Exam 6: Ch. 15 & 16 Integumentary

A patient has a new a skin lesion. Which should the nurse expect to be diagnosed with an oil slide test? Infestation Bacterial infection Viral infection Skin cancer

Infestation

While conducting a skin assessment, the nurse suspects an older patient is experiencing dehydration. What did the nurse most likely assess in this patient? Decreased turgor Pallor or cyanosis Increased moisture Presence of lesions

Decreased turgor

The nurse is conducting a physical assessment on a patient. Which skin condition should the nurse suspect when observing the following on the hands of the patient? Common wart Herpes zoster Psoriasis Melanoma

Common wart

A patient with melanoma on the lower back asks why the lesion developed in that area since it is not exposed to sunlight. Which response should the nurse make to this patient? -"A melanoma may start out as a mole and grow abnormally; it may not be the result of sun damage." -"The cancer started at another site on your body and was carried to that site." -"This type of skin cancer has a genetic component, and would develop with or without sunlight exposure." -"This type of cancer is the result of a virus, which can occur anywhere on the surface of the body."

"A melanoma may start out as a mole and grow abnormally; it may not be the result of sun damage."

At the completion of an assessment the nurse determines that education on methods to reduce the patient's increased risk for developing nonmelanoma skin cancer is required. What did the nurse assess in this patient? -Alopecia, thin hair, itching -Blond hair, freckles, fair skin -Dark hair, dark skin, dry skin -Tanned skin, dark hair, edema

-Blond hair, freckles, fair skin

A client is being admitted to the hospital for treatment of acute cellulitis of the lower left leg. During the admission assessment, the nurse expects to note which finding? 1. An inflammation of the epidermis only 2. A skin infection of the dermis and underlying hypodermis 3. An acute superficial infection of the dermis and lymphatics 4. An epidermal and lymphatic infection caused by Staphylococcus

2. A skin infection of the dermis and underlying hypodermis

A client returns to the clinic for follow-up treatment after a skin biopsy of a suspicious lesion performed 1 week ago. The biopsy report indicates that the lesion is a melanoma. The nurse understands that melanoma has which characteristics? Select all that apply. 1. Lesion is painful to touch. 2. Lesion is highly metastatic. 3. Lesion is a nevus that has changes in color. 4. Skin under the lesion is reddened and warm to touch. 5. Lesion occurs in body areas exposed to outdoor sunlight.

2. Lesion is highly metastatic. 3. Lesion is a nevus that has changes in color.

The clinic nurse notes that the health care provider has documented a diagnosis of herpes zoster (shingles) in the client's chart. Based on an understanding of the cause of this disorder, the nurse determines that this definitive diagnosis was made by which diagnostic test? 1. Positive patch test 2. Positive culture results 3. Abnormal biopsy results 4. Wood's light examination indicative of infection

2. Positive culture results

The intravenous access site infiltrated in a patient's right hand. When assessing the degree of edema, the nurse finds obvious pitting and the entire hand is swollen. How should the nurse document this assessment finding? 1+ 2+ 3+ 4+

3+

A client calls the emergency department and tells the nurse that he came directly into contact with poison ivy shrubs. The client tells the nurse that he cannot see anything on the skin and asks the nurse what to do. The nurse should make which response? 1. "Come to the emergency department." 2. "Apply calamine lotion immediately to the exposed skin areas." 3. "Take a shower immediately, lathering and rinsing several times." 4. "It is not necessary to do anything if you cannot see anything on your skin."

3. "Take a shower immediately, lathering and rinsing several times."

