NCLEX Q's CH43: Care of the patient with an integumentary disorder
The nurse is assigned to care for a client with herpes zoster. Which characteristics should the nurse expect to note when checking the lesions of this infection? a.) Clustered skin vesicles b.) A generalized body rash c.) Small blue-white spots with red bases c.) A fiery red edematous rash on the cheeks
a.) Clustered skin vesicles *Rationale*The primary lesion of herpes zoster is a vesicle. The classic presentation is grouped vesicles on an erythematous base along a dermatome. Because they follow nerve pathways, the lesions do not cross the body's midline. Options 2, 3, and 4 are incorrect descriptions.
The nurse prepares to care for a client with acute cellulitis of the lower leg. Which treatment should the nurse anticipate being prescribed for the client? a.) Cold compresses to the affected area b.) Warm compresses to the affected area c.) Alternating hot and cold compresses continuously d.) Intermittent heat-lamp treatments four times per day
b.) Warm compresses to the affected area *Rationale:* Warm compresses may be used to decrease discomfort, erythema, and edema. After tissue and blood cultures are obtained, antibiotics are initiated. Heat lamps can cause more disruption to tissue that is already inflamed. Continuous cold and hot compresses are not the best measures.
The nurse inspects the skin of a client who is suspected of having psoriasis. Which finding should the nurse note if this disorder is present? a.) Oily skin b.) Silvery-white scaly lesions c.) Patchy hair loss and round, red macules with scales d.) The presence of wheal patches scattered about the trunk
b.) Silvery-white scaly lesions *Rationale:* Psoriatic patches are covered with silvery white scales. There is no patchy hair loss or round, red macules with scales. The skin is dry and there is no presence of wheal patches scattered about the trunk.
Tinea capitis, Microsporum audouinii, Tinea corporis, and Tinea pedis are examples of: a.) bacterial skin infections. b.) viral skin infections. c.) fungal skin infections. d.) infections commonly acquired in health clubs.
*c.) fungal skin infections.* T. capitis, M. audouinii, T. corporis, and T. pedis are all examples of fungal skin infections. These dermatophytoses are superficial infections. These are not bacterial in origin. An example of a bacterial skin infection is cellulitis. These are not viral in nature. An example of a viral skin infection is herpes zoster. Not all of these fungal infections are commonly acquired at health clubs. T. pedis, or athlete's foot, can be found between the toes of a person whose feet perspire heavily; it also can be spread from contaminated public bathroom facilities and swimming pools.
Which of the following skin disorders is the most serious due to the possibility of an acute respiratory reaction? (Select all that apply.) a.) Contact dermatitis b.) Urticaria c.) Eczema d.) Psoriasis
*a.) Contact dermatitis b.) Urticaria* Contact dermatitis is caused by direct contact with an irritant to which an individual is hypersensitive, such as soap, chemicals, or plants. If the patient has a history of asthma, he or she may experience an acute asthmatic episode. Urticaria is an allergic reaction commonly caused by drugs, food, insect bites, inhalants, emotional stress, or exposure to heat or cold. It is caused by the release of histamine in an antigen-antibody reaction. Capillaries dilate, resulting in increased permeability; respiratory involvement may occur. Eczema, or atopic dermatitis, is a skin disorder primarily occurring in infants and children, associated with allergies to chocolate, eggs, wheat, and orange juice. Papular and vesicular lesions appear, which are surrounded by erythema. Psoriasis is a chronic, noninfectious skin disorder characterized by rapid skin cell division and scaling. Lesions are raised, erythematous, circumscribed plaques on the scalp, elbows, chin, and trunk.
Which of the following are true statements regarding cellulitis? (Select all that apply.) a.) The bacteria that cause cellulitis can be spread by direct contact with an open area on a person who has an infection. b.) Cellulitis occurs when bacteria enter the body through a break in the skin. c.) The primary treatment for cellulitis includes analgesics, dressing changes, and warm compresses. d.) Complications from cellulitis can include sepsis.
