Chapter 16 Nursing Care of Patients with Integumentary Disorders

A patient has a 3 cm in diameter lesion in the left axilla that is deep, painful, and contains pus. Which type of lesion should the nurse document in the patient's medical record? 1. Furuncle 2. Folliculitis 3. Carbuncle 4. Herpes varicella

Answer: 1 Explanation: 1. A furuncle develops when the infection from folliculitis becomes deeper. It is initially a deep, firm, red, painful nodule from 1 to 5 cm in diameter. 2. In folliculitis, a sebaceous gland is obstructed, causing a deep inflammatory reaction and infection most commonly from S. aureus. The lesions appear as pustules surrounded by an area of erythema on the surface of the skin and are accompanied by discomfort ranging from slight burning to intense itching. 3. A carbuncle is a group of infected hair follicles that interconnect. It is about 3 to 10 cm in diameter. 4. Herpes varicella (chickenpox) lesions are superficial and usually limited to the face, scalp, and chest. Page Ref: 478

A patient with herpes zoster has pruritus and reports difficulty resting at night. Which intervention will best help the patient? 1. Encourage to take prescribed antipruritic agents approximately one hour before bedtime. 2. Massage the irritated skin areas with lotion. 3. Apply powder to the lesions. 4. Use heavy bed linens to avoid chilling at night.

Answer: 1 Explanation: 1. A patient with herpes zoster might express difficulty sleeping. The inability to rest is often related to pruritus. The use of antipruritic agents prior to bedtime will facilitate rest. 2. Although lotion may be prescribed for the lesions, it should not be massaged into the skin. 3. Powder can irritate the skin lesions. 4. Heat will increase the occurrence of itching. Page Ref: 485

A patient has atopic dermatitis (eczema) with a secondary infection. What should the nurse emphasize when teaching to prevent this type of infection in the future? 1. Methods to prevent itching 2. Continuous antibiotic treatment 3. Frequent bathing 4. Allergy testing

Answer: 1 Explanation: 1. A secondary infection can develop due to skin trauma and breakdown from scratching. Therefore, it is important to control the itching that occurs with eczema. 2. Antibiotics would be given to treat the infection but not prevent it. 3. Frequent bathing may dry out the skin causing increased itching. 4. It is important to identify the irritants that cause the lesions, but this will not prevent a secondary infection. Page Ref: 487

A middle-aged female patient reports "strange pimples" over the buttocks region. Which health problem should the nurse suspect this patient is experiencing? 1. Acne conglobata 2. Contact dermatitis 3. Acne vulgaris 4. Acne rosacea

Answer: 1 Explanation: 1. Acne conglobata is a chronic type of acne of unknown cause that begins in middle adulthood. It causes serious skin lesions consisting of comedones, papules, pustules, nodules, cysts, and scars. This acne occurs primarily on the back, buttocks, and chest. 2. Contact dermatitis is manifested as a raised, reddened area that appears as a rash and can occur anywhere on the body, affecting individuals of all ages. 3. Acne vulgaris is found in preadolescents, adolescents, and young adults and occurs on the face and shoulders. 4. Acne rosacea appears as a red, blotchy area and is limited to the face. Page Ref: 490

A patient with fair skin and blond hair is diagnosed with basal cell cancer on the face and forehead. What should the nurse include when teaching this patient about the diagnosis? 1. This type of skin cancer tends to reoccur. 2. This is a virulent form of skin cancer. 3. This type of skin cancer should be left alone. 4. This type of skin cancer is rare.

Answer: 1 Explanation: 1. Basal cell cancer tends to reoccur. Tumors larger than 2 cm have a high rate of return. 2. Basal cell cancer is the least aggressive type of skin cancer. Malignant melanoma is the most virulent form of skin cancer. 3. No cancer should be left alone. 4. Basal cell cancer is the most common type of skin cancer. Page Ref: 494

An African American patient has reoccurring folliculitis on the face. What should the nurse instruct the patient to do about this health problem? 1. Practice good hygiene. 2. Shave daily. 3. Shave very closely. 4. Shave in the opposite direction of hair growth.

