142 Integument - PRACTICE QUESTIONS

A nurse in a dermatology clinic is reading the electronic health record of a new client. The nurse notes that the client has a history of a primary skin lesion. What skin lesion may this client have? A. Crust B. Keloid C. Pustule D. Ulcer

A pustule is an example of a primary skin lesion. Primary skin lesions are original lesions arising from previously normal skin. Crusts, keloids and ulcers are secondary lesions.

A nurse is caring for a client who has been diagnosed with psoriasis. The nurse is creating an education plan for the client. What information should be included in this plan? A. Lifelong management is likely needed. B. Avoid public places until symptoms subside. C. Wash skin frequently to prevent infection. D. Liberally apply corticosteroids as needed.

A. Psoriasis usually requires lifelong management. Psoriasis is not contagious. Many clients need reassurance that the condition is not infectious, not a reflection of poor personal hygiene, and not skin cancer. Excessive frequent washing of skin produces more soreness and scaling. Overuse of topical corticosteroids can result in skin atrophy, striae, and medication resistance.

An 80-year-old client is brought to the clinic by one of the client's children. The client asks the nurse why the client has gotten so many spots on the skin. What would be an appropriate response by the nurse? A. As people age, they normally develop uneven pigmentation in their skin. B. These 'spots' are called 'liver spots' or 'age spots.' C. Older skin is more apt to break down and tear, causing sores. D. These are usually the result of nutritional deficits earlier in life.

A. The major changes in the skin of older people include dryness, wrinkling, uneven pigmentation, and various proliferative lesions. Stating the names of these spots and identifying older adults' vulnerability to skin damage do not answer the question. These lesions are not normally a result of nutritional imbalances.

A nurse is assessing a teenage client with acne vulgaris. The client's mother states, I keep telling him that this is what happens when you eat as many french fries as he does. What aspect of the pathophysiology of acne should inform the nurse's response? A. A sudden change in client's diet may exacerbate, rather than alleviate, the client's symptoms. B. French fries are one of the foods that are known to directly cause acne. C. Elimination of fried foods from the client's diet will likely lead to resolution within several months. D. Diet is thought to play a minimal role in the development of acne.

D. Diet is not believed to play a major role in acne therapy. A change in diet is not known to exacerbate symptoms. However, there does appear to be a correlation between foods high in refined sugars and acne; therefore, these foods should be avoided.

A client with a suspected malignant melanoma is referred to the dermatology clinic. The nurse knows to facilitate what diagnostic test to rule out a skin malignancy? A. Tzanck smear B. Skin biopsy C. Patch testing D. Skin scrapings

A skin biopsy is done to rule out malignancies of skin lesions. A Tzanck smear is used to examine cells from blistering skin conditions, such as herpes zoster. Patch testing is performed to identify substances to which the client has developed an allergy. Skin scrapings are done for suspected fungal infections.

Which diagnostic test is used to examine cells from herpes zoster? A. Tzanck smear B. Skin biopsy C. Skin scrapings D. Patch testing

A. A Tzanck smear is a test used to examine cells from blistering skin conditions such as herpes zoster, varicella, herpes simplex, and all forms of pemphigus. Biopsies are performed on skin nodules, plaques, blisters, and other lesions to rule out malignancy and to establish an exact diagnosis. Skin scraping is used to diagnose spores and hyphae. A patch test is used to identify substances to which the client has developed an allergy.

While waiting to see the health care provider, a client shows the nurse skin areas that are flat, nonpalpable, and have had a change of color. The nurse recognizes that the client is demonstrating: A. macules. B. papules. C. vesicles. D. pustules.

A. A macule is a flat, non palpable skin color change, while a papule is an elevated, solid, palpable mass. A vesicle is a circumscribed, elevated, palpable mass containing serous fluid, while a pustule is a pus-filled vesicle.

A client has a boil that is located in the left axillary area and is elevated with a raised border, and filled with pus. How would the nurse document this type of lesion? A. Pustule B. Vesicle C. Cyst D. Macule

A. A pustule has an elevated, raised border, filled with pus. A macule is a flat, round, colored lesion such as a freckle or rash. A vesicle is a lesion that is elevated, round, and filled with serum. A cyst is an encapsulated, round, fluid-filled or solid mass beneath the skin.

