Chapter 43 Care of the Patient with an Integumentary Disorder

The medication prescribed is metoclopramide hydrochloride 10mg intramuscularly times one dose. The medication label reads metoclopramide hydrochloride 5mg/mL. The nurse prepares how much medication to administer the dose? 1ml 10mg 10/5= 2mL /5mg /1

2mL

An adult client was burned as a result of an explosion. The burn initially affected the client's entire face(the anterior half of the head) and the upper half of the anterior torso, and there were circumferential burns to the lower half of both arms. The client's clothes caught on fire and the client ran, which caused subsequent burn injuries of the posterior surface of the head and the upper half of the posterior torso. According to the rule of nines, what is the extent of this client's burn injury?

36%

A nurse is reinforcing teaching with a client about photochemotherapy and ultraviolet light (PUVA) treatments who has a history of psoriasis. Which of the following instructions should the nurse include?

Administer a psoralen medication before the treatment.

A patient has an inhalation burn injury. Which is a medical emergency?

Respiratory stridor

silver sulfadiazine is prescribed for a client with a burn injury. Which laboratory finding requires the NEED FOR MONITORING by the nurse?

WBC count of 3000mm

When teaching a patient to care for herpes zoster lesions at home, which is the most important instruction for the nurse to provide?

Wash hands before and after applying medication

A patient has been diagnosed with scabies. What does the nurse anticipate to assess with this patient? SELECT ALL THAT APPLY

Wavy brown lines on the skin Nocturnal pruritus

A nurse is reinforcing teaching with the guardian of a child who has contact dermatitis. Which of the following information should the nurse include?

place the child in a bath with colloidal oatmeal

A nurse is reinforcing teaching with a client who has a new prescription for clotrimazole topical cream. Which of the following statements should the nurse include?

"Apply the topical medication for up to 2 weeks after the lesions are gone".

The medication prescribed is levodopa 1g orally, daily. The medication label states levodopa, 500-mg tablets. The nurse prepares to administer how many tablets for one dose? 1 tablet 1000mg 1000/500= 2 tablets /500mg /1g

2 tablets

The intravenously prescription is 1000mL of 0.9% NaCL(normal saline) to run over 12 hours. The drop factor is 15gtt/1mL. The nurse plans to adjust the flow rate to how many gtts/minute?

21

A nurse is reinforcing discharge instructions with a client who has a bacterial infection of the skin. Which of the following instructions should the nurse include?

Apply warm compresses to the affected area.

An African American patient is seen with impending shock after an accident. How would the nurse expect the skin to appear during the assessment of the patient?

Ashen, gray, or dull

A patient states that he has basal cell carcinoma and is going to die. When planning the best response to make, the nurse should include what knowledge?

Basal cell carcinoma is rarely terminal.

The nurse is caring for a client with circumferential burns of both legs. Which leg position is appropriate for this type of burn?

Elevation above the level of the heart

A client returns to the clinic for follow up treatment after a skin biopsy of a suspicious lesion that was performed 1 week ago. The biopsy report indicates that the lesion is a melanoma. The nurse understands that which characteristics describe this type of a lesion? SELECT ALL THAT APPLY

It is highly metastatic Lesion is a nevus that has changed in color

The clinic nurse is performing an admission assessment on a client and notes that the client is taking azelaic acid. The nurse determines that which client complaint may be associated with the use of this medication?

Itching

The nurse is caring for a patient who has a warm, reddened extremity that has weeping skin. The patient has an elevated white blood cell count and it is suspected the patient has cellulitis. The patient asks what causes cellulitis. What is the nurse's best response?

The nurse should explain to the patient that cellulitis is a collection of different types of infection. Usually it is associated with poor blood flow and/or other comorbidities such as diabetes. The onset is usually insidious and the patient should be aware of signs and symptoms he or she should assess daily.

The nurse is caring for a patient with an open skin lesion. Which patient goal is the highest priority?

The patient does not develop an infection of the lesion.

An adolescent patient is seen in the clinic with a mild case of acne. What does the nurse expect to assess?

The patient reports a sense of low self-esteem

Which would be the anticipated therapeutic outcome of an escharotomy procedure performed for a circumferential arm burn?

The return of distal pulses

A parent tells the dermatologist that her daughter seems to be losing interest in school. Which medication could have caused the patient's change in behavior?

isotretinoin

The nurse reinforces instructions to a group of clients regarding measures that will assist with the prevention of skin cancer. Which statement by a client indicates the NEED FOR FURTHER TEACHING?

