Med surg success integumentary disorders comprehensive exam

14. The nurse is preparing the plan of care for a client diagnosed with Stevens-Johnson syndrome. Which interventions should the nurse include? Select all that apply. 1. Monitor intake and output every eight (8) hours. 2. Assess breath sounds and rate every four (4) hours. 3. Assess vesicles, erosions, and crusts frequently. 4. Perform the whisper test for auditory changes daily. 5. Assess orientation to person, place, and time every

14. 1. The client with Stevens-Johnson syndrome must be assessed for fluid volume deficit (FVD), the need for fluid replacement, and renal failure. Intake and output monitors both. 2. Breath sounds and respiratory status should be assessed because many clients develop respiratory failure and require mechanical ventilation. 3. The client with Stevens-Johnson syndrome has a combination of vesicles, erosions, and crusts at the same time. The skin should be assessed every eight (8) hours.

18. Which problem should the nurse identify for the client recently diagnosed with leprosy (Hansen's disease)? 1. Social isolation. 2. Altered body image. 3. Potential for infection. 4. Alteration in comfort.

18. 1. The client diagnosed with leprosy (Hansen's disease) may feel ostracized because of the stigma of the disease. Historically, people have been isolated from society when diagnosed. Leprosy colonies were sites of treatment for those diagnosed. Today much of the public is unaware of the presence of the disease. Clients are treated on an outpatient basis by health departments.

19. The nurse is teaching the client diagnosed with atopic dermatitis. Which information should the nurse include in the teaching? 1. Discuss skin care using hydrating lotions and minimal soap. 2. Tell the client the methods of treating secondary infection. 3. Explain there are no adverse effects to using topical corticosteroids daily. 4. Warn the client inhaled allergens have been linked to exacerbations.

19. 1. Skin care must be meticulous. Minimal soap and tepid water should be used when showering or bathing. Lotions that do not irritate should be used to keep the skin hydrated.

2. The nurse is assessing the client diagnosed with psoriasis. Which data would support that diagnosis? 1. Appearance of red, elevated plaques with silvery white scales. 2. A burning, prickling row of vesicles located along the torso. 3. Raised, flesh-colored papules with a rough surface area. 4. An overgrowth of tissue with an excessive amount of collagen.

2. 1. Most clients with psoriasis have red, raised plaques with silvery white scales.

5. The nurse is planning the care of a client diagnosed with psoriasis. Which psychosocial problem should be included in the plan? 1. Alteration in comfort. 2. Altered body image. 3. Anxiety. 4. Altered family processes.

2. Altered body image is a problem the nurse should assess in clients with psoriasis. Any chronic skin disease affecting appearance can cause psychosocial problems.

3. The nurse is preparing the plan of care for a client diagnosed with psoriasis. Which intervention should the nurse include in the plan of care? 1. Apply a thin dusting with Mycostatin, an antifungal powder, over the area. 2. Cover the area with an occlusive dressing after applying a steroid cream. 3. Administer Acyclovir, an antiviral medication, to the affected areas six (6) times a day. 4. Teach the client the risks and hazards of implanted radiation therapy.

2. Covering the affected area with an occlusive dressing enhances the steroid's effectiveness. This intervention should be limited to 12 hours to reduce systemic and local side effects.

7. The nurse is teaching clients at a community center about skin diseases. Which information about pruritus should the nurse include? Select all that apply. 1. Cool environments increase itching. 2. Use of soap increases itching. 3. Use hot water to rinse off soap. 4. Apply mild skin lotion for hydration. 5. Blot gently, but completely dry the skin.

2. Soaps cause itching to increase. The client should avoid soap when experiencing pruritus. 4. Mild lotion can help the skin stay hydrated. 5. The client should dry off completely after bathing and blot gently rather than rub vigorously.

6. The elderly client diagnosed with poison ivy is prescribed a solumedrol (a steroid) dose pack. Which intervention should the nurse teach the client? 1. Tell the client to return to the office in one (1) week for blood levels. 2. Instruct the client to take the medication exactly as prescribed. 3. Explain the medication should be taken on an empty stomach. 4. Teach to stop the medication immediately if side effects occur.

2. The client should take the medication exactly as instructed. The number of pills should be taken in a descending (tapering) manner.

