Chapter 61: Management of Patients with Dermatologic Disorders
A client has undergone dermabrasion to decrease scarring from severe acne endured as a teen. After completion of the procedure, the nurse reviews the client's home care instructions. Which instruction is appropriate for this client? Don't touch the area treated. Wash the area three times daily until healed. Dermabrasion is a painless procedure. Apply moisturizer after each washing until the area is healed.
Don't touch the area treated. Explanation: The client also must refrain from picking and touching the area because contact with the fingers might cause infection or scarring from secondary trauma. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1841.
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? End-stage kidney disease Hyperthyroidism Pneumonia Myasthenia gravis
End-stage kidney disease Explanation: Systemic disorders associated with generalized pruritus include chronic kidney disease. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Pharmacologic Therapy, p. 1812.
Which procedure done for skin cancer conserves the most amount of normal tissue? Mohs micrographic surgery Electrosurgery Cryosurgery Surgical excision
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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Mohs Micrographic Surgery, p. 1835.
The nurse is caring for a client with a furuncle. What advice should the nurse give a client with a furuncle to prevent the spread of the infection? Keep hair short, clean, and away from the face and forehead. Never pick or squeeze a furuncle. Avoid the use of cosmetics. Use tepid bath water.
Never pick or squeeze a furuncle. Explanation: The client with a furuncle should never pick or squeeze it as the drainage is infectious and this practice favors the spread of the infection. Infections by organisms that usually exist harmlessly on the skin surface cause furuncles. Keeping the hair short, clean, and away from the face and forehead, avoiding cosmetics, and using tepid bath water do not help in preventing the spread of a furuncle. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Medical Management, p. 1818.
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? Scarring Brain abscess Erythema Cellulitis
Brain abscess Explanation: Nurses must take special precautions in caring for boils on the face because the skin area drains directly into the cranial venous sinuses. Sinus thrombosis with fatal pyemia can develop after manipulating a boil in this location. The infection can travel through the sinus tract and penetrate the brain cavity, causing a brain abscess. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Quality and Safety Nursing Alert, p. 1819.
The nurse is caring for a client prescribed oral griseofulvin for treatment of a fungal toenail infection. Which instruction by the nurse is essential in understanding the treatment plan? Take the medication with meals. Administer medications daily. Continue medication regimen for several weeks. Administer a stool softener to offset constipation.
Continue medication regimen for several weeks. Explanation: Fungal infections are difficult to treat and often take many weeks of medication to eradicate. Taking medication with meals, administering daily, and stool softeners are good teaching components but not essential in understanding the treatment plan.
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? Corticosteroids Saline irrigations Antifungals Antivirals
Corticosteroids Explanation: Corticosteroids are used for contact dermatitis. Antifungals, antivirals, and saline irrigations are not used in the treatment of contact dermatitis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1810.
Which of the following is an example of a topical anesthetic? EMLA cream Bacitracin Silvadene Garamycin
EMLA cream Explanation: EMLA cream is a topical anesthetic. Bacitracin, Silvadene, and Garamycin are topical antibiotics. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Table 61-2, p. 1809.
Which drug is an oral retinoid used to treat acne? Estrogen Isotretinoin Tetracycline Benzoyl peroxide
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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1816.
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? 4 to 6 hours 8 hours 12 to 24 hours 24 to 36 hours
12 to 24 hours Explanation: Depending on the product used and the type of dermatologic conditions encountered, most moisture-retentive dressings may remain in place from 12 to 24 hours. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Moisture-Retentive Dressings, p. 1808.
Which assessment finding indicates an increased risk of skin cancer? A deep sunburn A dark mole on the client's back An irregular scar on the client's abdomen White irregular patches on the client's arm
A deep sunburn Explanation: A deep sunburn is a risk factor for skin cancer. A dark mole or an irregular scar is a benign finding. White irregular patches are abnormal but aren't a risk for skin cancer. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Chart 61-4, p. 1834.
The nurse is caring for a patient with extensive bullous lesions on the trunk and back. Prior to initiating skin care, what is a priority for the nurse to do? Wash the lesions vigorously. Rupture the bullous lesions. Administer analgesic pain medication. Apply cold compresses.
Administer analgesic pain medication. Explanation: The patient with painful and extensive lesions should be premedicated with analgesic agents before skin care is initiated. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Enhancing Skin Integrity and Relieving Discomfort, p. 1829.
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? Avoid cosmetics with fragrance. Wash skin in very hot water. Use a fabric softener. Wear gloves during the day.
