664 SDL 1 - Integumentary

A topical corticosteroid is prescribed for an infant with dermatitis in the gluteal area. The nurse provides instructions to the mother regarding the use of the medication. Which statement by the mother indicates an understanding of the use of the medication? A. "I should not rub the medication into the skin." B. "The medication will help relieve the inflammation." C. "I need to apply the medication in a thick layer to protect the skin." D. "I should protect the area by covering it with a diaper and plastic pants."

B. "The medication will help relieve the inflammation." Rationale: A topical corticosteroid will relieve inflammation. The mother should be advised not to apply a tight-fitting diaper or plastic pants after applying the medication because these items will act as an occlusive dressing. The use of occlusive dressings (bandages or plastic wraps) over the affected site is avoided after application of the topical corticosteroid unless the health care provider specifically prescribes this wound coverage. The medication is gently rubbed into the skin after a thin layer is applied.

While caring for a client recovering from a major burn injury, the nurse notes a significant increase in urine output. The nurse will plan care for which stage of burn treatment? A. Emergent B. Acute C. Rehabilitative D. Resuscitative

B. Acute Rationale: The acute stage begins with the start of diuresis and ends with the closure of the burn wound. Choices A and D are incorrect because this phase begins from the onset of injury and ends through successful fluid resuscitation as evidenced by diuresis. Choice C is incorrect because the rehabilitative phase begins after the burn wound has been closed and continues until the client is able to return to the highest level of independence and functioning.

Tetracycline is prescribed for a client with severe acne. The nurse instructs the client regarding the importance of reporting which finding if it occurs? A. Sunburn B. Persistent diarrhea C. Epigastric burning D. Abdominal cramping

B. Persistent diarrhea RATIONALE: Tetracycline can be used to treat severe acne. Adverse effects include gastrointestinal irritation manifested as epigastric burning, cramps, nausea, vomiting, and diarrhea. These effects do not need to be reported unless the diarrhea becomes persistent and severe. If this does occur, this could indicate another adverse effect, superinfection. Clostridium difficile infection is another potential adverse effect associated with tetracycline use. In addition, photosensitivity is another potential effect, which can more easily result in sunburn. Clients should be instructed to wear sunscreen. A sunburn does not need to be reported necessarily, as this is an expected and self-limiting effect. Other adverse effects include yellowing of the teeth (which can occur in the unborn fetus), hepatotoxicity, and renal toxicity.

A home health nurse is visiting a client who has been started on therapy with clotrimazole. The nurse determines the effectiveness of the medication by noting a decrease in which problem? A. Pain B. Rash C. Fever D. Sneezing

B. Rash Rationale: Clotrimazole is a topical antifungal agent used in the treatment of cutaneous fungal infections. It is not used for pain, fever, or sneezing.

Which of the following burns is most painful? A. First degree B. Second degree C. Third degree D. Fourth degree

B. Second degree

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 about the treatments? A. "The medication is an antibacterial." B. "The medication will help heal the burn." C. "The medication is likely to cause stinging every time it is applied." D. "The medication should be applied directly to the wound."

C. "The medication is likely to cause stinging every time it is applied." Rationale: Silver sulfadiazine is an antibacterial that has a broad spectrum of activity against gram-negative bacteria, gram-positive bacteria, and yeast. It is applied directly to the wound to assist in healing. It does not cause stinging when applied.

A 10-year-old male is playing with matches and gets burned. His burn is waxy white in appearance. This burn is classified as: A. First degree. B. Superficial partial-thickness. C. Deep partial-thickness. D. Third degree.

C. Deep partial-thickness.

A client is burned through all the dermis with only a few epidermal appendages intact. This burn is classified as: A. First degree. B. Superficial partial-thickness. C. Deep partial-thickness. D. Third degree.

C. Deep partial-thickness.

The fluid most often used in fluid resuscitation following a major burn injury is: A. 0.9% Normal Saline B. Human Albumin C. Lactated Ringer D. 5% Dextrose in water

C. Lactated Ringer

Tinea capitis is an infection involving the: A. Trunk B. Feet C. Scalp D. Nails

C. Scalp Tinea capitis: Ringworm of the scalp (tinea capitis) is a fungal infection of the scalp and hair shafts. The signs and symptoms of ringworm of the scalp may vary, but it usually appears as itchy, scaly, bald patches on the head.

A nurse gives a 13-year old client an ice bag to place over her sprained ankle. How long should the nurse have the client apply the bag before removing it? a. 25 minutes b. 20 minutes c. 15 minutes d. 10 minutes

b. 20 minutes

The school nurse has provided instructions regarding the use of permethrin rinse to the parents of children diagnosed with pediculosis capitis (head lice). Which statement by one of the parents indicates a need for further instruction? A. "It is applied to the hair and then shampooed out." B. "The hair should not be shampooed for 24 hours after treatment." C. "The permethrin rinse can be obtained over the counter in a local pharmacy." D. "It is applied to the hair after shampooing, left on for 10 minutes, and then rinsed out."