The nurse in an ambulatory care center is admitting an older adult client who has bright red moles on the skin. What benign changes in the skin of an older adult appear as bright red moles? A. Cherry angiomas B. Solar lentigines C. Seborrheic keratoses D. Xanthelasmas

A. Cherry angiomas appear as bright red moles, while solar lentigines are commonly called liver spots. Seborrheic keratoses are described as crusty brown stuck on patches, while xanthelasmas appear as yellowish, waxy deposits on the upper eyelids.

The nurse is conducting an admission history and physical examination of a client with a history of contact dermatitis. The nurse assesses whether the client uses which medication classification? A. Corticosteroids B. Antivirals C. Saline irrigations D. Antifungals

A. Corticosteroids are used for contact dermatitis. Antifungals, antivirals, and saline irrigations are not used in the treatment of contact dermatitis.

A nurse is conducting a health interview and is assessing for integumentary conditions that are known to have a genetic component. What assessment question is most appropriate? A. Does anyone in your family have eczema or psoriasis? B. Have any of your family members been diagnosed with malignant melanoma? C. Do you have a family history of vitiligo or port-wine stains? D. Does any member of your family have a history of keloid scarring?

A. Eczema and psoriasis are known to have a genetic component. This is not true of any of the other listed integumentary disorders.

A nurse in the emergency department (ED) is triaging a 5-year-old who has been brought to the ED by the parents for an outbreak of urticaria. What would be the most appropriate question to ask this client's parents? A. Has your child eaten any new foods today? B. Has your child bathed in the past 24 hours? C. Did your child go to a friend's house today? D. Was your child digging in the dirt today?

A. Foods can cause skin reactions, especially in children. In most cases, this is a more plausible cause of urticaria than bathing, contact with other children, or soil-borne pathogens.

A patient's skin is examined and the nurse notes the presence of herpes simplex/zoster skin lesions. The nurse describes the lesions as: A. Pus-filled vesicles; circumscribed and elevated masses >0.5 cm. B. Palpable, solid tumors >3 cm. C. Flat, mole-like lesions. D. Flat macules with irregular borders.

A. Herpes vesicles are circumscribed, elevated, palpable masses containing serous fluid.

A patient visits a clinic for assessment of an inflammatory skin disorder. The nurse diagnoses the condition as psoriasis based on the appearance of the skin. Which of the following describes the dermatoses? A. Red, raised patches of skin covered with silvery scales B. Clear vesicles with a dusky base C. Flat, elongated scales, dark in color D. Clusters of pustules with irregular borders

A. Lesions of psoriasis appear as red, raised patches of skin covered with silvery scales. The other choices describe different types of ringworm infections.

The nurse notes several very small, round, red and purple macules on a patient's skin. The patient has a history of anticoagulant use. The nurse records this finding as which of the following? A. Petechiae B. Cherry angiomas C. Telangiectasias D. Ecchymoses

A. Petechiae are small red or purple macules, usually 1 to 2 mm in size, associated with bleeding tendencies. A patient with a history of anticoagulant use would fall in this category. Ecchymoses are round or irregular macular lesions larger than petechiae. Cherry angiomas are papular, round, red or purple lesions that are normal-age related changes. Telangiectasias are spider-like or linear bluish or red lesions associated with varicosities.

A client is undergoing photochemotherapy involving a combination of a photosensitizing chemical and ultraviolet light. What health problem does this client most likely have? A. psoriasis B. undesired tattoo C. dandruff D. plantar warts

A. Photochemotherapy is used to treat psoriasis.

A client asks the nurse what psoriasis is. What is the best answer? A. It is characterized by patches of redness covered with silvery scales. B. The onset typically occurs in young children. C. A cure is possible with prompt treatment. D. It is a chronic, infectious inflammatory disease.

A. Psoriasis is characterized by patches of erythema covered with silvery scales, usually on the extensor surfaces of the elbows, knees, trunk, and scalp. It is a chronic non-infectious inflammatory disease. Psoriasis has no cure. The onset is in young and middle adulthood.

A 10-year-old child is brought to the office with complaints of severe itching in both hands that's especially annoying at night. On inspection, the nurse notes gray-brown burrows with epidermal curved ridges and follicular papules. The physician performs a lesion scraping to assess this condition. Based on the signs and symptoms, what diagnosis should the nurse expect? A. Scabies B. Contact dermatitis C. Impetigo D. Dermatophytosis

A. Signs and symptoms of scabies include gray-brown burrows, epidermal curved or linear ridges, and follicular papules. Clients complain of severe itching that usually occurs at night. Scabies commonly occurs in school-age children. The most common areas of infestation are the finger webs, flexor surface of the wrists, and antecubital fossa. Impetigo is a contagious, superficial skin infection characterized by a small, red macule that turns into a vesicle, becoming pustular with a honey-colored crust. Contact dermatitis is an inflammation of the skin caused by contact with an irritating chemical or allergen. Dermatophytosis, or ringworm, is a disease that affects the scalp, body, feet, nails, and groin. It's characterized by erythematous patches and scaling.