15. Which expected outcome should the nurse include in the plan of care for the client diagnosed with seborrheic dermatitis? 1. The client will have no further outbreaks. 2. The client will follow medical protocol. 3. The client will shampoo three (3) times a week. 4. The client will apply bacitracin twice daily.

2. To control the disorder by following the medical protocols would be realistic and appropriate.

10. The nurse is caring for the client diagnosed with contact dermatitis. Which collaborative intervention should the nurse implement? 1. Encourage the use of support stockings. 2. Administer a topical anti-inflammatory cream. 3. Remove scales frequently by shampooing. 4. Shampoo with lindane 1%, an antiparasitic, weekly.

2. Topical corticosteroids are administered to treat contact dermatitis, which comes from an allergic response to irritants. The irritant should be eliminated and topical anti-inflammatory creams should be administered.

20. The nurse is working with clients in an aesthetic surgery center. Which intervention should the nurse implement for a client undergoing a chemical peel? 1. Teach the client to expect extreme swelling after the procedure. 2. Apply the chemical mixture directly to skin after the face is cleansed. 3. Administer general anesthesia to the client prior to the procedure. 4. Explain that there will be no pain or discomfort during the procedure.

20. 1. After the first six (6) to eight (8) hours, the client will have extreme edema causing the eyes to swell. This is expected.

22. The nurse is caring for an elderly female client preoperative for facial reconstruction. Which client problem should the nurse include in the plan of care? 1. Loss of self-esteem. 2. Alteration in comfort. 3. Ineffective airway clearance. 4. Impaired communication.

22. 1. A loss of self-esteem can occur after a change in facial appearance through injury, disease, or age-related changes.

25. The nurse is caring for a male client diagnosed with folliculitis barbae. Which information should the nurse teach to prevent a reoccurrence? 1. Tell the client to not shave the face. 2. Instruct the client to rub on astringent aftershave lotion. 3. Recommend the client apply hot packs for 20 minutes before shaving. 4. Teach the client to use an antibacterial soap on the face.

25. 1. Shaving is the cause of this condition, and refraining from shaving is the only cure. Special brushes are used. If the client must shave, he should use a depilatory cream or electric razor.

26. The ED nurse is caring for a client admitted with extensive, deep partial-thickness and full-thickness burns. Which interventions should the nurse implement? List in order of priority. 1. Estimate the amount of burned area using the rule of nines. 2. Insert two (2) 18-gauge catheters and begin fluid replacement. 3. Apply sterile saline dressings to the burned areas. 4. Determine the client's airway status. 5. Administer morphine sulfate, a narcotic analgesic, IV.

26. In order of priority: 4, 2, 3, 1, 5. 4. Airway is always the first priority for any process in which the airway might be compromised. 2. The nurse should start fluid resuscitation as soon as possible before the client's blood pressure makes it more difficult to establish an IV route. 3. Covering the open burns will prevent further intrusion of bacteria. 1. Estimating the extent of the burned area should be done but does not have priority over airway, fluid replacement, and the prevention of infection. 5. Pain is priority but not over determining airway and fluid status and prevention of infection.

21. The nurse is preparing the client scheduled for a dermabrasion. Which information should the nurse include while teaching the client? 1. Erythema will go away within 24 hours. 2. Do not change the dressing until seen by the HCP. 3. Stay out of extreme cold or heat situations. 4. Avoid direct sunlight for three (3) days.

3. Extreme cold and heat, along with straining and lifting heavy objects, should be avoided.

8. Which laboratory test should the nurse monitor to identify an allergic reaction for the client diagnosed with contact dermatitis? 1. IgA. 2. IgD. 3. IgE. 4. IgG.

3. IgE is a protein responsible for allergic reactions.

11. The client had an allergic reaction to poison oak two (2) weeks ago. He has returned to the clinic with severe itching and weeping vesicles on the arms and legs. Which intervention should the nurse implement? 1. Obtain a sample of the drainage for culture and sensitivities. 2. Determine any allergic reactions to any medications taken recently. 3. Inquire how the poison ivy/oak plants were destroyed. 4. Assess for any temperature elevation since the last visit to the clinic.