The nurse manager is planning the clinical assignments for the day. Which staff members cannot be assigned to care for a client with herpes zoster? Select all that apply. 1. The nurse who never had roseola 2. The nurse who never had mumps 3. The nurse who never had chickenpox 4. The nurse who never had German measles 5. The nurse who never received the varicella-zoster vaccine

3. The nurse who never had chickenpox 5. The nurse who never received the varicella-zoster vaccine

A patient has vesicles and pustules along one area under the left clavicle. Which should the nurse suspect the client is experiencing? Herpes zoster Contact dermatitis Ringworm Urticaria

Herpes zoster

A patient has yellowed sclerae. Which health problem should the nurse associate with this finding? Liver disease Renal disease Heart disease Hypovolemia

Liver disease

Which condition should the nurse suspect a patient is experiencing? Malignant melanoma Psoriasis Herpes zoster Lipoma

Malignant melanoma

A patient is experiencing symptoms of a skin infestation. Which diagnostic test should the nurse prepare to obtain from this patient? Oil slide Biopsy Culture Scratch

Oil slide

A patient is experiencing changes in the structure and color of the fingernails. Which diagnostic test should the nurse expect to be prescribed for this patient? Potassium hydroxide (KOH) Culture Biopsy Tzanck smear

Potassium hydroxide (KOH)

Which skin condition should the nurse suspect is occurring in this patient? Shingles (herpes zoster) Psoriasis Melanoma Herpes simplex 1

Shingles (herpes zoster)

The nurse is concerned that a patient's skin lesion with an irregular border could become malignant. Which lesion did the nurse assess in the patient? Nevi Keloid Skin tag Angioma

Nevi

An older patient receives teaching on ways to maintain the status of the skin. Which patient statement indicates that teaching was effective? -"I need to apply sunscreen before going out of doors." -"My skin is thicker now so I do not need to be concerned about exposure to irritants." -"Skin tears and pressure ulcers are not likely to occur because of my age." -"The bags under my eyes are caused by not drinking enough water."

"I need to apply sunscreen before going out of doors."

A patient recently diagnosed with cellulitis asks the nurse for clarification about what it is. Which statement by the nurse provides an accurate description of cellulitis? -"It is an acute bacterial infection of the dermis and underlying connective tissue." -"It is a bacterial infection that reflects a systemic response to an injury." -"Cellulitis usually occurs on the torso or arms." -"A diagnosis of cellulitis is made when regional lymph node involvement occurs."

"It is an acute bacterial infection of the dermis and underlying connective tissue."

A patient asks why a punch biopsy is required for a skin problem. Which response should the nurse make? -"It is used to differentiate a benign lesion from a cancerous one." -"It will remove the entire lesion." -"It determines the reason for your skin infection." -"It will identify the reason for your skin infestation."

"It is used to differentiate a benign lesion from a cancerous one."

The nurse is caring for an older patient who has with right-sided paralysis and a deep sacral wound. The unlicensed assistive personnel (UAP) asks the nurse why it is important to reposition the patient every 2 hours. Which is the best response by the nurse? -"Repositioning every 2 hours will relieve the pressure and prevent further tissue damage." -"Since the patient cannot turn due to the stroke, it will help make them more comfortable." -"Repositioning improves lung function and increases oxygen-carrying capacity in the blood, which promotes wound healing." -"Frequent repositioning helps reduce the risk of aspiration pneumonia."

"Repositioning every 2 hours will relieve the pressure and prevent further tissue damage."

A patient is having a scratch test. Which teaching should the nurse provide about this test? -"Return in 48 hours to have the scratch areas evaluated." -"Wash the scratched areas with antimicrobial soap." -"Apply topical corticosteroid cream to the scratched areas twice a day." -"Rinse the scratched areas with warm water every 4 hours."

"Return in 48 hours to have the scratch areas evaluated."

A patient asks for actions to prevent the development of skin cancer. Which response should the nurse make? -"Stay out of the sun between the hours of 10 am and 3 pm." -"Wear shorts and a cotton shirt when out of doors." -"Use a sunscreen with a protective factor of 8 when out of doors." -"Apply sunscreen in the amount of a pencil eraser to both legs."

"Stay out of the sun between the hours of 10 am and 3 pm."

A patient uses a tanning bed instead of sitting in the sun to get a sun tan in the summer. Which response should the nurse make to this patient? -"Tanning beds emit ultraviolet rays that damage the deep skin layers." -"Tanning beds are safer than spending time in the sun." -"There is no difference between spending time in the sun or using a tanning bed." -"A tan from the sun is more natural that one from a tanning bed."

