SOC4- Integumentary

A client with severe acne is seen in the clinic and the HCP prescribes isotretinoin (amnesteem or claravis). The nurse reviews the client's medication record and would contact the HCP if the client is taking which medication? 1. vitamin A 2. digoxin (lanoxin) 3. furosemide (lasix) 4. phenytoin (dilantin)

1

When assessing a lesion diagnosed as malignant melanoma, the nurse most likely expects to note which finding? 1. an irregularly shaped lesion 2. a small papule with a dry, rough scale 3. a firm, nodular lesion topped with crust 4. a pearly papule with a central crater and a waxy border

1 A melanoma is an irregularly shaped pigmented papule or plaque with a red, white, or blue toned color. Antinic keratosis, a premalignant lesion, appears as a small macule or papule with a dry, rough, adherent yellow or brown scale. Squamos cell carcinoma is a firm nodular lesion topped with a crust or a central area of ulceration. Basal cell carcinoma appears as a pearly papule with a central crater and rolled waxy border

Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which finding indicates the presence of systemic toxicity from this medication? 1. tinnitus 2. diarrhea 3. constipation 4. decreased respirations

1

The clinic nurse is performing an admission assessment on a client and notes that the client is taking azelaic acid (azelex). Because of the medication prescription, the nurse would suspect that the client is being treated for which condition? 1. acne 2. eczema 3. hair loss 4. herpes simplex

1

The mother of a 3 yo arrives at a clinic and tells the nurse that the child has been scratching the skin continuously and has developed a rash. The nurse assesses the child and suspects the presence of scabies. The nurse bases this suspicion on which finding noted on assessment of the child's skin 1. fine greyish red lines 2. purple colored lesions 3. thick, honey covered crusts 4. clusters of fluid-filled vesicles

1 Scabies is a parasitic skin disorder caused by an infestation of Sarcoptes scabiei (itch mite). Scabies appears as burrors or fine, grayish red, threadlike lines. They may be difficult to see if they are obscured by excoriation and inflammation. Purple-colored lesions may indicate various disorders, including systemic conditions. Thick, honey- colored crusts are characteristics of impetigo or secondary infection in eczema. Clusters of fluid-filled vesicles are seen in herpes virus infection

The nurse manager is planning the clinical assignments for the day. Which staff members can be assigned to care for a client with herpes zoster. Select all that apply 1. the nurse who has never had roseola 2. the nurse who has never had mumps 3. the nurse who has never had chickenpox 4. the nurse who has never had German measles 5. the nurse who has never received the varicella-zoster vaccine

1, 2, 4 Herpes zoster is caused by a reactivation of the varicella-zoster virus, the causative virus of chickenpox. Individuals who have not been exposed to the varicella-zoster virus or who did not recieve the varicella-zoster vaccine are susceptible to chickenpox. Health care workers who are unsure of their immune status should have varicella titers done before exposure to a person with herpes zoster.

The nurse is caring for a client who suffered an inhalation injury from a wood stove. The carbon monoxide blood report reveals a level of 12%. Based on this level, the nurse would anticipate noting which sign in the client? 1. coma 2. flushing 3. dizziness 4. tachycardia

2 Carbon monoxide levels between 11-20% result in flushing, headache, decreased visual activity, decreased cerebral functioning, and slight breathlessness. Levels 21-40% result in nausea, vomiting, dizziness, tinnitus, vertigo, confusion, drowsiness, pale to reddish-purple skin, and tachycardia. 41-60% result in seizure and coma. Levels higher than 60% result in death

A client is being admitted to the hospital for treatment of acute cellulitis of the lower left leg and asks the admitting nurse to explain what cellulitis means. The nurse bases the response on the understanding that cellulitis has which characteristic? 1. an inflammation of the epidermis only 2. a skin infection of the dermis and underlying hypodermis 3. an acute superficial infection of the dermis and lymphatics 4. an epidermal and lymphatic infection caused by staphalococcus

2 Cellulitis is an infection of the dermis and underlying hypodermis that results in a deep red erythema without sharp boarders and spreads widely throughout tissue spaces. The skin is erythematous, tender, and sometimes nodular. Erysipelas is an acute, superficial, rapidly spreading inflammation of the dermis and lymphatics

