Chapter 61: Management of Patients with Dermatologic Disorders

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? "Apply sunscreen even on overcast days." "Minimize sun exposure from 1 to 4 p.m., when the sun is strongest." "Use a sunscreen with a sun protection factor of 6 or higher." "When at the beach, sit in the shade to prevent sunburn."

"Apply sunscreen even on overcast days." Sunscreen should be applied even on overcast days, because the sun's rays are as damaging then as on sunny days. The sun is strongest from 10 a.m. to 3 p.m. (11 a.m. to 4 p.m. daylight saving time) — not from 1 to 4 p.m. Sun exposure should be minimized during these hours. The nurse should recommend sunscreen with a sun protection factor of at least 15. Sitting in the shade when at the beach doesn't guarantee protection against sunburn because sand, concrete, and water can reflect more than half the sun's rays onto the skin.

A patient's severe and widespread psoriasis has prompted her care provider to prescribe potent topical corticosteroids. When teaching this patient about her new medication regimen, the nurse should recognize that topical corticosteroids that are applied to large skin surfaces create a risk of: Disseminated intravascular coagulation (DIC) Hypothyroidism Adrenal suppression Kaposi's sarcoma

Adrenal suppression When psoriasis involves large areas of the body, topical corticosteroid treatment can be expensive and involve some systemic risk. The more potent corticosteroids, when applied to large areas of the body, have the potential to cause adrenal suppression through percutaneous absorption of the medication. This treatment is not associated with a risk of DIC, Kaposi's sarcoma, or hypothyroidism.

A client has been diagnosed with shingles. Which of the following medication classifications will reduce the severity and prevent development of new lesions? Antipyretics Corticosteroids Analgesics Antiviral

Antiviral Oral acyclovir (Zovirax), when taken within 48 hours of the appearance of symptoms, reduces their severity, and prevents the development of additional lesions. Corticosteroids, analgesics,, and antipyretics are not used for this purpose.

Which of the following uses the body's own digestive enzymes to break down necrotic tissues? Enzymatic debridement Wet dressings Wet to dry dressings Autolytic debridement

Autolytic debridement Autolytic debridement is a process that uses the body's own digestive enzymes to break down necrotic tissue. Application of enzymatic debriding agents speeds the rate at which necrotic tissues is removed. A form of mechanical debridement is a wet to dry dressing, which removes necrotic tissue and absorbs small to large amounts of exudates.

The nurse is providing instruction to a client with acne. The nurse promotes avoidance of which food(s)? Select all that apply. Bananas Chocolate Ice cream Onions

Chocolate Ice cream The nurse should promote avoidance of foods associated with flare-up of acne, particularly those high in refined sugars, including chocolate, cola, and ice cream.

The nurse is working with community groups. At which of the following locations would the nurse anticipate a possible scabies outbreak? Gymnasium College dormitory Swimming pool Shopping mall

College dormitory The nurse is correct to anticipate a potential scabies outbreak in a college dormitory. Outbreaks are common where large groups of people are confined or housed. Spread of scabies is from skin-to-skin contact. Although there are groups of people at the shopping mall, swimming pool, and gymnasium, typically, there is no personal contact.

Which medication classification may be used for contact dermatitis? Corticosteroids Antifungals Antivirals Saline irrigations

Corticosteroids Corticosteroids are used for contact dermatitis. Antifungals, antivirals, and saline irrigations are not used in the treatment of contact dermatitis.

The nurse is assessing a client's skin when the client points out a mole. The nurse brings the mole to the physician's attention when which characteristic is noted? Uniform light brown color Diameter exceeding 6 mm Symmetrical appearance Distinct borders

Diameter exceeding 6 mm The nurse brings the mole to the physician's attention when characteristics of melanoma are detected, such as a diameter exceeding 6 mm. Other characteristics of melanoma include asymmetric appearance; irregular, indistinct borders; and red, white, or blue coloration.

A dermatologist recommends an over-the-counter suspension to relieve pruritus. The nurse advises the patient that the lotion should be applied: Twice a day to prevent crusting on the skin. Every 3 to 4 hours for sustained effectiveness. Overnight to enhance absorption. Hourly to prevent evaporation.

Every 3 to 4 hours for sustained effectiveness. Lotions are frequently used to replenish lost skin oils or to relieve pruritus. They are usually applied directly to the skin, but a dressing soaked in the lotion can be placed on the affected area. Lotions must be applied every 3 or 4 hours for sustained therapeutic effect because if left in place for a long period, they may crust and cake on the skin.

