Skin Disorders Adaptive Quizzing (Evolve)

Which cosmetic procedure is teratogenic? 1 Use of tretinoin 2 Use of chemical peels 3 Use of α-hydroxy acids 4 Use of microdermabrasion

1 Use of tretinoin Tretinoin is a teratogenic drug that can cause congenital abnormalities and should not be used during pregnancy. Chemical peels cause redness and photosensitivity. α-hydroxy acids cause photosensitivity, slight irritation, and severe redness. Microdermabrasion causes photosensitivity of the skin.

Which patient would be more likely to have the highest risk of developing malignant melanoma? 1 A fair-skinned woman who uses a tanning booth regularly 2 An African American patient with a family history of cancer 3 An adult who required phototherapy as an infant for the treatment of hyperbilirubinemia 4 A Hispanic male with a history of psoriasis and eczema who responded poorly to treatment

1 A fair-skinned woman who uses a tanning booth regularly Risk factors for malignant melanoma include a fair complexion and exposure to ultraviolet light. Psoriasis, eczema, short-duration phototherapy, and a family history of other cancers are less likely to be linked to malignant melanoma.

In a patient admitted with cellulitis of the left foot, which clinical manifestation would the nurse expect to find on assessment of the left foot? 1 Erythema and swelling 2 Pallor and poor turgor 3 Cyanosis and coolness 4 Edema and brown skin discoloration

1 Erythema and swelling Cellulitis is a diffuse, acute inflammation of the skin. It is characterized by erythematous, swelling, heat, and tenderness in the affected area. These changes accompany the processes of inflammation and infection.

A nurse is assessing a woman who has nodulocystic acne. While administering isotretinoin, which interventions are necessary to ensure patient safety? Select all that apply. 1 Conduct a pregnancy test. 2 Conduct a liver function test. 3 Conduct a cholesterol level test. 4 Perform a hemoglobin level test. 5 Determine if the patient has a history of depression.

1 Conduct a pregnancy test. 2 Conduct a liver function test. 3 Conduct a cholesterol level test. 5 Determine if the patient has a history of depression. Isotretinoin is used for the treatment of nodulocystic acne. A pregnancy test should be done before administering isotretinoin, because the drug is contraindicated in pregnancy. Isotretinoin can cause serious damage to the fetus. A liver function test is used to check abnormalities in liver function. The cholesterol level is checked because this drug increases blood cholesterol. A liver function test is used to check for abnormalities in liver function. If the patient has a history of depression, use of isotretinoin is prohibited. Hemoglobin levels are unrelated to administration of isotretinoin.

A patient has a growth on the bottom of one foot, which is growing inward, is painful when pressure is applied, and has interrupted skin markings. Which treatments may the patient receive? Select all that apply. 1 Cryosurgery 2 White petroleum 3 Silver sulfadiazine 4 Topical immunotherapy 5 Blunt dissection with scissors

1 Cryosurgery 4 Topical immunotherapy The patient has a plantar wart with interrupted markings that has grown inward because of the pressure exerted by walking or standing; it is painful when pressure is applied. Treatment for plantar warts consists of topical immunotherapy, cryosurgery, and the use of salicylic acid. White petroleum is applied as a symptomatic treatment to lesions caused by herpes simplex virus. Silver sulfadiazine is applied as a symptomatic treatment to ruptured vesicles caused by herpes zoster. Blunt dissection with scissors or curette is performed as a treatment for verruca vulgaris.

The patient is in the hospital for a surgical procedure and has dry skin and pruritus on the legs that cause the patient to scratch at the skin uncontrollably. What measures can the nurse use to help stop the itch/scratch cycle? Select all that apply. 1 Moisturize the skin on the legs. 2 Provide a warm blanket and room. 3 Administer antihistamines at bedtime. 4 Use careful hand washing after rubbing her legs. 5 Cleanse the legs with a saline solution twice daily.

