Chapter 61: Management of Patients with Dermatologic Problems

A nurse educator is teaching a group of medical nurses about Kaposis sarcoma. What would the educator identify as characteristics of endemic Kaposis sarcoma? Select all that apply. A) Affects people predominantly in the eastern half of Africa B) Affects men more than women C) Does not affect children D) Cannot infiltrate E) Can progress to lymphadenopathic forms

A) Affects people predominantly in the eastern half of Africa B) Affects men more than women E) Can progress to lymphadenopathic forms

34. A 55-year-old woman is scheduled to have a chemical face peel. The nurse is aware that the patient is likely seeking treatment for which of the following? A) Wrinkles near the lips and eyes B) Removal of acne scars C) Vascular lesions on the cheeks D) Real or perceived misshaping of the eyes

A) Wrinkles near the lips and eyes

5. When writing a plan of care for a patient with psoriasis, the nurse would know that an appropriate nursing diagnosis for this patient would be what? A) Impaired Skin Integrity Related to Scaly Lesions B) Acute Pain Related to Blistering and Erosions of the Oral Cavity C) Impaired Tissue Integrity Related to Epidermal Shedding D) Anxiety Related to Risk for Melanoma

A) Impaired Skin Integrity Related to Scaly Lesions

21. A patient has just been diagnosed with psoriasis and frequently has lesions around his right eye. What should the nurse teach the patient about topical corticosteroid use on these lesions? A) Cataract development is possible. B) The ointment is likely to cause weeping. C) Corticosteroid use is contraindicated on these lesions. D) The patient may develop glaucoma.

A) Cataract development is possible.

30. A patient has recently been diagnosed with advanced malignant melanoma and is scheduled for a wide excision of the tumor on her chest. In writing the plan of care for this patient, what major nursing diagnosis should the nurse include? A) Deficient Knowledge about Early Signs of Melanoma B) Chronic Pain Related to Surgical Excision and Grafting C) Depression Related to Reconstructive Surgery D) Anxiety Related to Lack of Social Support

A) Deficient Knowledge about Early Signs of Melanoma

2. A nurse is caring for a patient who has been diagnosed with psoriasis. The nurse is creating an education plan for the patient. What information should be included in this plan? A) Use caution when taking nonprescription medications. B) Avoid public places until symptoms subside. C) Wash skin frequently to prevent infection. D) Liberally apply corticosteroids as needed.

A) Use caution when taking nonprescription medications.

27. A nurse is providing self-care education to a patient who has been receiving treatment for acne vulgaris. What instruction should the nurse provide to the patient? A) Wash your face with water and gentle soap each morning and evening. B) Before bedtime, clean your face with rubbing alcohol on a cotton pad. C) Gently burst new pimples before they form a visible head. D) Set aside time each day to squeeze blackheads and remove the plug.

A) Wash your face with water and gentle soap each morning and evening.

24. A patients blistering disorder has resulted in the formation of multiple lesions in the patients mouth. What intervention should be included in the patients plan of care? A) Provide chlorhexidine solution for rinsing the patients mouth. B) Avoid providing regular mouth care until the patients lesions heal. C) Liaise with the primary care provider to arrange for parenteral nutrition. D) Encourage the patient to gargle with a hypertonic solution after each meal.

A) Provide chlorhexidine solution for rinsing the patients mouth.

A nurse is caring for a patient admitted to the medical unit with a diagnosis of pemphigus vulgaris. When writing the care plan for this patient, what nursing diagnoses should be included? Select all that apply. A) Risk for Infection Related to Lesions B) Impaired Skin Integrity Related to Epidermal Blisters C) Disturbed Body Image Related to Presence of Skin Lesions D) Acute Pain Related to Disruption in Skin Integrity E) Hyperthermia Related to Disruptions in Thermoregulation

A) Risk for Infection Related to Lesions B) Impaired Skin Integrity Related to Epidermal Blisters C) Disturbed Body Image Related to Presence of Skin Lesions D) Acute Pain Related to Disruption in Skin Integrity

A patient presents at the free clinic with a black, wart-like lesion on his face, stating, Ive done some research, and Im pretty sure I have malignant melanoma. Subsequent diagnostic testing results in a diagnosis of seborrheic keratosis. The nurse should recognize what significance of this diagnosis? A) The patient requires no treatment unless he finds the lesion to be cosmetically unacceptable. B) The patients lesion will be closely observed for 6 months before a plan of treatment is chosen. C) The patient has one of the few dermatologic malignancies that respond to chemotherapy. D) The patient will likely require wide excision.

