Chapter 23 - Integumentary Problems (Med Surg) EAQ's

Which white blood cell count is the best indicator that a 54-year-old patient with cellulitis has recovered from the infection? 1 2000/mm3 2 5000/mm3 3 13,000/mm3 4 16,500/mm3

2 - 5000/mm3 The normal white blood cell count is 4000 to 11,000 cells/mm3, according to most laboratory reference books. For this reason, the patient's level would have been deemed normal if it was 5000/mm3. A white blood cell count of 2000/mm3 is categorized as leukopenia and is abnormal. White blood cell counts of 13,000 or 16,500 mm3 would indicate continued infection. Text Reference - p. 414

A patient comes to the clinic and informs the nurse that the patient thinks that he or she may have been bitten or stung about three or four weeks ago. A ringlike rash is now present on the area and the patient states he or she has been feeling "flu-like". What question pertaining to this condition should the nurse ask the patient? 1 "Have you removed a tick?" 2 "Were you stung by a wasp?" 3 "Have you been itching all over? 4 "Have you noticed any bugs under your mattress?"

1 - "Have you removed a tick?" A tick bite may cause Lyme disease, which often presents with a ringlike rash that is warm, itchy, and painful three to four weeks after the bite, along with flu-like symptoms. Wasps sting rather than bite; a sting causes intense, burning local pain accompanied by swelling and itching. A bedbug bite causes a wheal surrounded by a vivid flare. Body lice bites result in minute red, noninflamed points flush with the skin that progress to popular, wheal-like lesions. Text Reference - p. 416

Which patient would be more likely to have the highest risk of developing malignant melanoma? 1 A fair-skinned woman who uses a tanning booth regularly 2 An African American patient with a family history of cancer 3 An adult who required phototherapy as an infant for the treatment of hyperbilirubinemia 4 A Hispanic male with a history of psoriasis and eczema who responded poorly to treatment

1 - A fair-skinned woman who uses a tanning booth regularly Risk factors for malignant melanoma include a fair complexion and exposure to ultraviolet light. Psoriasis, eczema, short-duration phototherapy, and a family history of other cancers are less likely to be linked to malignant melanoma. Text Reference - pp. 410-411

A nurse works in a dermatology clinic and counsels many patients in a day. Which patients should the nurse consider at high risk of developing skin malignancies? Select all that apply. 1 A farmer 2 A school teacher 3 A baseball player 4 A software engineer 5 A construction worker

1 - A farmer 3 - A baseball player 5 - A construction worker Sun exposure is the main risk factor for development of skin malignancies. People in occupations that involve outdoor activities are more prone to develop skin malignancies. A construction worker, a farmer, and a baseball player are exposed to sunlight throughout the day. Therefore these professionals may have high risk of skin malignancies. A software engineer and a school teacher are involved in indoor activities and are not exposed to sunlight. Therefore they have less risk of developing skin malignancies. Text Reference - pp. 407-409

In a patient admitted with cellulitis of the left foot, which clinical manifestation would the nurse expect to find on assessment of the left foot? 1 Erythema and swelling 2 Pallor and poor turgor 3 Cyanosis and coolness 4 Edema and brown skin discoloration

1 - Erythema and swelling Cellulitis is a diffuse, acute inflammation of the skin. It is characterized by erythematous, swelling, heat, and tenderness in the affected area. These changes accompany the processes of inflammation and infection. Text Reference - p. 414

The nurse would assess a patient admitted with cellulitis for what localized manifestation? 1 Pain 2 Fever 3 Chills 4 Malaise

1 - Pain Pain, redness, heat, and swelling are all localized manifestation of cellulitis. Fever, chills, and malaise are generalized, systemic manifestations of inflammation and infection. Text Reference - p. 414

The nurse is caring for four patients with skin infections. In which patient does the nurse suspect infection with group A β-hemolytic streptococci? 1 Patient 1 2 Patient 2 3 Patient 3 4 Patient 4

1 - Patient 1 Patient 1, with hot, red, painful, well-demarcated indurated plaques, may have erysipelas; it is an infection caused by group A β-hemolytic streptococci. Patient 2, with a hot, tender, erythematous, and edematous areas with diffuse border, may have cellulitis, which is caused by Staphylococcus and Streptococcus. Patient 3, with a unilateral linear distribution of vesicles, may have herpes zoster (shingles), a viral infection. Patient 4, with a tender, erythematous area around a hair follicle, may have a furuncle, which is caused by staphylococci. Text Reference - p. 414

A patient exhibits small, red pruritic lesions between the fingers and toes. On examination the nurse discovers that the lesions appear in a pattern of small lines. Which condition do these symptoms most likely represent? 1 Scabies 2 Varicella 3 Contusions 4 Herpes zoster

1 - Scabies Scabies are contagious microscopic mites that manifest as linear burrows, frequently seen between the fingers and toes. A scabies infestation causes intense itching, especially at night. Varicella (chickenpox) is a highly contagious airborne disease that appears as an itchy vesicular rash. A contusion is a bruise that results from the leakage of blood from capillary vessels into surrounding tissue. Herpes zoster (shingles) is a viral disease seen in older adults that manifests as a painful rash with blisters. Herpes zoster may occur as a reactivation of the varicella virus, which lies dormant in the ganglion after a primary case of chickenpox. Text Reference - p. 416

