Skin Cancer

Which skin cancer mostly occurs at the site of moles and birthmarks? A.) Melanoma B.) Actinic keratosis C.) Basal cell carcinoma D.) Squamous cell carcinoma

ANS: A Melanoma may occur anywhere in the body and is especially evident at the site of birthmarks and moles. Actinic keratosis may be distributed on the cheeks, temples, forehead, ears, neck, backs of hands, and forearms. Basal cell carcinoma occurs on sun-exposed areas, especially head, neck, and central portion of the face. Squamous cell carcinoma occurs on sun-exposed areas.

The nurse is teaching a client about decreasing the risk for melanomas and other skin cancers. Which primary prevention technique is most important for the nurse to include? A.) Avoiding or reducing skin exposure to sunlight B.) Avoiding tanning beds C.) Being aware of skin markings and performing skin self-examination D.) Wearing SPF 40 sunscreen

ANS: A Avoiding or reducing one's exposure to the sun is the most important prevention technique. This includes avoiding direct sunlight, using sunscreen, and wearing protective clothing (including hats). It is more important to teach about avoiding sunlight because one can be exposed to sunlight daily.Avoiding tanning beds is significant, but is not the most important technique. Assessing the skin is a secondary prevention. Wearing sunscreen is essential, but reducing overall exposure to the sun is more important.

While assessing a patient, the nurse finds irregularly shaped, pigmented papule and variegated colors, with red tones on the upper back. Which condition does the nurse suspect in this patient? A. Melanoma B. Actinic keratosis C. Basal cell carcinoma D. Squamous cell carcinoma

ANS: A Melanoma may be manifested by irregular shaped, pigmented papule and variegated colors with red tones distributed on the upper back. Actinic keratosis includes small papules with dry, rough, adherent yellow or brown scales. Basal cell carcinoma includes pearly papules with a central crater and rolled waxy borders. Squamous cell carcinoma is characterized by the firm nodular lesion topped with a crust and a central area of ulceration.

8. A nurse assesses a client who has open lesions. Which action should the nurse take first? a. Put on gloves. b. Ask the client about his or her occupation. c. Assess the client's pain. d. Obtain vital signs.

ANS: A Nurses should wear gloves as part of Standard Precautions when examining skin that is not intact. The other options should be completed after gloves are put on

5. A nurse assesses a client who has two skin lesions on his chest. Each lesion is the size of a nickel, flat, and darker in color than the client's skin. How should the nurse document these lesions? a. Two 2-cm hyperpigmented patches b. Two 1-inch erythematous plaques c. Two 2-mm pigmented papules d. Two 1-inch moles

ANS: A Patches are larger flat areas of the skin. The information provided does not indicate a mole or the presence of erythema.

In teaching a client about primary prevention of skin cancer, which instruction does the nurse include? A.) "Avoid sun exposure between 11 a.m. and 3 p.m." B.) "Examine your skin quarterly for possible cancerous or precancerous lesions." C.) "Keep a total body spot and lesion map." D.) "If you feel you must tan, use a tanning bed."

ANS: A The nurse teaches the client that the sun's rays are strongest between 11 a.m. and 3 p.m. and can cause more damage during this time.Skin should be examined at least monthly. A total body spot and lesion map is used for secondary prevention. The rays in tanning beds are just as harmful to skin as the sun's rays and should be avoided.

21. A nurse assesses a client who has a lesion on the skin that is suspicious for skin cancer, as shown below: There's no picture lol Which diagnostic test should the nurse anticipate being ordered for this client? a. Punch skin biopsy b. Viral cultures c. Wood's lamp examination d. Diascopy

ANS: A This lesion is suspicious for skin cancer and a biopsy is needed. A viral culture would not be appropriate. A Wood's lamp examination is used to determine if skin lesions have characteristic color changes. Diascopy eliminates erythema, making skin lesions easier to examine.

3. A nurse teaches a client to perform total skin self-examinations on a monthly basis. Which statements should the nurse include in this client's teaching? (Select all that apply.) a. "Look for asymmetry of shape and irregular borders." b. "Assess for color variation within each lesion." c. "Examine the distribution of lesions over a section of the body." d. "Monitor for edema or swelling of tissues." e. "Focus your assessment on skin areas that itch."

ANS: A, B Clients should be taught to examine each lesion following the ABCDE features associated with skin cancer: asymmetry of shape, border irregularity, color variation within one lesion, diameter greater than 6 mm, and evolving or changing in any feature.