A) The patient requires no treatment unless he finds the lesion to be cosmetically unacceptable.

3. A nurse is planning the care of a patient with herpes zoster. What medication, if administered within the first 24 hours of the initial eruption, can arrest herpes zoster? A) Prednisone (Deltasone) B) Azanthioprine (Imuran) C) Triamcinolone (Kenalog) D) Acyclovir (Zovirax)

D) Acyclovir (Zovirax)

1. A nurse practitioner is seeing a 16-year-old male patient who has come to the dermatology clinic for treatment of acne. The nurse practitioner would know that the treatment may consist of which of the following medications? A) Acyclovir (Zovirax) B) Benzoyl peroxide and erythromycin (Benzamycin) C) Diphenhydramine (Benadryl) D) Triamcinolone (Kenalog)

B) Benzoyl peroxide and erythromycin (Benzamycin)

25. When caring for a patient with toxic epidermal necrolysis (TEN), the critical care nurse assesses frequently for high fever, tachycardia, and extreme weakness and fatigue. The nurse is aware that these findings are potential indicators of what? Select all that apply. A) Possible malignancy B) Epidermal necrosis C) Neurologic involvement D) Increased metabolic needs E) Possible gastrointestinal mucosal sloughing

B) Epidermal necrosis D) Increased metabolic needs E) Possible gastrointestinal mucosal sloughing

18. A patient has received a diagnosis of irritant contact dermatitis. What action should the nurse prioritize in the patients subsequent care? A) Teaching the patient to safely and effectively administer immunosuppressants B) Helping the patient identify and avoid the offending agent C) Teaching the patient how to maintain meticulous skin hygiene D) Helping the patient perform wound care in the home environment

B) Helping the patient identify and avoid the offending agent

35. A patient comes to the dermatology clinic requesting the removal of a port-wine stain on his right cheek. The nurse knows that the procedure especially useful in treating cutaneous vascular lesions such as port-wine stains is what? A) Skin graft B) Laser treatment C) Chemical face peeling D) Free flap

B) Laser treatment

A school nurse has sent home four children who show evidence of pediculosis capitis. What is an important instruction the nurse should include in the note being sent home to parents? A) The child's scalp should be monitored for 48 to 72 hours before starting treatment. B) Nits may have to be manually removed from the child's hair shafts. C) The disease is self-limiting and symptoms will abate within 1 week. D) Efforts should be made to improve the child's level of hygiene.

B) Nits may have to be manually removed from the child's hair shafts.

14. A patient with a chronic diabetic wound is being discharged after receiving a skin graft to aid wound healing. What direction should the nurse include in home care instructions? A) Gently massage the graft site daily to promote perfusion. B) Protect the graft from direct sunlight and temperature extremes. C) Protect the graft site from any form of moisture for at least 12 weeks. D) Apply antibiotic ointment to the graft site and donor site daily.

B) Protect the graft from direct sunlight and temperature extremes.

28. A nurse is caring for a patient whose skin cancer will soon be removed by excision. Which of the following actions should the nurse perform? A) Teach the patient about early signs of secondary blistering diseases. B) Teach the patient about self-care after treatment. C) Assess the patients risk for recurrent malignancy. D) Assess the patient for adverse effects of radiotherapy.

B) Teach the patient about self-care after treatment.

9. A patient requires a full-thickness graft to cover a chronic wound. How is the donor site selected? A) The largest area of the body without hair is selected. B) Any area that is not normally visible can be used. C) An area matching the color and texture of the skin at the surgical site is selected. D) An area matching the sensory capability of the skin at the surgical site is selected.

C) An area matching the color and texture of the skin at the surgical site is selected.

22. A nurse is caring for a patient who has a diagnosis of bullous pemphigoid and who is being treated on the medical unit. When providing hygiene for this patient, the nurse should perform which of the following actions? A) After washing, wipe lesions with sterile gauze to remove cellular debris. B) Apply antibiotic ointment to lesions after washing. C) Apply cornstarch to the patients skin after bathing to facilitate mobility. D) Avoid using water to cleanse the patients skin in order to maintain skin integrity.