1 Moisturize the skin on the legs. 3 Administer antihistamines at bedtime. Moisturizing the skin to decrease the dryness and the itch sensation and bedtime antihistamines to decrease a potential allergic reaction and provide some sedation will help the patient sleep, because pruritus is often worse at night and the patient needs sleep for healing. Using nonallergic sheets also may help. Anything causing vasodilation, such as warmth or rubbing, should be avoided. Saline solution would only further dry the skin and so would not be used on the patient's legs.

Which white blood cell count is the best indicator that a 54-year-old patient with cellulitis has recovered from the infection? 1 2000/mm3 2 5000/mm3 3 13,000/mm3 4 16,500/mm3

2 5000/mm3 The normal white blood cell count is 4000 to 11,000 cells/mm3, according to most laboratory reference books. For this reason, the patient's level would have been deemed normal if it was 5000/mm3. A white blood cell count of 2000/mm3 is categorized as leukopenia and is abnormal. White blood cell counts of 13,000 or 16,500 mm3 would indicate continued infection.

Which therapy uses subfreezing temperatures to destroy epidermal lesions? 1 Excision 2 Cryosurgery 3 Punch biopsy 4 Electrodesiccation

2 Cryosurgery Cryosurgery uses subfreezing temperatures to remove epidermal lesions. Excision is the removal of the tissue and is considered if the lesion to be removed involves the dermis. A punch biopsy is a dermatologic procedure used to obtain tissue samples for histologic study or to remove small lesions. Electrodesiccation involves the use of heat to destroy superficial tissue.

When a patient has psoriasis, which sign would a nurse expect to find? 1 Pustules in skinfolds 2 Itchy, scaly patches on scalp 3 Macular rash on the trunk area 4 Vesicular rash on the extremities

2 Itchy, scaly patches on scalp Psoriasis is a noncontagious autoimmune disease. It usually presents as itchy scales on the scalp, knees, or elbows, the result of an overproduction of skin cells. Other commonly affected areas are the joints, fingernails, and toenails. Psoriasis does not present as pustules, as a macular rash, or as a vesicular rash.

A nurse is assessing a patient diagnosed with malignant melanoma. The nurse understands that the prognosis of the cancer can be assessed by using the Breslow's measurement. How is the prognosis related to Breslow's measurement? 1 The larger the tumor, the worse the prognosis 2 The deeper the tumor, the worse the prognosis 3 The darker the tumor, the worse the prognosis 4 The greater number of tumors, the worse the prognosis

2 The deeper the tumor, the worse the prognosis Tumor thickness is an important prognostic factor for melanoma. The Breslow's measurement is used to assess the depth of the tumor in millimeters. The deeper the tumor, the worse will be the prognosis of melanoma. Size of the tumor, color of the tumor, and an increase in the number of tumors are not determined using the Breslow's measurement.

A patient is being treated for scaly skin lesions. The results of a potassium hydroxide (KOH) test that was performed using the scrapings of the lesions are positive. How should the nurse interpret the result? 1 The patient has scabies. 2 The patient has a fungal infection. 3 The patient has contact dermatitis. 4 The patient has basal cell carcinoma.

2 The patient has a fungal infection. A potassium hydroxide (KOH) test involves microscopic examination of scrapings of scaly skin lesions in a 10% to 20% KOH solution. A positive KOH test indicates that the patient has a fungal infection of the skin. A basal cell carcinoma is confirmed through a biopsy examination. Contact dermatitis is confirmed through a patch test. Presence of scabies is confirmed through a mineral oil test.

A nurse is teaching a patient about self-examination of skin lesions. The skin should be examined for which characteristics? Select all that apply. 1 Depth of the lesion 2 Asymmetry of the lesion 3 Temperature of the lesion 4 Irregularity of the borders of the lesion 5 A change or evolution in appearance of the lesion

2 Asymmetry of the lesion 4 Irregularity of the borders of the lesion 5 A change or evolution in appearance of the lesion Self-examination of skin lesions is done by the ABCDE rule: A, Asymmetry; B, Border irregularity, C, Color change; D, Diameter of 6 mm or more; and E, Evolving in appearance. Depth and temperature of the lesion may be difficult to determine in a self-examination, and these characteristics are not included in the ABCDE rule.