Mafenide acetate (Sulfamylon) is prescribed for a client with a burn injury. When applying the medication, the client complains of local discomfort and burning. The nurse should take which most appropriate action? 1. Discontinue the medication 2. notify HCP 3. inform the client that this is expected 4. apply a thinner film than prescribed to the burn site

3

Silver sulfadiazine is prescribed for a client with a partial-thickness burn and the nurse provides teaching about the medication. Which statement made by the client indicates a need for further teaching abut the treatments? 1. "the medication is an antibacterial" 2. "the medication will help heal the burn" 3. "the medication will permanently stain my skin" 4. "the medication should be applied directly to the wound"

3

The nurse manager is observing a new nursing graduate caring for a burn client in protective isolation. The nurse manager intervenes if the new nursing graduate planned to implement which unsafe component of protective isolation technique? 1. Using sterile sheets and linens 2. Performing strict hand washing technique 3. Wearing gloves and a gown only when giving direct care to the client 4. Wearing protective garb, including a mask, gloves, cap, shoe covers, gowns, and plastic apron

3

A client calls the emergency department and tells the nurse that he came directly into contact with poison icy shrubs. The client tells the nurse that he cannot see anything on the skin and asks the nurse what to do. The nurse should make which response? 1. "come to the emergency department" 2. "apply calamine lotion immediately to the exposed skin areas" 3. "take a shower immediately, lathering and rinsing several times" 4, "it is not necessary to do anything if you cannot see anything on your skin"

3 When an individual comes in contact with a poison ivy plant, the sap from the plant forms and invisible film on the human skin. The client should be instructed to cleanse the area by showering immediately and to later the skin several times and rinse each time in running water. Calamine lotion may be one product recommended for use if dermatitis develops. The client does not need to be seen in the emergency department at this time

The clinic nurse notes that the health care provider has documented a diagnosis of herpes zoster (shingles) in the client's chart. Based on an understanding of the cause of this disorder, the nurse determines that this definitive diagnosis was made by which diagnostic test? 1. patch test 2. skin biopsy 3. culture of the lesion 4. wood's light examination

3 With the classic presentation of herpes zoster, the clinical examination is diagnostic. However, a viral culture of the lesion provides the definitive diagnosis.. Herpes zoster (shingles) is caused by a reactivation of the varicella-zoster virus, the virus that causes chickenpox. A patch test is a skin test that involves administration of an allergen to the surface of the skin to identify specific allergies. A biopsy would provide a cytological examination of tissue. In wood's light examination, the skin is viewed under ultraviolet light to identify superficial infections of the skin

A client arriving at the emergency department has experienced frostbite to the right hand. Which finding would the nurse note on assessment of the client's hand 1. a pink, edematous hand 2. a fiery red skin with edema in the nail beds 3. black fingertips surrounded by an erythematous rash 4. a white color to the skin, which is insensitive to touch

4 Assessment findings in frostbite include a white or blue color; the skin will be hard, cold, and insensitive to touch. As thawing occurs, flushing of the skin, the development of blisters or blebs, or tissue edema appears

A topical corticosteriod is prescribed by a health care provider for a child with atopic dermatitis (eczema). Which instruction should the nurse give the parent about applying the cream? 1. apply the cream over the entire body 2. apply a thick layer of cream to the affected area only 3. avoid cleansing the area before application of the cream 4. apply a thin layer of cream and rib it into the area thoroughly

4 Atopic dermatitis is a superficial inflammatory process involving primarily the epidermis. A topical corticosteroid may be prescribed and should be used sparingly (thin layer) and rubbed into the area thoroughly. The affected area should be cleaned gently before application. A topical corticosteroid should not be applied over extensive areas.

The nurse is caring for a client who sustained superficial partial-thickness burns on the anterior lower legs and anterior thorax. Which finding does he nurse expect to note during the resuscitation/emergent phase of burn injury 1. decreased HR 2. increased urinary output 3. increased BP 4. elevated hematocrit levels

4 During the resuscitation/emergent phase, the hematocrit level increases to above normal because of hemoconcentration from the large fluid shifts. Hematocrit levels of 50-55% are expected during the first 24 hours of injury, with return to normal within 36 hours.

