Chapter 25 Care of Patient with Skin Problems
Which of the following fungal infections is associated with athlete's foot?
Tinea pedis
A patient has a chronic pressure injury with a cavity-like defect. Which type of intention helps in healing the wound?
Second
What process of wound healing involves the production of keratin?
Resurfacing
Which description is characteristic of a wound that is healing by third intention?
It is a potentially infected surgical wound
A patient has pruritus. Which measure is used to reduce skin damage from scratching and prevent secondary infection?
Keep the fingernails trimmed short.
What should the nurse include in the plan of care when a patient reports itching?
Keep the patient's fingernails trimmed and filed.
The nurse is teaching a patient with loss of sensation and movement in the lower extremities secondary to spinal cord injury about protecting skin integrity. Which daily prevention strategy does the nurse include in the patient's teaching plan?
Lift hips off the chair at least every hour
A patient with a skin infection on the hand reports itching near the site of infection. Upon assessment, the nurse notices serpiginous patches with elevated borders. What could be the possible diagnosis?
Tinea manus
Which condition is characterized by the presence of a rash of white or red edematous papules?
Urticaria
When educating a patient about pressure injury prevention, what does the nurse suggest?
Use barrier ointments to protect intact skin if incontinence is present.
Which type of lesion occurs as a result of necrosis?
Eschar
Which type of cancer is resistant to radiation therapy?
Melanoma
Which inflammatory condition leads to dehydration and hypothermia?
Exfoliative psoriasis
What is the underlying cause of urticaria?
Exposure to allergens
A patient with a skin infection reports recurrence of the infection after treatment with topical antifungal therapy. While assessing the patient, the nurse notices erythematous macular eruptions in the infected area. Which drug would be beneficial for the patient?
Ketoconazole
Which factor may cause a systemic altered inflammatory response?
Leukemia
The nurse is teaching a patient ways to reduce skin inflammation. Which statement made by the patient shows effective learning?
"I will add cornstarch to the water before bathing."
The nurse is evaluating a student nurse after teaching about the use of antihistamines for pruritus. Which statements made by the student nurse indicate the need for further learning? Select all that apply.
"Antihistamines are used to treat skin trauma." "The effectiveness of many topical agents is decreased if the drug is applied to slightly damp skin."
The nurse is evaluating how much a patient retained after teaching ways to prevent dry skin. Which statements made by the patient need correction? Select all that apply.
"Apply alcohol or astringents to the skin." "I should use deodorant soap instead of non-alkaline soap."
A patient tells the nurse, "My skin always looks dry even after I apply lotion." How should the nurse respond?
"Bathe in lukewarm water to prevent your skin from drying."
A patient with psoriasis is prescribed topical corticosteroids. Which nursing instruction regarding medication usage would be beneficial to this patient?
"Check for local tissue reaction."
A patient with chronic psoriasis is prescribed anthralin. Which nursing instructions regarding the medication usage would be beneficial to the patient? Select all that apply.
"Check for local tissue reactions." "Apply the drug to each lesion and leave it on for shorter periods." "Prevent the drug from coming into contact with uninvolved skin."
What is the duration of the first phase of wound healing?
3 to 5 days
A patient is diagnosed with urticaria. Which factor is responsible for this condition?
Allergy
Which skin inflammation is characterized by extreme itching?
Atopic dermatitis
What systemic disease causes itching without skin lesions?
Liver disease
Which condition is associated with pruritus?
Liver disease
What is the dosage frequency of adalimumab?
Loading dose followed by maintenance dose every other week
A patient with chronic skin disorders complains of loss of vision. Which assessment finding made by the nurse confirms this diagnosis? Select all that apply.
Crusts Vesicles
What is the triggering factor for the recurrence of herpes simplex skin infection?
Fever
Which process involves the replacement of damaged tissue with scar tissue that aids in wound healing?
Granulation
Which processes are required for restoring skin integrity? Select all that apply.
