ch 23
The nurse plans care for a patient with a newly diagnosed malignant melanoma based on the knowledge that initial treatment may involve (select all that apply) a. shave biopsy. b. Mohs' surgery. c. surgical excision. e. localized radiation. f. fluorouracil (5-FU). g. topical nitrogen mustard
b,c
Important patient teaching after a chemical peel includes a. avoidance of sun exposure b. application of firm bandages c. limitation of vigorous exercise d. use of moist heat to relieve discomfort
A
What should the nurse include in the instructions for a patient with urticaria? a. Apply topical benzene hexachloride. b. Avoid contact with the causative agent. c. Gradually expose the area to increasing amounts of sunlight. d. Use over-the-counter antihistamines routinely to prevent the condition.
b
Which skin conditions are more common in immunosuppressed patients (select all that apply)? a. Acne b. Lentigo c. Candidiasis d. Herpes zoster e. Herpes simplex 1 f. Kaposi sarcoma
c,e,f
A patient with an enlarging, irregular mole that is 7 mm in diameter is scheduled for outpatient treatment. The nurse should plan to prepare the patient for which procedure? a. Curettage b. Cryosurgery c. Punch biopsy d. Surgical excision
D
What is the most common skin cancer and has pearly borders? a. Actinic keratosis b. Basal cell carcinoma c. Malignant melanoma d. Squamous cell carcinoma
B
What is a skin graft that is used to transfer skin and subcutaneous tissue to large areas of deep tissue destruction called? a. Skin flap b. Free graft c. Soft tissue extension d. Free graft with vascular anastomoses
a
Priority Decision: A patient is receiving chemotherapy. She calls the physician's office and says she is experiencing itching in her groin and under her breasts. What is the first nursing assessment that would be done before the nurse makes an appointment for the patient with the physician to determine the treatment? a. Her height and weight b. what the areas look like c. If chemotherapy was completed d. Culture and sensitivity of the areas
b
What is the best method to prevent the spread of infection to others when the nurse is changing the dressing over a wound infected with Staphylococcus aureus? a. Change the dressing using sterile gloves. b. Apply antibiotic ointment over the wound. c. Wash hands and properly dispose of soiled dressings. d. Soak the dressing in sterile normal saline before removal.
C
A mother and her two children have been diagnosed with pediculosis corporis at a health care center. An appropriate measure in treating this condition is a. applying pyrethrins to the body b. topical application of griseofulvin c. moist compresses applied frequently d. administration of systemic antibiotics
A
A patient in the dermatology clinic has a thin, scaly erythematous plaque on the right cheek. Which action should the nurse take? a. Prepare the patient for a skin biopsy. b. Teach the use of corticosteroid cream. c. Explain how to apply tretinoin (Retin-A) to the face. d. Discuss the need for topical application of antibiotics.
A
A patient with atopic dermatitis has been using a high-potency topical corticosteroid ointment for several weeks. The nurse should assess for which adverse effect? a. Thinning of the affected skin b. Alopecia of the affected areas c. Dryness and scaling in the area d. Reddish-brown skin discoloration
A
The health care provider diagnoses impetigo in a patient who has crusty vesicopustular lesions on the lower face. Which instructions should the nurse include in the teaching plan? a. Clean the infected areas with soap and water. b. Apply alcohol-based cleansers on the lesions. c. Avoid use of antibiotic ointments on the lesions. d. Use petroleum jelly (Vaseline) to soften crusty areas.
A
The nurse notes the presence of white lesions that resemble milk curds in the back of a patient's throat. Which question by the nurse is appropriate at this time? a. "Are you taking any medications?" b. "Do you have a productive cough?" c. "How often do you brush your teeth?" d. "Have you had an oral herpes infection?"
A
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.
A
What skin condition has keratotic and firm lesions, is a precursor of squamous cell carcinoma, and is treated with topical fluorouracil (5-FU)? a. Actinic keratosis b. Basal cell carcinoma c. Malignant melanoma d. Squamous cell carcinoma
A
When teaching a patient with malignant melanoma about this disorder, the nurse recognizes that the patient's prognosis is most dependent on a. the thickness of the lesion b. the degree of asymmetry in the lesion c. the amount of ulceration in the lesion d. how much the lesion has spread superficially
A
Which safe sun practices would the nurse include in the teaching plan for a patient who has photosensitivity (select all that apply)? 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 as long as it is purchased at a drugstore
A,B,D
A nurse is teaching a patient with contact dermatitis of the arms and legs about ways to decrease pruritus. Which information should the nurse include in the teaching plan (select all that apply)? a. Cool, wet cloths or compresses can be used to reduce itching. b. Take cool or tepid baths several times daily to decrease itching. c. Add oil to your bath water to aid in moisturizing the affected skin. d. Rub yourself dry with a towel after bathing to prevent skin maceration. e. Use of an over-the-counter (OTC) antihistamine can reduce scratching.