The nurse is differentiating between a macule and a papule when evaluating a client's skin lesion. The nurse determines that the lesion is a papule when which characteristic is noted? A. Elevated and palpable B. Flat with skin color change C. Circumscribed border D. Greater than 1 cm in diameter

A. The nurse determines that the lesion is a papule, and not a macule, when the lesion is noted to be elevated and palpable. Macules are flat, non palpable skin color changes. Both macules and papules have circumscribed borders. Macules are less than 1 cm in diameter and papules are less than 0.5 cm in diameter.

The nurse is working with community groups. At which of the following locations would the nurse anticipate a possible scabies outbreak? A. College dormitory B. Gymnasium C. Swimming pool D. Shopping mall

A. The nurse is correct to anticipate a potential scabies outbreak in a college dormitory. Outbreaks are common where large groups of people are confined or housed. Spread of scabies is from skin-to-skin contact. Although there are groups of people at the shopping mall, swimming pool, and gymnasium, typically, there is no personal contact.

A nurse is providing self-care education to a client who has been receiving treatment for acne vulgaris. What instruction should the nurse provide to the client? A. Wash your face with water and gentle soap each morning and evening. B. Before bedtime, clean your face with rubbing alcohol on a cotton pad. C. Gently burst new pimples before they form a visible 'head'. D. Set aside some time each day to squeeze blackheads and remove the plug.

A. The nurse should inform the client to wash the face and other affected areas with mild soap and water twice each day to remove surface oils and prevent obstruction of the oil glands. Cleansing with rubbing alcohol is not recommended and all forms of manipulation should be avoided.

To treat a client with acne vulgaris, the physician is most likely to order which topical agent for nightly application? A. Tretinoin (retinoic acid [Retin-A]) B. Fluorouracil (5-fluorouracil, 5-FU [Efudex]) C. Zinc oxide gelatin D. Minoxidil (Rogaine)

A. Tretinoin is a topical agent applied nightly to treat acne vulgaris. Minoxidil promotes hair growth. Zinc oxide gelatin treats stasis dermatitis on the lower legs. Fluorouracil is an antineoplastic topical agent that treats superficial basal cell carcinoma.

A client has received a diagnosis of irritant contact dermatitis. What action should the nurse prioritize in the client's subsequent care? A. Teaching the client to safely and effectively administer immunosuppressants B. Helping the client identify and avoid the offending agent C. Teaching the client how to maintain meticulous skin hygiene D. Helping the client perform wound care in the home environment

B. A focus of care for clients with irritant contact dermatitis is identifying and avoiding the offending agent. Immunosuppressants are not used to treat eczema and wound care is not normally required, except in cases of open lesions. Poor hygiene has no correlation with contact dermatitis.

A nurse practitioner is seeing a 16-year-old client who has come to the dermatology clinic for treatment of acne. The nurse practitioner would know that the treatment may consist of which of the following medications? A. Acyclovir B. Benzoyl peroxide and erythromycin C. Diphenhydramine D. Triamcinolone

B. A nurse practitioner is seeing a 16-year-old client who has come to the dermatology clinic for treatment of acne. The nurse practitioner would know that the treatment may consist of which of the following medications? A. Acyclovir B. Benzoyl peroxide and erythromycin C. Diphenhydramine D. Triamcinolone

Assessment of a client's leg reveals the presence of a 1.5-cm circular region of necrotic tissue that is deeper than the epidermis. The nurse should document the presence of what type of skin lesion? A. Keloid B. Ulcer C. Fissure D. Erosion

B. A pressure ulcer that is stage 2 or greater is one that extends past the epidermal layer and can develop necrotic tissue. Keloids lack necrosis and consist of scar tissue. A fissure is linear, and erosions do not extend to the dermis.