Granulation Re-epithelialization Wound contraction
Which skin infection would cause a patient to report facial drooping?
Herpes zoster
Which skin infection may spread to patients from health care personnel?
Herpetic whitlow
What condition can greatly increase the risk of accelerated tissue destruction in a patient with pressure injuries?
Negative nitrogen balance
A patient with contact dermatitis reports redness in the earlobes. What could be the reason for this?
Nickel allergy
A patient with mild folliculitis failed to respond to topical antibiotics. What would be the drug of choice to treat this? Select all that apply.
Oral clindamyc inIntravenous vancomycin
An older patient has pruritus. What does the nurse tell the patient's caregiver about preventing disruption of skin integrity? Select all that apply.
Provide therapeutic baths. Trim the patient's fingernails regularly Assist the patient to put on mittens or gloves.
Which condition will occur from stimulation of the itch-specific nerve fibers?
Pruritus
Which skin infection is associated with postherpetic neuralgia?
Shingles
The nurse is developing a teaching plan for a patient diagnosed with methicillin-resistant Staphylococcus aureus infection. The nurse plans to include which instruction in the patient's teaching plan?
The infected area should be covered with a clean, dry bandage.
A patient with a skin infection in the chin area reports small, red patches filled with fluid and hair in the center of the lesion. What should the nurse infer from these findings?
The patient has folliculitis.
The wound care nurse is teaching staff nurses to recognize pressure injuries in different stages. Which characteristics would indicate a stage 4 injury?
There is exposed bone or muscle, or the presence of a sinus
The nurse admits a patient to the clinic who is reporting severe itching of the arms and legs caused by exposure to poison ivy. The nurse anticipates that the health care provider will prescribe which medication?
Diphenhydramine
A patient with psoriasis who is on biologic therapy has developed an infection. What would be the priority nursing interventions to treat this patient? Select all that apply.
Discontinuing the medication Notifying the primary health care provider
A patient with a skin infection with a raised vesicle that becomes hemorrhagic reports itching and swelling. The patient has a history of contact with an infected animal. What drugs would be most beneficial for the patient? Select all that apply.
Doxycycline Ciprofloxacin
A patient with a skin infection reports intense itching that is unbearable at night. Which drug may be beneficial for this patient?
Permethrin
Which process promotes the healing of partial-thickness wounds?
Re-epithelialization
A patient with arteriosclerosis presents with impaired wound healing. What could be the reason for this condition?
Reduced local tissue circulation
Which factors may hamper the natural wound healing process? Select all that apply.
Infection Unrelieved pressure Mechanical obstacles
Which body area is most commonly affected by psoriasis?
Elbow
Which category of medications can aggravate psoriasis?
Beta-blocking agents
Which event takes place during the maturation phase of wound healing?
Collagen is reorganized to provide greater tensile strength.
A patient with a pediculosis skin infection reports itching and skin abrasions from scratching. What would be the drug of choice?
Malathion
The nurse is assessing a patient who is suspected to have tinea pedis. Which question asked by the nurse would be most appropriate to confirm the diagnosis?
"Did you share your athletic equipment with other people?"
The nurse is assessing a patient who is suspected to have shingles. Which question asked by the nurse would be most appropriate to confirm the diagnosis?
"Do you have a history of chickenpox?"
Which disease may cause urticaria?
Cancer
Which are common complications of pressure injuries? Select all that apply.
Sepsis Kidney failure
Which questions should the nurse ask a patient suspected of having psoriasis? Select all that apply.
"Do you have a history of skin trauma?" "Do you have a history of hypertension?" "Do you have a family history of psoriasis?"
How does the nurse measure a pressure injury that has formed in a patient's sacral area?
Trace the wound onto a plastic film daily
In teaching a patient about skin cancer prevention, which instruction does the nurse include?
"Avoid sun exposure between 11 AM and 3 PM."
Which factors can impair wound healing in a patient with a deep tissue injury? Select all that apply.
