Chapter 52: Nursing Management: Patients With Dermatologic Problems

When a patient has been diagnosed with scabies, if the infection has spread, family members may complain of pruritus within which time frame? 6 weeks 1 month 2 weeks 3 weeks

1 month If the infection has spread, other members of the family and close friends also complain of pruritus about 1 month later.

A 79-year-old female resident of a long-term care facility has developed a rash on her back and trunk and the health care provider who is on call to the facility has diagnosed her with shingles. The registered nurse who is responsible for coordinating the care at the facility should prioritize which of the following nursing diagnoses in the care of this resident? Activity Intolerance related to shingles Risk for Injury related to shingles Risk for Imbalanced Body Temperature related to shingles Acute Pain related to shingles

Acute Pain related to shingles This resident is likely to have her level of function and activity affected by her new diagnosis. However, this problem is most likely superseded by the problem of pain, which is nearly ubiquitous and often severe in cases of shingles. Risk for injury and impaired temperature regulation are less likely.

Which of the following uses the body's own digestive enzymes to break down necrotic tissues? Wet to dry dressings Autolytic debridement Wet dressings Enzymatic debridement

Autolytic debridement Autolytic debridement is a process that uses the body's own digestive enzymes to break down necrotic tissue. Application of enzymatic debriding agents speeds the rate at which necrotic tissues is removed. A form of mechanical debridement is a wet to dry dressing, which removes necrotic tissue and absorbs small to large amounts of exudates.

A client has undergone dermabrasion to decrease scarring from severe acne endured as a teen. After completion of the procedure, the nurse reviews the client's home care instructions. Which instruction is appropriate for this client? Wash the area three times daily until healed. Don't touch the area treated. Dermabrasion is a painless procedure. Apply moisturizer after each washing until the area is healed.

Don't touch the area treated. The client also must refrain from picking and touching the area because contact with the fingers might cause infection or scarring from secondary trauma.

Which term refers most precisely to a localized skin infection of a single hair follicle? Comedone Furuncle Cheilitis Carbuncle

Furuncle Furuncles occur anywhere on the body but are most prevalent in areas subjected to irritation, pressure, friction, and excessive perspiration, such as the back of the neck, the axillae, or the buttocks. A carbuncle is a localized skin infection involving several hair follicles. Cheilitis refers to dry cracking at the corners of the mouth. Comedones are the primary lesions of acne, caused by sebum blockage in the hair follicle.

The nurse inspects the appearance of a sacral ulcer and documents "a shallow open ulcer with a red-pink wound with partial thickness loss of dermis." The nurse knows to classify this ulcer as: Stage III. Stage II. Stage IV. Stage I.

Stage II. A stage I ulcer appears as intact skin with non-blanchable erythema of a localized area, usually over a bony prominence. A stage II ulcer appears as partial-thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed, without slough. A stage III ulcer includes full-thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscle is not exposed. Slough may be present but does not obscure the depth of tissue loss. A stage IV ulcer includes a full-thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present on some parts of the wound bed.

A client is coming to the office to have a growth removed by the doctor. The client asks "What does cryosurgery do to the growth?" What is the correct response? Freezes the growth, so the physician can remove it at the next appointment Removes the entire growth Lasers the growth off Through the application of extreme cold, the tissue is destroyed.

Through the application of extreme cold, the tissue is destroyed. Cryosurgery is the application of extreme cold to destroy tissue. The other statements are false.

What advice should the nurse give a client with dermatitis until the etiology of the dermatitis is identified? Wear rubber gloves when in contact with soaps. Use wool, synthetics, and other dense fibers. Use hot water for bathing. Rub the skin vigorously to dry.

Wear rubber gloves when in contact with soaps. The nurse should advise the client to wear rubber gloves when coming in contact with any substance such as soap or solvents. The client should avoid wool, synthetics, and other dense fibers. The client should use tepid bath water and should pat rather than rub the skin dry.