A patient with psoriasis tells the nurse that the patient has quit his or her job as a restaurant hostess because the patient believes the lesions on his or her hands and arms are unattractive to customers. Which nursing diagnosis best describes this patient response? 1 Social isolation related to fear of rejection 2 Ineffective coping related to lack of social support 3 Impaired skin integrity related to presence of lesions 4 Ineffective health maintenance because of presence of lesions

1 - Social isolation related to fear of rejection The chronicity of psoriasis can be severe and disabling as people withdraw from social contacts because of visible lesions. Quality of life is also affected negatively. The information presented does not indicate the patient does not have support. Impaired skin integrity is not a priority diagnosis. There is no information to indicate the patient has ineffective health maintenance. Text Reference - pp. 417, 419

A nurse is assessing a patient who has numerous nevi on the face. The nurse determines that the nevi are not cancerous. Which observations led the nurse to conclude that the nevi are normal? Select all that apply. 1 The nevi are dark in color. 2 The nevi are well circumscribed. 3 The skin over the nevi is eroded. 4 There is discharge from the nevi. 5 The nevi are larger than 5 mm in size.

1 - The nevi are dark in color. 2 - The nevi are well circumscribed. Normal nevi are well circumscribed and dark in color. Atypical or dysplastic nevi are larger than 5 mm in size. Eroded skin around the nevi and discharge of pus from the nevi are not associated with normal nevi. They are associated with skin cancer. Text Reference - p. 419

Which patient with a skin condition should be treated with 5% permethrin topical solution? 1 The patient with scabies 2 The patient with pediculosis 3 The patient with tinea corporis 4 The patient with Lyme disease

1 - The patient with scabies Scabies is caused by a mite, Sarcoptes scabiei. Scabies is marked by severe body itching, usually at night, and is treated with 5% permethrin solution, an insect repellent. A patient with pediculosis may be bitten by lice. γ-Benzene hexachloride is used to treat lice. Lyme disease is caused by Borrelia burgdorferi, which is transmitted through tick bites. The patient experiences a rash and flu-like symptoms. Oral antibiotics such as doxycycline and tetracycline are effective against Lyme disease. Tinea corporis is caused by various dermatophytes. It is treated with cool compresses and creams of ketoconazole, miconazole, and clotrimazole. Text Reference - p. 416

When a patient has psoriasis, which sign would a nurse expect to find? 1 Pustules in skinfolds 2 Itchy, scaly patches on scalp 3 Macular rash on the trunk area 4 Vesicular rash on the extremities

2 - Itchy, scaly patches on scalp Psoriasis is a noncontagious autoimmune disease. It usually presents as itchy scales on the scalp, knees, or elbows, the result of an overproduction of skin cells. Other commonly affected areas are the joints, fingernails, and toenails. Psoriasis does not present as pustules, as a macular rash, or as a vesicular rash. Text Reference - p. 419

The nurse assesses an eroded, ulcerative growth less than 1 cm wide on a patient's chest. The lesion is flat and variegated in color. What condition should be suspected related to this assessment finding? 1 Basal cell carcinoma 2 Malignant melanoma 3 Squamous cell carcinoma 4 Cutaneous T-cell lymphoma

2 - Malignant melanoma Malignant melanoma is characterized by variegated color, including red, white, blue, black, gray, and brown. The growth may be flat or elevated; it is eroded or ulcerated and usually less than 1 cm. Basal cell carcinoma is characterized by a small, slowly enlarging papule with semitranslucent borders and overlying telangiectasia. Squamous cell carcinoma is marked by a thin, scaly, erythematous plaque that does not invade the dermis. Cutaneous T-cell lymphoma involves three stages; a patch is the characteristic feature of the early stage, and tumors are observed in the advanced stage. Text Reference - p. 411

A patient tells a nurse, "I think I might have head lice." Which assessment findings would the nurse observe with this infestation? 1 Diffuse pruritic wheals 2 Oval white dots stuck to hair shafts 3 Pruritic papules with linear burrows at the hairline 4 Itchy redness and edema over the area of infestation

2 - Oval white dots stuck to hair shafts The eggs of lice, known as nits, appear as oval white dots attached to hair shafts. The lice are not usually visible. Diffuse pruritic wheals may be seen with localized inflammation such as that in response to an insect bite. Itchy redness and edema over the area of infestation are not characteristic of head lice. Pruritic papules with linear burrows at the hairline are characteristic of scabies. Text Reference - p. 416

The nurse is caring for four patients in a dermatology unit. Which patient may be treated with liquid nitrogen therapy? 1 Patient A 2 Patient B 3 Patient C 4 Patient D

2 - Patient B Patient B has a circumscribed, hypertrophic, flesh-colored papule that is painful on lateral compression; this is the clinical manifestation of verruca vulgaris caused by human papillomavirus. Liquid nitrogen therapy, which is used to remove abnormal growths from the skin, will be beneficial. Patient A has white cheesy plaques, resembling milk curds, in the mouth; this indicates candidiasis caused by Candida albicans. Candidiasis requires treatment with azole antifungals such as fluconazole and ketoconazole. Patient C has interdigital scaling and maceration, along with erythema, on scaly plantar surfaces; these are signs of tinea pedis caused by a dermatophyte. Treatment includes topical antifungal cream, solution, gel, or spray. Patient D has a unilateral distribution of vesicles along a dermatome on an erythematous base accompanied by burning and pain. This is the clinical appearance of herpes zoster (shingles), caused by varicella zoster. Antiviral agents such as famciclovir and acyclovir are recommended for the treatment of herpes zoster (shingles). Text Reference - p. 415

When studying the incidence of skin cancers in a population, a nurse finds that a greater number of skin cancer cases have been reported in white patients than in African American patients. What could be the most likely cause of such an occurrence? 1 Whites usually have less exposure to the sun than African Americans. 2 Whites have less melanin content in their skin than African Americans. 3 Whites usually have more exposure to the sun than African Americans. 4 Whites have greater melanin content in their skin than African Americans.

