Integumentary System Level 1 questions

A client is admitted with extensive bone and soft-tissue injuries to the leg. Sterile dressings are applied. Two days later, when removing the dressings, the nurse finds that one of the dressings has adhered to tissue in several places. Which action should the nurse take to loosen the dressing? a. Apply diluted hydrogen peroxide. b. Pull with gentle but steady traction. c. Soak the area in a solution of Betadine. d. Moisten the dressing with sterile saline.

d. Moisten the dressing with sterile saline. Sterile saline will soften the dried exudates adhered to the dressing, limiting tissue damage when the dressing is removed. The use of hydrogen peroxide can be irritating to the tissues. Pulling off the dressing with steady traction may be painful and cause unnecessary tissue damage. The use of Betadine to remove a dressing is not recommended.

A nurse is assessing the integumentary system of four clients. Which client has the least chance of a false-positive result while undergoing assessment of capillary refill time? A. Client with shock B. Client with anemia C. Client with epilepsy D. Client with peripheral vascular disease

C. Client with epilepsy Rational: A client with epilepsy does not have any circulatory inadequacy. Therefore the capillary refill time of this client, as assessed in the nails, is a reliable indicator (i.e., does not reveal a false-positive result). A client with shock has decreased oxygen saturation levels that further prolong the capillary refill time. Capillary refill time is not a reliable indicator of blood circulation for clients with anemia, peripheral vascular disease, or diabetes.

A client with a parotid tumor and enlarged lymph nodes in the neck is undergoing radiation therapy on an outpatient basis. Which condition will the nurse most closely assess the client for during the return visit to the radiology department? A. Ataxia B. Hypoxia C. Arthralgia D. Dysphagia

D. Dysphagia RATIONAL:The proximity of the parotid gland to the esophagus necessitates assessment of swallowing, because dysphagia may be a result of damage to surrounding tissue. Ataxia, an impairment in muscle coordination, is not a typical side effect of radiation therapy to the neck region. Hypoxia, an oxygen deficiency in body tissues, should not occur, because the lungs are not being radiated. Arthralgia, pain in a joint, is not a side effect of radiation therapy for this client.

Which benign condition of the client's skin is associated with the grouping of normal cells derived from melanocyte-like precursor cells? A. Nevi B. Psoriasis C. Acne vulgaris D. Plantar warts

A. Nevi

Which gastrointestinal (GI) change may be found in the client with burn injuries? A. Abdominal distention B. Increased peristalsis C.Activation of GI motility D. Increased blood flow to the GI area

A. Abdominal distention RATIONAL: The client with burn injuries may have abdominal distention due to loss of peristalsis. Gastrointestinal motility may be inhibited with burn injuries. Blood flow may be reduced and mucosal damage might have occurred

Which drug can cause chemical burns? A. Anthralin B. Prednisone C. Tazarotene D. Calcipotriene

A. Anthralin Anthralin is a strong irritant that has an action similar to tar. So this drug can cause chemical burns with topical use. Prednisone is a corticosteroid applied topically to treat psoriasis. Tazarotene and calcipotriene are teratogenic (cause birth defects).

A client is admitted to the hospital for the medical management of burns over 18% of the body's surface. What should the nurse teach the client to help manage pain during dressing changes? A. Deep breathing exercises B. Progressive muscle relaxation C. Active range-of-motion exercises D. Important elements of wound care

A. Deep breathing exercises RATIONAL: Deep breathing exercises are an effective intervention in controlling pain; this is a positive coping skill. Muscle relaxation techniques generally include muscle contraction and then relaxation, which may increase the pain. Active range-of-motion exercises may increase the pain. Understanding important aspects of wound care will not reduce pain; health teaching should be initiated before, not during, a procedure.

Which condition is an example of a bacterial infection? A. Impetigo B. Candidiasis C. Plantar warts D. Verucca vulgaris

A. Impetigo Impetigo is the bacterial infection of skin caused by group A β-hemolytic streptococci or Staphylococcus aureus. Candidiasis is the fungal infection caused by Candida albicans. Plantar warts and verucca vulgaris are viral infections caused by the human papilloma virus.

Which does the nurse understand related to negative pressure wound therapy? Select all that apply. A. Using a suction pump B. Treating necrotizing infections C.Administering oxygen under high pressure D. Application of a low-voltage current to a wound area E. Reducing chronic ulcers by removing fluids from the wound

A. Using a suction pump E. Reducing chronic ulcers by removing fluids from the wound rational: In negative pressure wound therapy, a suction pump is used to treat the wounds. This therapy can reduce chronic ulcers by removing fluids from the wound. Necrotizing infections are treated by hyperbaric oxygen therapy. Hyperbaric oxygen therapy is the administration of oxygen under high pressure. Electrical stimulation is the application of a low-voltage current to a wound area.