Aging Diabetes Chronic stress Protein deficiency
The nurse is providing care to a patient who is diagnosed with a stage 3 pressure injury that is infected. Which assessment finding indicates proteus colonization of the wound?
Beige pus with a fishy odor
A patient has an odorous purulent wound. How does the nurse best support this patient?
Changes the dressing frequently
A pregnant patient presents to the clinic with a skin infection and reports itching and swelling on the arm. While assessing the patient, the nurse finds the infected area to be elevated and hemorrhagic, edematous, and tender. The patient also presents with fever, chills, and enlarged lymph nodes. Which is the most suitable drug for this patient?
Intravenous ciprofloxacin
Which skin cancer mostly occurs at the site of moles and birthmarks?
Melanoma
Which risk categories are measured by the Braden Scale assessment tool? Select all that apply.
Mobility Incontinence Mental status Nutritional status
The nurse is evaluating the effectiveness of interventions for pressure injury management. Which diagnostic test result with an increased level indicates patient progress and effective health care team collaboration?
Serum albumin
Which drug-induced skin reaction is characterized by vesicles, erosions, and crusts?
Stevens-Johnson syndrome
A patient who is on chemotherapy reports diffuse redness and large blisters on the inner side of the lower lip. What could be the possible diagnosis?
Toxic epidermal necrolysis
Which surgical technique helps to remove full-thickness skin in the area of a lesion?
Wide excision
The nurse is teaching a patient with psoriasis about topical steroid therapy. Which statement made by the patient indicates the need for further teaching?
"I will stop using the medications when the symptoms subside."
The nurse is evaluating a group of student nurses after teaching them about wound healing in older adults. Which statements made by a student nurse indicate the need for further teaching? Select all that apply.
"Re-epithelialization and wound dilation is slower in older adults." "Incontinence or immobility in older adults lowers the risk of chronic wound development."
A patient presents with a rash of red edematous papules. Which nursing instructions would be beneficial to the patient? Select all that apply
"Refrain from being in warm environments." "Refrain from overexertion and alcohol consumption."
A registered nurse is precepting a student nurse who is educating the parents of a child with methicillin-resistant Staphylococcus aureus(MRSA) infection. Which of the nursing student's statements requires correction?
"Stop giving your child the antibiotics once the wound has healed."
Arrange the events of the proliferative phase of wound healing in the correct sequence.
1. Fibrin strands form a scaffold or framework 2. mitotic fibroblast cells migrate into the wound and stimulate the secretion of collagen. 3. Collagen, together with ground substance, builds tough and inflexible scar tissue 4. capillaries in areas surrounding the wound form "buds" that grow into new blood vessels 5. Capillary buds and collagen deposits form the "granulation" tissue in the wound, and the wound contracts. 6. epithelial cells grow over the granulation tissue bed.
Arrange the events of pathophysiology of psoriasis chronologically.
1. Overstimulation of Langerhans' cells 2.Activation of T-lymphocytes 3.Targeting the keratinocytes 4.Increase in cell division 5.Formation of plaque
What method does the nurse use to measure the length of a patient's wound?
12 o'clock position to the 6 o'clock position
A hospitalized patient has severe nutritional deficits and ongoing protein loss, which puts the patient at high risk for the development of pressure injuries. How much protein intake, in g/kg/day, is required for this patient to reduce the risk? Record your answer using a whole number. ___g/kg/day
2
Which conditions can make the symptoms of urticaria worse? Select all that apply.
Overexertion Warm environment Alcohol consumption
A patient has had a melanoma lesion removed. For secondary prevention, what is important for the nurse to teach the patient?
Perform a total skin self-examination monthly with a partner.
Which neurologic conditions can increase a patient's risk for pressure injury formation? Select all that apply.
Stroke Head injury Alzheimer's disease Organic brain disease
A patient diagnosed with leukemia has a non-healing wound. The medical history reveals that the patient received high doses of anti-inflammatory drugs. What could be the reason for the patient's condition?
