the diagnosis. 3. The client will state a diminished level of pain. 4. The client will demonstrate care of the operative site.

3. Pain is a physiological problem; this is an appropriate physiological goal.

25. The school nurse is preparing to teach a health promotion class to high school seniors. Which information regarding self-care should be included in the teaching? 1. Wear a sunscreen with a protection factor of 10 or less when in the sun. 2. Try to stay out of the sun between 0300 and 0500 daily. 3. Perform a thorough skin check monthly. 4. Remember caps and long sleeves do not help prevent skin cancer.

3. The American Cancer Society recom- mends a monthly skin check using mirrors to identify any suspicious skin lesion for early detection.

31. The nurse and an unlicensed assistive personnel (UAP) are caring for clients in a dermatology clinic. Which task should not be delegated to the UAP? 1. Stock the rooms with the equipment needed. 2. Weigh the clients and position the clients for the examination. 3. Discuss problems the client has experienced since the previous visit. 4. Take the biopsy specimens to the laboratory.

3. This is part of assessing the client and cannot be delegated.

28. Which client is at the greatest risk for the development of skin cancer? 1. The African American male who lives in the northeast. 2. The elderly Hispanic female who moved from Mexico as a child. 3. The client who has a family history of basal cell carcinoma. 4. The client with fair complexion who cannot get a tan.

4. Clients with very little melanin in the skin (fair-skinned) have an increased risk as a result of the UV damage to the underly- ing membranes. Damage to the underly- ing membranes never completely reverses itself; a lifetime of damage causes changes at the cellular level that can result in the development of cancer.

29. The middle-aged client has had two (2) lesions diagnosed as basal cell carcinoma removed. Which discharge instruction should the nurse include? 1. Teach the client that there is no more risk for cancer. 2. Refer the client to a prosthesis specialist for prosthesis. 3. Instruct the client how to apply sunscreen to the area. 4. Demonstrate care of the surgical site.

4. On discharge, all clients should receive in- structions in the care of surgical incisions.

36. The nurse participating in a health fair is discussing malignant melanoma with a group of clients. Which information regarding the use of sunscreen is important to include? 1. Sunscreen is only needed during the hottest hours of the day. 2. Toddlers should not have sunscreen applied to their skin. 3. Sunscreen does not help prevent skin cancer. 4. The higher the number of the sunscreen, the more it blocks UV rays.

4. Sunscreen products range in numerical value from 4 to 50; the higher the num- ber of the sunscreen, the greater the UV protection.

A patient has recently been diagnosed with advanced malignant melanoma and is scheduled for a wide excision of the tumor on her chest. In writing the plan of care for this patient, what major nursing diagnosis should the nurse include? A) Deficient Knowledge about Early Signs of Melanoma B) Chronic Pain Related to Surgical Excision and Grafting C) Depression Related to Reconstructive Surgery D) Anxiety Related to Lack of Social Support

Ans: A Feedback: The fact that the patient's disease was not reported until an advanced stage suggests that the patient lacked knowledge about skin lesions. Excision does not result in chronic pain. Reconstructive surgery is not a certainty, and will not necessarily lead to depression. Anxiety is likely, but this may or may not be related to a lack of social support.

A nurse is leading a health promotion workshop that is focusing on cancer prevention. What action is most likely to reduce participants' risks of basal cell carcinoma (BCC)? A) Teaching participants to improve their overall health through nutrition B) Encouraging participants to identify their family history of cancer C) Teaching participants to limit their sun exposure D) Teaching participants to control exposure to environmental and occupational radiation

Ans: C Feedback: Sun exposure is the best known and most common cause of BCC. BCC is not commonly linked to general health debilitation, family history, or radiation exposure.

A public health nurse is participating in a health promotion campaign that has the goal of improving outcomes related to skin cancer in the community. What action has the greatest potential to achieve this goal? A) Educating participants about the relationship between general health and the risk of skin cancer B) Educating participants about treatment options for skin cancer C) Educating participants about the early signs and symptoms of skin cancer D) Educating participants about the health risks associated with smoking and assisting with smoking cessation

Ans: C Feedback: The best hope of decreasing the incidence of skin cancer lies in educating patients about the early signs. There is a relationship between general health and skin cancer, but teaching individuals to identify the early signs and symptoms is more likely to benefit overall outcomes related to skin cancer. Teaching about treatment options is not likely to have a major effect on outcomes of the disease. Smoking is not among the major risk factors for skin cancer.

A patient with squamous cell carcinoma has been scheduled for treatment of this malignancy. The nurse should anticipate that treatment for this type of cancer will primarily consist of what intervention? A) Chemotherapy B) Radiation therapy C) Surgical excision D) Biopsy of sample tissue

Ans: C Feedback: The primary goal of surgical management of squamous cell carcinoma is to remove the tumor entirely. Radiation therapy is reserved for older patients, because x-ray changes may be seen after 5 to 10 years, and malignant changes in scars may be induced by irradiation 15 to 30 years later. Obtaining a biopsy would not be a goal of treatment; it may be an assessment. Chemotherapy and radiation therapy are generally reserved for patients who are not surgical candidates.

A patient has just been told that he has malignant melanoma. The nurse caring for this patient should anticipate that the patient will undergo what treatment? A) Chemotherapy B) Immunotherapy C) Wide excision D) Radiation therapy

Ans: C Feedback: Wide excision is the primary treatment for malignant melanoma, which removes the entire lesion and determines the level and staging. Chemotherapy may be used after the melanoma is excised. Immunotherapy is experimental and radiation therapy is palliative.

While performing an initial assessment of a patient admitted with appendicitis, the nurse observes an elevated blue-black lesion on the patient's ear. The nurse knows that this lesion is consistent with what type of skin cancer? A) Basal cell carcinoma B) Squamous cell carcinoma C) Dermatofibroma D) Malignant melanoma

Ans: D Feedback: A malignant melanoma presents itself as a superficial spreading melanoma which may appear in a combination of colors, with hues of tan, brown, and black mixed with gray, blue-black, or white. The lesion tends to be circular, with irregular outer portions. BCC usually begins as a small, waxy nodule with rolled, translucent, pearly borders; telangiectatic vessels may be present. SCC appears as a rough, thickened, scaly tumor that may be asymptomatic or may involve bleeding. A dermatofibroma presents as a firm, dome-shaped papule or nodule that may be skin colored or pinkish-brown.

A nurse is providing care for a patient who has developed Kaposi's sarcoma secondary to HIV infection. The nurse should be aware that this form of malignancy originates in what part of the body? A) Connective tissue cells in diffuse locations B) Smooth muscle cells of the gastrointestinal and respiratory tract C) Neural tissue of the brain and spinal cord D) Endothelial cells lining small blood vessels

Ans: D Feedback: Kaposi's sarcoma (KS) is a malignancy of endothelial cells that line the small blood vessels. It does not originate in connective tissue, smooth muscle cells of the GI and respiratory tract, or in neural tissue.

A patient has just undergone surgery for malignant melanoma. Which of the following nursing actions should be prioritized? A) Maintain the patient on bed rest for the first 24 hours postoperative. B) Apply distraction techniques to relieve pain. C) Provide soft or liquid diet that is high in protein to assist with healing. D) Anticipate the need for, and administer, appropriate analgesic medications.

Ans: D Feedback: Nursing interventions after surgery for a malignant melanoma center on promoting comfort, because wide excision surgery may be necessary. Anticipating the need for and administering appropriate analgesic medications are important. Distraction techniques may be appropriate for some patients, but these are not a substitute for analgesia. Bed rest and a modified diet are not necessary.