Chapter 56. Management of Patients with Dermatologic Disorders and Wound

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." "If someone develops symptoms, tell him to see a physician right away." "Just be careful not to share linens and towels with family members." "After you're treated, family members won't be at risk for contracting scabies."

"All family members need to be treated." Explanation: 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 caring for a client diagnosed with herpes zoster. Which statement by the client needs further clarification by the nurse? "Even though this is from a childhood disease, I am still contagious." "Herpes zoster is caused by a viral infection." "Herpes zoster is a reactivation of the varicella virus." "Once I get the infection, I cannot get it again."

"Once I get the infection, I cannot get it again." Explanation: The nurse is correct to clarify that even though the client has herpes zoster, the client can get herpes zoster again. The virus is contagious and can reoccur. The other options are accurate statements that reflect the client's understanding.

A patient has a moisture-retentive dressing for the treatment of a sacral decubitus ulcer. How long should the nurse leave the dressing in place before replacing it? 4 to 6 hours 8 hours 12 to 24 hours 24 to 36 hours

12 to 24 hours Explanation: Depending on the product used and the type of dermatologic conditions encountered, most moisture-retentive dressings may remain in place from 12 to 24 hours.

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? Skin biopsy Fungal culture Potassium hydroxide test A Wood's light examination

A Wood's light examination Explanation: A Wood's light is also known as a black light and is a handheld device that can identify certain fungal infections that fluoresce under long-wave ultraviolet light. In a darkened room, when a physician or nurse aims the light at a lesion caused by a fungus that fluoresces, the lesion emits a blue-green color. It is the only test that uses a light, the others use skin scrapings.

The nurse is caring for a patient with extensive bullous lesions on the trunk and back. Prior to initiating skin care, what is a priority for the nurse to do? Wash the lesions vigorously. Rupture the bullous lesions. Administer analgesic pain medication. Apply cold compresses.

Administer analgesic pain medication. Explanation: The patient with painful and extensive lesions should be premedicated with analgesic agents before skin care is initiated.

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

Antiviral Explanation: Oral acyclovir (Zovirax), when taken within 48 hours of the appearance of symptoms, reduces their severity, and prevents the development of additional lesions. Corticosteroids, analgesics,, and antipyretics are not used for this purpose.

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. Make sure that the skin is slightly dehydrated so that the medication can absorb through the skin cracks. Apply a thick layer of cream over the lesions so that if some rubs off, there is more to absorb. Apply the medication every 2 hours.

Apply an occlusive dressing over the site after application. Explanation: Corticosteroids are widely used in treating dermatologic conditions to provide anti-inflammatory, antipruritic, and vasoconstrictive effects. The patient is educated to apply this medication according to strict guidelines, using it sparingly but rubbing it into the prescribed area thoroughly. Absorption of topical corticosteroids is enhanced when the skin is hydrated or the affected area is covered by an occlusive or moisture-retentive dressing

Which term refers to a graft derived from one part of a client's body and used on another part of that same client's body? Autograft Allograft Homograft Heterograft

Autograft Explanation: Autografts of full-thickness and pedicle flaps are commonly used for reconstructive surgery months or years after the initial injury. Allografts and homografts are grafts transferred from one human (living or cadaveric) to another human. A heterograft is a graft obtained from an animal of a species other than that of the recipient.

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

Autolytic debridement Explanation: 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.

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

Avoid applying to the face. Avoid prolonged use. Explanation: 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.

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? 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. Wash the face several times a day and reapply the medication. Scrape the scaly patches off prior to applying the medication.

Avoid using the medication around the eyelids because it may cause cataracts and glaucoma. Explanation: 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 nurse is examining a client's scalp for evidence of lice. The nurse should pay particular attention to which part of the scalp? Temporal area Top of the head Behind the ears Middle area

Behind the ears Explanation: Adult lice usually bite the scalp behind the ears and along the back of the neck. Because such lice are tiny (1 to 2 mm) with grayish white bodies, they are hard to see. However, their bites result in visible pustular lesions. Although lice may bite any part of the scalp, bites are less common on the temporal area, top of the head, and middle area.