2. A nurse plans care for a client who has a wound that is not healing. Which focused assessments should the nurse complete to develop the client's plan of care? (Select all that apply.) a. Height b. Allergies c. Alcohol use d. Prealbumin laboratory results e. Liver enzyme laboratory results

ANS: A,C,D ANS: A, C, DNutritional status can have a significant impact on skin health and wound healing. The care plan for a client with poor nutritional status should include a high-protein, high-calorie diet. To determine the client's nutritional status, the nurse should assess height and weight, alcohol use, and prealbumin laboratory results. These data will provide information related to vitamin and protein deficiencies, and obesity. Allergies and liver enzyme laboratory results will not provide information about nutrition status or wound healing.

11. During skin inspection of a client, a nurse observes lesions with wavy borders that are widespread across the client's chest. Which descriptors should the nurse use to document these observations? a. Clustered and annular b. Linear and circinate c. Diffuse and serpiginous d. Coalesced and circumscribed

ANS: B "Diffuse" is used to describe lesions that are widespread. "Serpiginous" describes lesions with wavy borders. "Clustered" describes lesions grouped together. "Linear" describes lesions occurring in a straight line. Annular lesions are ringlike with raised borders, circinate lesions are circular, and circumscribed lesions have well-defined sharp borders. "Coalesced" describes lesions that merge with one another and appear confluent.

What is the appropriate nursing response when a client asks, "What is a punch biopsy?" A. "The health care provider will use a scalpel to remove a portion of the skin." B. "A circular cutting instrument will be used to remove a small plug of tissue." C. "A deep specimen of skin will be taken, and then the health care provider will suture this area closed." D. "A local anesthetic will be injected before a razor blade is moved parallel to the skin's surface to obtain a sample."

ANS: B A punch biopsy involves the use of a circular cutting instrument to remove a small plug of tissue. Other answers reflect shave or excisional biopsies.

During the follow-up visit, a patient reports the spontaneous disappearance and reappearance of small maculae with dry, yellow adherent scales on the skin. Which type of skin cancer does the nurse suspect in this patient? a. Melanoma b, Actinic keratosis c. Basal cell carcinoma d. Squamous cell carcinoma

ANS: B Actinic keratosis is characterized by small papule with dry, rough, adherent yellow or brown scales having an erythematous base. It may disappear spontaneously and reappear after the treatment. Melanoma involves the rapid invasion with metastasis of the pigmented papule and variegated colors with red tones. Basal cell carcinoma includes pearly papules with a central crater and rolled waxy borders on the sun exposed areas. Squamous cell carcinoma involves firm nodular lesions topped with a crust with a central area of ulceration.

What is the dosage frequency of adalimumab? A.) Infusions at 0, 2, and 6 weeks, then every 8 weeks B.) Loading dose followed by maintenance dose every other week C.) Twice weekly for 3 months followed by once-a-week injections D.) Once a week for 12 weeks followed by a 12-week drug-free interval

ANS: B Adalimumab is administered through the subcutaneous route with the loading dose followed by a maintaining dose every other week that is started 1 week after the loading dose. IV infusions of infliximab are administered at 0, 2, and 6 weeks and then every 8 weeks. Etanercept is administered through the subcutaneous route twice weekly for 3 months, followed by once-a-week injections. Alefacept is administered through the intramuscular route once a week for 12 weeks followed by a 12-week drug-free interval.

Which type of skin disorder is seen in the patient? Pic is the old guy with a giant growth on his face topped with crusting. A.)Psoriasis vulgaris B.) Squamous cell carcinoma C.) Stevens-Johnson syndrome D.) Toxic epidermal necrolysis (TEN

ANS: B Squamous cell carcinoma represents firm, nodular lesion topped with a crust or central area of ulceration and indurated margins. The underlying tissue with deep invasion is fixated. Psoriasis vulgaris may include thick, reddened papules or plaques covered by silvery white scales, which are not evident from the figure. Stevens-Johnson syndrome may be manifested by skin lesions widely distributed over the body. It has a mix of vesicles, erosions, and crusts. TEN may result in diffuse erythema and large blister formation.