Answer: 1 Explanation: 1. Careful hand hygiene is one of the most effective methods to reduce the spread of infection. All patients should be taught the importance of hand hygiene, but it is even more important for the patient with a bacterial infection. 2. There is no evidence that daily shaving will reduce folliculitis. 3. There is no evidence that shaving closely will reduce folliculitis. 4. There is no evidence that shaving in the opposite direction of hair growth will reduce folliculitis. Page Ref: 479

A middle-aged male patient says, "I wish I could have all of these tattoos removed." What solution should the nurse suggest to this patient? 1. Dermabrasion 2. Chemical peeling 3. Skin graft 4. Blepharoplasty

Answer: 1 Explanation: 1. Dermabrasion is a method of removing facial scars, severe acne, and pigment from unwanted tattoos. The area is sprayed with a chemical to cause light freezing and is then abraded with sandpaper or a revolving wire brush to remove the epidermis and a portion of the dermis. 2. Chemical peeling involves a process that smooths the skin by removing the surface layers. 3. Skin grafting involves removing skin from another body area and will cause scarring; it is not an acceptable management tool for this patient's problem. 4. Blepharoplasty is a cosmetic surgical procedure on the eyes. This cannot be used to remove the tattoos. Page Ref: 510

A patient with skin cancer is recovering from a surgical procedure in which the layers of the lesion were shaved off. For which procedure should the nurse prepare teaching for this patient? 1. Mohs surgery 2. Complete surgical excision of the lesion 3. Curettage 4. Electrodesiccation

Answer: 1 Explanation: 1. In Mohs surgery, thin layers of the tumor are horizontally shaved off. A frozen section of the tissue is stained at each level to determine tumor margins. 2. A surgical excision is the total removal of the lesion, not just layers. 3. Curettage is the shaving of abnormal tissue within 1 to 2 mm of the margin. 4. Electrodesiccation refers to the use of a low-voltage transmission to the base of the tumor. Page Ref: 496

A patient confined to bed has slid to the bottom of the bed. What should the nurse do to adjust this patient's body position? 1. Lift the patient up in bed. 2. Pull the patient up in bed. 3. Slide the patient up in bed. 4. Do nothing.

Answer: 1 Explanation: 1. Patients in hospital beds are subject to shearing forces when the head of the bed is elevated and the torso slides down toward the foot of the bed. Pulling up or sliding the patient when in bed subjects the patient to shearing forces. For this reason, always lift patients up in bed with the assistance of support staff as indicated. 2. Pulling up the patient when in bed subjects the patient to shearing forces. 3. Sliding the patient when in bed subjects the patient to shearing forces. 4. Doing nothing is not appropriate for the patient confined to bed. Page Ref: 507

A patient is receiving the first ultraviolet light therapy treatment for psoriasis. What should be included in this patient's teaching? 1. The skin will appear reddened approximately eight hours after the treatment. 2. The treatment will be the same length every time. 3. There is no anticipated damage to the eyes or mucous membranes. 4. This is the treatment of choice for patients with psoriasis on 10% of the body.

Answer: 1 Explanation: 1. Patients with generalized psoriasis or with psoriasis over 30% of the body will most likely be treated with phototherapy. The patient can expect areas of erythema approximately eight hours after the treatment. 2. The treatment is measured in seconds with a gradual increase in exposure times. 3. To avoid damage to the eyes, they will need to be shielded during the treatment. 4. Patients with generalized psoriasis or with psoriasis over 30% of the body will most likely be treated with phototherapy. Page Ref: 475

A school-age child is reported to frequently scratch the scalp and the hair "is clumpy and smells really bad." What should the nurse instruct the parent to do? 1. Suggest that the patient be checked for head lice. 2. Suggest that the patient have a blood glucose level drawn. 3. Suggest that the patient wash the hair. 4. Suggest that the patient have a haircut.

Answer: 1 Explanation: 1. Pediculosis capitis is an infestation with head lice. Manifestations of head lice include pruritis, scratching, and erythema of the scalp. If untreated, the hair appears matted and crusted with a foul-smelling substance. 2. There are no indications from the information provided that the child has diabetes. 3. Although hygiene may be an issue, the greatest indicator points toward the presence of head lice. 4. There is no need to encourage a haircut at this time. Page Ref: 482

A patient diagnosed with scabies asks how the disorder was "caught." What information should be provided to the patient? 1. The disorder is transmitted by contact with infected persons or their possessions. 2. The disorder is transmitted by the feces of infected animals. 3. Scabies is a bacterial infection transmitted by direct contact with infected persons. 4. Scabies is a fungal infection transmitted by contact with infected respiratory secretions.

