Chapter 56 Prep U
The nurse is teaching a client about the correct use of topical concentrated corticosteroids. The nurse includes which statement(s)? Select all that apply. Avoid applying to the face. Hypertrichosis is normal. Apply to intertriginous areas. Avoid prolonged use.
Avoid applying to the face. Avoid prolonged use.
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? Antivirals Saline irrigations Antifungals Corticosteroids
Corticosteroids Explanation: Corticosteroids are used for contact dermatitis. Antifungals, antivirals, and saline irrigations are not used in the treatment of contact dermatitis.
The nurse should assess all possible causes of pruritus for a patient complaining of generalized pruritus. What does the nurse understand can be another cause for this condition? Myasthenia gravis Pneumonia End-stage kidney disease Hyperthyroidism
End-stage kidney disease Explanation: Systemic disorders associated with generalized pruritus include chronic kidney disease.
Which drug is an oral retinoid used to treat acne? Isotretinoin Estrogen Benzoyl peroxide Tetracycline
Isotretinoin Explanation:Isotretinoin, an oral retinoid, is used in clients diagnosed with nodular cystic acne that does not respond to conventional therapy. Estrogen, tetracycline, and benzoyl peroxide are not oral retinoids.
The nurse is conducting a community education program on basal cell carcinoma (BCC). Which statement should the nurse make? It is a malignant proliferation arising from the epidermis. It metastasizes through blood or the lymphatic system. It begins as a small, waxy nodule with rolled translucent, pearly borders. It is more invasive than squamous cell carcinoma (SCC).
It begins as a small, waxy nodule with rolled translucent, pearly borders. Explanation: BCC usually begins as a small, waxy nodule with rolled, translucent, pearly borders. It is less invasive than SCC. It does not metastasize through the blood or lymphatic system. SCC is a malignant proliferation arising from the epidermis.
A nurse in a healthcare provider's office teaches a client how to apply plastic film as an occlusive dressing to cover a medicated ointment applied to the arm. What important teaching point would be included by the nurse? Immobilize the arm when it is wrapped. Cover the dressing with an elastic wrap to facilitate daily activities during treatment. Place heat on top of the dressing to increase skin temperature. Limit use of the dressing to 12 hours.
Limit use of the dressing to 12 hours. Explanation: Plastic film is thin and readily adapts to all sizes, body shapes, and skin surfaces. In general, plastic wrap should be used no more than 12 hours each day. Immobilization is not necessary. Applying heat or covering the dressing in an elastic wrap would be contraindicated.
Which of the following medications is used to reduce turnover time of the psoriatic epidermis? Triamcinolone acetamide (Kenalog) Tazarotene (Tazorac) Methotrexate Acyclovir (Zovirax)
Methotrexate Explanation: Methotrexate appears to inhibit DNA synthesis in epidermal cells, thereby reducing the turnover time of the psoriatic epidermis. Kenalog is an intralesional corticosteroid. Tazarotene, a retinoid, causes sloughing of the scales covering psoriatic plaques. It is listed as a category X drug in pregnancy. Zovirax is used in the treatment of shingles.
Which condition is an autoimmune disease involving immunoglobulin G? Bullous pemphigoid Stevens-Johnson syndrome (SJS) Toxic epidural necrolysis (TEN) Pemphigus
Pemphigus Explanation: Pemphigus is an autoimmune disease involving immunoglobulin G. TEN, SJS, and bullous pemphigoid do not involve immunoglobulin G.
A patient is diagnosed with psoriasis after developing scales on the scalp, elbows, and behind the knees. The patient asks the nurse where this was "caught." What is the best response by the nurse? A.Psoriasis is an inflammatory dermatosis that results from an overproduction of keratin. B.Psoriasis is an inflammatory dermatosis that results from a superficial infection with Staphylococcus aureus. c. Psoriasis comes from dermal abrasion. D. Psoriasis results from excess deposition of subcutaneous fat.