A. "It is applied to the hair and then shampooed out." Rationale: Permethrin rinse is an over-the-counter scabicide that kills lice and eggs with 1 application and has residual activity for 10 days. It is applied to the hair after shampooing (using a conditioner-free shampoo) and left for 10 minutes before rinsing out. The hair should not be shampooed for 24 hours after the treatment.

A patient comes to the clinic for a follow-up appointment after using a glucocorticoid ointment for eczema for 3 weeks. Because the patient is pleased with the results, she states that she would like to continue treatment with an oral glucocorticoid. What response from the nurse is most appropriate? A. "Oral glucocorticoids have more systemic side effects and are only indicated if topical glucocorticoids have been ineffective." B. "Oral glucocorticoids will have fewer side effects, so your suggestion is good. C. "You make an excellent point! Topical glucocorticoids can cause skin atrophy, whereas oral agents don't have the same effect." D. "Oral glucocorticoids are more convenient to use, so I agree with your suggestion."

A. "Oral glucocorticoids have more systemic side effects and are only indicated if topical glucocorticoids have been ineffective."

A 40-year-old is diagnosed with skin cancer. It is explained that the most important risk factor for skin cancer is: A. Amount of direct sun exposure at a young age. B. Amount of sun exposure over age 50. C. Lifetime amount of sun exposure. D. Living in equatorial regions where the sun is most intense.

A. Amount of direct sun exposure at a young age.

The nurse is applying a topical corticosteroid to a client with eczema. The nurse should apply the medication to which body area? Select all that apply. A. Back B. Axilla C. Eyelids D. Soles of the feet E. Palms of the hands

A. Back D. Soles of the feet E. Palms of the hands Rationale: Topical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions where permeability is poor (back, palms, soles). The nurse should avoid areas of higher absorption to prevent systemic absorption.

Which type of microbe causes Tinea infections? A. Fungus B. Virus C. Gram-negative bacterium D. Mite

A. Fungus

The adrenal gland secretes epinephrine and norepinephrine in response to sympathetic stimulation. When caring for a client in this phase, what will the nurse assess? (Select all that apply.) A. Peripheral vasoconstriction & decreased renal perfusion. B. Elevated blood glucose level. C. Rapid respirations and shallow breathing. D. Decreased urine output. E. Decreased blood pressure and heart rate. F. Decreased glycogen synthesis.

A. Peripheral vasoconstriction & decreased renal perfusion. B. Elevated blood glucose level. C. Rapid respirations and shallow breathing. D. Decreased urine output. Rationale: During times of stress, the adrenal medulla secretes hormones that will increase myocardial contractility, bronchial dilation, and cellular metabolism. The client will demonstrate tachycardia, an elevated blood glucose level, rapid respirations, and a decrease in urine output because the blood flow to the kidney will be reduced. Choice E is incorrect because renin is increased during this phase which causes the release of angiotensin that increases the blood pressure.

A client is seen in the clinic for a complaint of scalp itching that has been persistent over the past several weeks. After an assessment, it is determined that the client has head lice. Permethrin shampoo is prescribed, and the nurse provides instructions to the client regarding the use of the medication. The nurse should tell the client to take which measure? A. Put the medication in 1 time only. B. Leave the medication in for at least 4 hours. C. Wash, rinse, and towel-dry the hair before applying. D. Leave the shampoo on for 8 to 12 hours and then remove by washing.

C. Wash, rinse, and towel-dry the hair before applying. Rationale: Permethrin is toxic to adult mites and lice but less toxic to the ova. For this reason, retreatment may be required. It is required to wash, rinse, and towel-dry the hair before applying the medication. It is left in for 10 minutes and removed by a warm water rinse. Therefore, options 1, 2, and 4 are incorrect.

A burn client has been having 1% silver sulfadiazine applied to burns twice a day for the past 3 days. Which laboratory abnormality indicates that the client is experiencing a side or adverse effect of this medication? A. Serum sodium of 120 mEq/L (120 mmol/L) B. Serum potassium of 3.0 mEq/L (3.0 mmol/L) C. White blood cell count of 3000 mm3 (3 × 109/L) D. pH 7.30, PaCO2 of 32 mm Hg (32 mmHg), HCO3- of 19 mEq/L (19 mmol/L)

C. White blood cell count of 3000 mm3 (3 × 109/L) RATIONALE: Transient leukopenia typically occurs after 2 to 3 days of treatment. Knowing this and knowing normal white blood cell values will direct you to option 3. Although options 1, 2, and 4 are abnormal findings, they are not associated with this medication.

A topical corticosteroid is prescribed for a client with dermatitis. The nurse provides instructions to the client regarding the use of the medication. Which statement by the client would indicate a need for further instruction? A. "I need to apply the medication in a thin film." B. "I should gently rub the medication into the skin." C. "The medication will help relieve the inflammation and itching." D. "I should place a bandage over the site after applying the medication."

D. "I should place a bandage over the site after applying the medication." Rationale: Clients should be advised not to use occlusive dressings (bandages or plastic wraps) to cover the affected site after application of the topical corticosteroid unless the health care provider specifically prescribes wound coverage. The remaining options are accurate statements related to the use of this medication.