Which of the following nonsedating antihistamines is appropriate for daytime pruritus? Lorazepam (Ativan) Fexofenadine (Allegra) Hydroxyzine (Atarax) Diphenhydramine (Benadryl)

Fexofenadine (Allegra) Nonsedating antihistamine medications such as Allegra are more appropriate to relieve daytime pruritus. Benadryl or Atarax, when prescribed in a sedative dose at bedtime, may be beneficial in producing a restful and comfortable sleep. Ativan has sedating properties and is used as an antianxiety medication.

Which term refers most precisely to a localized skin infection of a single hair follicle? Comedone Carbuncle Furuncle Cheilitis

Furuncle Furuncles occur anywhere on the body but are most prevalent in areas subjected to irritation, pressure, friction, and excessive perspiration, such as the back of the neck, the axillae, or the buttocks. A carbuncle is a localized skin infection involving several hair follicles. Cheilitis refers to dry cracking at the corners of the mouth. Comedones are the primary lesions of acne, caused by sebum blockage in the hair follicle.

Development of malignant melanoma is associated with which risk factor? Residence in the Northeast African American heritage History of severe sunburn Skin that tans easily

History of severe sunburn Ultraviolet rays are strongly suspected as the etiology of malignant melanoma. Fair-skinned, blue-eyed, light-haired people of Celtic or Scandinavian origin are at higher risk for developing malignant melanoma. People who burn and do not tan are at risk for developing malignant melanoma. Elderly individuals who retire to the southwestern United States seem to have a higher incidence of developing malignant melanoma.

Which drug is an oral retinoid used to treat acne? Benzoyl peroxide Tetracycline Estrogen Isotretinoin

Isotretinoin Isotretinoin, an oral retinoid, is used in clients diagnosed with nodular cystic acne that does not respond to conventional therapy. Estrogen, tetracycline, and benzoyl peroxide are not oral retinoids.

When caring for a client in a prenatal clinic who has history of acne vulgaris, which client medication would the nurse advise against? Tazarotene Tretinoin Isotretinoin Benzoyl peroxide

Isotretinoin The nurse is correct to screen for the acne medication, isotretinoin (Accutane). It is contraindicated for pregnant females or those who may become pregnant due to the potential of first trimester miscarriages and congenital malformations.

The nurse assesses the client and observes reddish-purple to dark blue macules, plaques, and nodules. The nurse recognizes that these manifestations are associated with which condition? Kaposi sarcoma Platelet disorders Syphilis Allergic reactions

Kaposi sarcoma Kaposi sarcoma is a frequent comorbidity of clients with AIDS. With platelet disorders, the nurse observes ecchymosis (bruising) and purpura (bleeding into the skin). Urticaria (wheals or hives) is the manifestation of allergic reactions. A painless chancre or ulcerated lesion is a typical finding in clients with syphilis.

During a routine checkup, a client refers to a recent change in the color of the skin. Which of the following should the nurse suggest to the client? Start chemotherapy. Consider skin grafting. Get a biopsy done as soon as possible. Make an appointment for a medical examination as soon as possible.

Make an appointment for a medical examination as soon as possible. The nurse should encourage all those with any type of skin change to seek medical attention because it may be a sign of skin cancer. Diagnosis is made by visual inspection and confirmed by a biopsy, but it is not the recommended suggestion. The treatment of melanoma involves a radical excision of the tumor and the adjacent tissues followed by chemotherapy. In some instances, skin grafting may be necessary to replace large areas of defect when a wide excision of the tumor is necessary. Chemotherapy and skin grafting should be done only after the confirmation of skin cancer and as a treatment for skin cancer.

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? Povidone-iodine-soaked gauze Sterile petroleum gauze Dry sterile dressing Moist sterile saline gauze

Moist sterile saline gauze Moist sterile saline dressings support wound healing and are cost-effective. Dry sterile dressings adhere to the wound and debride the tissue when removed. Petroleum supports healing but is expensive. Povidone-iodine is used as an antiseptic cleaning agent but because it can irritate epithelial cells, it shouldn't be left on an open wound.

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? Dandruff is throughout the hair. Nits are located near the scalp. Dandruff looks white and flakey. Nits are difficult to move from hair shafts.

Nits are difficult to move from hair shafts. The nurse is correct to use the difference of the nits being securely attached to the hair shaft as a guide to confirmation of lice infestation. Dandruff is fine, white particles of dead, dry scalp cells that can be easily picked from the hair.

