Iggy Chp 25 - Care of Patients with Skin Problems

Which questions should the nurse ask a patient suspected of having psoriasis? Select all that apply. 1 "Do you have a history of diabetes?" 2 "Do you have a history of skin trauma?" 3 "Do you have a history of hypertension?" 4 "Do you have a family history of psoriasis?" 5 "Do you have a family history of hypertension?"

"Do you have a history of skin trauma?" "Do you have a history of hypertension?" "Do you have a family history of psoriasis?" A psoriatic skin lesion can appear after skin trauma such as surgery, sunburn, or excoriation. Patients with hypertension may use beta blockers, which is a precipitating factor for psoriasis. Psoriasis is an autoimmune disease that can develop in patients who have a positive family history of psoriasis, but a history of diabetes may not be associated with psoriasis. A patient with a positive family history of hypertension may be at risk for developing hypertension, but not psoriasis.

The nurse anticipates that a client with a deep necrotizing wound caused by a brown recluse spider bite may require which type of healing therapy? (Chp. 25, elsevier resources) A) Hyperbaric oxygen B) Nutrition therapy C) Topical growth factors D) Vacuum-assisted wound closure

A) Hyperbaric oxygen (Chp. 25, elsevier resources)

Which statement by a client with psoriasis indicates to the nurse that additional teaching about the client's condition is required? (Chp. 25, elsevier resources) A) "A tanning bed will supply the ultraviolet light I need." B) "Medicine can prevent the growth of new skin cells." C) "I can never be cured." D) "Stress can cause my flare-ups."

A) "A tanning bed will supply the ultraviolet light I need." (Chp. 25, elsevier resources)

In teaching a client about skin cancer prevention, which instruction does the nurse include? (Chp. 25, elsevier resources) A) "Avoid sun exposure between 11 a.m. and 3 p.m." B) "Examine your skin quarterly for possible cancerous or precancerous lesions." C) "Wear transparent clothing to protect your skin from the sun." D) "If you feel you must tan, use a tanning bed."

A) "Avoid sun exposure between 11 a.m. and 3 p.m." (Chp. 25, elsevier resources)

The nurse is teaching a client about decreasing the risk for melanomas and other skin cancers. Which primary prevention technique is most important for the nurse to include? (Chp. 25, elsevier resources) A) Avoiding or reducing skin exposure to sunlight B) Avoiding tanning beds C) Being aware of skin markings and performing skin self-examination D) Wearing SPF 40 sunscreen

A) Avoiding or reducing skin exposure to sunlight (Chp. 25, elsevier resources)

A client with bacteremia associated with a bacterial skin infection is receiving clindamycin (Cleocin) intravenously. Which assessment finding indicates the need for immediate action by the nurse? (Chp. 25, elsevier resources) A) Blood pressure of 88/40 mm Hg B) White blood cell count of 15,000/mm3 C) Oral temperature of 101° F (38.3° C) D) Heart rate of 102 beats/min

A) Blood pressure of 88/40 mm Hg (Chp. 25, elsevier resources)

A client has an odorous, purulent wound. How does the nurse best support this client? (Chp. 25, elsevier resources) A) Changes the dressing frequently B) Encourages a diet high in protein C) Suggests whirlpool therapy D) Places room deodorizers in the room

A) Changes the dressing frequently (Chp. 25, elsevier resources)

A client with a foot ulcer says, "I feel helpless." What is the nurse's best response? (Chp. 25, elsevier resources) A) Encourages participation in care of the wound B) Encourages visitors C) Says, "I know how you feel" D) Assures the client that it will be all right

A) Encourages participation in care of the wound (Chp. 25, elsevier resources)

The nurse is teaching a client 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 client's teaching plan? (Chp. 25, elsevier resources) A) Lift hips off the chair at least every hour. B) Eat a low-fat diet. C) Massage reddened areas. D) Complete a pressure map.

A) Lift hips off the chair at least every hour. (Chp. 25, elsevier resources)

The nursing instructor reviews instructions with the nursing student on caring for an older adult client with a pressure ulcer. What action by the nursing student indicates a need for further instruction about proper skin care for this client? (Chp. 25, elsevier resources) A) Massages bony prominences B) Avoids reddened areas C) Re-positions the client every 1 to 2 hours D) Uses a moisturizing lotion

A) Massages bony prominences (Chp. 25, elsevier resources)

Which medication acts as a strong irritant and causes chemical burns in patients with psoriasis? 1 Anthralin 2 Calcitriol 3 Tazarotene 4 Calcipotriene

Anthralin is used to treat psoriasis and is a strong irritant, which can cause chemical burns. Calcitriol, tazarotene, and calcipotriene are not skin irritants; hence, these will not cause chemical burns in a patient with psoriasis.