Answer: 1 Explanation: 1. Scabies is transmitted via contact with infected people or their contaminated articles. 2. Scabies is the result of infestation of the itch mite. 3. Scabies is a parasitic disorder. 4. Scabies is not a bacterial, viral, or fungal disorder. Page Ref: 483

A patient in a wheelchair has a history of sacral pressure injuries. What instruction should be included in the patient's teaching? 1. Shift the weight every 15 minutes to 1 hour. 2. Sit on a doughnut. 3. Stay in one position as long as possible. 4. Have a family pull the patient up in the wheelchair.

Answer: 1 Explanation: 1. Sitting uninterrupted in a wheelchair should be avoided. The patient should be repositioned every hour. If the patient can move, teach him or her to shift the weight every 15 minutes. 2. Avoid the use of doughnut devices because they cause a reduction in blood perfusion and contribute to a pressure injury. 3. Sitting uninterrupted in a wheelchair should be avoided. 4. Pulling the patient up in the chair may result in skin shear. Page Ref: 507

A patient who has a small, red, scaling lesion that is sitting on an elevated base on the forehead states the lesion began several weeks before and will not heal. What type of lesion does the nurse consider the patient is experiencing? 1. Squamous cell carcinoma 2. Melanoma 3. Psoriasis 4. Seborrheic keratosis

Answer: 1 Explanation: 1. Squamous cell carcinoma consists of tumors of the outer epidermis that occur with frequent exposure to the sun. The scaling lesions sit on an elevated base with an irregular border that may itch or be a nonhealing lesion after minor trauma. 2. Melanomas appear as a changing or unusual mole with an irregular border, an uneven surface, and a varying size and shape. 3. Psoriasis lesions are erythematous papules and plaques with silver-white scales that are sharply demarcated. 4. Seborrheic keratosis lesions are warty, dirty yellow to black papules with sharp margins. Page Ref: 495

A patient asks about options to treat a malignant melanoma lesion on her arm. How should the nurse respond to this patient? 1. "The preferred method of treatment is to remove all the cancer surgically." 2. "An anti-cancer cream will be used to dissolve the lesion." 3. "You will receive radiation to the skin lesion as a first method of treatment." 4. "You will receive intravenous chemotherapy as a first method of treatment"

Answer: 1 Explanation: 1. Surgical excision is the preferred treatment for malignant melanoma. 2. A topical cream would not be used for a melanoma. 3. Radiation is most often used for lesions that are inoperable because of location, which is not the case here. 4. Intravenous chemotherapy would not be used for a localized skin lesion. Page Ref: 498

A patient with a history of sun exposure is concerned about broken blood vessels on the cheeks. What should the nurse realize this patient is describing? 1. Telangiectases 2. Nevus flammeus 3. Venus lakes 4. Skin tags

Answer: 1 Explanation: 1. Telangiectases are single dilated capillaries or terminal arteries that appear most often on the cheeks and nose. These lesions are more common in older adults and result from photoaged skin. The lesions look like broken veins. 2. Nevus flammeus is a congenital vascular condition involving the capillaries. 3. Venus lakes are small, flat, blue blood vessels. 4. Skin tags are soft papules on a pedicle. Page Ref: 473

For several months a patient has been experiencing an infection of the cuticle involving several fingernails on both hands. Which type of employment should the nurse suspect is causing this patient's health problem? 1. Dish washer 2. Construction worker 3. Painter 4. Carpenter

Answer: 1 Explanation: 1. The chronic form of paronychia (an infection of the cuticle of the fingernails or toenails) is seen most often in people who have frequent exposure to water. 2. Construction workers could develop paronychia from trauma and subsequent secondary infection related to the employment, but they are more likely to have an acute form that begins with painful inflammation and may progress to an abscess. 3. Painters could develop paronychia from trauma and subsequent secondary infection related to the employment, but they are more likely to have an acute form that begins with painful inflammation and may progress to an abscess. 4. Carpenters could develop paronychia from trauma and subsequent secondary infection related to the employment, but they are more likely to have an acute form that begins with painful inflammation and may progress to an abscess. Page Ref: 514

A patient with a history of pruritis reports less itching when allergy medicine is used. Which should the nurse consider as the reason for the improvement in symptoms? 1. The allergy medication is reducing histamine release. 2. The patient is distracted from the itching because of the allergies. 3. The patient's pruritis is improving. 4. The patient is taking other medication the nurse is not aware of.