"I need to avoid sun exposure before 10:00am and after 4:00pm".

A nurse is reinforcing discharge instructions with a client who had a skin biopsy with sutures. Which of the following statements by the client indicates an understanding of the instructions?

"I should clean the site with a sterile saline solution".

A client with severe acne is seen in the clinic and the primary health care provider (PHCP), prescribes isotretinoin. The nurse reviews the client's medication record and would contact the PHCP if the client is also taking which medication?

Vitamin A

The client arrives at the emergency department after a burn injury that occurred in their home basement and an inhalation injury is suspected. Which would the nurse anticipate as being prescribed for the client?

100% oxygen via a tight fitting, nonrebreather face mask

The nurse, employed in a long-term care facility, is planning the clinical assignments for the day. The nurse prepares the assignment and would not assign which staff member to the client with a diagnosis of herpes zoster?

An unlicensed personnel who has never had chickenpox

A nurse is caring for a client who has a suspected fungal skin lesion. Which of the following diagnostic procedures should the nurse prepare the client for to confirm diagnosis?

Potassium Hydroxide (KOH) test

The nurse is told that an assigned client is suspected of having methicillin-resistant Staphylococcus aureus (MRSA). Which precautions must the nurse institute during the care of the client?

Wear a gown and gloves

The medication prescribed is haloperidol, 4mg intramuscularly, immediately. The medication label states 5mg/1mL. The nurse prepares how much medication to administer the dose? 1mL 4mg 4/5= 0.8mL /5mg /1

0.8mL

The medication is an intramuscular dose of 400,000 units of penicillin G benzathine (Bicillin). The medication label reads penicillin G benzathine (Bicillin) 300,000 units/mL. The nurse prepares how much medication to administer the correct dose? Fill in the blank and record the answer using one decimal place.

1.3 per dose

The medication prescribed is methylprednisolone acetate 60 mg intramuscularly. The medication label states methylprednisolone acetate 40mg/1 mL. How many milliliters will the nurse prepare to administer to the client? 1ml 60mg 60/40=1.5mL /40mg /1

1.5mL

The medication prescription reads phenytoin 0.2g orally, twice daily. The medication label states 100mg capsules. The nurse prepares how many capsules to administer one dose?

2 capsules

The medication prescribed is digoxin 0.25mg orally, daily. The medication label reads digoxin 0.125mg/tablet. The nurse would prepare how many tablets to administer the dose? 1 tab 0.25mg 0.25/0.125 =2 tablets /0.125mg /1

2 tablets

The medication prescribed is zidovudine, 0.2g orally, three times daily. The medication label states zidovudine, 100 mg tablet. The nurse prepares to administer how many tablets for one dose? 1 tablet 1000mg 0.2g 1000 times 0.2 = 2 tablets /100mg /1g / 100

2 tablets

The intravenous prescription is 3000 mL of 5% dextrose in water (D5W) to run over a 24 hour period. The drop factor is 10gtt/1mL. The nurse plans to adjust the flow rate to how many gtts/minute?

21 drops per minute

A client arrives at the emergency department and has experienced frostbite to the right hand. What would the nurse expect to find when inspecting the client's hands?

A white color of the skin which is insensitive to touch

A patient is admitted with herpes zoster. The health care provider orders an antiviral medication to slow the progression of the virus. Which medication will the nurse administer?

Acyclovir

The nurse is reviewing the history for a patient who has been admitted with cellulitis. Which conditions would predispose the patient to cellulitis? SELECT ALL THAT APPLY

Malnutrition Treatment with chemotherapy venous insufficiency of the lower legs diabetes mellitus

Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which finding indicates the presence of systemic toxicity from this medication?

Tinnitus

Silver sulfadiazine is prescribed for a client with a partial-thickness burn and the nurse provides teaching about the medication. Which statement made by the client indicates a NEED FOR FURTHER TEACHING about the treatments?

"The medication is likely to cause stinging initially".

The health care provider has scheduled a debridement for a patient who has partial thickness burns on his chest and right upper leg. Which nursing intervention is most important?

Administer an opioid analgesic intravenously before the debridement.

What should be included in the assessment of a patient with an electrical burn?

Cardiac irregularities

A patient tells the nurse she has not gone out of the house for weeks because she could not cover the lesions on her face with makeup. What would be an appropriate patient problem?

Distorted Body image, related to change in personal appearance.

