Integumentary Problems

Application of topical corticosteroids may be prescribed for a patient bitten by which organism? a. Lice b. Bees c. Mite d. Bedbugs

Rationale Bedbug bites are treated with the use of antihistamines and topical corticosteroids. Lice bites cause minute, red, noninflamed points that are flush with the skin; pyrethrins and spinosad are used in the treatment of pediculosis (lice infestation). People who are stung by bees or wasps may experience intense burning and local pain at the site of the bite, along with swelling and itching. The sting may be treated with cool compresses and antihistamines as necessary. The patient bitten by mites may have scabies, often marked by severe itching and crusting between the fingers. Scabies is treated with a 5% topical lotion of permethrin.

Which condition may manifest as an elevated, dry, hyperkeratotic, scaly papule on an older adult patient? a. Actinic keratosis b. Dysplastic nevus c. Basal cell carcinoma d. Squamous cell carcinoma

a. Actinic keratosis Rationale 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 patient admitted with cellulitis of the left foot may present with which clinical manifestations? a. Erythema and swelling b. Pallor and poor turgor c. Cyanosis and cooking d. Edema and brown discoloration

a. Erythema and swelling

Which condition does the nurse suspect based on the data in the following patient's chart? Background: Patient is a 52-year-old male who presents for yearly skin check. Assessment: Presences of 1.5cm flat, ulcerated mole on the back. Variegated coloration. Irregular surface and border. a. Melanoma b. Actinic keratosis c. Squamous cell carcinoma d. Cutaneous T-cell lymphome

a. Melanoma Rationale Melanoma presents as a large mole (usually >1 cm), most frequently on the back or the chest in men, or on the legs or back in women. It can be flat or elevated, eroded or ulcerated. It usually has an irregular surface, border, and coloration. Actinic keratosis presents as a flat or elevated dry, scaly papule. Squamous cell carcinoma is more common on the face and hands and presents as thin scaly plaque in its early stages. Cutaneous T-cell lymphoma present similarly to psoriasis, but it also causes pruritus and lymphadenopathy.

Which condition may present with small, red, pruritic lesions between the fingers and toes in a pattern of small lines? a. Scabies b. Varicella c. Contusions d. Herpes zoster

a. Scabies

Ultraviolet A (UVA) rays of the sun cause which effects on the skin? Select all that apply. a. Tanning b. Sunburn c. Premature aging d. Loss of skin elasticity e. Degenerative changes in the dermis

a. Tanning c. Premature aging d. Loss of skin elasticity e. Degenerative changes in the dermis Rationale Ultraviolet B rays cause sunburn. The effects of UVA rays are cumulative.

Methotrexate may be prescribed to treat which condition? a. A benign adipose tumor b. Autoimmune chronic dermatitis c. Inflammatory disorder of sebaceous glands d. An increase in normal melanocytes in the basal layer of the epidermis

b. Autoimmune chronic dermatitis Rationale The skin condition associated with autoimmune chronic dermatitis is psoriasis, which involves excessively rapid turnover of the cells. Methotrexate slows down the rapid division of skin cells that is a hallmark of psoriasis. A benign tumor of adipose tissue is called a lipoma; it generally does not require treatment, but excision is the usual treatment option. An inflammatory disorder of the sebaceous glands is acne vulgaris, usually treated with topical benzoyl peroxide

Which statement about basal cell carcinoma (BCC) is true? a. BCC is the deadliest type of skin cancer. b. BCC is the most common type of skin cancer. c. Prognosis depends upon the thickness of the lesion. d. The cancerous cells of BCC usually spread beyond the skin.

b. BCC is the most common type of skin cancer.

A patient with diabetes mellitus may have an increased incidence of which skin condition? Select all that apply. a. Erysipelas b. Folliculitis c. Furunculosis d. Actinic keratosis e. Cutaneous T-cell lymphoma

b. Folliculitis c. Furunculosis Rationale Patient with diabetes mellitus may have an increased incidence of folliculitis and furunculosis. Erysipelas is a form of superficial cellulitis and does not have an increased incidence with diabetes mellitus. Actinic keratosis has an increased incidence in older adults, not diabetes mellitus. Cutaneous T-cell lymphoma may be related to environmental toxins and chemical exposure.