Answer: 1 Explanation: 1. The irritant that causes the itching releases histamine. Antihistamines may relieve pruritis for some patients. 2. The allergies are the cause of the itching. 3. Pruritis is improving as a result of the medication blocking the histamine release. 4. There is no indication the patient is taking other medications. Page Ref: 489

The nurse is planning care for a patient with herpes zoster. Which problem should the nurse identify as being the priority for this patient? 1. Managing pain 2. Avoiding breakouts 3. Relieving itchiness 4. Improving hygiene

Answer: 1 Explanation: 1. The patient with herpes zoster often experiences severe pain over the entire dermatome supplied by the affected nerve root. Managing pain would be the priority for this patient. 2. Herpes zoster can only be prevented or reduced by having the varicella vaccination. 3. Itchiness might occur when the lesions begin to heal; however, the priority is to treat the pain. 4. Herpes zoster does not occur because of poor hygiene. Page Ref: 484

A patient is diagnosed with advanced malignant melanoma. What should the nurse consider when planning care for this patient? 1. The prognosis is uncertain. 2. Age of the patient has no impact on the prognosis. 3. The disease will be completely cured with surgery. 4. The patient will need chemotherapy and radiation.

Answer: 1 Explanation: 1. The prognosis for survival for people diagnosed with malignant melanoma is determined by tumor thickness, ulceration, metastasis, site, age, and gender. 2. Younger patients and women have a somewhat better chance of survival. 3. There is no evidence that the patient will be completely cured with surgery. 4. There is no evidence that the patient will need chemotherapy and radiation. Page Ref: 497

The parent of an adolescent voices concerns about the child's acne. Which response by the nurse is best? 1. "The skin needs to be washed at least twice a day with mild soap and water to remove surface oil." 2. "The greatest culprit for acne is dietary habits, not inadequate hygiene." 3. "Are you embarrassed by her appearance?" 4. "What are your concerns about her hygiene practices?"

Answer: 1 Explanation: 1. The teaching plan for the patient with acne includes general guidelines for skin care and health as well as specific guidelines for care of the acne lesions. The face should be washed with a mild soap and water at least twice a day to remove accumulated oils. 2. Dietary intake is not the primary cause of acne. 3. It would be premature to address the potential for the parent to be embarrassed about the adolescent's health problem. 4. Hygiene is not the primary cause of acne. Page Ref: 491

A female is experiencing eyelid redness and edema. What would be appropriate for the nurse to include in the assessment of this patient? 1. Ask if eye makeup is thoroughly removed. 2. Ask if swimming in a public pool has recently occurred. 3. Ask the patient if legs are routinely shaved. 4. Ask if facial soap has recently been changed.

Answer: 1 Explanation: 1. This patient is experiencing folliculitis, a bacterial infection of the hair follicle on the eyelid. This condition is found more frequently on the scalp and extremities. When found on the eyelids, it is called a stye. It is caused by a bacterial infection of the hair follicle, most commonly caused by Staphylococcus aureus. Not removing makeup could potentiate the development of this disorder. 2. An infection caused by the swimming pool would encompass the entire body. 3. Shaving would involve the legs. 4. The complaints are not generalized on the face but localized in the eye area, so the facial soap is not the culprit. Page Ref: 477

An older patient seeks medical attention for a "strange painful rash" located on the left side of the upper chest. Which health problem should the nurse suspect this patient is experiencing? 1. Herpes zoster 2. Herpes simplex 3. Verruca plana 4. Condylomata acuminata

Answer: 1 Explanation: 1. This patient is most likely experiencing herpes zoster. Vesicles appear on the skin and usually appear unilaterally on the face, trunk, or thorax. The patient often experiences severe pain for up to 48 hours before and during eruption of the lesions. The pain may continue for weeks to months. 2. Herpes simplex is usually located on the face, mouth, or genital regions. 3. The clinical manifestations that this patient reports are inconsistent with verruca. 4. The clinical manifestations that this patient reports are inconsistent with condylomata. Page Ref: 484

A middle-aged patient recovering from a facelift says, "I think this was a waste of time and money. I look horrible!" How should the nurse respond to this patient? 1. "It takes a while for the skin to heal." 2. "You could use makeup." 3. "I would complain to the doctor." 4. "What did you expect?"

Answer: 1 Explanation: 1. This patient needs to be reminded that there will be bruising and swelling that might take several weeks to disappear. It might also take a year for healing to complete and the final results to appear. The patient's reports are normal when faced with an alteration in appearance. 2. The use of makeup is not needed and is premature. 3. Filing a complaint with the doctor is not indicated. 4. The patient's emotional state warrants an empathetic response; asking the patient what he or she expected is not a therapeutic response. Page Ref: 512

A female patient seeks medical attention for an itchy reddened area on both hands. Which technique should the nurse use when assessing this patient? 1. Ask if soap or perfume have been recently changed. 2. Ask to remove both shoes and stockings. 3. Auscultate lung sounds. 4. Assess hand grasp strength.