A gerontologic nurse is teaching a group of nursing students about integumentary changes that occur in older adults. How should these students best integrate these changes into care planning? A. By avoiding the use of moisturizing lotions on older adults' skin B. By protecting older adults against shearing injuries C. By avoiding the use of ice packs to treat muscle pain D. By protecting older adults against excessive sweat accumulation

B. Cellular changes associated with aging include thinning at the junction of the dermis and epidermis, which creates a risk for shearing injuries. Moisturizing lotions can be safely used to address the increased dryness of older adults' skin. Ice packs can be used, provided skin is assessed regularly and the client possesses normal sensation. Older adults perspire much less than younger adults, thus sweat accumulation is rarely an issue.

Which of the following nonsedating antihistamines is appropriate for daytime pruritus? A. Diphenhydramine (Benadryl) B. Fexofenadine (Allegra) C. Hydroxyzine (Atarax) D. Lorazepam (Ativan)

B. Nonsedating antihistamine medications such as Allegra are more appropriate to relieve daytime pruritus. Benadryl or Atarax, when prescribed in a sedative dose at bedtime, may be beneficial in producing a restful and comfortable sleep. Ativan has sedating properties and is used as an antianxiety medication.

A nurse assesses a client with dry, rough, scaly skin without lesions on the legs. The client reports itching in the affected area. What skin assessment would the nurse document? A. Seborrhea B. Pruritus C. Candidiasis D. Shingles

B. Pruritus (itching) is one of the most common symptoms of patients with dermatologic disorders. Itch receptors are unmyelinated, penicillate (brush-like) nerve endings that are found exclusively in the skin, mucous membranes, and cornea. Shingles presents with lesions. Candidiasis presents with reddened skin and is often found in the folds of skin. Seborrhea refers to dry, scaly patches usually located on the scalp.

A nurse is explaining the importance of sunlight on the skin to a client with decreased mobility who rarely leaves the house. The nurse would emphasize that ultraviolet light helps to synthesize what vitamin? A. E B. D C. A D. C

B. Skin exposed to ultraviolet light can convert substances necessary for synthesizing vitamin D (cholecalciferol). Vitamin D is essential for preventing rickets, a condition that causes bone deformities and results from a deficiency of vitamin D, calcium, and phosphorus.

A young student is brought to the school nurse after falling off a swing. The nurse is documenting that the child has bruising on the lateral aspect of the right arm. What term will the nurse use to describe bruising on the skin in documentation? A. Telangiectasias B. Ecchymoses C. Purpura D. Urticaria

B. Telangiectasias consist of red marks on the skin caused by stretching of superficial blood vessels. Ecchymoses are bruises, and purpura consists of pinpoint hemorrhages into the skin. Urticaria is wheals or hives.

A client recently received lip and tongue piercings and subsequently developed a superinfection of candidiasis from the antibacterial mouthwash. What would the nurse recommend for this client? A. Move the piercing back and forth during washing. B. Use an antifungal mouthwash or salt water. C. Use a soft-bristled toothbrush. D. Rinse the mouth after eating food.

B. The client can substitute an antifungal mouthwash or salt water if a superinfection of candidiasis develops from the antibacterial mouthwash. A soft-bristled toothbrush should be used to avoid additional oral injury, but it is not the recommended solution for this problem. After eating, the client should rinse the mouth for 30 to 60 seconds with an antifungal mouthwash or salt water. Moving the jewelry at the piercing area back and forth during washing helps clean the pierced tract but does not solve the problem.

A nurse is doing a shift assessment on a group of clients after first taking report. An older adult client is having the second dose of IV antibiotics for a diagnosis of pneumonia. The nurse notices a new rash on the client's chest. The nurse should ask what priority question regarding the presence of a reddened rash? A. Is the rash worse at a particular time or season? B. Are you allergic to any foods or medication? C. Are you having any loss of sensation in that area? D. Is your rash painful?

B. The nurse should suspect an allergic reaction to the antibiotic therapy. Allergies can be a significant threat to the client's immediate health, thus questions addressing this possibility would be prioritized over those addressing sensation. Asking about previous rashes is important, but this should likely be framed in the context of an allergy assessment.

A client is being treated for acne vulgaris. What contributes to follicular irritation? A. stress B. overproduction of sebum C. chocolate D. potato chips

B. The overproduction of sebum provides an ideal environment for bacterial growth within the irritated follicle. The follicle becomes further distended and irritated, causing a raised papule in the skin.

A school nurse has sent home four children who show evidence of pediculosis capitis. What is an important instruction the nurse should include in the note being sent home to parents? A. The child's scalp should be monitored for 48 to 72 hours before starting treatment. B. Nits may have to be manually removed from the child's hair shafts. C. The disease is self-limiting and symptoms will abate within 1 week. D. Efforts should be made to improve the child's level of hygiene.

