Chapter 23&24/Chapter 60&61- Assessment and management of Integumentary Function

The nurse notes the presence of white lesions that resemble milk curds in the back of a patient's throat. Which question by the nurse is appropriate at this time? a. "Do you have a productive cough?" b. "How often do you brush your teeth?" c. "Are you taking any medications at present?" d. "Have you ever had an oral herpes infection?"

ANS: C The appearance of the lesions is consistent with an oral candidiasis (thrush) infection, which can occur in patients who are taking medications such as immunosuppressants or antibiotics. Candidiasis is not associated with poor oral hygiene or lower respiratory infections. The lesions do not look like an oral herpes infection.

A patient is undergoing psoralen plus ultraviolet A light (PUVA) therapy for treatment of psoriasis. What action should the nurse take to prevent adverse effects from this procedure? a. Cleanse the skin carefully with an antiseptic soap. b. Shield any unaffected areas with lead-lined drapes. c. Have the patient use protective eyewear while receiving PUVA. d. Apply petroleum jelly to the areas surrounding the psoriatic lesions.

ANS: C The eyes should be shielded from UV light (UVL) during and after PUVA therapy to prevent the development of cataracts. The patient should be taught about the effects of UVL on unaffected skin, but lead-lined drapes, use of antiseptic soap, and petroleum jelly are not used to prevent skin damage.

A patient presents at the free clinic with a black, wart-like lesion on his face, stating, ìI've done some research, and I'm pretty sure I have malignant melanoma.î Subsequent diagnostic testing results in a diagnosis of seborrheic keratosis. The nurse should recognize what significance of this diagnosis? A) The patient requires no treatment unless he finds the lesion to be cosmetically unacceptable. B) The patient's lesion will be closely observed for 6 months before a plan of treatment is chosen. C) The patient has one of the few dermatologic malignancies that respond to chemotherapy. D) The patient will likely require wide excision.

Ans: A Feedback: Seborrheic keratoses are benign, wart like lesions of various sizes and colors, ranging from light tan to black. There is no harm in allowing these growths to remain because there is no medical significance to their presence.

1. A nurse practitioner is seeing a 16-year-old male patient who has come to the dermatology clinic for treatment of acne. The nurse practitioner would know that the treatment may consist of which of the following medications? A) Acyclovir (Zovirax) B) Benzoyl peroxide and erythromycin (Benzamycin) C) Diphenhydramine (Benadryl) D) Triamcinolone (Kenalog)

Ans: B Feedback: Benzamycin gel is among the topical treatments available for acne. Zovirax is used in the treatment of herpes zoster as an oral antiviral agent. Benadryl is an oral antihistamine used in the treatment of pruritus. Intralesional injections of Kenalog have been utilized in the treatment of psoriasis.

When performing a skin assessment, the nurse notes several angiomas on the chest of an older patient. Which action should the nurse take next? a. Assess the patient for evidence of liver disease. b. Discuss the adverse effects of sun exposure on the skin. c. Teach the patient about possible skin changes with aging. d. Suggest that the patient make an appointment with a dermatologist.

ANS: A Angiomas are a common occurrence as patients get older, but they may occur with systemic problems such as liver disease. The patient may want to see a dermatologist to have the angiomas removed, but this is not the initial action by the nurse. The nurse may need to teach the patient about the effects of aging on the skin and about the effects of sun exposure, but the initial action should be further assessment.

A nurse is aware that the outer layer of the skin consists of dead cells that contain large amounts of keratin. The physiologic functions of keratin include which of the following? Select all that apply. A) Producing antibodies B) Absorbing electrolytes C) Maintaining acidñbase balance D) Physically repelling pathogens E) Preventing fluid loss

Ans: D, E Feedback: The dead cells of the epidermis contain large amounts of keratin, an insoluble, fibrous protein that forms the outer barrier of the skin. Keratin has the capacity to repel pathogens and prevent excessive fluid loss from the body. It does not contribute directly to antibody production, acidñbase balance, or electrolyte levels.

The nurse working in the dermatology clinic assesses a young adult female patient who is taking isotretinoin (Accutane) to treat severe cystic acne. Which assessment finding is most indicative of a need for further questioning of the patient? a. The patient recently had an intrauterine device removed. b. The patient already has some acne scarring on her forehead. c. The patient has also used topical antibiotics to treat the acne. d. The patient has a strong family history of rheumatoid arthritis.

ANS: A Because isotretinoin is teratogenic, contraception is required for women who are using this medication. The nurse will need to determine whether the patient is using other birth control methods. More information about the other patient data may also be needed, but the other data do not indicate contraindications to isotretinoin use.

A patient in the dermatology clinic has a thin, scaly erythematous plaque on the right cheek. Which action should the nurse take? a. Prepare the patient for a biopsy. b. Teach about the use of corticosteroid creams. c. Explain how to apply tretinoin (Retin-A) to the face. d. Discuss the need for topical application of antibiotics.

ANS: A Because the appearance of the lesion suggests actinic keratosis or possible squamous cell carcinoma (SCC), the appropriate treatment would be excision and biopsy. Over-the-counter (OTC) corticosteroids, topical antibiotics, and Retin-A would not be used for this lesion.

Which integumentary assessment data from an older patient admitted with bacterial pneumonia is of most concern for the nurse? a. Reports a history of allergic rashes b. Scattered macular brown areas on extremities c. Skin brown and wrinkled, skin tenting on forearm d. Longitudinal nail bed ridges noted; sparse scalp hair

ANS: A Because the patient will be receiving antibiotics to treat the pneumonia, the nurse should be most concerned about her history of allergic rashes. The nurse needs to do further assessment of possible causes of the allergic rashes and whether she has ever had allergic reactions to any drugs, especially antibiotics. The assessment data in the other response would be normal for an older patient.

There is one opening in the schedule at the dermatology clinic, and 4 patients are seeking appointments today. Which patient will the nurse schedule for the available opening? a. 38-year old with a 7-mm nevus on the face that has recently become darker b. 62-year-old with multiple small, soft, pedunculated papules in both axillary areas c. 42-year-old with complaints of itching after using topical fluorouracil on the nose d. 50-year-old with concerns about skin redness after having a chemical peel 3 days ago

ANS: A The description of the lesion is consistent with possible malignant melanoma. This patient should be assessed as soon as possible by the health care provider. Itching is common after using topical fluorouracil and redness is an expected finding a few days after a chemical peel. Skin tags are common, benign lesions after midlife.

Which information should the nurse include when teaching a patient who has just received a prescription for ciprofloxacin (Cipro) to treat a urinary tract infection? a. Use a sunscreen with a high SPF when exposed to the sun. b. Sun exposure may decrease the effectiveness of the medication. c. Photosensitivity may result in an artificial-looking tan appearance. d. Wear sunglasses to avoid eye damage while taking this medication.

ANS: A The patient should stay out of the sun. If that is not possible, teach them to wear sunscreen when taking medications that can cause photosensitivity. The other statements are not accurate.

The health care provider diagnoses impetigo in a patient who has crusty vesicopustular lesions on the lower face. Which instructions should the nurse include in the teaching plan? a. Clean the infected areas with soap and water. b. Apply alcohol-based cleansers on the lesions. c. Avoid use of antibiotic ointments on the lesions. d. Use petroleum jelly (Vaseline) to soften crusty areas.

ANS: A The treatment for impetigo includes softening of the crusts with warm saline soaks and then soap-and-water removal. Alcohol-based cleansers and use of petroleum jelly are not recommended for impetigo. Antibiotic ointments, such as mupirocin (Bactroban), may be applied to the lesions.

A patient with atopic dermatitis has been using a high-potency topical corticosteroid ointment for several weeks. The nurse should assess for which adverse effect? a. Thinning of the affected skin b. Alopecia of the affected areas c. Reddish-brown discoloration of the skin d. Dryness and scaling in the areas of treatment

ANS: A Thinning of the skin indicates that atrophy, a possible adverse effect of topical corticosteroids, is occurring. The health care provider should be notified so that the medication can be changed or tapered. Alopecia, red-brown discoloration, and dryness/scaling of the skin are not adverse effects of topical corticosteroid use.

A nurse is teaching a patient with contact dermatitis of the arms and legs about ways to decrease pruritus. Which information should the nurse include in the teaching plan (select all that apply)? a. Cool, wet cloths or dressings can be used to reduce itching. b. Take cool or tepid baths several times daily to decrease itching. c. Add oil to your bath water to aid in moisturizing the affected skin. d. Rub yourself dry with a towel after bathing to prevent skin maceration. e. Use of an over-the-counter (OTC) antihistamine can reduce scratching.

ANS: A, B, E Cool or tepid baths, cool dressings, and OTC antihistamines all help reduce pruritus and scratching. Adding oil to bath water is not recommended because of the increased risk for falls. The patient should use the towel to pat (not rub) the skin dry.

