Chapter 56: Management of Patients with Dermatologic Disorders and Wounds

While in a skilled nursing facility, a client contracts scabies, which is diagnosed the day after discharge. The client is living at her daughter's home with six other people. During her visit to the clinic, the client asks a staff nurse, "What should my family do?" The most accurate response from the nurse is: "Just be careful not to share linens and towels with family members." "After you're treated, family members won't be at risk for contracting scabies." "All family members need to be treated." "If someone develops symptoms, tell him to see a physician right away."

"All family members need to be treated." Explanation: When someone sharing a home with others contracts scabies, all individuals in the home need prompt treatment whether or not they're symptomatic. Towels and linens should be washed in hot water. Scabies can be transmitted from one person to another before symptoms develop. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Parasitic Skin Infestations, p. 1841.

The nurse is caring for a client diagnosed with herpes zoster. Which statement by the client needs further clarification by the nurse? "Even though this is from a childhood disease, I am still contagious." "Once I get the infection, I cannot get it again." "Herpes zoster is a reactivation of the varicella virus." "Herpes zoster is caused by a viral infection.

"Once I get the infection, I cannot get it again." Explanation: The nurse is correct to clarify that even though the client has herpes zoster, the client can get herpes zoster again. The virus is contagious and can reoccur. The other options are accurate statements that reflect the client's understanding. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Viral Skin Infections, p. 1836.

A physician orders an emollient for a client with pruritus of recent onset. The client asks why the emollient should be applied immediately after a bath or shower. How should the nurse respond? "To prevent skin inflammation." "To make the skin feel soft." "To prevent evaporation of water from the hydrated epidermis." "To minimize cracking of the dermis."

"To prevent evaporation of water from the hydrated epidermis." Explanation: The nurse should tell the client that applying an emollient immediately after taking a bath or shower prevents evaporation of water from the hydrated epidermis, the skin's upper layer. Although emollients make the skin feel soft, this effect occurs whether or not the client has just bathed or showered. An emollient minimizes cracking of the epidermis, not the dermis (the layer beneath the epidermis). An emollient doesn't prevent skin inflammation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, SKIN CARE, p. 1818.

A patient has a moisture-retentive dressing for the treatment of a sacral decubitus ulcer. How long should the nurse leave the dressing in place before replacing it? 4 to 6 hours 8 hours 12 to 24 hours 24 to 36 hours

12 to 24 hours Explanation: Depending on the product used and the type of dermatologic conditions encountered, most moisture-retentive dressings may remain in place from 12 to 24 hours. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, SKIN CARE, pp. 1817-1818.

The nurse is changing the dressing of a chronic wound. There is no sign of infection or heavy drainage. How long will the nurse leave the wound covered for? 48 to 72 hours 6 to 12 hours 12 to 24 hours 24 to 36 hours

48 to 72 hours Explanation: The natural wound-healing process should not be disrupted. Unless the wound is infected or has a heavy discharge, it is common to leave chronic wounds covered for 48 to 72 hours and acute wounds for 24 hours. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, SKIN CARE, pp. 1817-1818.

A client has a rash on the arm that has been treated with an antibiotic without eradicating the rash. What type of examination can be used to determine if the rash is a fungal rash using ultraviolet light? Skin biopsy A Wood's light examination Fungal culture Potassium hydroxide test

A Wood's light examination Explanation: A Wood's light is also known as a black light and is a handheld device that can identify certain fungal infections that fluoresce under long-wave ultraviolet light. In a darkened room, when a physician or nurse aims the light at a lesion caused by a fungus that fluoresces, the lesion emits a blue-green color. It is the only test that uses a light, the others use skin scrapings. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Fungal (Mycotic) Skin Infections, p. 1838.

Which assessment finding indicates an increased risk of skin cancer? A dark mole on the client's back White irregular patches on the client's arm A deep sunburn An irregular scar on the client's abdomen

A deep sunburn Explanation: A deep sunburn is a risk factor for skin cancer. A dark mole or an irregular scar is a benign finding. White irregular patches are abnormal but aren't a risk for skin cancer. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Malignant Skin Tumors, p. 1853.

The nurse is caring for a patient with extensive bullous lesions on the trunk and back. Prior to initiating skin care, what is a priority for the nurse to do? Wash the lesions vigorously. Rupture the bullous lesions. Administer analgesic pain medication. Apply cold compresses.

Administer analgesic pain medication. Explanation: The patient with painful and extensive lesions should be premedicated with analgesic agents before skin care is initiated. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Dermatitis Herpetiformis, p. 1847.

The nurse is instructing the patient in how to apply a corticosteroid cream to lesions on the arm. What intervention can the nurse instruct the patient to do to increase the absorption of the medication? Apply the medication every 2 hours. Make sure that the skin is slightly dehydrated so that the medication can absorb through the skin cracks. Apply an occlusive dressing over the site after application. Apply a thick layer of cream over the lesions so that if some rubs off, there is more to absorb.

Apply an occlusive dressing over the site after application. Explanation: Corticosteroids are widely used in treating dermatologic conditions to provide anti-inflammatory, antipruritic, and vasoconstrictive effects. The patient is educated to apply this medication according to strict guidelines, using it sparingly but rubbing it into the prescribed area thoroughly. Absorption of topical corticosteroids is enhanced when the skin is hydrated or the affected area is covered by an occlusive or moisture-retentive dressing (Karch, 2013). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, SKIN CARE, p. 1817.

Which of the following terms refers to a graft derived from one part of a patient's body and used on another part of that same patient's body? Homograft Autograft Heterograft Allograft

Autograft Explanation: Full-thickness autografts and pedicle flaps are commonly used for reconstructive surgery, months or years after the initial injury. An allograft is a graft transferred from one human (living or cadaveric) to another human. A homograft is a graft transferred from one human (living or cadaveric) to another human. A heterograft is a graft obtained from an animal of a species other than that of the recipient. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Wound Coverage: Grafts and Flaps, p. 1859.

