NU142- Chapter 61: Management of Patients With Dermatologic Disorders

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.

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

EMLA cream

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.

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?

Scabies

Which term refers to a graft derived from one part of a client's body and used on another part of that same client's body?

Autograft

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 assessing a client's skin when the client points out a mole. The nurse brings the mole to the physician's attention when which characteristic is noted?

Diameter exceeding 6 mm

A client has undergone dermabrasion to decrease scarring from severe acne endured as a teen. After completion of the procedure, the nurse reviews the client's home care instructions. Which instruction is appropriate for this client?

Don't touch the area treated.

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

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

Impetigo

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

Psoriasis

A physician orders an emollient for a client with pruritus of recent onset. The client asks why the emollient should be applied immediately after a bath or shower. How should the nurse respond?

"To prevent evaporation of water from the hydrated epidermis."

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."

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. Which instruction best prevents skin damage?

"Apply sunscreen even on overcast days."

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

College dormitory

Which of the following is the primary lesion associated with acne, caused by sebum blockage in hair follicles?

Comedone

Which medication classification may be used for contact dermatitis?

Corticosteroids

Which of the following aggravates the condition caused by acne vulgaris?

Cosmetics

Which of the following skin disorders is treated with intralesional therapy? Select all that apply.

Cystic acne Psoriasis Keloids

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.

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.

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

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.

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 patient has developed a boil on the face and the nurse observes the patient squeezing the boil. What does the nurse understand is a potential severe complication of this manipulation?

Brain abscess

Which of the following is a true statement regarding psoriasis?

It is characterized by patches of redness covered with silvery scales.

The nurse is providing teaching to a client with acne who is using isotretinoin therapy. Which statement should the nurse make?

It is teratogenic in humans.

Which statement is accurate regarding isotretinoin?

It is teratogenic in humans.

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.

dermatosis

any abnormal skin lesion

dermatitis

any inflammation of the skin

striae

bandlike streaks on the skin, distinguished by color, texture, depression, or elevation from the tissue in which they are found usually purplish or white

cytotoxic

destructive of cells

epidermopoiesis

development of epidermal cells

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

cheilitis

inflammation of the lips (when dry, cracking, inflamed skin occurs at the corners of the mouth, it is called angular cheilitis; when caused by sun exposure, it is called solar cheilitis)

Which is not a category of medications used for treatment of the skin?

inhaled steroids

pruritis

itching

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.

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

Preventing infection

Photochemotherapy combines the use of ultraviolet A (UVA) and which of the following medications?

Psoralen

With repeated reactions of contact dermatitis, which of the following can occur?

Secondary bacterial infection

A nurse is conducting a detailed skin assessment on an 80-year-old client. Which finding requires further investigation?

Small, waxy nodule with pearly borders

Which material consists of a powder in water?

Suspension

A patient is diagnosed with severe psoriasis. The health care provider prescribes a popular topical non-steroid. The nurse knows to prepare health teaching information for which of the following drugs?

Tazorac

A client is coming to the office to have a growth removed by the doctor. The client asks "What does cryosurgery do to the growth?" What is the correct response?

Through the application of extreme cold, the tissue is destroyed.

Which term describes a fungal infection of the scalp?

Tinea capitis

Pressure ulcers are caused by:

Extrinsic factors

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

Fexofenadine (Allegra)

The nurse is developing a plan of care for a client with toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome. Which action should the nurse include?

Frequently inspect the oral cavity.

Which factor aggravates the condition caused by acne vulgaris?

Friction

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

Furuncle

Which sedative medication is effective for treating pruritus?

Hydroxyzine

Which of the following reflect the pathophysiology of cutaneous signs of HIV disease?

Immune function deterioration

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

A nurse practitioner prescribes a therapeutic bath for a patient with an exacerbation of psoriasis. She tells the patient to make sure the bath area is well ventilated. Which of the following is the therapeutic bath solution prescribed by the nurse?

Medicated tars

Which procedure done for skin cancer conserves the most amount of normal tissue?