The nurse is interviewing a patient with contact dermatitis. Which finding indicates a need for patient teaching? a. The patient applies corticosteroid cream to pruritic areas. b. The patient uses Neosporin ointment on minor cuts or abrasions. c. The patient adds oilated oatmeal (Aveeno) to the bath water every day. d. The patient takes diphenhydramine (Benadryl) at night if itching occurs.

ANS: B Neosporin can cause contact dermatitis. The other medications are being used appropriately by the patient.

Which activities can the nurse working in the outpatient clinic delegate to a licensed practical/vocational nurse (LPN/LVN) (select all that apply)? a. Administer patch testing to a patient with allergic dermatitis. b. Interview a new patient about chronic health problems and allergies. c. Apply a sterile dressing after the health care provider excises a mole. d. Teach a patient about site care after a punch biopsy of an upper arm lesion. e. Explain potassium hydroxide testing to a patient with a superficial skin infection.

ANS: A, C Skills such as administration of patch testing and sterile dressing technique are included in LPN/LVN education and scope of practice. Obtaining a health history and patient education require more critical thinking and registered nurse (RN) level education and scope of practice.

A patient comes to the dermatology clinic requesting the removal of a port-wine stain on his right cheek. The nurse knows that the procedure especially useful in treating cutaneous vascular lesions such as port-wine stains is what? A) Skin graft B) Laser treatment C) Chemical face peeling D) Free flap

ANS: B Feedback: Argon lasers are useful in treating cutaneous vascular lesions such as port-wine stains. Skin grafts, chemical face peels, and free flaps would not be used to remove a port-wine stain.

A 38-year-old female patient states that she is using topical fluorouracil to treat actinic keratoses on her face. Which additional assessment information will be most important for the nurse to obtain? a. History of sun exposure by the patient b. Method of birth control used by the patient c. Length of time the patient has used fluorouracil d. Appearance of the treated areas on the patient's face

ANS: B Because fluorouracil is teratogenic, it is essential that the patient use a reliable method of birth control. The other information is also important for the nurse to obtain, but lack of reliable birth control has the most potential for serious adverse medication effects. Note: actinic keratoses- rough scaly patch on skin that develops from sun exposure Teratogenic- disturbance of the development of embryo which will cause birth defects.

A nurse is doing a shift assessment on a group of patients after first taking report. An elderly patient is having her second dose of IV antibiotics for a diagnosis of pneumonia. The nurse notices a new rash on the patient's chest. The nurse should ask what priority question regarding the presence of a reddened rash? A) ìIs the rash worse at a particular time or season?î B) ìAre you allergic to any foods or medication?î C) ìAre you having any loss of sensation in that area?î D) ìIs your rash painful?î

ANS: B Feedback: The nurse should suspect an allergic reaction to the antibiotic therapy. Allergies can be a significant threat to the patient's immediate health, thus questions addressing this possibility would be prioritized over those addressing sensation. Asking about previous rashes is important, but this should likely be framed in the context of an allergy assessment.

The nurse assesses a circular, flat, reddened lesion about 5 cm in diameter on a middle-aged patient's ankle. How should the nurse determine if the lesion is related to intradermal bleeding? a. Elevate the patient's leg. b. Press firmly on the lesion. c. Check the temperature of the skin around the lesion. d. Palpate the dorsalis pedis and posterior tibial pulses.

ANS: B If the lesion is caused by intradermal or subcutaneous bleeding or a nonvascular cause, the discoloration will remain when direct pressure is applied to the lesion. If the lesion is caused by blood vessel dilation, blanching will occur with direct pressure. The other assessments will assess circulation to the leg, but will not be helpful in determining the etiology of the lesion.

A patient reports chronic itching of the ankles and continuously scratches the area. Which assessment finding will the nurse expect? a. Hypertrophied scars on both ankles b. Thickening of the skin around the ankles c. Yellowish-brown skin around both ankles d. Complete absence of melanin in both ankles

ANS: B Lichenification is likely to occur in areas where the patient scratches the skin frequently. Lichenification results in thickening of the skin with accentuated normal skin markings. Vitiligo is the complete absence of melanin in the skin. Keloids are hypertrophied scars. Yellowish-brown skin indicates jaundice. Vitiligo, keloids, and jaundice do not usually occur as a result of scratching the skin.

A teenaged male patient who wrestles in high school is examined by the nurse in the clinic. Which assessment finding would prompt the nurse to teach the patient about the importance of not sharing headgear to prevent the spread of pediculosis? a. Ringlike rashes with red, scaly borders over the entire scalp b. Papular, wheal-like lesions with white deposits on the hair shaft c. Patchy areas of alopecia with small vesicles and excoriated areas d. Red, hivelike papules and plaques with sharply circumscribed borders

ANS: B Pediculosis is characterized by wheal-like lesions with parasites that attach eggs to the base of the hair shaft. The other descriptions are more characteristic of other types of skin disorders.

A patient in the dermatology clinic is scheduled for removal of a 15-mm multicolored and irregular mole from the upper back. The nurse should prepare the patient for which type of biopsy? a. Shave biopsy b. Punch biopsy c. Incisional biopsy d. Excisional biopsy

ANS: C An incisional biopsy would remove the entire mole and the tissue borders. The appearance of the mole indicates that it may be malignant. A shave biopsy would not remove the entire mole. The mole is too large to be removed with punch biopsy. Excisional biopsies are done for smaller lesions and where a good cosmetic effect is desired, such as on the face.

The nurse instructs a patient about application of corticosteroid cream to an area of contact dermatitis on the right leg. Which patient action indicates that further teaching is needed? a. The patient takes a tepid bath before applying the cream. b. The patient spreads the cream using a downward motion. c. The patient applies a thick layer of the cream to the affected skin. d. The patient covers the area with a dressing after applying the cream.

ANS: C Creams and ointments should be applied in a thin layer to avoid wasting the medication. The other actions by the patient indicate that the teaching has been successful.

A dark-skinned patient has been admitted to the hospital with chronic heart failure. How would the nurse best assess this patient for cyanosis? a. Assess the skin color of the earlobes. b. Apply pressure to the palms of the hands. c. Check the lips and oral mucous membranes. d. Examine capillary refill time of the nail beds.

ANS: C Cyanosis in dark-skinned individuals is more easily seen in the mucous membranes. Earlobe color may change in light-skinned individuals, but this change in skin color is difficult to detect on darker skin. Application of pressure to the palms of the hands and nail bed assessment would check for adequate circulation but not for skin color.

While waiting to see the physician, a patient shows the nurse skin areas that are flat, nonpalpable, and have had a change of color. The nurse recognizes that the patient is demonstrating what? A) Macules B) Papules C) Vesicles D) Pustules

Ans: A Feedback: A macule is a flat, nonpalpable skin color change, while a papule is an elevated, solid, palpable mass. A vesicle is a circumscribed, elevated, palpable mass containing serous fluid, while a pustule is a pus-filled vesicle.

The nurse prepares to obtain a culture from a patient who has a possible fungal infection on the foot. Which items should the nurse gather for this procedure? a. Sterile gloves b. Patch test instruments c. Cotton-tipped applicators d. Local anesthetic, syringe, and intradermal needle

ANS: C Fungal cultures are obtained by swabbing the affected area of the skin with cotton-tipped applicators. Sterile gloves are not needed because it is not a sterile procedure. Local injection is not needed because the swabbing is not usually painful. The patch test is done to determine whether a patient is allergic to specific testing material, not for obtaining fungal specimens.

When examining an older patient in the home, the home health nurse notices irregular patterns of bruising at different stages of healing on the patient's body. Which action should the nurse take first? a. Discourage the use of throw rugs throughout the house. b. Ensure the patient has a pair of shoes with non-slip soles. c. Talk with the patient alone and ask about what caused the bruising. d. Notify the health care provider so that x-rays can be ordered as soon as possible.

ANS: C The nurse should note irregular patterns of bruising, especially in the shapes of hands or fingers, in different stages of resolution. These may be indications of other health problems or abuse, and should be further investigated. It is important that the nurse interview the patient alone because, if mistreatment is occurring, the patient may not disclose it in the presence of the person who may be the abuser. Throw rugs and shoes with slippery surfaces may contribute to falls. X-rays may be needed if the patient has fallen recently and also has complaints of pain or decreased mobility. However, the nurse's first nursing action is to further assess the patient.

When assessing a new patient at the outpatient clinic, the nurse notes dry, scaly skin; thin hair; and thick, brittle nails. What is the nurse's best action? a. Instruct the patient about the importance of nutrition in skin health. b. Make a referral to a podiatrist so that the nails can be safely trimmed. c. Consult with the health care provider about the need for further diagnostic testing. d. Teach the patient about using moisturizing creams and lotions to decrease dry skin.