B. Treatment for head lice should begin promptly and may require manual removal of nits following medicating shampoo. Head lice are not related to a lack of hygiene. Treatment is necessary because the condition will not likely resolve spontaneously within 1 week.

Nursing students are reviewing information about various types of skin lesions. The students demonstrate understanding of the information when they identify which of the following as a vascular lesion? A. Pustule B. Cyst C. Spider angioma D. Erosion

C. A spider angioma is a vascular lesion. Erosion is a secondary lesion. Pustules and cysts are classified as primary skin lesions.

A nurse is providing care for a client who has psoriasis. Following the appearance of skin lesions, the nurse should prioritize what assessment? A. Assessment of the client's stool for evidence of intestinal sloughing B. Assessment of the client's apical heart rate for dysrhythmias C. Assessment of the client's joints for pain and decreased range of motion D. Assessment for cognitive changes resulting from neurologic lesions

C. Asymmetric rheumatoid factor-negative arthritis of multiple joints occurs in up to 42% of people with psoriasis, most typically after the skin lesions appear. The most typical joints affected include those in the hands or feet, although sometimes larger joints such as the elbow, knees, or hips may be affected. As such, the nurse should assess for this musculoskeletal complication. GI, cardiovascular, and neurologic function are not affected by psoriasis.

An older adult resident of a long-term care facility has been experiencing generalized pruritus that has become more severe in recent weeks. What intervention should the nurse add to this resident's plan of care? A. Avoid the application of skin emollients B. Apply antibiotic ointment, as prescribed, following baths C. Avoid using hot water during the client's baths D. Administer acetaminophen four times daily as prescribed

C. If baths have been prescribed, the client is reminded to use tepid (not hot) water and to shake off the excess water and blot between intertriginous areas (body folds) with a towel. Skin emollients should be applied to reduce pruritus. Acetaminophen and antibiotics do not reduce pruritus.

A nurse is working with a family whose 5-year-old child has been diagnosed with impetigo. What educational intervention should the nurse include in this family's care? A. Ensuring that the family knows that impetigo is not contagious B. Teaching about the safe and effective use of topical corticosteroids C. Teaching about the importance of maintaining high standards of hygiene D. Ensuring that the family knows how to safely burst the child's vesicles

C. Impetigo is associated with unhygienic conditions; educational interventions to address this are appropriate. The disease is contagious, thus vesicles should not be manually burst. Because of the bacterial etiology, corticosteroids are ineffective.

The nurse is assisting an older adult client with performing activities of daily living (ADL) and is brushing her hair. What does the nurse document as an abnormal finding? A. Dry, brittle hair B. Sparse hair, white in color C. Pearly white substance that is attached to the hair shaft that is not removed with brushing D. Knots in hair when brushed

C. The pearly white substance that is attached to the hair shaft is indicative of nits or head lice and should be reported to the physician so treatment can be administered. The other findings are not abnormal in the older adult client

The nurse teaches the client who demonstrates herpes zoster (shingles) that A. no known medications affect the course of shingles. B. once a client has had shingles, they will not have it a second time. C. the infection results from reactivation of the chickenpox virus. D. a person who has had chickenpox can contract it again upon exposure to a person with shingles.

C. It is assumed that herpes zoster represents a reactivation of the latent varicella (chickenpox) virus and reflects lowered immunity. It is believed that the varicella zoster virus lies dormant inside nerve cells near the brain and spinal cord and is reactivated with weakened immune systems and cancers. A person who has had chickenpox is immune and therefore not at risk of infection after exposure to clients with herpes zoster. Some evidence shows that infection is arrested if oral antiviral agents are administered within 24 hours of the initial eruption.

A client has been diagnosed with shingles. Which of the following medication classifications will reduce the severity and prevent development of new lesions? A. Antipyretics B. Analgesics C. Antiviral D. Corticosteroids

C. Oral acyclovir (Zovirax), when taken within 48 hours of the appearance of symptoms, reduces their severity, and prevents the development of additional lesions. Corticosteroids, analgesics,, and antipyretics are not used for this purpose.