"Tanning beds emit ultraviolet rays that damage the deep skin layers."

The nurse is preparing a patient with malignant melanoma for radiation therapy. Which patient statement reflects a correct understanding of the radiation therapy? -"The success of radiation depends on the site, thickness, and type of melanoma." -"Radiation can be used on all areas of the body." -"Radiation cannot be used to alleviate symptoms resulting from metastasis." -"Radiation is not an appropriate treatment for the metastasis found in my lymph nodes."

"The success of radiation depends on the site, thickness, and type of melanoma."

A patient with a skin lesion is prescribed an immunofluorescent study. Which teaching should the nurse provide the patient before collecting a sample for the test? -"There is nothing that you need to do." -"Please wash the area with antimicrobial soap." -"Apply a corticosteroid cream to the area after the sample is obtained." -"Wrap the area with sterile gauze for several days after the sample is obtained."

"There is nothing that you need to do."

The nurse is preparing a patient for a surgical excision of a malignant melanoma lesion that was diagnosed very early. Which statement by the patient indicates an understanding of the procedure? -"This early intervention will remove the lesion and hopefully prevent my cancer from spreading." -"Immunotherapy will be combined with surgery." -"Steroid medications will prevent the cancer from spreading." -"Phototherapy will be my next best option."

"This early intervention will remove the lesion and hopefully prevent my cancer from spreading."

A patient with basal cell carcinoma asks if the health problem is serious. Which response should the nurse make to this patient? -"This type of skin cancer is very slow-growing and rarely spreads, but can be serious if not treated." -"This type of skin cancer can spread easily to other parts of the body and aggressive treatment should begin immediately." -"This is a slow-growing cancer but unfortunately, there is no known treatment at this time." -"This type of skin cancer will resolve on its own, so no need to treat."

"This type of skin cancer is very slow-growing and rarely spreads, but can be serious if not treated."

The nurse plans to assess a patient diagnosed with paronychia caused by Candida. Which part of the body should the nurse assess? Cuticle of nails Oral cavity Diaper area Glans and prepuce of the penis

Cuticle of nails

The nurse caring for an older patient who is becoming increasing immobile teaches the family caregiver how about preventing pressure injuries. Which statement from the family members should indicate to the nurse that teaching was effective? -"We will monitor the diet to ensure adequate daily intake of proteins and calories." -"We will help the patient to move at least every 4 hours." -"We will use an alcohol-based sanitizer to clean the skin after incidences of incontinence." -"We will massage the bony prominences daily."

"We will monitor the diet to ensure adequate daily intake of proteins and calories."

The nurse is discussing the prevention of cellulitis with a patient who has diabetes mellitus and recently experienced cellulitis of the lower leg while gardening. Which information should the nurse include to help the patient prevent another episode of cellulitis? -"Wear pads on your knees when you are gardening to help prevent an injury." -"Monitor for inflammation and redness around any wounds you may have, and report such signs immediately." -"Make sure to drink plenty of fluids each day and maintain a balanced diet." -"Check your blood sugar routinely and administer insulin as ordered to keep your blood sugar in the normal range."

"Wear pads on your knees when you are gardening to help prevent an injury."

A patient reports constant brittle and split nails. Which question should the nurse ask during the focused assessment? -"What type of foods do you routinely consume?" -"Are your hands frequently in water?" -"Do you keep your nails painted?" -"Have you ever been told that you are anemic?

"What type of foods do you routinely consume?"

A patient is experiencing a rash of painful vesicles over the left thorax. What question should the nurse include when completing this patient's health history? -"Have you ever been diagnosed with acne?" -"Are you a regular patron of tanning salons?" -"Do you remember being sunburned as a child?" -"Did you have chickenpox when you were young?"

-"Did you have chickenpox when you were young?"

