Week 5

The nurse working in the dermatology clinic assesses a young adult female patient who has severe cystic acne. Which assessment finding is of concern related to the patient's prescribed isotretinoin? a. The patient recently had an intrauterine device removed. b. The patient already has some acne scarring on her forehead. c. The patient has also used topical antibiotics to treat the acne. d. The patient has a strong family history of rheumatoid arthritis.

ANS: A Because isotretinoin is teratogenic, contraception is required for women who are using this medication. The nurse will need to determine whether the patient is using other birth control methods. More information about the other patient data may also be needed, but the other data do not indicate contraindications to isotretinoin use.

A patient with atopic dermatitis has been using a high-potency topical corticosteroid ointment for several weeks. The nurse would assess for which adverse effect? a. Thinning of the affected skin b. Alopecia of the affected area c. Dryness and scaling in the area d. Reddish-brown skin discoloration

ANS: A Thinning of the skin indicates atrophy, a possible adverse effect of topical corticosteroids. The health care provider would be notified so that the medication can be changed or tapered. Alopecia, red-brown discoloration, and dryness and scaling of the skin are not adverse effects of topical corticosteroid use.

A nurse is teaching a patient with contact dermatitis of the arms and legs about ways to decrease itching. Which information would the nurse include in the teaching plan? (Select all that apply.) a. Take cool or tepid baths to decrease itching. b. Add oil to your bath water to moisturize the affected skin. c. Cool, wet clothes or compresses can be used to reduce itching. d. Use an over-the-counter (OTC) antihistamine to reduce itching. e. Rub yourself dry with a towel after bathing to prevent skin maceration.

ANS: A, C, D Cool or tepid baths, cool dressings, and OTC antihistamines all help reduce itching and scratching. Adding oil to bath water is not recommended because of the increased risk for falls. The patient would use the towel to pat (not rub) the skin dry.

A 35-yr-old female patient has a new prescription for isotretinoin. Which additional assessment information will be most important for the nurse to obtain? a. History of sun exposure by the patient b. Method of contraception used by the patient c. Length of time the patient has had acne lesions d. Appearance of the treated areas on the patient's face

ANS: B Because isotretinoin is teratogenic, it is essential that the patient use a reliable method of birth control. The other information is also important for the nurse to obtain, but lack of reliable contraception has the most potential for serious adverse medication effects.

The nurse is interviewing a patient with contact dermatitis who reports severe itching. Which finding indicates a need for patient teaching? a. The patient applies corticosteroid cream to pruritic areas. b. The patient applies warm compresses to the area twice daily. c. The patient adds oilated oatmeal to the bath water every day. d. The patient takes diphenhydramine at night for persistent itching

ANS: B Have the patient avoid anything that causes vasodilation, such as heat or rubbing. Dry skin lowers the itch threshold and increases the itch sensation. The patient is appropriately using the other treatments.

A patient with atopic dermatitis has a new prescription for pimecrolimus (Elidel). Which statement by the patient indicates that further teaching is needed? a. ―After I apply the medication, I can get dressed as usual. b. ―If the medication burns when I apply it, I will wipe it off. c. ―I need to minimize time in the sun while using the Elidel. d. ―I will rub the medication in gently every morning and night.‖

ANS: B The patient would be taught that transient burning at the application site is an expected effect of pimecrolimus and that the medication should be left in place. The other statements by the patient are accurate and indicate that patient teaching has been effective.

A patient is undergoing psoralen plus ultraviolet A light (PUVA) therapy for treatment of psoriasis. Which action would the nurse take to prevent adverse effects? a. Shield any unaffected areas with lead-lined drapes. b. Apply petroleum jelly to the areas around the lesions. c. Cleanse the skin carefully with antiseptic soap prior to PUVA. d. Have the patient use protective eyewear while receiving PUVA.

ANS: D The eyes would be shielded from UV light (UVL) during and after PUVA therapy to prevent the development of cataracts. The patient would be taught about the effects of UVL on unaffected skin, but lead-lined drapes, use of antiseptic soap, and petroleum jelly are not used to prevent skin damage.

The nurse is caring for a client who has vesicles filled with purulent fluid on the face and upper extremities. On the basis of these findings, the nurse should tell the client that the vesicles are consistent with which condition? 1.Acne 2.Freckles 3.Psoriasis 4.Sebaceous cysts

Ans: 1 Acne is characterized by vesicles filled with cloudy or purulent fluid. Freckles are flat lesions less than 1 centimeter. Psoriasis is presented by elevated, plateaulike patches more than 1 centimeter. Sebaceous cysts are nodules filled with either liquid or semisolid material that can be expressed.

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

Ans: 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 hypopigmentation of the skin in clients with a dark complexion. The effects noted in the other options are not specifically associated with this medication.

A client with severe psoriasis has a problem of chronic low self-esteem. The nurse should incorporate which nursing action when working with this client? 1.Listening attentively 2.Keeping communications brief 3.Approaching the client in a formal manner 4.Avoiding looking at the affected skin areas

Ans: 1 Clients with chronic skin disorders may experience chronic low self-esteem because of the disorder itself and possible rejection by others. The nurse demonstrates acceptance of the client by using a quiet, unhurried manner and by using appropriate visual contact, facial expression, and therapeutic touch. Communications that seem brief and formal may reinforce the feelings of rejection, as well as avoidance of looking at the affected skin areas.

Coal tar has been prescribed for the client with psoriasis, and the nurse provides instructions to the client regarding this treatment. Which statement by the client indicates a need for further instruction? 1."The medication can cause diarrhea." 2."The medication can cause phototoxicity." 3."The medication has an unpleasant odor." 4."The medication can stain the skin and hair."

Ans: 1 Coal tar is used to treat psoriasis and other chronic disorders of the skin. It suppresses DNA synthesis, mitotic activity, and cell proliferation. It has an unpleasant odor, frequently can stain the skin and hair, and can cause phototoxicity. It does not cause diarrhea.

