AH 1 Chapter 23 Patients with Skin Problems

When preparing to discharge a client who has a history of pediculosis, what teaching with the nurse provide? Select all that apply a. nits can be removed with a fine-tooth comb b. parasites eventually die off without treatment c. wash bed linens in hot water to remove lice and eggs d. lice can live on clothing items and any surface that is covered by fabric e. lice can infest any place on the body with hair, including eyelashes and axillae

A,C,D,E

A client who has been hiking in the woods comes to the ED with urticaria. After administering antihistamines as prescribed, what teaching does the nurse provide? a. avoid outdoor activity b. use a sauna to relieve pain c. apply tea bags to the lesions d. consume 1-2 alcoholic beverages

A. Avoid outdoor activity

Which statement by a client with psoriasis indicates to the nurse that additional teaching about the client's condition is required? (Select all that apply.) a. "Stress can cause my flare-ups." b. "I am glad that this drug therapy will cure my condition." c. "A tanning bed will supply the ultraviolet light I need." d. "I can never be cured." e. "Medicine can prevent the growth of new skin cells."

B, C Use of commercial tanning beds is specifically not recommended for clients. Psoriasis is a lifelong disorder and cannot be cured. These statements indicate that the client requires further teaching.Topical corticosteroids, when applied to psoriatic lesions, suppress cell division. Psoriasis is a lifelong disorder that has exacerbations and remissions and cannot be cured. Stress can indeed exacerbate psoriasis.

A client with a foot ulcer says, "I feel helpless." What is the appropriate nursing response? (Select all that apply.) a. State,"I know how you feel." b. Encourage participation in care of the wound. c. Assure that everything will be OK. d. Suggests inviting visitors to come. e.Ask what coping strategies have worked in the past.

B, E The nurse's appropriate responses are to encourage client participation in wound care, and to ask how the client has coped with feelings like this in the past. Participation in wound care gives the client a sense of autonomy. Learning what coping strategies worked in the past alerts the nurse to whether the client copes with healthy or unhealthy coping mechanisms.Encouraging visitors is not the right suggestion for this client at this time; he or she needs to participate in self-care first. By telling the client that he or she understands the client's feelings, the nurse not only fails to address the underlying issue but also is patronizing and nontherapeutic. Assuring the client that everything will be all right not only fails to address the underlying issue—but it also minimizes the client's feelings, and may give false hope.

Upon removing a dressing from a wound, the nurse notices a strong odor. What is the appropriate nursing action? A. No action is necessary at this time. B. Notify the physician of a possible wound infection. C. Clean the wound and reassess for presence of infection. D. Culture the wound and anticipate an order for antibiotics.

C. Clean the wound and anticipate an order for antibiotics

A client with a large, irregularly shaped mole on the upper chest expresses concern about the cosmetic appearance of the lesion. What is the priority nursing intervention? a. refer to a dermatologist health care provider b. ask if there are any other lesions that are bothersome c. perform a head-to-toe skin assessment and document the findings d. teach about the importance of avoiding excessive sun exposure and tanning beds

C. Perform a head-to-toe skin assessment and document the findings

The nurse is caring for a client who has been on biologic therapy for plaque psoriasis. Which assessment finding requires immediate nursing interventions? a. increased itching b. temp of 100F c. presence of new plaques on legs d. expression of impaired self image

C. Presence of new plaques on legs

An older adult client with a long history of CHF is being treated for a pressure injury over the coccyx that is 4 cm wide and 5 cm long, with eschar present. Which technique does the nurse anticipate will be used to remove the necrotic tissue? a. surgical removal b. biologic dressing c. continuous dry gauze dressing d. dressings along with a topical enzyme preperation

D. dressing along with a topical enzyme preparation

The nurse is developing a teaching plan for a client diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) infection. Which teaching will the nurse include? a. Cover the infected area with a clean, dry bandage. b. Take daily tub baths using a mild soap. c. Wash the infected areas first, then wash the uninfected areas. d. Use bath sponges or puffs when bathing.

a. Cover the infected area with a clean, dry bandage. The nurse includes the instruction that the infected area should be covered with a clean, dry bandage to prevent the spread of infection.The client should shower rather than take a tub bath, using an antibacterial soap. Uninfected areas should be washed first, then the infected areas should be washed, to prevent the spread of infection. Bath sponges or puffs should be avoided because they cannot be laundered. Washcloths should be used only once before laundering.

