Chapter 52: PrepU - Nursing Management: Patients With Dermatologic Problems

When caring for a client with severe impetigo, the nurse should include which intervention in the care plan? 1- Placing mitts on the client's hands 2- Administering systemic antibiotics as ordered 3- Applying topical antibiotics as ordered 4- Continuing to administer antibiotics for 21 days as ordered

2

Which of the following is a dermatophyte infection of the fingernails or toes? 1- Pediculosis 2- Tinea pedis 3- Onychomycosis 4- Onychocryptosis

3

Which skin condition is caused by staphylococci, streptococci, or multiple bacteria? 1- Scabies 2- Pediculosis capitis 3- Poison ivy 4- Impetigo

4

A client has been diagnosed with shingles. Which of the following medication classifications will reduce the severity and prevent development of new lesions? 1- Antiviral 2- Corticosteroids 3- Analgesics 4- Antipyretics

1

Which term refers most precisely to a localized skin infection of a single hair follicle? 1- Furuncle 2- Carbuncle 3- Cheilitis 4- Comedone

1

While in a skilled nursing facility, a client contracts scabies, which is diagnosed the day after discharge. The client is living at her daughter's home with six other people. During her visit to the clinic, the client asks a staff nurse, "What should my family do?" The most accurate response from the nurse is: 1- "All family members need to be treated." 2- "If someone develops symptoms, tell him to see a physician right away." 3- "Just be careful not to share linens and towels with family members." 4- "After you're treated, family members won't be at risk for contracting scabies."

1

The nurse is teaching a client about the correct use of topical concentrated corticosteroids. The nurse includes which statement(s)? Select all that apply. 1- Avoid applying to the face. 2- Avoid prolonged use. 3- Apply to intertriginous areas. 4- Hypertrichosis is normal.

1,2

A client presents with silvery scales on the elbows and knees. The physician has made a diagnosis of plaque psoriasis. What is the probable cause(s) of psoriasis? 1- genetic predisposition 2- a triggering mechanism, such as systemic infection, injury to the skin, vaccination, or injection 3- injury, such as squeezing a lesion 4- diabetes mellitus; elevated blood glucose level promotes microbial growth

1,2,

A client is coming to the office to have a growth removed by the doctor. The client asks "What does cryosurgery do to the growth?" What is the correct response? 1- Removes the entire growth 2- Through the application of extreme cold, the tissue is destroyed. 3- Freezes the growth, so the physician can remove it at the next appointment 4- Lasers the growth off

2

A patient has developed a boil on the face and the nurse observes the patient squeezing the boil. What does the nurse understand is a potential severe complication of this manipulation? 1- Scarring 2- Brain abscess 3- Erythema 4- Cellulitis

2

A patient is diagnosed with seborrheic dermatitis on the face and is prescribed a corticosteroid preparation for use. What should the nurse educate the patient about regarding use of the steroid on the face? 1- Use very warm water to clean the face prior to applying the medication. 2- Avoid using the medication around the eyelids because it may cause cataracts and glaucoma. 3- Wash the face several times a day and reapply the medication. 4- Scrape the scaly patches off prior to applying the medication.

2

Photochemotherapy has been used as a treatment for which of the following skin disorders? 1- Shingles 2- Psoriasis 3- Allergic dermatitis 4- Rosacea

2

The nurse and nursing assistant are moving a client who slid down in the chair. What does the nurse encourage the assistant to avoid shearing when moving the client to a higher position in the chair? 1- Tilt the chair back when moving the client. 2- Lift the client, do not slide them. 3- Encourage the client to slide up without assistance. 4- Use a donut device while the client is in the chair.

2

The nurse inspects the appearance of a sacral ulcer and documents "a shallow open ulcer with a red-pink wound with partial thickness loss of dermis." The nurse knows to classify this ulcer as: 1- Stage I. 2- Stage II. 3- Stage III. 4- Stage IV.

2

The nurse is providing care for a young woman who has sought care because of signs and symptoms that are characteristic of psoriasis. When planning this woman's care, the nurse should be mindful of the fact that the etiology of the problem involves which of the following? 1- Chronic infection 2- Immune dysfunction 3- Persistent physical irritation 4- Benign neoplastic processes

2

The nurse recommends which type of therapeutic bath for its antipruritic action? 1- Sodium bicarbonate (baking soda) 2- Colloidal (oatmeal) 3- Water 4- Saline

2

The patient is advised to apply a suspension-type lotion to a dermatosis site. The nurse should advise the patient to apply the lotion how often to be effective? 1- Every hour 2- Every 3 hours 3- Every 12 hours 4- Every day at the same time

2

What advice should the nurse give a client with a furuncle to prevent the spread of the infection? 1- Keep hair short, clean, and away from the face and forehead. 2- Never pick or squeeze a furuncle. 3- Avoid the use of cosmetics. 4- Use tepid bath water.