Isotretinoin is prescribed for a client with severe cystic acne. The nurse provides instructions to the client regarding administration of the medication. Which phrase stated by the client indicates a need for further teaching regarding this medication? 1."I need to continue to take my vitamin A supplements." 2."The medication may cause dryness and burning in my eyes." 3."I need to use emollients and lip balms for my dry skin and lips." 4."I will need to return for a blood test to check my triglyceride level."

Ans: 1 In severe cystic acne, isotretinoin is used to inhibit inflammation. Adverse effects include elevated triglyceride levels, skin dryness, eye discomfort such as dryness and burning, and cheilitis (lip inflammation). Close medical follow-up is required, and dry skin and cheilitis can be decreased by the use of emollients and lip balms. Vitamin A supplements are stopped during this treatment.

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

Ans: 1 Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can result. Symptoms include tinnitus, dizziness, hyperpnea, and psychological disturbances. Constipation and diarrhea are not associated with salicylism.

The nurse expects to note which prescription for a client with a skin infection that extends into the dermis? 1.Applying warm compresses to the affected area 2.Placing iced compresses to the affected area every 4 hours 3.Alternating the application of hot and iced compresses every 2 hours 4.Placing antibiotic ointment on the affected site followed by continuous heat lamp application

Ans: 1 Warm compresses may be prescribed to decrease the discomfort, erythema, and edema associated with a skin infection that is characteristic of cellulitis. The nurse should also provide supportive care as prescribed to manage associated symptoms such as fever or chills. After tissue and blood are obtained for culture, antibiotics are initiated. Heat lamps can cause more disruption to already inflamed tissue. Iced compresses are not prescribed because they can damage tissue.

The nurse is preparing to perform an assessment on a client being seen in the clinic. On review of the client's record, the nurse notes that the client has psoriasis. The nurse would expect to observe which characteristics on assessment of the client's psoriatic lesions? Select all that apply. 1.Red, raised papules 2.Large plaques covered by silvery scales 3.Tiny red vesicles that weep serous material 4.Erythema noted mostly under the breast area 5.Pink to dark red, patchy eruptions on the skin

Ans: 1, 2 Psoriasis lesions appear as red, raised papules that may coalesce into large plaques covered by silvery scales. Eczema can manifest as tiny red vesicles that weep serous or purulent material. Erythema noted mostly under the breast area is characteristic of seborrheic dermatitis. Pink to dark red, patchy eruptions on the skin may be indicative of exfoliative dermatitis.

The nurse is developing a teaching plan for a group of adolescents regarding the causes of acne. The nurse develops the plan based on which characteristics associated with acne? Select all that apply. 1.The exact cause of acne is unknown. 2.Acne requires active treatment for control until it resolves. 3.Oily skin and a genetic predisposition may be contributing factors for acne. 4.Acne is an acute skin disorder that usually begins in puberty and is more common in females. 5.The types of lesions in acne include comedones (open and closed), pustules, papules, and nodules.

Ans: 1, 2, 3, 5 Acne is a chronic skin disorder that usually begins in puberty and is more common in males. Lesions develop on the face, neck, chest, shoulders, and back. Acne requires active treatment for control until it resolves. The types of lesions include comedones (open and closed), pustules, papules, and nodules. The exact cause is unknown but may include androgenic influence on sebaceous glands, increased sebum production, and proliferation of Propionibacterium acnes (and the enzymes that reduce lipids to irritating fatty acids). Exacerbations coincide with the menstrual cycle because of hormonal activity. Oily skin and a genetic predisposition may be contributing factors.

The nurse is applying a topical corticosteroid to a client with eczema. The nurse understands that it is safe to apply the medication to which body areas? Select all that apply. 1.Back 2.Axilla 3.Eyelids 4.Soles of the feet 5.Palms of the hands

Ans: 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). The nurse should avoid areas of higher absorption to prevent systemic absorption.

The nurse performs an assessment on a client admitted with contact dermatitis. Which signs and symptoms should the nurse look for? 1.Lichenification with scaling and excoriation 2.Lesions with well-defined geometric margins 3.Bright red erythematous macules and papules 4.Evolution of lesions from vesicles to weeping papules and plaques

Ans: 2 Contact dermatitis findings include skin lesions with well-defined geometric margins. Option 1 describes a medication eruption. Option 3 describes nonspecific eczematous dermatitis. Option 4 describes atopic dermatitis.

An ambulatory care client with allergic dermatitis has been given a prescription for a tube of diphenhydramine 1% to use as a topical agent. The nurse determines that the medication was effective if which finding was noted? 1.Nighttime sedation 2.Decrease in urticaria 3.Absence of ecchymosis 4.Healing of burned tissue

Ans: 2 Diphenhydramine reduces the symptoms of allergic reaction, such as itching or urticaria, when used as a topical agent on the skin. The oral form also has other uses, such as to provide mild nighttime sedation. It is not used to treat burns or ecchymosis.

A client has been given diphenhydramine as a topical agent for allergic dermatitis. The nurse should instruct the client to observe for which intended medication effect? 1.Nighttime sedation 2.A decrease in urticaria 3.Healing of burned tissue 4.Resolution of ecchymosis

Ans: 2 Diphenhydramine reduces the symptoms of allergic reaction, such as itching or urticaria, when used as a topical agent on the skin. When taken orally it may provide mild nighttime sedation. It is not used to treat burns or ecchymosis.

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

Ans: 2 Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before treatment and periodically thereafter until the effect on the triglycerides has been evaluated. There is no indication that isotretinoin affects potassium, hemoglobin A1C, or total cholesterol levels.