A patient complains of a burning pain on his lower thoracic area. On inspection, the area is found to be erythematous and edematous with a cluster of vesicles. What condition is most likely to be diagnosed?

Herpes Zoster

Which of the following assessments should the nurse report to the health care provider immediately for an adult patient with partial-thickness burns over 25% of his body?

Hourly urinary output of 10 to 15ML.

A burn client is receiving treatments of topical mafenide acetate to the site of injury. The nurse monitors the client, knowing that which finding indicates the occurrence of a systemic effect?

Hyperventilation

A nurse is caring for a client who has sustained burns over 35% of total body surface area. The client's voice has become hoarse, a brassy cough has developed, and the client is drooling. The nurse should identify these findings as indications that the client has which of the following?

Inhalation injury

The nurse just finished an assessment for a patient with systemic lupus erythematous(SLE). Which clinical manifestation would the nurse expect to find? SELECT ALL THAT APPLY.

Oral ulcers Erythematous rash over the nose and cheeks

A patient is admitted with partial thickness burns on his upper chest and face. What is the most important thing for the nurse to monitor in the patient on admission?

Respiratory problems.

Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed?

Triglyceride level

The medication prescribed is heparin 5000 units subcutaneously, every 12 hours. The medication vial reads heparin 10,000 units/mL. The nurse prepares how many mL to administer one dose? 1ml 5000units 5000/10,000=0.5mL /10,000units /1

0.5mL

The medication prescribed is prochlorperazine 5mg intramuscularly, every 4 hours as needed. The medication label states prochlorperazine 10mg/mL. The nurse prepares how much medication to administer the dose? 1mL 5mg 5/10= 0.5mL /10mg /1

0.5mL

The medication prescribed is morphine sulfate 6mg subcutaneously. The medication label states morphine sulfate 10mg/1mL. The nurse plans to prepare how much medication to administer the dose? 1mL 6mg 6/10= 0.6mL /10mg /1

0.6mL

The medication prescribed is hydromorphone hydrochloride 3mg intramuscularly, every 4 hours as needed. The medication label reads hydromorphone hydrochloride 4mg/1mL. The nurse would prepare to administer how many mL to the client? 1ml 3mg = 3/4= 0.75mL /4mg =/1ml

0.75mL

The medication prescription states to administer acetaminophen 650mg orally for a temperature of more than 38C. The medication bottle states acetaminophen 325mg tablets. The nurse takes the client's temperature and notes that it is 101F. The nurse plans to take which action?

Administer two tablets of acetaminophen.

A nurse is reviewing information about a new prescription for corticosteroid cream with a client who has mild psoriasis. Which of the following instructions should the nurse include? SELECT ALL THAT APPLY

Apply an occlusive dressing after application wear gloves after application to lesions on the hands avoid applying in skin folds

A nurse is contributing to the plan of care for an adult client who sustained severe burn injuries. Which of the following interventions should the nurse recommend for inclusion in the plan of care? SELECT ALL THAT APPLY

Assign the client to a private room increase dietary protein intake Restrict fresh flowers in the client's room

The nurse is educating a patient about using the ABCD mnemonic for skin cancer. Which terms would the nurse use to describe what the ABCD's stand for? SELECT ALL THAT APPLY?

Asymmetry Borders Color Diameter

The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied at which times? 1. Immediately before swimming 2. 5 minutes before exposure to the sun 3. Immediately before exposure to the sun 4. At least 30 minutes before exposure to the sun

At least 30 minutes before exposure to the sun

The nurse is applying a topical corticosteroid to a client with eczema. The nurse would apply the medication to which body area to decrease the potential for systemic absorption? SELECT ALL THAT APPLY.

Back, Sole of the feet, Palms of the hands

It is important to teach a patient the warning signs of skin cancer. Which characteristics of a nevus is a warning sign of skin cancer? SELECT ALL THAT APPLY.

Border Irregularity Delayed or prolonged lesional healing

The nurse is assessing a patient and notes a raised, fluid filled area that measures 1.3cm in width. What is this called?

Bulla

A patient is admitted with partial thickness and full thickness burns on his right lower extremity. What is likely to be included in the plan of care initially?

Closed dressing change every 3 hours

A nurse is collecting data from a client who sustained deep partial-thickness and full-thickness burns over 40% of the body 24hr ago. Which of the following findings are common during this phase? SELECT ALL THAT APPLY

Hyperkalemia Hyponatremia decreased hematocrit

A nurse is assisting with the care of a client who sustained deep partial thickness and full thickness burns over 60% of their body 24 hr ago and is requesting pain medication. The nurse should ensure the medication is administered using which of the following routes to administer the medication?