Systemic inhibition of leukocytic responses
What does the nurse teach the older patient about self-management during bathing?
Take a complete bath every other day.
Which medication has the potential to cause teratogenic effects in a patient with psoriasis?
Tazarotene
A patient with a history of a leg ulcer reports pain and redness in the same area. Upon assessment, the nurse finds the area to be edematous, warm, and tender on palpation with noticeable lymphadenopathy. What should the nurse suspect the patient to be experiencing with these symptoms?
Cellulitis
A patient with skin inflammation reports redness at the affected area. The primary health care provider diagnosed the condition and prescribed the patient to use gel for hair. What diagnosis would the nurse expect to find in the patient's medical record?
Contact dermatitis
Which surgical therapy involves the isolated lesion's cell destruction by local application of liquid nitrogen?
Cryosurgery
Which clinical manifestation is observed during the inflammatory phase of wound healing?
Erythema
Which nursing interventions can the nurse working in a long-term care facility delegate to a nursing assistant?
Every 2 hours, reposition a patient who has had a stroke and is incontinent.
The nurse anticipates that a patient with a deep necrotizing wound caused by a brown recluse spider bite may require which type of healing therapy?
Hyperbaric oxygen
A patient is diagnosed with squamous cell carcinoma. Which surgical technique would be effective in treating this condition?
Mohs' surgery
Which of the following is the most common type of psoriasis?
Psoriasis vulgaris
A patient with skin inflammation reports redness and itching in the skinfold area. Which therapy is most suitable in this patient?
Water-soluble creams
A full-thickness pressure injury is covered by a layer of black nonviable, denatured collagen. What term is used to describe this condition?
Wound eschar
Which is a risk factor for candidial infection?
Diabetes mellitus
The registered nurse is teaching a student nurse about providing the emotional support to a patient with psoriasis. Which statement made by the student nurse indicates the need for further teaching?
"I will wear gloves while touching the patient during social interactions."
The nurse is asking a student nurse about the phases of wound healing. Which statements made by the student nurse indicate the need for further teaching? Select all that apply.
"In the inflammatory phase, the immediate response is vasodilatation." "In the proliferative phase, collagen is reorganized to provide greater tensile strength."
During the follow-up visit, a patient reports the spontaneous disappearance and reappearance of small maculae with dry, yellow adherent scales on the skin. Which type of skin cancer does the nurse suspect in this patient?
Actinic keratosis
A patient who is on drug therapy for epilepsy reports diffused redness and large blisters on buccal mucosa. What could be the possible reason behind this condition?
Administration of barbiturates
A patient who is receiving drug therapy for urticaria reports an increasing sedative effect. The patient admits to consuming alcohol on a daily basis. Which category of medication could be the reason for this condition?
Antihistamines
Which skin infection is characterized by a painless lesion and formation of eschar regardless of treatment?
Cutaneous anthrax
What category of medication may affect the wound contraction of wound healing?
Cytotoxic drugs
The nursing instructor reviews instructions with the nursing student on caring for an older adult patient with a pressure injury. What action by the nursing student indicates a need for further instruction about proper skin care for this patient?
Massages bony prominences
Which of the following laboratory studies is used to monitor nutritional status in a patient with a healing pressure injury?
Prealbumin
The nurse is assessing a lesion in a patient with psoriasis. Which information should the nurse obtain from this patient? Select all that apply.
Presence of itching Time of disease onset Description of disease progression
Which patient outcomes would the nurse include in the plan of care for a patient with a pressure injury that has deep-tissue destruction and drainage? Select all that apply.
Prevention of secondary infection Promotion of wound healing Restoration of baseline functioning
Which is a common causative drug of toxic epidermal necrolysis (TEN)?
Pyrazolones
Which process occurs in the first intention stage of wound healing?
Removal of dead space, which shortens phases of repair
Which process occurs in the third intention of wound healing?
Removal of debris
What is the nurse's primary focus in the management of urticaria?
Removal of triggering substance