ANS: C The patient has clinical manifestations that could be caused by systemic problems such as malnutrition or hypothyroidism, so further diagnostic evaluation is indicated. Patient teaching about nutrition, addressing the patient's dry skin, and referral to a podiatrist may also be needed, but the priority is to rule out underlying disease that may be causing these manifestations.

Which information will the nurse include when teaching an older patient about skin care? a. Dry the skin thoroughly before applying lotions. b. Bathe and wash hair daily with soap and shampoo. c. Use warm water and a moisturizing soap when bathing. d. Use antibacterial soaps when bathing to avoid infection.

ANS: C Warm water and moisturizing soap will avoid overdrying the skin. Because older patients have dryer skin, daily bathing and shampooing are not necessary and may dry the skin unnecessarily. Antibacterial soaps are not necessary. Lotions should be applied while the skin is still damp to seal moisture in.

An older adult patient with a squamous cell carcinoma (SCC) on the lower arm has a Mohs procedure in the dermatology clinic. Which nursing action will be included in the postoperative plan of care? a. Describe the use of topical fluorouracil on the incision. b. Teach how to use sterile technique to clean the suture line. c. Schedule daily appointments for wet-to-dry dressing changes. d. Teach about the use of cold packs to reduce bruising and swelling.

ANS: D Application of cold packs to the incision after the surgery will help decrease bruising and swelling at the site. Since the Mohs procedure results in complete excision of the lesion, topical fluorouracil is not needed after surgery. After the Mohs procedure the edges of the wound can be left open to heal or the edges can be approximated and sutured together. The suture line can be cleaned with tap water. No debridement with wet-to-dry dressings is indicated.

A nurse develops a teaching plan for a patient diagnosed with basal cell carcinoma (BCC). Which information should the nurse include in the teaching plan? a. Treatment plans include watchful waiting. b. Screening for metastasis will be important. c. Low dose systemic chemotherapy is used to treat BCC. d. Minimizing sun exposure will reduce risk for future BCC.

ANS: D BCC is frequently associated with sun exposure and preventive measures should be taken for future sun exposure. BCC spreads locally, and does not metastasize to distant tissues. Since BCC can cause local tissue destruction, treatment is indicated. Local (not systemic) chemotherapy may be used to treat BCC.

A patient has the following risk factors for melanoma. Which risk factor should the nurse assign as the priority focus of patient teaching? a. The patient has multiple dysplastic nevi. b. The patient is fair-skinned and has blue eyes. c. The patient's mother died of a malignant melanoma. d. The patient uses a tanning booth throughout the winter.

ANS: D Because the only risk factor that the patient can change is the use of a tanning booth, the nurse should focus teaching about melanoma prevention on this factor. The other factors also will contribute to increased risk for melanoma.

What is the best method to prevent the spread of infection when the nurse is changing the dressing over a wound infected with Staphylococcus aureus? a. Change the dressing using sterile gloves. b. Soak the dressing in sterile normal saline. c. Apply antibiotic ointment over the wound. d. Wash hands and properly dispose of soiled dressings.

ANS: D Careful hand washing and the safe disposal of soiled dressings are the best means of preventing the spread of skin problems. Sterile glove and sterile saline use during wound care will not necessarily prevent spread of infection. Applying antibiotic ointment will treat the bacteria but not necessarily prevent the spread of infection.

The nurse is caring for a patient diagnosed with furunculosis. Which nursing action could the nurse delegate to unlicensed assistive personnel (UAP)? a. Applying antibiotic cream to the groin. b. Obtaining cultures from ruptured lesions. c. Evaluating the patient's personal hygiene. d. Cleaning the skin with antimicrobial soap.

ANS: D Cleaning the skin is within the education and scope of practice for UAP. Administration of medication, obtaining cultures, and evaluation are higher-level skills that require the education and scope of practice of licensed nursing personnel.

The nurse assesses a patient who has just arrived in the postanesthesia recovery area (PACU) after a blepharoplasty. Which assessment data should be reported to the surgeon immediately? a. The patient complains of incisional pain. b. The patient's heart rate is 110 beats/minute. c. The patient is unable to detect when the eyelids are touched. d. The skin around the incision is pale and cold when palpated.

ANS: D Pale, cool skin indicates a possible decrease in circulation, so the surgeon should be notified immediately. The other assessment data indicate a need for ongoing assessment or nursing action. A heart rate of 110 beats/minute may be related to the stress associated with surgery. Assessment of other vital signs and continued monitoring are appropriate. Because local anesthesia would be used for the procedure, numbness of the incisional area is expected immediately after surgery. The nurse should monitor for return of feeling.

A dermatologist has asked the nurse to assist with examination of a patient's skin using a Wood's light. This test will allow the physician to assess for which of the following? A) The presence of minute regions of keloid scarring B) Unusual patterns of pigmentation on the patient's skin C) Vascular lesions that are not visible to the naked eye D) The presence of parasites on the epidermis

Ans: B Feedback: Wood's light makes it possible to differentiate epidermal from dermal lesions and hypopigmented and hyperpigmented lesions from normal skin.

Which abnormality on the skin of an older patient is the priority to discuss immediately with the health care provider? a. Several dry, scaly patches on the face b. Numerous varicosities noted on both legs c. Dilation of small blood vessels on the face d. Petechiae present on the chest and abdomen

ANS: D Petechiae are caused by pinpoint hemorrhages and are associated with a variety of serious disorders such as meningitis and coagulopathies. The nurse should contact the patient's health care provider about this finding for further diagnostic follow-up. The other skin changes are associated with aging. Although the other changes will also require ongoing monitoring or intervention by the nurse, they do not indicate a need for urgent action.

During assessment of the patient's skin, the nurse observes a similar pattern of small, raised lesions on the left and right upper back areas. Which term should the nurse use to document these lesions? a. Confluent b. Zosteriform c. Generalized d. Symmetric

ANS: D The description of the lesions indicates that they are grouped. The other terms are inconsistent with the description of the lesions.

A patient with an enlarging, irregular mole that is 7 mm in diameter is scheduled for outpatient treatment. The nurse should plan to prepare the patient for which procedure? a. Curettage b. Cryosurgery c. Punch biopsy d. Surgical excision

ANS: D The description of the mole is consistent with malignancy, so excision and biopsy are indicated. Curettage and cryosurgery are not used if malignancy is suspected. A punch biopsy would not be done for a lesion greater than 5 mm in diameter.

A patient who has severe refractory psoriasis on the face, neck, and extremities is socially withdrawn because of the appearance of the lesions. Which action should the nurse take first? a. Discuss the possibility of enrolling in a worker-retraining program. b. Encourage the patient to volunteer to work on community projects. c. Suggest that the patient use cosmetics to cover the psoriatic lesions. d. Ask the patient to describe the impact of psoriasis on quality of life.

ANS: D The nurse's initial actions should be to assess the impact of the disease on the patient's life and to allow the patient to verbalize feelings about the psoriasis. Depending on the assessment findings, other actions may be appropriate.

A patient with atopic dermatitis has a new prescription for pimecrolimus (Elidel). After teaching the patient about the medication, which statement by the patient indicates that further teaching is needed? a. "After I apply the medication, I can go ahead and get dressed as usual." b. "I will need to minimize my time in the sun while I am using the Elidel." c. "I will rub the medication gently onto the skin every morning and night." d. "If the medication burns when I apply it, I will wipe it off and call the doctor."

ANS: D The patient should be taught that transient burning at the application site is an expected effect of pimecrolimus and that the medication should be left in place. The other statements by the patient are accurate and indicate that patient teaching has been effective.

The nurse notes darker skin pigmentation in the skinfolds of a middle-aged patient who has a body mass index of 40 kg/m2. What is the nurse's best action? a. Teach the patient about the treatment of fungal infection. b. Discuss the use of drying agents to minimize infection risk. c. Instruct the patient about the use of mild soap to clean skinfolds. d. Ask the patient about type 2 diabetes or if there is a family history of it.

ANS: D The presence of acanthosis nigricans in skinfolds suggests either having type 2 diabetes or being at an increased risk for it. The description of the patient's skin does not indicate problems with fungal infection, poor hygiene, or the need to dry the skinfolds better.

Which information should the nurse include when teaching patients about decreasing the risk for sun damage to the skin? a. Use a sunscreen with an SPF of at least 8 to 10 for adequate protection. b. Water resistant sunscreens will provide good protection when swimming. c. Increase sun exposure by no more than 10 minutes a day to avoid skin damage. d. Try to stay out of the sun between the hours of 10 AM and 2 PM (regular time).

ANS: D The risk for skin damage from the sun is highest with exposure between 10 AM and 2 PM. No sunscreen is completely water resistant. Sunscreens classified as water resistant sunscreens still need to be reapplied after swimming. Sunscreen with an SPF of at least 15 is recommended for people at normal risk for skin cancer. Although gradually increasing sun exposure may decrease the risk for burning, the risk for skin cancer is not decreased.