1. While performing skin assessment on an elderly client, the nurse observes an isolated brownish-purple lesion with irregular borders on the anterior chest wall. The lesion feels slightly raised on palpation and crusted blood is visible at the lower edge. Which is the appropriate nursing intervention? a. Wash the lesion gently with warm water to remove the crusts and teach not to pick it. b. Document lesion's location, size, and characteristics and request a dermatology consult. c. Reassure that the lesion is a common occurrence with aging, especially in sun-exposed areas. d. Ask the client about exposure to new lotions or perfumes that could cause an allergic reaction.

ANS: B The lesion characteristics are consistent with the ABCDE melanoma assessment acronym; the nurse should document the lesion's location, size, and characteristics, and request a dermatology cons

14. A nurse performs a skin screening for a client who has numerous skin lesions. Which lesion does the nurse evaluate first? a. Beige freckles on the backs of both hands b. Irregular blue mole with white specks on the lower leg c. Large cluster of pustules in the right axilla d. Thick, reddened papules covered by white scales

ANS: B This mole fits two of the criteria for being cancerous or precancerous: variation of color within one lesion, and an indistinct or irregular border. Melanoma is an invasive malignant disease with the potential for a fatal outcome. Freckles are a benign condition. Pustules could mean an infection, but it is more important to take care of the potentially cancerous lesion first. Psoriasis vulgaris manifests as thick reddened papules covered by white scales. This is a chronic disorder and is not the priority.

Which surgical technique helps to remove full-thickness skin in the area of a lesion? A.) Cryosurgery B.) Wide excision C.) Mohs' surgery D.) Excisional biopsy

ANS: B Wide excision is used to remove full-thickness skin in the area of a lesion. Cryosurgery is used to treat isolated lesions, causing cell death and destruction. Mohs' surgery is a specialized form of excision that is usually preferred for squamous cell carcinomas. Excisional biopsy refers to total surgical removal of the small lesions for pathological examination.

3. A nurse prepares to admit a client who has herpes zoster. Which actions should the nurse take? (Select all that apply.) a. Prepare a room for reverse isolation. b. Assess staff for a history of or vaccination for chickenpox. c. Check the admission orders for analgesia. d. Choose a roommate who also is immune suppressed. e. Ensure that gloves are available in the room.

ANS: B, C, E Herpes zoster (shingles) is caused by reactivation of the same virus, varicella zoster, in clients who have previously had chickenpox. Anyone who has not had the disease or has not been vaccinated for it is at high risk for getting chickenpox. Herpes zoster is very painful and requires analgesia. Use of gloves and good handwashing are sufficient to prevent spread. It is best to put this client in a private room. Herpes zoster is a disease of immune suppression, so no one who is immune-suppressed should be in the same room.

The nurse is teaching a patient about decreasing the risk for melanomas and other skin cancers. Which primary prevention technique is most important for the nurse to include? A.) Avoiding tanning beds B.) Wearing SPF 40 sunscreen C.) Avoiding or reducing skin exposure to sunlight D.) Being aware of skin markings and performing skin self-examination

ANS: C Avoiding or reducing one's exposure to the sun is the most important prevention technique. This includes avoiding direct sunlight, using sunscreen, and wearing protective clothing (including hats). Avoiding tanning beds is significant but is not the most important technique. It is more important to teach about avoiding sunlight because one can be exposed to sunlight daily. Assessing the skin is a secondary prevention. Wearing sunscreen is essential, but reducing overall exposure to the sun is more important.

7. A nurse cares for an older adult client who has a chronic skin disorder. The client states, "I have not been to church in several weeks because of the discoloration of my skin." How should the nurse respond? a. "I will consult the chaplain to provide you with spiritual support." b. "You do not need to go to church; God is everywhere." c. "Tell me more about your concerns related to your skin." d. "Religious people are nonjudgmental and will accept you."

ANS: C Clients with chronic skin disorders often become socially isolated related to the fear of rejection by others. Nurses should assess how the client's skin changes are affecting the client's body image and encourage the client to express his or her feelings about a change in appearance. The other responses are not appropriate.

16. A nurse assesses a young female client who is prescribed isotretinoin (Accutane). Which question should the nurse ask prior to starting this therapy? a. "Do you spend a great deal of time in the sun?" b. "Have you or any family members ever had skin cancer?" c. "Which method of contraception are you using?" d. "Do you drink alcoholic beverages?"

ANS: C Isotretinoin has many side effects. It is a known teratogen and can cause severe birth defects. A pregnancy test is required before therapy is initiated, and strict birth control measures must be used during therapy. Sun exposure, alcohol ingestion, and family history of cancer are contraindications for isotretinoin.