Which assessment findings may be associated with a diagnosis of head lice? a. Diffuse, pruritic wheals b. Oval, white dots stuck to hair shafts c. Pruritic papules with linear burrows at the hairline d. Itchy redness and edema over the area of infestation.

b. Oval, white dots stuck to hair shafts

Which condition may present as small, skin-colored, soft pedunculated papules on the neck, axillae, and upper trunk of a middle-aged, obese patient? a. Nevi b. Lentigo c. Acrochordons d. Seborrheic keratoses

c. Acrochordons Rationale Small, skin-colored, soft, pedunculated papules are a manifestation of acrochordons. They are also called skin tags and are commonly found on the neck, axillae, and upper trunk. They are mostly found in obese patients during middle age. Nevi or moles are hyperpigmented areas that vary in form and color. Lentigo is hyperpigmented, brown to black maculae or patches on sun-exposed areas. Seborrheic keratosis is characterized by irregular verrucous papules or plaques that are well-defined in shape.

Which action should the nurse take to prevent postherpetic neuralgia for a patient with herpes zoster? a. Administer mild sedatives at night. b. Apply wet compresses to the affected area. c. Administer acyclovir as prescribed within 72 hours. d. Apply silver sulfadiazine on the ruptured vesicles.

c. Administer acyclovir as prescribed within 72 hours. Rationale Classic clinical manifestation of herpes zoster (shingles) is linear distribution of grouped vesicles along a dermatome. Often there is a burning pain preceding an outbreak. Postherpetic neuralgia is a preventable condition if the antiviral agents are administered within 72 hours. Using a mild sedative at night, applying silver sulfadiazine on the vesicles, and applying wet compresses may decrease symptoms, but they have no effect on the prevention of postherpetic neuralgia.

Which treatments may be prescribed for a patient diagnosed with folliculitis after frequent use of a hot tub? Select all that apply. a. Oral penicillin b. Incision and drainage c. Antistaphylococcal soap d. Warm compress of aluminum acetate e. Immobilization and elevation of the affected area

c. Antistaphylococcal soap d. Warm compress of aluminum acetate Rationale Folliculitis is characterized by small pustules at the hair follicle openings and minimal erythema. Antistaphylococcal soap-and-water cleansing is used to treat folliculitis. Warm compresses of water or aluminum acetate solution are also used as treatment. Systemic antibiotics, such as oral penicillin, are used in the treatment of impetigo, furunculosis, and cellulitis. Incision and drainage are used to treat furuncle and furunculosis. Immobilization and elevation of the affective area are appropriate for patients with cellulitis.

The nurse will expect which diagnosis for the patient with asthma who reports erythema, oozing vesicles, and severe itching of the skin? a. Urticaria b. Drug reaction c. Atopic dermatitis d. Allergic contact dermatitis

c. Atopic dermatitis Rationale Asthma and atopic dermatitis are atopic diseases with the same pathogenic base with regard to allergic reaction and type of oversensitivity leading to allergic inflammation. Therefore atopic dermatitis may be associated with asthma. Urticaria is an allergic reaction associated with erythema and edema in the upper epidermis. A drug reaction is caused by any drug that acts as as antigen and causes a hypersensitivity reaction, which results from sensitization after one or more exposures. It is characterized by the appearance of lesions two to seven days after contact with an allergen.

The incidence of which skin infection is increased in patients with diabetes mellitus? a. Cellulitis b. Impetigo c. Folliculitis d. Furunculosis

c. Folliculitis Rationale The incidence of folliculitis is increased among people with diabetes mellitus. Cellulitis is typically a secondary complication of a disease but may occur as a primary infection. Impetigo, typically associated wit poor hygiene, may be a primary or secondary infection. The incidence of furunculosis is increased among people with obesity, diabetes, chronic illness, and those who are regularly exposed to moisture or pressure.

Cellulitis of the right lower extremity may present with which assessment finding? a. Pallor of the right toes b. Delayed capillary refill time c. Hot, tender edematous area d. Paresthesia of the right lower extremity

c. Hot, tender edematous area

Which skin infection may present with a vesiculopustular lesion with a thick, honey-colored crust surrounded by erythema on the left side of a patient's arm? a. Cellulitis b. Furuncle c. Impetigo d. Folliculitis

c. Impetigo Rationale Impetigo is marked by vesiculopustular lesions that develop a thick, honey-colored crust surrounded by erythema. They are most common on the face as a primary infection. Cellulitis manifests clinically as a hot, tender, erythematous, edematous area with a diffuse border. Furuncle is marked by a tender, erythematous area around a hair follicle. Small pustules at the hair follicle opening with minimal erythema and development of crusting are indicative of folliculitis.

