EAQ- Lewis Med Surg CH.24, Nursing Management: Integumentary Problems

In a patient admitted with cellulitis of the left foot, which clinical manifestation would the nurse expect to find on assessment of the left foot? 1. Redness and swelling 2. Pallor and poor turgor 3. Cyanosis and coolness 4. Edema and brown skin discoloration

1. Redness and swelling Cellulitis is a diffuse, acute inflammation of the skin. It is characterized by redness, swelling, heat, and tenderness in the affected area. These changes accompany the processes of inflammation and infection.

Which patient would be more likely to have the highest risk of developing malignant melanoma? 1. A fair-skinned woman who uses a tanning booth regularly 2. An African American patient with a family history of cancer 3. An adult who required phototherapy as an infant for the treatment of hyperbilirubinemia 4. A Hispanic male with a history of psoriasis and eczema who responded poorly to treatment

1. A fair-skinned woman who uses a tanning booth regularly Risk factors for malignant melanoma include a fair complexion and exposure to ultraviolet light. Psoriasis, eczema, short-duration phototherapy, and a family history of other cancers are less likely to be linked to malignant melanoma.

Which white blood cell count is the best indicator that a 54-year-old patient with cellulitis has recovered from the infection? 1. 2000/mm3 2. 5000/mm3 3. 13,000/mm3 4. 16,500/mm3

2. 5000/mm3 The normal white blood cell count is 4000 to 11,000 cells/mm3, according to most laboratory reference books. For this reason, the patient's level would have been deemed normal if it was 5000/mm3. A white blood cell count of 2000/mm3 is categorized as leukopenia and is abnormal. White blood cell counts of 13,000 or 16,500 mm3 would indicate continued infection.

The nurse assesses an elevated, dry, hyperkeratotic, scaly papule in an older adult patient. With what condition does the assessment data correlate? 1. Dysplastic nevus 2. Actinic keratosis 3. Basal cell carcinoma 4. Squamous cell carcinoma

2. Actinic keratosis Actinic keratosis manifests clinically as dry, scaly, hyperkeratotic papules, either flat or elevated. A dysplastic or atypical nevus is often larger than 5 mm. It features irregular borders, which may be notched; variegated color (e.g., tan, brown, black, red, or pink) within a single mole; and at least one flat portion, often at the edge of the mole. Basal cell carcinoma is characterized by a small, slowly enlarging papule with semitranslucent or pearly borders. Squamous cell carcinoma appears as a thin, scaly, erythematous plaque that does not invade the dermis.

A 54-year-old patient with diabetes mellitus has cellulitis of the right lower extremity. Which assessment finding would the nurse expect on physical examination? 1. Delayed capillary refill time 2. Pallor of the right toes 3. Warmth of the area 4. Paresthesias of the right lower extremity

3. Warmth of the area Cellulitis is a diffuse, acute infection of the skin. It is characterized by redness, swelling, and heat in the affected area. These changes accompany the processes of inflammation and infection. Delayed capillary refill time and pallor of the toes would indicate a circulatory impairment, not infection. Paresthesias would be indicative of poorly controlled diabetes.

A nurse works in a dermatology clinic and counsels many patients in a day. Which patients should the nurse consider at high risk of developing skin malignancies? Select all that apply. 1. A construction worker 2. A software engineer 3. A farmer 4. A school teacher 5. A baseball player

1. A construction worker 3. A farmer 5. A baseball player Sun exposure is the main risk factor for development of skin malignancies. People in occupations that involve outdoor activities are more prone to develop skin malignancies. A construction worker, a farmer, and a baseball player are exposed to sunlight throughout the day. Therefore, these professionals may have high risk of skin malignancies. A software engineer and a school teacher are involved in indoor activities and are not exposed to sunlight. Therefore, they have less risk of developing skin malignancies.

A patient with psoriasis tells the nurse that the patient has quit his or her job as a restaurant hostess because the patient believes the lesions on his or her hands and arms are unattractive to customers. The nursing diagnosis that best describes this patient response is 1. Social isolation related to fear of rejection 2. Ineffective coping related to lack of social support 3. Impaired skin integrity related to presence of lesions 4. Ineffective health maintenance because of presence of lesions

1. Social isolation related to fear of rejection The chronicity of psoriasis can be severe and disabling as people withdraw from social contacts because of visible lesions. Quality of life is also affected negatively. The information presented does not indicate the patient does not have support. Impaired skin integrity is not a priority diagnosis. There is no information to indicate the patient has ineffective health maintenance.