Which of the following uses the body's own digestive enzymes to break down necrotic tissues? Wet dressings Autolytic debridement Enzymatic debridement Wet to dry dressings

Autolytic debridement Explanation: Autolytic debridement is a process that uses the body's own digestive enzymes to break down necrotic tissue. Application of enzymatic debriding agents speeds the rate at which necrotic tissues is removed. A form of mechanical debridement is a wet to dry dressing, which removes necrotic tissue and absorbs small to large amounts of exudates. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, SKIN CARE, p. 1817.

The nurse is teaching a client about the correct use of topical concentrated corticosteroids. The nurse includes which statement(s)? Select all that apply. Avoid prolonged use. Apply to intertriginous areas. Hypertrichosis is normal. Avoid applying to the face.

Avoid applying to the face. Avoid prolonged use. Explanation: The nurse should teach the client to avoid prolonged use, which could lead to hypertrichosis (excessive hair growth) and/or steroid-induced acne. The nurse should also tell the client to avoid applying the corticosteroid to the face and to intertriginous areas. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Irritant Contact Dermatitis, p. 1842.

The nurse caring for a client with repeated episodes of contact dermatitis is providing instruction to prevent future episodes. Which information should the nurse include? Avoid cosmetics with fragrance. Wash skin in very hot water. Use a fabric softener. Wear gloves during the day.

Avoid cosmetics with fragrance. Explanation: The nurse should teach the client to avoid cosmetics, soaps, and laundry detergents that contain fragrance. Other prevention methods include avoidance of heat and fabric softeners. Gloves used for cleaning and washing dishes should be worn to no longer than 15 to 20 minutes/day, and cotton-lined gloves should be used. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Irritant Contact Dermatitis, p. 1841.

A patient is diagnosed with seborrheic dermatitis on the face and is prescribed a corticosteroid preparation for use. What should the nurse educate the patient about regarding use of the steroid on the face? Use very warm water to clean the face prior to applying the medication. Avoid using the medication around the eyelids because it may cause cataracts and glaucoma. Wash the face several times a day and reapply the medication. Scrape the scaly patches off prior to applying the medication.

Avoid using the medication around the eyelids because it may cause cataracts and glaucoma. Explanation: Seborrheic dermatitis of the body and face may respond to a topically applied corticosteroid cream, which allays the secondary inflammatory response. However, this medication should be used with caution near the eyelids because it can lead to glaucoma and cataracts. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Seborrheic Dermatitis, p. 1831.

A nurse is examining a client's scalp for evidence of lice. The nurse should pay particular attention to which part of the scalp? Middle area Temporal area Behind the ears Top of the head

Behind the ears Explanation: Adult lice usually bite the scalp behind the ears and along the back of the neck. Because such lice are tiny (1 to 2 mm) with grayish white bodies, they are hard to see. However, their bites result in visible pustular lesions. Although lice may bite any part of the scalp, bites are less common on the temporal area, top of the head, and middle area. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Parasitic Skin Infestations, p. 1838.

The nurse is working with community groups. At which of the following locations would the nurse anticipate a possible scabies outbreak? College dormitory Swimming pool Shopping mall Gymnasium

College dormitory Explanation: The nurse is correct to anticipate a potential scabies outbreak in a college dormitory. Outbreaks are common where large groups of people are confined or housed. Spread of scabies is from skin-to-skin contact. Although there are groups of people at the shopping mall, swimming pool, and gymnasium, typically, there is no personal contact. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Parasitic Skin Infestations, p. 1840.

Which primary lesions are associated with acne caused by sebum blockage in hair follicles? Carbuncles Furuncles Striae Comedones

Comedones Explanation: A comedone is the primary lesion of acne caused by sebum blockage in the hair follicle. A furuncle is a localized skin infection of a single hair follicle. A carbuncle is a localized skin infection involving several hair follicles. Striae are bandlike streaks on the skin, distinguished by color, texture, depression, or elevation from the tissue in which they are found. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Acne Vulgaris, p. 1832.

The nurse is caring for a client prescribed oral griseofulvin for treatment of a fungal toenail infection. Which instruction by the nurse is essential in understanding the treatment plan? Take the medication with meals. Continue medication regimen for several weeks. Administer medications daily. Administer a stool softener to offset constipation.

Continue medication regimen for several weeks. Explanation: Fungal infections are difficult to treat and often take many weeks of medication to eradicate. Taking medication with meals, administering daily, and stool softeners are good teaching components but not essential in understanding the treatment plan. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Parasitic Skin Infestations, p. 1839.

Which medication classification may be used for contact dermatitis? Corticosteroids Saline irrigations Antifungals Antivirals

Corticosteroids Explanation: Corticosteroids are used for contact dermatitis. Antifungals, antivirals, and saline irrigations are not used in the treatment of contact dermatitis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, SKIN CARE, p. 1820.

Which of the following aggravates the condition caused by acne vulgaris? Chocolates Sunlight Cosmetics High-fat diet

Cosmetics Explanation: Acne vulgaris is aggravated by cosmetics. Any correlation with specific food items such as chocolate is more myth than fact. Sunlight does not aggravate the condition caused by acne vulgaris. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Acne Vulgaris, p. 1834.

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

Deficient Knowledge about Early Signs of Melanoma Explanation: The fact that the client's disease was not reported until an advanced stage suggests that the client lacked knowledge about skin lesions. Excision does not result in chronic pain, though it causes acute 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Malignant Skin Tumors, p. 1855.

A client has undergone dermabrasion to decrease scarring from severe acne as a teen. After completion of the procedure, the nurse reviews the client's home care instructions. Which instruction is appropriate for this client? Dermabrasion is a painless procedure. Don't touch the area treated. Apply moisturizer after each washing until the area is healed. Wash the area three times daily until healed.

Don't touch the area treated. Explanation: The client also must refrain from picking and touching the area because contact with the fingers might cause infection or scarring from secondary trauma. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Acne Vulgaris, p. 1834.