A new client has come to the dermatology clinic to be assessed for a reddened rash on the abdomen. For what diagnostic test should the nurse prepare the client to identify the causative allergen? A. Skin scrapings B. Skin biopsy C. Patch testing D. Tzanck smear

C. Patch testing is performed to identify substances to which the client has developed an allergy. Skin scrapings are done for suspected fungal lesions. A skin biopsy is completed to rule out malignancy and to establish an exact diagnosis of skin lesions. A Tzanck smear is used to examine cells from blistering skin conditions, such as herpes zoster.

The nurse recognizes which condition is associated with emboli to the skin? A. Telangiectasia B. Spider angioma C. Petechiae D. Ecchymosis

C. Petechiae are small, round red or purple macules and are associated with bleeding tendencies or emboli to the skin. Spider angioma is associated with liver disease, pregnancy, and vitamin B deficiency. Ecchymosis is associated with trauma and bleeding tendencies. Telangiectasia is associated with venous pressure states.

A new client presents at the clinic and the nurse performs a comprehensive health assessment. The nurse notes that the client's fingernail surfaces are pitted. The nurse should suspect the presence of what health problem? A. Eczema B. Systemic lupus erythematosus (SLE) C. Psoriasis D. Chronic obstructive pulmonary disease (COPD)

C. Pitted surface of the nails is a definite indication of psoriasis. Pitting of the nails does not indicate eczema, SLE, or COPD.

A nurse is leading a health promotion workshop that is focusing on cancer prevention. What action is most likely to reduce participants' risks of basal cell carcinoma (BCC)? A. Teaching participants to improve their overall health through nutrition B. Encouraging participants to identify their family history of cancer C. Teaching participants to limit their sun exposure D. Teaching participants to control exposure to environmental and occupational radiation

C. Sun exposure is the best known and most common cause of BCC. BCC is not commonly linked to general health debilitation, family history, or radiation exposure.

A client presents at the dermatology clinic with suspected herpes simplex. The nurse knows to prepare what diagnostic test for this condition? A. Skin biopsy B. Patch test C. Tzanck smear D. Examination with a Wood light

C. The Tzanck smear is a test used to examine cells from blistering skin conditions, such as herpes zoster, varicella, herpes simplex, and all forms of pemphigus. The secretions from a suspected lesion are applied to a glass slide, stained, and examined. This is not accomplished by biopsy, patch test, or Wood light.

A public health nurse is participating in a health promotion campaign that has the goal of improving outcomes related to skin cancer in the community. What action has the greatest potential to achieve this goal? A. Educating participants about the relationship between general health and the risk of skin cancer B. Educating participants about treatment options for skin cancer C. Educating participants about the early signs and symptoms of skin cancer D. Educating participants about the health risks associated with smoking and assisting with smoking cessation

C. The best hope of decreasing the incidence of skin cancer lies in educating clients about the early signs. There is a relationship between general health and skin cancer, but teaching individuals to identify the early signs and symptoms is more likely to benefit overall outcomes related to skin cancer. Teaching about treatment options is not likely to have a major effect on outcomes of the disease. Smoking is not among the major risk factors for skin cancer.

The classic lesions of impetigo manifest as A. comedones in the facial area. B. patches of grouped vesicles on red and swollen skin. C. honey-yellow crusted lesions on an erythematous base. D. abscess of skin and subcutaneous tissue.

C. The classic lesions of impetigo are honey-crusted lesions on an erythematous base. Comedones in the facial area are representative of acne. A carbuncle is an abscess of skin and subcutaneous tissue. Herpes zoster is exhibited by patches of grouped vesicles on red and swollen skin.

A client diagnosed with a stasis ulcer has been hospitalized. There is an order to change the dressing and provide wound care. Which activity should the nurse first perform when providing wound care? A. Assess the drainage in the dressing. B. Slowly remove the soiled dressing. C. Perform hand hygiene. D. Don nonlatex gloves.

C. The nurse and health care provider must adhere to standard precautions and wear gloves when inspecting the skin or changing a dressing. Use of standard precautions and proper disposal of any contaminated dressing is carried out according to Occupational Safety and Health Administration (OSHA) regulations. Hand hygiene must precede other aspects of wound care.

Which of the following information regarding the transmission of lice would the nurse identify as a myth? A. Lice need to be removed from the hair with a fine comb. B. Lice can be spread by sharing of hats, caps, and combs. C. Lice can jump from one individual to another. D. Lice can be seen without magnification.

C. The nurse is correct to identify that lice cannot jump from one individual to another. Direct contact is needed for transmission. The other options are correct.