Avoid cosmetics with fragrance. Explanation: The nurse should teach the client to avoid cosmetics, soaps, and laundry detergents that contain fragrance. Other prevention methods include avoidance of heat and fabric softeners. Gloves used for cleaning and washing dishes should be worn to no longer than 15 to 20 minutes/day, and cotton-lined gloves should be used. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Chart 61-3, p. 1823.
A nurse is examining a client's scalp for evidence of lice. The nurse should pay particular attention to which part of the scalp? Temporal area Top of the head Behind the ears Middle area
Behind the ears Explanation: Adult lice usually bite the scalp behind the ears and along the back of the neck. Because such lice are tiny (1 to 2 mm) with grayish white bodies, they are hard to see. However, their bites result in visible pustular lesions. Although lice may bite any part of the scalp, bites are less common on the temporal area, top of the head, and middle area. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Clinical Manifestations, p. 1820.
A client is being treated for acne vulgaris. What warning must be given to this client regarding the application of benzoyl peroxide? Use gloves with application. Only use with contact dermatitis. Apply a thick layer to assure coverage. Use with over-the-counter drying agents.
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.
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 of psoriasis? Select all that apply. genetic predisposition a triggering mechanism, such as systemic infection, injury to the skin, vaccination, or injection injury, such as squeezing a lesion diabetes mellitus; elevated blood glucose level promotes microbial growth
genetic predisposition a triggering mechanism, such as systemic infection, injury to the skin, vaccination, or injection injury, such as squeezing a lesion diabetes mellitus; elevated blood glucose level promotes microbial growth Probable causes include genetic predisposition; or a triggering mechanism such as systemic infection, injury to the skin, vaccination, or injection. Furuncles and carbuncles are caused by injury, such as squeezing a lesion. They are also associated with diabetes mellitus because an elevated blood glucose level promotes microbial growth. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1824.
The classic lesions of impetigo manifest as comedones in the facial area. honey-yellow crusted lesions on an erythematous base. abscess of skin and subcutaneous tissue. patches of grouped vesicles on red and swollen skin.
honey-yellow crusted lesions on an erythematous base. Explanation: The classic lesions of impetigo are honey-crusted lesions on an erythematous base. Comedones in the facial area are representative of acne. A carbuncle is an abscess of skin and subcutaneous tissue. Herpes zoster is exhibited by patches of grouped vesicles on red and swollen skin. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1817.
A client with a history of diabetes mellitus has recently developed furunculosis. What is causing the client's condition? infection diet hygiene unknown
infection Explanation: Furuncles and carbuncles are caused by skin infections with organisms that usually exist harmlessly on the skin surface. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1818.
Which is not a category of medications used for treatment of the skin? inhaled steroids topical corticosteroids antihistamines antibiotics
inhaled steroids Explanation: Inhaled steroids are not used for skin disorders. Topical corticosteroids, antihistamines, and antibiotics are all used in the treatment of skin disorders.
Which material consists of a powder in water? Hygroscopic agent Paste Liniment Suspension
Suspension Explanation: A suspension requires shaking before application, exemplified by calamine lotion. A hygroscopic agent is a powder that acts to absorb and retain moisture from the air and to reduce friction between surfaces. A paste is a mixture of powder and ointment. A liniment is a lotion with oil added to prevent crusting. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1809.
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 Through the application of extreme cold, the tissue is destroyed. Freezes the growth, so the physician can remove it at the next appointment Lasers the growth off
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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Cryosurgery, p. 1835.
Which term describes a fungal infection of the scalp? Tinea capitis Tinea corporis Tinea cruris Tinea pedis
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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Table 61-5, p. 1821.
Which statement indicates the client diagnosed with psoriasis understands the discharge teaching? "I will inspect my skin every week for redness with tenderness." "I must take a photosensitizing agent 2 days before the UV light therapy." "I will wear dark glasses all the time until my psoriasis is cured." "The coal tar ointments and shampoos are messy and will stain clothing."
"The coal tar ointments and shampoos are messy and will stain clothing."
A dermatologist recommends an over-the-counter suspension to relieve pruritus. The nurse advises the patient that the lotion should be applied: Overnight to enhance absorption. Hourly to prevent evaporation. Every 3 to 4 hours for sustained effectiveness. Twice a day to prevent crusting on the skin.
Every 3 to 4 hours for sustained effectiveness. Explanation: Lotions are frequently used to replenish lost skin oils or to relieve pruritus. They are usually applied directly to the skin, but a dressing soaked in the lotion can be placed on the affected area. Lotions must be applied every 3 or 4 hours for sustained therapeutic effect because if left in place for a long period, they may crust and cake on the skin. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Lotions, p. 1809.