Which statement made by a client with a furuncle in the groin indicates to the nurse that teaching about the care needed for this problem has been effective? (Chp. 25; p. 453) A) "I will wear tight jeans to keep the infection from spreading to other areas." B) "I will shower with an antibacterial soap before applying the topical ointment." C) "I will squeeze the lesion until it opens so I can remove all the pus and other material." D) "I will shave the area around the lesion and apply cortisone cream to reduce the inflammation."

B) "I will shower with an antibacterial soap before applying the topical ointment." (Chp. 25; p. 453)

Deep tissue wounds, such as chronic pressure ulcers, take longer to heal because they heal by which intention? (Chp. 25, elsevier resources) A) First B) Second C) Third D) Mixed

B) Second Second intention healing is seen in wounds that can be described as cavity-like defects. This type of healing, in deeper tissue injuries or wounds with tissue loss, requires gradual filling in of the dead space with connective tissue in. This process occurs over an extended period. First intention healing occurs in wounds without tissue loss. These wounds can be easily closed and dead space eliminated. Third intention healing is characterized by delayed primary closure. Wounds with a high risk for infection may be intentionally left open for several days while the wound is debrided and inflammation subsides. Mixed intention healing does not exist. (Chp. 25, elsevier resources)

The nurse is developing a teaching plan for a client diagnosed with methicillin-resistant Staphylococcus aureus infection. The nurse plans to include which instruction in the client's teaching plan? (Chp. 25, elsevier resources) A) Take daily tub baths using a mild soap. B) The infected area should be covered with a clean, dry bandage. C) Wash the infected areas first, then wash the uninfected areas. D) Use bath sponges or puffs when bathing.

B) The infected area should be covered with a clean, dry bandage. (Chp. 25, elsevier resources)

The nurse working in the same-day-surgery unit has just received report and plans to assess which client first? (Chp. 25, elsevier resources) A) Adult with a basal cell carcinoma excised who needs discharge teaching about wound care B) Young adult who has had rhinoplasty and is swallowing frequently C) Middle-aged adult who reports 7/10 pain after removal of a cyst D) Older adult ready to be transferred to a long-term-care facility after débridement of a pressure ulcer

B) Young adult who has had rhinoplasty and is swallowing frequently (Chp. 25, elsevier resources)

Which statement by a client with psoriasis indicates that teaching about the condition has been effective? (Chp. 25, elsevier resources) A) "I know that I need to avoid warm climates." B) "I must cover up the affected areas to prevent spread to my family." C) "I should practice good handwashing technique." D) "Psoriasis can be cured with steroids."

C) "I should practice good handwashing technique." (Chp. 25, elsevier resources)

A young client has been diagnosed with tinea corporis (ringworm), but the mother would like the child to return to school. To avoid spreading the infection, what does the nurse suggest to the mother? (Chp. 25, elsevier resources) A) "Wash your hands frequently." B) "Your child may return to school, but must be isolated from the rest of the class." C) "Keep the site covered with a bandage." D) "Keep your child out of school until the infection has cleared."

C) "Keep the site covered with a bandage." (Chp. 25, elsevier resources)

The client who has stage III metastatic melanoma and whose tumor is negative for a BRAF mutation asks why the treatment plan does not include the new drug Zelboraf (vemurafenib) that she has read about. What is the nurse's best response? (Chp. 25; p. 461) A) "Your immune system is too weak to tolerate Zelboraf." B) "This drug is experimental and too dangerous for you to take before trying other therapies." C) "Your melanoma does not have the gene mutation that responds to this drug, so you would not benefit from this therapy." D) "You are young and can better tolerate the standard therapies for melanoma that have been proven effective but have strong side effects."

C) "Your melanoma does not have the gene mutation that responds to this drug, so you would not benefit from this therapy." (Chp. 25; p. 461)

During morning rounds, the nurse discovers that an older adult client has been incontinent during the night. To protect the skin, what does the nurse do first? (Chp. 25, elsevier resources) A) Apply a barrier cream. B) Assess the area for skin breakdown. C) Clean the client. D) Place the client in a side-lying position.