2 - Whites have less melanin content in their skin than African Americans. Melanin provides natural protection to the skin against the harmful radiation of the sun. Therefore melanin plays a major role in preventing skin cancer. African American people are darker skinned and have greater melanin content in their skin. Therefore they are less susceptible to skin cancer than white people. White people are lighter skinned and have less melanin. Differences in sun exposure between the two populations cannot be predicted. Text Reference - p. 410

A patient is diagnosed with herpes zoster and is at risk for developing postherpetic neuralgia. What action should the nurse take to prevent postherpetic neuralgia in the patient? 1 Administer mild sedatives at night. 2 Apply wet compresses to the affected area. 3 Administer acyclovir as prescribed within 72 hours. 4 Apply silver sulfadiazine on the ruptured vesicles.

3 - Administer acyclovir as prescribed within 72 hours. Classic clinical manifestation of herpes zoster (shingles) is a linear distribution of grouped vesicles along a dermatome. Often there is a burning pain preceding an outbreak. Postherpetic neuralgia is a preventable condition if the antiviral agents are administered within 72 hours. Using a mild sedative at night, applying silver sulfadiazine on the vesicles, and applying wet compresses may decrease symptoms, but they have no effect on the prevention of postherpetic neuralgia. Text Reference - p. 415

About which treatments should the nurse educate the patient with scaly, ringlike lesions with well-defined margins on both arms? Select all that apply. 1 Cryosurgery 2 Oral penicillin 3 Cool compress 4 Mupirocin cream 5 Miconazole cream

3 - Cool compress 5 - Miconazole cream Scaly ringlike lesions with well-defined margins on the patient's arms are indicative of tinea corporis. The treatment of tinea corporis includes the use of cool compresses and creams or solutions of such antifungal drugs such as miconazole or ketoconazole. Cryosurgery is performed to remove plantar warts from the bottom of the foot. Oral penicillin, which is an antibiotic, is used to treat infections such as impetigo that are caused by bacteria. Creams such as mupirocin, which is an antibiotic, are used to treat skin conditions such as impetigo and folliculitis that are caused by bacteria. Text Reference - p. 418

The nurse is educating a patient regarding complications due to diabetes. Which skin infection's incidence is increased in patients with diabetes mellitus? 1 Cellulitis 2 Impetigo 3 Folliculitis 4 Furunculosis

3 - Folliculitis The incidence of folliculitis is increased among people with diabetes mellitus. Cellulitis is typically a secondary complication of a disease but may occur as a primary infection. Impetigo, typically associated with poor hygiene, may be a primary or secondary infection. The incidence of furunculosis is increased among people with obesity, diabetes, and chronic illness and those who are regularly exposed to moisture or pressure. Text Reference - p. 414

A 54-year-old patient with diabetes mellitus has cellulitis of the right lower extremity. Which assessment finding would the nurse expect on physical examination? 1 Pallor of the right toes 2 Delayed capillary refill time 3 Hot, tender edematous area 4 Paresthesias of the right lower extremity

3 - Hot, tender edematous area Cellulitis is a diffuse, acute infection of the skin. It is characterized by redness and hot, tender edematous area. These changes accompany the processes of inflammation and infection. Delayed capillary refill time and pallor of the toes would indicate a circulatory impairment, not infection. Paresthesias would be indicative of poorly controlled diabetes. Text Reference - p. 414

The nurse assesses a vesiculopustular lesion with a thick, honey-colored crust surrounded by erythema on the left side of a patient's arm. The patient states that he or she had a few bumps in the area that the patient had been scratching. What complication has the patient developed from this condition? 1 Cellulitis 2 Furuncle 3 Impetigo 4 Folliculitis

3 - Impetigo Impetigo is marked by vesiculopustular lesions that develop a thick, honey-colored crust surrounded by erythema. They are most common on the face as a primary infection. Cellulitis manifests clinically as a hot, tender, erythematous, edematous area with a diffuse border. Furuncle is marked by a tender erythematous area around a hair follicle. Small pustules at the hair follicle opening with minimal erythema and development of crusting are indicative of folliculitis. Text Reference - p. 414

During an admission assessment, the nurse decides to implement contact precautions if which of these disorders is present in a patient? 1 Psoriasis 2 Tinea unguium 3 Impetigo on the lower legs 4 Candidiasis in the groin area

3 - Impetigo on the lower legs Impetigo is caused by a bacterial infection (group A β-hemolytic streptococci or staphylococci) and is highly contagious. Good skin hygiene and infection control practices are necessary to prevent the spread of this infection. Psoriasis is an autoimmune chronic dermatitis and is not contagious. Tinea unguium is a fungal infection of the nails. Candidiasis is a fungal infection in the skin folds. Text Reference - p. 418

The nurse, preparing educational information about types of skin cancer, recalls that which type has a higher risk for metastasis and poor prognosis unless it is treated early? 1 Myeloma 2 Basal cell 3 Melanoma 4 Squamous cell

3 - Melanoma Malignant melanoma has a higher risk for metastasis than does basal cell or squamous cell carcinoma because of its invasiveness. There is a poor prognosis unless melanoma is diagnosed and treated early. Basal cell and squamous cell carcinoma are typically superficial, localized lesions that respond well to treatment. Myeloma is a hematologic malignancy, not a skin cancer. Text Reference - p. 411

A nurse is assessing an obese patient with skin that is dry and irritated. The nurse understands that the most likely reason the patient is experiencing the skin condition is what? 1 Obese people drink less water. 2 Obese people have lowered immunity. 3 Obese people are prone to overheating and sweating. 4 Obese people have improved arterial and venous flow.