The nurse should assess all possible causes of pruritus for a patient complaining of generalized pruritus. What does the nurse understand can be another cause for this condition? End-stage kidney disease Hyperthyroidism Pneumonia Myasthenia gravis

End-stage kidney disease Explanation: Systemic disorders associated with generalized pruritus include chronic kidney disease. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, General Pruritus, p. 1830.

A nurse is caring for a client experiencing an exacerbation of plaque psoriasis. The nurse assesses the area and documents a proliferation of which cell type? Epithelia Epidermal Endothelial Dermal

Epidermal Explanation: The nurse is correct to document that the proliferation of skin cells occurs in the first layer of skin cells, the epidermis. In the epidermal layer, there is rapid turnover of the cells. The dermis is under the epidermis. Endothelial is the layer on the inside such as the interior of the blood vessel. Epithelia are on the outside or coating of walls. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Psoriasis, p. 1842.

he patient is advised to apply a suspension-type lotion to a dermatosis site. The nurse should advise the patient to apply the lotion how often to be effective? Every day at the same time Every hour Every 3 hours Every 12 hours

Every 3 hours Explanation: Suspensions consist of either a powder in water that requires shaking before application, or clear solutions, which contain completely dissolved active ingredients. A suspension such as calamine lotion provides a rapid cooling and drying effect as it evaporates, leaving a thin, medicinal layer of powder on the affected skin. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, SKIN CARE, p. 1819.

A dermatologist recommends an over-the-counter suspension to relieve pruritus. The nurse advises the patient that the lotion should be applied: Overnight to enhance absorption. Hourly to prevent evaporation. Every 3 to 4 hours for sustained effectiveness. Twice a day to prevent crusting on the skin.

Every 3 to 4 hours for sustained effectiveness. Explanation: Lotions are frequently used to replenish lost skin oils or to relieve pruritus. They are usually applied directly to the skin, but a dressing soaked in the lotion can be placed on the affected area. Lotions must be applied every 3 or 4 hours for sustained therapeutic effect because if left in place for a long period, they may crust and cake on the skin. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, SKIN CARE, p. 1819.

Which of the following nonsedating antihistamines is appropriate for daytime pruritus? Lorazepam (Ativan) Hydroxyzine (Atarax) Diphenhydramine (Benadryl) Fexofenadine (Allegra)

Fexofenadine (Allegra) Explanation: Nonsedating antihistamine medications such as Allegra are more appropriate to relieve daytime pruritus. Benadryl or Atarax, when prescribed in a sedative dose at bedtime, may be beneficial in producing a restful and comfortable sleep. Ativan has sedating properties and is used as an antianxiety medication. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, General Pruritus, p. 1830.

The nurse is developing a plan of care for a client with toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome. Which action should the nurse include? Frequently inspect the oral cavity. Use friction when repositioning the client. Apply a continuous current of warm air. Limit fluids.

Frequently inspect the oral cavity. Explanation: The nurse should frequently inspect the oral cavity of a client with TEN or Stevens-Johnson syndrome. Additionally, care should be taken to reduce friction and shear when turning or repositioning the client. Fluids should not be limited because these clients are susceptible to dehydration. A continuous current of warm air on denuded skin can worsen dehydration. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome, p. 1848.

Which term refers most precisely to a localized skin infection of a single hair follicle? Furuncle Carbuncle Comedone Cheilitis

Furuncle Explanation: Furuncles occur anywhere on the body but are most prevalent in areas subjected to irritation, pressure, friction, and excessive perspiration, such as the back of the neck, the axillae, or the buttocks. A carbuncle is a localized skin infection involving several hair follicles. Cheilitis refers to dry cracking at the corners of the mouth. Comedones are the primary lesions of acne, caused by sebum blockage in the hair follicle. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Bacterial Skin Infections, pp. 1835-1836.

A client with scabies has been prescribed a scabicide. What should the nurse tell the client to do before beginning treatment? Wear clean clothing. Avoid contact with others who have scabies. Have a thorough bath. Expect itching to continue for 2 to 3 weeks after the treatment.

Have a thorough bath. Explanation: Before any treatment begins, the nurse advises the client to bathe thoroughly. Wearing clean clothing and avoiding contact with others who have scabies are essential in preventing a recurrence. As a part of client teaching, the nurse explains that itching may continue for 2 to 3 weeks after the treatment. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Parasitic Skin Infestations, pp. 1840-1841.

Which sedative medication is effective for treating pruritus? Hydroxyzine Tetracycline Fexofenadine Benzoyl peroxide

Hydroxyzine Explanation: Hydroxyzine is a sedating medication effective in the treatment of pruritus. Benzoyl peroxide, fexofenadine, and tetracycline are not effective in treating pruritus. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Parasitic Skin Infestations, p. 1841.

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

Impaired Skin Integrity Related to Scaly Lesions Explanation: An appropriate diagnosis for a client 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Psoriasis, p. 1843.

Which skin condition is caused by staphylococci, streptococci, or multiple bacteria? Scabies Pediculosis capitis Poison ivy Impetigo

Impetigo Explanation: Impetigo is seen at all ages but is particularly common among children living under poor hygienic conditions. Scabies is caused by the itch mite. Pediculosis capitis is caused by head lice. Poison ivy is a contact dermatitis caused by the oleoresin given off by a particular form of ivy. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Bacterial Skin Infections, p. 1835.

A nurse employed in a school suspects an outbreak of pediculosis. Which of the following nursing actions should be taken to prevent and control the outbreak? Wash clothing and vacuum furniture, bedding, and carpets. Improve the school hygiene. Insist that everyone who is infested with lice follows the prescribed treatment. Perform hair inspection.

Insist that everyone who is infested with lice follows the prescribed treatment. Explanation: If everyone who is infested with lice follows the prescribed treatment, the outbreak can be controlled and eliminated. The nurse performs hair inspection whenever there is an outbreak, but this cannot prevent or control the outbreak. Washing clothes and vacuuming furniture, bedding, and carpets are the aspects to be included in client teaching. They cannot prevent or control the outbreak. Anyone can become infected, and the infestation has no reflection on hygiene or living conditions. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Parasitic Skin Infestations, p. 1841.

