Chapter 61: Management of Patients with Dermatologic Disorders

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

Fexofenadine (Allegra)

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

1 month

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."

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."

Pressure ulcers are caused by:

Extrinsic factors

The nurse is caring for a client diagnosed with herpes zoster. Which statement by the client needs further clarification by the nurse?

"Once I get the infection, I cannot get it again."

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 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?

A Wood's light examination

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.

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

A nurse is examining a client's scalp for evidence of lice. The nurse should pay particular attention to which part of the scalp?

Behind the ears

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

Which primary lesions are associated with acne caused by sebum blockage in hair follicles?

Comedones

Which medication classification may be used for contact dermatitis?

Corticosteroids

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?

Diameter exceeding 6 mm

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

Which sedative medication is effective for treating pruritus?

Hydroxyzine

Which of the following reflect the pathophysiology of cutaneous signs of HIV disease?

Immune function deterioration

Which drug is an oral retinoid used to treat acne?

Isotretinoin

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?

Medicated tars

A patient is being evaluated for nodular cystic acne. What systemic pharmacologic agent may be prescribed for the treatment of this disorder?

Isotretinoin (Accutane)

The nurse is conducting a community education program on basal cell carcinoma (BCC). Which statement should the nurse make?

It begins as a small, waxy nodule with rolled translucent, pearly borders.

Which statement indicates a characteristic of a basal cell carcinoma (BCC)?

It begins as a small, waxy nodule with rolled translucent, pearly borders.

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.

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?

Kaposi sarcoma

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.

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.

Which procedure done for skin cancer conserves the most amount of normal tissue?

Mohs micrographic surgery

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 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?

Nodular melanoma

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

Preventing infection

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

A nurse is conducting a detailed skin assessment on an 80-year-old client. Which finding requires further investigation?

Small, waxy nodule with pearly borders

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 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

With repeated reactions of contact dermatitis, which of the following can occur?

Secondary bacterial infection

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

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?

Soothing lotion

Which of the following is a local side effect of topical corticosteroids?

Telangiectasia

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 of the following is also known as "jock itch"?

Tinea cruris

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?

Use an antifungal mouthwash or salt water.

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

Use shampoo with piperonyl butoxide.

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?

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 client reports noticing a greater than normal amount of hair loss, and is concerned about developing a bald spot on the head. Which condition is probably not causing the client's hair loss?

furunculosis

A client with a history of diabetes mellitus has recently developed furunculosis. What is causing the client's condition?

infection

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

inhaled steroids

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:

keep the wound moist.

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.

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:

melanoma.

A client is being treated for acne vulgaris. What contributes to follicular irritation?

overproduction of sebum

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

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

Tinea pedis

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

Antiviral

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 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 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?

Epidermal

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.

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 patient who was recently diagnosed with pruritus on the chest and back is given information about skin care and bathing. The most important advice on cleansing is to avoid:

Washing with soap and hot water.

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 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?

12 to 24 hours

Which assessment finding indicates an increased risk of skin cancer?

A deep sunburn