C) Clean the client. (Chp. 25, elsevier resources)

A discharged obese client will require frequent dressing changes for a skin condition on his left foot. How does the nurse assess whether the client is able to perform this task at home?(Chp. 25, elsevier resources) A) Asks the client if he is squeamish B) Demonstrates how to change the dressing C) Determines whether the client can reach the affected area D) Provides all of the necessary dressing materials

C) Determines whether the client can reach the affected area (Chp. 25, elsevier resources)

Which nursing interventions can the nurse working in a long-term care facility delegate to a nursing assistant? (Chp. 25, elsevier resources) A) Use the Braden Scale to determine pressure ulcer risk for a newly admitted client. B) Complete daily sterile dressing changes for a client with a venous leg ulcer. C) Every 2 hours, re-position a client who has had a stroke and is incontinent. D) Admit a newly transferred client who had pedicle flap surgery 1 week ago.

C) Every 2 hours, re-position a client who has had a stroke and is incontinent. (Chp. 25, elsevier resources)

The nurse is caring for a client prescribed linezolid (Zyvox) for treatment of methicillin-resistant Staphylococcus aureus infection. The nurse plans to monitor the client for which adverse effect of linezolid? (Chp. 25, elsevier resources) A) Depression B) Hyperglycemia C) Hypertension D) Incontinence

C) Hypertension (Chp. 25, elsevier resources)

The nurse prepares to administer vancomycin (Vancocin) to a client diagnosed with methicillin-resistant Staphylococcus aureus infection. How does the nurse administer this medication? (Chp. 25, elsevier resources) A) By bolus B) IV push C) Infused over 60 minutes D) Mix with the primary IV bag

C) Infused over 60 minutes (Chp. 25, elsevier resources)

An older adult client who is bedridden has a documented history of protein deficiency. What does the nurse plan to monitor for? (Chp. 25, elsevier resources) A) Anemia B) Decreased wound healing C) Pressure ulcer development D) Weight gain

C) Pressure ulcer development (Chp. 25, elsevier resources)

What is the best way for the nurse to prevent a client's stage I pressure ulcer from advancing to stage II? (Chp. 25, elsevier resources) A) Massage the reddened areas. B) Pad the ulcer. C) Promote mobility and/or frequent re-positioning. D) Suggest an egg crate mattress.

C) Promote mobility and/or frequent re-positioning. (Chp. 25, elsevier resources)

Which precaution is most important for the nurse to teach the 32-year-old female client prescribed topical tazarotene (Tazorac) cream for psoriasis? (Chp. 25; p. 458) A) Apply a dressing over the site with each application. B) Stop the drug use when psoriasis manifestations decrease. C) Report symptoms of infection to the prescriber immediately. D) Adhere to strict contraceptive measures while using the drug.

D) Adhere to strict contraceptive measures while using the drug. (Chp. 25; p. 458)

The nurse admits a client to the clinic who is reporting severe itching of the arms and legs caused by exposure to poison ivy. The nurse anticipates that the health care provider will prescribe which medication?(Chp. 25, elsevier resources) A) Anthralin (Drithocreme) B) Benzyl benzoate (Ascabiol) C) Calcipotriene (Dovonex) D) Diphenhydramine (Benadryl)

D) Diphenhydramine (Benadryl) (Chp. 25, elsevier resources)

A client has had a melanoma lesion removed. For secondary prevention, what is important for the nurse to teach the client? (Chp. 25, elsevier resources) A) Ensure that all lesions are reviewed by a dermatologist or a surgeon. B) Avoid sun exposure. C) Perform a total skin self-examination monthly. D) Perform a total skin self-examination monthly with a partner.

D) Perform a total skin self-examination monthly with a partner. (Chp. 25, elsevier resources) Performing a monthly total skin self-examination with another person is the best secondary preventive measure. If the patient is taught to use the ABCDE ( asymmetry, border, color, diameter, and evolving) method of lesion assessment, the patient will know whether a lesion warrants assessment by a specialist. Avoiding sun exposure is primary prevention. It is difficult for a person to assess all of the skin surfaces of his or her body by him- or herself, even with the use of mirrors. It is better to involve a partner with the assessment.