A nurse is assessing a client with a new skin disorder. Which questions would the nurse include when asking the client about the change in skin condition? Select all that apply. Have you tried to treat the lesions? Do you exercise daily? Has the problem spread? Where are the lesions located? When did the disorder first begin, and where did it first appear?

When did the disorder first begin, and where did it first appear? Where are the lesions located? Has the problem spread? Have you tried to treat the lesions? The nurse would ask the client when and where the disorder started, where the lesions are located and if they have spread, and if the client has attempted to treat them. The client's exercise habits would not affect the skin disorder.

A client is being treated for acne vulgaris. What contributes to follicular irritation? chocolate potato chips stress overproduction of sebum

overproduction of sebum The overproduction of sebum provides an ideal environment for bacterial growth within the irritated follicle. The follicle becomes further distended and irritated, causing a raised papule in the skin.

A patient is diagnosed with seborrheic dermatitis on the face and is prescribed a corticosteroid preparation for use. What should the nurse educate the patient about regarding use of the steroid on the face? Wash the face several times a day and reapply the medication. Use very warm water to clean the face prior to applying the medication. Avoid using the medication around the eyelids because it may cause cataracts and glaucoma. Scrape the scaly patches off prior to applying the medication.

Avoid using the medication around the eyelids because it may cause cataracts and glaucoma. Seborrheic dermatitis of the body and face may respond to a topically applied corticosteroid cream, which allays the secondary inflammatory response. However, this medication should be used with caution near the eyelids because it can lead to glaucoma and cataracts.

A male patient is being treated in the hospital for the effects of a debilitating ischemic stroke that he experienced 2 weeks ago. The patient's plan of care identifies a risk of skin breakdown due to the cognitive, sensory, and motor effects of the stroke. What intervention should the nurse prioritize in an effort to reduce the patient's risk of pressure ulcers? Turn the patient at least twice between 2200 and 0600 each night. Avoid seating the patient in a chair until his rehabilitation has been completed. Provide relevant health education to the patient about the management of pressure ulcers. Ensure that the patient's heels are elevated off the surface of his bed.

Ensure that the patient's heels are elevated off the surface of his bed. Nursing interventions for prevention and management of pressure ulcers include turning and repositioning the patient every 1 to 2 hours when in bed. A pillow or commercial heel protector may be used to support the heels off the bed when the patient is supine. Seating the patient in a chair is an important part of rehabilitation and should not be avoided for the sole purpose of reducing the risk of pressure ulcers. Teaching the patient about the management of pressure ulcers is unlikely to reduce their incidence; this is especially true given the patient's profound functional losses.

Which of the following nonsedating antihistamines is appropriate for daytime pruritus? Fexofenadine (Allegra) Diphenhydramine (Benadryl) Lorazepam (Ativan) Hydroxyzine (Atarax)

Fexofenadine (Allegra) Nonsedating antihistamine medications such as Allegra are more appropriate to relieve daytime pruritus. Benadryl or Atarax, when prescribed in a sedative dose at bedtime, may be beneficial in producing a restful and comfortable sleep. Ativan has sedating properties and is used as an antianxiety medication.

Which skin condition is caused by staphylococci, streptococci, or multiple bacteria? Impetigo Scabies Poison ivy Pediculosis capitis

Impetigo Impetigo is seen at all ages but is particularly common among children living under poor hygienic conditions. Scabies is caused by the itch mite. Pediculosis capitis is caused by head lice. Poison ivy is a contact dermatitis caused by the oleoresin given off by a particular form of ivy.

A patient is being evaluated for nodular cystic acne. What systemic pharmacologic agent may be prescribed for the treatment of this disorder? Salicylic acid Isotretinoin (Accutane) Retin-A Benzoyl peroxide

Isotretinoin (Accutane) Synthetic vitamin A compounds (i.e., retinoids) are used with dramatic results in patients with nodular cystic acne unresponsive to conventional therapy. One compound is isotretinoin, which is used for active inflammatory popular pustular acne that has a tendency to scar. Isotretinoin reduces sebaceous gland size and inhibits sebum production. It also causes the epidermis to shed (epidermal desquamation), thereby unseating and expelling existing comedones.

