Prep U: Chapter 56 Dermatologic conditions

A client is having cryosurgery to remove a growth on the leg. How long will the client be informed that healing will take?

4 to 6 weeks

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

Autolytic debridement

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

During the course of a health interview, Mrs. Young tells the nurse that she has been using a new perfume because she wants to smell good. She explains that she has had a rash on her arms and neck since she purchased and used the product. What would be an initial diagnosis for Mrs. Young?

Contact dermatitis

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

Cosmetics

A client has undergone dermabrasion to decrease scarring from severe acne 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.

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

Pressure ulcers are caused by:

Extrinsic factors

The most important principle of psoriasis treatment is which of the following?

Gentle removal of scales

Which sedative medication is effective for treating pruritus?

Hydroxyzine

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

Impetigo

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

Infection

Which drug is an oral retinoid used to treat acne?

Isotretinoin

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.

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

Keloid

The nurse is caring for a client with a furuncle. What advice should the nurse give a client with a furuncle to prevent the spread of the infection?

Never pick or squeeze a furuncle.

A client receives treatment for a dermatophyte infection of the toenail. How would the nurse document this condition in the chart?

Onychomycosis

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

Use shampoo with piperonyl butoxide.

Which drug is a topical corticosteroid used to treat psoriasis?

Triamcinolone

A client visits the physician's office for treatment of a skin disorder. As a primary treatment, the nurse expects the physician to order:

a topical agent.

What are places with common outbreaks of scabies? Select all that apply. 1. nursing homes 2. military barracks 3. prisons 4. boarding schools 5. child care centers 6. Anywhere large groups of people are confined

1 2 3 4 5 6

Which assessment finding indicates an increased risk of skin cancer?

A deep sunburn

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

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.

The nurse caring for a client with repeated episodes of contact dermatitis is providing instruction to prevent future episodes. Which information should the nurse include?

Avoid cosmetics with fragrance

Which medication classification may be used for contact dermatitis?

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

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

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.

A client with diabetes mellitus has impaired skin integrity due to an injury. Which skin disorder is the client likely to develop?

Furuncle

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

Furuncle

A client reports noticing a greater than normal amount of hair loss, and is concerned about developing a bald spot on the head. Which condition is probably not causing the client's hair loss?

Furunculosis

A nurse employed in a school suspects an outbreak of pediculosis. Which of the following nursing actions should be taken to prevent and control the outbreak?

Insist that everyone who is infested with lice follows the prescribed treatment.

The nurse is caring for a client with a skin lesion that is oozing. The surrounding skin is acutely inflamed. What type of dressing should the nurse apply?

Interactive

When caring for a client in a prenatal clinic who has history of acne vulgaris, which client medication would the nurse advise against?

Isotretinoin

Which infecting agent causes scabies?

Itch mite

Which of the following is the most common complaint related to a diagnosis of head lice?

Itching

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 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 of the following is an appropriate teaching component for the client diagnosed with lice to prevent reinfestation?

Perform hair inspection whenever there is an outbreak, even if asymptomatic.

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

Preventing infection

The nurse working at a physician's office is providing teaching to the parent of a child diagnosed with Tinea capitis (ringworm of the head). How often should the nurse instruct the parent to shampoo the child's hair with ketoconazole or a selenium sulfide shampoo?

Twice weekly

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.

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 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. 1. remove allergen 2. cool baths without soap twice daily 3. apply hydrogen peroxide to dry rash 4. All options are correct.

1 2

A client presents with silvery scales on the elbows and knees. The physician has made a diagnosis of plaque psoriasis. What is the probable cause of psoriasis? Select all that apply. 1. genetic predisposition 2. a triggering mechanism, such as systemic infection, injury to the skin, vaccination, or injection 3. injury, such as squeezing a lesion 4. diabetes mellitus; elevated blood glucose level promotes microbial growth

1 2

The nurse is teaching a client about the correct use of topical concentrated corticosteroids. The nurse includes which statement(s)? Select all that apply. 1. Avoid applying to the face. 2. Avoid prolonged use. 3. Apply to intertriginous areas. 4. Hypertrichosis is normal.