The school nurse is conducting pediculosis capitis (head lice) assessments. Which finding indicates a child has a "positive" head check 1. maculopapular lesions behind the ears 2. lesions in the scalp that extend to the hairline or neck 3. white flaky particles throughout the entire scalp region 4. white sacs attached to the hair shafts in the occipital area

4 Pediculosis capitis is an infestation of the hair and scalp with lice. The nits are visible and attached firmy to the hair shaft near the scalp. The occiput is an area in which nits can be seen. Maculopapular lesions behind the ears or lesions that extend to the hairline or neck are indicative of an infectious process, not pediculosis. White flaky particles are dandruff

Permethrin (elimite) is prescribed for a child with a diagnosis of scabies. The nurse should give which instruction to the parents regarding the use of this treatment? 1. apply the lotion to the rash only 2. apply the lotion and leave it on for 6 hours 3. avoid putting clothes on the child over the lotion 4. apply the lotion to cool, dry skin at least 30 minutes after bathing

4 Permethrin is massaged thoroughly and gently into all skin surfaces (not just the areas that have the rash) from the head to the soles of the feet. Care should be taken to avoid contact with eyes. The lotion should not be applied until at least 30 minutes after bathing and should be applied only to cool, dry, skin. The lotion should be kept on for 8 to 14 hours, and then the child should be given a bath. The child should be clothed during the 8-14 hours of treatment contact time

The clinic nurse assesses the skin of a client with a diagnosis of psoriasis. The nurse understands that which characteristic is associated with this skin disorder? 1. oily skin 2. clear, thin nail beds 3. red-purplish scaly lesions 4. silvery-white scaly patches

4 Psoriatic patches are covered with silvery white scales. Affected areas include the scalp, elbows, knees, shins, sacral area, and trunk. Thickening, pitting, and discoloration of the nails occur. Pururitis may occur. These lesions in psoriasis are not red-purplish scaly lesions and the skin is dry

A burn client is receiving treatments of topical mafenide acetate (sulfamylon) to the site of injury. The nurse monitors the client, knowing which finding indicates that a systemic effect as occurred? 1. hyperventilation 2. local rash at the burn site 3. elevated blood pressure 4. local pain at the burn site

1

The nurse is preparing to care for a burn client scheduled for an escharotomy procedure being performed for a third-degree circumferential arm burn. The nurse understands that which finding is the anticipated therapeutic outcome of the escharotomy? 1. return of distal pulses 2. brink bleeding from the site 3. decreasing edema formation 4. formation of granulation tissue

1 Escharotomies are performed to relieve the compartment syndrome that can occur when edema forms under nondistensible eschr in a circumferential third-degree burn. Escharotomies are performed through avascular eschar to sibcutaneous fat.

The clinic nurse is reviewing the health care provider's prescription for a child who has been diagnosed with scabies. Lindane has been prescribed for the child. The nurse questions the prescription if which is noted in the child's record? 1. the child is 18 months old 2. the child is being bottle fed 3. a sibling is using lindane for treatment of scabies 4. the child has a history of frequent respiratory infections

1 Lindane is pediculide product that may be prescribed to treat scabies. It is contraindicated in patients that are under 2 yo because they have moer permeable skin, and high systemic absorption may occur, placing children at risk for CNS toxicity and seizures. Lindane also is used with caution in children between 2 and 10 years.. Siblings and other household members should be treated simultaneously. Options 2 and 4 are unrelated to the use of lindane. Lindane is not recommended for breast feeding women.