The nurse is providing teaching to a client with acne who is using isotretinoin therapy. Which statement should the nurse make? The side effects are irreversible. Contraceptives are not needed during treatment. It is teratogenic in humans. Take vitamin A supplements.

It is teratogenic in humans. Isotretinoin is teratogenic in humans, meaning that it can have an adverse effect on a fetus, causing central nervous system and cardiovascular defects, and structural abnormalities of the face. Contraceptives are needed during treatment. The client should not take vitamin A supplements while taking this drug. Side effects are reversible with the withdrawal of the medication.

The nurse assesses the client and observes reddish-purple to dark blue macules, plaques, and nodules. The nurse recognizes that these manifestations are associated with which condition? Platelet disorders Kaposi sarcoma Syphilis Allergic reactions

Kaposi sarcoma Kaposi sarcoma is a frequent comorbidity in clients with AIDS. With platelet disorders, the nurse observes ecchymoses (bruising) and purpura (bleeding into the skin). Urticaria (wheals or hives) is the manifestation of allergic reactions. A painless chancre or ulcerated lesion is a typical finding in the client with syphilis.

A patient is diagnosed with malignant melanoma that directly invades the adjacent dermis (vertical growth). The nurse knows that this type of melanoma has a poor prognosis. Which of the following is most likely the type of melanoma described in this scenario? Superficial spreading Nodular melanoma Lentigo-maligna Acral-lentiginous

Nodular melanoma A nodular melanoma is a spherical, blueberry-like nodule with a relatively smooth surface and a relatively uniform, blue-black color. A nodular melanoma invades directly into adjacent dermis (i.e., vertical growth) and therefore has a poorer prognosis.

A nurse is admitting a client with toxic epidermal necrolysis. What is the nursing priority in preventing sepsis? Hydrating to prevent renal failure Preventing infection Limiting protein to limit liver failure Assessing for hemorrhage

Preventing infection The major cause of death from toxic epidermal necrolysis is from sepsis. Monitoring vital signs closely and noticing changes in respiratory, kidney, and gastrointestinal function may help the nurse to quickly detect the beginning of an infection. Strict asepsis is always maintained during routine skin care measures. Hand hygiene and wearing sterile gloves when carrying out procedures are essential. Visitors should wear protective garments and wash their hands before and after coming into contact with the patient. People with any infections or infectious disease should not visit the patient until they are no longer a danger to the patient. The nurse is critical in identifying early signs and symptoms of infection and notifying the primary provider. Antibiotic agents are not generally begun until there is an indication for the use. Hemorrhage, renal failure, and liver failure are not the major causes of toxic epidermal necrolysis.

The nurse is assessing a patient for psoriatic lesions after treatment with a nonsteroidal cream. What type of lesion does the nurse know is characteristic of psoriasis? Pattern of bullae that rupture and form a scaly crust Cluster of pustules Red, raised patch covered with silver scales Group of raised vesicles

Red, raised patch covered with silver scales Psoriasis may range in severity from a cosmetic source of annoyance to a physically disabling and disfiguring disorder. Lesions appear as red, raised patches of skin covered with silvery scales.

A young client has head lice. What are appropriate steps in eradication? Select all that apply. Apply a pediculicide to the hair (detailed directions also accompany this medication). Comb the hair free of tangles while the hair is damp. Comb through each area of the hair to remove lice. Use a special lice comb that has narrow stainless steel teeth. Repeat combings daily until there is no more evidence of lice or nits.

Repeat combings daily until there is no more evidence of lice or nits. Apply a pediculicide to the hair (detailed directions also accompany this medication). Comb the hair free of tangles while the hair is damp. Use a special lice comb that has narrow stainless steel teeth. Comb through each area of the hair to remove lice. All listed steps are correct. Apply a pediculicide to the hair (detailed directions also accompany this medication). Comb the hair free of tangles while the hair is damp. Use a special lice comb that has narrow stainless steel teeth. Comb through each area of the hair to remove lice. Repeat combings daily until there is no more evidence of lice or nits.