3 - Obese people are prone to overheating and sweating. Obesity increases the risk of skin inflammation and dryness. Increased subcutaneous fat can lead to overheating and increased sweating. Increased sweating may lead to skin inflammation and dryness. Obese people are not known to drink less water. Lowered immunity does not lead to skin inflammation and dryness. Obese people tend to have an impaired arterial and venous flow; however, this does not inflame or dry the skin. Text Reference - p. 409

A nurse is performing a skin assessment for an obese patient. The nurse suspects the patient has diabetes mellitus. Which skin conditions indicate diabetes mellitus? Select all that apply. 1 Petechiae 2 Skin desquamation 3 Presence of skin tags 4 Seborrhea-like lesions 5 Rashes under the breast and axillae

3 - Presence of skin tags 5 - Rashes under the breast and axillae Obese people have a high risk of developing type II diabetes mellitus. The presence of skin tags and rashes under the breast and axillae are signs of diabetes mellitus in obese people. Petechiae, skin desquamation, and seborrhea-like lesions are not seen in diabetic patients. Petechiae are minor hemorrhages characterized by small purple spots under the skin; petechiae are usually a sign of vitamin C deficiency. Skin desquamation may occur due to skin irritation. Seborrhea-like skin lesions indicate vitamin B deficiency. Text Reference - p. 419

Which does the nurse suspect in a patient who reports severe nighttime body itching and has red, crusted papules? 1 Lice 2 Ticks 3 Scabies 4 Bedbugs

3 - Scabies Severe nighttime itching and red papules are indicative of scabies. Lice bites result in minute, red noninflamed points that progress to a papular wheal-like lesion. A tick bite that transmits Lyme disease is characterized by a spreading ringlike rash that occurs three to four weeks after the bite. A bedbug bite results in a wheal surrounded by a vivid flare and firm urticaria that transforms into a persistent lesion. Text Reference - p. 416

A middle-aged obese patient presents with small, skin-colored, soft, pedunculated papules on the neck, axillae, and upper trunk. How should the nurse interpret these findings? 1 The patient has nevi. 2 The patient has lentigo. 3 The patient has acrochordons. 4 The patient has seborrheic keratoses.

3 - The patient has acrochordons. Small, skin-colored, soft, pedunculated papules are a manifestation of acrochordons. They are also called skin tags, and are commonly found on the neck, axillae, and upper trunk. They are mostly found in obese patients during middle age. Nevi or moles are hyperpigmented areas that vary in form and color. Lentigo is hyperpigmented, brown to black maculae or patches on sun-exposed areas. Seborrheic keratoses are characterized by irregular verrucous papules or plaques that are well-defined in shape. Text Reference - p. 419

Which fungal infection manifests on the surface of a patient's skin with an erythematous and typical annular scaly appearance and well-defined margins? 1 Tinea pedis 2 Tinea cruris 3 Tinea corporis 4 Tinea unguium

3 - Tinea corporis Tinea corporis is commonly referred to as ringworm. Tinea corporis infection has an erythematous, annular (ringlike) scaly appearance with well-defined margins. A tinea pedis fungal infection is characterized by scaly plantar surfaces that are pruritic and blistering in nature. Tinea cruris infection does not affect mucous membranes, and it is associated with well-defined scaly plaque on the patient's groin area. A patient with tinea unguium infection has brittle, thickened, and broken nails with yellowish discoloration. Text Reference - p. 418

A patient describes having small, firm reddened raised lesions with flat, rough patches causing intense pruritus to the nurse. The nurse suspects contact dermatitis. What would be the nurse's next assessment? 1 History of seasonal allergies 2 Initiation of new medication 3 Previous pruritic skin lesions 4 Activities in past two to seven days

4 - Activities in past two to seven days The patient's lesions are papules and plaques characteristic of contact dermatitis. The nurse should ask the patient about activities over the past two to seven days to identify potential allergens because contact dermatitis has a delayed onset. Even if an offending agent is not identified, the nurse can provide patient teaching about managing the pruritus and preventing infection by decreasing scratching. Seasonal allergies and new medications are more likely to cause urticaria than papules and plaque. The nurse should also ask about pruritic rashes in the past to determine potential illnesses that can cause dermatologic manifestations. Text Reference - p. 418

A patient shows the nurse how the skin around an abdominal dressing is red and states that it itches. The nurse identifies an area of red papules with occasional papules that matches the area that had been taped around the dressing. The nurse suspects that the patient has which skin condition? 1 Urticaria 2 Tinea corporis 3 Atopic dermatitis 4 Allergic contact dermatitis

4 - Allergic contact dermatitis Allergic contact dermatitis is a manifestation of delayed hypersensitivity characterized by red papules and plaques, and also is circumscribed sharply with occasional vesicles. It is usually pruritic. The area of dermatitis frequently takes the shape of the causative agent. Urticaria is spontaneously occurring, with raised or irregularly shaped wheals, varying size, and usually multiple in number. Tinea corporis is a fungal infection of the skin also known as ringworm. Text Reference - p. 418

The nurse is assessing a patient who had a face-lift procedure earlier in the day. The nurse notes that the skin in the surgical area is warm and pink and blanches with gentle pressure. What is the appropriate action by the nurse, based on this assessment finding? 1 Apply moist heat to the area. 2 Take the patient's temperature. 3 Notify the health care provider immediately. 4 Document the assessment finding as normal.

