Med Surg. Chapter 61

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."

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 of the following statements is true about Stevens Johnson syndrome and TEN?

Affected people are typically hospitalized in a burn unit.

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 instructing the patient in how to apply a corticosteroid cream to lesions on the arm. What intervention can the nurse instruct the patient to do to increase the absorption of the medication?

Apply an occlusive dressing over the site after application.

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

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

Avoid cosmetics with fragrance.

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.

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 of the following types of therapeutic baths for its antipruritic action?

Colloidal (Aveeno, oatmeal)

Which of the following medication classifications may be used for contact dermatitis?

Corticosteroids

Which of the following is the primary cause of skin cancer?

Exposure to UV radiation in sunlight

Which of the following terms refers most precisely to a localized skin infection of a single hair follicle?

Furuncle

Mary Glenn, age 44 years, has come to the clinic because she has noticed that she has been having a greater than normal amount of hair loss, and she thinks she is developing a bald spot on the top of her head. Choose the following condition that is probably not causing her hair loss.

Furunculosis

The classic lesions of impetigo are manifested as which of the following?

Honey crusted lesions on an erythematous base

Which of the following skin conditions is caused by staphylococci, streptococci, or multiple bacteria?

Impetigo

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

Infection

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

Isotretinoin (Accutane)

Which of the following is an oral retinoid used in the treatment of acne?

Isotretinoin (Accutane)

The nurse is providing teaching to a patient with acne who is using isotretinoin (Accutane) therapy. Which of the following statements should the nurse make?

It is teratogenic in humans.

Which of the following infecting agents is the cause of scabies?

Itch mite

A nurse practitioner prescribes a therapeutic bath for a patient with an exacerbation of psoriasis. She tells the patient to make sure the bath area is well ventilated. Which of the following is the therapeutic bath solution prescribed by the nurse?

Medicated tars

A young adult visits a health clinic for treatment of a severe case of eczema on his left leg. Which of the following is the preferred method for delivering medication in this scenario?

Ointment

Which of the following is a dermatophyte infection of the fingernails or toes?

Onychomycosis

Which of the following is an appropriate teaching component for the client diagnosed with lice to prevent reinfestation?

Perform hair inspection whenever there is an outbreak, even if asymptomatic.

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

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 patient visits a clinic for assessment of an inflammatory skin disorder. The nurse diagnoses the condition as psoriasis based on the appearance of the skin. Which of the following describes the dermatoses?

Red, raised patches of skin covered with silvery scales

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 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

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

Secondary bacterial infection

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

Shampoo with piperonyl butoxide (RID).

A patient visits a health clinic with a skin lesion on her right forearm. The lesion is inflamed, swollen, and draining. The nurse practitioner knows the best choice of a treatment would be the application of which of the following?

Soothing lotion

The nurse teaches the patient who demonstrates herpes zoster (shingles) which of the following?

The infection results from reactivation of the chickenpox virus.

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])

Which of the following 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.

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

the infection results from reactivation of the chickenpox virus.

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

Daily

In assessing a scar, you notice an overgrowth of tissue. It is best described as a

Keloid

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

Never pick or squeeze a furuncle.

The nurse is teaching a patient about the correct use of topical concentrated corticosteroids. The nurse includes which of the following? Select all that apply.

• Avoid applying to the face. • Avoid prolonged use.

The nurse is providing instruction to a patient with acne. The nurse promotes avoidance for which of the following foods? Select all that apply.

• Ice cream • Chocolate

What should the nurse assess for to determine if a patient using corticosteroids for a dermatologic condition is having local side effects? (Select all that apply.)

• Skin atrophy • Striae • Telangiectasia

Dermatophytes (also called tinea) are parasitic fungi that invade the skin, scalp, and nails. How is a diagnosis made for this condition? Choose all that are correct.

• Visual examination • Wood's light

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."

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

Frequent inspection of oral cavity

The nurse caring for a patient notes that the patient'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 being which of the following?

Lichenification

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 patient arrives in the emergency department after being burned in a house fire. The patient's burns cover the face and chest. What percentage of the patient's body is burned according to the rule of 9s?

13.5%

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.

The nurse is assessing a patient's skin when the patient points out a mole. The nurse brings the mole to the physician's attention when which of the following is noted?

Diameter exceeding 6 mm

The nurse is conducting a community education program on basal cell carcinoma (BCC). Which of the following statements should the nurse make?

It begins as a small, waxy nodule with rolled translucent, pearly borders.

A nurse in a health care provider's office teaches a patient how to apply an occlusive dressing (using plastic film) to cover a medicated ointment applied to her arm. An important teaching point would be to tell the patient to:

Limit use of the dressing to 12 hours.

While examining a client's leg, a nurse notes an open ulceration with visible granulation tissue in the wound. Until a wound specialist can be contacted, which type of dressing should the nurse apply?

Moist sterile saline gauze

A 17-year-old high school student is being treated for acne vulgaris and significant time is spent in client education to develop strategies to try to decrease the severity of his outbreaks. What contributes to follicular irritation?

Overproduction of sebum

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.

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.