Pressure ulcers are caused by: Extrinsic factors Low capillary pressure Necrosis Increased mobility
Extrinsic factors Explanation: Pressure ulcers involve breakdown of the skin due to prolonged pressure, friction, and shear forces, and insufficient blood supply, usually at bony prominences.
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? Frequently inspect the oral cavity. Use friction when repositioning the client. Limit fluids. Apply a continuous current of warm air.
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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1831.
Development of malignant melanoma is associated with which risk factor? History of severe sunburn African American heritage Skin that tans easily Residence in the Northeast
History of severe sunburn Explanation: Ultraviolet rays are strongly suspected as the etiology of malignant melanoma. Fair-skinned, blue-eyed, light-haired people of Celtic or Scandinavian origin are at higher risk for developing malignant melanoma. People who burn and do not tan are at risk for developing malignant melanoma. Elderly individuals who retire to the southwestern United States seem to have a higher incidence of developing malignant melanoma. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Chart 61-4, p. 1834.
The nurse is providing teaching to a client with acne who is using isotretinoin therapy. Which statement should the nurse make? It is teratogenic in humans. Contraceptives are not needed during treatment. Take vitamin A supplements. The side effects are irreversible.
It is teratogenic in humans. Explanation: Isotretinoin is teratogenic in humans, meaning that it can have an adverse effect on a fetus, causing central nervous system and cardiovascular defects, and structural abnormalities of the face. Contraceptives are needed during treatment. The client should not take vitamin A supplements while taking this drug. Side effects are reversible with the withdrawal of the medication. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1816.
The school nurse has sent four children home with head lice in one morning. The nurse writes a note for all students to take home to their parents containing information about head lice and how to treat them. What is an important instruction the nurse should include in the note being sent home to parents? To follow the enclosed staggered treatment schedule in treating their children's hair. Lindane may be toxic to the central nervous system when used more frequently or for longer periods of time than specified in the package insert. To be sure and treat combs, brushes and hats so the children can continue to share them. To work hard to improve the cleanliness in the home.
Lindane may be toxic to the central nervous system when used more frequently or for longer periods of time than specified in the package insert.
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? Psoriasis is an inflammatory dermatosis that results from a superficial infection with Staphylococcus aureus. Psoriasis comes from dermal abrasion. Psoriasis is an inflammatory dermatosis that results from an overproduction of keratin. Psoriasis results from excess deposition of subcutaneous fat.
Psoriasis is an inflammatory dermatosis that results from an overproduction of keratin. Explanation: Current evidence supports an autoimmune basis for psoriasis (Porth & Matfin, 2009). Periods of emotional stress and anxiety aggravate the condition, and trauma, infections, and seasonal and hormonal changes may also serve as triggers. In this disease, the epidermis becomes infiltrated by activated T cells and cytokines, resulting in both vascular engorgement and proliferation of keratinocytes. Epidermal hyperplasia results. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Psoriasis, p. 1824.
The nurse is instructing the parents of a child with head lice. Which statement should the nurse include? Use shampoo with piperonyl butoxide. Use shampoo with Kwell. Wash clothes in cold water. Disinfect brushes and combs with bleach.
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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1821.
A nurse is assessing a client with a new skin disorder. Which questions would the nurse include when asking the client about the change in skin condition? Select all that apply. When did the disorder first begin, and where did it first appear? Where are the lesions located? Has the problem spread? Have you tried to treat the lesions? Do you exercise daily?
When did the disorder first begin, and where did it first appear? Where are the lesions located? Has the problem spread? Have you tried to treat the lesions? The nurse would ask the client when and where the disorder started, where the lesions are located and if they have spread, and if the client has attempted to treat them. The client's exercise habits would not affect the skin disorder. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1795.
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: prevent the spread of the infection. debride the wound. keep the wound moist. reduce pain.
keep the wound moist. Explanation: Wet-to-damp dressings keep the wound bed moist, which helps promote the growth of granulation tissue. Because dead tissue adheres to a dry dressing, wet-to-dry dressings are used for debriding wounds. Wet-to-damp dressings don't prevent the spread of infection. Although these dressings provide a soothing, cool feeling, they don't relieve pain. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Table 61-1, p. 1808.
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 dermatitis. acantholysis. lichenification. pyodermas.
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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1809.
A client is undergoing photochemotherapy involving a combination of a photosensitizing chemical and ultraviolet light. What health problem does this client most likely have? psoriasis plantar warts undesired tattoo dandruff
psoriasis Explanation: Photochemotherapy is used to treat psoriasis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1826.
