Integumentary Trash Quiz

After 3 months of care with the dermatologist and changing the beta-blocker to a calcium channel blocker, the nurse reviews the client findings. For each client finding, click to specify if the care and client education were Effective (helped to meet expected outcomes) or Ineffective (did not help to meet expected outcomes). Each row must have only 1 response option selected. a) Psoriasis Area and Severity Index is Moderate and involves 5% of body surface area b) Reports locating the local Psoriasis Support Group and identifying meeting dates c) Visits dermatologist's office for nurse to administer systemic subcutaneous injections d) Participated in scheduled phototherapy three times per week for last 3 months e) Blood pressure is 146/98 mmHg on calcium channel blocker f) Weight gain of 35 pounds (15.88 kg) over last 3 months g) Reports feeling unsure about developing another personal relationship right now

"E" is for effective, "I" is for Ineffective. a) E b) I c) E d) E e) I f) I g) I The client's findings indicating effectiveness of care and education include a reduction of the Psoriasis Area and Severity Index to a lower Moderate score involving 5% of the total body surface area. The client is compliant with obtaining subcutaneous injections even if unable to self-administer, indicating effectiveness of care. Another findings of effectiveness includes the client is compliant with attending the scheduled phototherapy sessions three times per week for the last 3 months, which contributed to reduction of the skin lesions. The client reports locating, not attending any of the local psoriasis Support Group's meetings, indicating ineffectiveness. Since the beta-blocker contributed to the exacerbation of the client's psoriasis, a calcium channel blocker was prescribed; however, the calcium channel blocker is not controlling the client's hypertension (146/98 mmHg). The nurse should contact the primary healthcare provider prescribing the calcium channel blocker and update the provider with the client's blood pressure. Combined with a weight gain of 35 pounds (15.88 kg) in 3 months and reporting feeling unsure about developing another personal relationship indicates cues related to depression and a need for assessment of the client's well-being. The client may benefit from psychosocial counseling because of ongoing self-esteem issues. All of these findings indicate ineffectiveness.

The nurse reviews the new orders to develop interventions for the client's plan of care. For each intervention, click to indicate which interventions are indicated for the plan of care or are contraindicated for the client's plan of care. Each row must have only one response option selected. "I" for indicated, "C" for contraindicated. a) Continue use of over-the-counter shampoo containing coal tar b) Teach client to apply anthralin cream with plastic gloves to skin lesions beginning tonight and remove each morning c) Continue light therapy via intermittent tanning bed use d) Teach client betamethasone-salicylic acid ointment reduces swelling, redness, itch, and assists with removal of thick skin layers e) Provide client information on local psoriasis group for emotional support f) Teach client to report palpation tenderness, severe erythema, or blister formation g) Schedule office-based treatment with ultraviolent B (UVB) phototherapy three-times per week h) Explain client's moderate score on the Psoriasis Area and Severity Index

"I" for indicated, "C" for contraindicated. a) I b) C c) C d) I e) I f) I g) C h) I Indicated for Plan of Care: The client may continue regular use of an over-the-counter shampoo containing coal tar because the coal tar assists in treating the skin lesions. The nurse should also teach the client the purpose of prescribed medications. Betamethasone-salicylic acid ointment reduces swelling, redness, itch, and assists with removal of thick layers of skin. The nurse should provide information on local psoriasis groups for emotional support as the client recently experienced conclusion of a long-term relationship. The nurse should teach the client cues to report to the provider. Those cues include reporting palpation tenderness, severe erythema, or blister formation for over-exposure to topical therapy medications. The nurse should explain the "moderate" score on the Psoriasis Area and Severity Index: Mild is <3% of body surface are; Moderate involves 3%-10% of the client's body surface area; and Severe involves >10% of the client's body surface area. Contraindicated for Plan of Care: The client should apply anthralin cream using plastic gloves as the cream stains the nails and skin. However, the cream is applied for 10-30 minutes per treatment, not overnight. Even intermittent use of tanning beds for light therapy should be discouraged by the nurse due to the higher risk of developing skin cancers. The first line of treatment for mild to moderate disease is use of topical therapy. The primary care provider would not have the phototherapy lights available within their office. Office-based treatment with ultraviolent B (UVB) phototherapy three-times per weekly is within the realm of a dermatologist, not in a clinic.

Complete the diagram by dragging the choices below to specify 1 potential condition the client is most likely experiencing, 2 actions the nurse would take to address that condition, and 2 parameters the nurse would monitor to assess the client's progress.