2

What advice should the nurse give a client with dermatitis until the etiology of the dermatitis is identified? 1- Use wool, synthetics, and other dense fibers. 2- Wear rubber gloves when in contact with soaps. 3- Rub the skin vigorously to dry. 4- Use hot water for bathing.

2

A night-shift nurse receives a call from the emergency department about a client with herpes zoster who is going to be admitted to the floor. Based on this diagnosis, where should the nurse assign the client? 1- Semi-private room with a client diagnosed with pneumonia 2- Semi-private room with a client who had chickenpox and was admitted with a GI bleed 3- Private room 4- Isolation room with negative airflow

3

A patient has just been told that she has malignant melanoma. The nurse caring for this patient explains that the first and most important treatment for malignant melanoma is what? 1- Chemotherapy 2- Immunotherapy 3- Wide excision 4- Radiation therapy

3

A patient is diagnosed with malignant melanoma that directly invades the adjacent dermis (vertical growth). The nurse knows that this type of melanoma has a poor prognosis. Which of the following is most likely the type of melanoma described in this scenario? 1- Superficial spreading 2- Lentigo-maligna 3- Nodular melanoma 4- Acral-lentiginous

3

A physician has ordered a wet-to-damp dressing for an infected pressure ulcer. The nurse knows that the primary reason for this treatment is to: 1- prevent the spread of the infection. 2- debride the wound. 3- keep the wound moist. 4- reduce pain.

3

A young adult visits a health clinic for treatment of a severe case of eczema on his left leg. Which of the following is the preferred method for delivering medication in this scenario? 1- Therapeutic bath 2- Cream 3- Ointment 4- Topical anesthetic

3

An older adult patient's skin has become progressively drier in recent years, and the patient now describes many of her skin surfaces as being "incredibly itchy, all the time." The nurse who is contributing to this patient's care should encourage the patient to: 1- Use a moderately abrasive material to scratch the affected skin areas. 2- Apply an over-the-counter corticosteroid ointment to the affected regions. 3- Avoid scratching the affected skin areas because this may exacerbate pruritus. 4- Take analgesics to achieve relief from pruritus.

3

The nurse is working with community groups. At which of the following locations would the nurse anticipate a possible scabies outbreak? 1- Shopping mall 2- Swimming pool 3- College dormitory 4- Gymnasium

3

While examining a client's leg, a nurse notes an open ulceration with visible granulation tissue in the wound. Until a wound specialist can be contacted, which type of dressing should the nurse apply? 1- Dry sterile dressing 2- Sterile petroleum gauze 3- Moist sterile saline gauze 4- Povidone-iodine-soaked gauze

3

A nurse is caring for a patient with a stage IV ulcer. When considering treatment options, the nurse knows that: 1- The draining ulcer would need debridement. 2- A moist environment should be provided to aid wound healing. 3- Moisture to the skin should be avoided. 4- Surgical intervention may be necessary.

4

The nurse is a participant in a health fair that has been sponsored by the local VFW. An attendee has told the nurse about his wife's recent battle with skin cancer and others have replied with comments about the risk factors and prevention of the disease. What health education should the nurse provide to this group? 1- "If you like to tan, it's important that you do so for less than 60 minutes at a time." 2- "Any form of clothing will effectively block the sun's rays from damaging your skin." 3- "Sunscreens have been shown to have little effect on the ultraviolet damage that is caused by the sun." 4- "Even if it's cloudy outside, the sun's rays can still cause harm to your skin and contribute to skin cancer."

4

A patient with an ulcer on his right leg is examined by the nurse practitioner. The nurse records the appearance of the ulcer as "ruddy" in color with poorly defined wound edges and moderate amounts of exudate. Based on this assessment, the ulcer is characterized as which of the following? 1- Arterial ulcer 2- Venous ulcer 3- Neuropathic ulcer 4- Pressure ulcer

2

Which drug is an oral retinoid used to treat acne? 1- Estrogen 2- Isotretinoin 3- Tetracycline 4- Benzoyl peroxide

2

Which sedative medication is effective for treating pruritus? 1- Benzoyl peroxide 2- Hydroxyzine 3- Fexofenadine 4- Tetracycline

2

The nurse is caring for a client with a skin lesion that is oozing. The surrounding skin is acutely inflamed. What type of dressing should the nurse apply? 1- Occlusive 2- Protective 3- Passive 4- Interactive

