Chapter 56: Management of Patients with Dermatologic Disorders and Wounds

While in a skilled nursing facility, a client contracts scabies, which is diagnosed the day after discharge. The client is living at her daughter's home with six other people. During her visit to the clinic, the client asks a staff nurse, "What should my family do?" The most accurate response from the nurse is:

"All family members need to be treated."

When a patient has been diagnosed with scabies, if the infection has spread, family members may complain of pruritus within which time frame?

1 month

A patient has a moisture-retentive dressing for the treatment of a sacral decubitus ulcer. How long should the nurse leave the dressing in place before replacing it?

12 to 24 hours

The nurse is changing the dressing of a chronic wound. There is no sign of infection or heavy drainage. How long will the nurse leave the wound covered for?

48 to 72 hours

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 Wood's light examination

Which assessment finding indicates an increased risk of skin cancer?

A deep sunburn

The nurse is caring for a patient with extensive bullous lesions on the trunk and back. Prior to initiating skin care, what is a priority for the nurse to do?

Administer analgesic pain medication.

A client has been diagnosed with shingles. Which of the following medication classifications will reduce the severity and prevent development of new lesions?

Antiviral

The nurse is instructing the patient in how to apply a corticosteroid cream to lesions on the arm. What intervention can the nurse instruct the patient to do to increase the absorption of the medication?

Apply an occlusive dressing over the site after application.

Which of the following uses the body's own digestive enzymes to break down necrotic tissues?

Autolytic debridement

The nurse is teaching a client about the correct use of topical concentrated corticosteroids. The nurse includes which statement(s)? Select all that apply.

Avoid applying to the face. Avoid prolonged use.

A patient is diagnosed with seborrheic dermatitis on the face and is prescribed a corticosteroid preparation for use. What should the nurse educate the patient about regarding use of the steroid on the face?

Avoid using the medication around the eyelids because it may cause cataracts and glaucoma.

A client has recently been diagnosed with advanced malignant melanoma and is scheduled for a wide excision of the tumor on her chest. In writing the plan of care for this client, what major nursing diagnosis should the nurse include?

Deficient Knowledge about Early Signs of Melanoma

Which of the following is an example of a topical anesthetic?

EMLA cream

The nurse should assess all possible causes of pruritus for a patient complaining of generalized pruritus. What does the nurse understand can be another cause for this condition?

End-stage kidney disease

A nurse is caring for a client experiencing an exacerbation of plaque psoriasis. The nurse assesses the area and documents a proliferation of which cell type?

Epidermal

The patient is advised to apply a suspension-type lotion to a dermatosis site. The nurse should advise the patient to apply the lotion how often to be effective?

Every 3 hours

A dermatologist recommends an over-the-counter suspension to relieve pruritus. The nurse advises the patient that the lotion should be applied:

Every 3 to 4 hours for sustained effectiveness.

Which of the following nonsedating antihistamines is appropriate for daytime pruritus?

Fexofenadine (Allegra)

Which term refers most precisely to a localized skin infection of a single hair follicle?

Furuncle

A client with scabies has been prescribed a scabicide. What should the nurse tell the client to do before beginning treatment?

Have thorough bath

Which sedative medication is effective for treating pruritus?

Hydroxyzine

Which skin condition is caused by staphylococci, streptococci, or multiple bacteria?

Impetigo

A patient is being evaluated for nodular cystic acne. What systemic pharmacologic agent may be prescribed for the treatment of this disorder?

Isotretinoin (Accutane)

The nurse is conducting a community education program on basal cell carcinoma (BCC). Which statement should the nurse make?

It begins as a small, waxy nodule with rolled translucent, pearly borders.

Which statement is accurate regarding isotretinoin?

It is teratogenic in humans.

Which infecting agent causes scabies?

Itch mite

The nurse assesses the client and observes reddish-purple to dark blue macules, plaques, and nodules. The nurse recognizes that these manifestations are associated with which condition?

Kaposi sarcoma

In assessing a scar, you notice an overgrowth of tissue. It is best described as a

Keloid

Which of the following information regarding the transmission of lice would the nurse identify as a myth?

Lice can jump from one individual to another.

The nurse and nursing assistant are moving a client who slid down in the chair. What does the nurse encourage the assistant to avoid shearing when moving the client to a higher position in the chair?

Lift the client, do not slide them.

While examining a client's leg, a nurse notes an open ulceration with visible granulation tissue in the wound. Until a wound specialist can be contacted, which type of dressing should the nurse apply?

Moist sterile saline gauze

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?

Nits are difficult to move from hair shafts.

A nurse is admitting a client with toxic epidermal necrolysis. What is the nursing priority in preventing sepsis?

Preventing infection

A night-shift nurse receives a call from the emergency department about a client with herpes zoster who is going to be admitted to the floor. Based on this diagnosis, where should the nurse assign the client?

