Chapter 52: Nursing Management: Patients With Dermatologic Problems - ML5 ~ Nursing 1

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:

"All family members need to be treated."

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?

"Even if it's cloudy outside, the sun's rays can still cause harm to your skin and contribute to skin cancer."

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 prevent evaporation of water from the hydrated epidermis."

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."

Which of the following information regarding the transmission of lice would the nurse identify as a myth?

Lice can jump from one individual to another.

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

Lichenification aka scaling

While examining a client's leg, a nurse notes an open ulceration with visible granulation tissue in the wound. Until a wound specialist can be contacted, which type of dressing should the nurse apply?

Moist sterile saline gauze

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

The nurse is caring for a client who may have a lice infestation. The nurse is using a bright light focused on an area of the head to confirm the presence of lice. In which manner is it easiest to differentiate nits from dandruff?

Nits are difficult to move from hair shafts.

A nurse is admitting a client with toxic epidermal necrolysis. What is the nursing priority in preventing sepsis?

Preventing infection

The nurse is assessing a patient with toxic epidermal necrolysis (TEN). What assessment data would indicate that the patient may be progressing to keratoconjunctivitis? Select all that apply.

Pruritus of the eyes. Burning of the eyes. Dryness of the eyes.

A client is undergoing photochemotherapy involving a combination of a photosensitizing chemical and ultraviolet light. What health problem does this client most likely have?

Psoriasis

Photochemotherapy has been used as a treatment for which of the following skin disorders?

Psoriasis

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 is an inflammatory dermatosis that results from an overproduction of keratin.

A patient is scheduled for Mohs microscopic surgery for removal of a skin cancer lesion on his forehead. The nurse knows to prepare the patient by explaining that this type of surgery requires:

Removal of the tumor, layer by layer.

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?

Scabies

A patient is complaining of severe itching that intensifies at night. The nurse decides to assess the skin using a magnifying glass and penlight to look for the "itch mite." What skin condition does the nurse anticipate finding?

Scabies

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?

Through the application of extreme cold, the tissue is destroyed.

Which term describes a fungal infection of the scalp?

Tinea capitis

Which of the following superficial fungal infections begins in the skin between the toes and spreads to the soles of the feet?

Tinea pedis

To treat a client with acne vulgaris, the physician is most likely to order which topical agent for nightly application?

Tretinoin (retinoic acid [Retin-A])

The nurse is providing morning hygiene for an older adult patient who requires total care due to late-stage Alzheimer's disease. In recent weeks, the patient has shown signs of dermatitis on various skin surfaces. When providing a bed bath for this patient, the nurse should do which of the following?

Use a mild soap or a soap substitute when washing the patient's skin.

A client is being treated for acne vulgaris. What warning must be given to this client regarding the application of benzoyl peroxide?

Use gloves with application.

The nurse is instructing the parents of a child with head lice. Which statement should the nurse include?

Use shampoo with piperonyl butoxide.

A patient with a history of human immunodeficiency virus (HIV) has just been diagnosed with toxic epidermal necrolysis (TEN) and admitted to the regional burn unit for treatment. The nurses who will be providing direct care for this patient should prioritize which of the following practices?

Vigilant application of standard infection control precautions

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.

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.

Where are the lesions located? Have you tried to treat the lesions? When did the disorder first begin, and where did it first appear? Has the problem spread?

A client has a rash on the arm that has been treated with an antibiotic without eradicating the rash. What type of examination can be used to determine if the rash is a fungal rash using ultraviolet light?

Wood's light examination

The classic lesions of impetigo manifest as:

honey-yellow crusted lesions on an erythematous base.

A nurse is preparing an in-service education program for a group of nurses working on the unit. The topic is wound dressings. When describing secondary dressings, which type would the nurse most likely include? Select all that apply.

hydrocolloid. hydrogel. alginate.

Which is not a category of medications used for treatment of the skin?

inhaled steroids

The nurse teaches the client who demonstrates herpes zoster (shingles) that

the infection results from reactivation of the chickenpox virus.

A patient visits a dermatologist for assessment of a rough, scaly patch on his arm that shows evidence of underlying erythema. The dermatologist asks the nurse to assist him in removing the lesion using cryotherapy. Which of the following is most likely the lesion in this scenario?

Actinic Keratosis

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?

Acute pain related to shingles

The pharmacology class is learning about herpes zoster and medications that are used to treat this disease process. When planning care for a patient with herpes zoster what medications, if administered within the first 24 hours of the initial eruption, can arrest herpes zoster?

Acyclovir (Zovirax)

The nurse is instructing the patient in how to apply a corticosteroid cream to lesions on the arm. What intervention can the nurse instruct the patient to do to increase the absorption of the medication?

Apply an occlusive dressing over the site after application.

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?

Avoid using the medication around the eyelids because it may cause cataracts and glaucoma.

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?

Corticosteroids

The nurse should assess all possible causes of pruritus for a patient complaining of generalized pruritus. What does the nurse understand can be another cause for this condition?

End-stage kidney disease

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.

The patient is advised to apply a suspension-type lotion to a dermatosis site. The nurse should advise the patient to apply the lotion how often to be effective?

Every 3 hours

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.

Which of the following nonsedating antihistamines is appropriate for daytime pruritus?

Fexofenadine (Allegra)

The nurse is developing a plan of care for a client with toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome. Which action should the nurse include?

Frequently inspect the oral cavity.

Which term refers most precisely to a localized skin infection of a single hair follicle?

Furuncle

A client with scabies has been prescribed a scabicide. Which of the following advice should the nurse give the client before beginning the treatment?

Have a thorough bath

Which drug is an oral retinoid used to treat acne?

Isotretinoin

The nurse is providing teaching to a client with acne who is using isotretinoin therapy. Which statement should the nurse make?

It is teratogenic in humans. - teratogenic meaning that it can have an adverse effect on a fetus, causing central nervous system and cardiovascular defects, and structural abnormalities of the face.

Which infecting agent causes scabies?

Itch mite

A client has been diagnosed with shingles. Which of the following medication classifications will reduce the severity and prevent development of new lesions?

Antiviral

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.

The ABCD method offers one way to assess skin lesions for possible skin cancer. What does the A stand for?

Asymmetry

Which of the following uses the body's own digestive enzymes to break down necrotic tissues?

Autolytic debridement

The nurse caring for a client with repeated episodes of contact dermatitis is providing instruction to prevent future episodes. Which information should the nurse include?

Avoid cosmetics with fragrance.

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

Chocolate Ice cream

The nurse is working with community groups. At which of the following locations would the nurse anticipate a possible scabies outbreak?

College dormitory

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?

Private room

A nurse assesses a client with dry, rough, scaly skin without lesions on the legs. The client reports itching in the affected area. What skin assessment would the nurse document?

Pruritus - Pruritus (itching) is one of the most common symptoms of patients with dermatologic disorders. Itch receptors are unmyelinated, penicillate (brush-like) nerve endings that are found exclusively in the skin, mucous membranes, and cornea.

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?

Surgical excision