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

College dormitory Explanation: 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? Corticosteroids Saline irrigations Antifungals Antivirals

Corticosteroids Explanation: 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? Corticosteroids Saline irrigations Antifungals Antivirals

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

The nurse is assessing a client's skin when the client points out a mole. The nurse brings the mole to the physician's attention when which characteristic is noted? Symmetrical appearance Distinct borders Uniform light brown color Diameter exceeding 6 mm

Diameter exceeding 6 mm Explanation: The nurse brings the mole to the physician's attention when characteristics of melanoma are detected, such as a diameter exceeding 6 mm. Other characteristics of melanoma include asymmetric appearance; irregular, indistinct borders; and red, white, or blue coloration

Which of the following is an example of a topical anesthetic? EMLA cream Bacitracin Silvadene Garamycin

EMLA cream Explanation: EMLA cream is a topical anesthetic. Bacitracin, Silvadene, and Garamycin are topical antibiotics.

A nurse is caring for a client experiencing an exacerbation of plaque psoriasis. The nurse assesses the area and documents a proliferation of which cell type? Dermal Epidermal Endothelial Epithelia

Epidermal Explanation: The nurse is correct to document that the proliferation of skin cells occurs in the first layer of skin cells, the epidermis. In the epidermal layer, there is rapid turnover of the cells. The dermis is under the epidermis. Endothelial is the layer on the inside such as the interior of the blood vessel. Epithelia are on the outside or coating of walls.

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

Every 3 to 4 hours for sustained effectiveness. Explanation: 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.

Pressure ulcers are caused by: Extrinsic factors Low capillary pressure Necrosis Increased mobility

Extrinsic factors Explanation: Pressure ulcers involve breakdown of the skin due to prolonged pressure, friction, and shear forces, and insufficient blood supply, usually at bony prominences.

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

Fexofenadine (Allegra) Explanation: 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 sedative medication is effective for treating pruritus? Benzoyl peroxide Hydroxyzine Fexofenadine Tetracycline

Hydroxyzine Explanation: Hydroxyzine is a sedating medication effective in the treatment of pruritus. Benzoyl peroxide, fexofenadine, and tetracycline are not effective in treating pruritus.

Which of the following sedative medications is effective in treating pruritus? Hydroxyzine (Atarax) Benzoyl peroxide Fexofenadine (Allegra) Tetracycline

Hydroxyzine (Atarax) Explanation: Atarax is a sedating medication effective in the treatment of pruritus. Benzoyl peroxide, Allegra, and tetracycline are not effective in treating pruritus.

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

Impetigo Explanation: 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? Isotretinoin (Accutane) Benzoyl peroxide Retin-A Salicylic acid

Isotretinoin (Accutane) Explanation: 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.

Which statement indicates a characteristic of a basal cell carcinoma (BCC)? It is more invasive than squamous cell carcinoma (SCC). It metastasizes through blood or the lymphatic system. It begins as a small, waxy nodule with rolled translucent, pearly borders. It is a malignant proliferation arising from the epidermis.

It begins as a small, waxy nodule with rolled translucent, pearly borders. Explanation: BCC usually begins as a small, waxy nodule with rolled, translucent, pearly borders. It is less invasive than SCC. It does not metastasize through the blood or lymphatic system. SCC is a malignant proliferation arising from the epidermis.

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 Allergic reactions Syphilis

Kaposi sarcoma Explanation: Kaposi sarcoma is a frequent comorbidity of clients with AIDS. With platelet disorders, the nurse observes ecchymosis (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 clients with syphilis.

Which of the following information regarding the transmission of lice would the nurse identify as a myth? Lice can be spread by sharing of hats, caps, and combs. Lice can jump from one individual to another. Lice need to be removed from the hair with a fine comb. Lice can be seen without magnification.

Lice can jump from one individual to another. Explanation: The nurse is correct to identify that lice cannot jump from one individual to another. Direct contact is needed for transmission. The other options are correct.