*a.) The bacteria that cause cellulitis can be spread by direct contact with an open area on a person who has an infection. b.) Cellulitis occurs when bacteria enter the body through a break in the skin. d.) Complications from cellulitis can include sepsis. * Although not considered to be contagious, the bacteria that cause cellulitis can be spread by direct contact with an open area on a person who has an infection. Cellulitis occurs when bacteria enter the body through a break in the skin, such as a cut, scratch, or insect bite after the injury occurs and is not cleansed with soap and water. Complications from cellulitis can include sepsis, meningitis, and lymphangitis. The primary treatment for cellulitis includes prompt administration of antibiotics. If the cellulitis is mild, oral antibiotics may be prescribed; if the cellulitis is rapidly spreading or the patient has evidence of a serious infection, intravenous antibiotics may be required.
You have a pediatric patient who is being evaluated for a skin rash. The preliminary diagnosis is impetigo contagiosa. Which of the following describes impetigo contagiosa? a.) Is a viral skin infection b.) Is a highly contagious inflammatory disorder c.) Usually presents with a rash on the patient's back d.) Is present in all age groups, but especially the elderly
*b.) Is a highly contagious inflammatory disorder* Impetigo contagiosa is a highly contagious inflammatory disorder. It is highly contagious to a person who directly contacts the exudate of a lesion. Impetigo contagiosa is a bacterial skin infection, usually caused by Staphylococcus aureus, streptococci, or mixed bacteria. Impetigo contagiosa usually presents with a rash on the patient's face, hands, arms, and legs. Impetigo contagiosa is present in all age groups, but especially children.
The patient with herpes zoster is asking the nurse about her condition. What knowledge does the nurse base patient teaching on? a.) The pain experienced by most patients is typically described as "dull and aching." b.) There is usually a rash that occurs in the thoracic region. c.) Herpes zoster usually is permanently disabling to healthy adults. d.) Analgesics are often prescribed for pain; however, steroids are usually avoided because of the immune system suppression.
*b.) There is usually a rash that occurs in the thoracic region.* The rash usually occurs in the thorax region; vesicles erupt in a line along the involved nerve. The pain experienced by most patients is typically described as burning and knifelike. Herpes zoster usually is not permanently disabling to healthy adults. The greatest risk occurs to patients who have had a lower resistance to infection, such as those on chemotherapy or patients receiving large doses of prednisone, in whom the disease could be fatal due to the patient's compromised immune system. Analgesics are often prescribed for pain, including opioid analgesics. Steroids may be given to decrease inflammation and edema. Lotions may be used to relieve pruritus, and corticosteroids may be used to relieve pruritus and inflammation.
A female patient has come into a dermatology clinic and reports that she had a single 1-inch lesion that was scaly with a raised border and a pink center on her chest. Now, a little more than a week later, she has smaller matching spots of the rash on both sides of her chest. The nurse observes pink, oval-shaped spots that are ¼ to ½ inch across. What condition does the nurse suspect the physician will diagnose? a.) Herpes zoster b.) Herpes simplex type 1 c.) Pityriasis rosea d.) Impetigo contagiosa
*c.) Pityriasis rosea* Pityriasis rosea begins with a single lesion, 1 to 2 inches in diameter, known as a herald patch. This lesion is scaly with a raised border and a pink center, and is typically found on the patient's chest, abdomen, back, groin, or axillae. Seven to 14 days after the initial eruption, smaller matching spots of the rash become widespread on both sides of the body. Herpes zoster, commonly known as shingles, causes inflammation of the spinal ganglia, and then advances to the skin by way of the peripheral nerves when a patient's resistance to infection has been lowered. Herpes simplex type 1, commonly known as a cold sore, is characterized by a vesicle at the corner of the mouth, on the lips, or on the nose. Impetigo contagiosa consists of macular lesions that rupture and form a dried exudate on the face, hands, arms, and legs.