Isotretinoin (Amnesteem or Claravis) is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed? 1. platelet count 2. triglyceride level 3. complete blood count 4. white blood cell count

2

The nurse is applying a topical corticosteroid to a client with eczema. The nurse should monitor for the potential for increased systemic absorption of the medication if the medication were being applied to which body area? 1. back 2. axilla 3. soles of the feet 4. palms of the hands

2

The nurse is monitoring a child with burns during treatment for burn shock. The nurse understands that which assessment provides the most accurate guide to determine the adequacy of fluid restriction 1. skin turgor 2. neurological assessment 3. level of edema at burn site 4. quality of peripheral pulses

2 Seneorium is an accurate guide to determine the adequacy of fluid resusitation. The burn injury itself does not affect the sensorium, so the child should be alert and oriented. Any alteration in sensorium should be evaluated further. A neuro assessment would determine the level of sensorium in a child. Options 1, 3, and 4 would not provide an accurate assessment of adequacy of fluid restriction

The nurse is administrating fluids intravenously as prescribed to a client who sustained superficial partial-thickness burn injuries of the back and legs. In evaluating the adequacy of fluid resuscitation, the nurse understands that which assessment would provide the most reliable indicator for determining the adequacy? 1. vital signs 2. urine output 3. mental status 4. peripheral pulses

2 Successful or adequate fluid resuscitation in the client is signaled by stable vital signs, adequate urine output, palpable peripheral pulses, and clear sensorium. However, the most reliable is urine output

The health education nurse provides instructions to a group of clients regarding measures that will assist in preventing skin cancer. Which instructions should the nurse provide? Select all that apply 1. sunscreen should be applied every 8 hours 2. use sunscreen when participated in outdoor activities 3. wear a hat, opaque clothing, and sunglasses when in the sun 4. avoid sun exposure in the late afternoon and early evening hours 5. examine your body monthly for any lesions that may be suspicious

2, 3, 5

A client is brought to the emergency department with partial thickness burns to his face, neck, arms, and chest after trying to put out a car fire. The nurse should implement which nursing actions for this client? Select all that apply 1. restrict fluids 2. assess for airway patency 3. administer oxygen as prescribed 4. place a cooling blanket on the client 5. elevate extremities if no fracture are present 6. prepare to give oral pain medication as prescribed

2, 3, 5 The primary goal for a burn injury is to maintain patient airway, administer IV fluids to prevent hypovolemic shock, and preserve vital organ functioning. Therefore the priority actions are to assess for airway patency and maintain a patient airway. The nurse then prepares to administer oxygen. Oxygen is necessary to perfuse vital tissues and organs. An IV line should be obtained and fluid resuscitation started. The extremities are elevated to assist in preventing shock. The client iss kept warm and placed on NPO status because of the altered GI function that occurs as a result of a burn injury.

The nurse who is caring for a child who sustained a burn injury plans care based on which pediatric consideration associated with this injury? Select all the apply 1. scarring is less severe in a child than in an adult 2. a delay in growth may occur after a burn injury 3. an immature immune system presents an increased risk of infection for infants and young children 4. the lower proportion of body fluid to mass in a child increases the risk of cardiovascular problems 5. fluid resuscitation is unnecessary unless the burned area is more than 25% of the total body surface area 6. infants and young children are at increased risk for protein and calorie deficiency because they have smaller muscle mass and less body fat than adults

2, 3, 6 Pediatric considerations in the care of a burn victim include the following: scarring is more severe in children than adults. A delay in growth may occur after a burn injury. An immature immune system presents an increased risk of infection for infants and young children. The higher proportion of body fluid to mass in a child increases the risk of cardiovascular problems. Fluid resuscitation is unnecessary unless the burned area is more than 10% of the total body surface area. Infants and young children are at increased risk for protein and calorie deficiency because they have smaller muscle mass and less body fat than adults

An adult client was burned in an explosion. The burn initially affected the client's entire face (anterior half of the head) and the upper half of the anterior torso, and there were circumferential burns to the lower half of both arms. The client's clothes caught on fire, and the client ran, causing subsequent burn injuries to the posterior surface of the head and the upper half of the posterior torso. Using the rule of nines, what would be the extent of the burn injury? 1. 18% 2. 24% 3. 36% 4. 48%

3 According to the rule of nines, with the initial burns, the anterior half of the head equals 4.5%, the upper half of the anterior torso is 9%, the lower half of both arms equals 9%. The subsequent burn included the posterior half of the head (4.5%) and the upper half of posterior torso (9%) this totals 36%

A client is undergoing fluid replacement after being burned on 20% of her body 12 hours ago. The nursing assessment reveals a blood pressure of 90/50 mm Hg, a pulse rate of 110 beats/minute, and a urine output of 20 mL over the past hour. The nurse reports the findings to the health care provider (HCP) and anticipates which prescription? 1. transfusing 1 unit of PRBC 2. administering a diuretic to increase urine output 3. increasing the amount of IV LR solution administered per hour 4. changing the IV LR's solution to one that contains dextrose in water

3 Fluid management during the first 24 hours following a burn generally includes the infusion of (usually) LR solution. Fluid restriction is determined by urine output and hourly urine output should be at least 30ml/hour.