The nurse should implement contact precautions for the patient with which condition? a. Psoriasis b. Tinea unguium c. Impetigo on the lower legs d. Candidiasis in the groin area

c. Impetigo on the lower legs

Which factor puts a light-skinned patient at a higher risk for skin cancer than a patient with darker skin? a. Less sun exposure b. More sun exposure c. Less melanin content in the skin d. Greater melanin content in the skin

c. Less melanin content in the skin

A patient who reports severe nighttime body itching and has red, crusted papules may have which infestation? a. Lice b. Ticks c. Scabies d. Bedbugs

c. Scabies Rationale Severe nighttime itching and red papules are indicative of scabies. Lice bites result in minute, red, noninflamed points that progress to a papular wheal-like lesion. A tick bite that transmits Lyme disease is characterized by a spreading, ring-like rash that occurs three to four weeks after the bite. A bedbug bite results in a wheal surrounded by a vivid flare and firm urticaria that transforms into a persistent lesion.

Which diagnosis does the nurse expect for a patient who presents with redness and a group of vesicles on the lower lip, which has a tingling and burning sensation? a. Impetigo b. Candidiasis c. Herpes zoster d. Herpes simplex virus

d. Herpes simplex virus

A patient with pustules and redness only on the left side of the face may be diagnosed with which skin condition? a. Furuncle b. Candidiasis c. Verruca vulgaris d. Herpes zoster (shingles)

d. Herpes zoster (shingles) Rationale The patient may have herpes zoster (shingles), which is marked clinically by a linear distribution of vesicles or pustules along a dermatome on an erythematous base. The lesions resemble those of chickenpox. Herpes zoster appears unilaterally on the trunk, face, and lumbosacral areas. Furuncle is a bacterial infection characterized by a tender erythematous area around a hair follicle; it is most common on the face, back of the neck, axillae, breasts, and buttocks. Candidiasis is characterized by diffuse, papular, erythematous rash with pinpoint satellite lesions around the edges of affected area. Patients with verruca vulgaris have circumscribed, hypertrophic, flesh-colored papules that are painful when compressed laterally.

Which diagnosis does the nurse expect for a patient who presents with an area of irregularly round, verrucous papules with well-defined shapes which have become darker of the past few months and are often itchy and irritating? a. Lentigo b. Psoriasis c. Acne vulgaris d. Seborrheic keratosis

d. Seborrheic keratosis Rationale Clinical manifestations of seborrheic keratosis include irregularly round or oval, often verrucous papules or plaques with well-defined shape and the appearance of being stuck on. The lesions increase in pigmentation with time and are usually multiple and possibly itchy. Clinical manifestations of lentigo include hyperpigmented, brown to black maculae or patches (flat lesions) over sun-exposed areas. Clinical manifestations of psoriasis include sharply demarcated silvery scaling plaques on reddish colored skin commonly on the scalp, elbows, knees, palms, soles, and fingernails. Acne vulgaris is manifested by noninflammatory lesions, including open comedones (blackheads) and closed comedones (whiteheads), and inflammatory lesions, including papules and pustules

A patient who complains of an itchy rash in the groin area may have which common fungal infection? a. Tinea pedis b. Tinea cruris c. Tinea corporis d. Tinea unguium

b. Tinea cruris Rationale An itchy rash in the groin suggests tinea cruris, or jock itch, which is a fungal infection of the groin area. Tinea pedis is also a fungal infection but affects the feet or tows. Tinea corporis is more commonly known as ringworm and is an infection of the skin. Tinea unguium is a fungal infection of the fingernails or toenails and does not affect the groin.