In preparation for discharge, a client who had a total hip replacement is taught wound care by the nurse. Which statement from the client indicates a correct understanding of the nurse's instructions? A. "I will sit in a chair for several hours every day." B. "I will inspect the incision for healing when I change the dressing." C. "I will check to see whether the staples have dissolved within a few days." D."I will call the health care clinic if I see any clear drainage coming from the incision."

B. "I will inspect the incision for healing when I change the dressing." RATIONAL: At each dressing change, the incision should be assessed for approximation of the edges, extent of healing, and signs of infection. Sitting should last for 45 minutes or less to prevent hip stiffness, hip flexion contracture, and prosthetic dislocation. Staples do not dissolve; they are removed by a primary healthcare provider. Serous drainage may persist until healing of the incision is complete.

What could be the possible cause of a scald injury? A. Contact with grease B. Contact with hot liquids or steam C. Contact with alkali in oven cleaners D.Contact with open flame in house fires

B. Contact with hot liquids or steam RATIONAL: Scalding injuries usually result from contact with hot liquids or steam. Contact with grease and the alkali in oven cleaners may cause chemical injuries. An open flame in house fires may cause thermal injuries.

A client has a diagnosis of partial-thickness burns. While planning care, the nurse recalls that the client's burn is different than full-thickness burns. Which information did the nurse recall? A. Partial-thickness burns require grafting before they can heal. B. Partial-thickness burns are often painful, reddened, and have blisters. C. Partial-thickness burns cause destruction of both the epidermis and dermis. D. Partial-thickness burns often take months of extensive treatment before healing.

B. Partial-thickness burns are often painful, reddened, and have blisters. RATIONAL: Pain is from the loss of the protective covering of the nerve endings; blisters and redness occur because of the injury to the dermis and epidermis. Because some epithelial cells remain, grafting is not needed with a partial-thickness burn unless it becomes infected and further tissue damage occurs. Partial-thickness burns involve only the epidermis and only part of the dermis. Recovery from partial-thickness burns with no infection occurs in 2 to 6 weeks.

The nurse is caring for two clients. The first client had a below-the-knee amputation as a result of an accident. The second client had a below-the-knee amputation because of chronic decreased arterial perfusion. The nurse anticipates that the postoperative courses of these two clients may differ. Which information caused the nurse to come to this conclusion? A. The first client probably will adjust more quickly. B. The second client's incision will take longer to heal. C. The clients have different occupations . D. The first client is more likely to have phantom limb sensations.

B. The second client's incision will take longer to heal. Decreased arterial circulation will delay healing. Clients having an amputation without preoperative preparation for their loss have greater difficulty adapting. Clients with chronic limb pain before surgery are more likely to have phantom limb sensations. Both clients' responses may be influenced by their occupations, but there are no data to draw this conclusion.

A client who is receiving combination chemotherapy for stage II Hodgkin disease is at risk for stomatitis. Which information should the nurse include in the teaching plan? A ."Rinse the mouth three times a day with lemon juice and water." B. "Brush the teeth once daily and use dental floss after each meal." C."Clean the mouth with a soft toothbrush or a gentle spray." D."Gently clean the mouth with commercial mouthwash."

C. "Clean the mouth with a soft toothbrush or a gentle spray." RATIONAL: Chemotherapy destroys the rapidly dividing cells of the oral mucosa; frequent gentle oral hygiene limits additional trauma. Although it is recommended to rinse the mouth every 2 hours, the client does not need to brush teeth and clean the mouth as often. Lemon juice is too caustic to the compromised mucosa. Flossing can disrupt and traumatize the gum surfaces; oral hygiene is needed more than once a day. Commercial mouthwashes contain alcohol, which is irritating to the mucosa.

While palpating the skin of a client, the nurse observes pitting edema on the dorsum of the foot. What could be the reason for this condition? A. Endocrine imbalance B. Excessive collagen production C. Fluid and electrolyte imbalance D. Autonomic nervous system stimulation

C. Fluid and electrolyte imbalance Rational : Fluid and electrolyte imbalance results in pitting edema of the skin. An endocrine imbalance may result in non-pitting edema. Excessive collagen production leads to increased skin thickness. Stimulation of the autonomic nervous system may result in an increase in skin moisture.