Tetracycline is prescribed for a client with severe acne. The nurse instructs the client regarding the importance of reporting which finding if it occurs? 1.Sunburn 2.Persistent diarrhea 3.Epigastric burning 4.Abdominal cramping

Ans: 2 Tetracycline can be used to treat severe acne. Adverse effects include gastrointestinal irritation manifested as epigastric burning, cramps, nausea, vomiting, and diarrhea. These effects do not need to be reported unless the diarrhea becomes persistent and severe. If this does occur, this could indicate another adverse effect, superinfection. Clostridium difficile infection is another potential adverse effect associated with tetracycline use. In addition, photosensitivity is another potential effect, which can more easily result in sunburn. Clients should be instructed to wear sunscreen. A sunburn does not need to be reported necessarily, as this is an expected and self-limiting effect. Other adverse effects include yellowing of the teeth (which can occur in the unborn fetus), hepatotoxicity, and renal toxicity.

Ultraviolet (UV) light therapy is prescribed as a component of the treatment plan for a client with psoriasis, and the nurse provides instructions to the client regarding the treatment. Which statement by the client indicates a need for further instruction? 1."Treatments are limited to 2 or 3 times a week." 2."The UV light treatments are given on consecutive days." 3."Eye goggles need to be worn to prevent exposure to UV light." 4."Just the area requiring treatment should be exposed to the UV light."

Ans: 2 UV light treatments are limited to 2 or 3 times a week and are not given on consecutive days. Safety precautions are required during UV light therapy. It is best to expose only those areas requiring treatment to the UV light. Protective wraparound goggles prevent exposure of the eyes to UV light. The face should be shielded with a loosely applied pillowcase if it is unaffected. Direct contact with the lightbulbs of the treatment unit should be avoided to prevent burning of the skin.

Which individuals are most likely to be at risk for development of psoriasis? Select all that apply. 1.A 32-year-old African American 2.A woman experiencing menopause 3.A client with a family history of the disorder 4.An individual who has experienced a significant amount of emotional distress 5.A female client with a thin body frame who adheres to a regular exercise program

Ans: 2, 3, 4 Psoriasis is a chronic, noninfectious skin inflammation involving keratin synthesis that results in psoriatic patches. Various forms exist, with psoriasis vulgaris being the most common type. Possible causes of the disorder include stress, trauma, infection, hormonal changes, obesity, an autoimmune reaction, and climate changes; a genetic predisposition may also be a cause. The disorder also may be exacerbated by the use of certain medications. Psoriasis occurs equally among women and men, although the incidence is lower in darker-skinned races and ethnic groups.

A client with psoriasis is being treated with calcipotriene cream. Administration of high doses of this medication can cause which side or adverse effect? 1.Alopecia 2.Hyperkalemia 3.Hypercalcemia 4.Thinning of the skin

Ans: 3 Calcipotriene, an analogue of vitamin D3, is indicated for mild to moderate psoriasis. Responses are equal to those achieved with medium-potency topical glucocorticoids. The most common adverse effect is local irritation. Unlike glucocorticoids, calcipotriene does not cause thinning of the skin. At high doses, calcipotriene has caused hypercalcemia. Alopecia and hyperkalemia are not associated with this medication.

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

Ans: 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 should be discontinued before isotretinoin therapy. There are no contraindications associated with digoxin, phenytoin, or furosemide.

The home care nurse visits an older client who was discharged from the hospital after diagnostic testing. The client complains of chronic dry skin and episodes of pruritus. Which measure should the nurse recommend for the client to alleviate this discomfort? 1.Run a dehumidifier in the home. 2.Apply astringents to the skin twice daily. 3.Apply emollients to the skin after bathing. 4.Take baths twice daily using a dilute solution of alcohol and water.

Ans: 3 One bath or one shower per day for 15 to 20 minutes with warm water and a mild soap should be followed immediately by the application of an emollient to prevent evaporation of water from the hydrated epidermis. The client should avoid using a dehumidifier because this will further dry room air. The client should be instructed to avoid applying rubbing alcohol, astringents, or other drying agents to the skin. A bath using a dilute alcohol solution will cause further drying of the skin.

The nurse is providing skin care instructions to a female client with acne vulgaris. What should the nurse instruct the client to do? 1.Use oil-based cosmetics. 2.Vigorously rub her face when washing it. 3.Remove cosmetics from her face at bedtime. 4.Wash her face once daily with an astringent cleanser.

Ans: 3 The client should be instructed to wash her face 2 or 3 times daily with a mild cleanser. Vigorous rubbing of the face is avoided, and cosmetics need to be removed from the face at bedtime. The client is instructed to use only water-based cosmetics and to avoid exposure to skin products that contain oils because products that are oily may cause skin flare-ups.

The nurse is providing instructions to a mother of a child with atopic dermatitis (eczema) regarding the application of topical cortisone cream to the affected skin sites. Which statement made by the mother indicates an understanding of the use of this medication? 1."I shouldn't rub the medication into the skin." 2."The medication is applied everywhere except the face." 3."I need to wash the sites gently before I apply the medication." 4."I need to apply the medication generously and allow it to absorb."

Ans: 3 Topical corticosteroids should be applied sparingly and rubbed into the area thoroughly. The affected area should be cleansed gently before application. It should not be applied everywhere or over extensive areas. Systemic absorption is more likely to occur with extensive application. It is applied to the affected sites.

The nurse is applying a topical glucocorticoid as prescribed for a client with psoriasis. The nurse would be concerned about the potential for systemic absorption of the medication if it were being applied in which situation? 1.Applied for 2 days until the irritation has resolved 2.Applied to a small area on the arm underneath a gauze dressing 3.Applied to a reddened, itchy area underneath an occlusive dressing 4.Applied to a small area on the neck and another small area on the back

Ans: 3 Topical glucocorticoids can be absorbed into the systemic circulation. Toxicity is a concern if a glucocorticoid is used for an extended period of time, if it is applied underneath an occlusive dressing, or if it is applied to a large area of the body. Therefore, options 1, 2, and 4 are incorrect.

A topical corticosteroid is prescribed for a client with dermatitis. The nurse provides instructions to the client regarding the use of the medication. Which statement by the client would indicate a need for further instruction? 1."I need to apply the medication in a thin film." 2."I should gently rub the medication into the skin." 3."The medication will help relieve the inflammation and itching." 4."I should place a bandage over the site after applying the medication."