The nurse is assessing a patient who is complaining of severe itching. Which questions about the itching should the nurse ask the patient during the interview? (Select all that apply.) -"Tell me how this itch feels." -"Have you used a new soap?" -"Why do you keep scratching it?" -"When did you first notice the itch?" -"Have you ever had itching like this before now?"

-"Have you used a new soap?" -"When did you first notice the itch?" -"Have you ever had itching like this before now?"

A patient is devastated after being diagnosed with body lice. What should the nurse remember about body lice to reassure this patient? -"Lice are a form of fungus." -"Only dirty people have lice." -"Lice do not like to live on humans." -"Lice are associated with crowded living conditions."

-"Lice are associated with crowded living conditions."

The nurse is teaching a patient with generalized psoriasis about ultraviolet light therapy (UVB). What should be included in this teaching? (Select all that apply.) -"When combined with hot baths, UVB is very effective." -"Treatments with UVB have to be given in the hospital to be safe." -"UVB slows the growth of epidermal cells and decreases keratosis." -"The exact effect of UVB is unknown, but it decreases severe itching." -"You will wear eye shields during the treatment."

-"UVB slows the growth of epidermal cells and decreases keratosis." -"You will wear eye shields during the treatment."

A patient is being assessed for a melanoma skin lesion. Which assessment finding suggests that further investigation for a melanoma is necessary? -Change in the color or size of a nevus -Dry, fissured, and hyperkeratotic skin -Red circumscribed plaques covered by silvery white scales -Firm mass located in the subcutaneous tissue and the lower dermis

-Change in the color or size of a nevus

The nurse is preparing to assess a patient with a dark skin color. Which should the nurse keep in mind while completing this assessment? -It may be difficult to assess for anemia. -Strong, direct lighting is essential to assess color. -Skin color is the easiest finding to assess. -Only assess pigmented areas of the skin.

-It may be difficult to assess for anemia.

When caring for a patient recovering from a stroke, the nurse coordinates a group of caregivers to help lift the patient up in bed. Why should the patient be lifted instead of pulled into position? -Pulling a patient up in bed is hard on the patient's joints. -Lifting a patient prevents tissue injury from shearing forces. -Pulling a patient up in bed decreases tissue hypoxia. -Lifting a patient allows a brief period of increased capillary circulation.

-Lifting a patient prevents tissue injury from shearing forces.

The nurse notices multiple flat pinpoint red dots with tiny radiating blood vessels on the patient's skin. The lesions blanch with pressure. The nurse would conduct further assessment for which conditions? (Select all that apply.) Liver disease Poor hygiene Impaired immune system Vitamin B deficiency High sodium diet

-Liver disease -Vitamin B deficiency

An older patient has severe xerosis. What topic should the nurse include in a teaching plan for this patient? (Select all that apply.) -Take a hot bath every day. -Maintain a warm environment. -Apply skin lotions after a bath. -Use fabric softeners when laundering clothing. -Add bath oils at the end of the bath.

-Maintain a warm environment. -Apply skin lotions after a bath.

The nurse notes that the ends of a patient's fingers are enlarged. Which should the nurse do to further assess the fingers? -Inspect for ridges in the nails -Palpate for a dent in the fingers -Measure the length of the nail bed -Measure the angle of the nail base

-Measure the angle of the nail base

The nurse notes that the ends of a patient's fingers are enlarged. Which should the nurse do to further assess the fingers? -Measure the angle of the nail base -Measure the length of the nail bed -Palpate for a dent in the fingers -Inspect for ridges in the nails

-Measure the angle of the nail base

The school nurse suspects an outbreak of head lice among children in a first grade classroom. The nurse would assess these children for the presence of which finding? -Pustules behind the ears -Greasy scaling -Oval objects on the hair shafts -White flakes throughout the hair

-Oval objects on the hair shafts

The nurse is caring for multiple patients with mobility issues. Which patient should the nurse identify that is most at risk for a pressure injury? -A 96-year-old female who is dependent on staff to move into and out of a wheelchair -A 54-year-old male who experienced a stroke 6 months ago with residual left-sided weakness -A 32-year-old female admitted with a fractured pelvis -An 86-year-old male admitted to the step down unit recovering from pneumonia