Which complication may be caused by sepsis in burns? A. Diarrhea B. Constipation C. Paralytic ileus D. Curling's ulcer

C. Paralytic ileus Rational: Paralytic ileus, or hypoactive bowel, is a complication caused by sepsis in clients with burns. Diarrhea can be caused by the use of enteral feedings or antibiotics. Constipation can occur as a side effect of opioid analgesics, decreased mobility, and a low-fiber diet. Curling's ulcer is a type of gastroduodenal ulcer characterized by diffuse superficial lesions. It is caused by a generalized stress response to decreased blood flow to the gastrointestinal tract in clients with burns.

A 23-year-old client has white hair. Which change in the hair is responsible for this condition? A. Decreased oils B. Decreased density C. Decreased estrogen levels D. Decreased melanocytes

D. Decreased melanocytes RATIONAL: White hair is caused by a decrease in melanin and melanocytes. Dry, coarse hair is due to a decrease in oils. Thinning and loss of hair are due to decreased hair density. Facial hirsutism is due to decreased levels of estrogens.

Which infection is caused due to fungus? A. Furuncle B. Folliculitis C. Herpes zoster D. Dermatophytosis

D. Dermatophytosis Dermatophytosis is a fungal infection in which single or multiple patches appear on the skin. Furuncle is a bacterial infection in which small, tender, erythematous nodules filled with pus appear on the skin. Folliculitis is a bacterial infection in which erythematous pustules appear singly or in groups on the skin. Herpes zoster is a viral infection in which lesions are present on an erythematous base.

Which skin color in a client indicates an increased urochrome level? A. Red B. Blue C. Reddish blue D. Yellow-orange

D. Yellow-orange rational: A yellow-orange skin color indicates an increased urochrome level. A red-colored face, cheeks, nose, and upper chest indicate increased blood flow to the skin. A bluish color of the nail beds indicates an increase in deoxygenated blood in the body. A reddish-blue color of the distal extremities indicates decreased peripheral circulation.

A client with the diagnosis of breast cancer is scheduled to receive radiation therapy to the affected area. The nurse teaches the client about how to care for the area that will be irradiated. Which client statement indicates the nurse needs to follow up? a. "I will leave the skin markings intact." b. "I will protect the skin from sources of heat." c. "I will wear soft clothing over the upper body." d. "I will use an oatmeal-based lotion after each treatment."

d. "I will use an oatmeal-based lotion after each treatment." rational: While undergoing radiation therapy, lotions, powders, and ointments should not be applied to the area. The skin markings should not be removed, because they form the parameters for the delivery of radiation. To protect the irradiated skin, sunlight and heat should be avoided. Nonirritating clothing should be worn over the area to prevent trauma to the delicate irradiated skin.

Which type of laser is used in the treatment of vascular and other pigmented lesions? A. Argon B. Gold vapours C. Neodymium D. Carbon dioxide

A. Argon RATIONAL: An argon laser is used in the treatment of vascular and other pigmented lesions. Gold vapors and neodymium are type of lasers used in the treatment of skin disorders. A carbon dioxide laser is also a type of laser used in the treatment of skin disorders; it has numerous applications as a vaporizing and cutting tool for most tissues.

he nurse is caring for a client with burns and reviews the client's laboratory results: blood urea nitrogen (BUN), 30 mg/dL (10.2 mmol/L); creatinine, 2.4 mg/dL (184 mcmol/L); serum potassium, 6.3 mEq/L (6.3 mmol/L); pH, 7.1; Po2, 90 mm Hg; and hemoglobin (Hgb), 7.4 g/dL (74 mmol/L). Which condition does the nurse suspect the client has based upon these findings? A. Azotemia B. Hypokalemia C. Metabolic alkalosis D. Respiratory alkalosis

A. Azotemia Rational: The BUN is greater than the expected value of 10 to 20 mg/dL (3.6 to 7.1 mmol/L). Urea nitrogen is the major nitrogenous end product of protein and amino acid catabolism; azotemia is the accumulation of excessive nitrogenous compounds, such as BUN and creatinine, in the blood. The client has hyperkalemia; the expected value for potassium is 3.5 to 5.5 mEq/L (3.5 to 5.5 mmol/L). Although the client does have a metabolic acid-base imbalance, it is acidosis, not alkalosis, because the pH is less than the expected range of 7.35 to 7.45. The PO2 is within the expected range of 80 to 100 mm Hg, which indicates that the problem is metabolic, not respiratory.