Mohs micrographic surgery

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

What advice should the nurse give a client with a furuncle to prevent the spread of the infection?

Never pick or squeeze a furuncle.

The nurse is caring for a client with questionable 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 client is being treated for acne vulgaris. What warning must be given to this client regarding the application of benzoyl peroxide?

Use gloves with application.

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

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.

The nurse is assessing a patient for psoriatic lesions after treatment with a nonsteroidal cream. What type of lesion does the nurse know is characteristic of psoriasis?

Red, raised patch covered with silver scales

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.

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 young college student recently had her tongue and lip pierced. She has developed a superinfection of candidiasis from the antibacterial mouthwash. Which of the following would be the correct recommendation for her?

Use an antifungal mouthwash or salt water.

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.

tinea

a common superficial fungal infection on the skin or scalp also called ringworm

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.

hydrophilic

a material that absorbs moisture

hygroscopic

a material that absorbs moisture from the air

hydrophobic

a material that repels moisture

bullae

large, fluid-filled blisters

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.

suspensions

liquid preparations in which powder is suspended, requiring shaking before use

carbuncle

localized skin infection involving several hair follicles

furuncle

localized skin infection of a single hair follicle also known as a boil

liniments

lotions with added oil for increased softening of the skin

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.

What are places with common outbreaks of scabies? Select all that apply.

nursing homes military barracks prisons boarding schools child care centers Anywhere large groups of people are confined

xerosis

overly dry skin

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

overproduction of sebum

A client is undergoing photochemotherapy involving a combination of a photosensitizing chemical and ultraviolet light. What health problem does this client most likely have?

psoriasis

pyodermas

pus-forming bacterial skin infections

debridement

removal of necrotic or dead tissue by mechanical, surgical, chemical, or autolytic means

acantholysis

separation of epidermal cells from each other due to damage or abnormality of the intracellular substance

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

the infection results from reactivation of the chickenpox virus.

comedones

the primary lesions of acne, caused by sebum blockage in the hair follicle

lichenification

thickening of the horny layer of the skin also known as scaling

Which drug is an oral retinoid used to treat acne?

Isotretinoin

A client has a squamous cell carcinoma removed from the right lower leg. After the surgery, the nurse reviews instructions for care of the pressure dressing and provides health information about the cancer. Which statements are correct regarding squamous cell carcinoma? Select all that apply.

It is an invasive carcinoma. It can develop from a keratosis. It is responsible for approximately 4,000 deaths per year. It requires follow-up examinations every 3 months for 1 year.

A nurse in a healthcare provider's office teaches a client how to apply plastic film as an occlusive dressing to cover a medicated ointment applied to the arm. What important teaching point would be included by the nurse?

Limit use of the dressing to 12 hours.

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?

The ABCD method offers one way to assess skin lesions for possible skin cancer. What does the A stand for?

Asymmetry

Which of the following terms refers to a graft derived from one part of a patient's body and used on another part of that same patient's body?

Autograft

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

Autolytic debridement

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?

Corticosteroids

The nurse is caring for a geriatric client who has developed chapped and itchy skin. Which nursing intervention included in this client's plan of care should the nurse alter?

Daily bathing with warm-hot water

A client presents in the emergency department with complaints of cough, headache, and generalized aches and pains. Upon assessment, the nurse documents a temperature of 102.5°F (39.2°C) and redness on the arms, legs, and upper chest. She also notes that the client takes eight different medications each day. What nursing diagnosis is the priority for this client?

Impaired tissue integrity

A nurse assesses a client with dry, rough, scaly skin without lesions and the presence of itching on the legs. What skin assessment would the nurse document?

Pruritus

A patient is diagnosed with psoriasis after developing scales on the scalp, elbows, and behind the knees. The patient asks the nurse where this was "caught." What is the best response by the nurse?

Psoriasis is an inflammatory dermatosis that results from an overproduction of keratin.

The school nurse is instructing a parent in the care and elimination of lice from their child's hair. The parent brings all of the products for care in a bag. Which contents are not appropriate for use?

Shampoo and conditioner