Lewis 10th Chapter 23 Integumentary Problems Evolve NCLEX practice

The nurse assesses small, firm, reddened raised lesions with flat, rough patches on a patient that are causing intense pruritus. What question should the nurse next ask the patient? a. "Have you started any new medications?" b. "Do you have a history of seasonal allergies?" c. "Have you had any lesions such as this before?" d. "Tell me about your activities the past 2 to 7 days."

d. "Tell me about your activities the past 2 to 7 days." The patient's lesions are papules and plaques characteristic of contact dermatitis. The nurse should ask the patient about activities over the past 2 to 7 days to identify potential allergens because contact dermatitis has a delayed onset. Even if an offending agent is not identified, the nurse can provide patient teaching about managing the pruritus and preventing infection by decreasing scratching. Seasonal allergies and new medications are more likely to cause urticaria than papules and plaque. The nurse should also ask about pruritic rashes in the past to determine potential illnesses that can cause dermatologic manifestations.

The nurse is teaching a patient regarding her medications. With which mediation should the nurse be sure to inform the patient to avoid prolonged sun exposure? a. Tetracycline b. Ipratropium c. Morphine sulfate d. Oral contraceptives

a. Tetracycline Several antibiotics, including tetracycline, may cause photosensitivity. This is not the case with ipratropium, morphine, or oral contraceptives.

Which patient has the highest risk of developing malignant melanoma? a. A fair-skinned woman who uses a tanning booth regularly b. An African American patient with a family history of cancer c. An adult who required phototherapy as an infant for the treatment of hyperbilirubinemia d. A Hispanic man with a history of psoriasis and eczema that responded poorly to treatment

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

The nurse should recognize that which patient is likely to have the poorest prognosis? a. A patient who is being treated for stage IV malignant melanoma b. A patient diagnosed with nodular ulcerative basal cell carcinoma c. A patient who has been diagnosed with late squamous cell carcinoma d. A patient whose biopsy has revealed superficial squamous cell carcinoma

a. A patient who is being treated for stage IV malignant melanoma Late detection of malignant melanoma is associated with a poor outcome. Basal cell carcinomas often have very effective treatment success rates. Although late squamous cell carcinoma (SCC) has worse outcomes than superficial SCC, these are both exceeded in mortality rates by late-stage malignant melanoma.

Which nursing intervention would be most helpful in managing a patient newly admitted with cellulitis of the right foot? a. Applying warm, moist heat b. Wrapping the foot snugly in blankets c. Keeping the foot at or below heart level d. Limiting ambulation to three times daily

a. Applying warm, moist heat The application of warm, moist heat speeds the resolution of inflammation and infection when accompanied by appropriate antibiotic therapy. It does this by increasing local circulation to the affected area to bring macrophages to the area and carry off cellular debris. Immobilization and elevation is also used. Snug blankets would not be helpful and could decrease circulation to this sensitive tissue.

The postoperative patient has dry skin and complains of pruritus on both legs. What nursing actions can help stop the itch-scratch cycle? Select all that apply. a. Moisturize the skin on the legs. b. Provide a warm blanket and room. c. Administer antihistamines at bedtime. d. Vigorously rub the patient's legs after bathing. e. Cleanse the legs with a saline solution twice daily.

a. Moisturize the skin on the legs. c. Administer antihistamines at bedtime. Moisturizing the skin to decrease the dryness and the itch sensation and bedtime antihistamines to decrease a potential allergic reaction and provide some sedation will help the patient sleep since pruritus is often worse at night and the patient needs sleep for healing. Using nonallergic sheets may also help. Anything causing vasodilation, such as warmth or rubbing, should be avoided. Saline solution would only further dry the skin, so it should not be used on the patient's legs.

A patient has been diagnosed with tinea unguium (onychomycosis) under the nails but does not like the oral antifungal medication. What is the best alternate treatment the nurse should describe for her? a. Nail avulsion b. Antifungal cream c. Thinning of fingernails d. Soaking nails in salt water

a. Nail avulsion Nail avulsion is the best alternate treatment to the oral antifungal medication. Antifungal cream is minimally effective. Thinning fingernails is not needed if the tinea unguium is under her toenails. Soaking the nails will not be helpful.

The patient with a stage IV pressure ulcer on the coccyx will need a skin graft to close the wound. Which postoperative care should the nurse expect to use to facilitate healing? a. No straining of the grafted site b. The wound will be exposed to air. c. Soft tissue expansion will be done daily. d. The pressure dressing will not be removed.

a. No straining of the grafted site Straining or stretching of the grafted site must be avoided to allow the graft to be vascularized and fixed to the new site for healing. The wound may or may not be exposed to air depending on the type of graft, and the donor site will be covered with a protective dressing to prevent further damage. Soft tissue expansion and pressure dressings will not be used after this wound's skin graft.

The nurse would assess a patient admitted with cellulitis for what localized manifestation? a. Pain b. Fever c. Chills d. Malaise

a. Pain Pain, redness, heat, and swelling are all localized manifestation of cellulitis. Fever, chills, and malaise are generalized, systemic manifestations of inflammation and infection.

