Chapter 23: Integumentary Problems

isotretinoin

medication used to treat acne, teratogenic, causes photosensitivity

urticaria

spontaneously occurring raised or irregularly shaped wheals typically related to allergies

rhytidectomy

lifting and repositioning of the lower 2/3 of face and neck

acrochordons

skin tags

basal cell carcinoma

locally invasive malignancy arising from epidermal basal cells; most common type of skin cancer but least deadly

lichenification

thickening of epidermis with exaggerated markings resembling a washboard caused by chronic scratching or rubbing of the skin, often associated with atopic dermatoses

malignant melanoma

tumor arising in melanocytes; causes majority of skin cancer deaths; has the ability to metastasize to any other organ; there may be a genetic predisposition

tinea cruris

well-defined scaly plaque in groin area that does not affect mucous membranes, topical antifungal treatment

lentigo

small brown macules, especially on the face and arms, brought on by sun exposure, usually in a middle-aged or older person

folliculitis

small pustule at the hair follicle, crusting, tender; warm compresses and topical antibiotics

impetigo

contagious bacterial skin infection characterized by vesicopustular lesions that become crusted and rupture; requires topical or systemic antibiotics

scabies

contagious, parasitic infection of the skin with intense pruritus; presence of burrows; topical treatment; antibiotics may be needed if secondary infection

abe

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 compresses 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.

b

A patient has the following risk factors for melanoma. Which risk factor should the nurse assign as the priority focus of patient teaching? a. The patient has multiple dysplastic nevi. b. The patient uses a tanning booth weekly. c. The patient is fair-skinned and has blue eyes. d. The patient's mother died of a malignant melanoma.

a

A patient in the dermatology clinic has a thin, scaly erythematous plaque on the right cheek. Which action should the nurse take? a. Prepare the patient for a skin biopsy. b. Teach the use of corticosteroid cream. c. Explain how to apply tretinoin (Retin-A) to the face. d. Discuss the need for topical application of antibiotics.

d

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? a. Shield any unaffected areas with lead-lined drapes. b. Apply petroleum jelly to the areas around the lesions. c. Cleanse the skin carefully with antiseptic soap prior to PUVA. d. Have the patient use protective eyewear while receiving PUVA.

d

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? a. Discuss the possibility of participating in an online support group. b. Encourage the patient to volunteer to work on community projects. c. Suggest that the patient use cosmetics to cover the psoriatic lesions. d. Ask the patient to describe the impact of psoriasis on quality of life.

d

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? a. Curettage b. Punch biopsy c. Cryosurgery d. Surgical excision

b

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? a. "After I apply the medication, I can get dressed as usual." b. "If the medication burns when I apply it, I will wipe it off." c. "I need to minimize time in the sun while using the Elidel." d. "I will rub the medication in gently every morning and night."

a

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? a. Thinning of the affected skin b. Dryness and scaling in the area c. Alopecia of the affected areas d. Reddish-brown skin discoloration

b

A teenaged male patient who is on a wrestling team 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? a. Ringlike rashes with red, scaly borders over the entire scalp b. Papular, wheal-like lesions with white deposits on the hair shaft c. Patchy areas of alopecia with small vesicles and excoriated areas d. Red, hivelike papules and plaques with sharply circumscribed borders

carbuncle

multiple interconnecting furuncles, most common at nape of neck; i&d, antibiotics, often recurring, slow healing with scar formation

tinea unguium

nails and toenails affected causing brittle, thickened, broken, or crumbling nails with yellowish discoloration; treatment of oral or topical antifungal, nail avulsion

d

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? a. Schedule daily appointments for dressing changes. b. Describe the use of topical fluorouracil on the incision. c. Teach how to use sterile technique to clean the suture line. d. Teach the use of cold packs to reduce bruising and swelling.

erysipelas

Superficial form of cellulitis; red, hot, sharply demarcated plaque that is indurated and painful accompanied by fever, elevated WBC count, headache, and malaise; systemic antibiotics (typically penicillins) and often hospitalization

a

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? a. Clean the infected areas with soap and water. b. Apply alcohol-based cleansers on the lesions. c. Avoid use of antibiotic ointments on the lesions. d. Use petroleum jelly (Vaseline) to soften crusty areas.

b

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 patient's instructions? a. "5-FU will shrink the lesion to prepare for surgical excision." b. "Your cheek area will be eroded and it will take several weeks to heal." c. "You may develop nausea and anorexia, but good nutrition is important during treatment." d. "You will need to avoid crowds because of the risk for infection caused by chemotherapy."

d

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. The patient complains of incisional pain. b. The patient's heart rate is 110 beats/min. c. The patient is unable to detect when the eyelids are touched. d. The skin around the incision is pale and cold when palpated.

c

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? a. The patient takes a tepid bath before applying the cream. b. The patient spreads the cream using a downward motion. c. The patient applies a thick layer of the cream to the affected skin. d. The patient covers the area with a dressing after applying the cream.

d

The nurse is caring for a patient diagnosed with furunculosis. Which nursing action could the nurse delegate to unlicensed assistive personnel (UAP)? a. Applying antibiotic cream to the groin b. Obtaining cultures from ruptured lesions c. Evaluating the patient's personal hygiene d. Cleaning the skin with antimicrobial soap

c

The nurse is interviewing a patient with contact dermatitis. Which finding indicates a need for patient teaching? a. The patient applies corticosteroid cream to pruritic areas. b. The patient adds oilated oatmeal to the bath water every day. c. The patient uses bacitracin-neomycin-polymyxin on minor abrasions. d. The patient takes diphenhydramine at night if persistent itching occurs.