Actions to take: 1) Administer pain medication 30 minutes prior to scheduled physical therapy. 2) Hold topical dressing change until after schedule Occupational Therapy. Potential Conditions: 1) Compromised tissue integrity Parameters to monitor: 1) Effects of premedicating client for anticipatory pain and client's ability to participate in planned therapies 2) Comprehensive ongoing assessments of wound size, depth, and presence of drainage.

The nurse reviews the client's nurses' notes and new orders for potential revisions to the plan of care. Select the 4 interventions that the nurse would implement. a) Facilitate immediate referral to dermatologist b) Teach client about available phototherapies c) Teach client how to self-administer subcutaneous injections instead of cream/ointment d) Discuss continuing topical therapy and re-evaluating in 2 weeks e) Discuss current Psoriasis Area and Severity Index score f) Reexamine effects of disorder on client's quality of life g) Obtain a blood glucose instrument for client to monitor steroid side effects h) Explain that the clinic can obtain the light therapy lights, if ordered by the dermatologist

a) Facilitate immediate referral to dermatologist b) Teach client about available phototherapies e) Discuss current Psoriasis Area and Severity Index score f) Reexamine effects of disorder on client's quality of life The nurse should facilitate immediate referral of the client to the dermatologist because the topical therapy is not addressing the needs of the client with chronic psoriasis. The primary care provider can safely initiate and prescribe topical treatments; however, further evaluation by a dermatologist for systemic therapy is warranted. The nurse should explain the basics of available phototherapies utilized to treat psoriasis. Phototherapy is the mainstay of psoriasis unresponsive to topical agents. Treatment typically includes three treatments/week for 3 months. The client's Psoriasis Area and Severity Index score did not decrease because the body surface area did not decrease, indicating topical therapy did not work. The nurse should follow-up with the client regarding the effects of the disorder on the client's quality of life, as well as encouraging attendance at the suggested support group for emotional support. The nurse should not teach self-administration of subcutaneous injections as the dermatologist will include those teachings if prescribed for the client as a systemic therapy. The nurse would not teach about injections until the treatment was confirmed. Continuing the topical therapy and reevaluating in 2 weeks will extend the recovery time. There is not a need to obtain a blood glucose instrument for the client to monitor the side effects of topical steroid application. The therapy will change when the client visits the dermatologist and topical steroids absorb differently than oral steroids. Currently, the client is not a diabetic. Explaining that the clinic can obtain the light therapy lights, if ordered by the dermatologist, is unethical and unsafe. The light therapy requires prescriptions for light intensity, frequency, type of phototherapy, and recurring monitoring of the client's reaction to the phototherapy. The primary health provider and the clinic are not credentialed to perform this level of care.

An older adult in the hospital has an order for strict bed rest. The client has an increased risk for which complication? Select all that apply. One, some, or all responses may be correct. a) Friction injury b) Atelectasis c) Diarrhea d) Pressure injuries e) Urinary tract infection f) Contractures g) Muscle loss h) Shearing damage

a) Friction injury b) Atelectasis d) Pressure injuries e) Urinary tract infection f) Contractures g) Muscle loss h) Shearing damage A friction injury to the skin is caused when surfaces rub the skin, such as when a patient is moved across bed linens. Clients on bed rest are at risk for complications secondary to immobility, such as atelectasis, pressure injuries, urinary tract infections, contractures, muscle loss, and shearing damage. Damage from shearing is caused when the skin is stationary, but the tissues below the skin move causing reduced blood supply to the area. Immobility also increases the risk of constipation, not diarrhea.

The nurse is providing instructions about foot care for a client with diabetes mellitus. Which teaching point would the nurse include in the instructions? Select all that apply. One, some, or all responses may be correct. a) Wear shoes when out of bed b) Soak the feet in warm water daily c) Dry between the toes after bathing d) Remove corns as soon as they appear e) Trim toenails in a rounded shape with clippers f) Use a heating pad when the feet feel cold g) Perform foot inspection weekly h) Do not smoke or use nicotine products

a) Wear shoes when out of bed c) Dry between the toes after bathing h) Do not smoke or use nicotine products

The nurse reviews the client's data in the electronic health record to develop a plan of care. Drag one condition and one client finding to complete the sentence. The client has a higher risk for a) __________ due to a/an b) _____________ .