A client with squamous cell carcinoma has been scheduled for treatment of this malignancy. The nurse should anticipate that treatment for this type of cancer will primarily consist of what intervention? A. Chemotherapy B. Radiation therapy C. Surgical excision D. Biopsy of sample tissue

C. The primary goal of surgical management of squamous cell carcinoma is to remove the tumor entirely. Radiation therapy is reserved for older clients, because x-ray changes may be seen after 5 to 10 years, and malignant changes in scars may be induced by irradiation 15 to 30 years later. Obtaining a biopsy would not be a goal of treatment; it may be an assessment. Chemotherapy and radiation therapy are generally reserved for clients who are not surgical candidates.

A client has just been told that he has deep malignant melanoma. The nurse caring for this client should anticipate that the client will undergo what treatment? A. Chemotherapy B. Immunotherapy C. Wide excision D. Radiation therapy

C. Wide excision is the primary treatment for malignant melanoma, which removes the entire lesion and determines the level and staging. Chemotherapy may be used after the melanoma is excised. Immunotherapy is experimental and radiation therapy is palliative.

A client comes to the clinic reporting a red rash of small, fluid-filled blisters and is suspected of having herpes zoster. What presentation is most consistent with this diagnosis? A. Grouped vesicles occurring on lips and oral mucous membranes B. Grouped vesicles occurring on the genitalia C. Rough, fresh, or gray skin protrusions D. Grouped vesicles in linear patches along a dermatome

D. Herpes zoster, or shingles, is an acute inflammation of the dorsal root ganglia, causing localized, vesicular skin lesions following a dermatome. Herpes simplex type 1 is a viral infection affecting the skin and mucous membranes, usually producing cold sores or fever blisters. Herpes simplex type 2 primarily affects the genital area, causing painful clusters of small ulcerations. Warts appear as rough, fresh, or gray skin protrusions.

Which skin condition is caused by staphylococci, streptococci, or multiple bacteria? A. Scabies B. Pediculosis capitis C. Poison ivy D. Impetigo

D. Impetigo is seen at all ages but is particularly common among children living under poor hygienic conditions. Scabies is caused by the itch mite. Pediculosis capitis is caused by head lice. Poison ivy is a contact dermatitis caused by the oleoresin given off by a particular form of ivy.

The nurse is caring for a client who may have a lice infestation. The nurse is using a bright light focused on an area of the head to confirm the presence of lice. In which manner is it easiest to differentiate nits from dandruff? A. Nits are located near the scalp. B. Dandruff is throughout the hair. C. Dandruff looks white and flaky. D. Nits are difficult to move from hair shafts.

D. Lice eggs, or nits, can be confused with dandruff. However, dandruff consists of fine, white particles of dead, dry scalp cells that can be easily picked from the hair. Nits, on the other hand, look like small, yellowish-white ovals and are quite firmly fixed to the hair shaft. The nurse is correct to use the difference of the nits being securely attached to the hair shaft as a guide to confirmation of lice infestation.

A client has a rash on the arm that has been treated with an antibiotic without eradicating the rash. What type of examination can be used to determine if the rash is a fungal rash using ultraviolet light? A. Fungal culture B. Skin biopsy C. Potassium hydroxide test D. A Wood's light examination

D. A Wood's light is also known as a black light and is a handheld device that can identify certain fungal infections that fluoresce under long-wave ultraviolet light. In a darkened room, when a physician or nurse aims the light at a lesion caused by a fungus that fluoresces, the lesion emits a blue-green color. It is the only test that uses a light, the others use skin scrapings.

While performing an initial assessment of a client admitted with appendicitis, the nurse observes an elevated blue-black lesion on the client's ear. The nurse knows that this lesion is consistent with what type of skin cancer? A. Basal cell carcinoma B. Squamous cell carcinoma C. Dermatofibroma D. Malignant melanoma

D. A malignant melanoma presents itself as a superficial spreading melanoma which may appear in a combination of colors, with hues of tan, brown, and black mixed with gray, blue-black, or white. The lesion tends to be circular, with irregular outer portions. BCC usually begins as a small, waxy nodule with rolled, translucent, pearly borders; telangiectatic vessels may be present. SCC appears as a rough, thickened, scaly tumor that may be asymptomatic or may involve bleeding. A dermatofibroma presents as a firm, dome-shaped papule or nodule that may be skin colored or pinkish brown.