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." "Use a sunscreen with a sun protection factor of 6 or higher." "Apply sunscreen even on overcast days." "When at the beach, sit in the shade to prevent sunburn." TAKE ANOTHER QUIZ
"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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Chart 61-5, p. 1836.
The nurse is caring for a client diagnosed with herpes zoster. Which statement by the client needs further clarification by the nurse? "Even though this is from a childhood disease, I am still contagious." "Herpes zoster is caused by a viral infection." "Herpes zoster is a reactivation of the varicella virus." "Once I get the infection, I cannot get it again."
"Once I get the infection, I cannot get it again." Explanation: The nurse is correct to clarify that even though the client has herpes zoster, the client can get herpes zoster again. The virus is contagious and can reoccur. The other options are accurate statements that reflect the client's understanding. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Herpes Zoster, p. 1819.
Which of the following individuals is least likely at risk for the development of Kaposi's sacroma? A kidney transplant client A male with a history of same-gender partners A client receiving antineoplastic medications An individual working in an environment in which he or she is exposed to asbestos
An individual working in an environment in which he or she is exposed to asbestos
A client has been diagnosed with shingles. Which of the following medication classifications will reduce the severity and prevent development of new lesions? Antiviral Corticosteroids Analgesics Antipyretics
Antiviral Explanation: Oral acyclovir (Zovirax), when taken within 48 hours of the appearance of symptoms, reduces their severity, and prevents the development of additional lesions. Corticosteroids, analgesics,, and antipyretics are not used for this purpose. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Medical Management, p. 1819.
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? Autograft Allograft Homograft Heterograft
Autograft Explanation: Autografts of full-thickness and pedicle flaps are commonly used for reconstructive surgery months or years after the initial injury. Allografts and homografts are grafts 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1839.
A client with scabies has been prescribed a scabicide. What should the nurse tell the client to do before beginning treatment? Wear clean clothing. Avoid contact with others who have scabies. Expect itching to continue for 2 to 3 weeks after the treatment. Have a thorough bath.
Have a thorough bath. Explanation: Before any treatment begins, the nurse advises the client to bathe thoroughly. Wearing clean clothing and avoiding contact with others who have scabies are essential in preventing a recurrence. As a part of client teaching, the nurse explains that itching may continue for 2 to 3 weeks after the treatment. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Medical Management, p. 1822.
Which infecting agent causes scabies? Parasitic fungi Reactivated virus Itch mite Bacteria
Itch mite Explanation: Several skin disorders involve an infecting agent. Scabies is caused by Sarcoptes scabiei, an itch mite. Parasitic fungi cause dermatophytosis in skin, scalp, and nails. Shingles is caused by a reactivated virus. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1822.
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? Platelet disorders Kaposi sarcoma Allergic reactions Syphilis
Kaposi sarcoma Explanation: Kaposi sarcoma is a frequent comorbidity of clients with AIDS. With platelet disorders, the nurse observes ecchymosis (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 clients with syphilis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1839.
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? Dry sterile dressing Sterile petroleum gauze 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Protecting the Skin, p. 1807.
Which of the following is also known as "jock itch"? Tinea cruris Tinea corporis Tinea pedis Tinea unguium
Tinea cruris Explanation: Tinea cruris is also known as "jock itch." Tinea corporis is ringworm affecting the body. Tinea pedis is "athlete's foot." Tinea unguium is a type of ringworm that affects the toenails. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Table 61-5, p. 1821.
The nurse has assessed a client's superficial fungal infection that began in the skin between the toes and has spread to the soles of the feet. How would the nurse document this finding? Tinea corporis Tinea capitis Tinea pedis Tinea cruris
Tinea pedis Explanation: Tinea pedis is an infection that begins in the skin between the toes and spreads to the soles of the feet. Tinea corporis is a skin infection of the body. Tinea capitis invades the hair shaft below the scalp. Tinea cruris is a skin infection of the groin. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Table 61-5: Tinea (Ringworm) Infections, p. 1821.
A client recently received lip and tongue piercings and subsequently developed a superinfection of candidiasis from the antibacterial mouthwash. What would the nurse recommend for this client? Use an antifungal mouthwash or salt water. Use a soft-bristled toothbrush. Rinse the mouth after eating food. Move the piercing back and forth during washing.
Use an antifungal mouthwash or salt water. Explanation: The client can substitute an antifungal mouthwash or salt water if a superinfection of candidiasis develops from the antibacterial mouthwash. A soft-bristled toothbrush should be used to avoid additional oral injury, but it is not the recommended solution for this problem. After eating, the client should rinse the mouth for 30 to 60 seconds with an antifungal mouthwash or salt water. Moving the jewelry at the piercing area back and forth during washing helps clean the pierced tract but does not solve the problem.