Which drug is an oral retinoid used to treat acne? Tetracycline Estrogen Benzoyl peroxide Isotretinoin

Isotretinoin Explanation: Isotretinoin, an oral retinoid, is used in clients diagnosed with nodular cystic acne that does not respond to conventional therapy. Estrogen, tetracycline, and benzoyl peroxide are not oral retinoids. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Acne Vulgaris, p. 1834.

When caring for a client in a prenatal clinic who has history of acne vulgaris, which client medication would the nurse advise against? Isotretinoin Benzoyl peroxide Tazarotene Tretinoin

Isotretinoin Explanation: The nurse is correct to screen for the acne medication, isotretinoin (Accutane). It is contraindicated for pregnant females or those who may become pregnant due to the potential of first trimester miscarriages and congenital malformations. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Acne Vulgaris, p. 1833.

A patient is being evaluated for nodular cystic acne. What systemic pharmacologic agent may be prescribed for the treatment of this disorder? Benzoyl peroxide Isotretinoin (Accutane) Retin-A Salicylic acid

Isotretinoin (Accutane) Explanation: Synthetic vitamin A compounds (i.e., retinoids) are used with dramatic results in patients with nodular cystic acne unresponsive to conventional therapy. One compound is isotretinoin, which is used for active inflammatory popular pustular acne that has a tendency to scar. Isotretinoin reduces sebaceous gland size and inhibits sebum production. It also causes the epidermis to shed (epidermal desquamation), thereby unseating and expelling existing comedones. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Acne Vulgaris, p. 1833.

The nurse is conducting a community education program on basal cell carcinoma (BCC). Which statement should the nurse make? It begins as a small, waxy nodule with rolled translucent, pearly borders. It is a malignant proliferation arising from the epidermis. It is more invasive than squamous cell carcinoma (SCC). It metastasizes through blood or the lymphatic system.

It begins as a small, waxy nodule with rolled translucent, pearly borders. Explanation: BCC usually begins as a small, waxy nodule with rolled, translucent, pearly borders. It is less invasive than SCC. It does not metastasize through the blood or lymphatic system. SCC is a malignant proliferation arising from the epidermis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Malignant Skin Tumors, p. 1853.

Which of the following is the most common complaint related to a diagnosis of head lice? Itching Swelling Flaking of scalp Headache

Itching Explanation: Itching of the scalp is the most common complaint of persons with head lice. Flaking of the scalp and swelling may occur from the inflammatory response. Headache does not occur from head lice. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Parasitic Skin Infestations, p. 1838.

The nurse assesses the client and observes reddish-purple to dark blue macules, plaques, and nodules. The nurse recognizes that these manifestations are associated with which condition? Platelet disorders Kaposi sarcoma Allergic reactions Syphilis

Kaposi sarcoma Explanation: Kaposi sarcoma is a frequent comorbidity in clients with AIDS. With platelet disorders, the nurse observes ecchymoses (bruising) and purpura (bleeding into the skin). Urticaria (wheals or hives) is the manifestation of allergic reactions. A painless chancre or ulcerated lesion is a typical finding in the client with syphilis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Kaposi Sarcoma, p. 1859.

The nurse prepares a patient with a benign skin lesion for surgical excision, intralesional corticosteroid therapy, and radiation. Which of the following is most likely the lesion described? Angioma Seborrheic keratoses Keloid Wart

Keloid Explanation: Keloids are benign overgrowths of fibrous tissue at the site of a scar or trauma. They appear to be more common among dark-skinned people. Keloids are asymptomatic but may cause disfigurement and cosmetic concern. The treatment, which is not always satisfactory, consists of surgical excision, intralesional corticosteroid therapy, and radiation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Benign Skin Tumors, p. 1852.

Which of the following information regarding the transmission of lice would the nurse identify as a myth? Lice can jump from one individual to another. Lice can be spread by sharing of hats, caps, and combs. Lice need to be removed from the hair with a fine comb. Lice can be seen without magnification.

Lice can jump from one individual to another. Explanation: The nurse is correct to identify that lice cannot jump from one individual to another. Direct contact is needed for transmission. The other options are correct. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Parasitic Skin Infestations, p. 1838.

The nurse and nursing assistant are moving a client who slid down in the chair. What does the nurse encourage the assistant to avoid shearing when moving the client to a higher position in the chair? Tilt the chair back when moving the client. Lift the client, do not slide them. Use a donut device while the client is in the chair. Encourage the client to slide up without assistance.

Lift the client, do not slide them. Explanation: Avoid shearing, a physical force that separates layers of tissue in opposite directions, such as when a seated client slides downward. Lifting the client and not sliding them will avoid the shearing forces that can tear the skin. Tilting the chair back is a safety hazard and may cause injury to the client. If the client proceeds alone, they will produce a shearing effect. A donut device may cause shearing and should not be used. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Pressure Injury, p. 1827.

A nurse in a healthcare provider's office teaches a client how to apply plastic film as an occlusive dressing to cover a medicated ointment applied to the arm. What important teaching point would be included by the nurse? Immobilize the arm when it is wrapped. Place heat on top of the dressing to increase skin temperature. Cover the dressing with an elastic wrap to facilitate daily activities during treatment. Limit use of the dressing to 12 hours.

Limit use of the dressing to 12 hours. Explanation: Plastic film is thin and readily adapts to all sizes, body shapes, and skin surfaces. In general, plastic wrap should be used no more than 12 hours each day. Immobilization is not necessary. Applying heat or covering the dressing in an elastic wrap would be contraindicated. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, SKIN CARE, pp. 1817-1818.