The health care provider prescribes topical 5-FU for a patient with actinic keratosis on the left cheek. The nurse should include which statement in the patient's instructions? a. "5-FU will shrink the lesion so that less scarring occurs once the lesion is excised." b. "You may develop nausea and anorexia, but good nutrition is important during treatment." c. "You will need to avoid crowds because of the risk for infection caused by chemotherapy." d. "Your cheek area will be painful and develop eroded areas that will take weeks to heal."

ANS: D Topical 5-FU causes an initial reaction of erythema, itching, and erosion that lasts 4 weeks after application of the medication is stopped. The medication is topical, so there are no systemic effects such as increased infection risk, anorexia, or nausea.

When taking the health history of an older adult, the nurse discovers that the patient has worked in the landscaping business for 40 years. The nurse will plan to teach the patient about how to self-assess for which clinical manifestations (select all that apply)? a. Vitiligo b. Alopecia c. Intertrigo d. Erythema e. Actinic keratosis

ANS: D, E A patient who has worked as a landscaper is at risk for skin lesions caused by sun exposure such as erythema and actinic keratosis. Vitiligo, alopecia, and intertrigo are not associated with excessive sun exposure.

When writing a plan of care for a patient with psoriasis, the nurse would know that an appropriate nursing diagnosis for this patient would be what? A) Impaired Skin Integrity Related to Scaly Lesions B) Acute Pain Related to Blistering and Erosions of the Oral Cavity C) Impaired Tissue Integrity Related to Epidermal Shedding D) Anxiety Related to Risk for Melanoma

Ans: A Feedback: An appropriate diagnosis for a patient with psoriasis would include Impaired Skin Integrity as it relates to scaly lesions. Psoriasis causes pain but does not normally affect the oral cavity. Similarly, tissue integrity is impaired, but not through the process of epidermal shedding. Psoriasis is not related to an increased risk for melanoma.

A 55-year-old woman is scheduled to have a chemical face peel. The nurse is aware that the patient is likely seeking treatment for which of the following? A) Wrinkles near the lips and eyes B) Removal of acne scars C) Vascular lesions on the cheeks D) Real or perceived misshaping of the eyes

Ans: A Feedback: Chemical face peeling is especially useful for wrinkles at the upper and lower lip, forehead, and periorbital areas. Chemical face peeling does not remove acne scars, remove vascular lesions, or reshape the eyes.

The nurse in an ambulatory care center is admitting an older adult patient who has bright red moles on the skin. Benign changes in elderly skin that appear as bright red moles are termed what? A) Cherry angiomas B) Solar lentigo C) Seborrheickeratoses D) Xanthelasma

Ans: A Feedback: Cherry angiomas appear as bright red ìmoles,î while solar lentigo are commonly called ìliver spots.î Seborrheickeratoses are described as crusty brown ìstuck onî patches, while xanthelasma appears as yellowish, waxy deposits on the upper eyelids.

A patient's blistering disorder has resulted in the formation of multiple lesions in the patient's mouth. What intervention should be included in the patient's plan of care? A) Provide chlorhexidine solution for rinsing the patient's mouth. B) Avoid providing regular mouth care until the patient's lesions heal. C) Liaise with the primary care provider to arrange for parenteral nutrition. D) Encourage the patient to gargle with a hypertonic solution after each meal.

Ans: A Feedback: Frequent rinsing of the mouth with chlorhexidine solution is prescribed to rid the mouth of debris and to soothe ulcerated areas. A hypertonic solution would be likely to cause pain and further skin disruption. Meticulous mouth care should be provided and there is no reason to provide nutrition parenterally.

A patient has just been diagnosed with psoriasis and frequently has lesions around his right eye. What should the nurse teach the patient about topical corticosteroid use on these lesions? A) Cataract development is possible. B) The ointment is likely to cause weeping. C) Corticosteroid use is contraindicated on these lesions. D) The patient may develop glaucoma.

Ans: A Feedback: Patients using topical corticosteroid preparations repeatedly on the face and around the eyes should be aware that cataract development is possible. Weeping and glaucoma are less likely. There is no consequent risk of glaucoma.

A patient 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 patient, what major nursing diagnosis should the nurse include? A) Deficient Knowledge about Early Signs of Melanoma B) Chronic Pain Related to Surgical Excision and Grafting C) Depression Related to Reconstructive Surgery D) Anxiety Related to Lack of Social Support

Ans: A Feedback: The fact that the patient's disease was not reported until an advanced stage suggests that the patient lacked knowledge about skin lesions. Excision does not result in chronic pain. Reconstructive surgery is not a certainty, and will not necessarily lead to depression. Anxiety is likely, but this may or may not be related to a lack of social support.

A nurse is providing self-care education to a patient who has been receiving treatment for acne vulgaris. What instruction should the nurse provide to the patient? A) ìWash your face with water and gentle soap each morning and evening.î B) ìBefore bedtime, clean your face with rubbing alcohol on a cotton pad.î C) ìGently burst new pimples before they form a visible 'head'.î D) ìSet aside time each day to squeeze blackheads and remove the plug.î

Ans: A Feedback: The nurse should inform the patient to wash the face and other affected areas with mild soap and water twice each day to remove surface oils and prevent obstruction of the oil glands. Cleansing with rubbing alcohol is not recommended and all forms of manipulation should be avoided.

A nurse is caring for a patient who has been diagnosed with psoriasis. The nurse is creating an education plan for the patient. What information should be included in this plan? A) Use caution when taking nonprescription medications. B) Avoid public places until symptoms subside. C) Wash skin frequently to prevent infection. D) Liberally apply corticosteroids as needed.

Ans: A Feedback: The patient should be cautioned about taking nonprescription medications because some may aggravate mild psoriasis. Psoriasis is not contagious. Many patients need reassurance that the condition is not infectious, not a reflection of poor personal hygiene, and not skin cancer. Excessively frequent washing of skin produces more soreness and scaling. Overuse of topical corticosteroids can result in skin atrophy, striae, and medication resistance.

A patient with human immunodeficiency virus (HIV) has sought care because of the recent development of new skin lesions. The nurse should interpret these lesions as most likely suggestive of what? A) A reduction in the patient's CD4 count B) A reduction in the patient's viral load C) An adverse effect of antiretroviral therapy D) Virus-induced changes in allergy status

Ans: A Feedback: Cutaneous signs may be the first manifestation of human immunodeficiency virus (HIV), appearing in more than 90% of HIV-infected people as immune function deteriorates. These skin signs correlate with low CD4 counts and may become very atypical in immunocompromised people. Viral load increases, not decreases, as the disease progresses. Antiretrovirals are not noted to cause cutaneous changes and viruses do not change an individual's allergy status.

A nurse is conducting a health interview and is assessing for integumentary conditions that are known to have a genetic component. What assessment question is most appropriate? A) ìDoes anyone in your family have eczema or psoriasis?î B) ìHave any of your family members been diagnosed with malignant melanoma?î C) ìDo you have a family history of vitiligo or port-wine stains?î D) ìDoes any member of your family have a history of keloid scarring?î

Ans: A Feedback: Eczema and psoriasis are known to have a genetic component. This is not true of any of the other listed integumentary disorders.

An older adult patient is diagnosed with a vitamin D deficiency. What would be an appropriate recommendation by the nurse? A) Spend time outdoors at least twice per week B) Increase intake of leafy green vegetables C) Start taking a multivitamin each morning D) Eat red meat at least once per week

Ans: A Feedback: Skin exposed to ultraviolet light can convert substances necessary for synthesizing vitamin D (cholecalciferol). It is estimated that most people need five to thirty minutes of sun exposure twice a week in order for this synthesis to occur. Multivitamins may not resolve a specific vitamin D deficiency. Vitamin D is unrelated to meat and vegetable intake.

An 80-year-old patient is brought to the clinic by her son. The son asks the nurse why his mother has gotten so many ìspotsî on her skin. What would be an appropriate response by the nurse? A) ìAs people age, they normally develop uneven pigmentation in their skin.î B) ìThese 'spots' are called 'liver spots' or 'age spots.'î C) ìOlder skin is more apt to break down and tear, causing sores.î D) ìThese are usually the result of nutritional deficits earlier in life.î

Ans: A Feedback: The major changes in the skin of older people include dryness, wrinkling, uneven pigmentation, and various proliferative lesions. Stating the names of these spots and identifying older adults' vulnerability to skin damage do not answer the son's question. These lesions are not normally a result of nutritional imbalances.

The outer layer of the epidermis provides the most effective barrier to penetration of the skin by environmental factors. Which of the following is an example of penetration by an environmental factor? A) An insect bite B) Dehydration C) Sunburn D) Excessive perspiration

Ans: A Feedback: The stratum corneum, the outer layer of the epidermis, provides the most effective barrier to both epidermal water loss and penetration of environmental factors, such as chemicals, microbes, insect bites, and other trauma. Dehydration, sunburn, and excessive perspiration are not examples of penetration of an environmental factor.