Answer: 1 Explanation: 1. This patient's description is consistent with contact dermatitis. This is caused by a hypersensitivity response or chemical irritation. The major sources known to cause contact dermatitis are dyes, perfumes, poison plants, chemicals, or metals. A focused assessment is indicated. 2. There are no reports of the rash on the legs or feet. 3. Respiratory complications are not present. 4. It is not necessary to assess this patient's musculoskeletal strength. Page Ref: 488

A patient with a history of tinea pedis reports concerns about developing the disorder again. Which suggestion should the nurse make to reduce the likelihood of a reoccurrence? 1. Wear sandal-style footwear. 2. Begin to wear cotton undergarments. 3. Soak affected extremities in salted water nightly. 4. Apply lotions to moisturize potential areas of outbreak daily.

Answer: 1 Explanation: 1. Tinea pedis is a fungal infection of the soles of the feet, toes, and toenails. The condition is chronic, and can be seen more when the feet are hot and perspire. Wearing of open-style shoes such as sandals would allow the feet to be open to air. 2. Cotton undergarments would not impact tinea pedis. They could assist in the management of tinea corporis. 3. Salt water is not associated with the management of tinea pedis. 4. Lotions would increase moisture to the areas and potentially cause additional problems. Page Ref: 31

A patient with psoriasis is being treated with topical corticosteroids. What should the nurse instruct the patient about the use of this medication? 1. Apply in a thin layer. 2. Avoid rubbing into the skin. 3. Apply a thick layer. 4. Continue medication even if lesions worsen.

Answer: 1 Explanation: 1. Topical corticosteroids should be applied in a thin layer. 2. Topical corticosteroids should be rubbed in thoroughly on wet skin. 3. Topical corticosteroids should be applied in a thin layer. 4. Some infections may be made worse by corticosteroids. If the lesions worsen, the medication should be discontinued and the health provider notified. Page Ref: 489

The nurse instructs a patient with melanoma to "eat foods rich in protein and calories." For which health problem is this action most likely being directed? 1. Changes in skin integrity 2. Insufficient blood flow 3. Altered oxygen to blood tissues 4. Insufficient body fluid

Answer: 1 Explanation: 1. When planning care for a patient with changes in skin integrity, interventions should include monitoring for infection, wound care, careful hand hygiene, and adequate caloric and protein intake for wound healing. 2. Dietary alterations will not help with insufficient blood flow. 3. Dietary alterations will not help with oxygenation. 4. Fluid volume is not directly impacted by a diet high in protein and calories. Page Ref: 500

A patient with a basal cell carcinoma of the nose is scheduled for curettage and electrodesiccation to remove the lesion. Which criteria were used to select this procedure? Select all that apply. 1. The lesion must measure less than 2 cm in diameter. 2. The lesion must be superficial. 3. The lesion must measure at least 4 cm in diameter. 4. The lesion must be in an area where the dermis is thin. 5. The lesion must extend into the subcutaneous tissue

Answer: 1, 2 Explanation: 1. Curettage and electrodesiccation are used to treat basal cell carcinomas that are less than 2 cm in diameter. 2. Curettage and electrodesiccation are used to treat basal cell carcinomas that are superficial. 3. Curettage and electrodesiccation are not used for lesions that are larger. 4. Curettage and electrodesiccation are not used where the dermis is thin. 5. Curettage and electrodesiccation are not used where the tumor extends into the subcutaneous tissue. Page Ref: 496

Several individuals from a homeless shelter have been diagnosed with pediculosis. What should the nurse include when training the staff on the control and prevention of this infestation? Select all that apply. 1. Pediculosis is spread by contact with personal items such as hats and blankets. 2. Pediculosis is more common in people with lack of proper facilities for bathing and washing clothes. 3. Pediculosis is associated with wearing woolen hats. 4. Pediculosis affects children only. 5. Pediculosis is infestation by mites.