Which nursing intervention would be most effective in improving the comfort of a patient with herpes zoster? 1 Direct sunlight 2 Dry heating pad 3 Cool, wet dressing 4 Warm, moist compress

3 Cool, wet dressing Application of a cool, wet dressing followed by an analgesic is usually effective in relieving discomforts related to herpes zoster (shingles). The application of any form of warmth may increase the sensitivity of nerve endings and worsen the pain.

The nurse assesses a vesiculopustular lesion with a thick, honey-colored crust surrounded by erythema on the left side of a patient's arm. The patient states that he or she had a few bumps in the area that the patient had been scratching. What complication has the patient developed from this condition? 1 Cellulitis 2 Furuncle 3 Impetigo 4 Folliculitis

3 Impetigo Impetigo is marked by vesiculopustular lesions that develop a thick, honey-colored crust surrounded by erythema. They are most common on the face as a primary infection. Cellulitis manifests clinically as a hot, tender, erythematous, edematous area with a diffuse border. Furuncle is marked by a tender erythematous area around a hair follicle. Small pustules at the hair follicle opening with minimal erythema and development of crusting are indicative of folliculitis.

Which fungal infection manifests on the surface of a patient's skin with an erythematous and typical annular scaly appearance and well-defined margins? 1 Tinea pedis 2 Tinea cruris 3 Tinea corporis 4 Tinea unguium

3 Tinea corporis Tinea corporis is commonly referred to as ringworm. Tinea corporis infection has an erythematous, annular (ringlike) scaly appearance with well-defined margins. A tinea pedis fungal infection is characterized by scaly plantar surfaces that are pruritic and blistering in nature. Tinea cruris infection does not affect mucous membranes, and it is associated with well-defined scaly plaque on the patient's groin area. A patient with tinea unguium infection has brittle, thickened, and broken nails with yellowish discoloration.

When teaching sun safety guidelines, what instructions should the nurse include when teaching about sunscreen lotion and creams? Select all that apply. 1 Sunscreens are not required in cloudy weather. 2 Sunscreens should be reapplied after six hours. 3 Sunscreens should be reapplied immediately after swimming. 4 Sunscreens should have a minimum sun protection factor (SPF) of 15. 5 Sunscreens should be applied 20 to 30 minutes before going outdoors.

3 Sunscreens should be reapplied immediately after swimming. 4 Sunscreens should have a minimum sun protection factor (SPF) of 15. 5 Sunscreens should be applied 20 to 30 minutes before going outdoors. Sunscreens are creams and lotions that filter both ultraviolet A and ultraviolet B rays and can prevent dermatologic problems. When choosing a sunscreen, the patient should consider one with SPF 15. A patient with a family or personal history of melanoma should be advised to use a sunscreen with SPF 30. Sunscreen should be applied on the skin 20 to 30 minutes before going outdoors. Though many sunscreens are waterproof, they should be reapplied immediately after swimming in case the sunscreen is diluted in the water or rubbed off. Sunscreen should be applied even in cloudy weather, because the ultraviolet rays can penetrate clouds. Because the effect of a sunscreen decreases with time, it should be reapplied every two hours.

The nurse is teaching safety to a patient who has been prescribed phototherapy. Which statements by the patient indicate that teaching has been effective? 1 "I can be exposed to the sun any time except during sunrise." 2 "I can be exposed to ultraviolet bulbs at home but cannot go outside." 3 "I can remove my protective eyewear if the glass windows are closed." 4 "I must wear protective eyewear that blocks 100 percent of the ultraviolet light when going out."