A 10-year-old child is brought to the office with complaints of severe itching in both hands that's especially annoying at night. On inspection, the nurse notes gray-brown burrows with epidermal curved ridges and follicular papules. The physician performs a lesion scraping to assess this condition. Based on the signs and symptoms, what diagnosis should the nurse expect? Contact dermatitis Impetigo Scabies Dermatophytosis

Scabies Signs and symptoms of scabies include gray-brown burrows, epidermal curved or linear ridges, and follicular papules. Clients complain of severe itching that usually occurs at night. Scabies commonly occurs in school-age children. The most common areas of infestation are the finger webs, flexor surface of the wrists, and antecubital fossae. Impetigo is a contagious, superficial skin infection characterized by a small, red macule that turns into a vesicle, becoming pustular with a honey-colored crust. Contact dermatitis is an inflammation of the skin caused by contact with an irritating chemical or allergen. Dermatophytosis, or ringworm, is a disease that affects the scalp, body, feet, nails, and groin. It's characterized by erythematous patches and scaling.

A patient diagnosed with basal cell carcinoma asks the nurse how he got cancer. The nurse tells the patient that the most common cause of basal cell carcinoma is what? Sun exposure Immunosuppression Radiation exposure Burns

Sun exposure Sun exposure is the best known and most common cause of basal cell carcinoma. Immunosuppression, radiation, and burns are less common causes.

A patient with squamous cell carcinoma has been scheduled for treatment of this malignancy. The nurse knows that the primary method of treatment in this type of cancer is what? Biopsy of sample tissue Radiation therapy Chemotherapy Surgical excision

Surgical excision The primary goal of surgical management of squamous cell carcinoma is to remove the tumor entirely. Radiation therapy is reserved for older patients because x-ray changes may be seen after 5 to 10 years, and malignant changes in scars may be induced by irradiation 15 to 30 years later. Obtaining a biopsy would not be a goal of treatment, but it may be an intervention. Squamous cell carcinoma is an invasive carcinoma, metastasizing by the blood or lymphatic system. Chemotherapy would not be the treatment goal.

To treat a client with acne vulgaris, the physician is most likely to order which topical agent for nightly application? Zinc oxide gelatin Fluorouracil (5-fluorouracil, 5-FU [Efudex]) Minoxidil (Rogaine) Tretinoin (retinoic acid [Retin-A])

Tretinoin (retinoic acid [Retin-A]) Tretinoin is a topical agent applied nightly to treat acne vulgaris. Minoxidil promotes hair growth. Zinc oxide gelatin treats stasis dermatitis on the lower legs. Fluorouracil is an antineoplastic topical agent that treats superficial basal cell carcinoma.

A young college student recently had her tongue and lip pierced. She has developed a superinfection of candidiasis from the antibacterial mouthwash. Which of the following would be the correct recommendation for her? Move the piercing back and forth during washing. Use an antifungal mouthwash or salt water. Rinse the mouth after eating food. Use a soft-bristled toothbrush.

Use an antifungal mouthwash or salt water. The client can substitute an antifungal mouthwash or salt water if a superinfection of candidiasis develops from the antibacterial mouthwash. A soft-bristled toothbrush should be used to avoid additional oral injury, but it is not the recommended solution for this problem. After eating, the client should rinse her mouth for 30 to 60 seconds with an antifungal mouthwash or salt water. Moving the jewelry at the piercing area back and forth during washing helps clean the pierced tract but does not solve the problem.

A client is being treated for acne vulgaris. What warning must be given to this client regarding the application of benzoyl peroxide? Use with over-the-counter drying agents. Only use with contact dermatitis. Use gloves with application. Apply a thick layer to assure coverage.