The nurse is evaluating the effectiveness of interventions for pressure ulcer management. Which diagnostic test result with an increased level indicates client progress and effective health care team collaboration? (Chp. 25, elsevier resources) A) Calcium B) Hematocrit C) Numbers of immature white blood cells (WBCs) D) Serum albumin

D) Serum albumin (Chp. 25, elsevier resources)

While assessing a patient with epilepsy, the nurse finds diffused redness and large blisters on the oral mucosa. Which is the priority nursing intervention? 1 Discontinuing the medication 2 Monitoring the body temperature 3 Monitoring fluid intake and output 4 Administering topical antibacterial drug

Discontinuing the medication Diffused redness and large blisters are the typical clinical signs of toxic epidermal necrolysis (TEN). Barbiturates that are used in treating epilepsy are one of the most common causes of TEN, therefore, discontinuing the medication is the priority intervention in this situation. Monitoring the body temperature, fluid intake and output are performed at the bedside, but not a priority intervention to treat redness and blisters. Topical antibacterial drugs are administered to suppress the bacterial growth of causative organisms until healing is noticed.

Which inflammatory condition leads to dehydration and hypothermia? 1 Psoriasis vulgaris 2 Psoriatic arthritis 3 Exfoliative psoriasis 4 Palmoplantar pustulosis

Exfoliative psoriasis causes dehydration and hypothermia. Psoriasis vulgaris leads to thickened skin lesions on both sides of the body. Psoriatic arthritis leads to severe complications associated with joints. Palmoplantar pustulosis may cause social and physical problems.

Which features are associated with basal cell carcinoma? 1 Small papule with dry, rough, adherent yellow scales. 2 Pearly papule with a central crater and rolled waxy borders. 3 Firm nodular lesions topped with a crust with a central area of ulceration. 4 Irregular shaped, pigmented papule, and variegated colors with red tones.

Pearly papule with a central crater and rolled waxy borders.

Which is a common causative drug of toxic epidermal necrolysis (TEN)? 1 Pyrazolones 2 Tetracyclines 3 Opioid analgesics 4 Beta-blocking agents

Pyrazolones are one of the most common drugs that can cause TEN. Tetracyclines and opioid analgesics may not cause TEN. Beta-blocking agents can aggravate psoriasis, but not TEN.

What condition can greatly increase the risk of accelerated tissue destruction in a patient with pressure injuries? 1 Mechanical obstacles 2 Decrease in skin moisture 3 Negative nitrogen balance 4 Exposure to ultraviolet light

Skin and wound healing depend on a positive nitrogen balance and adequate serum protein levels. A negative nitrogen balance slows down the healing mechanism and increases the risk for accelerated tissue destruction. Mechanical obstacles and a decrease in skin moisture may hamper the wound healing process, but do not cause accelerated tissue destruction. Exposure to ultraviolet light causes sunburn.

Which drug-induced skin reaction is characterized by vesicles, erosions, and crusts? 1 Psoriasis 2 Basal cell carcinoma 3 Toxic epidermal necrolysis 4 Stevens-Johnson syndrome

Stevens-Johnson syndrome is a drug-induced skin reaction, typically characterized by vesicles, erosions, and crusts. In psoriasis, the lesions are scaled with underlying dermal inflammation. Basal cell carcinoma appears as papule with central crater and rolled waxy borders. Toxic epidermal necrolysis is associated with diffused erythema and large blisters.

Which medication is most effective for the treatment of multiple actinic keratosis? 1 Systemic therapy of cisplatin 2 Topical therapy of vismodegib 3 Systemic therapy of cetuximab 4 Topical therapy of 5-fluorouracil

Topical therapy of 5-fluorouracil Topical therapy with 5-fluorouracil is used in the treatment of multiple actinic keratosis. Systemic therapy of cisplatin and cetuximab are used to treat advanced or metastatic squamous cell carcinoma. Topical therapy of vismodegib is used to treat advanced or metastatic basal cell skin cancer.

Which surgical technique helps to remove full-thickness skin in the area of a lesion? 1 Cryosurgery 2 Wide excision 3 Mohs' surgery 4 Excisional biopsy

Wide excision is used to remove full-thickness skin in the area of a lesion. Cryosurgery is used to treat isolated lesions, causing cell death and destruction. Mohs' surgery is a specialized form of excision that is usually preferred for squamous cell carcinomas. Excisional biopsy refers to total surgical removal of the small lesions for pathological examination.

Which are common complications of pressure injuries? Select all that apply. 1 Sepsis 2 Uremia 3 Diabetes 4 Cirrhosis 5 Kidney failure

sepsis kidney failure