4

The nurse is caring for a geriatric client with thin, chapped, itchy skin. Which nursing intervention should the nurse alter in the plan of care? 1- Use of a gait belt for ambulation 2- Maintenance of foam pad on wheelchair 3- Daily bathing with warm-hot water 4- Applying lanolin ointment

4

A client is undergoing photochemotherapy involving a combination of a photosensitizing chemical and ultraviolet light. What health problem does this client most likely have? 1- psoriasis 2- plantar warts 3- undesired tattoo 4- dandruff

1

The most important principle of psoriasis treatment is which of the following? 1- Gentle removal of scales 2- Application of emollient creams 3- Establishment of regular skin care routine 4- Dressing changes

1

The nurse caring for a client with repeated episodes of contact dermatitis is providing instruction to prevent future episodes. Which information should the nurse include? 1- Avoid cosmetics with fragrance. 2- Wash skin in very hot water. 3- Use a fabric softener. 4- Wear gloves during the day.

1

Which assessment finding indicates an increased risk of skin cancer? 1- A deep sunburn 2- A dark mole on the client's back 3- An irregular scar on the client's abdomen 4- White irregular patches on the client's arm

1

Which statement is accurate regarding isotretinoin? 1- It is teratogenic in humans. 2- Contraceptives are not needed during treatment. 3- To achieve the full effect of the medication, the client should take vitamin A supplements. 4- The side effects are irreversible.

1

A nurse is assessing a client and finds a malignant lesion on the client's face. The nurse suspects this is what type of skin cancer? 1- Basal cell carcinoma 2- Squamous cell carcinoma 3- Malignant melanoma 4- Dermatofibroma

2

A client visits the physician's office for treatment of a skin disorder. As a primary treatment, the nurse expects the physician to order: 1- an IV corticosteroid. 2- an IV antibiotic. 3- an oral antibiotic. 4- a topical agent.

4

The nurse is conducting an admission history and physical examination of a client with a history of contact dermatitis. The nurse assesses whether the client uses which medication classification? 1- Corticosteroids 2- Saline irrigations 3- Antifungals 4- Antivirals

1

A client presents in the emergency department with complaints of cough, headache, and generalized aches and pains. Upon assessment, the nurse documents a temperature of 102.5°F (39.2°C) and redness on the arms, legs, and upper chest. She also notes that the client takes eight different medications each day. What nursing diagnosis is the priority for this client? 1- Impaired physical mobility 2- Impaired tissue integrity 3- Impaired thermoregulation 4- Ineffective therapeutic regimen management

2

A male patient is being treated in the hospital for the effects of a debilitating ischemic stroke that he experienced 2 weeks ago. The patient's plan of care identifies a risk of skin breakdown due to the cognitive, sensory, and motor effects of the stroke. What intervention should the nurse prioritize in an effort to reduce the patient's risk of pressure ulcers? 1- Turn the patient at least twice between 2200 and 0600 each night. 2- Ensure that the patient's heels are elevated off the surface of his bed. 3- Avoid seating the patient in a chair until his rehabilitation has been completed. 4- Provide relevant health education to the patient about the management of pressure ulcers.

2

Which of the following reflect the pathophysiology of cutaneous signs of HIV disease? 1- Immune function deterioration 2- High CD4 count 3- Genetic predisposition 4- Decrease in normal skin flora

1

A patient comes to the clinic complaining of a red rash of small, fluid-filled blisters. The patient is suspected of having herpes zoster. What should the nurse know about the distribution of lesions of herpes zoster? 1- Grouped vesicles occurring on lips and oral mucous membranes 2- Grouped vesicles occurring on the genitalia 3- Rough, fresh, or gray skin protrusions 4- Grouped vesicles in linear patches along a dermatome

4

A patient is being treated for chronic venous stasis ulcers of the lower extremities. What medication does the nurse understand will increase peripheral blood flow by decreasing the viscosity of blood and assist with the healing of the ulcers? 1- Heparin 2- Warfarin (Coumadin) 3- Aspirin 4- Pentoxifylline (Trental)

4

The pharmacology class is learning about herpes zoster and medications that are used to treat this disease process. When planning care for a patient with herpes zoster what medications, if administered within the first 24 hours of the initial eruption, can arrest herpes zoster? 1- Deltasone (Prednisone) 2- Azathioprine (Imuran) 3- Triamcinolone (Kenalog) 4- Acyclovir (Zovirax)

4

Which of the following uses the body's own digestive enzymes to break down necrotic tissues? 1- Autolytic debridement 2- Enzymatic debridement 3- Wet to dry dressings 4- Wet dressings