4 - Document the assessment finding as normal. Postoperative assessment for the patient who has had a face-lift includes careful monitoring for adequate circulation. Warm, pink skin that blanches on pressure indicates that adequate circulation is present in the surgical area. Supportive, compressive dressings and ice packs (not moist heat) may be necessary early in the postoperative period. Moist heat should not be applied to the area. It is not necessary to take the patient's temperature. The health care provider does not need to be notified because this finding is normal. Text Reference - p. 425

A patient has developed a skin infection with an associated fever of 101.6° F, white blood cell count of 28,000, headache, and malaise. With what skin infection does the nurse determine these clinical manifestations correlate? 1 Impetigo 2 Carbuncle 3 Folliculitis 4 Erysipelas

4 - Erysipelas Erysipelas is associated with toxic signs such as fever, headache, malaise, and an increase in white blood cell count. Impetigo is characterized by vesiculopustular lesions surrounded by erythema that develop a thick, honey-colored crust. Carbuncle is characterized by many pustules appearing in an erythematous area. Folliculitis is characterized by small pustules at the hair follicle opening and minimal erythema. Text Reference - p. 414

A patient who has redness around a hair follicle and necrotic debris in the ruptured material undergoes incision and drainage of painful nodules. The patient's temperature is 100° F. Which skin infection does the patient have? 1 Furuncle 2 Carbuncle 3 Folliculitis 4 Furunculosis

4 - Furunculosis Furunculosis is characterized by a tender, erythematous area around a hair follicle with drainage of pus and a core of necrotic debris on rupture. Furunculosis is also marked by clinical manifestations such as malaise, regional adenopathy, and increased body temperature. This patient, who displays most of the symptoms, may have furunculosis. A patient with furuncle has lesions similar to the furunculosis lesion but will not exhibit malaise, regional adenopathy, or increased body temperature. Carbuncle is marked by the appearance of many pustules in an erythematous area, most commonly at the nape of the neck. A patient with folliculitis has small pustules at hair follicle openings and minimal erythema. Text Reference - p. 414

A patient who is obese and has a diagnosis of diabetes is at risk for a bacterial skin infection. For what infection should the nurse educate the patient to monitor? 1 Cellulitis 2 Impetigo 3 Carbuncle 4 Furunculosis

4 - Furunculosis Patients who are obese and diabetic are at increased risk for furunculosis because of the likelihood of skin folds containing excess moisture. Therefore the nurse should warn the patient about the possibility of furunculosis. Cellulitis may be a secondary complication or a primary infection; it most often results from a break on the skin's surface. Impetigo is most common in patients with poor hygiene. Many factors are responsible for the development of carbuncle. Text Reference - p. 414

A patient informs the nurse that he or she has tingling and burning on the lower lip. The nurse assesses redness and a group of vesicles on the lower lip. Which infection should the nurse educate the patient? 1 Impetigo 2 Candidiasis 3 Herpes zoster 4 Herpes simplex virus

4 - Herpes simplex virus Infection caused by herpes simplex virus is characterized by single or grouped vesicles on an erythematous base with a painful local reaction. Impetigo is a bacterial infection characterized by vesiculopustular lesions that develop a thick, honey-colored crust surrounded by erythema. Candidiasis is a fungal infection of the skin characterized by cheesy white plaques in the mouth and diffuse papular erythematous rash with pinpoint satellite lesions around the edges of the affected area. Herpes zoster, which is also called shingles, is characterized by linear distribution of vesicles along a dermatome. It is usually unilateral. Text Reference - p. 415

The nurse is caring for a patient in whom chickenpox is suspected. The patient has pustules and redness only on the left side of the face. Which skin condition may the patient have? 1 Furuncle 2 Candidiasis 3 Verruca vulgaris 4 Herpes zoster (shingles)

4 - Herpes zoster (shingles) The patient may have herpes zoster (shingles), marked clinically by a linear distribution of vesicles or pustules along a dermatome on an erythematous base. The lesions resemble those of chickenpox. Herpes zoster appears unilaterally on the trunk, face, and lumbosacral areas. Furuncle is a bacterial infection characterized by a tender erythematous area around a hair follicle; it is most common on the face, back of the neck, axillae, breasts, and buttocks. Candidiasis is characterized by a diffuse papular erythematous rash with pinpoint satellite lesions around the edges of affected area. Patients with verruca vulgaris have circumscribed, hypertrophic, flesh-colored papules that are painful when compressed laterally. Text Reference - p. 415

The nurse is assessing four patients. Which patient should be advised to refrain from having sex? 1 Patient A 2 Patient B 3 Patient C 4 Patient D

4 - Patient D Patient D has a red, edematous, painful vaginal wall with white patches. These findings indicate that Patient D has candidiasis and should be advised to refrain from having sex. Patient A has interdigital scaling with erythema and blistering, suggesting tinea pedis. Patient B has a scaly, annular lesion with a well-defined margin, which is a clinical manifestation of tinea corporis. Patient C has several toenails that are brittle, thickened, broken, and yellowed, indicative of tinea unguium (onychomycosis). Text Reference - p. 418