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: erythematous with raised papules. dry and scaly with flaking skin. inflamed with weeping and crusting lesions. excoriated with multiple fissures.
erythematous with raised papules. Explanation: Contact dermatitis is caused by exposure to a physical or chemical allergen, such as skin care products, cleaning products, and latex gloves. Initial symptoms of itching, erythema, and raised papules occur at the site of exposure and can begin within 1 hour of exposure. Allergic reactions tend to be red, not scaly or flaky. Weeping, crusting lesions are also uncommon unless the reaction is severe or has been present for a long time. Excoriation is more common in skin disorders associated with a moist environment. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Clinical Manifestations, p. 1823.
A client is being treated for acne vulgaris. What contributes to follicular irritation? overproduction of sebum chocolate stress potato chips
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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1814.
A physician orders an emollient for a client with pruritus of recent onset. The client asks why the emollient should be applied immediately after a bath or shower. How should the nurse respond? "To make the skin feel soft." "To prevent evaporation of water from the hydrated epidermis." "To minimize cracking of the dermis." "To prevent skin inflammation."
"To prevent evaporation of water from the hydrated epidermis." Explanation: The nurse should tell the client that applying an emollient immediately after taking a bath or shower prevents evaporation of water from the hydrated epidermis, the skin's upper layer. Although emollients make the skin feel soft, this effect occurs whether or not the client has just bathed or showered. An emollient minimizes cracking of the epidermis, not the dermis (the layer beneath the epidermis). An emollient doesn't prevent skin inflammation.
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? Skin biopsy Fungal culture Potassium hydroxide test A Wood's light examination
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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Fungal (Mycotic) Skin Infections, p. 1820.
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: "All family members need to be treated." "If someone develops symptoms, tell him to see a physician right away." "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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Nursing Management, p. 1823.
The nurse is working with community groups. At which of the following locations would the nurse anticipate a possible scabies outbreak? Shopping mall Swimming pool College dormitory Gymnasium
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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Scabies, p. 1822.
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 an occlusive dressing over the site after application. 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 the medication every 2 hours.
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). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Occlusive Dressings, p. 1808.
Which of the following terms refers to a graft derived from one part of a patient's body and used on another part of that same patient's body? Autograft Allograft Homograft Heterograft
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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Skin Grafts, p. 1839.
Which of the following uses the body's own digestive enzymes to break down necrotic tissues? Autolytic debridement Enzymatic debridement Wet to dry dressings Wet dressings
Autolytic debridement Explanation: Autolytic debridement is a process that uses the body's own digestive enzymes to break down necrotic tissue. Application of enzymatic debriding agents speeds the rate at which necrotic tissues is removed. A form of mechanical debridement is a wet to dry dressing, which removes necrotic tissue and absorbs small to large amounts of exudates. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Autolytic Débridement, p. 1807.
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. Avoid prolonged use. Apply to intertriginous areas. Hypertrichosis is normal.
Avoid applying to the face. Avoid prolonged use. The nurse should teach the client to avoid prolonged use, which could lead to hypertrichosis (excessive hair growth) and/or steroid-induced acne. The nurse should also tell the client to avoid applying the corticosteroid to the face and to intertriginous areas. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1810.
Which medication classification may be used for contact dermatitis? Corticosteroids Saline irrigations Antifungals Antivirals
Corticosteroids Explanation: Corticosteroids are used for contact dermatitis. Antifungals, antivirals, and saline irrigations are not used in the treatment of contact dermatitis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1810.
Which of the following aggravates the condition caused by acne vulgaris? Cosmetics Chocolates High-fat diet Sunlight
Cosmetics Explanation: Acne vulgaris is aggravated by cosmetics. Any correlation with specific food items such as chocolate is more myth than fact. Sunlight does not aggravate the condition caused by acne vulgaris. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Educating Patients About Self-Care, p. 1816.
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? Dermal Epidermal Endothelial Epithelia
Epidermal Explanation: The nurse is correct to document that the proliferation of skin cells occurs in the first layer of skin cells, the epidermis. In the epidermal layer, there is rapid turnover of the cells. The dermis is under the epidermis. Endothelial is the layer on the inside such as the interior of the blood vessel. Epithelia are on the outside or coating of walls. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Pathophysiology, p. 1824.
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 3 hours Every 12 hours Every day at the same time
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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Lotions, p. 1809.
Which of the following nonsedating antihistamines is appropriate for daytime pruritus? Fexofenadine (Allegra) Diphenhydramine (Benadryl) Hydroxyzine (Atarax) Lorazepam (Ativan)
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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Pharmacologic Therapy, p. 1812.