Ans: 4 Clients should be advised not to use occlusive dressings (bandages or plastic wraps) to cover the affected site after application of the topical corticosteroid unless the primary health care provider specifically prescribes wound coverage. The remaining options are accurate statements related to the use of this medication.

The primary health care provider has prescribed coal tar treatments for a client with psoriasis, and the nurse provides information to the client about the treatments. Which statement made by the client indicates a need for further education about the treatments? 1."The medication has an unpleasant odor." 2."The medication can cause phototoxicity." 3."The medication can stain the skin and hair." 4."The medication always causes systemic toxicity."

Ans: 4 Coal tar is used to treat psoriasis and other chronic disorders of the skin. Coal tar suppresses DNA synthesis, mitotic activity, and cell proliferation. Coal tar has an unpleasant odor, frequently stains the skin and hair, and can cause phototoxicity. Systemic toxicity does not occur.

The nurse is caring for a client at home with a diagnosis of actinic keratosis. The client tells the nurse that her skin is very dry and irritated. The treatment includes diclofenac sodium. The nurse teaches the client that this medication is from which class of medications? 1.Anti-infectives 2.Vitamin A lotions 3.Coal tar preparations 4.Nonsteroidal anti-inflammatory drugs (NSAIDs)

Ans: 4 Diclofenac sodium is an NSAID for topical use. It is indicated for use to treat actinic keratosis. The mechanism underlying its benefits is unknown. The most common side effects are dry skin, itching, redness, and rash at the site of application. Diclofenac sodium may sensitize the skin to ultraviolet radiation, and clients should therefore avoid sunlamps and minimize exposure to sunlight. Anti-infectives are used for infections. Vitamin A would be contraindicated in the treatment of actinic keratosis. Coal tar is for psoriasis.

A primary health care provider (PHCP) prescribes isotretinoin for a client with severe acne. The nurse reviews the client's record and notifies the PHCP if which prescribed medication is noted on the medication record? 1.Digoxin 2.Phenytoin 3.Furosemide 4.Doxycycline

Ans: 4 Doxycycline is a tetracycline. Adverse effects of isotretinoin can be increased by the use of tetracyclines. Tetracyclines increase the risk of pseudotumor cerebri and papilledema. Because of the potential for increased toxicity, tetracyclines should be discontinued before isotretinoin therapy. Phenytoin, digoxin, and furosemide are not contraindicated.

Isotretinoin is prescribed for a client to treat severe cystic acne, and the nurse provides instructions to the client regarding the medication. Which statement by the client indicates a need for further instruction? 1."I need to take the medication with food." 2."I will be taking the medication twice a day." 3."I will need to take the medication for 15 to 20 weeks." 4."I cannot crush or chew the tablets if I have difficulty swallowing them whole."

Ans: 4 Isotretinoin is administered 2 times daily for 15 to 20 weeks. The usual adult dosage is 0.5 to 1 mg/kg/day. If needed, a second course may be given but not until 2 months have elapsed after completing the first course. The medication needs to be taken with food to facilitate absorption. Capsules can be chewed or opened and added to a soft food like applesauce or pudding.

An adolescent with severe cystic acne has been prescribed isotretinoin. Which statement by the client would suggest the need for further teaching? 1."I will return to the clinic for blood tests." 2."If my lips begin to burn, it is probably because of the medication." 3."My eyes may become dry and burn as a result of the medication." 4."I need to take my vitamin A supplement so that the treatment will work."

Ans: 4 Isotretinoin is used to inhibit inflammation in the client with severe cystic acne. Adverse effects include elevated triglyceride levels, skin dryness, and eye discomfort, such as dryness and burning. Lip inflammation, called cheilitis, can also occur. Vitamin A supplements are stopped during this treatment because of their additive effects.

Isotretinoin has been prescribed for an adolescent with a diagnosis of severe cystic acne. The nurse provides instructions to the adolescent regarding the use of the medication. Which statement, if made by the adolescent, indicates a need for further instruction? 1."I will return to the clinic for blood tests." 2."My eyes may become dry and burn as a result of the medication." 3."If my lips begin to burn, this is probably because of the medication." 4."I need to be sure to take my vitamin A supplement so that the treatment will work."

Ans: 4 Isotretinoin is used to inhibit inflammation in the client with severe cystic acne. Vitamin A supplements are stopped during this treatment because isotretinoin is a derivative of vitamin A, and taking vitamin A concurrently will induce additive effects. Adverse effects include elevated triglycerides, skin dryness, and eye discomfort, such as dryness and burning. Lip inflammation, called cheilitis, also can occur.

A client is receiving topical corticosteroid therapy for the treatment of psoriasis. What should the nurse include in client teaching to maximize the effects of the treatment? 1.Rub the application into the skin. 2.Place the area under a heat lamp for 20 minutes. 3.Apply a dry sterile dressing over the affected area. 4.Cover the application with a warm, moist dressing and an occlusive outer wrap.

Ans: 4 Penetration of topical corticosteroid therapy can be enhanced by applying warm, moist heat and an occlusive outer wrap. The wrap may consist of a plastic film, glove, bootie, or similar item. If large surface areas of skin are involved, the occlusive therapy may be limited to 12 hours per day to minimize local and systemic adverse effects. The medication is applied but not rubbed into the skin. Dry sterile dressings are not used. A heat lamp can cause a burn injury.

The nurse is conducting a screening program to identify clients at risk for an integumentary disorder. Which client seen at the screening would most likely be at risk for development of an integumentary disorder? 1.An athlete 2.An adolescent 3.An older client 4.A client who tans in an indoor tanning bed

Ans: 4 Prolonged exposure to the sun (including indoor tanning), unusual cold, or other extreme conditions can damage the skin, posing the highest risk for skin disorders. An athlete would be at low risk of developing an integumentary problem. An adolescent may be prone to the development of acne, but this does not occur in all adolescents. An older client may be at a higher risk than a younger person.