C) Apply cornstarch to the patients skin after bathing to facilitate mobility.

16. A nurse is providing care for a patient who has psoriasis. The nurse is aware of the sequelae that can result from this health problem. Following the appearance of skin lesions, the nurse should prioritize what assessment? A) Assessment of the patients stool for evidence of intestinal sloughing B) Assessment of the patients apical heart rate for dysrhythmias C) Assessment of the patients joints for pain and decreased range of motion D) Assessment for cognitive changes resulting from neurologic lesions

C) Assessment of the patients joints for pain and decreased range of motion

38. An older adult resident of a long-term care facility has been experiencing generalized pruritus that has become more severe in recent weeks. What intervention should the nurse add to this residents plan of care? A) Avoid the application of skin emollients. B) Apply antibiotic ointment as ordered following baths. C) Avoid using hot water during the patients baths. D) Administer acetaminophen 4 times daily as ordered.

C) Avoid using hot water during the patients baths.

39. A patient has a diagnosis of seborrhea and has been referred to the dermatology clinic, where the nurse contributes to care. When planning this patients care, the nurse should include which of the following nursing diagnoses? A) Risk for Deficient Fluid Volume Related to Excess Sebum Synthesis B) Ineffective Thermoregulation Related to Occlusion of Sebaceous Glands C) Disturbed Body Image Related to Excess Sebum Production D) Ineffective Tissue Perfusion Related to Occlusion of Sebaceous Glands

C) Disturbed Body Image Related to Excess Sebum Production

37. A public health nurse is participating in a health promotion campaign that has the goal of improving outcomes related to skin cancer in the community. What action has the greatest potential to achieve this goal? A) Educating participants about the relationship between general health and the risk of skin cancer B) Educating participants about treatment options for skin cancer C) Educating participants about the early signs and symptoms of skin cancer D) Educating participants about the health risks associated with smoking and assisting with smoking cessation

C) Educating participants about the early signs and symptoms of skin cancer

A 35-year-old kidney transplant patient comes to the clinic exhibiting new skin lesions. The diagnosis is Kaposis sarcoma. The nurse caring for this patient recognizes that this is what type of Kaposis sarcoma? A) Classic B) AIDS-related C) Immunosuppression-related D) Endemic

C) Immunosuppression-related

12. A patient diagnosed with a stasis ulcer has been hospitalized. There is an order to change the dressing and provide wound care. Which activity should the nurse first perform when providing wound care? A) Assess the drainage in the dressing. B) Slowly remove the soiled dressing. C) Perform hand hygiene. D) Don non-latex gloves.

C) Perform hand hygiene.

17. A patient is admitted to the intensive care unit with what is thought to be toxic epidermal necrolysis (TEN). When assessing the health history of the patient, the nurse would be alert to what precipitating factor? A) Recent heavy ultraviolet exposure B) Substandard hygienic conditions C) Recent administration of new medications D) Recent varicella infection

C) Recent administration of new medications

4. A patient with squamous cell carcinoma has been scheduled for treatment of this malignancy. The nurse should anticipate that treatment for this type of cancer will primarily consist of what intervention? A) Chemotherapy B) Radiation therapy C) Surgical excision D) Biopsy of sample tissue

C) Surgical excision

A nurse is working with a family whose 5 year-old daughter has been diagnosed with impetigo. What educational intervention should the nurse include in this family's care? A) Ensuring that the family knows that impetigo is not contagious B) Teaching about the safe and effective use of topical corticosteroids C) Teaching about the importance of maintaining high standards of hygiene D) Ensuring that the family knows how to safely burst the child's vesicles

C) Teaching about the importance of maintaining high standards of hygiene

11. A nurse is leading a health promotion workshop that is focusing on cancer prevention. What action is most likely to reduce participants risks of basal cell carcinoma (BCC)? A) Teaching participants to improve their overall health through nutrition B) Encouraging participants to identify their family history of cancer C) Teaching participants to limit their sun exposure D) Teaching participants to control exposure to environmental and occupational radiation

C) Teaching participants to limit their sun exposure

10. A patient has just been told that he has malignant melanoma. The nurse caring for this patient should anticipate that the patient will undergo what treatment? A) Chemotherapy B) Immunotherapy C) Wide excision D) Radiation therapy

C) Wide excision

29. A patient has just undergone surgery for malignant melanoma. Which of the following nursing actions should be prioritized? A) Maintain the patient on bed rest for the first 24 hours postoperative. B) Apply distraction techniques to relieve pain. C) Provide soft or liquid diet that is high in protein to assist with healing. D) Anticipate the need for, and administer, appropriate analgesic medications.