What is an example of third spacing in a burn injury? A. Blister formation B. Edema formation C. Fluid mobilization D. Fluid accumulation

A. Blister formation Blister formation is an example of third spacing in burn injuries. Edema formation and fluid mobilization generally happen in every burn injury. Fluid accumulation is formed in second spacing in a burn injury.

A client with a skin infection reports an itching sensation associated with pain at the site of infection. The assessment finding shows erythematous blisters and interdigital scaling and maceration. What could be the possible condition in the client? A. Tinea pedis B. Tinea curries C. Tinea corporis D. Tinea unguium

A. Tinea pedis rational: Tinea pedis is a fungal infection with an itching sensation associated with pain. It is clinically manifested as interdigital scaling and maceration and a scaly plantar surface, sometimes with erythema and blistering. Tinea cruris is a fungal infection that is clinically manifested with well-defined scaly plaque in the groin area. Tinea corporis is clinically manifested as an erythematous, annular, ring-like scaly appearance with well-defined margins. Tinea unguium or onychomycosis is manifested with scaliness under the distal nail plate.

The nurse is caring for a client 4 days after the client was admitted to the hospital with burns on the trunk and arms. The nurse collaborates with the dietician to develop a dietary plan for the following day. Which plan will the nurse follow? A.High caloric intake, liberal potassium intake, and 3 g protein/kg/day B. High caloric intake, restricted potassium intake, and 1 g protein/kg/day C. Moderate caloric intake, liberal potassium intake, and 3 g protein/kg/day D. Moderate caloric intake, restricted potassium intake, and 1 g protein/kg/day

A.High caloric intake, liberal potassium intake, and 3 g protein/kg/day RATIONAL: A high-calorie diet is needed for the increased metabolic rate associated with burns; the administration of potassium prevents hypokalemia, which can occur after the first 48 to 72 hours when potassium moves from the extracellular compartment into the intracellular compartment; protein promotes tissue repair. High caloric intake, restricted potassium intake, and 1 g protein/kg/day do not meet the body's needs for tissue repair; the protein and potassium are too limited. Moderate caloric intake, liberal potassium intake, and 3 g protein/kg/day do not meet the body's needs for tissue repair; the calories are too limited. Moderate caloric intake, restricted potassium intake, and 1 g protein/kg/day do not meet the body's needs for tissue repair; the calories, potassium, and protein are too limited

Which change in the epidermis causes increased risk of sunburn? A. Decreased cell division B. Decreased melanocyte activity C. Decreased vitamin D production D. Decreased immune system cells

B. Decreased melanocyte activity Decreased melanocyte activity in the epidermis leads to increased risk of sunburn. Decreased cell division causes delayed wound healing. Decreased vitamin D production leads to increased risk for osteomalacia. Decreased immune system cells results in a decreased skin inflammatory response.

Which practice would be suitable in the prevention of a pressure ulcer? A. Positioning a client directly on the trochanter B. Keeping the client's skin directly off plastic surfaces C. Keeping the head of the bed elevated above 30 degrees D.Placing a rubber ring or donut under the client's sacral area

B. Keeping the client's skin directly off plastic surfaces RATIONAL: For the prevention of a pressure ulcer, the client's skin should be kept directly off plastic surfaces. While the client is positioned on his or her side, direct positioning on the trochanter should be avoided. The head of the bed should not be kept elevated above 30 degrees. This is to prevent shearing. A rubber ring or donut under the client's sacral area should be avoided.

A client was admitted with full-thickness burns 2 weeks ago. Since admission, the client has lost an average of 1 lb (0.5 kg) of weight each day. Which action will the nurse most likely take based upon the adjusted dietary plan? A. Provide low-sodium milk. B. Provide high-protein drinks. C. Provide foods that are low in potassium. D. Provide 10% more calories in the form of fats.

B. Provide high-protein drinks. RATIONAL: High-protein drinks have twice the calories per volume of other fluids and provide protein for wound healing. Low-sodium milk does not contain adequate calories to help meet the high metabolic rate associated with burns. Potassium is restricted during the first 48 to 72 hours after a burn injury, not 2 weeks after the injury. Increased calories in the form of protein and carbohydrates, not fats, are needed.

