Integumentary NCLEX practice questions (CASBN)

herpes zoster

(Shingles) can occur during any immunocompromised state in a client with a history of chickenpox

What is MRSA?

(methicillin-resistant staphylococcus aureus) is contagious and is spread toothers by contact with infected skin or articles; can also spread to other parts of the body

The nurse is reviewing the health care record of a client with a lesion that has been diagnosed as basal cell carcinoma. The nurse would expect which characteristics of this type of lesion to be documented in the client's record? (Select all that apply) 1. Lesion has a waxy border. 2. Irregularly shaped lesion. 3. Pearly papule, with a central crater. 4. Small papule with a dry, rough scale. 5. A firm nodular lesion topped with a crust.

1 & 3; basal cell carcinoma appears as a pearly papule, with a central crater and a rolled, waxy border.

6 priority nursing actions for burn injuries

1. Assess for airway patency 2. Administer O2 as prescribed 3. Obtain vital signs 4. Assist to initiate IV line and begin fluid replacement as prescribed 5. Elevate the extremities if no fractures are obvious 6. Keep the client warm, and maintain NPO status

6 risk factors for Pressure Injuries

1. Skin pressure 2. Skin shearing or friction 3. Immobility 4. Malnutrition 5. Incontinence 6. Decreased sensory perception

Bee and wasp stings first aid

1. Stings usually cause a wheal and flare reaction 2. Emergency care involves quick removal of the stinger and ice pack application 3. The stinger is removed by gently scraping with a flat object (back of knife, credit card) 4. Individuals who are allergic should carry and Epi-Pen

The clinic nurse is performing an admission assessment on a client and notes that the client is taking azelaic acid. Nurse determines that which client complaint may be associated with the use of this medication? 1. Itching 2. Euphoria 3. Drowsiness 4. Frequent urination

1; azelaic acid is a topical medication used to treat mild to moderate acne. Adverse effects include burning itching, stinging redness of the skin and hypo pigmentation of the skin in clients with dark complexion.

A burn client is receiving treatments of topical mafenide acetate to the site of the injury. The nurse monitors the client, knowing that which finding indicates the occurrence of a systemic effect? 1. Hyperventilation 2. Elevated BP 3. Local rash at the burn site 4. Local pain at burn site

1; mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal excretion of acid, thereby causing acidosis. Clients receiving this tax need to be monitored for signs of an acid-base imbalance (hyperventilation). If this occurs, the medication will probably be discontinued for 1 to 2 days.

The nurse is assisting with caring for a client who is receiving intravenous fluids, and who has sustained full-thickness burn injuries of the back and legs. The nurse understands that which would provide the most reliable indicator for determining the adequacy of the fluid resuscitation. 1. Vital signs. 2. Urine output. 3. Mental status 4. Peripheral pulses

2; Successful or adequate fluid resuscitation in the adult is signaled by stable vital signs, adequate urine output, palpable peripheral pulses, and a clear sensorium. The most reliable indicator for determining the adequacy of fluid resuscitation is the urine output. For an adult, the hourly urine volume needs to be 30 to 50 mL.

The nurse inspects the skin of a client who is suspected of having psoriasis. Which finding would the nurse note if this disorder is present? 1. Oily skin 2. Silvery-white scaly lesions 3. Patchy har loss and round, red macules with scales 4. The presence of wheal patches scattered about the trunk

2; psoriatic patches are covered with silvery-white scales.

Th nurse in a LTC facility is planning clinical assignments for the day. The nurse would not assign which staff member to the client with a diagnosis of herpes zoster? 1. A staff member who has never had roseola 2. A staff member who has never had mumps 3. An UAP who has never had chicken pox 4. An UAP who has never had German Measles

3. An UAP who has never had herpes zoster. Herpes zoster is caused by a reactivation virus that causes chickenpox

The nurse is told that an assigned client is suspected of having MRSA. Which precautions must the nurse institute during the care of the client? 1. Wear gloves only 2. Wear a mask and gloves 3. Wear a gown and gloves 4. Wear a mask and face shield

3; MRSA is contagious and is spread to others by direct contact with infected skin or articles. Always use contact precautions with MRSA or suspected MRSA.

