Chapter 61: Management of Patients with Dermatologic Disorders

While in a skilled nursing facility, a client contracts scabies, which is diagnosed the day after discharge. The client is living at her daughter's home with six other people. During her visit to the clinic, the client asks a staff nurse, "What should my family do?" The most accurate response from the nurse is:

"All family members need to be treated."

A patient has a moisture-retentive dressing for the treatment of a sacral decubitus ulcer. How long should the nurse leave the dressing in place before replacing it?

12 to 24 hours

Which term refers to a graft derived from one part of a client's body and used on another part of that same client's body?

Autograft

The nurse caring for a client with repeated episodes of contact dermatitis is providing instruction to prevent future episodes. Which information should the nurse include?

Avoid cosmetics with fragrance.

A disease that affects the scalp, body, feet, nails, and groin. It's characterized by erythematous patches and scaling.

Dermatophytosis, or ringworm

Development of malignant melanoma is associated with which risk factor?

History of severe sunburn

(BLANK) is seen at all ages but is particularly common among children living under poor hygienic conditions.

Impetigo

Contagious, superficial skin infection characterized by a small, red macule that turns into a vesicle, becoming pustular with a honey-colored crust.

Impetigo

Which skin condition is caused by staphylococci, streptococci, or multiple bacteria?

Impetigo

What is the major cause of death in toxic epidermal necrolysis (TEN)?

Infection

(BLANK), an oral retinoid, is used in clients diagnosed with nodular cystic acne that does not respond to conventional therapy.

Isotretinoin

Which drug is an oral retinoid used to treat acne?

Isotretinoin

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

Which of the following information regarding the transmission of lice would the nurse identify as a myth?

Lice can jump from one individual to another.

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?

Nits are difficult to move from hair shafts.

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.

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?

Scabies

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?

Use an antifungal mouthwash or salt water.

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."

An abscess of skin and subcutaneous tissue.

Carbuncle

Cluster of furuncles in the subcutaneous tissue

Carbuncle

Localized skin infection involving several hair follicles

Carbuncle

Dry cracking at the corners of the mouth.

Cheilitis

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

Chocolate, Ice cream

The nurse is working with community groups. At which of the following locations would the nurse anticipate a possible scabies outbreak?

College dormitory

The nurse recommends which type of therapeutic bath for its antipruritic action?

Colloidal (oatmeal)

Acne in the facial area

Comedones

Primary lesions of acne, caused by sebum blockage in the hair follicle.

Comedones

An inflammation of the skin caused by contact with an irritating chemical or allergen.

Contact dermatitis

The nurse is conducting an admission history and physical examination of a client with a history of contact dermatitis. The nurse assesses whether the client uses which medication classification?

Corticosteroids

Which medication classification may be used for contact dermatitis?

Corticosteroids

Which of the following aggravates the condition caused by acne vulgaris?

Cosmetics

Fine, white particles of dead, dry scalp cells that can be easily picked from the hair.

Dandruff

A dermatologist recommends an over-the-counter suspension to relieve pruritus. The nurse advises the patient that the lotion should be applied:

Every 3 to 4 hours for sustained effectiveness.

A patient is being evaluated for nodular cystic acne. What systemic pharmacologic agent may be prescribed for the treatment of this disorder?

Isotretinoin (Accutane)

When a patient has been diagnosed with scabies, if the infection has spread, family members may complain of pruritus within which time frame?

1 month

Depending on the product used and the type of dermatologic conditions encountered, most moisture-retentive dressings may remain in place from (BLANK) to (BLANK) hours.

12, 24

The nurse is caring for a patient with extensive bullous lesions on the trunk and back. Prior to initiating skin care, what is a priority for the nurse to do?

Administer analgesic pain medication.

(BLANK) and (BLANK) are grafts transferred from one human (living or cadaveric) to another human.

Allografts, homographs

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

Antiviral

The nurse is caring for a geriatric client with thin, chapped, itchy skin. Which nursing intervention should the nurse alter in the plan of care?

Applying lanolin ointment

Which of the following terms refers to a graft derived from one part of a patient's body and used on another part of that same patient's body?

Autograft

A patient is diagnosed with seborrheic dermatitis on the face and is prescribed a corticosteroid preparation for use. What should the nurse educate the patient about regarding use of the steroid on the face?

Avoid using the medication around the eyelids because it may cause cataracts and glaucoma.

Poison ivy is a (BLANK) (BLANK) caused by the oleoresin given off by a particular form of ivy.

contact dermatitis

Oral acyclovir (Zovirax), when taken within 48 hours of the appearance of symptoms, reduces their severity, and prevents the development of additional lesions from

herpes zoster

Reactivation of latent varicella (chickenpox) virus and reflects lowered immunity

herpes zoster

A (BLANK) is a graft obtained from an animal of a species other than that of the recipient.

heterograft

A graft obtained from an animal of a species other than that of the recipient.

heterograft

Foods associated with flare-up of acne

high refined sugars, including chocolate, cola, and ice cream.

