Porth's Patho: Disorders of Skin, Chapter 52

The nurse assesses a client's skin and finds an elevated palpable mass with a circumscribed border. How will the nurse chart this finding? -"Client has a wheal" -Client has hives." -"Client has a macule." -"Client has a papule."

-"Client has a papule." An elevated mass with a circumscribed border describes a papule. Hives would involve multiple lesions. A macule is not elevated and a wheal does not have circumscribed borders.

What should a nurse tell a client who is concerned about melasma? -"Steroid cream may help." -"Stay out of the sun." -"Don't scratch the area." -"Use lotion."

-"Stay out of the sun." A client who has melasma should stay out of the sun, as the condition is exacerbated by sun exposure. The use of lotion, steroid cream, or itching should not affect the condition.

What should the nurse teach the client about the diagnosis of "primary skin disorder"? -"This disorder occurs primarily in children." -"This disorder occurs after another primary systemic diagnosis." -"This disorder occurs from side effects of primary medications." -"This disorder is caused by a virus, bacteria, or fungus that invades the skin."

-"This disorder is caused by a virus, bacteria, or fungus that invades the skin." The client who has a primary skin disorder should understand that this is caused by something that invades the skin and causes the inflammatory response. It is not secondary to any other diagnosis or medication reaction.

A client is admitted to the hospital with thermal injuries as a result of a fire. What type of damage of the skin can occur as a result of the thermal injuries? Select all that apply. -Destroy the barrier function of the skin -Accelerate the effect of aging on the skin -Predispose to the development of skin cancer -Cause damage to the skin and subcutaneous tissue

-Destroy the barrier function of the skin -Cause damage to the skin and subcutaneous tissue Thermal injury can damage skin and subcutaneous tissue and destroy the barrier function of the skin in terms of preventing the loss of body fluids and protecting against the entry of infectious organisms. The ultraviolet rays of sunlight have the potential for directly damaging skin cells, accelerating the effect of aging on the skin, and predisposing to the development of skin cancer.

Allergic and hypersensitivity dermatoses are usually characterized by which descriptor? -Dark erythema -Epidermal edema -Silver-white scaling -Target lesions

-Epidermal edema Allergic and hypersensitivity dermatoses involve the inflammatory response and are usually characterized by epidermal edema with separation of epidermal cells. Rosacea is characterized by repeated episodes of facial blushing that eventually becomes a permanent dark red erythema on the nose. The lesions of erythema multiforme are round, erythematous papules that enlarge and coalesce, changing to concentric zones of color appearing as "target" or "iris" lesions.

A nurse is caring for an older adult recently diagnosed with actinic keratoses. The client is being treated with topical chemotherapy agents. What is the expected result of this treatment regimen? -Moisturizing the skin -Eliminating scarring -Eroding the lesions -Proper cleansing of the skin

-Eroding the lesions The chemotherapy agents are applied to erode the lesions. The goal is to decrease the size of the growth until it disappears. Applying emollient daily will moisturize the skin. Washing the skin daily will contribute to dryness. Topical therapy may help with scarring compared with surgical removal.

Which cause of pressure injuries (decubitus injuries or bedsores) impairs the flow of blood in the capillary beds? -Thrombosis -Shearing forces -Tissue edema -External pressure

-External pressure Factors contributing to the development of pressure injuries include external pressure that compresses blood vessels and friction and shearing forces that tear and injure blood vessels. External pressure that exceeds capillary pressure interrupts blood flow in the capillary beds. Shearing forces are caused by the sliding of one tissue layer over another with stretching and angulation of blood vessels, causing injury and thrombosis. As a result of the ischemia and shearing forces, the injured tissues become edematous.

With aging, the skin acquires an overall thin and transparent quality while becoming dry and wrinkled. Which skin disorders are common among the older adult population? -Skin cancers and xenobiotic -Dermatitis and xenomas -Xenomas and keratosis -Keratoses and solar lentigines

-Keratoses and solar lentigines Skin disorders are common among the older adult population and can include skin cancers, keratoses (i.e., warty lesions), xerosis (i.e., excessive dryness), dermatitis, pruritus (i.e., generalized itching), and solar lentigines (brown benign spots on sun-exposed areas). The term xenobiotic refers to a chemical compound foreign to a given biologic system. Xenomas are tumors that develop on skin infested with certain parasites.

Which intervention will the nurse recommend for the client who has tinea versicolor? -Intravenous antifungal agents -Steroid cream -Ketoconazole cream or shampoo -Oral griseofulvin

-Ketoconazole cream or shampoo The client with tinea versicolor is usually treated with ketoconazole cream on the lesions, or even shampoos with ketoconazole left on the areas when the client showers.

A client has been using a topical antibiotic ointment on a urticaria skin disorder. Which best describes the drug-induced skin eruption caused by topical drugs? -No contact dermatitis or generalized skin lesion will be present -Generalized skin lesions -Localized contact dermatitis as well as generalized skin lesions -Localized contact dermatitis

-Localized contact dermatitis Most drugs can cause a localized or generalized skin eruption. Topical drugs are usually responsible for localized contact dermatitis types of rashes, whereas systemic drugs cause generalized skin lesions.

Which client would be predisposed to developing a yeast-like Candida albicans fungal infection? -A dance instructor with a rash on the hands described as raised borders -A high school football player with fungal spores cultured on the feet -A diabetic male child with circular patches on the arms -An immunosuppressed client with cancer who has developed maculopapular satellite lesions

An immunosuppressed client with cancer who has developed maculopapular satellite lesions In addition to microscopic analysis of skin scrapings for tinea fungal spores, a candida infection often can be differentiated from a tinea infection by the presence of maculopapular satellite lesions found outside the clearly demarcated borders. Some persons are predisposed to candida infections by conditions such as diabetes mellitus, antibiotic therapy, pregnancy, oral contraceptive use, poor nutrition, and immunosuppressive diseases. The most common types of tinea lesions are oval or circular patches with raised red borders consisting of vesicles, papules, or pustules on exposed skin surfaces.

The photoaging effect caused by UVB exposure to sunlight causes changes primarily in which skin layer? -Panniculus -Basement membrane -Epidermis -Dermis

Dermis Solar elastosis (also known as actinic elastosis) is due to a large amount of abnormal, elastotic material in the upper dermis, not the epidermis, basement membrane, or panniculus.

Rubella, or 3-day measles, is a childhood disease caused by a togavirus. Because rubella can be easily transmitted and because it is dangerous to the fetus if contracted by pregnant women early in their gestational period, immunization can be required. What type of vaccine is the rubella vaccine? -Antibody/antigen vaccine -Live-virus vaccine -Dead-virus vaccine -Attenuated virus vaccine

Live-virus vaccine Immunization is accomplished by live-virus injection. Rubella vaccination has nearly 100% immunity response in immunized children.

A young child has recently developed macules on the trunk, extremities, and mucous membranes. The child is mildly febrile, but the primary symptom is extreme pruritus. What disorder of the skin most likely is the cause of this child's condition? -Rosacea -Varicella -Impetigo -Lichen planus

Varicella Varicella (chickenpox) begins with a macular stage that is characterized by the development of macules over the trunk, spreading to the limbs, buccal mucosa, scalp, axillae, upper respiratory tract, and conjunctiva. Mild to extreme pruritus accompanies the lesions, and clients are often mildly febrile. Impetigo manifests vesicles or pustules that are primarily on the face. Rosacea and lichen planus are chronic skin disorders of older adults.