Answer: 1, 2 Explanation: 1. Pediculosis is a contagious infestation with lice transmitted by personal contact. The lice live in clothing fibers and are transmitted primarily by contact with infested clothing and bed linens. 2. Pediculosis is more common in people with lack of proper facilities for bathing and washing clothes. 3. Pediculosis can be spread through infested clothing and bed linens. 4. Anyone can contract pediculosis. 5. Infestation by mites is scabies, not pediculosis. Page Ref: 482

The nurse instructs a patient who is prescribed oral griseofulvin for a fungal infection of the nails to take the medication with food. Which foods should the nurse recommend to the patient? Select all that apply. 1. Ice cream 2. Cheese 3. Crackers 4. Pretzels 5. Alcohol

Answer: 1, 2 Explanation: 1. The medication should be taken with meals or food high in fat such as ice cream to avoid stomach upset and to help with absorption. 2. The medication should be taken with meals or food high in fat such as cheese to avoid stomach upset and to help with absorption. 3. Crackers and pretzels are high-carbohydrate, lower fat foods. 4. Crackers and pretzels are high-carbohydrate, lower fat foods. 5. Alcohol should be avoided since it may cause rapid pulse and flushing in patients prescribed griseofulvin. Page Ref: 482

The nurse is preparing a teaching plan about acne for a group of adolescents. What should be included in this teaching plan? Select all that apply. 1. Sun exposure is permitted when protected with sunscreen, but avoid sunburn. 2. Keep hair clean with frequent shampoos. 3. Avoid eating greasy foods. 4. Wash the affected skin area at least six times per day. 5. Squeeze pimples when they occur.

Answer: 1, 2 Explanation: 1. The teaching plan for the patient with acne should include exposing the skin to sunlight but avoiding sunburn. 2. The teaching plan for the patient with acne should include shampooing the hair often enough to prevent oiliness. 3. The teaching plan for the patient with acne should include eating a regular, well-balanced diet as foods do not cause or increase acne. 4. The teaching plan for the patient with acne should include washing the skin with a mild soap and water at least twice a day. 5. The teaching plan for the patient with acne should include trying to avoid putting hands on the face and not squeezing pimples. Page Ref: 491

The nurse is planning care for a patient at risk for a pressure injury. What should the nurse include in this patient's plan of care? Select all that apply. 1. Initiate a frequent toileting schedule. 2. Turn the patient every 2 hours. 3. Massage pressure areas with lotion every 4 hours. 4. Use inflatable doughnut rings to reduce pressure on the sacrum. 5. Use hot water to cleanse the skin immediately after incontinence.

Answer: 1, 2 Explanation: 1. Urine and feces are destructive to skin. A frequent toileting schedule will reduce periods of incontinence and potential for skin breakdown. 2. The patient should be turned at least every 2 hours. 3. Massage of pressure areas can cause friction and damage to problem skin areas. 4. Inflatable doughnut rings are contraindicated, as they increase pressure and reduce perfusion to affected areas. 5. Use of hot water for cleansing may cause skin injury. Page Ref: 507

The nurse is planning care for a patient who is at risk for a pressure injury. Which action should be included in this patient's plan of care? Select all that apply. 1. Use pillows to offload pressure. 2. Turn at least every 2 hours. 3. Use a mild cleansing agent on the skin. 4. Keep on bed rest. 5. Pull up in bed every 2 hours or less.

Answer: 1, 2, 3 Explanation: 1. Pillows provide a cushion for bony prominences, which decreases pressure. 2. Turning every 2 hours takes prolonged pressure off a single area. 3. Mild cleansing agents are less likely to remove the skin's natural barrier. 4. Keeping a patient on bed rest would be inappropriate because activity and mobility prevent prolonged pressure in one area. 5. Pulling patients up in bed increases friction and shear but does not prevent pressure. Page Ref: 506-507

A patient scheduled for Mohs surgery for basal cell skin cancer asks how long the procedure will take. How should the nurse respond to this patient? Select all that apply. 1. "The procedure occurs in steps, and time needed depends on your lesion." 2. "The time depends on how deep the lesion is." 3. "It is difficult to predict how long the procedure will take." 4. "This is a long, complicated procedure and may take all day." 5. "The procedure should be completed in an hour or less."

Answer: 1, 2, 3 Explanation: 1. The procedure proceeds in stages until the tumor is entirely removed. Depending on the depth of the lesion, it may take a short time or a long time. 2. Depending on the depth of the lesion, it may take a short time or a long time. 3. It is difficult to predict in advance. 4. There is no way of knowing how long the procedure will take to complete. 5. There is no way of knowing how long the procedure will take to complete. Page Ref: 496

The nurse is assessing a patient's risk for a pressure injury. Which factors should the nurse include in this assessment? Select all that apply. 1. Sensory perception 2. Moisture 3. Mobility 4. Nutrition 5. Social interaction