Use gloves with application. Warn clients using acne preparations containing benzoyl peroxide that this ingredient is an oxidizing agent and may remove the color from clothing, rugs, and furniture. Thorough handwashing after drug use may not remove all the drug and permanent fabric discoloration may still occur. Users of products containing benzoyl peroxide should wear disposable plastic gloves when applying the drug.

The nurse is instructing the parents of a child with head lice. Which statement should the nurse include? Disinfect brushes and combs with bleach. Wash clothes in cold water. Use shampoo with Kwell. Use shampoo with piperonyl butoxide.

Use shampoo with piperonyl butoxide. The nurse's instructions should include shampooing with piperonyl butoxide, washing clothes in hot water, and disinfecting brushes and combs with piperonyl butoxide shampoo.

While in a skilled nursing facility, a client contracts scabies, which is diagnosed the day after discharge. The client is living at her daughter's home with six other people. During her visit to the clinic, the client asks a staff nurse, "What should my family do?" The most accurate response from the nurse is: "Just be careful not to share linens and towels with family members." "If someone develops symptoms, tell him to see a physician right away." "After you're treated, family members won't be at risk for contracting scabies." "All family members need to be treated."

"All family members need to be treated." When someone sharing a home with others contracts scabies, all individuals in the home need prompt treatment whether or not they're symptomatic. Towels and linens should be washed in hot water. Scabies can be transmitted from one person to another before symptoms develop.

The nurse is providing instruction to a client with acne. The nurse promotes avoidance of which food(s)? Select all that apply. Bananas Onions Ice cream Chocolate

Chocolate Ice cream The nurse should promote avoidance of foods associated with flare-up of acne, particularly those high in refined sugars, including chocolate, cola, and ice cream.

The nurse is working with community groups. At which of the following locations would the nurse anticipate a possible scabies outbreak? Shopping mall College dormitory Swimming pool Gymnasium

College dormitory The nurse is correct to anticipate a potential scabies outbreak in a college dormitory. Outbreaks are common where large groups of people are confined or housed. Spread of scabies is from skin-to-skin contact. Although there are groups of people at the shopping mall, swimming pool, and gymnasium, typically, there is no personal contact.

The nurse is conducting an admission history and physical examination of a client with a history of contact dermatitis. The nurse assesses whether the client uses which medication classification? Antivirals Corticosteroids Saline irrigations Antifungals

Corticosteroids Corticosteroids are used for contact dermatitis. Antifungals, antivirals, and saline irrigations are not used in the treatment of contact dermatitis.

Which medication classification may be used for contact dermatitis? Antifungals Corticosteroids Antivirals Saline irrigations

Corticosteroids Corticosteroids are used for contact dermatitis. Antifungals, antivirals, and saline irrigations are not used in the treatment of contact dermatitis.

A client comes to the physician's office for treatment of severe sunburn. The nurse takes this opportunity to discuss the importance of protecting the skin from the sun's damaging rays. What is the appropriate teaching by the nurse to prevent skin damage? "Apply sunscreen even on overcast days." "Minimize sun exposure from 1 to 4 p.m., when the sun is strongest." "When at the beach, sit in the shade to prevent sunburn." "Use a sunscreen with a sun protection factor of 6 or higher."

"Apply sunscreen even on overcast days." Sunscreen should be applied even on overcast days, because the sun's rays are as damaging then as on sunny days. The sun is strongest from 10 a.m. to 4 p.m. — not from 1 to 4 p.m. Sun exposure should be minimized during these hours. The nurse should recommend sunscreen with a sun protection factor of at least 15. Sitting in the shade when at the beach doesn't guarantee protection against sunburn alone because sand, concrete, and water can reflect more than half the sun's rays onto the skin.