Which procedure done for skin cancer conserves the most amount of normal tissue? Mohs micrographic surgery Surgical excision Electrosurgery Cryosurgery

Mohs micrographic surgery Explanation: Mohs micrographic surgery is the technique that is most accurate and that best conserves normal tissue. The procedure removes the tumor layer by layer. Electrosurgery, cryosurgery, and surgical excision do not conserve the amount of normal tissue. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Malignant Skin Tumors, p. 1854.

While examining a client's leg, a nurse notes an open ulceration with visible granulation tissue in the wound. Until a wound specialist can be contacted, which type of dressing should the nurse apply? Moist sterile saline gauze Dry sterile dressing Sterile petroleum gauze Povidone-iodine-soaked gauze

Moist sterile saline gauze Explanation: Moist sterile saline dressings support wound healing and are cost-effective. Dry sterile dressings adhere to the wound and debride the tissue when removed. Petroleum supports healing but is expensive. Povidone-iodine is used as an antiseptic cleaning agent but because it can irritate epithelial cells, it shouldn't be left on an open wound. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, SKIN CARE, p. 1816.

The nurse is caring for a client with a furuncle. What advice should the nurse give a client with a furuncle to prevent the spread of the infection? Keep hair short, clean, and away from the face and forehead. Never pick or squeeze a furuncle. Avoid the use of cosmetics. Use tepid bath water.

Never pick or squeeze a furuncle. Explanation: The client with a furuncle should never pick or squeeze it as the drainage is infectious and this practice favors the spread of the infection. Infections by organisms that usually exist harmlessly on the skin surface cause furuncles. Keeping the hair short, clean, and away from the face and forehead, avoiding cosmetics, and using tepid bath water do not help in preventing the spread of a furuncle. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Bacterial Skin Infections, p. 1836.

The nurse is caring for a client who may have a lice infestation. The nurse is using a bright light focused on an area of the head to confirm the presence of lice. In which manner is it easiest to differentiate nits from dandruff? Nits are located near the scalp. Dandruff looks white and flaky. Nits are difficult to move from hair shafts. Dandruff is throughout the hair.

Nits are difficult to move from hair shafts. Explanation: Lice eggs, or nits, can be confused with dandruff. However, dandruff consists of fine, white particles of dead, dry scalp cells that can be easily picked from the hair. Nits, on the other hand, look like small, yellowish-white ovals and are quite firmly fixed to the hair shaft. The nurse is correct to use the difference of the nits being securely attached to the hair shaft as a guide to confirmation of lice infestation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Parasitic Skin Infestations, p. 1838.

A patient is diagnosed with malignant melanoma that directly invades the adjacent dermis (vertical growth). The nurse knows that this type of melanoma has a poor prognosis. Which of the following is most likely the type of melanoma described in this scenario? Superficial spreading Acral-lentiginous Lentigo-maligna Nodular melanoma

Nodular melanoma Explanation: A nodular melanoma is a spherical, blueberry-like nodule with a relatively smooth surface and a relatively uniform, blue-black color. A nodular melanoma invades directly into adjacent dermis (i.e., vertical growth) and therefore has a poorer prognosis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Malignant Skin Tumors, p. 1855.

A nurse is admitting a client with toxic epidermal necrolysis. What is the nursing priority in preventing sepsis? Hydrating to prevent renal failure Preventing infection Assessing for hemorrhage Limiting protein to limit liver failure

Preventing infection Explanation: The major cause of death from toxic epidermal necrolysis is from sepsis. Monitoring vital signs closely and noticing changes in respiratory, kidney, and gastrointestinal function may help the nurse to quickly detect the beginning of an infection. Strict asepsis is always maintained during routine skin care measures. Hand hygiene and wearing sterile gloves when carrying out procedures are essential. Visitors should wear protective garments and wash their hands before and after coming into contact with the patient. People with any infections or infectious disease should not visit the patient until they are no longer a danger to the patient. The nurse is critical in identifying early signs and symptoms of infection and notifying the primary provider. Antibiotic agents are not generally begun until there is an indication for the use. Hemorrhage, renal failure, and liver failure are not the major causes of toxic epidermal necrolysis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome, p. 1849.

A night-shift nurse receives a call from the emergency department about a client with herpes zoster who is going to be admitted to the floor. Based on this diagnosis, where should the nurse assign the client? Semi-private room with a client diagnosed with pneumonia Semi-private room with a client who had chickenpox and was admitted with a GI bleed Isolation room with negative airflow Private room

Private room Explanation: Herpes zoster, a highly contagious infection, is transmitted by direct contact with vesicular fluid or airborne droplets from the infected host's respiratory tract. Placing the client with a client diagnosed with pneumonia places that client at risk for contracting herpes zoster. An isolation room with negative airflow isn't necessary for the client with herpes zoster. The nurse should assign the client to a private room. The client could safely room with the client who already had chickenpox; however, visitors might be unnecessarily exposed. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Viral Skin Infections, p. 1837.

The nurse applies a moisture-retentive dressing to a patient's wound. She understands that the main advantage of this dressing, rather than a wet dressing, is its ability to: Enhance the absorption of topical medications. Promote the formation of a protective scab that traps excess exudate. Provide autolytic debridement. Decrease epidermal resurfacing.

Provide autolytic debridement. Explanation: Commercially produced moisture-retentive dressings can perform the same functions as wet dressings but are more efficient at removing exudate because of their higher moisture-vapor transmission rate; some have reservoirs that can hold excessive exudate. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, SKIN CARE, pp. 1817-1818.

A nurse assesses a client with dry, rough, scaly skin without lesions on the legs. The client reports itching in the affected area. What skin assessment would the nurse document? Shingles Seborrhea Candidiasis Pruritus

Pruritus Explanation: Pruritus (itching) is one of the most common symptoms of patients with dermatologic disorders. Itch receptors are unmyelinated, penicillate (brush-like) nerve endings that are found exclusively in the skin, mucous membranes, and cornea. Shingles presents with lesions. Candidiasis presents with reddened skin and is often found in the folds of skin. Seborrhea refers to dry, scaly patches usually located on the scalp. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, General Pruritus, p. 1829.