A,B,E
Which statements are true about skin and skin care (select all that apply)? a. One of the detrimental effects of obesity on the skin is increased sweating. b. The nutrient that is critical in maintaining and repairing the structure of epithelial cells is vitamin C. c. Exposure to UVA rays is believed to be the most important factor in the development of skin cancer. d. The photosensitivity caused by various drugs can be blocked by the use of topical hydrocortisone. e. Photosensitivity results when certain chemicals in body cells and tissues absorb light from the sun and releaseenergy that harms the tissues and cells. f. When teaching a patient about the use of sunscreens that protect against exposure to both UVA and UVB rays, thenurse advises the patient to look for the inclusion of benzophenones.
A,E,F
In teaching a patient who is using topical corticosteroids to treat acute dermatitis, the nurse should tell the patient that (select all that apply) a. the cream form is the most efficient system of delivery b. short-term use of topical corticosteroids usually does not cause systemic side effects c. apply creams and ointments with a glove in small amounts to prevent further infection d. abruptly discontinuing the use of topical corticosteroids may cause a reappearance of the dermatitise. systemic side effects may be experienced from topical corticosteroids if the person is malnourished
B
The health care provider prescribes topical 5-FU for a patient with actinic keratosis on the left cheek. The nurse should include which statement in the patient's instructions? a. "5-FU will shrink the lesion to prepare for surgical excision." b. "Your cheek area will be eroded and it will take several weeks to heal." c. "You may develop nausea and anorexia, but good nutrition is important during treatment." d. "You will need to avoid crowds because of the risk for infection caused by chemotherapy."
B
A patient has the following risk factors for melanoma. Which risk factor should the nurse assign as the priority focus of patient teaching? a. The patient has multiple dysplastic nevi. b. The patient uses a tanning booth weekly. c. The patient is fair-skinned and has blue eyes. d. The patient's mother died of a malignant melanoma.
B
A patient with atopic dermatitis has a new prescription for pimecrolimus (Elidel). After teaching the patient about the medication, 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."
B
A teenaged male patient who is on a wrestling team is examined by the nurse in the clinic. Which assessment finding would prompt the nurse to teach the patient about the importance of not sharing headgear to prevent the spread of pediculosis? a. Ringlike rashes with red, scaly borders over the entire scalp b. Papular, wheal-like lesions with white deposits on the hair shaft c. Patchy areas of alopecia with small vesicles and excoriated areas d. Red, hivelike papules and plaques with sharply circumscribed borders
B
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 recognize this finding as a. lentigo b. psoriasis c. actinic keratosis d. seborrheic keratosis
B
The nurse determines that a patient with a diagnosis of 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
B
There is one opening in the schedule at the dermatology clinic, and four patients are seeking appointments today. Which patient will the nurse schedule for the available opening? a. 50-yr-old with skin redness after having a chemical peel 3 days ago b. 38-year old with a 7-mm nevus on the face that has recently become darker c. 62-yr-old with multiple small, soft, pedunculated papules in both axillary areas d. 42-yr-old with complaints of itching after using topical fluorouracil on the nose
B
Which statements characterize malignant melanomas (select all that apply)? a. Lesion is keratotic and firm b. Neoplastic growth of melanocytes c. Skin cancer with highest mortality rate d. Irregular color and asymmetric shape e. Frequently occurs on previously damaged skin
B,C,D
A common site for lesions associated with atopic dermatitis is the a. buttocks b. temporal area c. antecubital space d. plantar surface of the feet
C
The nurse instructs a patient about application of corticosteroid cream to an area of contact dermatitis on the right leg. Which patient action indicates that further teaching is needed? a. The patient takes a tepid bath before applying the cream. b. The patient spreads the cream using a downward motion. c. The patient applies a thick layer of the cream to the affected skin. d. The patient covers the area with a dressing after applying the cream.
C
The nurse is interviewing a patient with contact dermatitis. Which finding indicates a need for patient teaching? a. The patient applies corticosteroid cream to pruritic areas. b. The patient adds oilated oatmeal to the bath water every day. c. The patient uses bacitracin-neomycin-polymyxin on minor abrasions. d. The patient takes diphenhydramine at night if persistent itching occurs.