When studying the incidence of skin cancers in a population, a nurse finds that a greater number of skin cancer cases have been reported in white patients than in African American patients. What could be the most likely cause of such an occurrence? 1. Whites have less melanin content in their skin than African Americans. 2. Whites have greater melanin content in their skin than African Americans. 3. Whites usually have more exposure to the sun than African Americans. 4. Whites usually have less exposure to the sun than African Americans.

1. Whites have less melanin content in their skin than African Americans. Melanin provides natural protection to the skin against the harmful radiation of the sun. Therefore, melanin plays a major role in preventing skin cancer. African American people are darker skinned and have greater melanin content in their skin. Therefore, they are less susceptible to skin cancer than white people. White people are lighter skinned and have less melanin. Differences in sun exposure between the two populations cannot be predicted.

A patient tells a nurse, "I think I might have head lice." Which assessment findings would the nurse observe with this infestation? 1. Diffuse pruritic wheals 2. Oval white dots stuck to hair shafts 3. Itchy redness and edema over the area of infestation 4. Pruritic papules with linear burrows at the hairline

2. Oval white dots stuck to hair shafts The eggs of lice, known as nits, appear as oval white dots attached to hair shafts. The lice are not usually visible. Diffuse pruritic wheals may be seen with localized inflammation such as that in response to an insect bite. Itchy redness and edema over the area of infestation are not characteristic of head lice. Pruritic papules with linear burrows at the hairline are characteristic of scabies.

The nurse is assessing a patient who had a face-lift procedure earlier in the day. The nurse notes that the skin in the surgical area is warm and pink and blanches with gentle pressure. What is the appropriate action by the nurse, based on this assessment finding? 1. Apply moist heat to the area. 2. Take the patient's temperature. 3. Notify the health care provider immediately. 4. Document the assessment finding as normal.

4. Document the assessment finding as normal. Postoperative assessment for the patient who has had a face-lift includes careful monitoring for adequate circulation. Warm, pink skin that blanches on pressure indicates that adequate circulation is present in the surgical area. Supportive, compressive dressings and ice packs (not moist heat) may be necessary early in the postoperative period. Moist heat should not be applied to the area. It is not necessary to take the patient's temperature. The health care provider does not need to be notified because this finding is normal.

A nurse is assessing a patient who reports extreme fatigue and muscle pain. The patient reports spending very little time outdoors. The skeletal muscles of the patient are very weak. Which deficiency is most likely to cause such symptoms? 1. Vitamin A deficiency 2. Vitamin B deficiency 3. Vitamin C deficiency 4. Vitamin D deficiency

4. Vitamin D deficiency Muscle pain and weakness are signs of Vitamin D deficiency. Vitamin D is produced naturally by cutaneous photosynthesis due to exposure to UVB light. The patient is most likely to have Vitamin D deficiency because of restricted sun exposure. Vitamin C deficiency causes scurvy, which is characterized by purpura, bleeding gums and petechiae. Deficiency of vitamin A causes dryness of the conjunctiva and poor wound healing. Deficiency of Vitamin B causes dermatologic symptoms such as erythema, bullae, and seborrhea-like lesions.

The nurse reviews lab values for a male patient with herpes zoster. With which result should the nurse be most concerned? 1. Calcium: 9.0 mg/dL 2. Hemoglobin: 14 g/dL 3. Platelets: 150,000/mm3 4. White blood cell count: 1000/mm3

4. White blood cell count: 1000/mm3 Herpes zoster may occur as reactivation of the varicella virus, which is dormant in the ganglion after a primary case of chickenpox. Reactivation is seen in immunocompromised patients. The nurse would be concerned about the patient's immune status, and therefore a check of the white blood cell count would be warranted. A normal white blood cell count is 4000 to 10,000 mm3. The other answer options all contain lab values within normal limits: platelets 150,000 to 350,000/mm3, hemoglobin 13 to 18 g/dL in males and 12 to 16 g/dL in females, and calcium 8.5 to 10.5 mg/dL.