Photochemotherapy has been used as a treatment for which of the following skin disorders? Shingles Rosacea Psoriasis Allergic dermatitis

Psoriasis Explanation: Photochemotherapy is used for severe, disabling psoriasis that does not respond to other methods of treatments. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Psoriasis, p. 1843.

A patient is diagnosed with psoriasis after developing scales on the scalp, elbows, and behind the knees. The patient asks the nurse where this was "caught." What is the best response by the nurse? Psoriasis is an inflammatory dermatosis that results from a superficial infection with Staphylococcus aureus. Psoriasis comes from dermal abrasion. Psoriasis is an inflammatory dermatosis that results from an overproduction of keratin. Psoriasis results from excess deposition of subcutaneous fat.

Psoriasis is an inflammatory dermatosis that results from an overproduction of keratin. Explanation: Current evidence supports an autoimmune basis for psoriasis (Porth & Matfin, 2009). Periods of emotional stress and anxiety aggravate the condition, and trauma, infections, and seasonal and hormonal changes may also serve as triggers. In this disease, the epidermis becomes infiltrated by activated T cells and cytokines, resulting in both vascular engorgement and proliferation of keratinocytes. Epidermal hyperplasia results. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Psoriasis, p. 1842.

A patient is scheduled for Mohs microscopic surgery for removal of a skin cancer lesion on his forehead. The nurse knows to prepare the patient by explaining that this type of surgery requires: Destruction of the tissue by electrical energy. Removal of the tumor, layer by layer. A process of deep-freezing the tumor, thawing and refreezing. The use of radiation therapy.

Removal of the tumor, layer by layer. Explanation: Mohs micrographic surgery removes the tumor layer by layer. The first layer excised includes all evident tumor and a small margin of normal-appearing tissue. The specimen is frozen and analyzed by section to determine if all the tumor has been removed. If not, additional layers of tissue are shaved and examined until all tissue margins are tumor-free. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Malignant Skin Tumors, p. 1854.

A patient is complaining of severe itching that intensifies at night. The nurse decides to assess the skin using a magnifying glass and penlight to look for the "itch mite." What skin condition does the nurse anticipate finding? Contact dermatitis Pediculosis Scabies Tinea corporis

Scabies Explanation: Scabies is an infestation of the skin by the itch mite Sarcoptes scabiei. The patient complains of severe itching caused by a delayed type of immunologic reaction to the mite or its fecal pellets. During examination, the patient is asked where the pruritus is most severe. A magnifying glass and a penlight are held at an oblique angle to the skin while a search is made for the small, raised burrows created by the mites. One classic sign of scabies is the increased itching that occurs during the overnight hours, perhaps because the increased warmth of the skin has a stimulating effect on the parasite. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Parasitic Skin Infestations, p. 1840.

A 10-year-old child is brought to the office with complaints of severe itching in both hands that's especially annoying at night. On inspection, the nurse notes gray-brown burrows with epidermal curved ridges and follicular papules. The physician performs a lesion scraping to assess this condition. Based on the signs and symptoms, what diagnosis should the nurse expect? Dermatophytosis Scabies Impetigo Contact dermatitis

Scabies Explanation: Signs and symptoms of scabies include gray-brown burrows, epidermal curved or linear ridges, and follicular papules. Clients complain of severe itching that usually occurs at night. Scabies commonly occurs in school-age children. The most common areas of infestation are the finger webs, flexor surface of the wrists, and antecubital fossae. Impetigo is a contagious, superficial skin infection characterized by a small, red macule that turns into a vesicle, becoming pustular with a honey-colored crust. Contact dermatitis is an inflammation of the skin caused by contact with an irritating chemical or allergen. Dermatophytosis, or ringworm, is a disease that affects the scalp, body, feet, nails, and groin. It's characterized by erythematous patches and scaling. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Parasitic Skin Infestations, p. 1840.

With repeated reactions of contact dermatitis, which of the following can occur? Secondary bacterial infection Sepsis Pain along the sensory nerve Hemorrhage

Secondary bacterial infection Explanation: If repeated reactions occur, or if the patient continually scratches the skin, lichenification (thickening of the horny layer of the skin) and pigmentation occur. Secondary bacterial invasion may follow. During shingles, there will be pain along the sensory nerve. Sepsis and hemorrhage would not occur from repeated bouts of contact dermatitis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Irritant Contact Dermatitis, p. 1841.

The school nurse is instructing a parent in the care and elimination of lice from their child's hair. The parent brings all of the products for care in a bag. Which contents are not appropriate for use? Permethrin (Nix) Shampoo and conditioner Plastic fine-toothed comb New hair clips

Shampoo and conditioner Explanation: The nurse is correct to instruct the parent to avoid shampoo and conditioner because this coats the hair and protects the nits. Nix and a fine-toothed comb are recommended. New hair clips may be used once the infestation is gone. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Parasitic Skin Infestations, p. 1839.

Which material consists of a powder in water? Suspension Hygroscopic agent Paste Liniment

Suspension Explanation: A suspension requires shaking before application, exemplified by calamine lotion. A hygroscopic agent is a powder that acts to absorb and retain moisture from the air and to reduce friction between surfaces. A paste is a mixture of powder and ointment. A liniment is a lotion with oil added to prevent crusting. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, SKIN CARE, p. 1819.

A patient is diagnosed with severe psoriasis. The health care provider prescribes a popular topical non-steroid. The nurse knows to prepare health teaching information for which of the following drugs? Tazorac Aristocort Kenalog Valisone

Tazorac Explanation: Tazorac is a topical non-steroid. The other choices are topical corticosteroids. Refer to Table 52-5 in the text. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Psoriasis, p. 1843.

Which of the following is a local side effect of topical corticosteroids? Altered immunity Telangiectasia Symptoms of Cushing's syndrome Hyperglycemia

Telangiectasia Explanation: Inappropriate use of topical corticosteroids can result in local and systemic side effects. Local side effects may include skin atrophy and thinning, striae, and telangiectasia. Systemic side effects may include hyperglycemia and symptoms of Cushing's syndrome. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, SKIN CARE, p. 1820.