The nurse is caring for four patients. Which patient will benefit from treatment with gabapentin for postherpetic neuralgia? 1 Patient A 2 Patient B 3 Patient C 4 Patient D

4 - Patient D Unilateral linear distribution of vesicles and papules on an erythematous base, a burning sensation, and pain are the symptoms of herpes zoster (shingles). Patient D may experience postherpetic neuralgia, for which gabapentin is beneficial. Patient A has a group of vesicles on an erythematous base and a fever; these are clinical manifestations of herpes simplex virus (HSV) infection. This patient may benefit from treatment with such antiviral agents as acyclovir, famciclovir, and valacyclovir. Patient B has a wart on the bottom of his foot that is painful when pressure is applied. This is a plantar wart and requires treatment with topical immunotherapy, salicylic acid, and cryosurgery. Patient C has a circumscribed, hypertrophic, flesh-colored papule that is painful when compressed laterally. This is verruca vulgaris; treatment options include liquid nitrogen therapy, cantharidin, and salicylic acid. Text Reference - p. 415

The nurse is caring for patients at a camp with bites and stings inflicted by insects or arachnids. Which patient may require the application of topical corticosteroids? 1 Patient bitten by lice 2 Patient stung by a bee 3 Patient bitten by mites 4 Patient bitten by bedbugs

4 - Patient bitten by bedbugs Bedbug bites are treated with the use of antihistamines and topical corticosteroids. Lice bites cause minute, red noninflamed points that are flush with the skin. Pyrethrins and spinosad are used in the treatment of pediculosis (lice infestation). People who are stung by bees or wasps may experience intense burning and local pain at the site of the bite, along with swelling and itching. The sting may be treated with cool compresses and antihistamines as necessary. The patient bitten by mites may have scabies, often marked by severe itching and crusting between the fingers. Scabies is treated with a 5% topical lotion of permethrin. Text Reference - p. 416

During the assessment of a patient, the nurse notes an area of irregularly round verrucous papules with well-defined shapes. The patient states that they have become darker over the past few months and are often itchy and irritating. The nurse recognizes this finding as what? 1 Lentigo 2 Psoriasis 3 Acne vulgaris 4 Seborrheic keratosis

4 - Seborrheic keratosis Clinical manifestations of seborrheic keratosis include irregularly round or oval, often verrucous papules or plaques with well-defined shape and the appearance of being stuck on. The lesions increase in pigmentation with time and are usually multiple and possibly itchy Clinical manifestations of lentigo include hyperpigmented, brown to black macule or patch (flat lesion) over sun-exposed areas. Clinical manifestations of psoriasis include sharply demarcated silvery scaling plaques on reddish colored skin commonly on the scalp, elbows, knees, palms, soles, and fingernails. Acne vulgaris is manifested by noninflammatory lesions, including open comedones (blackheads) and closed comedones (whiteheads), and inflammatory lesions, including papules and pustules. Text Reference - p. 419

Which localized finding would the nurse expect in the patient with diabetes recently diagnosed with cellulitis? 1 Chills 2 Fever 3 Fatigue 4 Swelling

4 - Swelling Signs of cellulitis are local; swelling is a localized finding. Chills, fever, and fatigue are systemic (generalized). Text Reference - p. 414

A patient with a history of persistent macular eruption notices the gradual appearance of hard, reddened plaques on his or her trunk that are similar in appearance to psoriasis lesions. Which treatment does the nurse suspect will be beneficial in this patient? 1 Chemical peels 2 Surgical excision 3 Electrodesiccation 4 Topical nitrogen mustard

4 - Topical nitrogen mustard Mycosis fungoides is a form of cutaneous T-cell lymphoma in which lymphocytes become malignant, affecting the skin. It is characterized by indurated erythematous plaques on the trunk that are similar in appearance to psoriasis lesions. Therefore topical nitrogen mustard, a chemotherapy agent, will be beneficial. Chemical peeling is useful against actinic keratosis. Surgical excision is a treatment option for both basal cell carcinoma and squamous cell carcinoma. Squamous cell carcinoma, a malignant tumor of squamous cells of the epidermis, requires treatment with electrodesiccation, in which the skin growths are scraped or burned away. Text Reference - p. 412

A nurse is assessing a patient who reports extreme fatigue and muscle pain. The patient reports spending very little time outdoors. The skeletal muscles of the patient are very weak. Which deficiency is most likely to cause such symptoms? 1 Vitamin A deficiency 2 Vitamin B deficiency 3 Vitamin C deficiency 4 Vitamin D deficiency

4 - Vitamin D deficiency Muscle pain and weakness are signs of Vitamin D deficiency. Vitamin D is produced naturally by cutaneous photosynthesis due to exposure to UVB light. The patient is most likely to have Vitamin D deficiency because of restricted sun exposure. Vitamin C deficiency causes scurvy, which is characterized by purpura, bleeding gums and petechiae. Deficiency of vitamin A causes dryness of the conjunctiva and poor wound healing. Deficiency of Vitamin B causes dermatologic symptoms such as erythema, bullae, and seborrhea-like lesions. Text Reference - p. 409

The nurse reviews lab values for a male patient with herpes zoster. With which result should the nurse be most concerned? 1 Calcium: 9.0 mg/dL 2 Hemoglobin: 14 g/dL 3 Platelets: 150,000/mm3 4 White blood cell count: 1000/mm3