A patient is diagnosed with malignant melanoma that directly invades the adjacent dermis (vertical growth). The nurse knows that this type of melanoma has a poor prognosis. Which of the following is most likely the type of melanoma described in this scenario? Superficial spreading Lentigo-maligna Nodular melanoma Acral-lentiginous

Nodular melanoma A nodular melanoma is a spherical, blueberry-like nodule with a relatively smooth surface and a relatively uniform, blue-black color. A nodular melanoma invades directly into adjacent dermis (i.e., vertical growth) and therefore has a poorer prognosis.

A nurse is admitting a client with toxic epidermal necrolysis. What is the nursing priority in preventing sepsis? Limiting protein to limit liver failure Preventing infection Assessing for hemorrhage Hydrating to prevent renal failure

Preventing infection The major cause of death from toxic epidermal necrolysis is from sepsis. Monitoring vital signs closely and noticing changes in respiratory, kidney, and gastrointestinal function may help the nurse to quickly detect the beginning of an infection. Strict asepsis is always maintained during routine skin care measures. Hand hygiene and wearing sterile gloves when carrying out procedures are essential. Visitors should wear protective garments and wash their hands before and after coming into contact with the patient. People with any infections or infectious disease should not visit the patient until they are no longer a danger to the patient. The nurse is critical in identifying early signs and symptoms of infection and notifying the primary provider. Antibiotic agents are not generally begun until there is an indication for the use. Hemorrhage, renal failure, and liver failure are not the major causes of toxic epidermal necrolysis.

A nurse assesses a client with dry, rough, scaly skin without lesions and the presence of itching on the legs. What skin assessment would the nurse document? Seborrhea Shingles Candidiasis Pruritus

Pruritus Pruritus (itching) is one of the most common symptoms of patients with dermatologic disorders. Itch receptors are unmyelinated, penicillate (brush-like) nerve endings that are found exclusively in the skin, mucous membranes, and cornea. Shingles is a skin condition with lesions. Candidiasis is a red condition often found in the folds of skin. Seborrhea refers to dry scaly patches usually located on the scalp.

Photochemotherapy has been used as a treatment for which of the following skin disorders? Allergic dermatitis Shingles Rosacea Psoriasis

Psoriasis Photochemotherapy is used for severe, disabling psoriasis that does not respond to other methods of treatments.

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? Psoriasis is an inflammatory dermatosis that results from an overproduction of keratin. Psoriasis results from excess deposition of subcutaneous fat. Psoriasis comes from dermal abrasion. Psoriasis is an inflammatory dermatosis that results from a superficial infection with Staphylococcus aureus.

Psoriasis is an inflammatory dermatosis that results from an overproduction of keratin. Current evidence supports an autoimmune basis for psoriasis (Porth & Matfin, 2009). Periods of emotional stress and anxiety aggravate the condition, and trauma, infections, and seasonal and hormonal changes may also serve as triggers. In this disease, the epidermis becomes infiltrated by activated T cells and cytokines, resulting in both vascular engorgement and proliferation of keratinocytes. Epidermal hyperplasia results.

A patient is scheduled for Mohs microscopic surgery for removal of a skin cancer lesion on his forehead. The nurse knows to prepare the patient by explaining that this type of surgery requires: A process of deep-freezing the tumor, thawing and refreezing. Destruction of the tissue by electrical energy. Removal of the tumor, layer by layer. The use of radiation therapy.

Removal of the tumor, layer by layer. Mohs micrographic surgery removes the tumor layer by layer. The first layer excised includes all evident tumor and a small margin of normal-appearing tissue. The specimen is frozen and analyzed by section to determine if all the tumor has been removed. If not, additional layers of tissue are shaved and examined until all tissue margins are tumor-free.

A 10-year-old child is brought to the office with complaints of severe itching in both hands that's especially annoying at night. On inspection, the nurse notes gray-brown burrows with epidermal curved ridges and follicular papules. The physician performs a lesion scraping to assess this condition. Based on the signs and symptoms, what diagnosis should the nurse expect? Contact dermatitis Dermatophytosis Scabies Impetigo

Scabies Signs and symptoms of scabies include gray-brown burrows, epidermal curved or linear ridges, and follicular papules. Clients complain of severe itching that usually occurs at night. Scabies commonly occurs in school-age children. The most common areas of infestation are the finger webs, flexor surface of the wrists, and antecubital fossae. Impetigo is a contagious, superficial skin infection characterized by a small, red macule that turns into a vesicle, becoming pustular with a honey-colored crust. Contact dermatitis is an inflammation of the skin caused by contact with an irritating chemical or allergen. Dermatophytosis, or ringworm, is a disease that affects the scalp, body, feet, nails, and groin. It's characterized by erythematous patches and scaling.