Cultural and ethnic considerations for skin assessment include which of the following? a.) Baseline skin color should be assessed in areas with the most pigmentation. b.) Pallor in black-skinned individuals will appear as a pale pink color. c.) To assess rashes and skin inflammation in dark-skinned individuals, the nurse should rely on palpation. d.) The darker the patient's skin, the easier it is to assess for color change.
*c.) To assess rashes and skin inflammation in dark-skinned individuals, the nurse should rely on palpation.* *Rationale:* To assess rashes and skin inflammation in dark-skinned individuals, the nurse should rely on palpation for warmth and induration rather than observation. Baseline skin color should be assessed in areas with the least pigmentation. Examples are the palms of the hands, soles of the feet, undersides of the forearms, abdomen, and buttocks. Pallor in black-skinned individuals will appear as ashen or gray. The darker the patient's skin, the more difficult it is to assess for color change. A baseline needs to be established in natural lighting, if possible, or with at least a 60-watt light bulb.
What is important for the nurse to assess when inspecting the skin of a patient? a.) Avoid potentially embarrassing questions about rashes or scars. b.) Wear gloves only if the skin appears broken or inflamed. c.) Have artificial, preferably fluorescent, lighting for proper illumination of the skin. d.) Ask the patient about personal skin care.
*d.) Ask the patient about personal skin care.* *Rationale:* The patient should be asked about personal skin care. The nurse should ask about recent color changes, sun exposure (with and without sunscreen), and family history of skin cancer. The nurse should ask the patient about recent skin lesions or rashes, where the lesions first appeared, and how long they have been present. It is important for the nurse to remember to wear gloves when inspecting the skin, mucous membranes, and any involved area. When assessing the skin, the nurse should have natural lighting.
The nurse is reviewing the health care record of a client with a lesion that has been diagnosed as malignant melanoma. The nurse should expect which characteristic of this type of lesion to be documented in the client's record? A.) An irregularly shaped lesion B.) A small papule with a dry, rough scale C.) A firm nodular lesion topped with a crust d.) A pearly papule with a central crater and a waxy border
A.) An irregularly shaped lesion A melanoma is an irregularly shaped pigmented papule or plaque with a red, white, or blue color. Basal cell carcinoma appears as a pearly papule with a central crater and a rolled, waxy border. Squamous cell carcinoma is a firm nodular lesion that is topped with a crust or a central area of ulceration. Actinic keratosis, which is a premalignant lesion, appears as a small macule or papule with a dry, rough, adherent yellow or brown scale.
The nurse inspects the oral cavity of a client with cancer and notes white patches on the mucous membranes. The nurse interprets this occurrence as which? A.) Common B.) Suggests that the client is anemic C.) Characteristic of a thrush infection D.) Indicative that oral hygiene needs to be improved
C.) Characteristic of a thrush infection *Rationale:* Candidiasis is a fungal infection caused by Candida albicans. When it occurs in the mouth, it is called thrush and appears as white plaques. Although it can occur in an immunocompromised client, it is not considered to be common. Options 2 and 4 are not accurate regarding this infection.
A client returns to the clinic for follow-up treatment after a skin biopsy of a suspicious lesion that was performed 1 week ago. The biopsy report indicates that the lesion is a melanoma. The nurse understands that which describes a characteristic of this type of a lesion? A.) Metastasis is rare. B.) It is encapsulated. C.) It is highly metastatic. D.) It is characterized by local invasion.
C.) It is highly metastatic. Melanomas are pigmented malignant lesions that originate in the melanin-producing cells of the epidermis. This skin cancer is highly metastatic, and a person's survival depends on early diagnosis and treatment. Basal cell carcinomas arise in the basal cell layer of the epidermis. Early malignant basal cell lesions often go unnoticed, and although metastasis is rare, underlying tissue destruction can progress to include vital structures. Squamous cell carcinomas are malignant neoplasms of the epidermis. They are characterized by local invasion and the potential for metastasis.