In planning care for the client with psoriasis, the nurse understands that which represents a priority client problem? 1.Fatigue 2.Constipation 3.Impaired safety 4.Altered body image

Ans: 4 Psoriasis is an autoimmune dermatitis that is expressed as silvery scales on reddish-colored skin on areas such as scalp, elbows, hands, and knees. Onset of the disease generally occurs before age 40, with symptoms varying in intensity from mild to severe. Skin disorders, particularly when experienced by young persons and particularly when visible on exposed body parts, can cause significant psychosocial distress. Altered body image is a priority client problem that should be considered when planning care for a client with psoriasis. The remaining options are not priority client problems associated with psoriasis.

The nurse is providing instructions to a client with psoriasis who will be receiving ultraviolet (UV) light therapy. Which statement would be most appropriate for the nurse to include in the client's instructions? 1."Each treatment will last at least 30 minutes." 2."Your entire body will be exposed to the light treatment." 3."You will need to wear cotton clothes during the treatment." 4."You will need to wear dark eye goggles during the treatment."

Ans: 4 Safety precautions are required during UV light therapy. Protective dark eye goggles are required to prevent exposure of the eyes to the UV light; it may be necessary to wear the goggles for the remainder of the day following treatment. The face also is shielded with a loosely applied cloth if it is unaffected by the psoriasis. Most UV light therapies require the client to stand in a light treatment chamber for up to a maximum of 15 minutes. The client will not wear clothing on the body parts to be exposed and will expose only those areas requiring treatment to the UV light. Direct contact with the lightbulbs used for the treatment should be avoided to prevent burning of the skin.

A client with acute seborrheic dermatitis of the back, chest, and legs is receiving treatments with salicylic acid. The nurse should monitor the client for which symptom that indicates the presence of systemic toxicity from this medication? 1.Diarrhea 2.Constipation 3.Lower leg pain 4.Increased respirations

Ans: 4 Salicylic acid is readily absorbed through the skin, and systemic toxicity (salicylism) can result. Symptoms include tinnitus, hyperpnea, dizziness, and psychological disturbances. Lower leg pains, constipation, and diarrhea are not associated with salicylism.

Tretinoin is prescribed for a client with acne, and the nurse provides instructions to the client regarding the medication. Which statement by the client indicates a need for further instruction? 1."I need to avoid exposure to the sun." 2."I should start to see results in 2 to 3 weeks." 3."I will cleanse the skin thoroughly before applying the medication." 4."If my skin begins to peel, I will notify the primary health care provider (PHCP)."

Ans: 4 Tretinoin decreases cohesiveness of the epithelial cells, increasing cell mitosis and turnover. It is potentially irritating, particularly when used correctly. Within 48 hours of use, the skin generally becomes red and begins to peel. It is not necessary to notify the PHCP if this occurs. The client needs to avoid sun exposure, will see therapeutic results within 2 to 3 weeks, and needs to cleanse the skin thoroughly before applying the medication.

The clinic nurse assesses the skin of a client with psoriasis after the client has used a new topical treatment for 2 months. The nurse identifies which characteristics as improvement in the manifestations of psoriasis? Select all that apply. 1.Presence of striae 2.Palpable radial pulses 3.Absence of any ecchymosis on the extremities 4.Thinner and decrease in number of reddish papules 5.Scarce amount of silvery-white scaly patches on the arms

Ans: 4, 5 Psoriasis skin lesions include thick reddened papules or plaques covered by silvery-white patches. A decrease in the severity of these skin lesions is noted as an improvement. The presence of striae (stretch marks), palpable pulses, or lack of ecchymosis is not related to psoriasis.

A male client with psoriasis visits the dermatology clinic. When inspecting the affected areas, the nurse expects to see which type of secondary lesion? A. Scale B. Crust C. Ulcer D. Scar

Ans: A A scale is the characteristic secondary lesion occurring in psoriasis. Although crusts, ulcers, and scars also are secondary lesions in skin disorders, they don't accompany psoriasis. Psoriasis is a chronic proliferative and inflammatory condition of the skin. It is characterized by erythematous plaques covered with silvery scales particularly over the extensor surfaces, scalp, and lumbosacral region.

The nurse assessed a patient's skin lesions as firm, edematous, and irregularly shaped with a variable diameter. They would be called a. wheals b. papules c. fissures d. plaques

Ans: A A wheal is a firm, edematous, irregularly shaped area with variable diameter. Examples include insect bites, angioedema, and urticaria.

Important patient teaching after a chemical peel include a. avoidance of sun exposure b. application of firm bandages c. limitation of vigorous exercise d. use of moist heat to relieve discomfort

Ans: A Patient teaching after a chemical peel should include instructions to use sunscreen and to avoid sun exposure for 6 months to prevent hyperpigmentation.

A mother and her children have been diagnoses with pediculosis corporis at a heath care center. An appropriate treatment is a. applying pyrethrins to body b. topical application of griseofulvin c. moist compress applied frequently d. administration of systemic antibiotics

Ans: A Pediculosis corporis (i.e., body lice) is treated with γ-benzene hexachloride or pyrethrins.

Patients with dark skin are more likely to develop a. keloids b. wrinkles c. skin rashes d. skin cancer

Ans: A Persons with dark skin are predisposed to certain skin and hair conditions, such as keloids, which are overgrowths of collagenous tissue at the site of a skin injury.

Which of the following individuals is least likely to be at risk of developing psoriasis? A. A 32 year-old-African American. B. A woman experiencing menopause. C. A client with a family history of the disorder D. An individual who has experienced a significant amount of emotional distress.

Ans: A Psoriasis occurs equally among women and men, although the incidence is lower in darker-skinned races and ethnic groups. Psoriasis has a prevalence ranging from 0.2% to 4.8%. The exact etiology is unknown, but it is considered to be an autoimmune disease mediated by T lymphocytes. There is an association of HLA antigens seen in many psoriatic patients particularly in various racial and ethnic groups.