A client is coming to the office to have a growth removed by the doctor. The client asks "What does cryosurgery do to the growth?" What is the correct response? Lasers the growth off Freezes the growth, so the physician can remove it at the next appointment Removes the entire growth Through the application of extreme cold, the tissue is destroyed.

Through the application of extreme cold, the tissue is destroyed. Explanation: Cryosurgery is the application of extreme cold to destroy tissue. The other statements are false. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Malignant Skin Tumors, p. 1854.

Which of the following is also known as "jock itch"? Tinea corporis Tinea cruris Tinea unguium Tinea pedis

Tinea cruris Explanation: Tinea cruris is also known as "jock itch." Tinea corporis is ringworm affecting the body. Tinea pedis is "athlete's foot." Tinea unguium is a type of ringworm that affects the toenails. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Parasitic Skin Infestations, p. 1839.

To treat a client with acne vulgaris, the physician is most likely to order which topical agent for nightly application? Fluorouracil (5-fluorouracil, 5-FU [Efudex]) Minoxidil (Rogaine) Tretinoin (retinoic acid [Retin-A]) Zinc oxide gelatin

Tretinoin (retinoic acid [Retin-A]) Explanation: Tretinoin is a topical agent applied nightly to treat acne vulgaris. Minoxidil promotes hair growth. Zinc oxide gelatin treats stasis dermatitis on the lower legs. Fluorouracil is an antineoplastic topical agent that treats superficial basal cell carcinoma. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Cosmetic Procedures, p. 1860.

A client is being treated for acne vulgaris. What warning must be given to this client regarding the application of benzoyl peroxide? Use gloves with application. Only use with contact dermatitis. Apply a thick layer to assure coverage. Use with over-the-counter drying agents.

Use gloves with application. Explanation: Warn clients using acne preparations containing benzoyl peroxide that this ingredient is an oxidizing agent and may remove the color from clothing, rugs, and furniture. Thorough handwashing after drug use may not remove all the drug and permanent fabric discoloration may still occur. Users of products containing benzoyl peroxide should wear disposable plastic gloves when applying the drug. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Acne Vulgaris, p. 1833.

The nurse is instructing the parents of a child with head lice. Which statement should the nurse include? Use shampoo with Kwell. Wash clothes in cold water. Use shampoo with piperonyl butoxide. Disinfect brushes and combs with bleach.

Use shampoo with piperonyl butoxide. Explanation: The nurse's instructions should include shampooing with piperonyl butoxide, washing clothes in hot water, and disinfecting brushes and combs with piperonyl butoxide shampoo. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Parasitic Skin Infestations, p. 1839.

A patient who was recently diagnosed with pruritus on the chest and back is given information about skin care and bathing. The most important advice on cleansing is to avoid: Applying a cold compress to the area after washing. Bathing with warm water and mild soap. Washing with soap and hot water. Using bath oils mixed with water.

Washing with soap and hot water. Explanation: Hot water and soap are to be avoided when washing the pruritic area. The other choices are all appropriate measures. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, General Pruritus, p. 1830.

What advice should the nurse give a client with dermatitis until the etiology of the dermatitis is identified? Use wool, synthetics, and other dense fibers. Wear rubber gloves when in contact with soaps. Rub the skin vigorously to dry. Use hot water for bathing.

Wear rubber gloves when in contact with soaps. Explanation: The nurse should advise the client to wear rubber gloves when coming in contact with any substance such as soap or solvents. The client should avoid wool, synthetics, and other dense fibers. The client should use tepid bath water and should pat rather than rub the skin dry. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, SKIN CARE, p. 1816.

A nurse is assessing a client with a new skin disorder. Which questions would the nurse include when asking the client about the change in skin condition? Select all that apply. Do you exercise daily? When did the disorder first begin, and where did it first appear? Where are the lesions located? Has the problem spread? Have you tried to treat the lesions?

When did the disorder first begin, and where did it first appear? Where are the lesions located? Has the problem spread? Have you tried to treat the lesions? Explanation: The nurse would ask the client when and where the disorder started, where the lesions are located and if they have spread, and if the client has attempted to treat them. The client's exercise habits would not affect the skin disorder. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Dermatitis Herpetiformis, p. 1847.

When performing a skin assessment, the nurse notes a localized skin infection of a single hair follicle. The nurse documents the presence of cheilitis. a comedone. a carbuncle. a furuncle.

a furuncle. Explanation: Furuncles are localized skin infections of a single hair follicle. They can occur anywhere on the body but are most prevalent in areas subjected to irritation, pressure, friction, and excessive perspiration, such as the back of the neck, the axillae, or the buttocks. A carbuncle is a localized skin infection involving several hair follicles. Cheilitis refers to dry cracking at the corners of the mouth. Comedones are the primary lesions of acne, caused by sebum blockage in the hair follicle. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Bacterial Skin Infections, pp. 1835-1836.

A day care worker comes to the clinic for mild itching and rash of both hands. The nurse suspects contact dermatitis. The diagnosis is confirmed if the rash appears: excoriated with multiple fissures. dry and scaly with flaking skin. erythematous with raised papules. inflamed with weeping and crusting lesions.

erythematous with raised papules. Explanation: Contact dermatitis is caused by exposure to a physical or chemical allergen, such as skin care products, cleaning products, and latex gloves. Initial symptoms of itching, erythema, and raised papules occur at the site of exposure and can begin within 1 hour of exposure. Allergic reactions tend to be red, not scaly or flaky. Weeping, crusting lesions are also uncommon unless the reaction is severe or has been present for a long time. Excoriation is more common in skin disorders associated with a moist environment. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Irritant Contact Dermatitis, p. 1842.