Intravenous

The nurse is reviewing the health care record of a client with a lesion that has been diagnosed as basal cell carcinoma. The nurse would expect which characteristics of this type of lesion to be documented in the client's record? SELECT ALL THAT APPLY?

Lesion has a waxy border Pearly papule, with a central crater

The evening nurse reviews the nursing documentation in the client's chart and notes that the day nurse has documented that the client has a stage 2 pressure ulcer in the sacral area. Which should the nurse expect to find when checking the client's sacral area?

Partial-thickness skin loss of the epidermis

The patient has a rash on her back that began about 10 days ago with a raised, scaly border and a pink center. Now she has a similar eruptions on both sides of her back, From these signs, the nurse would determine the rash to be?

Pityriasis Rosea

The nurse is assigned to care for a client with herpes zoster. Based on an understanding of the cause of this disorder, the nurse determines that this definitive diagnosis was made by which diagnostic test?

Positive culture results

When teaching home care to a patient with recurrent genital herpes infection, it is important to include which information? SELECT ALL THAT APPLY

Precautions for delivery must be made in the event of becoming pregnant The patient will need to use protection even when no lesions are evident

The nurse planning the care for a patient who has impetigo expects to administer which topical drug to the patient?

Retapamulin

Which method of assessing burn size applies only to adults?

Rule of nines

The nurse inspects the skin of a client who is suspected of having psoriasis. Which finding would the nurse note if this disorder is present?

Silvery-white scaly lesions

A patient with thermal burns over 30% of his body has maintained a urinary output of 250mL for the past 8 hours. What can the nurse infer from this information?

Stage of hypovolemic burn shock is resolving

A nurse in a providers office is collecting data from a client who has a severe sunburn. Which of the following classifications should the nurse use to document this burn?

Superficial thickness

Identify whether the following skin coverings are used as temporary or permanent graft. A) Allograft B). Autograft C). Cultured epithelium' D). Xenograft

Temporary: Allograft and Xenograft Permanent: Autograft and Cultured epithelium

The nurse is caring for a client who has just been admitted to the nursing unit after receiving flame burns to the face and chest. The nurse notes a hoarse cough, and the client is expectorating sputum with black flecks. The client suddenly becomes restless, and his color is becoming dusky. Based on this data, which interpretation would the nurse make?

The burn has probably caused laryngeal edema, which has occluded the airway.

The nurse is precepting a nursing student in the emergency department when a burn patient is admitted in the emergent phase. The student is unaware of how to begin caring for this patient. The nurse would begin by explaining what major concepts about the emergent phase of burn care?

The emergent phase begins with establishing an airway. Then fluid resuscitation should be initiated. Insert a Foley catheter to closely monitor urinary output, as this could change significantly. Insert an NG tube. Treat pain and reassess frequently. Vital signs should be monitored closely and regularly because there could be rapid changes in hemodynamic status.

A nurse is caring for a burn client whose calculated 24 hour intravenous fluid requirements are determined to be 5,000 mL. What is the total volume(mL) that the nurse should infuse after the first 8 hours of fluid resuscitation has infused?

The nurse should prepare to administer half of the total 24 hr IV fluid volume within the first 8 hr from the time the burn occurred (2,500 mL) and the remaining volume over the next 16 hr (2,500mL).

The health care provider has ordered oral griseofulvin for tinea capitis. The patient's mother asks the nurse why an oral medication is used rather than a cream. What information should be provided by the nurse?

Topical creams do not reach the root of the hair to kill the fungus

The nurse is assisting with caring for a client who is receiving intravenous fluids and who has sustained full-thickness burn injuries of the back and legs. The nurse understands that which would provide the MOST reliable indicator for determining the adequacy of the fluid resuscitation?

Urine output

A nurse in a clinic is preparing to assist with obtaining a skin specimen from a client who has a suspected herpes infection. Which of the following actions should the nurse take?

Use a cotton tipped applicator to obtain fluid from the lesion Place collected specimen tube immediately on ice.

The health education nurse provides instructions to a group of clients regarding measures that will assist with preventing skin cancer. Which instructions would the nurse provide? SELECT ALL THAT APPLY

Use sunscreen when participating in outdoor activities. Wear a hat, opaque clothing, and sunglasses when in the sun Examine your body monthly for any lesions that may be suspicious