a) developing skin cancer b) consistent with use of a tanning bed long term nt has a higher risk for developing skin cancer due to a consistent use of a tanning bed long-term. The ultraviolet A light has a strong correlation to developing skin cancers and the client reported long-term use. Skin cancer can be life-threatening, and the client should reconsider the use of tanning beds. Kaposi sarcoma can present as skin lesions but it is usually purple, not silvery. Even though the client has hypertension, there is no evidence of acute kidney injury (creatinine level elevated or changes in urine color). If the client does not control the hypertension, the client may develop acute kidney injury secondary to hypertension. However, the client did obtain a prescribed medication to treat the hypertension. There is not enough evidence to state the client's hypertension is uncontrolled with a single blood pressure reading of 156/72 mmHg. Client Finding: Consistent use of a tanning bed long-term can lead to skin cancer. The ultraviolet rays used in tanning beds can damage skin cells, leading to mutations and skin cancer. Although the systolic pressure is elevated, emotions and stress can elevate readings. The client is also taking blood pressure medication for hypertension. Hypertension can elevate systolic blood pressure readings. Also, hypertension is not associated with skin cancer. The client is exhibiting no signs of Crohn's disease, such as inflammatory gastrointestinal problems, excessive diarrhea, and malnutrition. The skin lesions are a result of psoriasis and do not have the hallmark characteristics of skin cancer.

A client underwent surgery and developed a wound without tissue loss. While caring for the client, the nurse detects abscess formation. Which assessment made by the nurse supports the observation? Select all that apply. One, some, or all responses may be correct. a) Necrosis of skin edges b) Swelling of the incision line c) Purulent drainage from the incision site d) Erythema of the incision line of more than 1 cm e) Localized fluctuance beneath the wound when palpated f) Sanguineous drainage on the first day g) Crusting on the incision line h) Partial separation of the outer wound layers

c) Purulent drainage from the incision site e) Localized fluctuance beneath the wound when palpated Purulent drainage from the incision site's portion is detected during checks performed every 24 hours to detect abscess formation until sutures or staples are removed. Localized fluctuance and tenderness beneath a portion of the wound is palpated to detect abscess formation. Wound dehiscence is indicated by the presence of necrosis of skin edges. Swelling of the incision line or erythema of the incision line of more than 1 cm indicates cellulitis. Sanguineous to serosanguineous drainage for the first few days post-surgery is considered normal. Crusting on the incision line is also considered normal. Partial to complete separation of the outer wound layers is indicative of wound dehiscence.

The nurse analyzes the client's assessment findings. Choose the most likely options for the information missing from the statement by selecting from the lists of options provided. The nurse would immediately obtain a) _______ as evidenced by b) _______.

a) family history b) red, raised rash with silvery white scales. Options for 1: The nurse should immediately obtain family history of skin disorders as multiple disorders are genetically based or autoimmune disorders transmitted genetically. The client's skin lesions are probably an incurable autoimmune skin disorder, plaque psoriasis, which is the most common type of psoriasis and may be genetically linked. There are not any indications to obtain blood cultures, blood glucose levels, or the provider's name who prescribed the beta-blocker right now. Blood cultures are needed for an infection and/or sepsis, the client has no signs of systemic infection (fever, chills, malaise, or drainage). The client has no history or signs of diabetes for a blood glucose level to be drawn. It is not necessary to obtain the provider's name who prescribed the beta-blocker; the client has hypertension and needs medication but there is not enough data to support contacting the prescribing provider until the beta-blocker is identified as exacerbating the skin disorder. Further assessment findings are needed related to family history. Options for 2: The nurse based the decision to obtain a family history of skin disorders based upon the client's red, raised rash with silvery white scales, as this is a classic symptom of one type of psoriasis. A BMI of 24.4 kg/m2 is normal and expected (normal BMI 18.5-24.9 kg/m2). The client is not exhibiting a temperature, or any detrimental cues related to a bacterial infection. The client's systolic blood pressure is slightly elevated, which is expected since the client has hypertension.