A nurse is caring for a patient admitted to the medical unit with a diagnosis of pemphigus vulgaris. When writing the care plan for this patient, what nursing diagnoses should be included? Select all that apply. A) Risk for Infection Related to Lesions B) Impaired Skin Integrity Related to Epidermal Blisters C) Disturbed Body Image Related to Presence of Skin Lesions D) Acute Pain Related to Disruption in Skin Integrity E) Hyperthermia Related to Disruptions in Thermoregulation

Ans: A, B, C, D Feedback: Blistering diseases disrupt skin integrity and are associated with pain and a risk for infection. Because of the visibility of blisters, body image is often affected. The patient faces a risk for hypothermia, not hyperthermia.

A nurse educator is teaching a group of medical nurses about Kaposi's sarcoma. What would the educator identify as characteristics of endemic Kaposi's sarcoma? Select all that apply. A) Affects people predominantly in the eastern half of Africa B) Affects men more than women C) Does not affect children D) Cannot infiltrate E) Can progress to lymphadenopathic forms

Ans: A, B, E Feedback: Endemic (African) Kaposi's sarcoma affects people predominantly in the eastern half of Africa, near the equator. Men are affected more often than women, and children can be affected as well. The disease may resemble classic KS or it may infiltrate and progress to lymphadenopathic forms.

A patient has received a diagnosis of irritant contact dermatitis. What action should the nurse prioritize in the patient's subsequent care? A) Teaching the patient to safely and effectively administer immunosuppressants B) Helping the patient identify and avoid the offending agent C) Teaching the patient how to maintain meticulous skin hygiene D) Helping the patient perform wound care in the home environment

Ans: B Feedback: A focus of care for patients with irritant contact dermatitis is identifying and avoiding the offending agent. Immunosuppressants are not used to treat eczema and wound care is not normally required, except in cases of open lesions. Poor hygiene has no correlation with contact dermatitis.

A nurse is caring for a patient whose skin cancer will soon be removed by excision. Which of the following actions should the nurse perform? A) Teach the patient about early signs of secondary blistering diseases. B) Teach the patient about self-care after treatment. C) Assess the patient's risk for recurrent malignancy. D) Assess the patient for adverse effects of radiotherapy.

Ans: B Feedback: Because many skin cancers are removed by excision, patients are usually treated in outpatient surgical units. The role of the nurse is to teach the patient about prevention of skin cancer and about self-care after treatment. Assessing the patient's risk for recurrent malignancy is primarily the role of the physician. Blistering diseases do not result from cancer or subsequent excision. Excision is not accompanied by radiotherapy.

A new patient presents at the clinic and the nurse performs a comprehensive health assessment. The nurse notes that the patient's fingernail surfaces are pitted. The nurse should suspect the presence of what health problem? A) Eczema B) Systemic lupus erythematosus (SLE) C) Psoriasis D) Chronic obstructive pulmonary disease (COPD)

Ans: C Feedback: Pitted surface of the nails is a definite indication of psoriasis. Pitting of the nails does not indicate eczema, SLE, or COPD.

A patient with a chronic diabetic wound is being discharged after receiving a skin graft to aid wound healing. What direction should the nurse include in home care instructions? A) Gently massage the graft site daily to promote perfusion. B) Protect the graft from direct sunlight and temperature extremes. C) Protect the graft site from any form of moisture for at least 12 weeks. D) Apply antibiotic ointment to the graft site and donor site daily.

Ans: B Feedback: Both the donor site and the grafted area must be protected from exposure to extremes in temperature, external trauma, and sunlight because these areas are sensitive, especially to thermal injuries. Antibiotic ointments are not typically prescribed and massage may damage these fragile sites. There is no need to protect the sites from all forms of moisture for the long term.

A school nurse has sent home four children who show evidence of pediculosis capitis. What is an important instruction the nurse should include in the note being sent home to parents? A) The child's scalp should be monitored for 48 to 72 hours before starting treatment. B) Nits may have to be manually removed from the child's hair shafts. C) The disease is self-limiting and symptoms will abate within 1 week. D) Efforts should be made to improve the child's level of hygiene.

Ans: B Feedback: Treatment for head lice should begin promptly and may require manual removal of nits following medicating shampoo. Head lice are not related to a lack of hygiene. Treatment is necessary because the condition will not likely resolve spontaneously within 1 week.

A patient with a suspected malignant melanoma is referred to the dermatology clinic. The nurse knows to facilitate what diagnostic test to rule out a skin malignancy? A) Tzanck smear B) Skin biopsy C) Patch testing D) Skin scrapings

Ans: B Feedback: A skin biopsy is done to rule out malignancies of skin lesions. A Tzanck smear is used to examine cells from blistering skin conditions, such as herpes zoster. Patch testing is performed to identify substances to which the patient has developed an allergy. Skin scrapings are done for suspected fungal infections.

Assessment of a patient's leg reveals the presence of a 1.5-cm circular region of necrotic tissue that is deeper than the epidermis. The nurse should document the presence of what type of skin lesion? A) Keloid B) Ulcer C) Fissure D) Erosion

Ans: B Feedback: An ulcer is skin loss extending past the epidermis with the involvement of necrotic tissue. Keloids lack necrosis and consist of scar tissue. A fissure is linear and erosions do not extend to the dermis.

A gerontologic nurse is teaching a group of nursing students about integumentary changes that occur in older adults. How should these students best integrate these changes into care planning? A) By avoiding the use of moisturizing lotions on older adults' skin B) By protecting older adults against shearing injuries C) By avoiding the use of ice packs to treat muscle pain D) By protecting older adults against excessive sweat accumulation

Ans: B Feedback: Cellular changes associated with aging include thinning at the junction of the dermis and epidermis, which creates a risk for shearing injuries. Moisturizing lotions can be safely used to address the increased dryness of older adults' skin. Ice packs can be used, provided skin is assessed regularly and the patient possesses normal sensation. Older adults perspire much less than younger adults, thus sweat accumulation is rarely an issue.

A patient is diagnosed with atrial fibrillation and the physician orders Coumadin (warfarin). For what skin lesion should the nurse monitor this patient? A) Ulcer B) Ecchymosis C) Scar D) Erosion

Ans: B Feedback: Ecchymosis refers to a round or irregular macular lesion, which is larger than petechiae. This occurs secondary to blood extravasation. It is important to watch for ecchymosis in a patient receiving any type of anticoagulant. An ulcer is an open lesion eroded into the patient's flesh. A scar is an area on the skin caused by the healing of an injury. Erosion is loss of superficial epidermis that does not extend to the dermisóa depressed, moist area.

A nurse practitioner working in a dermatology clinic finds an open lesion on a patient who is being assessed. What should the nurse do next? A) Obtain a swab for culture. B) Assess the characteristics of the lesion. C) Obtain a swab for pH testing. D) Apply a test dose of broad-spectrum topical antibiotic.

Ans: B Feedback: If acute open wounds or lesions are found on inspection of the skin, a comprehensive assessment should be made and documented. Testing for culture and pH are not necessarily required, and assessment should precede these actions. Antibiotics are not applied on an empiric basis.

A nurse is explaining the importance of sunlight on the skin to a woman with decreased mobility who rarely leaves her house. The nurse would emphasize that ultraviolet light helps to synthesize what vitamin? A) E B) D C) A D) C

Ans: B Feedback: Skin exposed to ultraviolet light can convert substances necessary for synthesizing vitamin D (cholecalciferol). Vitamin D is essential for preventing rickets, a condition that causes bone deformities and results from a deficiency of vitamin D, calcium, and phosphorus.

A young student is brought to the school nurse after falling off a swing. The nurse is documenting that the child has bruising on the lateral aspect of the right arm. What term will the nurse use to describe bruising on the skin in documentation? A)Telangiectasias B)Ecchymoses C)Purpura D)Urticaria

Ans: B Feedback: Telangiectasias consists of red marks on the skin caused by stretching of superficial blood vessels. Ecchymoses are bruises, and purpura consists of pinpoint hemorrhages into the skin. Urticariais wheals or hives.

A patient is suspected of developing an allergy to an environmental substance and has been given a patch test. During the test, the patient develops fine blisters, papules, and severe itching. The nurse knows that this is indicative of what strength reaction? A) Weak positive B) Moderately positive C) Strong positive D) Severely positive

Ans: B Feedback: The development of redness, fine elevations, or itching is considered a weak positive reaction; fine blisters, papules, and severe itching indicate a moderately positive reaction; and blisters, pain, and ulceration indicate a strong positive reaction.