A. Psoriasis is an inflammatory dermatosis that results from a overproduction of keratin.
A client has a rash on the arm that has been treated with an antibiotic without eradicating the rash. What type of examination can be used to determine if the rash is a fungal rash using ultraviolet light? Potassium hydroxide test A Wood's light examination Skin biopsy Fungal culture
A Wood's light examination Explanation: A Wood's light is also known as a black light and is a handheld device that can identify certain fungal infections that fluoresce under long-wave ultraviolet light. In a darkened room, when a physician or nurse aims the light at a lesion caused by a fungus that fluoresces, the lesion emits a blue-green color. It is the only test that uses a light, the others use skin scrapings.
Which procedure done for skin cancer conserves the most amount of normal tissue? Mohs micrographic surgery Electrosurgery Surgical excision Cryosurgery
Mohs micrographic surgery Explanation: Mohs micrographic surgery is the technique that is most accurate and that best conserves normal tissue. The procedure removes the tumor layer by layer. Electrosurgery, cryosurgery, and surgical excision do not conserve the amount of normal tissue.
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? Sterile petroleum gauze Dry sterile dressing Moist sterile saline gauze Povidone-iodine-soaked gauze
Moist sterile saline gauze Explanation: Moist sterile saline dressings support wound healing and are cost-effective. Dry sterile dressings adhere to the wound and debride the tissue when removed. Petroleum supports healing but is expensive. Povidone-iodine is used as an antiseptic cleaning agent but because it can irritate epithelial cells, it shouldn't be left on an open wound.
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? Superficial spreading Acral-lentiginous Nodular melanoma Lentigo-maligna
Nodular melanoma Explanation: A nodular melanoma is a spherical, blueberry-like nodule with a relatively smooth surface and a relatively uniform, blue-black color. A nodular melanoma invades directly into adjacent dermis (i.e., vertical growth) and therefore has a poorer prognosis.
The nurse is assessing a patient with toxic epidermal necrolysis (TEN). What assessment data would indicate that the patient may be progressing to keratoconjunctivitis? Select all that apply. Blurred optic discs Pruritus of the eyes Burning of the eyes Dryness of the eyes Skin peeling on eyelids
Pruritus of the eyes Burning of the eyes Dryness of the eyes The eyes should be inspected daily for signs of pruritus, burning, and dryness, which may indicate progression to keratoconjunctivitis—the principal eye complication of toxic epidermal necrolysis (TEN).
Photochemotherapy has been used as a treatment for which of the following skin disorders? Shingles Psoriasis Rosacea Allergic dermatitis
Psoriasis Explanation: Photochemotherapy is used for severe, disabling psoriasis that does not respond to other methods of treatments.
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? Removes the entire growth Lasers the growth off Through the application of extreme cold, the tissue is destroyed. Freezes the growth, so the physician can remove it at the next appointment
Through the application of extreme cold, the tissue is destroyed. Explanation: Cryosurgery is the application of extreme cold to destroy tissue. The other statements are false.
The nurse is instructing the parents of a child with head lice. Which statement should the nurse include? Use shampoo with Kwell. Disinfect brushes and combs with bleach. Wash clothes in cold water. Use shampoo with piperonyl butoxide.
Use shampoo with piperonyl butoxide. Explanation: The nurse's instructions should include shampooing with piperonyl butoxide, washing clothes in hot water, and disinfecting brushes and combs with piperonyl butoxide shampoo.
What advice should the nurse give a client with dermatitis until the etiology of the dermatitis is identified? Wear rubber gloves when in contact with soaps. Rub the skin vigorously to dry. Use wool, synthetics, and other dense fibers. Use hot water for bathing.
Wear rubber gloves when in contact with soaps. Explanation: The nurse should advise the client to wear rubber gloves when coming in contact with any substance such as soap or solvents. The client should avoid wool, synthetics, and other dense fibers. The client should use tepid bath water and should pat rather than rub the skin dry.
When performing a skin assessment, the nurse notes a localized skin infection of a single hair follicle. The nurse documents the presence of a comedone. a furuncle. a carbuncle. cheilitis.
a furuncle. Explanation: Furuncles are localized skin infections of a single hair follicle. They can occur anywhere on the body but are most prevalent in areas subjected to irritation, pressure, friction, and excessive perspiration, such as the back of the neck, the axillae, or the buttocks. A carbuncle is a localized skin infection involving several hair follicles. Cheilitis refers to dry cracking at the corners of the mouth. Comedones are the primary lesions of acne, caused by sebum blockage in the hair follicle.
