CH 23 - Integumentary Problems

A patient with pustules and redness only on the left side of the face may be diagnosed with which skin condition? Furuncle Candidiasis Verruca vulgaris Herpes zoster (shingles)

Herpes zoster (shingles) The patient may have herpes zoster (shingles), which is 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.

Which condition may present as small, skin-colored, soft, pedunculated papules on the neck, axillae, and upper trunk of a middle-aged, obese patient? Nevi Lentigo Acrochordons Seborrheic keratoses

Acrochordons Small, skin-colored, soft, pedunculated papules are a manifestation of acrochordons. They are also called skin tags and are commonly found on the neck, axillae, and upper trunk. They are mostly found in obese patients during middle age. Nevi or moles are hyperpigmented areas that vary in form and color. Lentigo is hyperpigmented, brown to black maculae or patches on sun-exposed areas. Seborrheic keratosis is characterized by irregular verrucous papules or plaques that are well-defined in shape.

Which condition may manifest as an elevated, dry, hyperkeratotic, scaly papule on an older adult patient? Actinic keratosis Dysplastic nevus Basal cell carcinoma Squamous cell carcinoma

Actinic keratosis Actinic keratosis manifests clinically as dry, scaly, hyperkeratotic papules, either flat or elevated. A dysplastic or atypical nevus is often larger than 5 mm. It features irregular borders, which may be notched; variegated color (e.g., tan, brown, black, red, or pink) within a single mole; and at least one flat portion, often at the edge of the mole. Basal cell carcinoma is characterized by a small, slowly enlarging papule with semitranslucent or pearly borders. Squamous cell carcinoma appears as a thin, scaly, erythematous plaque that does not invade the dermis.

Which treatments may be prescribed for a patient diagnosed with folliculitis after frequent use of a hot tub? Select all that apply. Oral penicillin Incision and drainage Antistaphylococcal soap Warm compress of aluminum acetate Immobilization and elevation of the affected area

Antistaphylococcal soap Warm compress of aluminum acetate Folliculitis is characterized by small pustules at the hair follicle openings and minimal erythema. Antistaphylococcal soap-and-water cleansing is used to treat folliculitis. Warm compresses of water or aluminum acetate solution are also used as treatment. Systemic antibiotics, such as oral penicillin, are used in the treatment of impetigo, furunculosis, and cellulitis. Incision and drainage are used to treat furuncle and furunculosis. Immobilization and elevation of the affected area are appropriate for patients with cellulitis.

The nurse expects which diagnosis for a patient who has developed a skin infection with an associated fever of 101.6° F (38.7° C), a white blood cell count of 28,000, a headache, and malaise? Impetigo Carbuncle Folliculitis Erysipelas

Erysipelas Erysipelas is associated with toxic signs such as fever, headache, malaise, and an increase in white blood cell count. Impetigo is characterized by vesiculopustular lesions surrounded by erythema that develop a thick, honey-colored crust. Carbuncle is characterized by many pustules appearing in an erythematous area. Folliculitis is characterized by small pustules at the hair follicle opening and minimal erythema.

A patient with diabetes mellitus may have an increased incidence of which skin condition? Select all that apply. Erysipelas Folliculitis Furunculosis Actinic keratosis Cutaneous T-cell lymphoma

Folliculitis Furunculosis Patients with diabetes mellitus may have an increased incidence of folliculitis and furunculosis. Erysipelas is a form of superficial cellulitis and does not have an increased incidence with diabetes mellitus. Actinic keratosis has an increased incidence in older adults, not diabetes mellitus. Cutaneous T-cell lymphoma may be related to environmental toxins and chemical exposure.

The nurse should implement contact precautions for the patient with which condition? Psoriasis Tinea unguium Impetigo on the lower legs Candidiasis in the groin area

Impetigo on the lower legs Impetigo is caused by a bacterial infection (group A β-hemolytic streptococci or staphylococci) and is highly contagious. Good skin hygiene and infection control practices are necessary to prevent the spread of this infection. Psoriasis is an autoimmune chronic dermatitis and is not contagious. Tinea unguium is a fungal infection of the nails. Candidiasis is a fungal infection in the skinfolds.