A wound care nurse is reviewing skin anatomy with a group of medical nurses. Which area of the skin would the nurse identify as providing a cushion between the skin layers, muscles, and bones? A) Dermis B) Subcutaneous tissue C) Epidermis D) Stratum corneum

Ans: B Feedback: The subcutaneous tissue, or hypodermis, is the innermost layer of the skin that is responsible for providing a cushion between the skin layers, muscles, and bones. The dermis is the largest portion of the skin, providing strength and structure. The epidermis is the outermost layer of stratified epithelial cells and composed of keratinocytes. The stratum corneum is the outermost layer of the epidermis, which provides a barrier to prevent epidermal water loss.

When caring for a patient with toxic epidermal necrolysis (TEN), the critical care nurse assesses frequently for high fever, tachycardia, and extreme weakness and fatigue. The nurse is aware that these findings are potential indicators of what? Select all that apply. A) Possible malignancy B) Epidermal necrosis C) Neurologic involvement D) Increased metabolic needs E) Possible gastrointestinal mucosal sloughing

Ans: B, D, E Feedback: Assessment for high fever, tachycardia, and extreme weakness and fatigue is essential because these factors indicate the process of epidermal necrosis, increased metabolic needs, and possible gastrointestinal and respiratory mucosal sloughing. These factors are less likely to suggest malignancy or neurologic involvement, as these are not common complications of TEN.

A nurse is caring for a patient who has a diagnosis of bullous pemphigoid and who is being treated on the medical unit. When providing hygiene for this patient, the nurse should perform which of the following actions? A) After washing, wipe lesions with sterile gauze to remove cellular debris. B) Apply antibiotic ointment to lesions after washing. C) Apply cornstarch to the patient's skin after bathing to facilitate mobility. D) Avoid using water to cleanse the patient's skin in order to maintain skin integrity.

Ans: C Feedback: After the patient's skin is bathed, it is dried carefully and dusted liberally with nonirritating powder (e.g., cornstarch), which enables the patient to move about freely in bed. Open blisters should not normally be wiped and antibiotics are not applied to wound beds in the absence of a secondary infection. Water can safely be used to provide hygiene.

A nurse is providing care for a patient who has psoriasis. The nurse is aware of the sequelae that can result from this health problem. Following the appearance of skin lesions, the nurse should prioritize what assessment? A) Assessment of the patient's stool for evidence of intestinal sloughing B) Assessment of the patient's apical heart rate for dysrhythmias C) Assessment of the patient's joints for pain and decreased range of motion D) Assessment for cognitive changes resulting from neurologic lesions

Ans: C Feedback: Asymmetric rheumatoid factorñnegative arthritis of multiple joints occurs in up to 30 %of people with psoriasis, most typically after the skin lesions appear. The most typical joints affected include those in the hands or feet, although sometimes larger joints such as the elbow, knees, or hips may be affected. As such, the nurse should assess for this musculoskeletal complication. GI, cardiovascular, and neurologic function are not affected by psoriasis.

An older adult resident of a long-term care facility has been experiencing generalized pruritus that has become more severe in recent weeks. What intervention should the nurse add to this resident's plan of care? A) Avoid the application of skin emollients. B) Apply antibiotic ointment as ordered following baths. C) Avoid using hot water during the patient's baths. D) Administer acetaminophen 4 times daily as ordered.

Ans: C Feedback: If baths have been prescribed, the patient is reminded to use tepid (not hot) water and to shake off the excess water and blot between intertriginous areas (body folds) with a towel. Skin emollients should be applied to reduce pruritus. Acetaminophen and antibiotics do not reduce pruritus.

A 35-year-old kidney transplant patient comes to the clinic exhibiting new skin lesions. The diagnosis is Kaposi's sarcoma. The nurse caring for this patient recognizes that this is what type of Kaposi's sarcoma? A) Classic B) AIDS-related C) Immunosuppression-related D) Endemic

Ans: C Feedback: Immunosuppression-associated Kaposi's sarcoma occurs in transplant recipients and people with AIDS. This form of KS is characterized by local skin lesions and disseminated visceral and mucocutaneous diseases. Classic Kaposi's sarcoma occurs predominantly in men of Mediterranean or Jewish ancestry between 40 and 70 years of age. Endemic KS affects people predominantly in the eastern half of Africa. AIDS-related KS is seen in people with AIDS.

A nurse is working with a family whose 5 year-old daughter has been diagnosed with impetigo. What educational intervention should the nurse include in this family's care? A) Ensuring that the family knows that impetigo is not contagious B) Teaching about the safe and effective use of topical corticosteroids C) Teaching about the importance of maintaining high standards of hygiene D) Ensuring that the family knows how to safely burst the child's vesicles

Ans: C Feedback: Impetigo is associated with unhygienic conditions; educational interventions to address this are appropriate. The disease is contagious, thus vesicles should not be manually burst. Because of the bacterial etiology, corticosteroids are ineffective.

A patient is admitted to the intensive care unit with what is thought to be toxic epidermal necrolysis (TEN). When assessing the health history of the patient, the nurse would be alert to what precipitating factor? A) Recent heavy ultraviolet exposure B) Substandard hygienic conditions C) Recent administration of new medications D) Recent varicella infection

Ans: C Feedback: In adults, TEN is usually triggered by a reaction to medications. Antibiotics, antiseizure agents, butazones, and sulfonamides are the most frequent medications implicated. TEN is unrelated to UV exposure, hygiene, or varicella infection.

A patient has a diagnosis of seborrhea and has been referred to the dermatology clinic, where the nurse contributes to care. When planning this patient's care, the nurse should include which of the following nursing diagnoses? A) Risk for Deficient Fluid Volume Related to Excess Sebum Synthesis B) Ineffective Thermoregulation Related to Occlusion of Sebaceous Glands C) Disturbed Body Image Related to Excess Sebum Production D) Ineffective Tissue Perfusion Related to Occlusion of Sebaceous Glands

Ans: C Feedback: Seborrhea causes highly visible manifestations that are likely to have a negative effect on the patient's body image. Seborrhea does not normally affect fluid balance, thermoregulation, or tissue perfusion.

A nurse is leading a health promotion workshop that is focusing on cancer prevention. What action is most likely to reduce participants' risks of basal cell carcinoma (BCC)? A) Teaching participants to improve their overall health through nutrition B) Encouraging participants to identify their family history of cancer C) Teaching participants to limit their sun exposure D) Teaching participants to control exposure to environmental and occupational radiation

Ans: C Feedback: Sun exposure is the best known and most common cause of BCC. BCC is not commonly linked to general health debilitation, family history, or radiation exposure.

A public health nurse is participating in a health promotion campaign that has the goal of improving outcomes related to skin cancer in the community. What action has the greatest potential to achieve this goal? A) Educating participants about the relationship between general health and the risk of skin cancer B) Educating participants about treatment options for skin cancer C) Educating participants about the early signs and symptoms of skin cancer D) Educating participants about the health risks associated with smoking and assisting with smoking cessation

Ans: C Feedback: The best hope of decreasing the incidence of skin cancer lies in educating patients about the early signs. There is a relationship between general health and skin cancer, but teaching individuals to identify the early signs and symptoms is more likely to benefit overall outcomes related to skin cancer. Teaching about treatment options is not likely to have a major effect on outcomes of the disease. Smoking is not among the major risk factors for skin cancer.

A patient diagnosed with a stasis ulcer has been hospitalized. There is an order to change the dressing and provide wound care. Which activity should the nurse first perform when providing wound care? A) Assess the drainage in the dressing. B) Slowly remove the soiled dressing. C) Perform hand hygiene. D) Don non-latex gloves.

Ans: C Feedback: The nurse and physician must adhere to standard precautions and wear gloves when inspecting the skin or changing a dressing. Use of standard precautions and proper disposal of any contaminated dressing is carried out according to Occupational Safety and Health Administration (OSHA) regulations. Hand hygiene must precede other aspects of wound care.

A patient with squamous cell carcinoma has been scheduled for treatment of this malignancy. The nurse should anticipate that treatment for this type of cancer will primarily consist of what intervention? A) Chemotherapy B) Radiation therapy C) Surgical excision D) Biopsy of sample tissue

Ans: C Feedback: The primary goal of surgical management of squamous cell carcinoma is to remove the tumor entirely. Radiation therapy is reserved for older patients, because x-ray changes may be seen after 5 to 10 years, and malignant changes in scars may be induced by irradiation 15 to 30 years later. Obtaining a biopsy would not be a goal of treatment; it may be an assessment. Chemotherapy and radiation therapy are generally reserved for patients who are not surgical candidates.

A patient requires a full-thickness graft to cover a chronic wound. How is the donor site selected? A) The largest area of the body without hair is selected. B) Any area that is not normally visible can be used. C) An area matching the color and texture of the skin at the surgical site is selected. D) An area matching the sensory capability of the skin at the surgical site is selected.

Ans: C Feedback: The site where the intact skin is harvested is called the donor site. Selection of the donor site is made to match the color and texture of skin at the surgical site and to leave as little scarring as possible.