Answer: 1, 2, 3, 4 Explanation: 1. Decreased sensation increases the risk for a pressure injury. 2. Moisture increases skin breakdown, thereby increasing the risk for a pressure injury. 3. Decreased mobility level increases the risk for a pressure injury due to prolonged pressure in one area. 4. Nutrition supplementation is an essential intervention for a pressure injury. Protein is the building block for collagen synthesis, interstitial fluid balance, granulation, and epithelialization. 5. The patient's social interaction is not a risk level since a chair-bound person may be able to socialize, but not move. Page Ref: 504

A patient has had cryosurgery to treat a skin lesion. What instructions should be given to the patient and family on discharge? Select all that apply. 1. The effects may not be seen for 24 hours. 2. Apply a topical antibiotic as ordered. 3. Keep the treated areas clean. 4. Healing may take several weeks. 5. Healing should occur in a few days.

Answer: 1, 2, 3, 4 Explanation: 1. It may take 24 hours for the effects to become obvious. 2. Postoperatively, infection is prevented by applying a topical antibiotic. 3. Postoperatively, infection is prevented by keeping the treated areas clean. 4. Healing occurs in 2 to 3 weeks. 5. Healing occurs in 2 to 3 weeks. Page Ref: 509

The nurse is preparing a teaching tool to reduce the incidence of pressure injuries. Which patient characteristic should the nurse identify as being at an increased risk for this health problem? Select all that apply. 1. Restricted activity 2. Decreased sensation 3. Very thin 4. Urinary and fecal incontinence 5. Good nutrition

Answer: 1, 2, 3, 4 Explanation: 1. Patients who have restricted activity, as would occur with quadriplegia, strokes, and fractured hips, are at risk for a pressure injury. 2. Decreased sensation prevents patients from feeling the pain associated with the development of a pressure injury, which increases the risk of development and progression. 3. Patients who are very thin or have decreased protein in the diet have skin that is more likely to ulcerate. 4. Patients who have urinary or fecal incontinence or are exposed to other types of moisture such as perspiration, wound drainage, or emesis are more prone to pressure injuries 5. Patients with good nutrition are at a decreased risk for a pressure injury. Page Ref: 503-504

The nurse is reviewing the health history of a patient with alopecia. What should the nurse recognize as a possible cause for this disorder? Select all that apply. 1. Thyroid disorder 2. Systemic lupus erythematosus 3. Three months of chemotherapy for cancer 4. Androgenic causes 5. An overactive pituitary

Answer: 1, 2, 3, 4 Explanation: 1. Systemic causes of alopecia can include thyroid disorders. 2. Systemic causes of alopecia can include systemic lupus erythematosus. 3. Numerous drugs can cause alopecia, including many chemotherapeutic drugs used to treat cancer. 4. Hair loss from androgenic causes may occur in postmenopausal women. 5. Systemic causes of alopecia can include pituitary insufficiency, not pituitary over-secretion. Page Ref: 513

During a health assessment a patient reports a family member having a severe skin reaction after receiving an antibiotic that required care in a burn unit for several weeks. Which additional risk factors for Stevens-Johnson syndrome should the nurse assess this patient? Select all that apply. 1. Nation of origin 2. Previous organ transplantation 3. History of an autoimmune disease 4. Medications prescribed for fluid balance 5. History of human immunodeficiency virus (HIV)

Answer: 1, 2, 3, 5 Explanation: 1. Persons of Chinese, Southeast Asian, or Indian descent are more likely to carry the gene for Stevens-Johnson syndrome. 2. Risk factors for Stevens-Johnson syndrome include an immune system abnormality related to organ transplantation. 3. Risk factors for Stevens-Johnson syndrome include an immune system abnormality related to an autoimmune disease. 4. Medications specific for fluid balance are not identified as a risk factor for Stevens-Johnson syndrome. 5. Risk factors for Stevens-Johnson syndrome include an immune system abnormality related to HIV. Page Ref: 492

The nurse is collecting data to be used to complete the SCORTEN scale for a patient with Stevens-Johnson syndrome. Which information should the nurse have prepared to calculate the score for this patient? Select all that apply. 1. Patient age 2. Serum urea level 3. Current heart rate 4. Oxygen saturation 5. Serum glucose level