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: A.Removal of the tumor, layer by layer. B.The use of radiation therapy. C.Destruction of the tissue by electrical energy. D.A process of deep-freezing the tumor, thawing and refreezing.
A.Removal of the tumor, layer by layer.Explanation:Mohs micrographic surgery removes the tumor layer by layer. The first layer excised includes all evident tumor and a small margin of normal-appearing tissue. The specimen is frozen and analyzed by section to determine if all the tumor has been removed. If not, additional layers of tissue are shaved and examined until all tissue margins are tumor-free.
A patient who was recently diagnosed with pruritus on the chest and back is given information about skin care and bathing. The most important advice on cleansing is to avoid: A.Washing with soap and hot water. B.Using bath oils mixed with water. C.Applying a cold compress to the area after washing. D.Bathing with warm water and mild soap.
A.Washing with soap and hot water. Explanation: Hot water and soap are to be avoided when washing the pruritic area. The other choices are all appropriate measures.
Which medication classification may be used for contact dermatitis? Saline irrigations Antifungals Antivirals Corticosteroids
Corticosteroids Explanation: Corticosteroids are used for contact dermatitis. Antifungals, antivirals, and saline irrigations are not used in the treatment of contact dermatitis.
The nurse assesses the client and observes reddish-purple to dark blue macules, plaques, and nodules. The nurse recognizes that these manifestations are associated with which condition? A.Platelet disorders B.Allergic reactions C.Syphilis D.Kaposi sarcoma
D.Kaposi sarcoma Explanation: Kaposi sarcoma is a frequent comorbidity in clients with AIDS. With platelet disorders, the nurse observes ecchymoses (bruising) and purpura (bleeding into the skin). Urticaria (wheals or hives) is the manifestation of allergic reactions. A painless chancre or ulcerated lesion is a typical finding in the client with syphilis.
The nurse is caring for a client who may have a lice infestation. The nurse is using a bright light focused on an area of the head to confirm the presence of lice. In which manner is it easiest to differentiate nits from dandruff? A.Nits are located near the scalp. B.Dandruff is throughout the hair. C.Dandruff looks white and flaky. D.Nits are difficult to move from hair shafts.
D.Nits are difficult to move from hair shafts. Explanation:The nurse is correct to use the difference of the nits being securely attached to the hair shaft as a guide to confirmation of lice infestation. Dandruff is fine, white particles of dead, dry scalp cells that can be easily picked from the hair.
A client is being treated for acne vulgaris. What contributes to follicular irritation? A.potato chips B.stress C.chocolate D.overproduction of sebum
D.overproduction of sebum Explanation: The overproduction of sebum provides an ideal environment for bacterial growth within the irritated follicle. The follicle becomes further distended and irritated, causing a raised papule in the skin.
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? Every hour Every day at the same time Every 12 hours Every 3 hours
Every 3 hours Explanation: Suspensions consist of either a powder in water that requires shaking before application, or clear solutions, which contain completely dissolved active ingredients. A suspension such as calamine lotion provides a rapid cooling and drying effect as it evaporates, leaving a thin, medicinal layer of powder on the affected skin.
Which of the following nonsedating antihistamines is appropriate for daytime pruritus? Lorazepam (Ativan) Diphenhydramine (Benadryl) Hydroxyzine (Atarax) Fexofenadine (Allegra)
Fexofenadine (Allegra) Explanation: Nonsedating antihistamine medications such as Allegra are more appropriate to relieve daytime pruritus. Benadryl or Atarax, when prescribed in a sedative dose at bedtime, may be beneficial in producing a restful and comfortable sleep. Ativan has sedating properties and is used as an antianxiety medication.
The nurse is developing a plan of care for a client with toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome. Which action should the nurse include? Limit fluids. Apply a continuous current of warm air. Frequently inspect the oral cavity. Use friction when repositioning the client.
Frequently inspect the oral cavity. Explanation: The nurse should frequently inspect the oral cavity of a client with TEN or Stevens-Johnson syndrome. Additionally, care should be taken to reduce friction and shear when turning or repositioning the client. Fluids should not be limited because these clients are susceptible to dehydration. A continuous current of warm air on denuded skin can worsen dehydration.