The nurse is teaching a patient about her medications. For which medication would the nurse teach the patient to avoid prolonged sun exposure? a. tetracycline b. ipratropium c. morphine sulfate d. oral contraceptive

Ans: A Several antibiotics, including tetracycline, may cause photosensitivity. This is not the case with ipratropium, morphine, or oral contraceptives.

When teaching a patient with melanoma, the nurse recognizes that the patient's prognosis is most dependent on a. thickness of lesion b. degree of asymmetry in the lesion c. amount of ulceration in the surrounding skin d. how much color variation is present in the lesion

Ans: A The most important prognostic factor is tumor thickness at the time of diagnosis. The Breslow measurement is used to indicate the depth of the tumor in millimeters. The higher the number, the deeper the melanoma, and the poorer the prognosis.

You are developing a care plan for a patient with psoriasis. What would you include in your nursing interventions? a. Administer daily soaks with tepid, wet compresses to affected area of the skin. b. Keep blisters intact and protected. c. Apply acetic acid compresses as prescribed. d. Place the patient in contact isolation.

Ans: A The only option that is correct is: "Administer daily soaks with tepid, wet compresses to affected are of the skin"...this allow for the scales to be removed. All of the other options are nursing interventions for a patient with shingles.

A patient with acne vulargis is taking Accutane. Which statement by the patient is correct? a. "I stopped taking my vitamin A supplement before I took my 1st dose of Accutane." b. "I can't wait to start seeing results next week." c. "I love using oil-based cosmetics...it hides my pimples better." d. "I scrub by face three times a day with over-the-counter cleansers."

Ans: A The patient should stopped taking any vitamin A supplement because this interacts with Accutane. In addition, the patient should be instructed that results will take 4 to 6 weeks to notice and that WATER based cosmetic should be used, and to avoid scrub the face with any type of OTC cleansers.

The patient has diffuse distribution of moles on the body and the nurse is preparing the patient for a punch biopsy of one of the moles. What is the benefit of doing a punch biopsy for this patient? a. It provides a full thickness of skin. b. It is used for good cosmetic results. c. It removes only the upper layer of the cells. d. It is used because the lesion is too large to remove.

Ans: A The punch biopsy provides full-thickness skin for diagnostic purposes. A shave biopsy is used for a superficial lesion or when only a small sample is needed for diagnostic purposes. An excisional biopsy is used when a good cosmetic result is desired. An incisional biopsy is a wedge-shaped incision made in a lesion that is too large for an excisional biopsy. It is useful when a larger specimen is needed than a shave or punch biopsy can provide.

Which safe sun practices would the nurse include in a teaching plan for a patient with photosensitivity? SATA a. wear protective clothing b. apply sunscreen liberally and often c. emphasize the short-term use of a tanning booth d. avoid exposure to the sun, especially during midday e. wear any sunscreen that is available in the drugstore

Ans: A B D Patients should recognize that sun safety guidelines include sun avoidance, especially during the midday hours; protective clothing; and broad-spectrum sunscreen (e.g., sun protective factor [SPF] 15; SPF 30 if a patient has a history of skin cancer or sun sensitivity). Sunscreens should be applied 20 to 30 minutes before the patient goes outdoors and should be reapplied every 2 hours and after swimming. Patients should avoid tanning booths and sun lamps.

Diagnostic testing is recommended for skin lesions when a. a healthy history cant be obtained b. a more definitive diagnosis is needed c. percussion reveals an abnormal finding d. treatment with prescribed medication has failed

Ans: B Biopsy is one of the most common diagnostic tests used in the evaluation of a skin lesion. A biopsy is needed in all conditions in which cancer is suspected or a specific diagnosis is questionable.

During the assessment of a patient, you note an area of red, sharply defined plaques covered with silvery scales that are mildly itchy on the patient's knees and elbows. You would describe this finding as a. lentigo b. psoriasis c. actinic keratosis d. seborrheic keratosis

Ans: B Clinical manifestations of psoriasis include sharply demarcated, silvery scaling plaques on reddish skin, commonly on the knees, elbows, scalp, hands, feet, and lower back; itching, burning, and pain; localized or general, intermittent or continuous pattern; and symptoms that vary in intensity from mild to severe.

A nurse is providing teaching for a 14-year old client who has acne. Which of the following instructions should the nurse include? a. use an exfoliant cleanser b. keep hair off your forehead c. take tetracycline after meals d. squeezer acne lesions as they appear

Ans: B Hair and scalp care can provide relief from the manifestations of acne, frequent shampooing and keeping hair away from face can improve acne.

The nurse determined that a patient with which disorder is most at risk for spreading the disease? a. tinea pedis b. impetigo on the face c. candidiasis of the nails d. psoriasis on the palms and soles

Ans: B Impetigo is caused by a bacterial infection (group A β-hemolytic streptococci or staphylococci) and is highly contagious. Good skin hygiene and infection control practices are necessary to prevent the spread of this infection. Tinea pedis and candidiasis are fungal infections. Psoriasis is an autoimmune chronic dermatitis and is not contagious.

The nurse provides diligent skincare because the primary function of skin is a. insulation b. protection c. sensation d. absorption

Ans: B The primary function of the skin is to protect the underlying tissues of the body by serving as a surface barrier to the external environment. The skin acts as a barrier against invasion by bacteria and viruses and prevents excess water loss.

In teaching a patient who is using topical corticosteroids to treat acute dermatitis, the nurse should tell the patient that (SATA) a. the cream is the most efficient system of delivery b. short-term topical corticosteroid use usually does not cause systemic side effects c. use a glove to apply a large amount of topical ointment to prevent further infection d. abruptly stopping the use of topical corticosteroids may cause the dermatitis to reappear e. systemic side effects from topical corticosteroids are likely if the patient is malnourished

Ans: B D Systemic corticosteroids often have undesirable systemic effects. Topical corticosteroids for short-term therapy have fewer systemic effects. Rebound dermatitis is common when therapy is stopped abruptly. This effect can be reduced by tapering the use of topical corticosteroids.