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? A. Immediately before swimming B. 5 minutes before exposure to the sun C. Immediately before exposure to the sun D. At least 30 minutes before exposure to the sun

D. At least 30 minutes before exposure to the sun Rationale: Sunscreens are most effective when applied at least 30 minutes before exposure to the sun so that they can penetrate the skin. All sunscreens should be reapplied after swimming or sweating.

A client with a total body surface area burn of 45% is experiencing hypovolemic shock. How can the nurse explain this type of shock to the client's family? A. Inflammation causes hyperemia B. Decreased peristalsis increases the risk of aspiration C. Antidiuretic hormone is released from the posterior pituitary gland D. Fluids shift from capillaries into interstitial compartments reducing circulating fluid volume

D. Fluids shift from capillaries into interstitial compartments reducing circulating fluid volume. Rationale: Hypovolemic shock or burn shock occurs when a massive amount of fluid shifts from the intracellular and intravascular compartments into the interstitium causing third-spacing. Choice A describes what occurs to the respiratory system with a major burn injury. Choice B describes the gastrointestinal effects of a major burn injury. Choice C describes the urinary system effects of a major burn injury.

A 50-year-old male recently underwent a liver transplant & is taking immunosuppressive drugs. He now has painful vesicular eruptions on the face and trunk. He reports that he had chickenpox as a child. Which is the most likely diagnosis based on his chickenpox history? A. Erysipelas B. Poliomyelitis C. Warts D. Herpes zoster

D. Herpes zoster

A patient wants to know which malignant skin lesion is the most serious. The correct response is: A. Basal cell carcinoma. B. Squamous cell carcinoma. C. Kaposi sarcoma (KS). D. Malignant melanoma.

D. Malignant melanoma.

A client has a wound with a moderate amount of drainage and is scheduled for a dressing change. Which dressing, if selected by the student nurse, requires further intervention by the nursing instructor? A. Foam B. Alginate dressing C. Hydrocolloid dressing D. Semipermeable transparent film

D. Semipermeable transparent film Rationale: The client's wound has moderate drainage. Recall that foam, alginate, and hydrocolloid dressings are applied to wounds with moderate to heavy drainage. Semipermeable transparent films are applied to dry wounds.

Which of the following best describes the typical lesion of psoriasis? A. Purplish papules B. Firm raised pruritic nodules C. Moist red vesicles D. Silvery plaques on an erythematous base

D. Silvery plaques on an erythematous base Psoriasis is a common skin condition that speeds up the life cycle of skin cells. It causes cells to build up rapidly on the surface of the skin. The extra skin cells form scales and red patches that are itchy and sometimes painful. Psoriasis is a chronic disease that often comes and goes.

The most reliable criterion of adequate fluid resuscitation following a major burn injury is: A. Blood pressure. B. Pulse rate. C. Respiratory rate. D. Urine output.

D. Urine output.

Silver sulfadiazine is prescribed for a client with a burn injury. Which laboratory finding requires the need for follow-up by the nurse? A. Glucose level of 99 mg/dL (5.65 mmol/L) B. Magnesium level of 1.5 mEq/L (0.75 mmol/L) C. Platelet level of 300,000 mm3 (300 × 109/L) D. White blood cell count of 3000 mm3 (3.0 × 109/L)

D. White blood cell count of 3000 mm3 (3.0 × 109/L) Rationale: Silver sulfadiazine is used for the treatment of burn injuries. Adverse effects of this medication include rash and itching, blue-green or gray skin discoloration, leukopenia, and interstitial nephritis. The nurse should monitor a complete blood count, particularly the white blood cells, frequently for the client taking this medication. If leukopenia develops, the health care provider is notified and the medication is usually discontinued. The white blood cell count noted in option 4 is indicative of leukopenia. The other laboratory values are not specific to this medication, and are also within normal limits.

When evaluating the initial laboratory values of a client with an extensive burn injury, the emergency department nurse notes an elevated hematocrit level. What does this finding indicate? a. the client did not suffer internal hemorrhage b. the client requires aggressive fluid replacement therapy c. the client inhaled carbon monoxide d. the client requires anticoagulation therapy.

b. the client requires aggressive fluid replacement therapy RATIONALE: The elevated hematocrit in this client is caused by massive loss of intravascular fluid into the interstitium (third spacing) as part of the acute inflammatory reaction following burn injury. This is called hemoconcentration. It does not mean that the client is hemodynamically stable. Aggressive fluid resuscitation is required to prevent distributive shock. Once fluid replacement is initiated, the hematocrit will fall rapidly, revealing the client's "real" hemodynamic status. Choice A is incorrect because the high hematocrit is caused by hemoconcentration and is not a reliable indicator of the client's hemodynamic status. A client with a burn injury is more likely to develop third spacing (loss of fluid to the interstitial tissue and body cavities) than internal hemorrhage. Choice C is incorrect because the hematocrit does not provide evidence for this statement. Choice D is incorrect because the client is likely to need blood replacement therapy due to the loss of blood gas and coagulation factors into the third space.