Answer: 1, 2, 3, 5 Explanation: 1. The SCORTEN scale can provide a prognostic indicator of survival in severe cases of Stevens-Johnson syndrome. One indicator is age. Those under the age of 40 have a better prognosis. 2. The SCORTEN scale can provide a prognostic indicator of survival in severe cases of Stevens-Johnson syndrome. One indicator is serum urea level. Levels under 28 mg/dL have a better prognosis. 3. The SCORTEN scale can provide a prognostic indicator of survival in severe cases of Stevens-Johnson syndrome. One indicator is heart rate. A rate under 120 beats/minute will have a better prognosis. 4. Oxygen saturation is not an indicator measured on the SCORTEN scale. 5. The SCORTEN scale can provide a prognostic indicator of survival in severe cases of Stevens-Johnson syndrome. One indicator is serum glucose. Levels under 252 mg/dL have a better prognosis. Page Ref: 492

A patient who was stranded during a snowstorm is admitted for frostbite of the fingers and toes. Which action should the nurse expect to perform for this patient? Select all that apply. 1. Elevate the feet and hands. 2. Provide pain medication as prescribed. 3. Apply elastic compression bandages to the feet and hands. 4. Massage the fingers and toes for 10 minutes after warming. 5. Warm the digits with circulating water for 20 to 30 minutes.

Answer: 1, 2, 5 Explanation: 1. After rewarming the affected parts, they should be elevated. 2. Pain medications are provided as prescribed. 3. Elastic compression bandages are not used in the treatment of frostbite. 4. The affected areas should not be massaged. 5. Rapidly rewarm affected areas in circulating warm water, 40° to 40.5°C (104° to 105°F) for 20 to 30 minutes. Page Ref: 509

A patient with a skin disorder is prescribed a therapeutic bath to be used at home. What should the nurse include when teaching the patient about this treatment? Select all that apply. 1. Place a bath mat in the tub. 2. Stay in the tub bath for 1 hour. 3. Keep the bathroom well-ventilated. 4. Rub the skin vigorously with a dry towel. 5. Expect the skin to be itchy after the bath.

Answer: 1, 3 Explanation: 1. A bath mat should be used in the tub because medications may cause the tub to become slippery. 2. The patient should be instructed to stay in the tub for 20 to 30 minutes and immerse the area being treated. 3. The bathroom should be well-ventilated when using medications in a bath. 4. The skin should be blotted and not rubbed with a towel. 5. If itching is not relieved or becomes worse, the healthcare provider should be contacted. Page Ref: 472

A patient with psoriasis is prescribed photochemotherapy treatments. What should the nurse teach the patient about future health risks caused by this treatment? Select all that apply. 1. It can accelerate aging. 2. It can exacerbate psoriasis. 3. It can alter immune functions. 4. It can induce cataract development. 5. It can increase the risk of melanoma.

Answer: 1, 3, 4, 5 Explanation: 1. Photochemotherapy can accelerate aging of exposed skin. 2. Photochemotherapy has had a high success rate in achieving remission of psoriasis. 3. Photochemotherapy can alter immune function. 4. Photochemotherapy can induce cataract development. 5. Photochemotherapy can increase the risk of melanoma. Page Ref: 475

A female patient is prescribed tretinoin (Retin-A). What should the nurse instruct the patient about this medication? Select all that apply. 1. Wear protective clothing when out of doors. 2. Avoid the use of vitamin A supplements. 3. Use caution when driving at night. 4. Apply to clean, dry skin. 5. Use a reliable form of contraception one month prior to and during use of the medication.

Answer: 1, 4 Explanation: 1. The medication could cause hypersensitivity to sun. 2. There is no reason to avoid the use of vitamin A supplements. 3. There is no need to exercise caution during night driving when using this medication. 4. The medication should be applied to clean, dry skin. 5. There is no need to alter birth control approaches when using this medication. Page Ref: 491

A patient with a skin infection is diagnosed with methicillin-resistant Staphylococcus aureus (MRSA). What medication should the nurse expect to be prescribed for this patient? Select all that apply. 1. Penicillin (Pen-V-K) 2. Clindamycin (Cleocin) 3. Minocycline (Minocin) 4. Doxycycline (Vibramycin) 5. Trimethoprim-sulfamethoxazole (Bactrim)

Answer: 2, 3, 4, 5 Explanation: 1. Penicillin (Pen-V-K) is not used to treat MRSA infections. 2. MRSA infections may be treated with antimicrobial therapy, including clindamycin (Cleocin). 3. MRSA infections may be treated with antimicrobial therapy, including minocycline (Minocin). 4. MRSA infections may be treated with antimicrobial therapy, including doxycycline (Vibramycin). 5. MRSA infections may be treated with antimicrobial therapy, including trimethoprim-sulfamethoxazole (Bactrim). Page Ref: 479