The school nurse is instructing a parent in the care and elimination of lice from their child's hair. The parent brings all of the products for care in a bag. Which contents are not appropriate for use? Permethrin (Nix) Plastic wide-toothed comb New hair clips Shampoo and conditioner

Shampoo and conditioner The nurse is correct to instruct the parent to avoid shampoo and conditioner because this coats the hair and protects the nits. Nix and a wide-toothed comb are recommended. New hair clips may be used once the infestation is gone.

Which term describes a fungal infection of the scalp? Tinea corporis Tinea cruris Tinea pedis Tinea capitis

Tinea capitis Tinea capitis is a fungal infection of the scalp. Tinea corporis involves fungal infections of the body. Tinea cruris describes fungal infections of the inner thigh and inguinal creases. Tinea pedis is the term for fungal infections of the foot.

The nurse is triaging a client over the phone who states having a contact dermatitis rash. Which treatment option of over-the-counter preparations does the nurse suggest for the client? Select all that apply. Hydrocortisone cream Moisturizing cream Topical antihistamines Cosmetic lotions Lanolin based ointment

Topical antihistamines Hydrocortisone cream Moisturizing cream Lanolin based ointment The nurse is correct to suggest that the client apply a topical antihistamine or hydrocortisone cream to the rash area. This is helpful to decrease itchiness and swelling. Moisturizing cream, some lanolin based, is helpful in restoring lubrication. Cosmetic lotions have a scent or color, which is not suggested for use on rashes.

To treat a client with acne vulgaris, the physician is most likely to order which topical agent for nightly application? Tretinoin (retinoic acid [Retin-A]) Fluorouracil (5-fluorouracil, 5-FU [Efudex]) Zinc oxide gelatin Minoxidil (Rogaine)

Tretinoin (retinoic acid [Retin-A]) Tretinoin is a topical agent applied nightly to treat acne vulgaris. Minoxidil promotes hair growth. Zinc oxide gelatin treats stasis dermatitis on the lower legs. Fluorouracil is an antineoplastic topical agent that treats superficial basal cell carcinoma.

A young college student recently had her tongue and lip pierced. She has developed a superinfection of candidiasis from the antibacterial mouthwash. Which of the following would be the correct recommendation for her? Rinse the mouth after eating food. Move the piercing back and forth during washing. Use a soft-bristled toothbrush. Use an antifungal mouthwash or salt water.

Use an antifungal mouthwash or salt water. The client can substitute an antifungal mouthwash or salt water if a superinfection of candidiasis develops from the antibacterial mouthwash. A soft-bristled toothbrush should be used to avoid additional oral injury, but it is not the recommended solution for this problem. After eating, the client should rinse her mouth for 30 to 60 seconds with an antifungal mouthwash or salt water. Moving the jewelry at the piercing area back and forth during washing helps clean the pierced tract but does not solve the problem.

A client is being treated for acne vulgaris. What warning must be given to this client regarding the application of benzoyl peroxide? Apply a thick layer to assure coverage. Use gloves with application. Only use with contact dermatitis. Use with over-the-counter drying agents.

Use gloves with application. Warn clients using acne preparations containing benzoyl peroxide that this ingredient is an oxidizing agent and may remove the color from clothing, rugs, and furniture. Thorough handwashing after drug use may not remove all the drug and permanent fabric discoloration may still occur. Users of products containing benzoyl peroxide should wear disposable plastic gloves when applying the drug.

The home health nurse is caring for a client with scabies. When instructing on the proper procedure to wash preworn contaminated clothing, which nursing instruction is essential? Pretreat clothing where scabies contact existed. Use hot water throughout wash cycle. Use commercial grade laundry detergent. Wash clothes through two laundry cycles.

Use hot water throughout wash cycle. The nurse is correct to use hot water throughout the wash cycle. Using hot water kills scabies and infectious agents on the laundry. If using the correct wash settings, the client does not need to use commercial-grade laundry detergent, the clothing does not need pretreated nor washed through two cycles.

The nurse is instructing the parents of a child with head lice. Which statement should the nurse include? Use shampoo with Kwell. Use shampoo with piperonyl butoxide. Disinfect brushes and combs with bleach. Wash clothes in cold water.