Which type of vascular lesion appears on areas exposed to sun or harsh weather, such as the cheeks and nose? -Venous lakes -Angiomas -Telangiectases -Varicella

Telangiectases are single dilated blood vessels, capillaries, or terminal arteries that appear on areas exposed to sun or harsh weather, such as the cheeks and the nose.

A client has been referred to the dermatology office for an evaluation of a suspected common malignant tumor of the skin. Which is the most common malignant tumor of the skin? -Bowen disease -Malignant melanoma -Squamous cell carcinoma -Basal cell carcinoma

Basal cell carcinoma Basal cell carcinoma (BCC), which is a neoplasm of the nonkeratinizing cells of the basal layer of the epidermis, is the most common skin cancer in light-skinned people.

A female client has been diagnosed with a severe case of lichen planus. Which treatment measures should the nurse include in the client education packet? Select all that apply. -Treatment with systemic corticosteroids -Orally administered acitretin -Use of occlusive dressings -Discontinuation of all medications

ALL Treatment measures include discontinuation of all medications, followed by treatment with topical corticosteroids and occlusive dressings. Occlusion may be used to enhance the effect of topical medications. Antipruritic agents are helpful in reducing itch. Orally administered acitretin may also be effective.

A client with herpes simplex virus (HSV) of the mucous membranes is complaining about pain. Which intervention will the nurse likely recommend? -Intravenous pain therapy -Oral opioid pain medication -Acetaminophen -Topical numbing agents

Acetaminophen Usually, acetaminophen and aspirin are recommended to reduce the pain associated with HSV of the mucous membranes (also known as "fever blisters").

A middle-aged individual visits the primary care physician with a possible primary skin disorder. Which is a common chronic acneiform disorder seen in middle-aged and older persons? -Acne vulgaris -Rosacea -Comedones -Cysts with scarring

Rosacea Rosacea is a chronic acneiform disorder of middle-aged and older persons. Acne vulgaris, cysts with scarring, and comedones occur in adolescence.

What would be the best response to the mother of two teens who have been diagnosed with scabies? -"One of the parents is likely an unaffected carrier." -"One of your children probably had direct contact with an infected person." -"Scabies usually occurs when hygiene practices need improvement." -"Scabies occurs with increased sexual activity."

-"One of your children probably had direct contact with an infected person." Scabies is spread through direct person-to-person contact; the teens could have contacted with someone who has scabies. Scabies does not occur only with sexual contact. This condition does not involve unaffected carriers. Poor hygiene is not the trigger for this condition.

A client presents to the urgent care and tells the health care provider he came home from vacation 4 days ago and does not feel well. Upon assessment, the provider notes the client's right upper thigh area is red, warm, and painful, and the lymph nodes are palpable. The client states he had been swimming in a lake all week. The health care provider recognizes these manifestations as: -Rosacea -Scabies -Impetigo -Cellulitis

Cellulitis is a deeper infection affecting the dermis and subcutaneous tissues. It is usually caused by group A beta-hemolytic streptococci or Streptococcus aureus but can be caused by bacteria specific to certain activities, such as fish handling, swimming in fresh or salt water, or from animal bites or scratches. Legs are the most common sites. It is frequently accompanied by fever, erythema, heat, edema, and pain and often involves the lymph system. The other options would not have these manifestations.

Which type of vascular lesion appears on areas exposed to sun or harsh weather, such as the cheeks and nose? -Angiomas -Venous lakes -Telangiectases -Varicella

Telangiectases Telangiectases are single dilated blood vessels, capillaries, or terminal arteries that appear on areas exposed to sun or harsh weather, such as the cheeks and the nose.

Upon assessment, it is noted that a client has a dark yellowish brown tint to the great toenail. The client reports no injury and that "it's been like that for years." The nurse recognizes this as which type of fungal infection? -Tinea capitis -Tinea unguium -Tinea pedis -Tinea corporis

Tinea unguium Tinea unguium is a dermatophyte infection of the nails. Tinea capitis is a fungal infection of the scalp and hair shaft. Tinea pedis is the most common fungal dermatosis, primarily affecting the spaces between the toes, the soles, or sides of the feet. Tinea corporis involves the body.

Which term is used to denote the pigmentation disorder in which the skin suddenly develops white patches on the face and arms? -Vitiligo -Albinism -Paleness -Melasma

Vitiligo The condition described above that comes on suddenly is vitiligo. Albinism is present from birth, and melasma involves dark spots on the skin. Paleness is a term used to denote minimal skin color.

A woman has just delivered a child with a hemangioma on his right cheek area. The mother asks, "What is that thing on his face?" The nurse will respond with discussing which facts about hemangiomas? Select all that apply. -"This is a vascular birthmark that can be located in anatomic regions; it is associated with other anomalies." -"Most of these hemangiomas will remain with the infant for the rest of his life. However, they are not cancerous." -"These hemangiomas may grow larger early on followed by a period where the growth is reversed." -"We will keep a close watch on your infant's vision since hemangiomas can develop malformation of the eye that could develop into glaucoma." -"If this birth mark develops ulceration, we will need to keep a close eye on it to prevent any infections."

-"This is a vascular birthmark that can be located in anatomic regions; it is associated with other anomalies." -"These hemangiomas may grow larger early on followed by a period where the growth is reversed." -"If this birth mark develops ulceration, we will need to keep a close eye on it to prevent any infections." Hemangiomas of infancy (formerly called strawberry hemangiomas) are small, red lesions that are noticed shortly after birth. Hemangiomas of infancy are generally benign vascular tumors produced by proliferation of endothelial cells. They are seen in approximately 10% of children in the first year of life. Hemangiomas of infancy typically undergo an early period of proliferation during which they enlarge, followed by a period of slow involution during which the growth is reversed until complete resolution. A small percentage of hemangiomas develop complications. Ulceration, the most frequent complication, can be painful and carries the risk of infection, hemorrhage, and scarring. Port-wine stains usually are confined to the skin but may be associated with vascular malformations of the eye, resulting primarily in glaucoma.

A client with new-onset herpes zoster (shingles) asks the nurse, "Why is this rash just on my face?" Which response by the nurse is most accurate? -"When shingles is only in one location, this means one is having a milder case than what most people have." -"This eruption looks bad, but this rash will clear up in 2 to 3 days after the appearance of this rash." -"This virus was reactivated and travels from the ganglia to the skin of the corresponding single spinal nerve like your face." -"This rash only appears in patches throughout various body parts, so you are lucky it's not in other locations."

-"This virus was reactivated and travels from the ganglia to the skin of the corresponding single spinal nerve like your face." Herpes zoster (shingles) lesions appear as an eruption of vesicles. Eruptions are usually unilateral in the thoracic region, trunk, or face. New groups of vesicles erupt for 3 to 5 days along the nerve pathway. The lesions usually clear in 2 to 3 weeks, although they can persist up to 6 weeks in some older adults.