What is the term for an infection of a hair follicle? a.) Folliculitis b.) A furuncle c.) A carbuncle d.) A felon
a.) Folliculitis Folliculitis is an infection of a hair follicle, usually from Staphylococcus aureus bacteria. The infection may involve one or several follicles. It often occurs after shaving. A furuncle, also known as a boil, is an inflammation that begins deep in the hair follicles and spreads to the surrounding skin, and is often located in the posterior area of the neck, the forearm, buttocks, and the axillae. A carbuncle is a cluster of furuncles. It is an infection of several hair follicles that spreads to surrounding tissue. A felon occurs when the soft tissue under and around an area, such as the fingernail, becomes infected. The involved finger becomes erythematous, edematous, and tender.
Which should be the anticipated therapeutic outcome of an escharotomy procedure performed for a circumferential arm burn? a.) The return of distal pulses b.) Decreasing edema formation c.) Brisk bleeding from the injury site d.) The formation of granulation tissue
a.) The return of distal pulses *Rationale:* Escharotomies are performed to alleviate the compartment syndrome that can occur when edema forms under nondistensible eschar in a circumferential burn. Escharotomies are performed through avascular eschar to subcutaneous fat. Although bleeding may occur from the site, it is considered a complication rather than an anticipated therapeutic outcome. The formation of granulation tissue is not the intent of an escharotomy, and escharotomy will not affect the formation of edema
A client arrives at the emergency department and has experienced frostbite to the right hand. Which should the nurse expect to find when inspecting the client's hand? a.) A pink, edematous hand b.) Fiery red skin with edema in the nail beds c.) Black fingertips surrounded by an erythematous rash d.) A white color of the skin, which is insensitive to touch
d.) A white color of the skin, which is insensitive to touch The findings related to frostbite include a white or blue skin 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. Gangrene can develop in 9 to 15 days.
The nurse is caring for a client with circumferential burns of both legs. Which leg position is appropriate for this type of a burn? a.) A dependent position b.) Elevation of the knees c.) Flat, without elevation d.) Elevation above the level of the heart
d.) Elevation above the level of the heart *Rationale:* 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. Options 1, 2, and 3 are incorrect.
What is herpes simplex type 2? a.) Is commonly known as a cold sore b.) Usually affects the labia in women c.) Is characterized by a vesicle at the corner of the mouth, lips, or nose d.) Is accompanied by flulike symptoms 3 to 4 days after the vesicles erupt
d.) Is accompanied by flulike symptoms 3 to 4 days after the vesicles erupt Herpes simplex type 2 is accompanied by flulike symptoms 3 to 4 days after the vesicles erupt. Headache, fatigue, myalgia, elevated temperature, and anorexia are common. Herpes simplex type 1 is commonly known as a cold sore. Herpes simplex type 2 usually affects the cervix in women and the penis in men. Herpes simplex type 2 causes lesions in the genital area and is commonly known as genital herpes. The primary mode of transmission is through sexual contact. Herpes simplex type 1 is characterized by a vesicle at the corner of the mouth, lips, or nose.
The evening nurse reviews the nursing documentation in the client's chart and notes that the day nurse has documented that the client has a stage 2 pressure ulcer in the sacral area. Which should the nurse expect to find when checking the client's sacral area? a.) Intact skin b.) The presence of tunneling c.) A deep, crater-like appearance d.) Partial-thickness skin loss of the epidermis
d.) Partial-thickness skin loss of the epidermis *Rationale:* With a stage 2 pressure ulcer, the skin is not intact. There is partial-thickness skin loss of the epidermis or dermis. The ulcer is superficial, and it may look like an abrasion, blister, or shallow crater. The skin is intact with a stage 1 pressure ulcer. A deep, crater-like appearance occurs during stage 3, and tunneling develops during stage 4.