4 - White blood cell count: 1000/mm3 Herpes zoster may occur as reactivation of the varicella virus, which is dormant in the ganglion after a primary case of chickenpox. Reactivation is seen in immunocompromised patients. The nurse would be concerned about the patient's immune status, and therefore a check of the white blood cell count would be warranted. A normal white blood cell count is 4000 to 10,000 mm 3. The other answer options all contain lab values within normal limits: platelets 150,000 to 350,000/mm 3, hemoglobin 13 to 18 g/dL in males and 12 to 16 g/dL in females, and calcium 8.5 to 10.5 mg/dL. Text Reference - p. 415

The nurse assesses an elevated, dry, hyperkeratotic, scaly papule in an older adult patient. What condition does the assessment data correlate? 1 Actinic keratosis 2 Dysplastic nevus 3 Basal cell carcinoma 4 Squamous cell carcinoma

1 - Actinic keratosis Actinic keratosis manifests clinically as dry, scaly, hyperkeratotic papules, either flat or elevated. A dysplastic or atypical nevus is often larger than 5 mm. It features irregular borders, which may be notched; variegated color (e.g., tan, brown, black, red, or pink) within a single mole; and at least one flat portion, often at the edge of the mole. Basal cell carcinoma is characterized by a small, slowly enlarging papule with semitranslucent or pearly borders. Squamous cell carcinoma appears as a thin, scaly, erythematous plaque that does not invade the dermis. Text Reference - p. 411

A patient has a growth on the bottom of one foot, which is growing inward, is painful when pressure is applied, and has interrupted skin markings. Which treatments may the patient receive? Select all that apply. 1 Cryosurgery 2 White petroleum 3 Silver sulfadiazine 4 Topical immunotherapy 5 Blunt dissection with scissors

1 - Cryosurgery 4 - Topical immunotherapy The patient has a plantar wart with interrupted markings that has grown inward because of the pressure exerted by walking or standing; it is painful when pressure is applied. Treatment for plantar warts consists of topical immunotherapy, cryosurgery, and the use of salicylic acid. White petroleum is applied as a symptomatic treatment to lesions caused by herpes simplex virus. Silver sulfadiazine is applied as a symptomatic treatment to ruptured vesicles caused by herpes zoster. Blunt dissection with scissors or curette is performed as a treatment for verruca vulgaris. Text Reference - p. 415

Which treatments would be beneficial for a patient with papular, wheal-like lesions and severe pruritus? Select all that apply. 1 Spinosad 2 Doxycycline 3 Chlorocyclohexane 4 γ-Benzene hexachloride 5 Permethrin topical solution

1 - Spinosad 4 - γ-Benzene hexachloride Papular, wheal-like lesions and severe pruritus indicate that the patient has been bitten by lice. Spinosad can be used to treat the scalp and hair to rid them of lice. Pyrethrins or γ-benzene hexachloride can also be used to treat lice on various parts of the body. Doxycycline is an antibiotic used in the treatment of tick bites. Chlorocyclohexane is used to control bedbugs. Permethrin topical solution is used in the treatment of scabies. Text Reference - p. 416

A patient has sharply demarcated red plaques on the face that are hot, hard, and painful, along with a body temperature of 101o F as a result of a β-hemolytic Streptococcus infection. About what treatment should the nurse educate the patient? 1 Systemic penicillin 2 Warm, moist compresses on the plaques 3 Application of retapamulin to the affected area 4 Cleansing with antistaphylococcal soap and water

1 - Systemic penicillin The patient has demarcated red plaques that are hot, indurated, and painful, as well as an increased body temperature; this indicates erysipelas. Erysipelas is caused by β-hemolytic streptococci. Systemic antibiotics such as penicillin are used to treat erysipelas; hospitalization is often required. Warm, moist compresses are used for skin infections such as folliculitis, furuncle, and furunculosis. Topical antibiotics such as retapamulin are used to treat such skin infections such as impetigo. Cleansing with antistaphylococcal soap and water is performed to treat folliculitis. Text Reference - p. 414

A nurse observes that a group of patients has a darker skin tone after being outside for a period of time. The nurse recalls that the reason for this finding is what? 1 The UVA rays of the sun cause tanning. 2 The UVB rays of the sun cause sunburn. 3 The UVC rays of the sun cause collagen damage. 4 The UVC rays of the sun cause increased melanin production.

1 - The UVA rays of the sun cause tanning. Sunlight is composed of ultraviolet rays and visible light rays. Extended exposure to the sun causes the skin to tan. The sun's UVA rays increase the production of melanin in the skin, leading to a tan. UVB rays cause sunburn. UVC rays do not reach the earth because they are blocked by the atmosphere. Both UVA and UVB rays can cause collagen damage and accelerate skin aging. Melanin production increases in response to sunlight exposure. UVC rays alone do not increase melanin production. Text Reference - p. 407

The nurse should recognize which patient is likely to have the poorest prognosis? 1 A 60-year-old diagnosed with nodular ulcerative basal cell carcinoma 2 A 59-year-old man who is being treated for stage IV malignant melanoma 3 A 70-year-old woman who has been diagnosed with late squamous cell carcinoma (SCC) 4 A 51-year-old woman whose biopsy has revealed superficial squamous cell carcinoma

2 - A 59-year-old man who is being treated for stage IV malignant melanoma Late detection of malignant melanoma is associated with a poor outcome. Basal cell carcinomas often have very effective treatment success rates. Although late SCC has worse outcomes than superficial SCC, these are both exceeded in mortality by late-stage malignant melanoma. Text Reference - p. 411

In teaching a patient with basal cell carcinoma (BCC) about this disorder, the nurse considers that which statement about this skin cancer is true? 1 BCC is the deadliest type of skin cancer. 2 BCC is the most common type of skin cancer. 3 Prognosis depends upon the thickness of the lesion. 4 The cancerous cells of BCC usually spread beyond the skin.