A client with diabetes mellitus has impaired skin integrity due to an injury. Which skin disorder is the client likely to develop? Psoriasis Furuncle Dermatitis Dermatophytosis
Furuncle Explanation: Furunculosis is associated with diabetes mellitus because an elevated blood glucose level promotes microbial growth. Infections by organisms that usually exist harmlessly on the skin surface cause furuncles. When an injury such as that caused by squeezing a lesion impairs the integrity of the skin, microorganisms can enter and colonize in the skin. Psoriasis is a genetic predisposition. Dermatitis is caused by allergens. Dermatophytosis is caused by fungal parasites. The client is unlikely to develop psoriasis, dermatitis, and dermatophytosis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Folliculitis, Furuncles, and Carbuncles, p. 1818.
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 does the nurse know about the distribution of herpes zoster? Grouped vesicles occurring on lips and oral mucous membranes. Grouped vesicles occurring on the genitalia. Rough, fresh, or gray skin protrusions. Grouped vesicles in linear patches along a dermatome.
Grouped vesicles in linear patches along a dermatome.
Which of the following sedative medications is effective in treating pruritus? Hydroxyzine (Atarax) Benzoyl peroxide Fexofenadine (Allegra) Tetracycline
Hydroxyzine (Atarax) Explanation: Atarax is a sedating medication effective in the treatment of pruritus. Benzoyl peroxide, Allegra, and tetracycline are not effective in treating pruritus. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Pharmacologic Therapy, p. 1812.
Which skin condition is caused by staphylococci, streptococci, or multiple bacteria? Scabies Pediculosis capitis Poison ivy Impetigo
Impetigo Explanation: Impetigo is seen at all ages but is particularly common among children living under poor hygienic conditions. Scabies is caused by the itch mite. Pediculosis capitis is caused by head lice. Poison ivy is a contact dermatitis caused by the oleoresin given off by a particular form of ivy. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1817.
The nurse is conducting a community education program on basal cell carcinoma (BCC). Which statement should the nurse make? It is more invasive than squamous cell carcinoma (SCC). It metastasizes through blood or the lymphatic system. It begins as a small, waxy nodule with rolled translucent, pearly borders. It is a malignant proliferation arising from the epidermis.
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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1834.
Which of the following information regarding the transmission of lice would the nurse identify as a myth? Lice can be spread by sharing of hats, caps, and combs. Lice can jump from one individual to another. Lice need to be removed from the hair with a fine comb. Lice can be seen without magnification.
Lice can jump from one individual to another. Explanation: The nurse is correct to identify that lice cannot jump from one individual to another. Direct contact is needed for transmission. The other options are correct. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Pediculosis Capitis, p. 1820.
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? Place heat on top of the dressing to increase skin temperature. Immobilize the arm when it is wrapped. Limit use of the dressing to 12 hours. Cover the dressing with an elastic wrap to facilitate daily activities during treatment.
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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Occlusive Dressings, p. 1808.
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? Nits are located near the scalp. Dandruff is throughout the hair. Nits are difficult to move from hair shafts. Dandruff looks white and flaky.
Nits are difficult to move from hair shafts. Explanation: Lice eggs, or nits, can be confused with dandruff. However, dandruff consists of fine, white particles of dead, dry scalp cells that can be easily picked from the hair. Nits, on the other hand, look like small, yellowish-white ovals and are quite firmly fixed to the hair shaft. 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Pediculosis Capitis, p. 1820.
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 Lentigo-maligna Nodular melanoma Acral-lentiginous
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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Clinical Manifestations, p. 1836.
The nurse is caring for a 72-year-old female client with a stage 2 pressure injury on the left heel.
Nursing measures should be implemented to relieve pressure on bony prominences to prevent new pressure injuries and to allow the present wound to heal. The client should be turned and repositioned every 2 hours to relieve and redistribute pressure on the client's skin. The wound should be assessed and documented in the medical record so that the nurse can determine the therapeutic effectiveness of nursing interventions. The head of the bed should be elevated to no more than 30 degrees to prevent shearing forces as the patient slides down the bed. Proteins can drain from a wound predisposing the patient to hypoproteinemia. Therefore, proteins should be encouraged rather than limited in the diet. The wound should be kept moist to encourage the migration of epidermal cells over the wound surface. Therefore, a heat lamp should not be used since it would dry out the wound and impair healing.
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? Therapeutic bath Cream Ointment Topical anesthetic
Ointment Explanation: Ointments retard water loss and lubricate and protect the skin. They are the preferred vehicle for delivering medication to chronic or localized dry skin conditions, such as eczema or psoriasis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Ointments, p. 1810.