Which term refers to a graft derived from one part of a client's body and used on another part of that same client's body? A.Heterograft B.Autograft C.Allograft D.Homograft
B.Autograft Explanation:Full-thickness autografts and pedicle flaps are commonly used for reconstructive surgery, months or years after the initial injury. An allograft is a graft transferred from one human (living or cadaveric) to another human. A homograft is a graft transferred from one human (living or cadaveric) to another human. A heterograft is a graft obtained from an animal of a species other than that of the recipient.
A client is being treated for acne vulgaris. What warning must be given to this client regarding the application of benzoyl peroxide? A.Only use with contact dermatitis. B.Use gloves with application. C.Apply a thick layer to assure coverage. D.Use with over-the-counter drying agents.
B.Use gloves with application Explanation:Warn clients using acne preparations containing benzoyl peroxide that this ingredient is an oxidizing agent and may remove the color from clothing, rugs, and furniture. Thorough handwashing after drug use may not remove all the drug and permanent fabric discoloration may still occur. Users of products containing benzoyl peroxide should wear disposable plastic gloves when applying the drug.
Which term describes a fungal infection of the scalp? A.Tinea cruris B.Tinea corporis C.Tinea capitis D.Tinea pedis
C.Tinea capitis Explanation: Tinea capitis is a fungal infection of the scalp. Tinea corporis involves fungal infections of the body. Tinea cruris describes fungal infections of the inner thigh and inguinal creases. Tinea pedis is the term for fungal infections of the foot.
A nurse is admitting a client with toxic epidermal necrolysis. What is the nursing priority in preventing sepsis? AHydrating to prevent renal failure B.Assessing for hemorrhage C.Limiting protein to limit liver failure D.Preventing infection
Preventing infection Explanation: The major cause of death from toxic epidermal necrolysis is from sepsis. Monitoring vital signs closely and noticing changes in respiratory, kidney, and gastrointestinal function may help the nurse to quickly detect the beginning of an infection. Strict asepsis is always maintained during routine skin care measures. Hand hygiene and wearing sterile gloves when carrying out procedures are essential. Visitors should wear protective garments and wash their hands before and after coming into contact with the patient. People with any infections or infectious disease should not visit the patient until they are no longer a danger to the patient. The nurse is critical in identifying early signs and symptoms of infection and notifying the primary provider. Antibiotic agents are not generally begun until there is an indication for the use. Hemorrhage, renal failure, and liver failure are not the major causes of toxic epidermal necrolysis.
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? Semi-private room with a client who had chickenpox and was admitted with a GI bleed Semi-private room with a client diagnosed with pneumonia Isolation room with negative airflow Private room
Private room Explanation: Herpes zoster, a highly contagious infection, is transmitted by direct contact with vesicular fluid or airborne droplets from the infected host's respiratory tract. Placing the client with a client diagnosed with pneumonia places that client at risk for contracting herpes zoster. An isolation room with negative airflow isn't necessary for the client with herpes zoster. The nurse should assign the client to a private room. The client could safely room with the client who already had chickenpox; however, visitors might be unnecessarily exposed.
A 10-year-old child is brought to the office with complaints of severe itching in both hands that's especially annoying at night. On inspection, the nurse notes gray-brown burrows with epidermal curved ridges and follicular papules. The physician performs a lesion scraping to assess this condition. Based on the signs and symptoms, what diagnosis should the nurse expect? Contact dermatitis Scabies Dermatophytosis Impetigo
Scabies Explanation: Signs and symptoms of scabies include gray-brown burrows, epidermal curved or linear ridges, and follicular papules. Clients complain of severe itching that usually occurs at night. Scabies commonly occurs in school-age children. The most common areas of infestation are the finger webs, flexor surface of the wrists, and antecubital fossae. Impetigo is a contagious, superficial skin infection characterized by a small, red macule that turns into a vesicle, becoming pustular with a honey-colored crust. Contact dermatitis is an inflammation of the skin caused by contact with an irritating chemical or allergen. Dermatophytosis, or ringworm, is a disease that affects the scalp, body, feet, nails, and groin. It's characterized by erythematous patches and scaling.