1

Which procedure done for skin cancer conserves the most amount of normal tissue? 1- Moh's micrographic surgery 2- Electrosurgery 3- Cryosurgery 4- Surgical excision

1

A client is being treated for acne vulgaris. What contributes to follicular irritation? 1- overproduction of sebum 2- chocolate 3- stress 4- potato chips

1

A day care worker comes to the clinic for mild itching and rash of both hands. The nurse suspects contact dermatitis. The diagnosis is confirmed if the rash appears: 1- erythematous with raised papules. 2- dry and scaly with flaking skin. 3- inflamed with weeping and crusting lesions. 4- excoriated with multiple fissures.

1

The nurse is providing morning hygiene for an older adult patient who requires total care due to late-stage Alzheimer's disease. In recent weeks, the patient has shown signs of dermatitis on various skin surfaces. When providing a bed bath for this patient, the nurse should do which of the following? 1- Use only water to wash and rinse the patient's skin surfaces. 2- Utilize a deodorant soap to reduce the risk of skin breakdown due to excessive perspiration. 3- Avoid using a towel to dry the patient's skin. 4- Use a mild soap or a soap substitute when washing the patient's skin.

4

When caring for a client in a prenatal clinic who has history of acne vulgaris, which client medication would the nurse advise against? 1- Tretinoin 2- Benzoyl peroxide 3- Tazarotene 4- Isotretinoin

4

A patient is scheduled for Mohs microscopic surgery for removal of a skin cancer lesion on his forehead. The nurse knows to prepare the patient by explaining that this type of surgery requires: 1- Destruction of the tissue by electrical energy. 2- Removal of the tumor, layer by layer. 3- A process of deep-freezing the tumor, thawing and refreezing. 4- The use of radiation therapy.

2

A nurse employed in a school suspects an outbreak of pediculosis. Which of the following nursing actions should be taken to prevent and control the outbreak? 1- Perform hair inspection. 2- Wash clothing and vacuum furniture, bedding, and carpets. 3- Insist that everyone who is infested with lice follows the prescribed treatment. 4- Improve the school hygiene.

3

A nurse is examining a client's scalp for evidence of lice. The nurse should pay particular attention to which part of the scalp? 1- Temporal area 2- Top of the head 3- Behind the ears 4- Middle area

3

A patient has a moisture-retentive dressing for the treatment of a sacral decubitus ulcer. How long should the nurse leave the dressing in place before replacing it? 1- 4 to 6 hours 2- 8 hours 3- 12 to 24 hours 4- 24 to 36 hours

3

A patient with squamous cell carcinoma has been scheduled for treatment of this malignancy. The nurse knows that the primary method of treatment in this type of cancer is what? 1- Chemotherapy 2- Radiation therapy 3- Surgical excision 4- Biopsy of sample tissue

3

The nurse notes that the client's lower extremities are covered with very dry skin and that the horny layer of the skin has become thickened. The nurse notes the finding as 1- dermatitis. 2- acantholysis. 3- lichenification. 4- pyodermas.

3

Which condition is an autoimmune disease involving immunoglobulin G? 1- Toxic epidural necrolysis (TEN) 2- Stevens-Johnson syndrome (SJS) 3- Pemphigus 4- Bullous pemphigoid

3

Which of the following is an appropriate teaching component for the client diagnosed with lice to prevent reinfestation? 1- There is no risk when used in pregnant women. 2- Pediculicides may be used on pets. 3- Perform hair inspection whenever there is an outbreak, even if asymptomatic. 4- Infestation is a reflection of hygiene practices.

3

A nurse discovers scabies when assessing a client who has just been transferred to the medical-surgical unit from the day surgery unit. To prevent scabies infection in other clients, the nurse should: 1- wash her hands, apply a pediculicide to the client's scalp, and remove any observable mites. 2- isolate the client's bed linens until the client is no longer infectious. 3- notify the nurse in the day surgery unit of a potential scabies outbreak. 4- place the client on enteric precautions.

2

A nurse is caring for a client experiencing an exacerbation of plaque psoriasis. The nurse assesses the area and documents a proliferation of which cell type? 1- Dermal 2- Epidermal 3- Endothelial 4- Epithelia

2

Which statement indicates a characteristic of a basal cell carcinoma (BCC)? 1- It is more invasive than squamous cell carcinoma (SCC). 2- It metastasizes through blood or the lymphatic system. 3- It begins as a small, waxy nodule with rolled translucent, pearly borders. 4- It is a malignant proliferation arising from the epidermis.