A 96-year-old female who is dependent on staff to move into and out of a wheelchair

The nurse caring for a patient with a wound on the lower leg. Which symptom should the nurse consider as a distinctive manifestation in assessing for the presence of cellulitis? Inflammation Elevated white blood count Numbness Tingling

Inflammation

When assessing a lesion diagnosed as basal cell carcinoma, the nurse most likely expects to note which findings? Select all that apply. 1. An irregularly shaped lesion 2. A small papule with a dry, rough scale 3. A firm, nodular lesion topped with crust 4. A pearly papule with a central crater and a waxy border 5. Location in the bald spot atop the head that is exposed to outdoor sunlight

4. A pearly papule with a central crater and a waxy border 5. Location in the bald spot atop the head that is exposed to outdoor sunlight

A client arriving at the emergency department has experienced frostbite to the right hand. Which finding would the nurse note on assessment of the client's hand? 1. A pink, edematous hand 2. Fiery red skin with edema in the nailbeds 3. Black fingertips surrounded by an erythematous rash 4. A white color to the skin, which is insensitive to touch

4. A white color to the skin, which is insensitive to touch

The nurse is conducting a session about the principles of first aid and is discussing the interventions for a snakebite to an extremity. The nurse should inform those attending the session that the first-priority intervention in the event of this occurrence is which action? 1. Immobilize the affected extremity. 2. Remove jewelry and constricting clothing from the victim. 3. Place the extremity in a position so that it is below the level of the heart. 4. Move the victim to a safe area away from the snake and encourage the victim to rest.

4. Move the victim to a safe area away from the snake and encourage the victim to rest.

The staff nurse reviews the nursing documentation in a client's chart and notes that the wound care nurse has documented that the client has a stage II pressure injury in the sacral area. Which finding would the nurse expect to note on assessment of the client's sacral area? 1. Intact skin 2. Full-thickness skin loss 3. Exposed bone, tendon, or muscle 4. Partial-thickness skin loss of the dermis

4. Partial-thickness skin loss of the dermis

The clinic nurse assesses the skin of a client with psoriasis after the client has used a new topical treatment for 2 months. The nurse identifies which characteristics as improvement in the manifestations of psoriasis? Select all that apply. 1. Presence of striae 2. Palpable radial pulses 3. Absence of any ecchymosis on the extremities 4. Thinner and decrease in number of reddish papules 5. Scarce amount of silvery-white scaly patches on the arms

4. Thinner and decrease in number of reddish papules 5. Scarce amount of silvery-white scaly patches on the arms

The nurse is reviewing medical records for assigned patients. Which patient should the nurse identify as being at the greatest risk for developing a pressure injury? -A patient who is unable to transfer into and out of a wheelchair without assistance -A patient who experienced a stroke 6 months ago and has residual left-sided weakness -A patient recovering from cardiac surgery in the intensive care unit -A patient admitted to the step down unit recovering from pneumonia

A patient who is unable to transfer into and out of a wheelchair without assistance

The nurse is preparing a teaching session for a group of community members on the dangers of skin cancer. Which skin lesion should the nurse emphasize as increasing the risk of developing skin cancer? Folliculitis Pressure ulcer Lice infestation Actinic keratosis

Actinic keratosis

The nurse is preparing a teaching tool on various skin problems. Which statement should the nurse include that accurately describes psoriasis? -An inflammatory skin disease that is immune-mediated -The same virus that causes chickenpox -A bacterial infection that enters through open wounds -A topical allergic reaction to an environmental factor

An inflammatory skin disease that is immune-mediated

The nurse is preparing to assess a patient's skin. Which technique should the nurse use to check for elasticity? -Pinch a fold of skin -Press on the skin -Feel the skin using the back of the hand -Observe the skin in sunlight