A 50-year-old man of Greek ancestry has been diagnosed with classic Kaposi's sarcoma (KS) after seeking care for new lesions that appeared on his legs. The patient is shocked at his diagnosis after reading on the Internet that he now has a form of cancer. How should the nurse best respond to this patient's concerns? "Most people with this disease have it for the rest of their lives with no serious effects." "Surgical advances in the treatment of KS have extended survival times greatly." "Your treatment plan will probably focus on ensuring that the disease does not spread to other organs." "Your doctor will probably talk to you about chemotherapy and radiation therapy, which are usually very successful."

"Most people with this disease have it for the rest of their lives with no serious effects." Classic KS is chronic, relatively benign, and rarely fatal. Metastases are highly unlikely, and radiotherapy, chemotherapy, and surgery are not normally necessary.

The nurse is teaching a client about the correct use of topical concentrated corticosteroids. The nurse includes which statement(s)? Select all that apply. Hypertrichosis is normal. Avoid applying to the face. Avoid prolonged use. Apply to intertriginous areas.

Avoid applying to the face. Avoid prolonged use. The nurse should teach the client to avoid prolonged use, which could lead to hypertrichosis (excessive hair growth) and/or steroid-induced acne. The nurse should also tell the client to avoid applying the corticosteroid to the face and to intertriginous areas.

An older adult patient's skin has become progressively drier in recent years, and the patient now describes many of her skin surfaces as being "incredibly itchy, all the time." The nurse who is contributing to this patient's care should encourage the patient to: Take analgesics to achieve relief from pruritus. Avoid scratching the affected skin areas because this may exacerbate pruritus. Apply an over-the-counter corticosteroid ointment to the affected regions. Use a moderately abrasive material to scratch the affected skin areas.

Avoid scratching the affected skin areas because this may exacerbate pruritus. Scratching the pruritic area causes the inflamed cells and nerve endings to release histamine, which produces more pruritus, generating a vicious itch-scratch cycle. Steroids and analgesics should not be recommended by the nurse because these are unlikely to be effective and may be contraindicated.

Which of the following reflect the pathophysiology of cutaneous signs of HIV disease? High CD4 count Immune function deterioration Decrease in normal skin flora Genetic predisposition

Immune function deterioration Cutaneous signs may be the first manifestations of HIV, appearing in more than 90% of HIV-infected patients as immune function deteriorates. Common complaints include pruritus, folliculitis, and chronic actinic dermatitis. Cutaneous signs of HIV disease correlate to low CD4 counts. Cutaneous signs of HIV disease appear as immune function deteriorates.

A nurse is providing care for a patient with human immunodeficiency virus (HIV) who has been admitted to the hospital because of a recent decrease in his CD4+ count. The nurse is aware of the patient's high risk of developing secondary illnesses, including Kaposi's sarcoma (KS). When assessing the patient for signs and symptoms of KS, the nurse would examine the patient for: Newly acquired lesions that are reddish or bluish in color Skin tears on the patient's trunk that are slow to heal Patches of scaly, dry, pruritic skin on the patient's torso Changes in the shape, character, or color of a mole

Newly acquired lesions that are reddish or bluish in color The skin lesions associated with KS consist of reddish-purple to dark-blue macules, plaques, or nodules.

A patient is diagnosed with psoriasis after developing scales on the scalp, elbows, and behind the knees. The patient asks the nurse where this was "caught." What is the best response by the nurse? Psoriasis results from excess deposition of subcutaneous fat. Psoriasis is an inflammatory dermatosis that results from an overproduction of keratin. Psoriasis comes from dermal abrasion. Psoriasis is an inflammatory dermatosis that results from a superficial infection with Staphylococcus aureus.

Psoriasis is an inflammatory dermatosis that results from an overproduction of keratin. Current evidence supports an autoimmune basis for psoriasis (Porth & Matfin, 2009). Periods of emotional stress and anxiety aggravate the condition, and trauma, infections, and seasonal and hormonal changes may also serve as triggers. In this disease, the epidermis becomes infiltrated by activated T cells and cytokines, resulting in both vascular engorgement and proliferation of keratinocytes. Epidermal hyperplasia results.