Age-related assessment findings of the hair and nails include (SATA) a. oily scalp b. scaly scalp c. thinner nails d. thicker, brittle nails e. longitudinal nail ridging

Ans: B D E Decreased oil causes hair to become dry and coarse and the scalp to become scaly. Decreased peripheral blood supply causes nails to become thick and brittle. Longitudinal ridging in the nails may occur with aging.

A female adult client with atopic dermatitis is prescribed a potent topical corticosteroid, to be covered with an occlusive dressing. To address a potential client problem associated with this treatment, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement, the nurse should add which "related-to" phrase? A. Related to potential interactions between the topical corticosteroid and other prescribed drugs B. Related to vasodilatory effects of the topical corticosteroid C. Related to percutaneous absorption of the topical corticosteroid D. Related to topical corticosteroid application to the face, neck, and intertriginous sites

Ans: C A potent topical corticosteroid may increase the client's risk for injury because it may be absorbed percutaneously, causing the same adverse effects as systemic corticosteroids. Corticosteroids are better absorbed and more permeable in regions of thin epidermis, such as the eyelid, compared to thicker regions of epidermis, such as the sole. The penetration difference between the two varies by 300 fold. The penetration increases two- to ten-fold in diseased states, such as inflammation and desquamation.

On inspection of a patient's dark skin, the nurse notes a blue-gray birthmark on the forehead and eye area. This assessment finding is called a. vitiligo b. intertrigo c. Nevus of Ota d. telangiactasia

Ans: C Nevus of Ota is a slate-gray to blue-gray pigmentation on the forehead and eye area of the face; it may involve the sclera. This condition may occur in those with dark skin.

A common site for the lesions caused by atopic dermatitis is the a. buttocks b. temporal area c. antecubital space d. plantar surface of the feet

Ans: C The most common location for atopic dermatitis in adults is the antecubital or popliteal space.

When assessing an older adult patient, the nurse notes general wrinkles, sagging breasts, and tenting of the skin; gray hair; and thick brittle toenails. What age-related changes can cause these assessment findings? a. Decreased activity of apocrine and sebaceous glands, decreased density of hair, and increased keratin in nails b. Decreased extracellular water, surface lipids, and sebaceous gland activity; decreased scalp oil; and decreased circulation c. Muscle laxity, degeneration of elastic fibers, collagen stiffening, decreased melanin, and decreased peripheral blood supply d. Increased capillary fragility and permeability, cumulative androgen effect and decreasing estrogen levels, and decreased circulation

Ans: C The normal changes of aging include muscle laxity, degeneration of elastic fibers, and collagen stiffening that contribute to the wrinkles, sagging breasts, and tenting of the skin. Decreased melanin and melanocytes in the hair lead to gray hair and decreased peripheral blood supply leads to thick brittle nails with diminished growth. Decreased apocrine and sebaceous glands would lead to dry skin with minimal to no perspiration and uneven skin color. Decreased density of hair leads to thinning and loss of hair. Increased keratin in nails leads to longitudinal ridging of the nails. The decreased extracellular water, surface lipids, and sebaceous gland activity lead to dry flaking skin. Decreased scalp oil leads to dry coarse hair and a scaly scalp, and decreased circulation leads to prolonged return of blood to nails on blanching. Increased capillary fragility and permeability in aging leads to bruising. A cumulative androgen effect and decreased estrogen levels lead to facial hirsutism in women and baldness in men. Decreased circulation leads to prolonged return of blood to nails on blanching.

During the physical assessment of a patient's skin, the nurse would a. use a flashlight in a poorly lit room b. note cool, moist skin as a normal finding c. pinch up a fold of skin to assess for turgor d. perform a lesion-specific assessment and then a general inspection

Ans: C Turgor is the elasticity of the skin. The nurse should assess turgor by gently pinching an area of skin under the clavicle or on the back of the hand. Skin with good turgor should move easily when lifted and should immediately return to its original position when released.

Nurse Bea plans to administer dexamethasone cream to a client who has dermatitis over the anterior chest. How should the nurse apply this topical agent? A. With a circular motion, to enhance absorption. B. With an upward motion, to increase blood supply to the affected area. C. In long, even, outward, and downward strokes in the direction of hair growth. D. In long, even, outward, and upward strokes in the direction opposite hair growth.

Ans: C When applying a topical agent, the nurse should begin at the midline and use long, even, outward, and downward strokes in the direction of hair growth. This application pattern reduces the risk of follicle irritation and skin inflammation. One fingertip unit (FTU) is equal to 0.5 grams. The suggested dose of FTU is dependent upon the body region being treated. Topical corticosteroids are recommended for once to twice daily use.

When assessing the nutritional-metabolic pattern in relation to the skin, the nurse asks the patient about a. joint pain b. the use of moisturizing shampoo c. recent changes in wound healing d. self-care habits related to daily hygiene

Ans: C When assessing the nutritional-metabolic pattern, the nurse asks the following questions: "Describe any changes in the condition of your skin, hair, nails, and mucous membranes. Have you noticed any recent changes in the way sores or wounds heal? Have you had any weight loss or dietary changes, including supplemental vitamins and minerals?"

The nurse is teaching a patient about diagnostic testing for allergic dermatitis. Which patient statement indicates teaching has been effective? a. "A blood test will confirm the presence of abnormal antibodies." b. "My skin cells will be stained and examined under the microscope." c. "The rash will be scraped with a razor blade and the flakes cultured." d. "I will return to have the substances removed and the areas evaluated."

Ans: D A patch test is used to determine skin reactions to certain allergens applied to the skin. The patient will return in 48 to 72 hours for allergen removal and return in 96 hours for evaluation.

The clinic nurse is assessing the skin of a white client who is diagnosed with psoriasis. Which of the following characteristics is associated with this skin disorder? A. Clear, thin nail beds. B. Red-purplish scaly lesions. C. Oily skin and no episodes of pruritus. D. Silvery-white scaly patches on the scalp, elbow, knees, and sacral regions.