Pinch a fold of skin

It is documented in the medical record that a middle-aged male patient has a hair pattern associated with a genetic predisposition. Which should the nurse expect when assessing this patient? -Balding over the middle of the scalp -Completely bald -Patches of hair loss -Hair loss over the base of the skull and upper neck

Balding over the middle of the scalp

A fair-skinned patient is diagnosed with a slow-growing skin cancer and is considered the most common type . Which type of skin cancer should the nurse prepare teaching for this patient? Basal cell Actinic keratosis Melanoma Lipoma

Basal cell

It is documented in the medical record that a patient has liver spots on both hands. Which should the nurse expect to assess in this patient? -Brown or black benign macules with a defined border -Soft brown or flesh-colored benign papules -Horney growths of keratinocytes -Small, dark blue slightly raised benign papules

Brown or black benign macules with a defined border

The nurse is assessing a patient with heart disease. For which reason should the nurse assess the patient for edema? Check for fluid accumulation Assess for dehydration Check for pressure injuries Assess capillary refill

Check for fluid accumulation

The nurse measures the angle of the nail base in a patient with chronic lung disease. Which assessment finding should the nurse anticipate? Clubbing Cyanosis Spoon nails Paronychia

Clubbing

A patient has a patch of scales on the left forearm. Which health problem should the nurse suspect this patient is experiencing? Psoriasis Seborrheic keratosis Folliculitis Herpes simplex

Psoriasis

A young adult with acne scars asks the nurse what can be done to reduce the scarring. Which procedure should the nurse discuss with this patient? Skin flap Liposuction Dermabrasion Blepharoplasty

Dermabrasion

The nurse is providing discharge instructions for a patient newly diagnosed with malignant melanoma skin cancer. Which instruction should be included in the teaching related to self-care? -Encouraging open communication with the healthcare team to address emotions associated with the diagnosis -Cleansing the affected area thoroughly -Continuing the same skin care regimen as prior to admission -Encouraging the patient to write down any questions/concerns and bring them to the next appointment

Encouraging open communication with the healthcare team to address emotions associated with the diagnosis

A patient's oral body temperature is elevated by 3 degrees. What other assessment finding would be consistent with this body temperature? Pallor Jaundice Cyanosis Erythema

Erythema

The nurse is preparing teaching material on self-examination of the skin. Which should the nurse include? -Examine the skin on the same day every month -Look at the skin while showering or bathing -Focus on areas that are exposed to the sun -Examine the torso first

Examine the skin on the same day every month

A patient asks the nurse if receiving the shingles vaccine is necessary. Which factor should the nurse identify as being the greatest risk for this patient to develop shingles? Exposure to varicella virus Hypertension Diabetes Exposure to known carcinogens

Exposure to varicella virus

A patient has contact dermatitis. Which action should the nurse know is essential in determining treatment? -Finding and avoiding the cause -Trying herbal remedies such as witch hazel cream and St. John's wort -Going to the emergency department for systemic corticosteroids -Obtaining a patch test to reduce the eruption

Finding and avoiding the cause

The nurse is preparing to assess a patient's integumentary status. Which technique will the nurse use first? Palpation Inspection Percussion Auscultation

Inspection

A nurse is admitting a patient who is paraplegic with a wound on the coccyx. Based on the health history, the nurse should determine that which factor had the greatest impact on wound development? -Inability to reposition frequently -Lack of bowel and bladder control -Low-carbohydrate diet -Wrinkled linens

Inability to reposition frequently

The nurse assesses rough thickened areas on a patient with chronic dermatitis. What term should the nurse use to document this assessment finding? Ulcers Papules Atrophy Lichenification

Lichenification

The nurse is performing a physical examination of a patient's skin. Which skin condition should the suspect reflected in the image? Psoriasis Melanoma Shingles Warts

Psoriasis

An older patient has brown spots on both hands. In which way should the nurse document this finding? Liver spots Skin tags Keratoses Venous lake