A client comes into the hospital with a Tegaderm dressing in place on the buttocks. The nurse documents this as being which type of dressing? Active Inactive Passive Interactive
Passive Explanation: There are three categories of wound dressings: active, passive, and interactive. The nurse labels Tegaderm as being a passive dressing, one that acts as a protective, moist environment for natural healing. Interactive dressings absorb wound exudate and include hydrocolloids. Active dressings decrease healing time to improve the healing process and include biologic skin substitutes. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1807.
The nurse notes that a client who uses a wheelchair for long periods after recovering from an amputation has a reddened area over the coccyx. Which teaching will the nurse provide to the client to relieve the pressure? Select all that apply. Perform push-ups. Move from side to side. Shift weight in the chair. Complete half push-ups. Tense the quadriceps muscles.
Perform push-ups. Move from side to side. Shift weight in the chair. Complete half push-ups. For the client who spends long periods of time in a wheelchair, pressure can be relieved by performing push-ups or pushing down on armrests and raising the buttocks off the seat of the chair. Another action is moving from side to side while sitting in the chair. Shifting weight in the chair is done by bending forward with the head down between the knees if able and constantly moving in the chair. One additional action is to complete one half of a push-up by completing a push-up on the right side and then the left side by pushing down on the armrest. Tensing the quadriceps muscle is used to strengthen the muscle for walking.
A nurse is admitting a client with toxic epidermal necrolysis. What is the nursing priority in preventing sepsis? Preventing infection Assessing for hemorrhage Hydrating to prevent renal failure Limiting protein to limit liver failure
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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Complications, p. 1832.
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 diagnosed with pneumonia Semi-private room with a client who had chickenpox and was admitted with a GI bleed Private room Isolation room with negative airflow
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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Medical Management, p. 1820.
The nurse applies a moisture-retentive dressing to a patient's wound. She understands that the main advantage of this dressing, rather than a wet dressing, is its ability to: Provide autolytic debridement. Decrease epidermal resurfacing. Promote the formation of a protective scab that traps excess exudate. Enhance the absorption of topical medications.
Provide autolytic debridement. Explanation: Commercially produced moisture-retentive dressings can perform the same functions as wet dressings but are more efficient at removing exudate because of their higher moisture-vapor transmission rate; some have reservoirs that can hold excessive exudate. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Moisture-Retentive Dressings, p. 1808.
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? Pruritus Shingles Candidiasis Seborrhea
Pruritus Explanation: 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 presents with lesions. Candidiasis presents with reddened skin and is often found in the folds of skin. Seborrhea refers to dry, scaly patches usually located on the scalp. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, General Pruritus, p. 1811.
Photochemotherapy combines the use of ultraviolet A (UVA) and which of the following medications? Psoralen Methotrexate Hydroxyurea Retinoic acid
Psoralen Explanation: During photochemotherapy, the patient takes a photosensitizing medication (Psoralen) in a standard dose and is subsequently exposed to long-wave UV light as the medication plasma levels peaks. It is thought that this treatment decreases cellular proliferation in psoriasis. Methotrexate, hydroxyurea, and retinoic acid are not used in photochemotherapy. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Phototherapy, p. 1825.
Photochemotherapy has been used as a treatment for which of the following skin disorders? Shingles Psoriasis Allergic dermatitis Rosacea
Psoriasis Explanation: Photochemotherapy is used for severe, disabling psoriasis that does not respond to other methods of treatments. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Nursing Management, p. 1826.
A young client has head lice. What are appropriate steps in eradication? Select all that apply. Repeat combings daily until there is no more evidence of lice or nits. Apply a pediculicide to the hair (detailed directions also accompany this medication). Comb the hair free of tangles while the hair is damp. Use a special lice comb that has narrow stainless steel teeth. Comb through each area of the hair to remove lice.
Repeat combings daily until there is no more evidence of lice or nits. Apply a pediculicide to the hair (detailed directions also accompany this medication). Comb the hair free of tangles while the hair is damp. Use a special lice comb that has narrow stainless steel teeth. Comb through each area of the hair to remove lice. All listed steps are correct. Apply a pediculicide to the hair (detailed directions also accompany this medication). Comb the hair free of tangles while the hair is damp. Use a special lice comb that has narrow stainless steel teeth. Comb through each area of the hair to remove lice. Repeat combings daily until there is no more evidence of lice or nits. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1821.