A patient has just been told that he has malignant melanoma. The nurse caring for this patient should anticipate that the patient will undergo what treatment? A) Chemotherapy B) Immunotherapy C) Wide excision D) Radiation therapy

Ans: C Feedback: Wide excision is the primary treatment for malignant melanoma, which removes the entire lesion and determines the level and staging. Chemotherapy may be used after the melanoma is excised. Immunotherapy is experimental and radiation therapy is palliative.

A nurse in a dermatology clinic is reading the electronic health record of a new patient. The nurse notes that the patient has a history of a primary skin lesion. What is an example of a primary skin lesion? A) Crust B) Keloid C) Pustule D) Ulcer

Ans: C Feedback: A pustule is an example of a primary skin lesion. Primary skin lesions are original lesions arising from previously normal skin. Crusts, keloids and ulcers are secondary lesions.

The nurse is performing an initial assessment of a patient who has a raised, pruritic rash. The patient denies taking any prescription medication and denies any allergies. What would be an appropriate question to ask this patient at this time? A) ìIs anyone in your family allergic to anything?î B) ìHow long have you had this abrasion?î C) ìDo you take any over-the-counter drugs or herbal preparations?î D) ìWhat do you do for a living?î

Ans: C Feedback: If suspicious areas are noted, the patient is questioned about nonprescription or herbal preparations that might be in use. Ascertaining a family history of allergies would not give helpful information at this time. The patient's lesion is not described as an abrasion. The patient's occupation may or may not be relevant; it is more important to assess for herb or drug reactions.

The nurse is performing a comprehensive assessment of a patient's skin surfaces and intends to assess moisture, temperature, and texture. The nurse should perform this component of assessment in what way? A) By examining the patient under a Wood's light B) By inspecting the patient's skin in direct sunlight C) By palpating the patient's skin D) By performing percussion of major skin surfaces

Ans: C Feedback: Inspection and palpation are techniques commonly used in examining the skin. A patient would only be examined under a Wood's light if there were indications it could be diagnostic. The patient is examined in a well-lit room, not in direct sunlight. Percussion is not a technique used in assessing the skin.

A nurse is reviewing gerontologic considerations relating to the care of patients with dermatologic problems. What vulnerability results from the age-related loss of subcutaneous tissue? A) Decreased resistance to ultraviolet radiation B) Increased vulnerability to infection C) Diminished protection of tissues and organs D) Increased risk of skin malignancies

Ans: C Feedback: Loss of the subcutaneous tissue substances of elastin, collagen, and fat diminishes the protection and cushioning of underlying tissues and organs, decreases muscle tone, and results in the loss of the insulating properties of fat. This age-related change does not correlate to an increased vulnerability to sun damage, infection, or cancer.

A new patient has come to the dermatology clinic to be assessed for a reddened rash on his abdomen. What diagnostic test would most likely be ordered to identify the causative allergen? A) Skin scrapings B) Skin biopsy C) Patch testing D) Tzanck smear

Ans: C Feedback: Patch testing is performed to identify substances to which the patient has developed an allergy. Skin scrapings are done for suspected fungal lesions. A skin biopsy is completed to rule out malignancy and to establish an exact diagnosis of skin lesions. A Tzanck smear is used to examine cells from blistering skin conditions, such as herpes zoster.

While assessing a 25-year-old female, the nurse notes that the patient has hair on her lower abdomen. Earlier in the health interview, the patient stated that her menses are irregular. The nurse should suspect what type of health problem? A) A metabolic disorder B) A malignancy C) A hormonal imbalance D) An infectious process

Ans: C Feedback: Some women with higher levels of testosterone have hair in the areas generally thought of as masculine, such as the face, chest, and lower abdomen. This is often a normal genetic variation, but if it appears along with irregular menses and weight changes, it may indicate a hormonal imbalance. This combination of irregular menses and hair distribution is inconsistent with metabolic disorders, malignancy, or infection.

A patient presents at the dermatology clinic with suspected herpes simplex. The nurse knows to prepare what diagnostic test for this condition? A) Skin biopsy B) Patch test C) Tzanck smear D) Examination with a Wood's light

Ans: C Feedback: The Tzanck smear is a test used to examine cells from blistering skin conditions, such as herpes zoster, varicella, herpes simplex, and all forms of pemphigus. The secretions from a suspected lesion are applied to a glass slide, stained, and examined. This is not accomplished by biopsy, patch test, or Wood's light.

When planning the skin care of a patient with decreased mobility, the nurse is aware of the varying thickness of the epidermis. At what location is the epidermal layer thickest? A) The scalp B) The elbows C) The palms of the hands D) The knees

Ans: C Feedback: The epidermis is the thickest over the palms of the hands and the soles of the feet.

A nurse is preparing to perform the physical assessment of a newly admitted patient. During which of the following components of the assessment should the nurse wear gloves? Select all that apply. A) Palpation of the patient's scalp B) Palpation of the patient's upper extremities C) Palpation of a rash on the patient's trunk D) Palpation of a lesion on the patient's upper back E) Palpation of the patient's fingers

Ans: C, D Feedback: Gloves are worn during skin examination if a rash or lesions are to be palpated. It is not normally necessary to wear gloves to palpate a patient's scalp, extremities, or fingers unless contact with body fluids is reasonably foreseeable.

While performing an initial assessment of a patient admitted with appendicitis, the nurse observes an elevated blue-black lesion on the patient's ear. The nurse knows that this lesion is consistent with what type of skin cancer? A) Basal cell carcinoma B) Squamous cell carcinoma C) Dermatofibroma D) Malignant melanoma

Ans: D Feedback: A malignant melanoma presents itself as a superficial spreading melanoma which may appear in a combination of colors, with hues of tan, brown, and black mixed with gray, blue-black, or white. The lesion tends to be circular, with irregular outer portions. BCC usually begins as a small, waxy nodule with rolled, translucent, pearly borders; telangiectatic vessels may be present. SCC appears as a rough, thickened, scaly tumor that may be asymptomatic or may involve bleeding. A dermatofibroma presents as a firm, dome-shaped papule or nodule that may be skin colored or pinkish-brown.

A nurse is planning the care of a patient with herpes zoster. What medication, if administered within the first 24 hours of the initial eruption, can arrest herpes zoster? A) Prednisone (Deltasone) B) Azanthioprine (Imuran) C) Triamcinolone (Kenalog) D) Acyclovir (Zovirax)

Ans: D Feedback: Acyclovir, if started early, is effective in significantly reducing the pain and halting the progression of the disease. There is evidence that infection is arrested if oral antiviral agents are administered within the first 24 hours. Prednisone is an anti-inflammatory agent used in a variety of skin disorders, but not in the treatment of herpes. Azanthioprine is an immunosuppressive agent used in the treatment of pemphigus. Triamcinolone is utilized in the treatment of psoriasis.

A 65-year-old man presents at the clinic complaining of nodules on both legs. The man tells the nurse that his son, who is in medical school, encouraged him to seek prompt care and told him that the nodules are related to the fact that he is Jewish. What health problem should the nurse suspect? A) Stasis ulcers B) Bullous pemphigoid C) Psoriasis D) Classic Kaposi's sarcoma

Ans: D Feedback: Classic Kaposi's sarcoma occurs predominantly in men of Mediterranean or Jewish ancestry between 40 and 70 years of age. Most patients have nodules or plaques on the lower extremities that rarely metastasize beyond this area. Classic KS is chronic, relatively benign, and rarely fatal. Stasis ulcers do not create nodules. Bullous pemphigoid is characterized by blistering. Psoriasis characteristically presents with silvery plaques.

A nurse is assessing a teenage patient with acne vulgaris. The patient's mother states, ìI keep telling him that this is what happens when you eat as much chocolate as he does.î What aspect of the pathophysiology of acne should inform the nurse's response? A) A sudden change in patient's diet may exacerbate, rather than alleviate, the patient's symptoms. B) Chocolate is not among the foods that are known to cause acne. C) Elimination of chocolate from the patient's diet will likely lead to resolution within several months. D) Diet is thought to play a minimal role in the development of acne.

Ans: D Feedback: Diet is not believed to play a major role in acne therapy. A change in diet is not known to exacerbate symptoms.

A patient comes to the clinic complaining of a red rash of small, fluid-filled blisters and is suspected of having herpes zoster. What presentation is most consistent with herpes zoster? A) Grouped vesicles occurring on lips and oral mucous membranes B) Grouped vesicles occurring on the genitalia C) Rough, fresh, or gray skin protrusions D) Grouped vesicles in linear patches along a dermatome

Ans: D Feedback: Herpes zoster, or shingles, is an acute inflammation of the dorsal root ganglia, causing localized, vesicular skin lesions following a dermatome. Herpes simplex type 1 is a viral infection affecting the skin and mucous membranes, usually producing cold sores or fever blisters. Herpes simplex type 2 primarily affects the genital area, causing painful clusters of small ulcerations. Warts appear as rough, fresh, or gray skin protrusions.