Liver spots

The nurse notes a small lesion on a patient's scalp. Which step should the nurse take next? Look for asymmetry Ask if it itches Attempt to scratch it off Photograph the lesion

Look for asymmetry

During an assessment the nurse notes different areas of skin color over the back and chest of a patient who spends time in the sun. What is responsible for this change in skin color? Sebum Melanin Carotene Red blood cells

Melanin

The nurse is providing teaching to the family caregiver of an older patient who has become increasingly immobile at home. Which instruction should the nurse provide to reduce the patient's risk of developing a pressure injury? -Monitor the diet to ensure adequate intake of proteins and calories. -Help the patient to move at least every 4 hours. -Use an alcohol-based sanitizer to clean the skin after incidences of incontinence. -Massage the bony prominences daily.

Monitor the diet to ensure adequate intake of proteins and calories.

The nurse inspects the nails of a patient. Which should the nurse document if the nails are considered normal? -Nail surfaces smooth, and nail folds firm, without redness -Transverse rippling of the nails -Scattered nail grooves present -Nails thin, spoon-shaped

Nail surfaces smooth, and nail folds firm, without redness

A patient reports constant red and painful cuticles from frequent hand washing. Which should the nurse suspect is the reason for the patient's symptom? Paronychia Vitamin deficiency Smoking Overexposure to sunlight

Paronychia

A patient has a skin change on a small area of the upper arm. Which diagnostic test should the nurse anticipate will be prescribed for this patient? Punch biopsy Incisional biopsy Culture Oil slide

Punch biopsy

The nurse is planning care for an older patient. For which reason should the nurse remind the client to use sunscreen before going out of doors? -Reduced number of melanocytes -Increased permeability of the epidermis -Flattened dermal-epidermal junction -Redistribution of adipose tissue

Reduced number of melanocytes

While teaching a skin cancer prevention class, which instruction should the nurse include in the presentation? -Refrain from using tanning equipment. -Use sunscreen with an SPF of 10. -Use sunscreen with mineral oil. -Wear short-sleeved shirts.

Refrain from using tanning equipment.

A patient with type 1 diabetes mellitus has a blister on the left heel caused by ill-fitting shoes. Which stage should the nurse document this injury to be? Stage 2 Stage 1 Stage 3 Stage 4

Stage 2

In the Clark system of microstaging, the vertical growth of a lesion is measured from the epidermis to which area to determine the level of invasion? Subcutaneous tissue Dermis Epithelial tissue Muscle layer

Subcutaneous tissue

A melanoma is identified early on a patient's shoulder. Which is the appropriate initial intervention for this skin problem? Surgical excision Immunotherapy Topical corticosteroids Phototherapy

Surgical excision

A patient with basal cell carcinoma asks which is the most effective, long-term treatment for the condition. Which response should the nurse make to the patient? Surgical excision of the lesion Topical corticosteroids Systemic antibiotics Antiviral medications

Surgical excision of the lesion

A patient has a skin wound that has purulent drainage. Which action should the nurse take when obtaining a culture from this wound? -Use a sterile culture swab and culture tube -Follow clean technique -Apply a gauze pad to the exudate and send for culture -Use a cotton swab to absorb the exudate and send for culture

Use a sterile culture swab and culture tube

A patient presents with an open leg wound and cellulitis. The nurse receives an order for a culture and sensitivity of the drainage from the wound. Which statement reflects the nurse's correct understanding of what this test will indicate? -Which antibiotic will be most effective. -How much pain to expect. -Whether another surgery is needed. -If any special dressing needs to be used.

Which antibiotic will be most effective.

Following a burn involving several layers of a patient's skin, the healed burn area does not grow hair or sweat. When teaching the patient, which layer of the skin should the nurse explain as being the deepest layer burned? Dermis Epidermis Stratum basale Stratum spinosum

dermis

A patient reports having an allergy to sulfonamides. Which sunscreen should the nurse remind the patient to avoid? p-Aminobenzoic acid (PABA) Benzophenones Anthranilates Salicylates

p-Aminobenzoic acid (PABA)