C
When assessing a new patient at the outpatient clinic, the nurse notes dry, scaly skin; thin hair; and thick, brittle nails. What is the nurse's most important action? a. Instruct the patient about the importance of nutrition for skin health. b. Make a referral to a podiatrist so that the nails can be safely trimmed. c. Consult with the health care provider about the need for further diagnostic testing. d. Teach the patient about using moisturizing creams and lotions to decrease dry skin.
C
Which information should the nurse include in the teaching plan for a patient diagnosed with basal cell carcinoma (BCC)? a. Treatment plans include watchful waiting. b. Screening for metastasis will be important. c. Minimizing sun exposure reduces risk for future BCC. d. Low dose systemic chemotherapy is used to treat BCC.
C
Which information will the nurse include when teaching an older patient about skin care? a. Dry the skin thoroughly before applying lotions. b. Bathe and wash hair daily with soap and shampoo. c. Use warm water and a moisturizing soap when bathing. d. Use antibacterial soaps when bathing to avoid infection.
C
A patient is undergoing psoralen plus ultraviolet A light (PUVA) therapy for treatment of psoriasis. What action should the nurse take to prevent adverse effects from this procedure? 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.
D
A patient who has severe refractory psoriasis on the face, neck, and extremities is socially withdrawn because of the appearance of the lesions. Which action should the nurse take first? a. Discuss the possibility of participating 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.
D
A patient with acne vulgaris tells the nurse that she has quit her job as a receptionist because she believes her facial appearance is unattractive to customers. The nursing diagnosis that best describes this patient response is a. ineffective coping related to lack of social support b. impaired skin integrity related to presence of lesions c. anxiety related to lack of knowledge of the disease process d. social isolation related to decreased activities secondary to fear of rejection
D
An older adult patient with a squamous cell carcinoma (SCC) on the lower arm has a Mohs procedure in the dermatology clinic. Which nursing action will be included in the postoperative plan of care? a. Schedule daily appointments for dressing changes. b. Describe the use of topical fluorouracil on the incision. c. Teach how to use sterile technique to clean the suture line. d. Teach the use of cold packs to reduce bruising and swelling.
D
The nurse assesses a patient who has just arrived in the postanesthesia recovery area (PACU) after a blepharoplasty. Which assessment data should be reported to the surgeon immediately? a. The patient complains of incisional pain. b. The patient's heart rate is 110 beats/min. c. The patient is unable to detect when the eyelids are touched. d. The skin around the incision is pale and cold when palpated.
D
The nurse is caring for a patient diagnosed with furunculosis. Which nursing action could the nurse delegate to unlicensed assistive personnel (UAP)? a. Applying antibiotic cream to the groin b. Obtaining cultures from ruptured lesions c. Evaluating the patient's personal hygiene d. Cleaning the skin with antimicrobial soap
D
What characteristic is commonly seen with dysplastic nevus syndrome? a. Associated with sun exposure b. Precursor of squamous cell carcinoma c. Slow-growing tumor with rare metastasis d. Lesion has irregular color and asymmetric shape
D
Which skin condition would be treated with laser surgery? a. Preauricular lesion b. Redundant soft tissue conditions c. Obesity with subcutaneous fat accumulation d. Fine wrinkle reduction or facial lesion removal
d
A nurse caring for a disheveled patient with poor hygiene observes that the patient has small red lesions flush with the skin on the head and body. The patient complains of severe itching at the sites. For what should the nurse further assess the patient? a. Nits on the shafts of his head hair b. A history of sexually transmitted diseases c. The presence of ticks attached to the scalp d. The presence of burrows in the interdigital webs
a
To prevent lichenification related to chronic skin problems, what does the nurse encourage the patient to do? a. Use measures to control itching. b. Wear sterile gloves when touching the lesions. c. Use careful hand washing and safe disposal of soiled dressings. d. Use topical antibiotics with wet-to-dry dressings over the lesions.
a
What are the most appropriate dressings to use to promote comfort for a patient with an inflamed, pruritic dermatitis? a. Cool tap water dressings b. Cool acetic acid dressings c. Warm sterile saline dressings d. Warm potassium permanganate dressings
a
What is the most common reason elective cosmetic surgery is requested by patients? a. Improve self-image b. Remove deep acne scars c. Lighten the skin in pigmentation problems d. Prevent skin changes associated with aging
a
Which information should the nurse include when teaching a patient who has just received a prescription for ciprofloxacin (Cipro) to treat a urinary tract infection? a. Use a sunscreen with a high SPF when exposed to the sun. b. Sun exposure may decrease the effectiveness of the medication. c. Photosensitivity may result in an artificial-looking tan appearance. d. Wear sunglasses to avoid eye damage while taking this medication.