A client reports facial lesions that are surrounded by redness and cause itching. On assessment, the lesions are found to be thick with a honey-colored crust and surrounded by erythema. Which infection is suspected by the primary healthcare provider? A. Shingles B. Impetigo C. Folliculitis D. Verruca vulgaris

B. impetigo rational: Impetigo is a primary bacterial infection most common on the face. This is clinically manifested as vesiculopustular lesions that develop as thick, honey-colored crust surrounded by erythema. Shingles or herpes zoster is a viral infection that usually occurs unilaterally on the trunk, face, and lumbosacral areas. Folliculitis is a bacterial infection seen most commonly on the scalp, beard, and extremities in men. Verruca vulgaris is a viral infection that is clinically manifested as circumscribed, hypertrophic, flesh-colored papule limited to the epidermis.

Which physiologic activity is associated with the "proliferative phase" of normal wound healing? A.White blood cells migrate into the wound B.Epithelial cells grow over the granulation tissue bed C.Scar tissue gradually becomes thinner and pale in colour D.Vasodilation occurs with increased capillary permeability

B.Epithelial cells grow over the granulation tissue bed Rational: During the "proliferative phase" of normal wound healing, the epithelial cells grow over the granulation tissue bed. The white blood cells are migrated into the wound during the inflammatory phase. In the maturation phase, the scar tissues gradually become thinner and pale in color. The vasodilation with the increased capillary permeability may occur during the inflammatory phase.

Which skin infection would cause facial paralysis? A. Candidiasis B.Herpes zoster C. Herpes simplex D. Dermatophytosis

B.Herpes zoster RATIONAL: Facial paralysis is the clinical sign of Bell's palsy, a complication of the herpes zoster infection. This is seen when the trigeminal nerve is infected by the varicella-zoster virus. Candidiasis is a fungal infection not associated with Bell's palsy. Herpes simplex is a viral infection and may not cause Bell's palsy. Dermatophytosis is also a fungal infection not associated with Bell's palsy.

Which benign condition shows silver scaly plaques on the skin? A. Nevi B. Psoriasis C. Urticaria D.Acne vulgaris

B.Psoriasis RATIONAL: A silver scaly plaque on the skin is due to psoriasis and is most commonly seen on the elbows and scalp. Hyperpigmented areas that vary in form and color are due to nevi. Spontaneously occurring raised or irregular-shaped wheals of varying size are usually due to urticaria. Non-inflammatory lesions, including open comedones and closed comedones, are due to acne vulgaris.

Which condition will the nurse monitor for in a client with interruption of venous return? A.Tenting B.Varicosity C.Petechiae D.Ecchymosis

B.Varicosity RATIONAL: Varicosity is the interruption of venous return that will cause a bulge and prominence of superficial veins. Tenting is the failure of skin to return immediately to normal position after gentle pinching, which occurs because of aging, dehydration, and cachexia. Petechiae are flat, pinpoint (<1 to 2 mm in size), discrete deposits of blood found on the extravascular tissues that result from decreased platelet count in blood. Ecchymosis is a small, bruise-like lesion, larger than a petechia, caused by the collection of extravascular blood in the dermis and subcutaneous tissue that occurs due to trauma and bleeding disorders.

The client reports crumbly, discolored, and thickened toenails. What could be the possible reason for this condition? C. Allergy B. Insect bite C. Fungal infection D. Bacterial infection

C.Fungal infection RATIONAL: Exposure to the pathological fungal varieties may cause infections to the nails along with hair and skin. Dermatological problems associated with allergies and hypersensitivity reactions may include only skin and may not include nails and hair. Insect bites may cause life-threatening allergic reactions due to the venom of the insect. Bacteria may cause scalp infections to hair and skin but do not usually cause nail infections.

A burn victim has waxy white areas interspersed with pink and red areas on the anterior trunk and all of both arms. The nurse calculates the percentage of total body surface area (TBSA). Which percentage will the nurse report? A.20 B. 25 C. 30 D. 36

D. 36 RATIONAL: Using the rule of nines, the percentage of total body surface area burned is 9% for each arm (18% total for both arms) and 18% for the anterior trunk; thus the total body surface area burned is 36%. The choices 20%, 25%, and 30% are too low.

Which technology would the nurse use to reduce chronic ulcers by removing fluids from the wound? A. Electrical stimulation B. Topical growth factors C. Hyperbaric oxygen therapy D. Negative pressure wound therapy

D. Negative pressure wound therapy RATIONAL: Negative pressure wound therapy is a new technology used to reduce chronic ulcers by removing fluids from the wound and enhancing granulation. Electrical stimulation is done by the application of low-voltage current to a wound area to increase blood vessel growth and promote granulation. Topical growth factors are the normal body substances that stimulate cell movement and growth. Hyperbaric oxygen therapy is the administration of oxygen under pressure, raising the tissue oxygen concentration.