The nurse and nursing assistant are moving a client who slid down in the chair. What does the nurse encourage the assistant to avoid shearing when moving the client to a higher position in the chair? Tilt the chair back when moving the client. Lift the client, do not slide them. Encourage the client to slide up without assistance. Use a donut device while the client is in the chair.

Lift the client, do not slide them. Explanation: Avoid shearing, a physical force that separates layers of tissue in opposite directions, such as when a seated client slides downward. Lifting the client and not sliding them will avoid the shearing forces that can tear the skin. Tilting the chair back is a safety hazard and may cause injury to the client. If the client proceeds alone, they will produce a shearing effect. A donut device may cause shearing and should not be used.

A nurse practitioner prescribes a therapeutic bath for a patient with an exacerbation of psoriasis. She tells the patient to make sure the bath area is well ventilated. Which of the following is the therapeutic bath solution prescribed by the nurse? Sodium bicarbonate Medicated tars Water or saline Colloids

Medicated tars Explanation: Medicated tars are volatile, so the bath area needs to be well ventilated. Refer to Box 52-1 in the text.

Which of the following medications is used to reduce turnover time of the psoriatic epidermis? Methotrexate Triamcinolone acetamide (Kenalog) Tazarotene (Tazorac) Acyclovir (Zovirax)

Methotrexate Explanation: Methotrexate appears to inhibit DNA synthesis in epidermal cells, thereby reducing the turnover time of the psoriatic epidermis. Kenalog is an intralesional corticosteroid. Tazarotene, a retinoid, causes sloughing of the scales covering psoriatic plaques. It is listed as a category X drug in pregnancy. Zovirax is used in the treatment of shingles.

Which procedure done for skin cancer conserves the most amount of normal tissue? Mohs micrographic surgery Electrosurgery Cryosurgery Surgical excision

Mohs micrographic surgery Explanation: Mohs micrographic surgery is the technique that is most accurate and that best conserves normal tissue. The procedure removes the tumor layer by layer. Electrosurgery, cryosurgery, and surgical excision do not conserve the amount of normal tissue.

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? Dry sterile dressing Sterile petroleum gauze Moist sterile saline gauze Povidone-iodine-soaked gauze

Moist sterile saline gauze Explanation: Moist sterile saline dressings support wound healing and are cost-effective. Dry sterile dressings adhere to the wound and debride the tissue when removed. Petroleum supports healing but is expensive. Povidone-iodine is used as an antiseptic cleaning agent but because it can irritate epithelial cells, it shouldn't be left on an open wound.

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 Lentigo-maligna Nodular melanoma Acral-lentiginous

Nodular melanoma Explanation: 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 client comes into the hospital with a Tegaderm dressing in place on the buttocks. The nurse documents this as being which type of dressing? Active Inactive Passive Interactive

Passive Explanation: There are three categories of wound dressings: active, passive, and interactive. The nurse labels Tegaderm as being a passive dressing, one that acts as a protective, moist environment for natural healing. Interactive dressings absorb wound exudate and include hydrocolloids. Active dressings decrease healing time to improve the healing process and include biologic skin substitutes.

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

Preventing infection Explanation: 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.

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 Semi-private room with a client who had chickenpox and was admitted with a GI bleed Private room Isolation room with negative airflow

Private room Explanation: 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.

A client seeks medical attention for a new skin condition. Which finding indicates to the nurse that the client is experiencing contact dermatitis? Select all that apply. Pruritus Burning Papules Vesicles Silvery scales

Pruritus Burning Papules Vesicles Explanation: Contact dermatitis is an inflammatory reaction of the skin to physical, chemical, or biological agents. The epidermis is damaged by repeated physical and chemical irritations. The eruptions begin when the causative agent contacts the skin. The first reactions include pruritis and burning. Later reactions include papules and vesicles. Silvery scales are associated with psoriasis.

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 Shingles Candidiasis Seborrhea

Pruritus Explanation: 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. Shingles presents with lesions. Candidiasis presents with reddened skin and is often found in the folds of skin. Seborrhea refers to dry, scaly patches usually located on the scalp.

Photochemotherapy has been used as a treatment for which of the following skin disorders? Shingles Psoriasis Allergic dermatitis Rosacea

Psoriasis Explanation: Photochemotherapy is used for severe, disabling psoriasis that does not respond to other methods of treatments.