The nurse is a participant in a health fair that has been sponsored by the local VFW. An attendee has told the nurse about his wife's recent battle with skin cancer and others have replied with comments about the risk factors and prevention of the disease. What health education should the nurse provide to this group? "Sunscreens have been shown to have little effect on the ultraviolet damage that is caused by the sun." "If you like to tan, it's important that you do so for less than 60 minutes at a time." "Even if it's cloudy outside, the sun's rays can still cause harm to your skin and contribute to skin cancer." "Any form of clothing will effectively block the sun's rays from damaging your skin."

"Even if it's cloudy outside, the sun's rays can still cause harm to your skin and contribute to skin cancer." Ultraviolet light can penetrate cloud cover, and a sunburn can still occur. Up to 50% of ultraviolet rays can penetrate loosely woven clothing and a sunscreen should be applied daily to block harmful sun rays. Tanning is a practice that should be avoided; skin exposure of 60 minutes is very capable of causing harm.

A physician orders an emollient for a client with pruritus of recent onset. The client asks why the emollient should be applied immediately after a bath or shower. How should the nurse respond? "To make the skin feel soft." "To prevent skin inflammation." "To minimize cracking of the dermis." "To prevent evaporation of water from the hydrated epidermis."

"To prevent evaporation of water from the hydrated epidermis." The nurse should tell the client that applying an emollient immediately after taking a bath or shower prevents evaporation of water from the hydrated epidermis, the skin's upper layer. Although emollients make the skin feel soft, this effect occurs whether or not the client has just bathed or showered. An emollient minimizes cracking of the epidermis, not the dermis (the layer beneath the epidermis). An emollient doesn't prevent skin inflammation.

A patient has been prescribed a topical corticosteroid and the nurse is providing relevant patient teaching about the correct technique for applying this medication. What guideline should the nurse provide to this patient? Apply a thin coating of the medication, but ensure that all affected areas are covered with the medication. Apply a coating of the medication to the affected area and then gently rub it off after 5 to 10 minutes. Apply the medication to the affected area and to unaffected skin within 2 to 3 inches of the affected skin. Avoid covering affected areas with clothing or bandages after applying the medication.

Apply a thin coating of the medication, but ensure that all affected areas are covered with the medication. The patient is taught to apply a corticosteroid sparingly and rub it into the prescribed area thoroughly. Absorption of topical corticosteroid is enhanced when the skin is hydrated or when the affected area is covered by an occlusive or moisture-retentive dressing. It should not be removed from the skin after application and unaffected skin should not be treated.

A male patient is being treated in the hospital for the effects of a debilitating ischemic stroke that he experienced 2 weeks ago. The patient's plan of care identifies a risk of skin breakdown due to the cognitive, sensory, and motor effects of the stroke. What intervention should the nurse prioritize in an effort to reduce the patient's risk of pressure ulcers? Ensure that the patient's heels are elevated off the surface of his bed. Turn the patient at least twice between 2200 and 0600 each night. Provide relevant health education to the patient about the management of pressure ulcers. Avoid seating the patient in a chair until his rehabilitation has been completed.

Ensure that the patient's heels are elevated off the surface of his bed. Nursing interventions for prevention and management of pressure ulcers include turning and repositioning the patient every 1 to 2 hours when in bed. A pillow or commercial heel protector may be used to support the heels off the bed when the patient is supine. Seating the patient in a chair is an important part of rehabilitation and should not be avoided for the sole purpose of reducing the risk of pressure ulcers. Teaching the patient about the management of pressure ulcers is unlikely to reduce their incidence; this is especially true given the patient's profound functional losses.

A dermatologist recommends an over-the-counter suspension to relieve pruritus. The nurse advises the patient that the lotion should be applied: Every 3 to 4 hours for sustained effectiveness. Twice a day to prevent crusting on the skin. Overnight to enhance absorption. Hourly to prevent evaporation.