a
Which skin condition occurs as an allergic reaction to mite eggs? a. Scabies c. Folliculitis b. Impetigo d. Pediculosis
a
A nurse is assessing a client who has seborrheic keratosis on the forehead and nose. Which of thefollowing manifestations should the nurse expect to find? (Select all that apply.) A. Waxy appearance of the lesions B. Black, rough lesions C. Pruritus of the lesions D. Purplish skin stain around the lesion E. Wartlike surface of the lesions
a,b,e
A nurse is providing information about a new prescription for corticosteroid cream to a client who hasmild psoriasis. Which of the following should the nurse include in the information? (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,c,d
The patient has diabetes mellitus and chronic obstructive pulmonary disease that has been treated with high-dose corticosteroids for the past several years. Which dermatologic manifestations could be related to these systemic problems (select all that apply)? a. Acne b. Increased sweating c. Dry, coarse, brittle hair d. Impaired wound healing e. Erythematous plaques of the shins f. Decreased subcutaneous fat over extremities
a,d,e,f
A female patient with chronic skin lesions of the face and arms tells the nurse that she cannot stand to look at herself in the mirror anymore because of her appearance. Based on this information, the nurse identifies which nursing diagnosis? a. Anxiety related to personal appearance b. Disturbed body image related to perception of unsightly lesions c. Social isolation related to decreased activities as a result of poor self-image d. Ineffective self-health management related to lack of knowledge of cover-up techniques
b
A nurse is providing teaching to a client who has a prescription for methotrexate (Trexall) for severepsoriasis. Which of the following information should the nurse include? A. Drink a glass of wine daily. B. Monitor for evidence of infection. C. Monitor kidney function tests regularly. D. Expect increased bruising.
b
A nurse is teaching a client who has a history of psoriasis about photochemotherapy and ultravioletlight (PUVA) treatments. Which of the following should the nurse include in the teaching? A. Apply coal tar 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
What is an appropriate intervention to promote debridement and removal of scales and crusts of skin lesions? a. Warm oatmeal baths b. Warm saline dressings c. Cool sodium bicarbonate baths d. Cool magnesium sulfate dressings
b
Which description characterizes seborrheic keratosis? a. White patchy yeast infection b. Warty, irregular papules or plaques c. Excessive turnover of epithelial cells d. Deep inflammation of subcutaneous tissue
b
Which information should the nurse include when teaching patients about decreasing the risk for sun damage to the skin? a. Use a sunscreen with an SPF of at least 10 for adequate protection. b. Try to stay out of the direct sun between the hours of 10 AM and 2 PM. c. Water resistant sunscreens will provide good protection when swimming. d. Increase sun exposure by no more than 10 minutes a day to avoid skin damage.
b
A nurse is educating a female client on the use of calcipotriene (Dovonex) topical medication for thetreatment of psoriasis. Which of the following information should the nurse include? (Select all that apply.) A. Recommended for facial lesions .B. Expect a stinging sensation upon application. C. Apply to the scalp. D. Obtain a pregnancy test. E. Limit application to skin folds.
b,c,d,e
A patient with a contact dermatitis is treated with calamine lotion. What is the rationale for using this base for a topical preparation? a. A suspension of oil and water to lubricate and prevent drying b. An emulsion of oil and water used for lubrication and protection c. Insoluble powders suspended in water that leave a residual powder on the skin d. A mixture of a powder and ointment that causes drying when moisture is absorbed
c
66 year old African american patient is scheduled to have basal cell carcinoma on his cheek excised in his HCP's office. what discharge teaching is most important for the nurse to include for this patient? a. you will probably need radiation as well after the excision b. it is good you are having it removed to avoid massive tissue destruction c. it is too bad you can't have this done by laser because it leaves a scarring d. using prescribed ointment and an adhesive bandage will promote the healing with less scaring
d
A patient with psoriasis is being treated with psoralen plus UVA light (PUVA) phototherapy. During the course of therapy, for what duration should the nurse teach the patient to wear protective eyewear that blocks all UV rays? a. Continuously for 6 hours after taking the medication b. Until the pupils are able to constrict on exposure to light c. For 12 hours following treatment to prevent retinal damage d. For 24 hours following treatment when outdoors or when indoors near a bright window
d
What is the name for papillomavirus infection seen on the skin? a. Furuncle b. Carbuncle c. Erysipelas d. Plantar wart
d