Which nursing interventions can the nurse working in a long-term care facility delegate to a nursing assistant? a. Every 2 hours, reposition a client who has had a stroke and is incontinent. b. Use the Braden Scale to determine pressure injury risk for a newly admitted client. c. Complete daily sterile dressing changes for a client with a venous leg ulcer. d. Admit a newly transferred client who had pedicle flap surgery 1 week ago.

a. Every 2 hours, reposition a client who has had a stroke and is incontinent. The nurse can delegate repositioning a client to a nursing assistant. A nursing assistant has the education and scope of practice to perform such a task.Using the Braden Scale, changing a sterile dressing, and client admissions are actions that should be done by licensed nursing staff who have broader education and scope of practice.

The nurse is caring for a client who has several infected lesions on both arms. The client is afebrile and does not have enlarged regional lymph nodes. The nurse notifies the provider who will most likely order which medication? a. Topical mupirocin b. IV vancomycin c. Oral amoxicillin d. Oral linezolid

a. Topical mupirocin Topical mupirocin is an antibiotic that is most likely to be ordered for a client with a mild bacterial skin infection without fever or lymphadenopathy.Recurrent or severe infections may be treated with oral amoxicillin. Clients with methicillin-resistant Staphylococcus aureus infections should be treated with oral linezolid or clindamycin or intravenous vancomycin if the infection is severe.

In teaching a client about primary prevention of skin cancer, which instruction does the nurse include? a. "Examine your skin quarterly for lesions." b. "Avoid sun exposure between 11 a.m. and 3 p.m." c. "If you feel, you must tan, use a tanning bed." d. "Report skin changes only if a lesion gets larger."

b. "Avoid sun exposure between 11 a.m. and 3 p.m." The nurse teaches the client that the sun's rays are strongest between 11 a.m. and 3 p.m. and can cause more damage during this time.Skin should be examined at least monthly. Skin changes of any kind should be reported. The rays in tanning beds are just as harmful to skin as the sun's rays and should be avoided.

A client with a bacterial skin infection is being taught home care for treatment of this infection. Which statement by the client indicates a need for further teaching? a. "I should cover the lesions if necessary to limit exposure to other people." b. "I may stop using the topical antibiotic when the lesions disappear." c. "I will remove crusts with soap and water before applying the medication." d. "I should contact my provider if I develop a fever or if the lesions spread.

b. "I may stop using the topical antibiotic when the lesions disappear." The statement by the client that, "I may stop using the topical antibiotic when the lesions disappear," indicates the need for further teaching. The antibiotic should be used for the time prescribed and not just until the lesions seem to be resolved.Clients should be taught to remove crusts before applying the medication to improve absorption. If signs of systemic disease occur, the client should contact the provider since oral antibiotics may be necessary. Covering the lesions will help prevent spread to others.

Which statement by a client with psoriasis indicates that teaching by the nurse has been effective? a. "Lesions must be covered to prevent spread to my family." b. "If I plan to get pregnant while taking tazarotene, I'll talk with my provider." c. "I should be in the sunlight as much as possible for UV rays." d. "Psoriasis can be cured with steroids."

b. "If I plan to get pregnant while taking tazarotene, I'll talk with my provider." The client taking tazarotene who acknowledges the need to talk with the provider if planning a pregnancy has demonstrates that teaching has been effective. This drug is teratogenic, even if used topically. Therefore, this client should speak with the provider to consider other therapies, and practice strict contraceptive measures.Although ultraviolet irradiation has been shown to be beneficial in controlling psoriatic lesions, treatment should be completed under the supervision of a dermatologist; the client should be taught to avoid being in the sun for health promotion purposes. Psoriasis is not contagious, but it cannot be cured.

A client has been diagnosed with tinea corporis (ringworm). To avoid spreading the infection, what does the nurse suggest? a. "No special precautions are necessary as this is not contagious." b. "Keep the site covered with a bandage." c. "Use hand sanitizer instead of soap and water to clean your hands." d. "Isolate yourself from everyone until healed."

b. "Keep the site covered with a bandage." Keeping the site covered with a bandage prevents spread of the infection.The client should always wash with soap and water. Hand sanitizer is an alternate if soap and water are not available. Total isolation is not needed, yet precautions to avoid transmission of the infection are necessary.

A client has an odorous, purulent wound, and reports feeling embarrassed. Which nursing intervention is appropriate? a. Place room deodorizers in the room. b. Change the dressing frequently. c. Suggest whirlpool therapy. d. Encourage a diet high in protein.

b. Change the dressing frequently. The nurse knows that frequent dressing changes help with healing and help the client feel clean. This is the appropriate nursing intervention.A diet high in protein does not address the client's feelings of embarrassment. Whirlpool therapy may not be appropriate for this client. Room deodorizers do not address the source of the problem and may be offensive to the client and the family.