a

The nurse notes the presence of white lesions that resemble milk curds in the back of a patient's throat. Which question by the nurse is appropriate at this time? a. "Are you taking any medications?" b. "Do you have a productive cough?" c. "How often do you brush your teeth?" d. "Have you had an oral herpes infection?"

a

The nurse working in the dermatology clinic assesses a young adult female patient who has. severe cystic acne. Which assessment finding is of concern related to the patient's prescribed isotretinoin ? a. The patient recently had an intrauterine device removed. b. The patient already has some acne scarring on her forehead. c. The patient has also used topical antibiotics to treat the acne. d. The patient has a strong family history of rheumatoid arthritis.

b

There is one opening in the schedule at the dermatology clinic, and four patients are seeking appointments today. Which patient will the nurse schedule for the available opening? a. 50-yr-old with skin redness after having a chemical peel 3 days ago b. 38-year old with a 7-mm nevus on the face that has recently become darker c. 62-yr-old with multiple small, soft, pedunculated papules in both axillary areas d. 42-yr-old with complaints of itching after using topical fluorouracil on the nose

corticosteroids

Thinning of the skin indicates that atrophy, a possible adverse effect of topical ___, is occurring.

b

Vitamin ___ complex is essential for metabolic functions; deficiency can cause erythema, bullae, and seborrhea-like lesions.

a

Vitamin ___ is essential for cell structure maintenance (particularly epithelial), and wound healing; deficiency causes dry conjunctiva and poor wound healing.

c

Vitamin ___ is essential for connective tissue formation and wound healing; deficiency can cause petechiae, bleeding gums, and purpura.

d

Vitamin ___3 is essential for bone health; produced cutaneously; deficiency manifests as bone and muscle weakness and pain.

c

What is the best method to prevent the spread of infection to others when the nurse is changing the dressing over a wound infected with Staphylococcus aureus? a. Change the dressing using sterile gloves. b. Apply antibiotic ointment over the wound. c. Wash hands and properly dispose of soiled dressings. d. Soak the dressing in sterile normal saline before removal.

c

When assessing a new patient at the outpatient clinic, the nurse notes dry, scaly skin; thin hair; and thick, brittle nails. What is the nurse's most important action? a. Instruct the patient about the importance of nutrition for skin health. b. Make a referral to a podiatrist so that the nails can be safely trimmed. c. Consult with the health care provider about the need for further diagnostic testing. d. Teach the patient about using moisturizing creams and lotions to decrease dry skin.

c

Which information should the nurse include in the teaching plan for a patient diagnosed with basal cell carcinoma (BCC)? a. Treatment plans include watchful waiting. b. Screening for metastasis will be important. c. Minimizing sun exposure reduces risk for future BCC. d. Low dose systemic chemotherapy is used to treat BCC.

a

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? a. Use a sunscreen with a high SPF when exposed to the sun. b. Sun exposure may decrease the effectiveness of the medication. c. Photosensitivity may result in an artificial-looking tan appearance. d. Wear sunglasses to avoid eye damage while taking this medication.

b

Which information should the nurse include when teaching patients about decreasing the risk for sun damage to the skin? a. Use a sunscreen with an SPF of at least 10 for adequate protection. b. Try to stay out of the direct sun between the hours of 10 AM and 2 PM. c. Water resistant sunscreens will provide good protection when swimming. d. Increase sun exposure by no more than 10 minutes a day to avoid skin damage.

c

Which information will the nurse include when teaching an older patient about skin care? a. Dry the skin thoroughly before applying lotions. b. Bathe and wash hair daily with soap and shampoo. c. Use warm water and a moisturizing soap when bathing. d. Use antibacterial soaps when bathing to avoid infection.

dysplastic nevi

atypical moles that appear near puberty and continue to develop past 40; may number over 100; identify individuals at risk of developing melanoma

strep

bacteria that causes impetigo, erysipelas, cellulitis, and lymphangitis

staph

bacteria that causes impetigo, folliculitis, cellulitis, and furuncles

irritant

contact dermatitis resulting from direct chemical injury to the skin

allergic

contact dermatitis that is an antigen-specific response

furuncle

deep infection around hair follicle, tender and erythemous, draining pus and core of necrotic debris upon rupture; incision and drainage, antibiotics, warm moist compresses

furunculosis

furuncle lesions accompanied by malaise, regional adenopathy, fever; i&d of painful lesions, topical and systemic antibiotics, often recurrent with scarring

actinic keratosis

hyperkeratonic papules and plaques on sun-exposed areas; premalignant; affect nearly all older white population; most common precancerous skin lesion; flat, reddened papule with indistinct borders and an overlying hard keratotic scale

cellulitis

inflammation of subcutaneous tissues; hot, tender, erythemous, edematous area with diffuse borders accompanied by chills, malaise, and fever; requires systemic antibiotics

tinea pedis

interdigital scaling and maceration, scaly plantar surfaces with erythema and blistering, can be pruritic and painful; topical antifungal treatment

squamous cell carinoma

malignant neoplasm of keratinizing epidermal cells; frequently occurs on sun-exposed skin at the base of actinic keratosis or other lesions; less common than BCC; highly aggressive, potentially metastatic, and may be fatal if not treated early

tinea corporis

round scaly erythematous appearance with well-defined margins, topical antifungal treatment