A client asks "Why do I have albinism?" What is the nurse's best answer? -"Your mother ingested something that made her ill when she was pregnant." -"It is a type of birth defect." -"As you grew, your melanocytes did not multiply." -"You inherited this disorder."

-"You inherited this disorder." Albinism is an inherited genetic disorder in which there is complete or partial congenital absence of pigment in the skin, hair, and eyes.

What are the nutritional protein requirements for an individual with a pressure ulcer? -10-15 calories/kg/day -30-35 calories/kg/day -40-45 calories/kg/day -20-25 calories/kg/day

-30-35 calories/kg/day The protein nutritional requirements for an individual with a pressure ulcer is 30-35 calories/kg/day.

A nurse is caring for four clients. Select the client most at risk for the development of a pressure ulcer. -A 40-year-old male paraplegic who has strong upper body strength -A 22-year-old female who is in traction after a motor vehicle accident -An 80-year-old male who requires a walker for ambulation but who is otherwise healthy -A 72-year-old undernourished female who recently underwent thigh surgery

-A 72-year-old undernourished female who recently underwent thigh surgery Populations at risk for pressure ulcers include persons with quadriplegia and older adults with restricted activity and hip fractures in a critical care setting. An undernourished postsurgical client is at risk for ulcer development.

A 30-year-old woman who just found out that she is pregnant seeks treatment for her severe acne. Which treatment for her skin condition is most appropriate? -Low-dose tetracycline -Tretinoin -Isotretinoin -A benzoyl peroxide agent

-A benzoyl peroxide agent Benzoyl peroxide is a topical agent that has both antibacterial and comedolytic properties. It is the topical agent most effective in reducing the Cutibacterium acnes (formerly known as Propionibacterium acnes) population. Bacterial resistance does not develop to benzoyl peroxide. The irritant effect of the drug also causes vasodilation and increased blood flow, which may hasten resolution of the inflammatory lesions. Although isotretinoin, low-dose tetracycline, and tretinoin are often used to treat severe acne, these drugs should not be given to those who are pregnant because they can affect the development of the fetus.

A client has been diagnosed with lentigo. Which is the most accurate description of lentigo? -A small area of scaliness -A small lesion of melanocytes -A small area of erythema -A small area of depigmentation

-A small lesion of melanocytes Lentigo maligna (i.e., Hutchinson freckle) is a small, slowly progressive neoplastic disorder of melanocytes. The lesion is a pigmented macule with a well-defined border and grows to 5 cm or sometimes larger.

A client presents with a skin infection in which the health care provider uses a potassium hydroxide (KOH) preparation and the Wood (UV) light to determine the cause. Which type of infection does this client most likely have? -Varicella zoster infection -A superficial fungal infection -Impetigo -Atopic dermatitis

-A superficial fungal infection Diagnosis of superficial fungal infections is primarily done by microscopic examination of skin scrapings for fungal spores, the reproducing bodies of fungi. Potassium hydroxide (KOH) preparations are used to prepare slides of skin scrapings. KOH disintegrates human tissue and leaves behind the threadlike filaments, or hyphae, that grow from the fungal spores, as some types of fungi fluoresce yellow-green when the light is directed onto the affected area. The other options would not be diagnosed with these methods.

Which skin finding is the priority for the nurse to assess? -A papule on the back -A macule on the arm -Wheals over the trunk -A vesicle on the heel

-Wheals over the trunk The priority finding to assess is the client with wheals over the trunk. This could be a type of allergic reaction that may affect the airway.

Which skin changes are normal in the older adult population? Select all that apply. -A thickening of blood vessels. -An increase in the amount of subcutaneous tissue. -Skin may become dry, rough, and scaly. -Increased amount of padding on the buttocks. -The dermis and epidermis thin as one ages.

-A thickening of blood vessels. -Skin may become dry, rough, and scaly. -The dermis and epidermis thin as one ages. Normal skin changes associated with aging are seen on areas of the body that have not been exposed to the sun. They include thinning of the dermis and the epidermis, diminution in subcutaneous tissue, and a decrease and thickening of blood vessels. These result in less padding and thinner skin, with color and elasticity changes. Although the reason is poorly understood, the skin in most older adults age 70 years and older becomes dry, rough, scaly, and itchy.

The parents of an 18-month-old child noticed a small vesicle on her face that ruptured a few days later and left a straw-colored crust on the child's face. New vesicles have prompted them to bring the child to the health care provider. Which treatment for the child's skin problem is most likely? -A topical antibiotic -A topical antifungal ointment -An oral corticosteroid -An antiviral ointment

-A topical antibiotic The course and symptomatology of the child's skin disorder is characteristic of impetigo, which is bacterial in etiology and would likely be treated with a topical antibiotic such as mupirocin.

Which disorder of the skin is most likely to respond to treatment with systemic antibiotics like tetracycline? -Urticaria -Acne vulgaris -Atopic dermatitis -Verrucae

-Acne vulgaris The etiology of acne vulgaris is bacterial, and some clients may require treatment with systemic antibiotics. Urticaria (hives) and atopic dermatitis result from allergic and hypersensitivity processes. Verrucae, or warts, are of viral origin and thus unresponsive to antibiotic therapy.

Which skin disorder seen in older adults is considered a premalignant lesion? -Actinic keratosis -Solar lentigines -Cherry angiomas -Telangiectases

-Actinic keratosis Actinic keratoses are the most common premalignant skin lesions that develop on sun-exposed areas. Solar lentigines are tan to brown, benign spots on sun-exposed areas. They are commonly referred to as liver spots. Senile angiomas (cherry angiomas) are smooth, cherry-red or purple, dome-shaped papules, usually found on the trunk. Telangiectases are single-dilated blood vessels, capillaries, or terminal arteries that appear on areas exposed to sun or harsh weather, such as the cheeks and the nose.

A teenager reports ugly warts that have invaded her hands. She wants them gone before prom season. The nurse will likely be explaining which treatment measure to this teenager? -Applying a keratolytic agent like salicylic acid -How to safely use cryotherapy at home -How to apply steroid creams and Band-Aids -Taking a pair of tweezers and pulling the wart off

-Applying a keratolytic agent like salicylic acid Verrucae, or warts, are common, benign papillomas caused by DNA-containing human papillomavirus (HPV) that invade the superficial skin keratinocytes. Removal is usually done by applying a keratolytic agent, such as salicylic acid, which works by dissolving intercellular cement and producing desquamation of the horny layer of skin without affecting normal epidermal cells. Steroid creams will not help with removal of a wart. Pulling the wart off is not recommended. Cryotherapy may be needed, but this is performed in a doctor's office.

Which statements are true concerning cellulitis? Select all that apply. -Cellulitis is caused by a streptococcus or a staphylococcus infection. -Cellulitis is accompanied by fever. -Cellulitis is treated with antifungal agents. -Cellulitis is complicated by fungus. -Cellulitis is a deep infection.

-Cellulitis is caused by a streptococcus or a staphylococcus infection. -Cellulitis is accompanied by fever. -Cellulitis is a deep infection. Cellulitis is a deeper infection caused by streptococcus and staphylococcus infection. It is not a fungal infection or typically complicated by fungus. It is often accompanied by fever, erythema, heat, and pain.

