Med Surg - Chapter 22 & 23
Cotton-tipped applicators
The nurse prepares to obtain a culture from a patient who has a possible fungal infection on the foot. Which items should the nurse gather for this procedure?
The patient recently had an intrauterine device removed.
The nurse working in the dermatology clinic assesses a young adult female patient who is taking isotretinoin (Accutane) to treat severe cystic acne. Which assessment finding is most indicative of a need for further questioning of the patient?
38-year old with a 7-mm nevus on the face that has recently become darker
There is one opening in the schedule at the dermatology clinic, and 4 patients are seeking appointments today. Which patient will the nurse schedule for the available opening?
Wash hands and properly dispose of soiled dressings.
What is the best method to prevent the spread of infection when the nurse is changing the dressing over a wound infected with Staphylococcus aureus?
Consult with the health care provider about the need for further diagnostic testing.
When assessing a new patient at the outpatient clinic, the nurse notes dry, scaly skin; thin hair; and thick, brittle nails. What is the nurses best action?
Talk with the patient alone and ask about what caused the bruising.
When examining an older patient in the home, the home health nurse notices irregular patterns of bruising at different stages of healing on the patients body. Which action should the nurse take first?
Assess the patient for evidence of liver disease.
When performing a skin assessment, the nurse notes several angiomas on the chest of an older patient. Which action should the nurse take next?
D, E
When taking the health history of an older adult, the nurse discovers that the patient has worked in the landscaping business for 40 years. The nurse will plan to teach the patient about how to self-assess for which clinical manifestations (select all that apply)? a. Vitiligo b. Alopecia c. Intertrigo d. Erythema e. Actinic keratosis
Petechiae present on the chest and abdomen
Which abnormality on the skin of an older patient is the priority to discuss immediately with the health care provider?
Cleaning the skin with antimicrobial soap.
The nurse is caring for a patient diagnosed with furunculosis. Which nursing action could the nurse delegate to unlicensed assistive personnel (UAP)?
The patient uses Neosporin ointment on minor cuts or abrasions.
The nurse is interviewing a patient with contact dermatitis. Which finding indicates a need for patient teaching?
Symmetric
During assessment of the patients skin, the nurse observes a similar pattern of small, raised lesions on the left and right upper back areas. Which term should the nurse use to document these lesions?
Minimizing sun exposure will reduce risk for future BCC.
A nurse develops a teaching plan for a patient diagnosed with basal cell carcinoma (BCC). Which information should the nurse include in the teaching plan?
Method of birth control used by the patient
A 38-year-old female patient states that she is using topical fluorouracil to treat actinic keratoses on her face. Which additional assessment information will be most important for the nurse to obtain?
Check the lips and oral mucous membranes.
A dark-skinned patient has been admitted to the hospital with chronic heart failure. How would the nurse best assess this patient for cyanosis?
A, B, E
A nurse is teaching a patient with contact dermatitis of the arms and legs about ways to decrease pruritus. Which information should the nurse include in the teaching plan (select all that apply)? a. Cool, wet cloths or dressings can be used to reduce itching. b. Take cool or tepid baths several times daily to decrease itching. c. Add oil to your bath water to aid in moisturizing the affected skin. d. Rub yourself dry with a towel after bathing to prevent skin maceration. e. Use of an over-the-counter (OTC) antihistamine can reduce scratching.
The patient uses a tanning booth throughout the winter.
A patient has the following risk factors for melanoma. Which risk factor should the nurse assign as the priority focus of patient teaching?
Prepare the patient for a biopsy.
A patient in the dermatology clinic has a thin, scaly erythematous plaque on the right cheek. Which action should the nurse take?
Incisional biopsy
A patient in the dermatology clinic is scheduled for removal of a 15-mm multicolored and irregular mole from the upper back. The nurse should prepare the patient for which type of biopsy?
Have the patient use protective eyewear while receiving PUVA.