During morning rounds, the nurse discovers that an older adult client has been incontinent during the night. To protect the skin, what does the nurse do first? a. Apply a barrier cream to the area. b. Clean and dry the client's skin. c. Assess the area for skin breakdown. d. Place the client in a side-lying position.

b. Clean and dry the client's skin. Cleaning and drying the client to prevent skin breakdown is the first priority for skin protection.Applying a barrier cream, assessing the area, and placing the client in a side-lying position can all be done after the client has been cleaned.

A client with obesity requires frequent dressing changes for an infection on the foot. Which nursing assessment is the priority? a. Provide the necessary dressing materials. b. Determine whether the client can reach the affected area. c. Demonstrate how to change the dressing. d. Ask the client if he or she is squeamish.

b. Determine whether the client can reach the affected area. Whether the client can access the affected area is the priority to assess. If the dressing site cannot be accessed by the client, it will be difficult for the client to independently perform frequent dressing changes at home.All other assessments can be performed after determining if the client can reach the affected area.

The nurse is preparing to perform a dressing change for a client who has methicillin-resistant Staphylococcus aureus (MRSA) infection. What precaution will the nurse take while performing this dressing change? a. Apply a mask. b. Don disposable gloves. c. Place soiled dressings directly in the trash. d. Use sterile technique.

b. Don disposable gloves. The nurse will wear disposable gloves as a precaution to avoid contact with the infection. Disposable gloves are necessary when changing a dressing on a wound infected with MRSA to prevent transmission to others.It is not necessary to wear a mask, since the infection is spread by direct contact with the infected material. Sterile technique is not indicated. Soiled dressings should be placed in a sealed plastic bag before discarding.

The nurse is evaluating the effectiveness of interventions for pressure injury management. Which laboratory will the nurse monitor? a. Calcium b. Serum albumin c. Numbers of immature white blood cells (WBCs) d. Hematocrit

b. Serum albumin Albumin measures protein, which is necessary for healing. Increased serum albumin indicates successful collaboration with the dietitian.Calcium, hematocrit, and WBC readings do not relate to successful pressure injury management.

The nurse is teaching a client with loss of sensation and movement in the lower extremities secondary to spinal cord injury. Which daily prevention strategy to protect skin integrity does the nurse include in the teaching plan? a. Eat a low-fat, low-protein diet. b. Massage reddened areas several times daily. c. Lift hips off the chair at least every hour. d. Complete a pressure map to identify areas of concern.

c. Lift hips off the chair at least every hour. The daily prevention strategy the nurse includes in the client's teaching plan is that the client will lift the hips off the chair at least every hour to relieve pressure and help prevent pressure injuries.Eating a low-fat diet is not a daily prevention strategy for skin integrity. Reddened areas should never be massaged. Pressure mapping is not a daily activity and is not performed by the client.

An older adult client who is bedridden has a documented history of protein deficiency. For which condition will the nurse monitor and attempt to prevent? a. Decreased wound healing b. Melanoma c. Pressure injury development d. Bed bugs

c. Pressure injury development This client is at risk for developing pressure injuries related to protein deficiency if he or she remains bedridden.Melanoma and bed bugs have no correlation with this client's protein deficiency. The client does not have a wound that needs monitoring.

The nurse is teaching a client about decreasing the risk for melanomas and other skin cancers. Which primary prevention technique is most important for the nurse to include? a. Avoiding tanning beds b. Wearing SPF 40 sunscreen c. Being aware of skin markings and performing skin self-examination d. Avoiding or reducing skin exposure to sunlight

d. Avoiding or reducing skin exposure to sunlight Avoiding or reducing one's exposure to the sun is the most important prevention technique. This includes avoiding direct sunlight, using sunscreen, and wearing protective clothing (including hats). It is more important to teach about avoiding sunlight because one can be exposed to sunlight daily.Avoiding tanning beds is significant, but is not the most important technique. Assessing the skin is a secondary prevention. Wearing sunscreen is essential, but reducing overall exposure to the sun is more important.

The nurse observes an assistive personnel (AP) interacting with a client with a pressure injury. Which AP action requires intervention by the nurse? a. Repositions the client every 1 to 2 hours. b. Uses a moisturizing lotion on skin without pressure injuries. c. Avoids touching reddened areas. d. Massages bony prominences.

d. Massages bony prominences. Massaging bony prominences should be avoided in clients with pressure injuries because they are at high risk for skin tears.Reddened areas should not be touched because this can damage capillary beds and increase tissue necrosis. The client should be repositioned at least every 1 to 2 hours to prevent ulcer extension and the generation of additional pressure injuries. Using a moisturizing lotion on the rest of the skin is appropriate.