An adult man has been brought to the emergency department with severe electrical burns. Which assessment finding leads the providers to suspect the brain has been damaged with this burn? -Confusion, memory loss, and lethargy -Acute pain, tachycardia, light sensitivity -Infection with drainage on the ears -Impaired hearing, double-vision, and wheezing

-Confusion, memory loss, and lethargy The most immediate threat to this client is hemodynamic instability. If the brain or spine is directly injured from the burn, the client will have neurologic signs/symptoms like confusion, memory loss, insomnia, lethargy, and combativeness. Infection would develop later if at all. Pain control is essential, but inadequate pain control does not pose a direct threat to survival. Impaired hearing and double-vision may occur if the client has had a head injury but wheezing is usually caused by smoke inhalation.

Some skin problems occur in specific age groups. What are common skin disorders in infants? Select all that apply. -Cradle cap -Diaper rash -Scarlet fever -Prickly heat

-Cradle cap -Diaper rash -Prickly heat

Lentigines are skin lesions common in older adults. A type of lentigo is tan to brown in color with benign spots. Lentigines are removed because they are considered precursors to skin cancer. How are lentigines removed? -Curettage -Cryotherapy -Bleaching agents -Chemotherapy

-Cryotherapy Lentigines can be removed surgically (cryotherapy, laser therapy, liquid nitrogen). Topical creams and lotions containing adapalene and tretinoin have been used.

Basal cell carcinoma is the most common skin cancer in white-skinned people. The treatment goal that is most important is elimination of the lesion, but it is also important to maintain the function and cosmetic effect. Which treatment is used for basal cell carcinoma? -Curettage with electrodesiccation -Topical chemotherapy -Systemic chemotherapy -Simple radiographic radiation

-Curettage with electrodesiccation The most important treatment goal is complete elimination of the lesion. Also important is the maintenance of function and optimal cosmetic effect. Curettage with electrodesiccation, surgical excision, irradiation, laser, cryosurgery, and chemosurgery are effective in removing all cancerous cells.

Which factor is most protective against squamous cell carcinomas? -Male gender -Dark skin color -Under 50 years of age -Lack of family history

-Dark skin color Dark-skinned people are rarely affected. Males are twice as likely as females to have squamous cell carcinoma. Age and history are not protective, as the increase in the incidence of squamous cell carcinomas is consistent with increased exposure to ultraviolet radiation.

Which process accounts for the damaging effects of the sun's radiation? -Compensatory increases in melanin production -Generation of reactive oxygen species and damage to melanin -Hyperkeratinization and the formation of microscopic, subcutaneous lesions -Initiation of an autoimmune response

-Generation of reactive oxygen species and damage to melanin Ultraviolet (UV) B radiation is primarily responsible for sunburns, and it acts mainly on the cells in the basal layer of the epidermis, causing the generation of reactive oxygen species and damage to melanin. It also provokes free radical production and induces a significant reduction in skin antioxidants, impairing the ability of the skin to protect itself against the free radicals that are generated. UV radiation does not provoke an autoimmune response or hyperkeratinization, although there is an inflammatory response. Increased melanin production is a protective mechanism and does not participate in the deleterious effects of UV radiation.

An older adult client presents with noted burning pain along the thoracic region with a tingling sensation and extreme sensitivity of the skin to touch, but there is no rash present at this time. Which skin problem will the health care provider interpret for this client? -Impetigo -Psoriasis -Chickenpox -Herpes zoster

-Herpes zoster The lesions of herpes zoster (shingles) typically are preceded by a prodrome (may be present for 1 to 3 days or longer before the appearance of the rash) consisting of a burning pain, a tingling sensation, extreme sensitivity of the skin to touch, and pruritus along the affected dermatome. The dermatomes' most frequently involved areas are thoracic, cervical, trigeminal, and the lumbosacral. Shingles is caused by the same herpesvirus, varicella zoster, that causes chickenpox. The other conditions do not have these symptoms. Impetigo is caused by beta-hemolytic streptococci, a common bacterial infection; it is and common in infants and young children and is primarily located on the face. Psoriasis is a chronic inflammatory skin disease characterized by red, thickened plaques with overlying silvery-white scales.

A client with third-degree burns over 40% of his body is best cared for in which type of health care environment? -Referral to plastic surgeon -Hospital admission and referral to burn center -Outpatient management -Hospital admission

-Hospital admission and referral to burn center Minor burns are managed on an outpatient basis. Moderate burns involve a hospital admission. Major burns in involve hospital admission with a referral to a burn center if available.

Squamous cell carcinoma (SCC) appears in dark-skinned people as which type of abnormal lesion? -Pinkish translucent papule -Lichenous plaques with silvery scales -Keratotic lesions with rolling, irregular borders -Hyperpigmented nodules

-Hyperpigmented nodules In dark-skinned persons, the lesions may appear as hyperpigmented nodules and occur more frequently on non-sun-exposed areas. The other answers do not describe squamous cell carcinoma in dark-skinned people.

In severe Stevens-Johnson syndrome and toxic epidermal necrolysis, hospitalization is required. When large areas of the skin are lost, what intravenous medication may speed up the healing process? -Corticosteroids -Fluconazole -Immunoglobulin -Broad-spectrum antibiotics

-Immunoglobulin Intravenous immunoglobulin may hasten the healing response of the skin. Broad-spectrum antibiotics and corticosteroids may be given, but they do not hasten the healing response of the skin. Fluconazole is given for vaginal candidiasis.

Dry, itchy plaques on the elbows and knees have prompted a 23-year-old client to seek care. The health care provider has diagnosed the client with psoriasis, based on which histologic characterization? -Increased epidermal cell turnover with marked epidermal thickening -An IgE-mediated immune reaction -Human papillomaviruses (HPV) swabbing -Hormonal influences on sebaceous gland activity

-Increased epidermal cell turnover with marked epidermal thickening Psoriasis is characterized by increased epidermal cell turnover with marked epidermal thickening, a process called hyperkeratosis. Hives are caused by an IgE-mediated immune reaction. HPV causes warts. Dysfunction of the sebaceous glands results in acne.

A client has been diagnosed with nevus with architectural disorder with cytologic atypia (former known as dysplastic nevus). Because of the large size of the nevi, the nurse will educate this client on which priority topic? -Easily becomes infected with pustules -Transmitted by physical contact -Increased risk for melanoma -Frequent bleeding if touches fabric

-Increased risk for melanoma Nevus with architectural disorder with cytologic atypia (dysplastic nevi) is a precursor of malignant melanoma. The nevi are larger than other nevi (often >5 mm in diameter), have a flat, slightly raised plaque and pebbly surface or a target-like lesion with a darker, raised center and irregular border. Nevocellular nevi are tan to deep brown, uniformly pigmented, small papules with well-defined and rounded borders that grow in nests or clusters along the dermal-epidermal junction. Eventually, most junctional nevi grow into the surrounding dermis as nests or cords of cells. They are not transmitted to others by contact. They may bleed as the cancer grows within the nevi but not by just being touched by fabric. Because this is not an infection, there should be no pustules forming.