3

A nurse is providing care for a patient with human immunodeficiency virus (HIV) who has been admitted to the hospital because of a recent decrease in his CD4+ count. The nurse is aware of the patient's high risk of developing secondary illnesses, including Kaposi's sarcoma (KS). When assessing the patient for signs and symptoms of KS, the nurse would examine the patient for: 1- Newly acquired lesions that are reddish or bluish in color 2- Skin tears on the patient's trunk that are slow to heal 3- Changes in the shape, character, or color of a mole 4- Patches of scaly, dry, pruritic skin on the patient's torso

1

A patient is being evaluated for nodular cystic acne. What systemic pharmacologic agent may be prescribed for the treatment of this disorder? 1- Isotretinoin (Accutane) 2- Benzoyl peroxide 3- Retin-A 4- Salicylic acid

1

A patient is diagnosed with pemphigus, a skin disease caused by an autoimmune response involving immunoglobulin G. Medical management includes administering high doses of corticosteroids. Which of the following is a drug that the health care provider may likely prescribe? 1- Temovate 2- Aristocort 3- Decaderm 4- Topicort

1

A young college student recently had her tongue and lip pierced. She has developed a superinfection of candidiasis from the antibacterial mouthwash. Which of the following would be the correct recommendation for her? 1- Use an antifungal mouthwash or salt water. 2- Use a soft-bristled toothbrush. 3- Rinse the mouth after eating food. 4- Move the piercing back and forth during washing.

1

While assessing the skin of a 45-year-old, fair-skinned female client, the nurse notes a lesion on the medial aspect of her lower leg. It has irregular borders, with various shades of black and brown. The client states that the lesion itches occasionally and bled slightly a few weeks ago. She also reveals a history of sunburns. Based on these signs and symptoms, the nurse suspects: 1- squamous cell carcinoma. 2- actinic keratoses. 3- melanoma. 4- basal cell carcinoma.

3

A client is having cryosurgery to remove a growth on the leg. How long will the client be informed that healing will take? 1- 3 to 5 days 2- Up to 1 week 3- 2 to 4 weeks 4- 4 to 6 weeks

4

A nurse is conducting a detailed skin assessment on an 80-year-old client. Which finding requires further investigation? 1- Yellow, waxy deposits on the lower eyelids 2- Bright red moles on the hands 3- Several areas of dry, scaly skin 4- Small, waxy nodule with pearly borders

4

The nurse is changing the dressing of a chronic wound. There is no sign of infection or heavy drainage. How long will the nurse leave the wound covered for? 1- 6 to 12 hours 2- 12 to 24 hours 3- 24 to 36 hours 4- 48 to 72 hours

4

While performing an initial assessment of a patient, the nurse observes an elevated blue-black lesion on the patient's ear. The nurse knows that this is indicative of what type of skin cancer? 1- Basal cell carcinoma 2- Squamous cell carcinoma 3- Dermatofibroma 4- Malignant melanoma

4

The nurse is instructing the patient in how to apply a corticosteroid cream to lesions on the arm. What intervention can the nurse instruct the patient to do to increase the absorption of the medication? 1- Apply an occlusive dressing over the site after application. 2- Make sure that the skin is slightly dehydrated so that the medication can absorb through the skin cracks. 3- Apply a thick layer of cream over the lesions so that if some rubs off, there is more to absorb. 4- Apply the medication every 2 hours.

1

The nurse should assess all possible causes of pruritus for a patient complaining of generalized pruritus. What does the nurse understand can be other causes for this condition? 1- End-stage kidney disease 2- Hypothyroidism 3- Pneumonia 4- Myasthenia gravis

1

The school nurse is instructing a parent in the care and elimination of lice from their child's hair. The parent brings all of the products for care in a bag. Which contents are not appropriate for use? 1- Shampoo and conditioner 2- Permethrin (Nix) 3- Plastic wide-toothed comb 4- New hair clips

1

What is the major cause of death in toxic epidermal necrolysis (TEN)? 1- Infection 2- Hemorrhage 4- Renal failure 5- Liver failure

1

When performing a skin assessment, the nurse notes a localized skin infection of a single hair follicle. The nurse documents the presence of 1- a furuncle. 2- a carbuncle. 3- cheilitis. 4- a comedone.

1

Which is not a category of medications used for treatment of the skin? 1- inhaled steroids 2- topical corticosteroids 3- antihistamines 4- antibiotics

1

Which of the following medications is used to reduce turnover time of the psoriatic epidermis? 1- Methotrexate 2- Triamcinolone acetamide (Kenalog) 3- Tazarotene (Tazorac) 4- Acyclovir (Zovirax)

1