Private room

A patient is scheduled for Mohs microscopic surgery for removal of a skin cancer lesion on his forehead. The nurse knows to prepare the patient by explaining that this type of surgery requires:

Removal of the tumor, layer by layer

A young client has head lice. What are appropriate steps in eradication? Select all that apply.

Repeat combings daily until there is no more evidence of lice or nits. Apply a pediculicide to the hair (detailed directions also accompany this medication). Comb the hair free of tangles while the hair is damp. Use a special lice comb that has narrow stainless steel teeth. Comb through each area of the hair to remove lice.

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?

Scabies

A 1-year-old client has a localized rash and is miserably itchy. The client's mother indicates having just started to use a new skin cream and that the rash developed within 12 hours of the first dose. What treatments would pediatrician prescribe? Select all that apply.

cool baths without soap twice daily remove allergen

A day care worker comes to the clinic for mild itching and rash of both hands. The nurse suspects contact dermatitis. The diagnosis is confirmed if the rash appears:

erythematous with raised papules.

The classic lesions of impetigo manifest as

honey-yellow crusted lesions on an erythematous base.

A client with a history of diabetes mellitus has recently developed furunculosis. What is causing the client's condition?

infection

A nurse discovers scabies when assessing a client who has just been transferred to the medical-surgical unit from the day surgery unit. To prevent scabies infection in other clients, the nurse should:

isolate the client's bed linens until the client is no longer infectious.

While assessing the skin of a 45-year-old, fair-skinned female client, the nurse notes a lesion on the medial aspect of her lower leg. It has irregular borders, with various shades of black and brown. The client states that the lesion itches occasionally and bled slightly a few weeks ago. She also reveals a history of sunburns. Based on these signs and symptoms, the nurse suspects:

melanoma.

A client is being treated for acne vulgaris. What contributes to follicular irritation?

overproduction of sebum

The nurse teaches the client who demonstrates herpes zoster (shingles) that

the infection results from reactivation of the chickenpox virus.

To treat a client with acne vulgaris, the physician is most likely to order which topical agent for nightly application?

Tretinoin (retinoic acid [Retin-A])

A client comes to the physician's office for treatment of severe sunburn. The nurse takes this opportunity to discuss the importance of protecting the skin from the sun's damaging rays. What is the appropriate teaching by the nurse to prevent skin damage?

"Apply sunscreen even on overcast days."

The nurse is caring for a client diagnosed with herpes zoster. Which statement by the client needs further clarification by the nurse?

"Once I get the infection, I cannot get it again."

A nurse is examining a client's scalp for evidence of lice. The nurse should pay particular attention to which part of the scalp?

Behind the ears

The nurse is providing instruction to a client with acne. The nurse promotes avoidance of which food(s)? Select all that apply.

Chocolate Ice cream

The nurse notes that a client is scheduled for a procedure to apply a skin graft. For which reason will the nurse consider this a form of reconstructive surgery? Select all that apply.

Close a surgical wound After excision of a skin tumor Cover loss of skin after a burn injury

The nurse is working with community groups. At which of the following locations would the nurse anticipate a possible scabies outbreak?

College dormitory

The nurse applies a moisture-retentive dressing to a patient's wound. She understands that the main advantage of this dressing, rather than a wet dressing, is its ability to:

Provide autolytic debridement.

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?

Pruritus

Photochemotherapy has been used as a treatment for which of the following skin disorders?

Psoriasis

Which material consists of a powder in water?

Suspension

Which of the following is also known as "jock itch"?

Tinea cruris

The home health nurse is caring for a client with scabies. When instructing on the proper procedure to wash preworn contaminated clothing, which nursing instruction is essential?

Use hot water throughout wash cycle.

The nurse is instructing the parents of a child with head lice. Which statement should the nurse include?

Use shampoo with piperonyl butoxide.

What advice should the nurse give a client with dermatitis until the etiology of the dermatitis is identified?

Wear rubber gloves when in contact with soaps.

A nurse is assessing a client with a new skin disorder. Which questions would the nurse include when asking the client about the change in skin condition? Select all that apply.

When did the disorder first begin, and where did it first appear? Where are the lesions located? Has the problem spread? Have you tried to treat the lesions?

When performing a skin assessment, the nurse notes a localized skin infection of a single hair follicle. The nurse documents the presence of

a furuncle.

Which drug is an oral retinoid used to treat acne?

isotretinoin

A physician has ordered a wet-to-damp dressing for an infected pressure ulcer. The nurse knows that the primary reason for this treatment is to:

keep the wound moist.

The nurse notes that the client's lower extremities are covered with very dry skin and that the horny layer of the skin has become thickened. The nurse notes the finding as

lichenification.