In a patient admitted with cellulitis of the left foot, which clinical manifestation would the nurse expect to find on assessment of the left foot? a. Redness and swelling b. Pallor and poor turgor c. Cyanosis and coolness d. Edema and brown skin discoloration

a. Redness and swelling Cellulitis is a diffuse, acute inflammation of the skin. It is characterized by redness, swelling, heat, and tenderness in the affected area. These changes accompany the processes of inflammation and infection.

A patient admitted with heart failure is also diagnosed with herpes zoster and draining vesicles. Which action, if observed by the nurse, would require additional teaching for that individual? a. The dietitian wears a mask when entering the patient's room. b. The patient keeps the draining vesicles covered with a dressing. c. The student nurse who takes prednisone requests a different patient assignment. d. The nursing assistant washes hands frequently and wears gloves when in the room.

a. The dietitian wears a mask when entering the patient's room. Herpes zoster, commonly known as shingles, is spread by contact with fluid draining from the vesicles (not by coughing, sneezing, or casual contact). Shingles is not contagious before the vesicles appear or after the vesicles have crusted over. The risk of a person with shingles spreading the virus is low if the rash is covered. Wearing a mask would not prevent the spread of infection. Until the rash develops crusts, the patient should not have contact with an immunocompromised person (e.g., a person taking prednisone). Frequent hand washing helps to prevent the spread of varicella zoster virus.

A patient reports to the clinic nurse a ring-like itchy rash on the upper leg, low-grade fever, nausea, and joint pain for the past 3 weeks. What question is important for the nurse to ask the patient? a. "Is the itching worse at night?" b. "Have you had a tick bite recently?" c. "Have you been exposed to pubic lice?" d. "Have you had unprotected sexual contact?"

b. "Have you had a tick bite recently?" Symptoms are consistent with Lyme disease caused by the organism Borrelia burgdorferi, which is transmitted by a tick bite. The itching would not necessarily be worse at night. Exposure to pubic lice would cause itching in the genital area and not fever, nausea, and joint pain. Unprotected sexual contact would not cause an isolated itchy rash on the upper leg.

The nurse educates a patient with chronic kidney disease about several interventions to reduce pruritus associated with dry skin and uremia. Which statement, if made by the patient to the nurse, indicates further teaching is required? a. "I will avoid taking hot showers." b. "I can rub my skin instead of scratching." c. "Menthol can be used to numb the itch sensation." d. "A lubricating lotion right after bathing will help."

b. "I can rub my skin instead of scratching." Any activity that causes vasodilation, such as rubbing or bathing and showering in hot water, should be avoided because vasodilation leads to increased itching. Menthol in skin products provides a sensation that may distract the patient from the sensation of itchiness. Applying lotion right after bathing helps retain moisture in the skin.

A patient is admitted with a diagnosis of cellulitis of the left leg and has been placed on antibiotics. Which laboratory result is the best indicator that the treatment is having a positive outcome for the patient? a. WBC of 2900/μL b. WBC of 8200/μL c. WBC of 12,700/μL d. WBC of 16,300/μL

b. WBC of 8200/μL The normal white blood cell count is generally 4000 to 11,000/μL. For this reason, the patient's level would be returning to normal if it was 8200/μL, indicating recovery from cellulitis. The 2900/µL is too low and indicates another problem is occurring. The 12,700/µL and 16,300/µL are evidence of continuing infection.

The nurse is caring for a patient admitted for uncontrolled seizures who is also diagnosed with impetigo on the face and neck. Which action is appropriate for the nurse to take? a. Put on a protective gown before entering the room. b. Wash hands for 1 to 2 minutes when leaving the room. c. Wear gloves to leave a diet menu on the patient's table. d. Wear a particulate mask when within 3 feet of the patient.

b. Wash hands for 1 to 2 minutes when leaving the room. Impetigo is a bacterial skin infection with group A β-hemolytic streptococci or staphylococci. Meticulous hygiene (including hand washing) is essential to prevent the spread of infection. A particulate mask or a gown would not be necessary to prevent the spread of impetigo. Gloves would not be needed to make a delivery to the room.

The nurse is providing preoperative teaching for the patient having a facelift (rhytidectomy) surgery. Which patient response indicates the patient understands the teaching? a. "I am afraid of the pain afterwards, while it is healing." b. "I can't wait to have my forehead and lip wrinkles eliminated." c. "I have some time off work so I will not look so bad when I go back." d. "Now I can be excited to go to my 50th high school reunion this week."

c. "I have some time off work so I will not look so bad when I go back." A rhytidectomy or face-lift surgery will not have immediate results and will take time to heal, so taking time off from work will allow more healing to be accomplished before returning to work. There is not much pain with most cosmetic surgeries. A rhytidectomy will not eliminate forehead lines and vertical lip wrinkles.