A client arrives at the emergency department and has experienced frostbite to the right hand. What would the nurse expect to find when inspecting the clients hand? 1. A pink edematous hand 2. Fiery red skin with edema in the nail beds 3. Black fingertips surrounded by an erythematous rash 4. White color of the skin, which is insensitive to touch.

4. Findings related to frostbite, including white or blue skin in color and skin that is hard, cold and insensitive to touch. As thawing occurs so does flushing of the skin, the development of blisters or blebs, or tissue edema.

Silver sulfadiazine (Silvadene) is prescribed for a client with a burn injury. Which laboratory finding requires the need for monitoring by the nurse? 1. Glucose level of 99mg/dL 2. Platelet level of 3000,000 mm3 3.magnesium level of 1.5 mEq/L 4. White blood cell count of 3000 mm3

4; adverse effects of this medication include rash and itching, blue-green or gray skin discoloration, leukopenia, and interstitial nephritis. The nurse needs to monitor a complete blood count, particularly the white blood cells, frequently for the client taking this medication. If leukopenia develops, the PCP is notified and the medication is usually discontinued.

Stevens-Johnson Syndrome

A medication induced skin reaction that occurs through an immunological response; common medications causing the reaction include antibiotics (esp. sulfonamides), anti seizure meds, and NSAIDS (ibuprofen, naproxen, diclofenac)

Frostbite treatment

Rewarm the affected part rapidly and continuously with a warm water bath or towel at 104F-107.6F; avoid dry heat, never rub or massage area

Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which finding indicates the presence of systemic toxicity from this medication? 1. Tinnitus 2. Diarrhea 3. Constipation 4. Decreased respirations

1; salicylic acid is absorbed readily through the skin and systemic toxicity (salicylism) can result. Symptoms include tinnitus, dizziness, hyperpnea, and psychological disturbances.

The health education nurse provides instructions to a group of clients regarding measures that will assist with preventing skin cancer. Which instructions would the nurse provide? (Select all that apply) 1. One screen needs to be applied every 8 hours. 2. Use sunscreen when participating in outdoor activities. 3. Wear a hat, opaque clothing, and sunglasses when in the sun. 4. Avoid sun exposure in the late afternoon and early evening hours. 5. Examine your body monthly for any lesions that may be suspicious.

2, 3 & 5; sunscreen should be reapplied every 2 to 3 hours and after swimming or sweating. The client needs to be instructed to avoid sun exposure between the hours of brightest sunlight: 10 am to 4 pm. Sunscreen, opaque clothing and sunglasses need to be worn for outdoor activities.

Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed? 1. Potassium level 2. Triglyceride level 3. Hemoglobin A1C 4. Total cholesterol level

2; isotretinoin can elevate triglyceride levels. Blood triglyceride levels need to be measured before treatment and periodically thereafter until the affect on triglycerides has been evaluated.

The nurse is assigned to care for a client with herpes zoster. Based on an understanding of the cause of this disorder, the nurse determines that this definitive diagnosis was made by which diagnostic test. 1. Positive patch test 2. Positive culture results. 3. Abnormal biopsy results. 4. Wood's light examination indicative of infection

2; with the classic presentation of herpes zoster the clinical examination is diagnostic. However, a viral culture of the lesion provides the definitive diagnosis. Herpes zoster (shingles) is cause by reactivation of the varicella -zoster virus, the virus that causes chickenpox.

A client returns to the clinic for follow-up after a skin biopsy of a suspicious lesion that was performed one week ago. The biopsy report indicates that the lesion is melanoma. The nurse understands that which characteristics describe this type of a lesion. (Select all that apply) 1. Metastasis is rare 2. It is encapsulated 3. It is highly metastatic 4. It is characterized by local invasion. 5. Lesion is a nevus that has changed in color.