A client visited the primary health care provider complaining of inflammatory lesions on the face and is diagnosed with an inflammatory disorder of the sebaceous glands. Which medication would the nurse anticipate being prescribed for this client? Select all that apply. One, some, or all responses may be correct. a) Bacitracin b) Benzoyl peroxide c) Mupirocin d) Clindamycin e) Erythromycin f) Dapsone g) Retinoid h) Metronidazole

b) Benzoyl peroxide d) Clindamycin e) Erythromycin f) Dapsone g) Retinoid Benzoyl peroxide is a first line treatment for mild acne vulgaris. Clindamycin and erythromycin are topical antibiotics used in the treatment of acne vulgaris, which occurs due to inflammation of the sebaceous glands. To avoid development of bacterial resistance these should be used in combination with benzoyl peroxide. Dapsone, an antibacterial drug, is also a common first line treatment of mild acne vulgaris. Often a retinoid, a prescription anti-acne drug, is used alone as the first line of treatment for mild acne. Bacitracin is an over-the-counter topical antibiotic used in the treatment of dermatological problems; however, it does not treat the most common bacteria found in acne and therefore could worsen the acne. Bacitracin is also petroleum jelly based and could contribute to further clogging of pores. Mupirocin is used in the treatment of superficial Staphylococcus infections such as impetigo. Topical metronidazole is used in the treatment of rosacea and bacterial vaginosis.

The nurse reviews the client's initial assessment data available in the electronic health record. Which client assessment finding requires immediate follow-up by the nurse? Select all that apply. a) Lack of isolation to prevent spread of rash to others b) Consistent use of tanning bed long-term c) use of an over-the-counter shampoo with coal tar d) Thick skin patches on bilateral knees and elbows e) Takes a beta-blocker medication for blood pressure f) Clothing consists of shorts and short sleeved shirt g) Recent conclusion of long-term relationship h) Hair style is shoulder length to covers skin patches

b) Consistent use of tanning bed long-term d) Thick skin patches on bilateral knees and elbows e) Takes a beta-blocker medication for blood pressure g) Recent conclusion of long-term relationship The client assessment findings requiring immediate follow-up by the nurse in the clinic are the consistent use of tanning bed long term; thick skin patches on bilateral knees and elbows; takes a beta-blocker medication for blood pressure; and recent conclusion of long-term relationship. Together, these findings indicate an integumentary disorder. Light therapy by use of a tanning bed is a common self-management treatment, but the tanning bed uses ultraviolet A (UVA) light and is not helpful unless combined with certain medications and has a much higher risk of skin cancer. Thick skin patches on bilateral knees and elbows indicate a potential type of skin disorder such as one of the five types of psoriasis. Side effects of beta-blockers include causing plaque psoriasis, erythrodermic psoriasis, and palmoplantar pustular psoriasis. The recent conclusion of a long-term relationship indicates an increase in the client's stress, which increases the presence of some skin disorders. The assessment findings that do not require immediate follow-up include: lack of isolation to prevent spread of rash to others, use of over-the-counter shampoo with coal tar, clothing consists of shorts and short sleeved shirt, and hair style is shoulder length to cover skin patches. The assessment findings do not indicate the rash is transmittable to others and there is not a need to isolate to prevent the spread. Over-the-counter shampoos with coal tar do assist with treating skin disorders of the scalp and are beneficial to the client. Clothing style does not require immediate follow-up because it indicates the client is not trying to hide the rash and is not embarrassed about the rash; exposure to light can help the rash. While the length of the client's hair does not require immediate follow-up, it may indicate a low self-esteem; emotional needs at this time are not as immediate as the physical findings at this point in time.

The nurse reviews the electronic health record and documents care in the nursing progress notes. Client education provided as appropriate. Which assessment would the nurse include when taking the health history of a toddler with an exacerbation of eczema? Select all that apply. One, some, or all responses may be correct. a) Change in appetite b) Wearing polyester clothes c) Exposure to new foods d) Increased emotional stress e) Exposure to a viral infection f) Smoking in the home g) Recent contact with someone with eczema h) Use of fragrant fabric detergents

b) Wearing polyester clothes c) Exposure to new foods d) Increased emotional stress f) Smoking in the home h) Use of fragrant fabric detergents Eczema is a common manifestation of allergies in the young child and is often related to foods and clothing. Fabrics such as polyester or wool are common triggers for eczema. Exposure to new foods is a common trigger for eczema. Although it is not known why, increased emotional stress can trigger an eczema exacerbation. Cigarette smoke can serve as a trigger for eczema outbreaks. Perfumes, dyes, and detergents are common triggers for eczema. Appetite does not play a role in the occurrence of eczema. Eczema is an allergic manifestation; it is not contagious and therefore cannot be transmitted by being around a viral infection, someone else with eczema, or through travel.