The nurse is teaching about skin cancer prevention at the community center. Which person is most at risk for developing skin cancer? a. A 67-yr-old bald-headed man with psoriasis and type 2 diabetes mellitus b. A 76-yr-old Hispanic man who has a latex allergy and numerous acrochordons c. A 55-yr-old woman with fair skin and red hair who has a family history of skin cancer d. A 62-yr-old woman with chronic kidney disease who has blond hair with dry, pale skin

c. A 55-yr-old woman with fair skin and red hair who has a family history of skin cancer Risk factors for skin cancer include having fair skin (with red hair) and a family history of skin cancer. Allergies, acrochordons (skin tags), psoriasis, type 2 diabetes mellitus, and chronic kidney disease are not risk factors associated with the development of skin cancer.

A patient presents with a flat, dry, scaly area on the eyebrows that is treated with a chemical peel. What should the nurse include in the discharge teaching? a. Metastasis of this type of lesion is rare. b. The patient has an increased risk for melanoma. c. Recurrence of the premalignant lesion is possible. d. Untreated lesions may metastasize to regional lymph nodes.

c. Recurrence of the premalignant lesion is possible. The flat or elevated dry scaly area is actinic keratosis from sun damage and is a premalignant skin lesion common in older whites with possible recurrence even with adequate treatment. Metastasis of basal cell carcinoma is rare; it is a small slowly enlarging papule. There is an increased risk for melanoma with atypical or dysplastic nevi. With squamous cell carcinoma, untreated lesions may metastasize to regional lymph nodes and distant organs, but it has a high cure rate with early detection and treatment.

The nurse is performing a skin assessment for an older adult patient. What finding should the nurse immediately report to the health care provider? a. The presence of wrinkles on the face and hands b. The patient's report of dry skin that is frequently itchy c. The presence of an irregularly shaped mole that the patient states is new d. The presence of veins on the back of the patient's leg that are blue and tortuous

c. The presence of an irregularly shaped mole that the patient states is new The presence of an irregular mole that is new is suggestive of a neoplasm and warrants immediate reporting and follow-up. Age-related changes may occur that involve the decrease in skin oils that may cause dry skin that itches. Blue and tortuous veins may be unsightly for the patient but are a normal age-related change. Wrinkles are a normal age related change.

The patient has bleeding gums and purpura. What vitamin in which foods should be encouraged as a nutritional aid to these problems? a. Vitamin B7 in liver, cauliflower, salmon, carrots b. Vitamin A in sweet potatoes, carrots, dark leafy greens c. Vitamin C in peppers, dark leafy greens, broccoli, and kiwi d. Vitamin D in canned salmon, sardines, fortified dairy, and eggs

c. Vitamin C in peppers, dark leafy greens, broccoli, and kiwi An absence of vitamin C causes symptoms of scurvy, including petechiae, bleeding gums, and purpura. A deficiency of vitamin B7 (biotin) may result in rashes and alopecia. Vitamins A is needed for wound healing. Vitamin D is needed for bone and body health.

A patient informs the nurse that they are afraid to use the treatment recommended for psoriasis. What is the best response by the nurse? a. "You will only know if you try it and see." b. "You may need to get counseling to help you cope." c. "No treatment is medically necessary, but it can be removed." d. "Topical, light therapy, and systemic medications are now available."

d. "Topical, light therapy, and systemic medications are now available." Treatment of psoriasis usually involves a combination of strategies, including topical treatments; phototherapy; and/or systemic medications, including biologic drugs. Telling her that she will only know if she tries or that she may need counseling is denying the patient's concern. Psoriasis is treated to manage the disease as the patient may have a weakened immune system and be at risk for cardiovascular disease.

The nurse is teaching a patient about the application of a topical medication. What should the nurse include in the instruction for the patient? a. Avoid applying medications directly onto dressings. b. Use a tongue blade whenever the patient's skin integrity allows. c. Avoid covering skin areas where a topical medication has been applied. d. Apply a layer of medication that is just thick enough to ensure coverage.

d. Apply a layer of medication that is just thick enough to ensure coverage. Topical medication should be applied in a thin film to clean skin and spread evenly in a downward motion in the direction of hair growth. Medications may be applied directly on to secondary dressings, and regions with medications may be covered. A tongue blade is not normally used for the application of a thin coat.

The nurse is teaching the residents of an independent living facility about preventing skin infections and infestations. What should be included in the teaching? a. Use cool compresses if an infection occurs. b.Oral antibiotics will be needed for any skin changes. c. Antiviral agents will be needed to prevent outbreaks. d. Inspect skin for changes when bathing with mild soap.

d. Inspect skin for changes when bathing with mild soap. Persons living in independent living facilities are usually older, which means their skin does not need cleaning with hot water and vigorous scrubbing or as often as a younger person. Mild soap (e.g., Ivory) should be used to avoid loss of protection from neutralization of the skin's surface. The skin should be inspected for changes with bathing. Cool compresses are used with ringworm or stings for the antiinflammatory effect. Oral antibiotics are used for Lyme disease from ticks. Antiviral agents are used for viral infections but not to prevent outbreaks.