4 "I must wear protective eyewear that blocks 100 percent of the ultraviolet light when going out." The patient is undergoing phototherapy, which means that the patient is taking psoralen, a photosensitizing drug. Therefore the patient should wear any protective eyewear that blocks 100 percent of ultraviolet light when going outside, to prevent the sun's ultraviolet rays from affecting the eyes. Any exposure to the sun during the day may affect the patient's skin. The patient should not be exposed to ultraviolet radiation at home. The patient must wear protective eyewear even if the glass windows are closed because ultraviolet light can penetrate glass.

A patient shows the nurse how the skin around an abdominal dressing is red and states that it itches. The nurse identifies an area of red papules with occasional papules that matches the area that had been taped around the dressing. The nurse suspects that the patient has which skin condition? 1 Urticaria 2 Tinea corporis 3 Atopic dermatitis 4 Allergic contact dermatitis

4 Allergic contact dermatitis Allergic contact dermatitis is a manifestation of delayed hypersensitivity characterized by red papules and plaques, and also is circumscribed sharply with occasional vesicles. It is usually pruritic. The area of dermatitis frequently takes the shape of the causative agent. Urticaria is spontaneously occurring, with raised or irregularly shaped wheals, varying size, and usually multiple in number. Tinea corporis is a fungal infection of the skin also known as ringworm.

A patient informs the nurse that he or she has tingling and burning on the lower lip. The nurse assesses redness and a group of vesicles on the lower lip. Which infection should the nurse educate the patient? 1 Impetigo 2 Candidiasis 3 Herpes zoster 4 Herpes simplex virus

4 Herpes simplex virus Infection caused by herpes simplex virus is characterized by single or grouped vesicles on an erythematous base with a painful local reaction. Impetigo is a bacterial infection characterized by vesiculopustular lesions that develop a thick, honey-colored crust surrounded by erythema. Candidiasis is a fungal infection of the skin characterized by cheesy white plaques in the mouth and diffuse papular erythematous rash with pinpoint satellite lesions around the edges of the affected area. Herpes zoster, which is also called shingles, is characterized by linear distribution of vesicles along a dermatome. It is usually unilateral.

The nurse is caring for a patient in whom chickenpox is suspected. The patient has pustules and redness only on the left side of the face. Which skin condition may the patient have? 1 Furuncle 2 Candidiasis 3 Verruca vulgaris 4 Herpes zoster (shingles)

4 Herpes zoster (shingles) The patient may have herpes zoster (shingles), marked clinically by a linear distribution of vesicles or pustules along a dermatome on an erythematous base. The lesions resemble those of chickenpox. Herpes zoster appears unilaterally on the trunk, face, and lumbosacral areas. Furuncle is a bacterial infection characterized by a tender erythematous area around a hair follicle; it is most common on the face, back of the neck, axillae, breasts, and buttocks. Candidiasis is characterized by a diffuse papular erythematous rash with pinpoint satellite lesions around the edges of affected area. Patients with verruca vulgaris have circumscribed, hypertrophic, flesh-colored papules that are painful when compressed laterally.

During the assessment of a patient, the nurse notes an area of irregularly round verrucous papules with well-defined shapes. The patient states that they have become darker over the past few months and are often itchy and irritating. The nurse recognizes this finding as what? 1 Lentigo 2 Psoriasis 3 Acne vulgaris 4 Seborrheic keratosis

4 Seborrheic keratosis Clinical manifestations of seborrheic keratosis include irregularly round or oval, often verrucous papules or plaques with well-defined shape and the appearance of being stuck on. The lesions increase in pigmentation with time and are usually multiple and possibly itchy Clinical manifestations of lentigo include hyperpigmented, brown to black macule or patch (flat lesion) over sun-exposed areas. Clinical manifestations of psoriasis include sharply demarcated silvery scaling plaques on reddish colored skin commonly on the scalp, elbows, knees, palms, soles, and fingernails. Acne vulgaris is manifested by noninflammatory lesions, including open comedones (blackheads) and closed comedones (whiteheads), and inflammatory lesions, including papules and pustules.