An 81-year-old resident of an elder care facility is immobile and has been restricted to her bed for the past 6 weeks. Her physician recently discovered a decubitus ulcer on her left buttock. Which etiology is most likely? -An opportunistic viral infection -Ischemia from prolonged pressure -A laceration due to immobility -Bacterial infection from improper bathing

-Ischemia from prolonged pressure The resident has been in bed, in the same position for a long period of time. The pressure of her pelvis on the tissue caused ischemia and necrosis. Following ulcer formation, viral and bacterial infections are likely, but these are not probably initial causes. Ulcers do not usually result from lacerations.

A faculty member has just completed a lecture on seborrheic keratosis. Which statements by the students indicate that further teaching is required on the topic? Select all that apply. -It is a tumor of melanocytes. -It usually does not warrant treatment. -It is caused by a virus. -It is precancerous.

-It is a tumor of melanocytes. -It is caused by a virus. -It is precancerous. Seborrheic keratoses are common benign tumors that arise spontaneously and are particularly numerous on the trunk of the body, although they can also occur on the extremities, head, and neck.

Scabies infections are caused by mites that burrow under the skin. They are usually easily treated by bathing with a mite-killing agent and leaving it on for 12 hours. When scabies are resistant to the mite-killing agent, what oral drug is prescribed? -Interferon B -Ivermectin -Potassium hydroxide -Clindamycin

-Ivermectin Oral ivermectin, a broad-spectrum antiparasitic agent, has been used for treatment-resistant scabies. The other drugs are not used for treatment-resistant scabies.

A child has been admitted to the burn unit after pulling a pan of hot water off the stove. Given the fact that there are primarily second- and third-degree burns, the health care worker should prioritize care to focus on which of the following? Select all that apply. -Maintain sterile field when doing dressing changes and debridement. -Withhold foods/nutrition since the GI tract may have slowed down in response to stress. -Focus on replacing fluids that have been lost from the vascular, interstitial, and cellular compartments. -Minimize pain medication administration so as to not compromise the child's respiratory effort. -Assess for indications that the child's airway has been compromised by assessing breath sounds and voice quality.

-Maintain sterile field when doing dressing changes and debridement. -Focus on replacing fluids that have been lost from the vascular, interstitial, and cellular compartments. -Assess for indications that the child's airway has been compromised by assessing breath sounds and voice quality. Fluid is lost from the vascular, interstitial, and cellular compartments. Because of a loss of vascular volume, major burn victims often present in the emergency department in a form of hypovolemic shock. Manifestations of inhalation injury include hoarseness; drooling and inability to handle secretions; hacking cough; and labored, shallow breathing. Immunologically, the skin is the body's first line of defense. When the skin is no longer intact, the body is open to bacterial infection. The stress of burn injury increases metabolic and nutritional requirements; therefore, nutrition should not be withheld. Pain medication should be titrated to the child's need.

Which of these is a characteristic of impetigo? -Heals with scars -High fever, lymphadenopathy, abscesses -Ringworm infection -Most common superficial bacterial infection

-Most common superficial bacterial infection Impetigo, which is caused by staphylococci or beta-hemolytic streptococci, is the most common superficial bacterial infection. Superficial fungal infections are called dermatophytoses and are commonly known as tinea or ringworm

The health care provider will document which description upon initial assessment of onychomycosis? -Cracked -Black -Eroded -Opaque

-Opaque Onychomycosis often begins at the tip of the nail, where the fungus digests the nail keratin. Initially, the nail appears opaque, white, or silvery. The nail then turns yellow or brown and remains unchanged for years. Gradually, the nail thickens and cracks as the infection spreads. Less common are superficial white onychomycosis, in which areas of the nails become powdery white and erode.

The nurse notices that an adolescent she is meeting with has several whiteheads on her face. Which description best describes the whiteheads? -Larger than 5 mm diameter -Central cores that contain purulent material -Pale, slightly elevated papules with no visible orifice -Raised areas less than 5 mm in diameter

-Pale, slightly elevated papules with no visible orifice Whiteheads are pale, slightly elevated papules with no visible orifice. Pustules have a central core of purulent material. Nodules may become suppurative or hemorrhagic.

A client is being seen in the dermatologist clinic for psoriasis. What term should the nurse select in the electronic health record (EHR) to describe the client's lesions associated with psoriasis? -Cysts -Nodules -Plaques -Pustules

-Plaques Psoriasis has raised, well-demarcated, erythematous plaques with adherent silvery scales. Disorders of the pilosebaceous unit occur most frequently in adolescents and manifests as nodules, pustules, or cysts.

Our bodies have, as endemic organisms, both yeast (Candida albicans) and molds. When a fungus invades the skin of our body, what is used as a confirmatory diagnostic tool? -Tinea preparations -Potassium hydroxide preparations -Sodium chloride preparations -The Forest light

-Potassium hydroxide preparations Treatment of fungal infections usually follows diagnosis confirmed by potassium hydroxide preparation or culture.

A client is being evaluated for malignant melanoma. What is a risk factor associated with the development of malignant melanoma? -Presence of actinic keratoses -Living in a mountainous environment -Palmar nevi -Whiteheads across the bridge of the nose

-Presence of actinic keratoses Other risk factors include a family history of malignant melanoma, presence of marked freckling on the upper back, history of three or more blistering sunburns before 20 years of age, and presence of actinic keratoses.

What disease has primary lesions that have a silvery scale over thick red plaques? -Lichen planus -Psoriasis vulgaris -Pityriasis rosea -Lichen simplex chronicus

-Psoriasis vulgaris In psoriasis vulgaris, the primary lesions are sharply demarcated, thick, red plaques with a silvery scale that vary in size and shape.

Which action could result in pressure ulcer formation? -Allowing a client to slide up in a chair at mealtime -Pulling a stroke client up in bed -Applying powder to buttocks area when diaphoresis has become a problem -Turning a client from side to side every 2 hours

-Pulling a stroke client up in bed Factors contributing to the development of pressure ulcers include external pressure that compresses blood vessels and friction and shearing forces that tear and injure blood vessels. Shearing forces are caused by the sliding of one tissue layer over another with stretching and angulation of blood vessels, causing injury and thrombosis. Shear occurs when the skeleton moves, but the skin remains fixed to an external surface, such as occurs with transfer from a stretcher to a bed or pulling a person up in bed. Whether a person is sitting or lying down, the weight of the body is borne by tissues covering the bony prominences. Moisture contributes to pressure ulcer formation by weakening the cell wall of individual skin cells and by changing the protective pH of the skin.

Which nursing intervention involves the greatest risk of skin shearing? -Rolling the client from a supine to side-lying position -Pulling the client up in bed -Inserting a peripheral intravenous catheter -Helping the client ambulate after surgery

-Pulling the client up in bed Shear occurs when the skeleton moves but the skin remains fixed to an external surface, such as occurs with transfer from a stretcher to a bed or pulling a person up in bed. Rolling a client, starting an IV catheter, or assisting with mobilization does not pose a risk of skin shearing.

A client is admitted to the hospital with first- and second-degree burns. Which assessment findings are associated with first-degree burns? Select all that apply. -Red or pink -Full-thickness burn -Wet -Painful

-Red or pink -Painful First-degree burns (superficial partial thickness burns) involve only the outer layers of the epidermis. They are red or pink, dry, and painful.