A client reports noticing a greater than normal amount of hair loss, and is concerned about developing a bald spot on the head. Which condition is probably not causing the client's hair loss? thyroid disease furunculosis alopecia areata androgenetic alopecia

furunculosis Explanation: Furunculosis is not a cause of hair loss. Alopecia areata, androgenetic alopecia, and thyroid disease are all possible causes of hair loss. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Bacterial Skin Infections, p. 1835.

The classic lesions of impetigo manifest as abscess of skin and subcutaneous tissue. patches of grouped vesicles on red and swollen skin. comedones in the facial area. honey-yellow crusted lesions on an erythematous base.

honey-yellow crusted lesions on an erythematous base. Explanation: The classic lesions of impetigo are honey-crusted lesions on an erythematous base. Comedones in the facial area are representative of acne. A carbuncle is an abscess of skin and subcutaneous tissue. Herpes zoster is exhibited by patches of grouped vesicles on red and swollen skin. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Bacterial Skin Infections, p. 1835.

A client with a history of diabetes mellitus has recently developed furunculosis. What is causing the client's condition? unknown infection diet hygiene

infection Explanation: Furuncles and carbuncles are caused by skin infections with organisms that usually exist harmlessly on the skin surface. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Bacterial Skin Infections, p. 1835.

A physician has ordered a wet-to-damp dressing for an infected pressure ulcer. The nurse knows that the primary reason for this treatment is to: prevent the spread of the infection. debride the wound. reduce pain. keep the wound moist.

keep the wound moist. Explanation: Wet-to-damp dressings keep the wound bed moist, which helps promote the growth of granulation tissue. Because dead tissue adheres to a dry dressing, wet-to-dry dressings are used for debriding wounds. Wet-to-damp dressings don't prevent the spread of infection. Although these dressings provide a soothing, cool feeling, they don't relieve pain. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Pressure Injury, p. 1828.

The nurse notes that the client's lower extremities are covered with very dry skin and that the horny layer of the skin has become thickened. The nurse notes the finding as lichenification. pyodermas. acantholysis. dermatitis.

lichenification. Explanation: The nurse should note this as being lichenification, also called scaling. Dermatitis is an inflammation of the skin. Acantholysis is a separation of the epidermal cells from each other, and pyodermas is a bacterial skin infection. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, SKIN CARE, p. 1819.

While assessing the skin of a 45-year-old, fair-skinned female client, the nurse notes a lesion on the medial aspect of her lower leg. It has irregular borders, with various shades of black and brown. The client states that the lesion itches occasionally and bled slightly a few weeks ago. She also reveals a history of sunburns. Based on these signs and symptoms, the nurse suspects: melanoma. squamous cell carcinoma. actinic keratoses. basal cell carcinoma.

melanoma. Explanation: The "ABCDs" of melanoma are Asymmetry of the lesion, Borders that are irregular, Colors that vary in shades, and increased Diameter. Fair skin with a history of sunburn and the location of the lesion on the leg (the most common site in women) suggest melanoma. Squamous cell carcinoma commonly develops on the skin of the face, the ears, the dorsa of the hands and forearms, and other sun-damaged areas. Early lesions appear as opaque, firm nodules with indistinct borders, scaling, and ulceration. Actinic keratosis is a premalignant skin lesion. Basal cell carcinoma presents as lesions that are lightly pigmented. As they enlarge, their centers become depressed and their borders become firm and elevated. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Malignant Skin Tumors, p. 1855.

What are places with common outbreaks of scabies? Select all that apply. Anywhere large groups of people are confined boarding schools nursing homes child care centers military barracks prisons

nursing homes military barracks prisons boarding schools child care centers Anywhere large groups of people are confined Explanation: All listed locations commonly experience outbreaks of scabies. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Parasitic Skin Infestations, p. 1840.

A client is being treated for acne vulgaris. What contributes to follicular irritation? chocolate overproduction of sebum potato chips stress

overproduction of sebum Explanation: The overproduction of sebum provides an ideal environment for bacterial growth within the irritated follicle. The follicle becomes further distended and irritated, causing a raised papule in the skin. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Seborrheic Dermatitis, p. 1831.

A client is undergoing photochemotherapy involving a combination of a photosensitizing chemical and ultraviolet light. What health problem does this client most likely have? psoriasis undesired tattoo dandruff plantar warts

psoriasis Explanation: Photochemotherapy is used to treat psoriasis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Psoriasis, pp. 1843-1844.

The nurse teaches the client who demonstrates herpes zoster (shingles) that once a client has had shingles, they will not have it a second time. no known medications affect the course of shingles. the infection results from reactivation of the chickenpox virus. a person who has had chickenpox can contract it again upon exposure to a person with shingles.

the infection results from reactivation of the chickenpox virus. Explanation: It is assumed that herpes zoster represents a reactivation of the latent varicella (chickenpox) virus and reflects lowered immunity. It is believed that the varicella zoster virus lies dormant inside nerve cells near the brain and spinal cord and is reactivated with weakened immune systems and cancers. A person who has had chickenpox is immune and therefore not at risk of infection after exposure to clients with herpes zoster. Some evidence shows that infection is arrested if oral antiviral agents are administered within 24 hours of the initial eruption. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Viral Skin Infections, p. 1836.

There is an increase in the incidence of skin cancer being reported. Which have been identified as factors that predispose to malignant changes in the skin? Select all that apply. prolonged, repeated exposure to UV rays in those who do farming, fishing, road construction, etc. residence in high-altitude areas where the atmosphere is thinner than at sea level use of sun block thinning ozone layer

thinning ozone layer residence in high-altitude areas where the atmosphere is thinner than at sea level prolonged, repeated exposure to UV rays in those who do farming, fishing, road construction, etc. Explanation: Contributing factors include the thinning ozone layer; residence in high-altitude areas where the atmosphere is thinner than at sea level; and prolonged, repeated exposure to UV rays in those who do farming, fishing, road construction, etc. Use of sunblock is a protector from UV rays. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 56: Management of Patients with Dermatologic Disorders, Malignant Skin Tumors, p. 1856.