3. Many people dispose of the poison oak plant in ways that spread the sap. Burning or pulling the plant without gloves can cause another allergic reaction. Pets can spread the allergen on fur. Tools should be cleaned prior to touching the skin.

23. The nurse is caring for a client one (1) day postoperative for facial reconstruction. Which intervention should the nurse implement? 1. Provide all activities of daily living. 2. Allow client to voice fears and concerns. 3. Monitor nutritional food and fluid intake. 4. Assess signs and symptoms of infection.

3. Monitoring the client's nutritional intake and fluid balance is important for healing.

13. The home health nurse is visiting an elderly client who shows the nurse an area of rough skin with a greasy feel and multiple papules. Which information should the nurse provide the client? 1. Contact the health-care provider immediately for an appointment. 2. Tell the client this is a normal aging change and no action should be taken. 3. Tell the client to discuss this with the HCP at the next appointment. 4. Have the client buy a wart remover kit at the store.

3. The client should discuss any suspicious area with the health-care provider. This is not an emergency,

17. The health department nurse is caring for the client who has leprosy (Hansen's disease). Which assessment data indicate the client is experiencing a complication of the disease? 1. Elevated temperature at night. 2. Brownish-black discoloration to the skin. 3. Reduced skin sensation in the lesions. 4. A high count of mycobacteria in the culture.

3. The decrease in sensation of the lesions is the result of peripheral nerve damage. Leprosy is a peripheral nervous system disease.

4. The nurse has completed the teaching plan for the client diagnosed with psoriasis. Which statement indicates the need for further teaching? 1. "I will check my skin every day for redness with tenderness." 2. "I must take my psoralen medication two (2) hours before my treatment." 3. "I will wear dark glasses during my treatment and the rest of the day." 4. "The coal-tar ointments and lotions will not stain my clothes."

4. Coal tar comes in lotions, ointments, shampoos, and gels. They are used more in the hospital setting than in home settings because of the staining and mess associated with their use. The client needs more teaching.

16. The public health nurse is caring for a client diagnosed with leprosy (Hansen's disease). Which intervention should the nurse implement? 1. Explain the need for admission to the hospital. 2. Administer dapsone, a sulfone, for one (1) month only. 3. Instruct to use skin moisturizing lotion to control the symptoms. 4. Discuss the ways leprosy is transmitted to other individuals.

4. Contrary to popular thought, leprosy, although contagious, usually requires a prolonged exposure for the infection to spread to another person. Touching the lesions directly will increase the potential for infection.

1. The nurse is caring for a client with complaints of a rash and itching on the face for one (1) week. Which intervention should the nurse implement first? 1. Check for the presence of hirsutism on the face. 2. Use the Wood's light to visualize the rash under the black light. 3. Determine what OTC medications the client has used on the rash. 4. Ask the client to describe the rash when it first appeared.

4. It is important to assess the rash as it appeared. If the client treated the rash with an ointment or cream, its appearance may have changed. Many times the appearance has changed from first onset and from the treatment. Assessment is the first part of the nursing process.

24. The nurse and an unlicensed assistive personnel (UAP) are caring for a client with a stage IV pressure ulcer. Which action by the UAP warrants intervention by the nurse? 1. The UAP turns the client every two (2) hours. 2. The UAP keeps the sheets wrinkle free. 3. The UAP encourages the client to drink high-protein drinks. 4. The UAP places multiple diapers on the client.

4. Placing extra diapers saves the UAP from changing the linens, but it keeps wet plastic against the skin, leading tofurther skin breakdown. This action would warrant intervention by the nurse.

12. The client is complaining of severe itching following a course of antibiotics. Which independent nursing action should the nurse implement? 1. Refer to an allergy specialist to begin desensitization. 2. Use a tar-preparation gel after each shower or bath. 3. Keep the covers tightly around the client at night. 4. Take baths with an OTC colloidal oatmeal preparation.

4. Soothing baths, such as colloidal baths or emollient baths, are helpful in treating pruritus. Balneotherapy is a term used to refer to therapeutic baths.

9. Which client signs and symptoms indicate contact dermatitis to the nurse? 1. Erythema and oozing vesicles. 2. Pustules and nodule formation. 3. Varicosities and edema. 4. Telangiectasia and flushing.

9. 1. Contact dermatitis presents with erythema and small oozing vesicles.