Following assessment of a client with papulosquamous dermatoses manifesting as psoriasis, the nurse will most likely document which finding? -Large area of nodular ulcerations with crusts and raised red borders -Raised black, irregular borders and uneven surfaces -Red, thickened plaques with overlying silvery-white scale -Rupture of vesicles with granular scabbing formed over the lesion

-Red, thickened plaques with overlying silvery-white scale Papulosquamous dermatoses are a group of skin disorders characterized by scaling papules and plaques. Psoriasis is a common manifestation of papulosquamous dermatoses. It is a chronic inflammatory skin disease characterized by red, thickened plaques with overlying silvery-white scale. Nodular ulcerative type is a frequently occurring type of basal cell carcinoma. Varicella (chickenpox) is caused by the varicella-zoster virus; characteristic skin lesion occurs in three stages: macule, vesicle, and granular scab. Raised black, irregular borders and uneven surfaces are seen in malignant melanomas.

A client's admission assessment notes lichenification on bilateral lower extremities. The nurse plans care for this condition, which is caused by which factor? -Epidermal breakage -Decreased skin shedding -Repeated scratching -Chronic area pressure

-Repeated scratching Repeated itching and scratching can lead to lichenification (thickened and roughened skin characterized by prominent skin markings caused by repeated scratching or rubbing) or excoriation (lesion caused by breakage of the epidermis, producing a raw linear area). A callus is caused by chronic pressure or friction that increases cohesion between cells, resulting in hyperkeratosis and decreased skin shedding.

The student nurse is reviewing a client chart in preparation for a clinical experience. The student sees the term nummular to describe the client's lesion. What would describe a nummular lesion? -Linear, crusted -Oily, scaly -Round, coin-like -Elevated, flat topped

-Round, coin-like The lesions of nummular eczema are coin-shaped papulovesicular patches mainly involving the arms and legs. They are not elevated, flat topped, oily, scaly, or linear and crusted.

Hearing impairment, blindness, and adverse neurodevelopment in newborns can be prevented by immunization against which childhood disease? -Herpes simplex virus type 2 -Rubella -Epstein-Barr virus -Toxoplasmosis

-Rubella Although the introduction of the rubella vaccine has virtually eliminated the congenital rubella syndrome in most developed countries, it remains endemic in many developing countries, where it is the major preventable cause of hearing impairment, blindness, and adverse neurodevelopmental outcomes such as cognitive impairment or microcephaly. The other options are infectious agents implicated in fetal anomalies, but do not have vaccines.

Hearing impairment, blindness, and adverse neurodevelopment in newborns can be prevented by immunization against which childhood disease? -Toxoplasmosis -Rubella -Herpes simplex virus type 2 -Epstein-Barr virus

-Rubella Although the introduction of the rubella vaccine has virtually eliminated the congenital rubella syndrome in most developed countries, it remains endemic in many developing countries, where it is the major preventable cause of hearing impairment, blindness, and adverse neurodevelopmental outcomes such as cognitive impairment or microcephaly. The other options are infectious agents implicated in fetal anomalies, but do not have vaccines.

Which childhood diseases that present with a rash can be protected against via vaccines? Select all that apply. -Rubeola -Rubella -Scarlet fever -Varicella -Roseola infantum

-Rubeola -Rubella -Varicella

Manifestations of superficial dermatophytosis of the skin would include which descriptor? -Vesicles -Scaling -Erythema -Infiltration

-Scaling The fungi that cause superficial mycoses are called dermatophytes and require keratin for growth. Therefore, these fungi do not infect deeper body tissues or mucosal surfaces. The dermatophytes emit an enzyme that enables them to digest keratin, which results in superficial skin scaling, nail disintegration, or hair breakage, depending on the location of the infection. Deeper reactions involving vesicles, erythema, and infiltration are caused by the inflammation that results from exotoxins liberated by the fungus.

Upon inspection, the health care provider assesses a thermal burn as involving the entire epidermis and dermis. The provider will document this as which type of burn? -Second-degree (partial-thickness) -Second-degree (full-thickness) -Third-degree (full-thickness) -First-degree (superficial partial-thickness)

-Second-degree (full-thickness) Second-degree full-thickness burns involve the entire epidermis and dermis. First-degree burns (superficial partial-thickness burns) involve only the outer layers of the epidermis. Second-degree partial-thickness burns involve the epidermis and various degrees of the dermis. Third-degree full-thickness burns extend into the subcutaneous tissue and may involve muscle and bone.

A client has a burn that involves the entire epidermis and various degrees of the dermis. It is painful, moist, and blistered. The nurse recognizes the burn as: -First-degree partial thickness -Third-degree full thickness -Second-degree partial thickness -Second-degree full thickness

-Second-degree partial thickness Second-degree partial-thickness burns involve the epidermis and parts of the dermis. First-degree partial-thickness burns involve only the outer layers of the epidermis. Third-degree full-thickness burns extend into the subcutaneous tissue and may involve bone and muscle. Second-degree full-thickness burns involve the entire epidermis and dermis.

A client has a stage III pressure ulcer in the sacral area. What factors can contribute to the development of pressure ulcers? Select all that apply. -Shearing force -Friction -Pressure -Dry skin

-Shearing force -Friction -Pressure Four factors contribute to the development of pressure ulcers: (1) pressure, (2) shearing forces, (3) friction, and (4) moisture.

The nurse is assessing a client's skin and notices a few papules. What is the best description to include in the assessment about papules? -Small, raised superficial lesions -Flat-topped, solid lesions -Closed, rounded spaces containing fluid -Small abscesses

-Small, raised superficial lesions Papules are small, raised superficial lesions. Plaque is a flat-topped solid lesion. Cyst is a closed, rounded space containing fluid.

The nurse is assessing a client's pressure ulcers. The client has a shallow crater in the sacral area. The nurse will document this in the electronic medical record as which stage? -Stage IV -Stage III -Stage I -Stage II

-Stage II Stage I ulcers are characterized by a defined area of persistent redness in lightly pigmented skin or an area of persistent redness with blue or purple hues in darker skin. Stage II ulcers represent a partial-thickness loss of skin involving the epidermis or dermis, or both. Stage III ulcers represent a full-thickness skin loss involving damage and necrosis of subcutaneous tissue that may extend down to but not through underlying fascia. The ulcer manifests as a deep crater with or without undermining of adjacent tissue. Stage IV ulcers involve full-thickness skin loss and necrosis with extensive destruction or damage to the underlying subcutaneous tissues that may extend to involve muscle, bone, and supporting structures.

Which microorganism is responsible for the development of bullous impetigo? -Propionibacterium acnes -Group A beta-hemolytic streptococci -Tinea capitis -Staphylococcus aureus

-Staphylococcus aureus Staphylococcus aureus is the microorganism that causes bullous impetigo. Group A beta-hemolytic Streptococcus is the common organism in superficial bacterial infection of impetigo. Tinea capitis is a fungal infection involving the scalp and head. Propionibacterium acnes is the organism responsible for acne.