1 2

There is an increase in the incidence of skin cancer being reported. Which have been identified as factors that predispose to malignant changes in the skin? Select all that apply. 1. Thinning ozone layer 2. residence in high-altitude areas where the atmosphere is thinner than at sea level 3. prolonged, repeated exposure to UV rays in those who do farming, fishing, road construction, etc. 4. use of sun block

1 2 3

What should the nurse assess for to determine if a patient using corticosteroids for a dermatologic condition is having local side effects? Select all that apply. 1. Skin atrophy 2. Striae 3. Telangiectasia 4. Comedones 5. Ecchymosis

1 2 3

Which of the following skin disorders is treated with intralesional therapy? Select all that apply. 1. Cystic acne 2. Psoriasis 3. Keloids 4. Contact dermatitis 5. Pemphigus vulgaris

1 2 3

A client seeks medical attention for a new skin condition. Which finding indicates to the nurse that the client is experiencing contact dermatitis? Select all that apply. 1. Pruritus 2. Burning 3. Papules 4. Vesicles 5. Silvery scales

1 2 3 4

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. 1. When did the disorder first begin, and where did it first appear? 2. Where are the lesions located? 3. Has the problem spread? 4. Have you tried to treat the lesions? 5. Do you exercise daily?

1 2 3 4

The nurse notes that a client who uses a wheelchair for long periods after recovering from an amputation has a reddened area over the coccyx. Which teaching will the nurse provide to the client to relieve the pressure? Select all that apply. 1. Perform push-ups. 2. Move from side to side. 3. Shift weight in the chair. 4. Complete half push-ups. 5. Tense the quadriceps muscles.

1 2 3 4

A young client has head lice. What are appropriate steps in eradication? Select all that apply. 1. Repeat combings daily until there is no more evidence of lice or nits. 2. Apply a pediculicide to the hair (detailed directions also accompany this medication). 3. Comb the hair free of tangles while the hair is damp. 4. Use a special lice comb that has narrow stainless steel teeth. 5. Comb through each area of the hair to remove lice.

1 2 3 4 5

The nurse is caring for a client with a blistering disease. Which action will the nurse take to relieve this client's discomfort? Select all that apply. 1. Dry the skin carefully after bathing. 2. Apply warmed blankets as necessary. 3. Measure temperature every 4 hours. 4. Premedicate with analgesics before skincare. 5. Apply tape to hold the dressing onto the skin.

1 2 4

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. 1. Close a surgical wound 2. After excision of a skin tumor 3. Repair a congenital deformity 4. Cover tendons and blood vessels 5. Cover loss of skin after a burn injury

1 2 5

The nurse is triaging a client over the phone who states having a contact dermatitis rash. Which treatment option of over-the-counter preparations does the nurse suggest for the client? Select all that apply. 1. Topical antihistamines 2. Cosmetic lotions 3. 1820 cream 4. Moisturizing cream 5. Lanolin based ointment

1 3 4 5

The nurse is providing instruction to a client with acne. The nurse promotes avoidance of which food(s)? Select all that apply. 1. Chocolate 2. Onions 3. Bananas 4. Ice cream

1 4

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 o 24 hours

The nurse is assessing a patient with toxic epidermal necrolysis (TEN). What assessment data would indicate that the patient may be progressing to keratoconjunctivitis? Select all that apply. 1. Skin peeling on eyelids 2. Pruritus of the eye 3. Burning of the eyes 4. Dryness of the eyes 5. Blurred optic discs

2 3 4

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. 1. It is the third most common of all three types of skin cancer. 2. It is an invasive carcinoma. 3. It can develop from a keratosis. 4. It is responsible for approximately 4,000 deaths per year. 5. It requires follow-up examinations every 3 months for 1 year.

2 3 4 5

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

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.

When caring for a client with severe impetigo, the nurse should include which intervention in the care plan?