Which fungal infection manifests on the surface of a patient's skin with an erythematous and typically annular, scaly appearance and well-defined margins? a. Tinea pedis b. Tinea cruris c. Tinea corporis d. Tinea unguium

c. Tinea corporis Rationale Tinea corporis is commonly referred to as ringworm. A tinea corporis infection has an erythematous, annular (ring-like), scaly appearance with well-defined margins. A tinea pedis fungal infection in characterized by scaly plantar surfaces that are pruritic and blistering in nature. A tinea cruris infection does not affect mucous membranes, and it is associated with well-defined scaly plaque on the patient's groin area. A patient with tinea unguium infection has brittle, thickened, and broken nails with yellowish discoloration.

The nurse suspects which condition is occurring for a patient who has reddened, itchy skin with papules around an abdominal dressing where there had been tape? a. Urticaria b. Tinea corporis c. Atopic dermatitis d. Allergic contact dermatitis

d. Allergic contact dermatitis

A patient who is obese and has a diagnosis of diabetes has an increased risk for which bacterial skin infection? a. Cellulitis b. Impetigo c. Carbuncle d. Furunculosis

d. Furunculosis Rationale Patients who are obese and diabetic are at increased risk for furunculosis because of the likelihood of skinfolds containing excess moisture. Therefore the nurse should warn the patient about the possibility of furunculosis. Cellulitis may be a secondary complication or a primary infection; it most often results from a break on the skin's surface. Impetigo is most common in patients with poor hygiene. Many factors are responsible for the development of carbuncle.

A patient with which occupation may have a higher risk for developing skin malignancies? Select all that apply. a. Farmer b. School teacher c. Baseball player d. Software engineer e. Construction worker

a. Farmer c. Baseball player e. Construction worker

A patient who presents with ring-like rash and flu-like symptoms following a hiking vacation three to four weeks ago may have been bitten or stung by which organism? a. Tick b. Wasp c. Lice d. Bedbug

a. Tick

Which diagnosis does the nurse expect for a patient with circumscribed, hypertrophic, flesh-colored papules on the knee that recur even after removal? a. Plantar warts b. Herpes zoster c. Verruca vulgaris d. Herpes simplex virus type 1

c. Verruca vulgaris

Which treatments may be included in the plan of care for a patient who was stung by a bee? a. Antihistamine b. Cool compresses c. Warm compresses d. Antipruritic ointment e. Liquid nitrogen therapy

a. Antihistamine b. Cool compresses d. Antipruritic ointment

A patient diagnosed with psoriasis may present with which clinical manifestations? a. Pustules in skinfolds b. Itchy, scaly patches on scalp c. Macular rash on the trunk area d. Vesicular rash on the extremities

b. Itchy, scaly patches on scalp

If dermatitis is suspected, the nurse will assess which factor next? a. History of seasonal allergies b. Initiation of new medication c. Previous pruritic skin lesions d. Activities in the past two to seven days

d. Activities in the past two to seven days

In which order will the nurse tach a patient to perform the steps for wound care following a skin biopsy? a. Cleanse with plain water. b. Apply a topical antibiotic. c. Cover with a dry dressing. d. Look for signs of infection.

d. Look for signs of infection. a. Cleanse with plain water. b. Apply a topical antibiotic. c. Cover with a dry dressing.

Which type of skin cancer has a higher risk for metastasis and poor prognosis unless it is treated early? a. Myeloma b. Melanoma c. Basal cell carcinoma d. Squamous cell carcinoma

b. Melanoma

A patient admitted with cellulitis may present with which localized manifestation? a. Pain b. Fever c. Chills d. Malaise

a. Pain

A patient bitten by which organism is at risk for contracting Lyme disease? a. Lice b. Ticks c. Mites d. Wasps

b. Ticks

The nurse expects which diagnosis for a patient who has developed a skin infection with an associated fever of 101.6 degrees F (38.7 degrees C), a white blood cell count of 26,000, a headache, and malaise? a. Impetigo b. Carbuncle c. Folliculitis d. Erysipelas

d. Erysipelas Rationale Erysipelas is associated with toxic signs such as fever, headache, malaise, and an increase in white blood cell count. Impetigo is characterized by vesiculopustular lesions surrounded by erythema that develop a thick, honey-colored crust. Carbuncle is characterized by many pustules appearing in an erythematous area. Folliculitis is characterized by small pustules at the hair follicle opening and minimal erythema.

A 5% permethrin topical solution may be prescribed to treat which skin condition? a. Scabies b. Pediculosis c. Lyme disease d. Tinea corporis

a. Scabies