3 & 5; melanomas are pigmented malignant lesions that originate in the melanin producing cells of the epidermis. The lesion is a Nevis that changes in color. This skin cancer is highly metastatic and a person's survival depends on early diagnosis and treatment.

Silver sulfadiazine (Silvadene) is prescribed for a client with a partial thickness burn, and the nurse provides teaching about the medication. Which statement made by the client indicates a need for further teaching about the treatments? 1. The medication is an anti-bacterial. 2. The medication will help heal the burn. 3. The medication is likely to cause stinging initially. 4. The medication needs to be applied directly to the wound.

3; silver sulfadiazine is an anti-bacterial that has a broad spectrum of activity against gram-negative bacteria, gram-positive bacteria, and yeast. It is applied directly to the wound to assist in healing. It does not cause stinging when applied.

The evening nurse reviews the nursing documentation in the clients chart and notes that the day nurse has documented that the client has a stage 2 pressure injury in the sacral area. What would the nurse expect to find when checking the client's sacral area? 1. Intact skin 2. The presence of tunneling 3. A deep, crater-like appearance 4. Partial-thickness skin loss of the epidermis.

4; with a stage 2 pressure injury, the skin is not intact. There is partial-thickness skin loss of the epidermis or dermis.

The nurse is applying a topical corticosteroid to a client with eczema. The nurse would apply the medication to which body area to decrease the potential for systemic absorption? 9select all that apply) 1. Back 2. Axilla 3. Eyelids 4. Soles of feet 5. Palms of hands

1, 4 & 5; topical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions where permeability is poor (back, palms, soles)

A client with severe acne is seen in the clinic and the primary health care provider prescribes isotretinoin. The nurse reviews the clients medication record and would contact the PCP if the client is also taking which medication? 1. Digoxin 2. Phenytoin 3. Vitamin A 4. Furosemide

3; isotretinoin is a metabolite of vitamin a, and can produce generalized intensification of isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements would be discontinued before isotretinoin therapy.

The nurse is caring for a client who has just been admitted to the nursing unit after receiving flame burns to the face and chest. The nurse notes, a horse cough, and the client is expectorating sputum with black flecks. The client suddenly becomes restless, and his color is becoming dusky. Based on this data, which interpretation would the nurse make? 1. The client is hypotensive 2. Pain is present from the burn injury. 3. The burn has probably caused laryngeal edema which has occluded the airway. 4. The client is afraid and is having a panic attack as a result of the unfamiliar surroundings.

3; the client exhibits several warning signs of an inhalation injury: a history of a flame burn to the face, hoarseness, cough, carbonaceous sputum, singed facial hair, facial edema, and color change. Additionally, one of the cardinal signs of hypoxia is restlessness.

The client arrives at the emergency department after a burn injury that occurred in their home basement and an inhalation injury is suspected. Which would the nurse anticipate as being prescribed for the client? 1. Oxygen via nasal cannula at 10 L 2. Oxygen via nasal cannula at 15 L 3. 100% oxygen via an aerosol mask 4. 100% oxygen via a tight-fitting, nonrebreather face mask

4. If an inhalation injury is suspected the administration of 100% oxygen via a tight fitting nonrebreather facemask is prescribed until the carboxyhemoglobin level decreases to less than 15%.

The nurse is caring for a client with circumferential burns of both legs. Which leg position is appropriate for this type of burn? 1. A dependent position 2. Elevation of the knees 3. Flat, with no elevation 4. Elevation above the level of the heart.

4; circumferential burns of the extremities may compromise circulation. Elevating injured extremities above the level of the heart and performing active exercise help to reduce dependent edema formation.

The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most affective when applied at which times? 1. Immediately before swimming. 2. 5 minutes before exposure to the sun. 3. Immediately before exposure to the sun. 4. At least 30 minutes before exposure to the sun.

4; sunscreens are most effective when applied at least 30 minutes before exposure to the sun so that they can penetrate the skin. All sunscreens need to be or reapplied after swimming or sweating.