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 a superficial infection with Staphylococcus aureus. Psoriasis comes from dermal abrasion. Psoriasis is an inflammatory dermatosis that results from an overproduction of keratin. Psoriasis results from excess deposition of subcutaneous fat.

Psoriasis is an inflammatory dermatosis that results from an overproduction of keratin. Explanation: Current evidence supports an autoimmune basis for psoriasis. 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.

A young client has head lice. What are appropriate steps in eradication? Select all that apply. 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.

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. Explanation: 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? Impetigo Scabies Contact dermatitis Dermatophytosis

Scabies Explanation: 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.

With repeated reactions of contact dermatitis, which of the following can occur? Secondary bacterial infection Pain along the sensory nerve Sepsis Hemorrhage

Secondary bacterial infection Explanation: If repeated reactions occur, or if the patient continually scratches the skin, lichenification (thickening of the horny layer of the skin) and pigmentation occur. Secondary bacterial invasion may follow. During shingles, there will be pain along the sensory nerve. Sepsis and hemorrhage would not occur from repeated bouts of contact dermatitis.

The school nurse is instructing a parent in the care and elimination of lice from their child's hair. The parent brings all of the products for care in a bag. Which contents are not appropriate for use? Shampoo and conditioner Permethrin (Nix) Plastic fine-toothed comb New hair clips

Shampoo and conditioner Explanation: The nurse is correct to instruct the parent to avoid shampoo and conditioner because this coats the hair and protects the nits. Nix and a fine-toothed comb are recommended. New hair clips may be used once the infestation is gone.

What should the nurse assess for to determine if a patient using corticosteroids for a dermatologic condition is having local side effects? Select all that apply. Skin atrophy Striae Telangiectasia Comedones Ecchymosis

Skin atrophy Striae Telangiectasia Explanation: Local side effects of topical corticosteroids may include skin atrophy and thinning, striae (bandlike streaks), and telangiectasias (small, red lesions caused by dilation of blood vessels).

A patient visits a health clinic with a skin lesion on her right forearm. The lesion is inflamed, swollen, and draining. The nurse practitioner knows the best choice of a treatment would be the application of which of the following? Water-soluble emulsion Cream or paste Ointment Soothing lotion

Soothing lotion Explanation: As a rule, if the skin is acutely inflamed, edematous (swollen), and draining, it is best to apply wet or specialty dressings and/or soothing lotions. For chronic conditions in which the skin surface is dry and scaly, water-soluble emulsions, creams, ointments, and pastes are used.

Which material consists of a powder in water? Hygroscopic agent Paste Liniment Suspension

Suspension Explanation: A suspension requires shaking before application, exemplified by calamine lotion. A hygroscopic agent is a powder that acts to absorb and retain moisture from the air and to reduce friction between surfaces. A paste is a mixture of powder and ointment. A liniment is a lotion with oil added to prevent crusting.

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? Removes the entire growth Through the application of extreme cold, the tissue is destroyed. Freezes the growth, so the physician can remove it at the next appointment Lasers the growth off

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

Which term describes a fungal infection of the scalp? Tinea capitis Tinea corporis Tinea cruris Tinea pedis

Tinea capitis Explanation: Tinea capitis is a fungal infection of the scalp. Tinea corporis involves fungal infections of the body. Tinea cruris describes fungal infections of the inner thigh and inguinal creases. Tinea pedis is the term for fungal infections of the foot.

A client recently received lip and tongue piercings and subsequently developed a superinfection of candidiasis from the antibacterial mouthwash. What would the nurse recommend for this client? Use an antifungal mouthwash or salt water. Use a soft-bristled toothbrush. Rinse the mouth after eating food. Move the piercing back and forth during washing.

Use an antifungal mouthwash or salt water. Explanation: 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 the 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 gloves with application. Only use with contact dermatitis. Apply a thick layer to assure coverage. Use with over-the-counter drying agents.