A client with psoriasis visits the dermatology clinic. When inspecting the affected areas, the nurse expects to see which type of secondary lesion? A. Scar B. Crust C. Ulcer D. Scale

D. A scale is the characteristic secondary lesion occurring in psoriasis. Although crusts, ulcers, and scars also are secondary lesions in skin disorders, they don't occur with psoriasis.

A nurse is planning the care of a client with herpes zoster. What medication, if given within the first 24 hours of the initial eruption, can arrest herpes zoster? A. Prednisone B. Azathioprine C. Triamcinolone D. Acyclovir

D. Acyclovir, if started early, is effective in significantly reducing the pain and halting the progression of the disease. There is evidence that infection is arrested if oral antiviral agents are given within the first 24 hours. Prednisone is an anti-inflammatory agent used in a variety of skin disorders, but not in the treatment of herpes. Azathioprine is an immunosuppressive agent used in the treatment of pemphigus. Triamcinolone is utilized in the treatment of psoriasis.

A nurse is assessing the skin of a client who has been diagnosed with bacterial cellulitis on the dorsal portion of the great toe. When reviewing the client's health history, the nurse should identify what comorbidity as increasing the client's vulnerability to skin infections? A. Chronic obstructive pulmonary disease B. Rheumatoid arthritis C. Gout D. Diabetes

D. Clients with diabetes are particularly susceptible to skin infections. COPD, RA, and gout are less commonly associated with integumentary manifestations.

Which medication classification may be used for contact dermatitis? A. Antifungals B. Saline irrigations C. Antivirals D. Corticosteroids

D. Corticosteroids are used for contact dermatitis. Antifungals, antivirals, and saline irrigations are not used in the treatment of contact dermatitis.

A client has just undergone surgery for malignant melanoma. Which of the following nursing actions should be prioritized? A. Maintain the client on bed rest for the first 24 hours postoperative. B. Apply distraction techniques to relieve pain. C. Provide soft or liquid diet that is high in protein to assist with healing. D. Anticipate the need for, and administer, appropriate analgesic medications.

D. Nursing interventions after surgery for a malignant melanoma center on promoting comfort, because wide excision surgery may be necessary. Anticipating the need for and administering appropriate analgesic medications are important. Distraction techniques may be appropriate for some clients, but these are not a substitute for analgesia. Bed rest and a modified diet are not necessary.

A patient is complaining of severe itching that intensifies at night. The nurse decides to assess the skin using a magnifying glass and penlight to look for the itch mite. What skin condition does the nurse anticipate finding? A. Tinea corporis B. Contact dermatitis C. Pediculosis D. Scabies

D. Scabies is an infestation of the skin by the itch mite Sarcoptes scabiei. The patient complains of severe itching caused by a delayed type of immunologic reaction to the mite or its fecal pellets. During examination, the patient is asked where the pruritus is most severe. A magnifying glass and a penlight are held at an oblique angle to the skin while a search is made for the small, raised burrows created by the mites. One classic sign of scabies is the increased itching that occurs during the overnight hours, perhaps because the increased warmth of the skin has a stimulating effect on the parasite.

A nurse is admitting a client with toxic epidermal necrolysis. What is the nursing priority in preventing sepsis? A. Limiting protein to limit liver failure B. Hydrating to prevent renal failure C. Assessing for hemorrhage D. Preventing infection

D. The major cause of death from toxic epidermal necrolysis is from sepsis. Monitoring vital signs closely and noticing changes in respiratory, kidney, and gastrointestinal function may help the nurse to quickly detect the beginning of an infection. Strict asepsis is always maintained during routine skin care measures. Hand hygiene and wearing sterile gloves when carrying out procedures are essential. Visitors should wear protective garments and wash their hands before and after coming into contact with the patient. People with any infections or infectious disease should not visit the patient until they are no longer a danger to the patient. The nurse is critical in identifying early signs and symptoms of infection and notifying the primary provider. Antibiotic agents are not generally begun until there is an indication for the use. Hemorrhage, renal failure, and liver failure are not the major causes of toxic epidermal necrolysis.

An 82-year-old client is being treated in the hospital for a sacral pressure ulcer. What age-related change is most likely to affect the client's course of treatment? A. Increased thickness of the subcutaneous skin layer B. Increased vascular supply to superficial skin layers C. Changes in the character and quantity of bacterial skin flora D. Increased time required for wound healing

D. Wound healing becomes slower with age, requiring more time for older adults to recover from surgical and traumatic wounds. There are no changes in skin flora with increased age. Vascular supply and skin thickness both decrease with age.