2 - BCC is the most common type of skin cancer. BCC is a locally invasive malignancy arising from epidermal basal cells. It is the most common type of skin cancer and also the least deadly. The cancerous cells of BCC almost never spread beyond the skin. BCC is the least deadly type of skin cancer. Prognosis depends on other factors too, not just the thickness of the lesion. BCC does not generally spread beyond the skin. Text Reference - p. 411

Which patient does the nurse determine will benefit the most from treatment with methotrexate? 1 The patient with a benign adipose tumor 2 The patient with autoimmune chronic dermatitis 3 The patient with inflammatory disorder of sebaceous glands 4 The patient with an increase in normal melanocytes in the basal layer of epidermis

2 - The patient with autoimmune chronic dermatitis The skin condition associated with autoimmune chronic dermatitis is psoriasis, which involves excessively rapid turnover of the cells. Methotrexate slows down the rapid division of skin cells that is a hallmark of psoriasis. A benign tumor of adipose tissue is called a lipoma; it generally does not require treatment but excision is the usual treatment option. An inflammatory disorder of sebaceous glands is acne vulgaris, usually treated with topical benzoyl peroxide or other antimicrobials. An increased number of normal melanocytes in the basal layer of epidermis is called lentigo. Treatment options include liquid nitrogen and laser resurfacing. Text Reference - p. 419

Which laboratory result is the best indicator that a patient with cellulitis is recovering from this infection? 1 White blood cells (WBC) of 2900/µL 2 White blood cells (WBC) of 8200/µL 3 White blood cells (WBC) of 12,700/µL 4 White blood cells (WBC) of 16,300/µL

2 - White blood cells (WBC) of 8200/µL The normal WBC count is generally 4000 to 11,000/µL. For this reason, the patient's level would be returning to normal if it were 8200/µL, indicating recovery from cellulitis. The 2900/µL is too low and indicates that another problem is occurring. WBCs of 12,700/µL and 16,300/µL are evidence of continuing infection. Text Reference - p. 414

A patient is diagnosed with folliculitis after frequent use of a hot tub. About what treatment options should the nurse educate the patient? Select all that apply. 1 Oral penicillin 2 Incision and drainage 3 Antistaphylococcal soap 4 Warm compress of aluminum acetate 5 Immobilization and elevation of the affected area

3 - Antistaphylococcal soap 4 - Warm compress of aluminum acetate Folliculitis is characterized by small pustules at the hair follicle openings and minimal erythema. Antistaphylococcal soap-and-water cleansing is used to treat folliculitis. Warm compresses of water or aluminum acetate solution are also used as treatment. Systemic antibiotics, such as oral penicillin, are used in the treatment of impetigo, furunculosis, and cellulitis. Incision and drainage is used to treat furuncle and furunculosis. Immobilization and elevation of the affected area is appropriate for patients with cellulitis. Text Reference - p. 414

What condition does the nurse suspect in an asthmatic patient who reports erythema, oozing vesicles, and severe itching of the skin? 1 Urticaria 2 Drug reaction 3 Atopic dermatitis 4 Allergic contact dermatitis

3 - Atopic dermatitis Asthma and atopic dermatitis are atopic diseases with the same pathogenic base with regard to allergic reaction and type of oversensitivity leading to allergic inflammation. Therefore atopic dermatitis may be associated with asthma. Urticaria is an allergic reaction associated with erythema and edema in the upper epidermis. A drug reaction is caused by any drug that acts as an antigen and causes a hypersensitivity reaction. Allergic contact dermatitis is a manifestation of delayed hypersensitivity reaction, which results from sensitization after one or more exposures. It is characterized by the appearance of lesions two to seven days after contact with an allergen. Text Reference - p. 418

The nurse assesses circumscribed, hypertrophic, flesh-colored papules on a patient's knee. The patient states they are recurring even after removal. How should the nurse document these findings? 1 Plantar warts 2 Herpes zoster 3 Verruca vulgaris 4 Herpes simplex virus type 1

3 - Verruca vulgaris Verruca vulgaris is characterized by circumscribed, hypertrophic, flesh-colored papules that are limited to the epidermis. Plantar warts are found on the bottom surface of the foot; they may grow inward as a result of the pressure of walking and standing. Herpes zoster is characterized by linear distribution along a dermatome of grouped vesicles and pustules on an erythematous base. Herpes simplex virus type 1's clinical manifestations are single or grouped vesicles on an erythematous base occurring with systematic symptoms of fever and malaise. Text Reference - p. 415

A patient complains of frequently having bleeding gums as well as widespread bruising and small red and purple dots all over the body. The patient is most likely deficient in which vitamin? 1 Vitamin A 2 Vitamin B 3 Vitamin C 4 Vitamin K

3 - Vitamin C Vitamin C is responsible for connective tissue building and wound healing. Its deficiency leads to a condition known as scurvy, which is characterized by petechiae, purpura, and bleeding gums. Vitamin A deficiency causes dryness of the conjunctiva and night blindness. Vitamin B deficiency usually manifests as dermatologic symptoms, such as erythema, bullae, and seborrhea-like lesions. Vitamin K deficiency causes decreased synthesis of clotting factors, and the primary manifestation is bruising. Text Reference - p. 409