Ans: D Psoriatic patches are covered with silvery-white scales. Affected areas include the scalp, elbows, knees, shins, trunk, and sacral area. Psoriasis presents as well-defined erythematous plaques covered with silvery scales commonly over the scalp, extensors of extremity particularly over knees and elbows, and lumbosacral region. Psoriasis is classified into two types. Type 1 psoriasis, which has a positive family history, starts before age 40 and is associated with HLA-Cw6; while type 2 psoriasis does not show a family history, presents after age 40, and is not associated with HLA-Cw6.

An adolescent is brought to the clinic by a parent for the treatment of acne. What assessment finding would the nurse expect? a. Ulcers b. Wheals c. Vesicles d. Pustules

Ans: D Pustules are elevated, superficial lesions filled with purulent fluid, such as those commonly associated with acne. Wheals, ulcers, and vesicles are not common manifestations of acne.

A nurse is providing information about a new prescription for corticosteroid cream to a client who has mild psoriasis. Which of the following instructions should the nurse include? (Select all that apply.) A. Apply an occlusive dressing after application. B. Apply three to four times per day. C. Wear gloves after application to lesions on the hands. D. Avoid applying in skin folds. E. Use medication continuously over a period of several months.

A. CORRECT: An occlusive dressing can enhance the efficacy of the topical corticosteroid on the exposed lesions. C. CORRECT: Gloves worn after the medication can enhance the efficacy of the topical corticosteroid on the exposed lesions of the hands. D. CORRECT: Corticosteroid cream applied to lesions in skin folds increases the risk of yeast infections.

A patient who has severe refractory psoriasis on the face, neck, and extremities reports being socially withdrawn because of the appearance of the lesions. Which action would the nurse take first? a. Discuss the possibility of taking part in an online support group. b. Encourage the patient to volunteer to work on community projects. c. Suggest that the patient use cosmetics to cover the psoriatic lesions. d. Ask the patient to describe the impact of psoriasis on quality of life.

ANS: D The nurse's initial actions would be to assess the impact of the disease on the patient's life and to allow the patient to verbalize feelings about the psoriasis. Depending on the assessment findings, other actions may be appropriate.

The nurse is preparing a client for punch biopsy. What should the nurse do to prepare for this procedure? 1.Ensure that the consent form has been signed. 2.Ensure that a Foley catheter has been inserted. 3.Provide chlorhexidine wipes to be used before the procedure. 4.Verify the blood bank has 1 unit of packed red blood cells available if needed.

Ans: 1 A punch biopsy involves use of a punch instrument that punctures the skin and is rotated to obtain some of the dermis and fat. It is used for diagnostic purposes. A signed consent form is required for this procedure. A Foley catheter is not indicated and should be avoided if possible for any condition or procedure due to the risk for catheter-associated urinary tract infection. Chlorhexidine wipes are not specifically indicated for this procedure; usually an antibacterial such as povidone-iodine is used. There is not typically a lot of bleeding with this procedure; therefore, units of blood are not typically made available for the client undergoing punch biopsy.

A female client with atopic dermatitis is prescribed medication for photochemotherapy. The nurse teaches the client about the importance of protecting the skin from ultraviolet light before drug administration and for 8 hours afterward and stresses the need to protect the eyes. After administering medication for photochemotherapy, the client must protect the eyes for: A. 4 hours B. 8 hours C. 24 hours D. 48 hours

Ans: D To prevent eye discomfort, the client must protect the eyes for 48 hours after taking medication for photochemotherapy. Protecting the eyes for a shorter period increases the risk of eye injury. PUVA or photochemotherapy is a type of ultraviolet radiation treatment (phototherapy) used for severe skin diseases. PUVA is a combination treatment which consists of Psoralens (P) and then exposing the skin to UVA (long wave ultraviolet radiation). It has been available in its present form since 1976.

A patient tells the nurse that they are afraid to use the treatment recommended for psoriasis. What is the best response by the nurse? a. "You will only know if you try it and see." b. "You may need to get counseling to help you cope." c. "No treatment is medically necessary, but it can be removed." d. "Topical, light therapy, and systemic medications are now available."

Ans: D Treatment of psoriasis usually involves a combination of strategies, including topical treatments; phototherapy; and/or systemic medications, including biologic drugs. Telling her that she will only know if she tries or that she may need counseling is denying the patient's concern. Psoriasis is treated to manage the disease as the patient may have a weakened immune system and be at risk for cardiovascular disease.

A nurse is educating a client on the use of calcipotriene topical medication for the treatment of psoriasis. Which of the following laboratory values should the nurse monitor? A. Potassium B. Calcium C. Sodium D. Chloride

B. CORRECT: Hypercalcemia is a possible adverse effect of calcipotriene.

A nurse caring for a client who has contact dermatitis and has a new prescription for diphenhydramine. For which of the following adverse effects should the nurse monitor? A. Elevated blood glucose levels B. Anorexia C. Increased salivation D. Insomnia

B. CORRECT: Monitor the client for anorexia, which is a possible adverse effect of diphenhydramine

A nurse is teaching a client who has a history of psoriasis about photochemotherapy and ultraviolet light (PUVA) treatments. Which of the following instructions should the nurse include in the teaching? A. Apply vitamin A cream before each treatment. B. Administer a psoralen medication before the treatment. C. Use this treatment every evening. D. Remove the scales gently following each treatment.

B. CORRECT: PUVA treatment involves the administration of a medication (psoralen) to enhance photosensitivity.

A nurse is providing teaching to the guardian of a child who has contact dermatitis. Which of the following information should the nurse include? A. Use fabric softener dryer sheets when drying the child's clothing. B. Apply a warm, dry compress to the rash area. C. Place the child in a bath with colloidal oatmeal. D. Leave the child's hands uncovered during the night.

C. CORRECT: The use of a colloidal oatmeal bath will relieve the child's itching.