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 pyodermas. acantholysis. lichenification. dermatitis.
lichenification. Explanation: The nurse should note this as being lichenification, also called scaling. Dermatitis is an inflammation of the skin. Acantholysis is a separation of the epidermal cells from each other, and pyodermas is a bacterial skin infection.
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: "If someone develops symptoms, tell him to see a physician right away." "All family members need to be treated." "Just be careful not to share linens and towels with family members." "After you're treated, family members won't be at risk for contracting scabies."
All family members need to be treated." Explanation: When someone sharing a home with others contracts scabies, all individuals in the home need prompt treatment whether or not they're symptomatic. Towels and linens should be washed in hot water. Scabies can be transmitted from one person to another before symptoms develop.
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? Apply the medication every 2 hours. Make sure that the skin is slightly dehydrated so that the medication can absorb through the skin cracks. Apply a thick layer of cream over the lesions so that if some rubs off, there is more to absorb. Apply an occlusive dressing over the site after application.
Apply an occlusive dressing over the site after application. Explanation: Corticosteroids are widely used in treating dermatologic conditions to provide anti-inflammatory, antipruritic, and vasoconstrictive effects. The patient is educated to apply this medication according to strict guidelines, using it sparingly but rubbing it into the prescribed area thoroughly. Absorption of topical corticosteroids is enhanced when the skin is hydrated or the affected area is covered by an occlusive or moisture-retentive dressing (Karch, 2013).
A client comes to the physician's office for treatment of severe sunburn. The nurse takes this opportunity to discuss the importance of protecting the skin from the sun's damaging rays. What is the appropriate teaching by the nurse to prevent skin damage? "Minimize sun exposure from 1 to 4 p.m., when the sun is strongest." "When at the beach, sit in the shade to prevent sunburn." "Use a sunscreen with a sun protection factor of 6 or higher." "Apply sunscreen even on overcast days."
Apply sunscreen even on overcast days." Explanation: Sunscreen should be applied even on overcast days, because the sun's rays are as damaging then as on sunny days. The sun is strongest from 10 a.m. to 4 p.m. — not from 1 to 4 p.m. Sun exposure should be minimized during these hours. The nurse should recommend sunscreen with a sun protection factor of at least 15. Sitting in the shade when at the beach doesn't guarantee protection against sunburn alone because sand, concrete, and water can reflect more than half the sun's rays onto the skin.
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? A.Encourage the client to slide up without assistance. B.Tilt the chair back when moving the client. C.Lift the client, do not slide them. D.Use a donut device while the client is in the chair.
C.Lift the client, do not slide them. Explanation: Avoid shearing, a physical force that separates layers of tissue in opposite directions, such as when a seated client slides downward. Lifting the client and not sliding them will avoid the shearing forces that can tear the skin. Tilting the chair back is a safety hazard and may cause injury to the client. If the client proceeds alone, they will produce a shearing effect. A donut device may cause shearing and should not be used.
The nurse is providing instruction to a client with acne. The nurse promotes avoidance of which food(s)? Select all that apply. Bananas Chocolate Onions Ice cream
Chocolate, ice cream
The nurse is working with community groups. At which of the following locations would the nurse anticipate a possible scabies outbreak? Gymnasium Swimming pool College dormitory Shopping mall
College dormitory Explanation: The nurse is correct to anticipate a potential scabies outbreak in a college dormitory. Outbreaks are common where large groups of people are confined or housed. Spread of scabies is from skin-to-skin contact. Although there are groups of people at the shopping mall, swimming pool, and gymnasium, typically, there is no personal contact.
A nurse assesses a client with dry, rough, scaly skin without lesions on the legs. The client reports itching in the affected area. What skin assessment would the nurse document? Candidiasis Pruritus Shingles Seborrhea
Pruritus Pruritus (itching) is one of the most common symptoms of patients with dermatologic disorders. Itch receptors are unmyelinated, penicillate (brush-like) nerve endings that are found exclusively in the skin, mucous membranes, and cornea. Shingles is a skin condition with lesions. Candidiasis is a red condition often found in the folds of skin. Seborrhea refers to dry scaly patches usually located on the scalp.