The school nurse has provided an instructional session about impetigo to parents of the children attending the school. Which statement, if made by a parent indicates need for further instruction? 1. "it is extremely contagious" 2. "it is most common in humid weather" 3. "lesions are most often located on the arms and chest" 4. "it might show up on an area of broken skin such as an insect bite"

3 Impetigo is a contagious bacterial infection of the skin caused by b-hemolytic strep or staph or both. It is most common during hot, humid, summer months. Impetigo may begin in an area of broken skin, such as an insect bite or atopic dermatitis. Impetigo is extremely contgious. Lesions are usually located around the mouth and nose, but may be present on other extremeities

A client returns to the clinic for follow-up treatment following a skin biopsy of a suspicious lesion performed 1 week ago. The biopsy report indicates that the lesion is a melanoma. The nurse understands that melanoma has which characteristic? 1. metastasis is rare 2. it is encapsulated 3. it is highly metastatic 4. it is characterized by local invasion

3 Melanomas are pigmented malignant lesions originating in the melanin-producing cells of the epidermis. This skin cancer is highly metastatic, and a person's survival depends on early diagnosis and treatment.

The nurse is caring for a client following an autograft and grafting to a burn wound on the right knee. What would the nurse anticipate to be prescribed for the client? 1. Out-of-bed activities 2. Bathroom privileges 3. Immobilization of the affected leg 4. Placing the affected leg in a dependent position

3 The period of immobilization allows the autograft time to adhere to the wound bed

The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied at which times? 1. immediately before swimming 2. 5 minutes before exposure to the sun 3. immediately before exposure to the sun 4. at least 30 minutes before exposure to the sun

4

A client arrives at the emergency department following a burn injury that occurred in the basement at home, and an inhalation injury is suspected. What would the nurse anticipate to be prescribed for the client? 1. 100% oxygen via an aerosol mask 2. Oxygen via nasal cannula at 6 L/minute 3. Oxygen via nasal cannula at 15 L/minute 4. 100% oxygen via a tight-fitting, nonrebreather face mask

4 If an inhalatioon injury is suspected, administration of 100% oxygen via a tight fitting nonrebreather face mask is prescribed until carboxyhemoglobin levels fall.

The evening nurse reviews nursing documentation in a client's chart and notes that the day nurse has documented that the client has a stage 2 pressure ulcer in the sacral area. What finding would the nurse expect to note on assessment of the client's sacral area? 1. intact skin 2. full-thickness skin ulcer 3. exposed bone, tendon, or muscle 4.. partial-thickness skin loss of the dermis

4 In a stage 2 pressure ulcer, the skin is not intact. Partial-thickness skin loss of the dermis has occurred. It presents as a shallow open ulcer with a red-pink wound bed, without slough. It may also present as an intact, open or ruptured, serum-filled blister. The skin is intact in stage 1. Full thickness skin loss occurs at stage 3. Exposed bone, tendon, or muscle is stage 4

The nurse is conducting a session about the principles of first aid and is discussing the interventions for a snakebite to an extremity. The nurse should inform those attending the session that the first priority intervention in the event of this occurrence is which action? 1. immobilize the affected extremity 2. remove jewelry and constricting clothing from the victim 3. place the extremity in a position so that it is below the level of the heart 4. move the victim to a safe area away from the snake and encourage the victim to rest

4 In the event of a snakebite, the first priority is to move the victim to a safe area away from the snake and encourage them to rest to decrease venom circulation. Next, jewelry and constricting clothing are removed before swelling occurs. Immobilizing the extremity and maintaining the extremity below the heart level would be done next; these actions limit the spread of the venom. The victim is kept warm and calm.