D) Anticipate the need for, and administer, appropriate analgesic medications.

33. A 65-year-old man presents at the clinic complaining of nodules on both legs. The man tells the nurse that his son, who is in medical school, encouraged him to seek prompt care and told him that the nodules are related to the fact that he is Jewish. What health problem should the nurse suspect? A) Stasis ulcers B) Bullous pemphigoid C) Psoriasis D) Classic Kaposis sarcoma

D) Classic Kaposis sarcoma

26. A nurse is assessing a teenage patient with acne vulgaris. The patients mother states, I keep telling him that this is what happens when you eat as much chocolate as he does. What aspect of the pathophysiology of acne should inform the nurses response? A) A sudden change in patients diet may exacerbate, rather than alleviate, the patients symptoms. B) Chocolate is not among the foods that are known to cause acne. C) Elimination of chocolate from the patients diet will likely lead to resolution within several months. D) Diet is thought to play a minimal role in the development of acne.

D) Diet is thought to play a minimal role in the development of acne.

8. A nurse is providing care for a patient who has developed Kaposis sarcoma secondary to HIV infection. The nurse should be aware that this form of malignancy originates in what part of the body? A) Connective tissue cells in diffuse locations B) Smooth muscle cells of the gastrointestinal and respiratory tract C) Neural tissue of the brain and spinal cord D) Endothelial cells lining small blood vessels

D) Endothelial cells lining small blood vessels

13. A patient comes to the clinic complaining of a red rash of small, fluid-filled blisters and is suspected of having herpes zoster. What presentation is most consistent with herpes zoster? A) Grouped vesicles occurring on lips and oral mucous membranes B) Grouped vesicles occurring on the genitalia C) Rough, fresh, or gray skin protrusions D) Grouped vesicles in linear patches along a dermatome

D) Grouped vesicles in linear patches along a dermatome

While performing an initial assessment of a patient admitted with appendicitis, the nurse observes an elevated blue-black lesion on the patients ear. The nurse knows that this lesion is consistent with what type of skin cancer? A) Basal cell carcinoma B) Squamous cell carcinoma C) Dermatofibroma D) Malignant melanoma

D) Malignant melanoma

19. A nurse is caring for a patient whose chemical injury has necessitated a skin graft to his left hand. The nurse enters the room and observes that the patient is performing active range of motion (ROM) exercises with the affected hand. How should the nurse best respond? A) Liaise with the physical therapist to ensure that the patient is performing exercises safely. B) Validate the patients efforts to increase blood perfusion to the graft site. C) Remind the patient that ROM exercises should be passive, not active. D) Remind the patient of the need to immobilize the graft to facilitate healing.

D) Remind the patient of the need to immobilize the graft to facilitate healing.

A patient who has sustained third-degree facial burns and a facial fracture is undergoing reconstructive surgery and implantation of a prosthesis. The nurse has identified a nursing diagnosis of Disturbed Body Image Related to Disfigurement. What would be an appropriate nursing intervention related to this diagnosis? A) Referring the patient to a speech therapist B) Gradually adding soft foods to diet C) Administering analgesics as prescribed D) Teaching the patient how to use and care for the prosthesis

D) Teaching the patient how to use and care for the prosthesis

A 30-year-old male patient has just returned from the operating room after having a flap done following a motorcycle accident. The patients wife asks the nurse about the major complications following this type of surgery. What would be the nurses best response? A) The major complication is when the patient develops chronic pain. B) The major complication is when the patient loses sensation in the flap. C) The major complication is when the pedicle tears loose and the flap dies. D) The major complication is when the blood supply fails and the tissue in the flap dies.

D) The major complication is when the blood supply fails and the tissue in the flap dies.