A nurse comes upon a automobile accident where smoke and flames are coming from the car's engine. What would be the nurse's first priority in this situation? -Assess the airway of people in the car -Give water to the people in the vehicle -Go in search of people to help -Stop the fire or remove the person from the vehicle

-Stop the fire or remove the person from the vehicle Regardless of the type of burn, it is first priority to stop the fire and provide a safe environment for the people affected. The heat source should be removed, and flames should be doused with water or smothered with a blanket. The people should be removed from the vehicle, especially if the fire cannot be contained. After moving them to a safe distance, their airways should be assessed next. If cellular phone is working, the nurse should call 911 and report the findings. That way, help will be on the way.

Which characteristics of a cherry angioma should be considered suspicious? -Appearance before age 40 -Sudden collection of several papules -Purple color -Observed on the trunk

-Sudden collection of several papules Cherry angiomas are smooth, cherry red or purple, dome-shaped papules that occur in nearly all people older than 30 years of age. They usually are found on the trunk and are generally benign unless there is a sudden appearance of many cherry angiomas.

The nurse caring for a client with a malignant melanoma should prepare the client for which prescribed treatment measures? Select all that apply. -Surgical excision with lymph node biopsy -Cosmetic surgery to remove the mole without leaving a scar -Biologic chemotherapy with interferon alfa-2B -Immediate radiation therapy to shrink the tumors

-Surgical excision with lymph node biopsy -Biologic chemotherapy with interferon alfa-2B Treatment of melanoma is usually surgical excision, the extent of which is determined by the thickness of the lesion, invasion into the deeper skin layers, and spread to the regional lymph nodes. Current capability allows for mapping lymph flow to a regional lymph node that receives lymphatic drainage from tumor sites on the skin. This lymph node, which is called the sentinel lymph node, is then sampled for biopsy. If tumor cells have spread from the primary tumor to the regional lymph nodes, the sentinel node will be the first node in which tumor cells appear. Therefore, sentinel node biopsy can be used to test for the presence of melanoma cells and determine if radical lymph node dissection is necessary. Interferon alfa-2b is a biologic chemotherapy available for adjuvant treatment of melanoma.

A young adult is going on vacation to a sunny climate and plans on using a tanning booth to build up a protective tan. Which instructions should the nurse provide to the young adult? -Tanning booths should be avoided under all circumstances. -The client should confirm the type of bulbs that the tanning booth uses. -The client should use a high-SPF sunscreen in the tanning booth. -Avoid using the tanning booth for more than 15 minutes in a 7-day period.

-Tanning booths should be avoided under all circumstances. There is no known safe use of tanning booths, and they should be wholly avoided. Sunscreen would defeat the purpose of a tanning booth.

A 14-year-old client presents to the dermatologist clinic with a severe case of acne vulgaris. Which explanation by the nurse is most accurate when describing this to the adolescent? -The acne is due to follicular bulb distention -The acne is a chronic inflammatory disease of the pilosebaceous unit -The acne results from tortuous and dilated dermal papillae -The acne is a hyperfunction of the apocrine glands

-The acne is a chronic inflammatory disease of the pilosebaceous unit The pilosebaceous unit are the structures that become inflamed in acne vulgaris. Growth of the hair is centered in the bulb (i.e., the base) of the hair follicle, which is just one part of the hair structure. Apocrine sweat glands are located deep in the dermal layer and open through a hair follicle. Dermal papillae minimize separation of the dermis and the epidermis and contain capillary venules that nourish the epidermal layers of the skin.

Which client would the nurse be most concerned about? -The client with postherpetic neuralgia -The client with herpes zoster affecting the back -The client who had a prodromal episode before herpes zoster -The client with herpes zoster affecting the trigeminal nerve

-The client with herpes zoster affecting the trigeminal nerve The nurse would be most concerned about the client with herpes zoster affecting the trigeminal nerve, as an episode affecting the face can affect hearing or vision. Blindness or deafness could result. Prodromal episodes are very common, as is postherpetic neuralgia.

An adult client has a large number of nevi on her neck and back. How should the nurse best interpret this assessment finding? -Each nevi must be biopsied before any conclusions can be drawn -The nevi are likely benign, unless they are undergoing changes -The client's risk of skin cancer is proportionate to the number of nevi -The appearance of large number of nevi is an expected, age-related change

-The nevi are likely benign, unless they are undergoing changes Nevi are generally benign, though those that undergo changes in size or character are suggestive of skin cancer. It is not necessary to biopsy all nevi in most cases and the number of nevi is not the main determinant of cancer risk.

A child is sent home from school following a check for head lice by the nurse. The parents call to ask, "How do you know it is head lice? We thought our child just had dry skin and dandruff." Which manifestation(s) will the school nurse share with these parents? Select all that apply. -There are firmly attached nits on the hair shaft. -The child has red, excoriated scalp lesions. -The head has dry skin with brittle hair. -The child is scratching at the head. -Round or oval patches of hair loss have appeared quite suddenly.

-There are firmly attached nits on the hair shaft. -The child has red, excoriated scalp lesions. -The child is scratching at the head. A positive diagnosis depends on the presence of firmly attached nits or live adult lice on hair shafts. Pruritus and scratching of the head are the primary indicators that head lice may be present. The scalp may appear red and excoriated from scratching. Swimming is a great exercise but the chlorine used to keep out harmful bacteria from the pool water can also strip your hair and skin of its natural oils. This can cause dry skin, brittle hair. Alopecia areata is a noncontagious condition of hair loss thought to be caused by the body's immune system attacking the hair follicles. It is characterized by the sudden appearance of round or oval patches of hair loss.

Which statements regarding hemangiomas of infancy are true? Select all that apply. -They are generally benign -They generally appear at the time of birth -They are small lesions -Boys are more likely to present with hemangiomas -Hemangiomas are red in color

-They are generally benign -They are small lesions -Hemangiomas are red in color Hemangiomas of infancy are small, red lesions that are noticed shortly after birth. Hemangiomas of infancy are generally benign vascular tumors. A small proportion of these lesions are present at birth, and the remainder develop within a few weeks after birth. Girls are three times more likely to have hemangiomas than boys.

A groups of students are reviewing information about common warts (verrucae). Which statements by one of the students indicate the need for further review of the information? Select all that apply. -They are precancerous. -They are related to condyloma acuminatum. -They are caused by herpes virus. -No matter the age, they tend to regress.

-They are precancerous. -No matter the age, they tend to regress. Verrucae, or warts, are common benign papillomas caused by the DNA-containing human papillomavirus (HPV). As benign papillomas, warts represent an exaggeration of the normal skin structures; they are not considered precancerous.

Which statements regarding skin tags are true? Select all that apply. -They can be as large as a pea. -They are considered precancerous. -They vary in color. -They are common among adults. -They can be removed by electrodesiccation

-They can be as large as a pea. -They vary in color. -They are common among adults. -They can be removed by electrodesiccation Skin tags are soft, brown or flesh-colored papules commonly seen in 25% of adults. They occur on any skin surface but most frequently the neck, axilla, and intertriginous areas. They range in size from a pinhead to the size of a pea. Skin tags have the normal texture of the skin. They are benign and can be removed with scissors or electrodesiccation for cosmetic purposes.

An individual has suffered an electrical burn. Which term best describes this burn and should be included in the electronic medical record? -Second degree, deep partial thickness -First degree -Third degree -Second degree, superficial partial thickness

-Third degree A sunburn is an example a first degree burn. Scalding water is an example of superficial partial-thickness second degree burn. Fire burn is an example of deep partial-thickness second degree burn. Electrical burn is an example of a full-thickness third degree burn.