A patient is undergoing psoralen plus ultraviolet A light (PUVA) therapy for treatment of psoriasis. What action should the nurse take to prevent adverse effects from this procedure?
Thickening of the skin around the ankles
A patient reports chronic itching of the ankles and continuously scratches the area. Which assessment finding will the nurse expect?
Ask the patient to describe the impact of psoriasis on quality of life.
A patient who has severe refractory psoriasis on the face, neck, and extremities is socially withdrawn because of the appearance of the lesions. Which action should the nurse take first?
Surgical excision
A patient with an enlarging, irregular mole that is 7 mm in diameter is scheduled for outpatient treatment. The nurse should plan to prepare the patient for which procedure?
If the medication burns when I apply it, I will wipe it off and call the doctor.
A patient with atopic dermatitis has a new prescription for pimecrolimus (Elidel). After teaching the patient about the medication, which statement by the patient indicates that further teaching is needed?
Thinning of the affected skin
A patient with atopic dermatitis has been using a high-potency topical corticosteroid ointment for several weeks. The nurse should assess for which adverse effect?
Papular, wheal-like lesions with white deposits on the hair shaft
A teenaged male patient who wrestles in high school is examined by the nurse in the clinic. Which assessment finding would prompt the nurse to teach the patient about the importance of not sharing headgear to prevent the spread of pediculosis?
Teach about the use of cold packs to reduce bruising and swelling.
An older adult patient with a squamous cell carcinoma (SCC) on the lower arm has a Mohs procedure in the dermatology clinic. Which nursing action will be included in the postoperative plan of care?
The patient applies a thick layer of the cream to the affected skin.
The nurse instructs a patient about application of corticosteroid cream to an area of contact dermatitis on the right leg. Which patient action indicates that further teaching is needed?
Ask the patient about type 2 diabetes or if there is a family history of it.
The nurse notes darker skin pigmentation in the skinfolds of a middle-aged patient who has a body mass index of 40 kg/m2 . What is the nurses best action?
Are you taking any medications at present?
The nurse notes the presence of white lesions that resemble milk curds in the back of a patients throat. Which question by the nurse is appropriate at this time?
Clean the infected areas with soap and water.
The health care provider diagnoses impetigo in a patient who has crusty vesicopustular lesions on the lower face. Which instructions should the nurse include in the teaching plan?
Your cheek area will be painful and develop eroded areas that will take weeks to heal.
The health care provider prescribes topical 5-FU for a patient with actinic keratosis on the left cheek. The nurse should include which statement in the patients instructions?
Press firmly on the lesion.
The nurse assesses a circular, flat, reddened lesion about 5 cm in diameter on a middle-aged patients ankle. How should the nurse determine if the lesion is related to intradermal bleeding?
The skin around the incision is pale and cold when palpated.
The nurse assesses a patient who has just arrived in the postanesthesia recovery area (PACU) after a blepharoplasty. Which assessment data should be reported to the surgeon immediately?
A, C
Which activities can the nurse working in the outpatient clinic delegate to a licensed practical/vocational nurse (LPN/LVN) (select all that apply)? a. Administer patch testing to a patient with allergic dermatitis. b. Interview a new patient about chronic health problems and allergies. c. Apply a sterile dressing after the health care provider excises a mole. d. Teach a patient about site care after a punch biopsy of an upper arm lesion. e. Explain potassium hydroxide testing to a patient with a superficial skin infection.
Use a sunscreen with a high SPF when exposed to the sun.
Which information should the nurse include when teaching a patient who has just received a prescription for ciprofloxacin (Cipro) to treat a urinary tract infection?
Try to stay out of the sun between the hours of 10 AM and 2 PM (regular time).
Which information should the nurse include when teaching patients about decreasing the risk for sun damage to the skin?
Use warm water and a moisturizing soap when bathing.
Which information will the nurse include when teaching an older patient about skin care?
Reports a history of allergic rashes
Which integumentary assessment data from an older patient admitted with bacterial pneumonia is of most concern for the nurse?