A (BLANK) is a graft transferred from one human (living or cadaveric) to another human.

homograft

The classic lesions of impetigo manifest as

honey-yellow crusted lesions on an erythematous base.

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

infection

Which is not a category of medications used for treatment of the skin?

inhaled steroids

Head lice

pediculosis capitis

A continuous current of warm air on denuded skin can (BLANK) dehydration.

worsen

Breakdown of the skin due to prolonged pressure, friction, and shear forces, and insufficient blood supply, usually at bony prominences.

Pressure ulcers

Caused by the itch mite.

Scabies

Signs and symptoms of (BLANK) include gray-brown burrows, epidermal curved or linear ridges, and follicular papules. Clients complain of severe itching that usually occurs at night. Commonly occurs in school-age children. The most common areas of infestation are the finger webs, flexor surface of the wrists, and antecubital fossae.

Scabies

With repeated reactions of contact dermatitis, which of the following can occur?

Secondary bacterial infection

Ringworm affecting the body

Tinea corporis

"athlete's foot"

Tinea pedia

A type of ringworm that affects the toenails

Tinea unguium

The nurse is caring for a client diagnosed with herpes zoster. Which statement by the client needs further clarification by the nurse?

"Once I get the infection, I cannot get it again."

Pressure ulcers are caused by:

Extrinsic factors

Which of the following nonsedating antihistamines is appropriate for daytime pruritus?

Fexofenadine (Allegra)

The nurse is developing a plan of care for a client with toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome. Which action should the nurse include?

Frequently inspect the oral cavity.

Which term refers most precisely to a localized skin infection of a single hair follicle?

Furuncle

(BLANK) (BLANK), a highly contagious infection, is transmitted by direct contact with vesicular fluid or airborne droplets from the infected host's respiratory tract.

Herpes zoster

Exhibited by patches of grouped vesicles on red and swollen skin.

Herpes zoster

Which of the following reflect the pathophysiology of cutaneous signs of HIV disease?

Immune function deterioration

Which infecting agent causes scabies?

Itch mite

Which of the following is the most common complaint related to a diagnosis of head lice?

Itching

What advice should the nurse give a client with a furuncle to prevent the spread of the infection?

Never pick or squeeze a furuncle.

A night-shift nurse receives a call from the emergency department about a client with herpes zoster who is going to be admitted to the floor. Based on this diagnosis, where should the nurse assign the client?

Private room

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:

Removal of the tumor, layer by layer.

A client is being treated for acne vulgaris. What warning must be given to this client regarding the application of benzoyl peroxide?

Use gloves with application.

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])

The nurse working at a physician's office is providing teaching to the parent of a child diagnosed with Tinea capitis (ringworm of the head). How often should the nurse instruct the parent to shampoo the child's hair with ketoconazole or a selenium sulfide shampoo?

Twice weekly

The nurse is instructing the parents of a child with head lice. Which statement should the nurse include?

Use shampoo with piperonyl butoxide.

When performing a skin assessment, the nurse notes a localized skin infection of a single hair follicle. The nurse documents the presence of

a furuncle.

The nurse notes that the client's lower extremities are covered with very dry skin and that the horny layer of the skin has become thickened. The nurse notes the finding as

lichenification

People who burn and do not tan are at risk for developing malignant (BLANK).

melanoma

A client is being treated for acne vulgaris. What contributes to follicular irritation?

overproduction of sebum

Outbreaks are common where large groups of people are confined or housed. Spread of (BLANK) is from skin-to-skin contact.

scabies

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

psoriasis

The nurse teaches the client who demonstrates herpes zoster (shingles) that

the infection results from reactivation of the chickenpox virus.

Topical corticosteroids, antihistamines, and antibiotics are all used in the treatment of

skin disorders

(BLANK) (BLANK) virus lies dormant inside nerve cells near the brain and spinal cord and is reactivated with weakened immune systems and cancers.

varicella zoster

(BLANK) 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.

Pruritus

Dry, rough, scaly skin with the presence of itching is best described as:

Pruritus

Photochemotherapy has been used as a treatment for which of the following skin disorders?

Psoriasis

A client is coming to the office to have a growth removed by the doctor. The client asks "What does cryosurgery do to the growth?" What is the correct response?

Through the application of extreme cold, the tissue is destroyed.

Which of the following is also known as "jock itch"?

Tinea cruris

What advice should the nurse give a client with dermatitis until the etiology of the dermatitis is identified?

Wear rubber gloves when in contact with soaps.