A client has sustained serious first degree, second degree, and third degree burns in a fire. Which best describes this full-thickness burn and the burned area that involves subcutaneous tissue, muscle, and bone? -Second-degree burn -First- and second-degree burns -Third-degree burn -Second- and third-degree burns

-Third-degree burn Third-degree full-thickness burns extend into the subcutaneous tissue and may involve muscle and bone. Thrombosed vessels can be seen under the burned skin, indicating that the underlying vasculature is involved. Third-degree burns vary in color from waxy white or yellow to tan, brown, deep red, or black. First-degree burns (superficial partial-thickness burns) involve only the outer layers of the epidermis. They are red or pink, dry, and painful. Second-degree burns involve both the epidermis and dermis. Second-degree partial-thickness burns involve the epidermis and various degrees of the dermis.

A 4-year-old male child has several small pustules with honey-colored crusted drainage on his face but in no other location. The child is diagnosed with impetigo. The most appropriate treatment would be: -Because it is only located on the face, it does not need to be treated. -Oral antifungal, such as griseofulvin -Topical mupirocin and limiting exposure, as it is transmitted easily -Oral antibiotics

-Topical mupirocin and limiting exposure, as it is transmitted easily The condition should be treated with topical mupirocin with limited exposure due to risk of transmission with direct contact. Oral antibiotics would not be the first-line treatment as it is isolated in one area. Antifungals would not be effective for a bacterial infection. Due to the risk of further transmission to self and others, impetigo is treated with either topical or systemic antibiotics (decision based on location of impetigo).

A client has an appointment concerning the possible diagnosis of malignant melanoma. Which statement is correct concerning malignant melanoma? -The growth phase can predict outcomes. -Melanomas rarely metastasize. -Tumor thickness is a very important factor. -Never do a complete excisional biopsy of a lesion suspicious for malignant melanoma.

-Tumor thickness is a very important factor. Malignant melanomas are determined by tumor thickness. A complete excisional biopsy of a lesion is completed for malignant melanoma. Melanomas frequently develop metastasis.

Which terms best describes acute atopic dermatitis? Select all that apply. -Round, erythematous papules that enlarge and coalesce -Raised wheals with associated itching -Vesicle formation -Oozing

-Vesicle formation -Oozing The lesions of atopic dermatitis are usually characterized by vesicle formation, oozing, and crusting with excoriations. The lesions of erythema multiforme are round, erythematous papules that enlarge and coalesce, changing to concentric zones of color appearing as "target" or "iris" lesions. Urticaria, or hives, is a common skin disorder characterized by the development of edematous wheals accompanied by intense itching.

What do lesions caused by allergic contact dermatitis look like? -Ulcers -Papules -Papulosquamous pustules -Vesicles

-Vesicles The lesions of allergic contact dermatitis range from a mild erythema with edema to vesicles or large bullae.

A client has just received the diagnosis of malignant melanoma, stage 3B. He asks the nurse what this means. The nurse should respond by relaying which information? Select all that apply. -Your cancer has grown into the deep tissues and quite likely into lymph nodes. -This cancer is mainly contained to the head and neck area. -This cancer usually extends wide and deep but rarely metastasizes. -Malignant melanoma is a very rapid growing, aggressive cancer.

-Your cancer has grown into the deep tissues and quite likely into lymph nodes. -Malignant melanoma is a very rapid growing, aggressive cancer. Although melanoma represents a small subset of skin cancers, it is the most deadly. It is a rapidly progressing, metastatic form of cancer. Malignant melanomas differ in size and shape. Usually, they are slightly raised and black or brown. Borders are irregular and surfaces are uneven. Most appear to arise from preexisting nevi or new mole-like growths. There may be surrounding erythema, inflammation, and tenderness. Because most melanomas initially metastasize to regional lymph nodes, additional information may be obtained through lymph node biopsy. Consistent with other cancerous tumors, melanoma is commonly staged using the TNM (tumor, lymph node, and metastasis) staging system. Basal cell cancer usually extends wide and deep but rarely metastasizes and are most frequently seen on the head and neck, most often occurring on skin that has hair.

A client calls the clinic and tells the nurse she is concerned because her husband has developed shingles. She asks the nurse if he is contagious. The best response would be that herpes zoster (shingles) is: -not contagious and cannot be transmitted to nonimmune contacts. -not contagious because you are married. -contagious but only to children. -contagious and can be transmitted to nonimmune contacts.

-contagious and can be transmitted to nonimmune contacts. Herpes zoster (shingles) is contagious and can be transmitted to nonimmune contacts. Although not as contagious as chickenpox, the reactivated virus can be transmitted to nonimmune contacts. Age or marital status will not affect transmission.

Atopic dermatitis, or eczema, occurs at all ages and in all races. What happens in dark-skinned people who have eczema? -papules covering the area affected -hyperpigmentation of the skin -prominent erythema -loss of pigmentation from lichenified skin

-loss of pigmentation from lichenified skin In persons with dark skin, pigmentation may be lost from lichenified skin. The other answers do not occur in people with dark skin who have eczema.

A public health nurse is teaching a group of individuals about sun protection. When teaching about sunscreen, the nurse should teach the individuals that: -their chosen sunscreen should contain PABA derivatives. -using a product that contains a benzophenone is appropriate. -the benefits of sunscreen have been greatly exaggerated in advertising. -children need a sunscreen with a sun protection factor of at least 10.

-using a product that contains a benzophenone is appropriate. Sunscreen agents no longer contain para-aminobenzoic acid (PABA), a chemical blocking agent that protects against UVB, because of its allergenic and staining properties. However, PABA derivatives are used widely, but protect only against UVB. Broad-spectrum suntan lotions protect against both UVA and UVB. These products contain a benzophenone, such as oxybenzone, dioxybenzone, or avobenzone. Children younger than 18 years of age should use broad-spectrum (blocks UVA and UVB) sunscreens that have a Sun Protection Factor (SPF) of at least 30. Sunscreens have proven benefits in the prevention of skin cancer.

The clinic health care worker notices that a client has a fungal infection on her nails that looks like the fungus is digesting the nail keratin. The nail appears opaque and white in color. The client states she has had this for years. The health care worker suspects the client has: -Cellulitis -Candidiasis -Onychomycosis -Tinea corporis

Onychomycosis often begins at the tip of the nail, where the fungus digests the nail keratin. Initially, the nail appears opaque, white, or silvery. The nail then turns yellow or brown and remains unchanged for years. Gradually, the nail thickens and cracks as the infection spreads. Candidiasis (moniliasis) is a fungal infection caused by C. albicans. This yeast-like fungus is a normal inhabitant of the gastrointestinal tract, mouth, and vagina. Cellulitis is a deeper infection affecting the dermis and subcutaneous tissues. The lesion consists of an expanding red, swollen, tender plaque with an indefinite border, covering a variety of widths. Cellulitis is frequently accompanied by fever, erythema, heat, edema, and pain. Tinea corporis (ringworm of the body) are oval or circular patches on exposed skin surfaces and the trunk, back, or buttocks.