Use shampoo with piperonyl butoxide. The nurse's instructions should include shampooing with piperonyl butoxide, washing clothes in hot water, and disinfecting brushes and combs with piperonyl butoxide shampoo.

What advice should the nurse give a client with dermatitis until the etiology of the dermatitis is identified? Rub the skin vigorously to dry. Use wool, synthetics, and other dense fibers. Wear rubber gloves when in contact with soaps. Use hot water for bathing.

Wear rubber gloves when in contact with soaps. The nurse should advise the client to wear rubber gloves when coming in contact with any substance such as soap or solvents. The client should avoid wool, synthetics, and other dense fibers. The client should use tepid bath water and should pat rather than rub the skin dry.

A client visits the physician's office for treatment of a skin disorder. As a primary treatment, the nurse expects the physician to order: an IV corticosteroid. a topical agent. an oral antibiotic. an IV antibiotic.

a topical agent. Although many drugs are used to treat skin disorders, topical agents — not IV or oral agents — are the mainstay of treatment.

The classic lesions of impetigo manifest as abscess of skin and subcutaneous tissue. comedones in the facial area. honey-yellow crusted lesions on an erythematous base. patches of grouped vesicles on red and swollen skin.

honey-yellow crusted lesions on an erythematous base. The classic lesions of impetigo are honey-crusted lesions on an erythematous base. Comedones in the facial area are representative of acne. A carbuncle is an abscess of skin and subcutaneous tissue. Herpes zoster is exhibited by patches of grouped vesicles on red and swollen skin.

A client with a history of diabetes mellitus has recently developed furunculosis. What is causing the client's condition? diet hygiene unknown infection

infection Furuncles and carbuncles are caused by skin infections with organisms that usually exist harmlessly on the skin surface.

A physician has ordered a wet-to-damp dressing for an infected pressure ulcer. The nurse knows that the primary reason for this treatment is to: reduce pain. debride the wound. prevent the spread of the infection. keep the wound moist.

keep the wound moist. Wet-to-damp dressings keep the wound bed moist, which helps promote the growth of granulation tissue. Because dead tissue adheres to a dry dressing, wet-to-dry dressings are used for debriding wounds. Wet-to-damp dressings don't prevent the spread of infection. Although these dressings provide a soothing, cool feeling, they don't relieve pain.

A client is being treated for acne vulgaris. What contributes to follicular irritation? potato chips chocolate stress overproduction of sebum

overproduction of sebum The overproduction of sebum provides an ideal environment for bacterial growth within the irritated follicle. The follicle becomes further distended and irritated, causing a raised papule in the skin.

A client is undergoing photochemotherapy involving a combination of a photosensitizing chemical and ultraviolet light. What health problem does this client most likely have? undesired tattoo dandruff psoriasis plantar warts

psoriasis Photochemotherapy is used to treat psoriasis.

The nurse teaches the client who demonstrates herpes zoster (shingles) that a person who has had chickenpox can contract it again upon exposure to a person with shingles. no known medications affect the course of shingles. the infection results from reactivation of the chickenpox virus. once the client has had shingles, they will not have it a second time.

the infection results from reactivation of the chickenpox virus. It is assumed that herpes zoster represents a reactivation of latent varicella (chickenpox) virus and reflects lowered immunity. It is believed that the varicella zoster virus lies dormant inside nerve cells near the brain and spinal cord and is reactivated with weakened immune systems and cancers. A person who has had chickenpox is immune and therefore not at risk of infection after exposure to a client with herpes zoster. Some evidence indicates that infection is arrested if oral antiviral agents are administered within 24 hours of the initial eruption.

The nurse teaches the client who demonstrates herpes zoster (shingles) that no known medications affect the course of shingles. the infection results from reactivation of the chickenpox virus. once a client has had shingles, they will not have it a second time. a person who has had chickenpox can contract it again upon exposure to a person with shingles.

the infection results from reactivation of the chickenpox virus. It is assumed that herpes zoster represents a reactivation of the latent varicella (chickenpox) virus and reflects lowered immunity. It is believed that the varicella zoster virus lies dormant inside nerve cells near the brain and spinal cord and is reactivated with weakened immune systems and cancers. A person who has had chickenpox is immune and therefore not at risk of infection after exposure to clients with herpes zoster. Some evidence shows that infection is arrested if oral antiviral agents are administered within 24 hours of the initial eruption.