A patient diagnosed with psoriasis may present with which clinical manifestations? Pustules in skinfolds Itchy, scaly patches on scalp Macular rash on the trunk area Vesicular rash on the extremities

Itchy, scaly patches on scalp Psoriasis is a noncontagious autoimmune disease. It usually presents as itchy scales on the scalp, knees, or elbows and is 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.

Which type of skin cancer has a higher risk for metastasis and poor prognosis unless it is treated early? Myeloma Melanoma Basal cell carcinoma Squamous cell carcinoma

Melanoma Malignant melanoma has a higher risk for metastasis than does basal cell or squamous cell carcinoma because of its invasiveness. There is a poor prognosis unless melanoma is diagnosed and treated early. Basal cell and squamous cell carcinoma are typically superficial, localized lesions that respond well to treatment. Myeloma is a hematologic malignancy, not a skin cancer.

A patient who reports severe nighttime body itching and has red, crusted papules may have which infestation? Lice Ticks Scabies Bedbugs

Scabies Severe nighttime itching and red papules are indicative of scabies. Lice bites result in minute, red, noninflamed points that progress to a papular wheal-like lesion. A tick bite that transmits Lyme disease is characterized by a spreading, ring-like rash that occurs three to four weeks after the bite. A bedbug bite results in a wheal surrounded by a vivid flare and firm urticaria that transforms into a persistent lesion.

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

Tinea corporis Tinea corporis is commonly referred to as ringworm. A tinea corporis infection has an erythematous, annular (ring-like), scaly appearance with well-defined margins. A tinea pedis fungal infection is characterized by scaly plantar surfaces that are pruritic and blistering in nature. A 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.

Methotrexate may be prescribed to treat which condition? A benign adipose tumor Autoimmune chronic dermatitis Inflammatory disorder of sebaceous glands An increase in normal melanocytes in the basal layer of the epidermis

Autoimmune chronic dermatitis The skin condition associated with autoimmune chronic dermatitis is psoriasis, which involves excessively rapid turnover of the cells. Methotrexate slows down the rapid division of skin cells that is a hallmark of psoriasis. A benign tumor of adipose tissue is called a lipoma; it generally does not require treatment, but excision is the usual treatment option. An inflammatory disorder of the sebaceous glands is acne vulgaris, usually treated with topical benzoyl peroxide or other antimicrobials. An increased number of normal melanocytes in the basal layer of epidermis is called lentigo. Treatment options include liquid nitrogen and laser resurfacing.

Which diagnosis does the nurse expect for a patient with circumscribed, hypertrophic, flesh-colored papules on the knee that recur even after removal? Plantar warts Herpes zoster Verruca vulgaris Herpes simplex virus type 1

Verruca vulgaris Verruca vulgaris is characterized by circumscribed, hypertrophic, flesh-colored papules that are limited to the epidermis. Plantar warts are found on the bottom surface of the foot; they may grow inward as a result of the pressure of walking and standing. Herpes zoster is characterized by linear distribution along a dermatome of grouped vesicles and pustules on an erythematous base. Herpes simplex virus type 1's clinical manifestations are single or grouped vesicles on an erythematous base occurring with systematic symptoms of fever and malaise.

Which action should the nurse take to prevent postherpetic neuralgia for a patient with herpes zoster? Administer mild sedatives at night. Apply wet compresses to the affected area. Administer acyclovir as prescribed within 72 hours. Apply silver sulfadiazine on the ruptured vesicles.

Administer acyclovir as prescribed within 72 hours. Classic clinical manifestation of herpes zoster (shingles) is a linear distribution of grouped vesicles along a dermatome. Often there is a burning pain preceding an outbreak. Postherpetic neuralgia is a preventable condition if the antiviral agents are administered within 72 hours. Using a mild sedative at night, applying silver sulfadiazine on the vesicles, and applying wet compresses may decrease symptoms, but they have no effect on the prevention of postherpetic neuralgia.