A patient is diagnosed with squamous cell carcinoma. Which surgical technique would be effective in treating this condition? A. Cryosurgery B. Wide excision C. Mohs' surgery D. Curettage and electrodissection

ANS: C Mohs' surgery is a specialized form of excision, which is usually preferred for squamous cell carcinomas. Cryosurgery is used to treat isolated lesions. Wide excision is used to remove full-thickness skin in the area of the lesion. A curettage and electrodissection procedure scrapes away cancerous tissue and helps to destroy the remaining tumor tissue by applying an electric probe.

A patient has had a melanoma lesion removed. For secondary prevention, what is important for the nurse to teach the patient? a.) Avoid sun exposure. b.) Perform a total skin self-examination monthly. c.) Perform a total skin self-examination monthly with a partner. d.) Ensure that all lesions are reviewed by a dermatologist or a surgeon.

ANS: C Performing a monthly total skin self-examination with another person is the best secondary preventive measure. If the patient is taught to use the ABCDE ( asymmetry, border, color, diameter, and evolving) method of lesion assessment, the patient will know whether a lesion warrants assessment by a specialist. Avoiding sun exposure is primary prevention. It is difficult for a person to assess all of the skin surfaces of his or her body by him- or herself, even with the use of mirrors. It is better to involve a partner with the assessment.

1. The nurse is performing an assessment on a female client and notices a large, irregularly-shaped mole on her upper back. The client expresses concern about the cosmetic appearance of the lesion. What is the priority nursing intervention? a. Refer to a dermatological health care provider. b. Ask if there are any other lesions that bother her. c. Perform a head-to-toe skin assessment and document the findings. d. Teach about the importance of avoiding excessive sun exposure and tanning beds.

ANS: C The nurse should perform a head-to-toe skin assessment (scalp, skin folds, nails, etc.) to identify any other suspicious lesions. All other actions can then be taken.

Which drug-induced skin reaction is characterized by vesicles, erosions, and crusts? A.) Psoriasis B.) Basal cell carcinoma C.) Toxic epidermal necrolysis D.) Stevens-Johnson syndrome

ANS: D Stevens-Johnson syndrome is a drug-induced skin reaction, typically characterized by vesicles, erosions, and crusts. In psoriasis, the lesions are scaled with underlying dermal inflammation. Basal cell carcinoma appears as papule with central crater and rolled waxy borders. Toxic epidermal necrolysis is associated with diffused erythema and large blisters.

A client has had a melanoma lesion removed. For secondary prevention, what is most important for the nurse to teach the client? A.) Ensure that all lesions are reviewed by a dermatologist B.) Avoid sun exposure. C.) Have any new lesions genetically tested D.) Perform a total skin self-examination monthly with a partner.

ANS: D The nurse teaches the client that performing a monthly total skin self-examination with another person is the best secondary preventive measure.If the client is taught to use the ABCDE (asymmetry, border, color, diameter, and evolving) method of lesion assessment, the client will know whether a lesion warrants assessment by a specialist. Avoiding sun exposure is primary prevention. Genetic testing of lesions is performed to determine whether targeted therapy will be effective.

Which medication is most effective for the treatment of multiple actinic keratosis? A.) Systemic therapy of cisplatin B.) Topical therapy of vismodegib C.) Systemic therapy of cetuximab D.) Topical therapy of 5-fluorouracil

ANS: D Topical therapy with 5-fluorouracil is used in the treatment of multiple actinic keratosis. Systemic therapy of cisplatin and cetuximab are used to treat advanced or metastatic squamous cell carcinoma. Topical therapy of vismodegib is used to treat advanced or metastatic basal cell skin cancer.

1. A nurse assesses an older adult's skin. Which findings require immediate referral? (Select all that apply.) a. Excessive moisture under axilla b. Increased hair thinning c. Increased presence of fungal toenails d. Lesion with various colors e. Spider veins on legs f. Asymmetric 6-mm dark lesion on forehead

ANS: D,F ANS: D, FThe lesion with various colors, as well as the asymmetric 6-mm dark lesion, fits two of the American Cancer Society's hallmark signs for cancer according to the ABCD method. Other manifestations are variants of normal seen in various age groups.

Skin that has been injured previously is at greatest risk for cancer development, otherwise known as ______________________

ANS: Koebner's Phenomenon