A nurse is providing care for a patient who has developed Kaposi's sarcoma secondary to HIV infection. The nurse should be aware that this form of malignancy originates in what part of the body? A) Connective tissue cells in diffuse locations B) Smooth muscle cells of the gastrointestinal and respiratory tract C) Neural tissue of the brain and spinal cord D) Endothelial cells lining small blood vessels

Ans: D Feedback: Kaposi's sarcoma (KS) is a malignancy of endothelial cells that line the small blood vessels. It does not originate in connective tissue, smooth muscle cells of the GI and respiratory tract, or in neural tissue.

A patient has just undergone surgery for malignant melanoma. Which of the following nursing actions should be prioritized? A) Maintain the patient on bed rest for the first 24 hours postoperative. B) Apply distraction techniques to relieve pain. C) Provide soft or liquid diet that is high in protein to assist with healing. D) Anticipate the need for, and administer, appropriate analgesic medications.

Ans: D Feedback: Nursing interventions after surgery for a malignant melanoma center on promoting comfort, because wide excision surgery may be necessary. Anticipating the need for and administering appropriate analgesic medications are important. Distraction techniques may be appropriate for some patients, but these are not a substitute for analgesia. Bed rest and a modified diet are not necessary.

A 30-year-old male patient has just returned from the operating room after having a ìflapî done following a motorcycle accident. The patient's wife asks the nurse about the major complications following this type of surgery. What would be the nurse's best response? A) ìThe major complication is when the patient develops chronic pain.î B) ìThe major complication is when the patient loses sensation in the flap.î C) ìThe major complication is when the pedicle tears loose and the flap dies.î D) ìThe major complication is when the blood supply fails and the tissue in the flap dies.î

Ans: D Feedback: The major complication of a flap is necrosis of the pedicle or base as a result of failure of the blood supply. This is more likely than tearing of the pedicle and chronic pain and is more serious than loss of sensation.

A nurse is caring for a patient whose chemical injury has necessitated a skin graft to his left hand. The nurse enters the room and observes that the patient is performing active range of motion (ROM) exercises with the affected hand. How should the nurse best respond? A) Liaise with the physical therapist to ensure that the patient is performing exercises safely. B) Validate the patient's efforts to increase blood perfusion to the graft site. C) Remind the patient that ROM exercises should be passive, not active. D) Remind the patient of the need to immobilize the graft to facilitate healing.

Ans: D Feedback: The nurse should instruct the patient to keep the affected part immobilized as much as possible in order to facilitate healing. Passive ROM exercises can be equally as damaging as active ROM.

A patient who has sustained third-degree facial burns and a facial fracture is undergoing reconstructive surgery and implantation of a prosthesis. The nurse has identified a nursing diagnosis of Disturbed Body Image Related to Disfigurement. What would be an appropriate nursing intervention related to this diagnosis? A) Referring the patient to a speech therapist B) Gradually adding soft foods to diet C) Administering analgesics as prescribed D) Teaching the patient how to use and care for the prosthesis

Ans: D Feedback: The process of facial reconstruction is often slow and tedious. Because a person's facial appearance affects self-esteem so greatly, this type of reconstruction is often a very emotional experience for the patient. Reinforcement of the patient's successful coping strategies improves self-esteem. If prosthetic devices are used, the patient is taught how to use and care for them to gain a sense of greater independence. This is an intervention that relates to Disturbed Body Image in these patients. None of the other listed interventions relates directly to the diagnosis of Disturbed Body Image.

A young student comes to the school nurse and shows the nurse a mosquito bite. As the nurse expects, the bite is elevated and has serous fluid contained in the dermis. How would the nurse classify this lesion? A) Vesicle B) Macule C) Nodule D) Wheal

Ans: D Feedback: A wheal is a primary skin lesion that is elevated and has fluid contained in the dermis. An example of a wheal would be an insect bite or hives. Vesicles, macules, and nodules are not characterized by elevation and the presence of serous fluid.

A patient's health assessment has resulted in a diagnosis of alopecia areata. What nursing diagnosis should the nurse most likely associate with this health problem? A) Chronic Pain B) Impaired Skin Integrity C) Impaired Tissue Integrity D) Disturbed Body Image

Ans: D Feedback: Alopecia areata causes hair loss in smaller defined areas. As such, it is common for the patient to experience a disturbed body image. Hair loss does not cause pain and does not affect skin or tissue integrity.

A nurse is working with a patient who has a diagnosis of Cushing syndrome. When completing a physical assessment, the nurse should specifically observe for what integumentary manifestation? A) Alopecia B) Yellowish skin tone C) Patchy, bronze pigmentation D) Hirsutism

Ans: D Feedback: Cushing syndrome causes excessive hair growth, especially in women. Alopecia is hair loss from the scalp and other parts of the body. Jaundice causes a yellow discoloration in light-skinned patients, but this does not accompany Cushing syndrome. Patients that have Addison's disease exhibit a bronze discoloration to their skin due to increased melanin production.

An African American is admitted to the medical unit with liver disease. To correctly assess this patient for jaundice, on what body area should the nurse look for yellow discoloration? A) Elbows B) Lips C) Nail beds D) Sclerae

Ans: D Feedback: Jaundice, a yellowing of the skin, is directly related to elevations in serum bilirubin and is often first observed in the sclerae and mucous membranes.

A nurse is assessing the skin of a patient who has been diagnosed with bacterial cellulitis on the dorsal portion of the great toe. When reviewing the patient's health history, the nurse should identify what comorbidity as increasing the patient's vulnerability to skin infections? A) Chronic obstructive pulmonary disease B) Rheumatoid arthritis C) Gout D) Diabetes

Ans: D Feedback: Patients with diabetes are particularly susceptible to skin infections. COPD, RA, and gout are less commonly associated with integumentary manifestations.

A patient with an exceptionally low body mass index has been admitted to the emergency department with signs and symptoms of hypothermia. The nurse should know that this patient's susceptibility to heat loss is related to atrophy of what skin component? A) Epidermis B) Merkel cells C) Dermis D) Subcutaneous tissue

Ans: D Feedback: The subcutaneous tissues and the amount of fat deposits are important factors in body temperature regulation. The epidermis is an outermost layer of stratified epithelial cells. Merkel cells are receptors that transmit stimuli to the axon through a chemical synapse. The dermis makes up the largest portion of the skin, providing strength and structure. It is composed of two layers: papillary and reticular.

An 82-year-old patient is being treated in the hospital for a sacral pressure ulcer. What age-related change is most likely to affect the patient's course of treatment? A) Increased thickness of the subcutaneous skin layer B) Increased vascular supply to superficial skin layers C) Changes in the character and quantity of bacterial skin flora D) Increased time required for wound healing

Ans: D Feedback: Wound healing becomes slower with age, requiring more time for older adults to recover from surgical and traumatic wounds. There are no changes in skin flora with increased age. Vascular supply and skin thickness both decrease with age.

An unresponsive Caucasian patient has been brought to the emergency room by EMS. While assessing this patient, the nurse notes that the patient's face is a cherry-red color. What should the nurse suspect? A) Carbon monoxide poisoning B) Anemia C) Jaundice D) Uremia

Ans:A Feedback: Carbon monoxide poisoning causes a bright cherry red color in the face and upper torso in light-skinned persons. In dark-skinned persons, there will be a cherry red color to nail beds, lips, and oral mucosa. When anemia occurs in light-skinned persons, the skin has generalized pallor. Anemia in dark-skinned persons manifests as a yellow-brown coloration. Jaundice appears as a yellow coloration of the sclerae. Uremia gives a yellow-orange tinge to the skin.

A nurse in the emergency department (ED) is triaging a 5-year-old who has been brought to the ED by her parents for an outbreak of urticaria. What would be the most appropriate question to ask this patient and her family? A)Has she eaten any new foods today? B)Has she bathed in the past 24 hours? C)Did she go to a friend's house today? D)Was she digging in the dirt today?

Ans:A Feedback: Foods can cause skin reactions, especially in children. In most cases, this is a more plausible cause of urticaria than bathing, contact with other children, or soil-borne pathogens.

While assessing a dark-skinned patient at the clinic, the nurse notes the presence of patchy, milky white spots. The nurse knows that this finding is characteristic of what diagnosis? A) Cyanosis B) Addison's disease C) Polycythemia D) Vitiligo

Ans:D Feedback: With cyanosis, nail beds are dusky. With polycythemia, the nurse notes ruddy blue face, oral mucosa, and conjunctiva. A bronzed appearance, or ìexternal tan,î is associated with Addison's disease. Vitiligo is a condition characterized by destruction of the melanocytes in circumscribed areas of skin and appears in light or dark skin as patchy, milky white spots, often symmetric bilaterally.