Every 3 to 4 hours for sustained effectiveness. Lotions are frequently used to replenish lost skin oils or to relieve pruritus. They are usually applied directly to the skin, but a dressing soaked in the lotion can be placed on the affected area. Lotions must be applied every 3 or 4 hours for sustained therapeutic effect because if left in place for a long period, they may crust and cake on the skin.

A nurse in a healthcare provider's office teaches a client how to apply plastic film as an occlusive dressing to cover a medicated ointment applied to the arm. What important teaching point would be included by the nurse? Limit use of the dressing to 12 hours. Cover the dressing with an elastic wrap to facilitate daily activities during treatment. Immobilize the arm when it is wrapped. Place heat on top of the dressing to increase skin temperature.

Limit use of the dressing to 12 hours. Plastic film is thin and readily adapts to all sizes, body shapes, and skin surfaces. In general, plastic wrap should be used no more than 12 hours each day. Immobilization is not necessary. Applying heat or covering the dressing in an elastic wrap would be contraindicated.

A night-shift nurse receives a call from the emergency department about a client with herpes zoster who is going to be admitted to the floor. Based on this diagnosis, where should the nurse assign the client? Semi-private room with a client diagnosed with pneumonia Private room Isolation room with negative airflow Semi-private room with a client who had chickenpox and was admitted with a GI bleed

Private room Herpes zoster, a highly contagious infection, is transmitted by direct contact with vesicular fluid or airborne droplets from the infected host's respiratory tract. Placing the client with a client diagnosed with pneumonia places that client at risk for contracting herpes zoster. An isolation room with negative airflow isn't necessary for the client with herpes zoster. The nurse should assign the client to a private room. The client could safely room with the client who already had chickenpox; however, visitors might be unnecessarily exposed.

When performing a skin assessment, the nurse notes a localized skin infection of a single hair follicle. The nurse documents the presence of cheilitis. a carbuncle. a furuncle. a comedone.

a furuncle. Furuncles are localized skin infections of a single hair follicle. They can occur anywhere on the body but are most prevalent in areas subjected to irritation, pressure, friction, and excessive perspiration, such as the back of the neck, the axillae, or the buttocks. A carbuncle is a localized skin infection involving several hair follicles. Cheilitis refers to dry cracking at the corners of the mouth. Comedones are the primary lesions of acne, caused by sebum blockage in the hair follicle.

The classic lesions of impetigo manifest as comedones in the facial area. abscess of skin and subcutaneous tissue. honey-yellow crusted lesions on an erythematous base. patches of grouped vesicles on red and swollen skin.

honey-yellow crusted lesions on an erythematous base. The classic lesions of impetigo are honey-crusted lesions on an erythematous base. Comedones in the facial area are representative of acne. A carbuncle is an abscess of skin and subcutaneous tissue. Herpes zoster is exhibited by patches of grouped vesicles on red and swollen skin.

The nurse notes that the client's lower extremities are covered with very dry skin and that the horny layer of the skin has become thickened. The nurse notes the finding as pyodermas. dermatitis. lichenification. acantholysis.

lichenification. The nurse should note this as being lichenification, also called scaling. Dermatitis is an inflammation of the skin. Acantholysis is a separation of the epidermal cells from each other, and pyodermas is a bacterial skin infection.

The nurse teaches the client who demonstrates herpes zoster (shingles) that the infection results from reactivation of the chickenpox virus. a person who has had chickenpox can contract it again upon exposure to a person with shingles. once a client has had shingles, they will not have it a second time. no known medications affect the course of shingles.

the infection results from reactivation of the chickenpox virus. It is assumed that herpes zoster represents a reactivation of the latent varicella (chickenpox) virus and reflects lowered immunity. It is believed that the varicella zoster virus lies dormant inside nerve cells near the brain and spinal cord and is reactivated with weakened immune systems and cancers. A person who has had chickenpox is immune and therefore not at risk of infection after exposure to clients with herpes zoster. Some evidence shows that infection is arrested if oral antiviral agents are administered within 24 hours of the initial eruption.