Use gloves with application. Explanation: 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 home health nurse is caring for a client with scabies. When instructing on the proper procedure to wash preworn contaminated clothing, which nursing instruction is essential? Use commercial grade laundry detergent. Pretreat clothing where scabies contact existed. Wash clothes through two laundry cycles. Use hot water throughout wash cycle.

Use hot water throughout wash cycle. Explanation: The nurse is correct to instruct the client to use hot water throughout the wash cycle. Using hot water kills scabies and infectious agents on the laundry. If using the correct wash settings, the client does not need to use commercial-grade laundry detergent, the clothing does not need pretreated nor washed through two cycles.

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

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

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

Wear rubber gloves when in contact with soaps. Explanation: 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. 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? Do you exercise daily?

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? Explanation: 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.

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

a furuncle. Explanation: 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.

A day care worker comes to the clinic for mild itching and rash of both hands. The nurse suspects contact dermatitis. The diagnosis is confirmed if the rash appears: erythematous with raised papules. dry and scaly with flaking skin. inflamed with weeping and crusting lesions. excoriated with multiple fissures.

erythematous with raised papules. Explanation: Contact dermatitis is caused by exposure to a physical or chemical allergen, such as skin care products, cleaning products, and latex gloves. Initial symptoms of itching, erythema, and raised papules occur at the site of exposure and can begin within 1 hour of exposure. Allergic reactions tend to be red, not scaly or flaky. Weeping, crusting lesions are also uncommon unless the reaction is severe or has been present for a long time. Excoriation is more common in skin disorders associated with a moist environment.

Which is not a category of medications used for treatment of the skin? inhaled steroids topical corticosteroids antihistamines antibiotics

inhaled steroids Explanation: Inhaled steroids are not used for skin disorders. Topical corticosteroids, antihistamines, and antibiotics are all used in the treatment of skin disorders.

A nurse is caring for a client admitted to the medical unit with a diagnosis of pemphigus. When writing the care plan for this client, what issues should be included? Select all that apply. Risk for infection Impaired skin integrity Disturbed body image Acute pain Hyperthermia

isk for infection Impaired skin integrity Disturbed body image Acute pain Explanation: Blistering diseases disrupt skin integrity and are associated with pain and a risk for infection. Because of the visibility of blisters, body image is often affected. The client faces a risk for hypothermia, not hyperthermia.

A physician has ordered a wet-to-damp dressing for an infected pressure ulcer. The nurse knows that the primary reason for this treatment is to: prevent the spread of the infection. debride the wound. keep the wound moist. reduce pain.

keep the wound moist. Explanation: Wet-to-damp dressings keep the wound bed moist, which helps promote the growth of granulation tissue. Because dead tissue adheres to a dry dressing, wet-to-dry dressings are used for debriding wounds. Wet-to-damp dressings don't prevent the spread of infection. Although these dressings provide a soothing, cool feeling, they don't relieve pain.

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 dermatitis. acantholysis. lichenification. pyodermas

lichenification. Explanation: 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.

While assessing the skin of a 45-year-old, fair-skinned female client, the nurse notes a lesion on the medial aspect of her lower leg. It has irregular borders, with various shades of black and brown. The client states that the lesion itches occasionally and bled slightly a few weeks ago. She also reveals a history of sunburns. Based on these signs and symptoms, the nurse suspects: squamous cell carcinoma. actinic keratoses. melanoma. basal cell carcinoma.

melanoma Explanation: The "ABCDs" of melanoma are Asymmetry of the lesion, Borders that are irregular, Colors that vary in shades, and increased Diameter. Fair skin with a history of sunburn and the location of the lesion on the leg (the most common site in women) suggest melanoma. Squamous cell carcinoma commonly develops on the skin of the face, the ears, the dorsa of the hands and forearms, and other sun-damaged areas. Early lesions appear as opaque, firm nodules with indistinct borders, scaling, and ulceration. Actinic keratosis is a premalignant skin lesion. Basal cell carcinoma presents as lesions that are lightly pigmented. As they enlarge, their centers become depressed and their borders become firm and elevated.

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

overproduction of sebum Explanation: 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.

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

the infection results from reactivation of the chickenpox virus. Explanation: 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.