Administering systemic antibiotics as ordered.

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

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

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

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

Fexofenadine (Allegra)

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

Have a thorough bath.

Which of the following medications is used to reduce turnover time of the psoriatic epidermis?

Methotrexate

Which of the following is a local side effect of topical corticosteroids?

Telangiectasia

A client's orders include a wound dressing using an autolytic debriding agent. The nurse providing discharge instructions to the client should include which statement?

The wound may have a foul odor.

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

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

Tinea cruris

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 patient who was recently diagnosed with pruritus on the chest and back is given information about skin care and bathing. The most important advice on cleansing is to avoid:

Washing with soap and hot water.

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 teaches the client who demonstrates herpes zoster (shingles) that:

the infection results from reactivation of the chickenpox virus.

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.

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.

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

Psoralen

Which material consists of a powder in water?

Suspension

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.

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 client comes into the hospital with a Tegaderm dressing in place on the buttocks. The nurse documents this as being which type of dressing?

Passive

A client has been diagnosed with melanoma. What treatment option can the nurse expect will be used?

Radical excision

A client is receiving autolytic debridement therapy. It would be important for the nurse to complete which procedure?

Advise the client about the foul odor that will occur during therapy.

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

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

Mohs micrographic surgery

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 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."

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

Antiviral

Diagnosis of skin cancer is confirmed by which of the following diagnostic tests?

Biopsy

When writing a plan of care for a client with psoriasis, the nurse would know that an appropriate nursing diagnosis for this client would be what? The nurse is working with community groups. At which of the following locations would the nurse anticipate a possible scabies outbreak?

College dormitory

Which primary lesions are associated with acne caused by sebum blockage in hair follicles?

Comedones

The nurse is caring for a client prescribed oral griseofulvin for treatment of a fungal toenail infection. Which instruction by the nurse is essential in understanding the treatment plan?

Continue medication regimen for several weeks.

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

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

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.

When writing a plan of care for a client with psoriasis, the nurse would know that an appropriate nursing diagnosis for this client would be what?

Impaired Skin Integrity Related to Scaly Lesions

A client asks the nurse what psoriasis is. What is the best answer?

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

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 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

The nurse prepares a patient with a benign skin lesion for surgical excision, intralesional corticosteroid therapy, and radiation. Which of the following is most likely the lesion described?

Keloid

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.

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.

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.

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

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 patient is diagnosed with malignant melanoma that directly invades the adjacent dermis (vertical growth). The nurse knows that this type of melanoma has a poor prognosis. Which of the following is most likely the type of melanoma described in this scenario?

Nodular melanoma

A young adult visits a health clinic for treatment of a severe case of eczema on his left leg. Which of the following is the preferred method for delivering medication in this scenario?

Ointment

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

Overproduction of sebum

Which condition is an autoimmune disease involving immunoglobulin G?

Pemphigus

A patient is being treated for chronic venous stasis ulcers of the lower extremities. What medication does the nurse understand will increase peripheral blood flow by decreasing the viscosity of blood and assist with the healing of the ulcers?

Pentoxifylline (Trental)

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

Psoriasis

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

Psoriasis

A client with atopic dermatitis is ordered a potent topical corticosteroid to be covered with an occlusive dressing. To address a potential client problem associated with this treatment, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement, the nurse should add which "related-to" phrase?

Related to percutaneous absorption of the topical corticosteroid

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 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

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

Secondary bacterial infection

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

A patient visits a health clinic with a skin lesion on her right forearm. The lesion is inflamed, swollen, and draining. The nurse practitioner knows the best choice of a treatment would be the application of which of the following?

Soothing lotion

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 dermatologist has asked the nurse to assist with examination of a client's skin using a Wood light. This test will allow the health care provider to assess for which of the following?

Unusual patterns of pigmentation on the client's skin

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?

Use an antifungal mouthwash or salt water.

The classic lesions of impetigo manifest as

honey-yellow crusted lesions on an erythematous base.