A patient is complaining of severe itching that intensifies at night. The nurse decides to assess the skin using a magnifying glass and penlight to look for the "itch mite." What skin condition does the nurse anticipate finding? Contact dermatitis Pediculosis Scabies Tinea corporis
Scabies Explanation: Scabies is an infestation of the skin by the itch mite Sarcoptes scabiei. The patient complains of severe itching caused by a delayed type of immunologic reaction to the mite or its fecal pellets. During examination, the patient is asked where the pruritus is most severe. A magnifying glass and a penlight are held at an oblique angle to the skin while a search is made for the small, raised burrows created by the mites. One classic sign of scabies is the increased itching that occurs during the overnight hours, perhaps because the increased warmth of the skin has a stimulating effect on the parasite. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Clinical Manifestations, p. 1822.
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? Impetigo Scabies Contact dermatitis Dermatophytosis
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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Clinical Manifestations, p. 1822.
With repeated reactions of contact dermatitis, which of the following can occur? Secondary bacterial infection Pain along the sensory nerve Sepsis Hemorrhage
Secondary bacterial infection Explanation: If repeated reactions occur, or if the patient continually scratches the skin, lichenification (thickening of the horny layer of the skin) and pigmentation occur. Secondary bacterial invasion may follow. During shingles, there will be pain along the sensory nerve. Sepsis and hemorrhage would not occur from repeated bouts of contact dermatitis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Irritant Contact Dermatitis, p. 1823.
The nurse is triaging a client over the phone who states having a contact dermatitis rash. Which treatment option of over-the-counter preparations does the nurse suggest for the client? Select all that apply. Topical antihistamines Cosmetic lotions 1820 cream Moisturizing cream Lanolin based ointment
Topical antihistamines 1820 cream Moisturizing cream Lanolin based ointment The nurse is correct to suggest that the client apply a topical antihistamine or hydrocortisone cream to the rash area. This is helpful to decrease itchiness and swelling. Moisturizing cream, some lanolin based, is helpful in restoring lubrication. Cosmetic lotions have a scent or color, which is not suggested for use on rashes. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Pharmacologic Therapy, p. 1809.
To treat a client with acne vulgaris, the physician is most likely to order which topical agent for nightly application? Minoxidil (Rogaine) Tretinoin (retinoic acid [Retin-A]) Zinc oxide gelatin Fluorouracil (5-fluorouracil, 5-FU [Efudex])
Tretinoin (retinoic acid [Retin-A]) Explanation: Tretinoin is a topical agent applied nightly to treat acne vulgaris. Minoxidil promotes hair growth. Zinc oxide gelatin treats stasis dermatitis on the lower legs. Fluorouracil is an antineoplastic topical agent that treats superficial basal cell carcinoma. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Dermabrasion, p. 1841.
The home health nurse is caring for a client with scabies. When instructing on the proper procedure to wash preworn contaminated clothing, which nursing instruction is essential? Use commercial grade laundry detergent. Pretreat clothing where scabies contact existed. Wash clothes through two laundry cycles. Use hot water throughout wash cycle.
Use hot water throughout wash cycle. Explanation: The nurse is correct to instruct the client to use hot water throughout the wash cycle. Using hot water kills scabies and infectious agents on the laundry. If using the correct wash settings, the client does not need to use commercial-grade laundry detergent, the clothing does not need pretreated nor washed through two cycles. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Nursing Management, p. 1823.
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: Applying a cold compress to the area after washing. Bathing with warm water and mild soap. Washing with soap and hot water. Using bath oils mixed with water.
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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Medical Management, p. 1812.
What advice should the nurse give a client with dermatitis until the etiology of the dermatitis is identified? Use wool, synthetics, and other dense fibers. Wear rubber gloves when in contact with soaps. Rub the skin vigorously to dry. 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, Preventing Secondary Infection, p. 1807.
The classic lesions of impetigo manifest as comedones in the facial area. honey-yellow crusted lesions on an erythematous base. abscessed skin and subcutaneous tissue. patches of grouped vesicles on red and swollen skin.
honey-yellow crusted lesions on an erythematous base. Explanation: The classic lesions of impetigo are honey-yellow crusted lesions on an erythematous base. Comedones in the facial area are representative of acne. A carbuncle is an abscess of skin and subcutaneous tissue. Herpes zoster is exhibited by patches of grouped vesicles on red and swollen skin. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1817.
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: squamous cell carcinoma. actinic keratoses. melanoma. basal cell carcinoma.
melanoma. Explanation: The "ABCDs" of melanoma are Asymmetry of the lesion, Borders that are irregular, Colors that vary in shades, and increased Diameter. Fair skin with a history of sunburn and the location of the lesion on the leg (the most common site in women) suggest melanoma. Squamous cell carcinoma commonly develops on the skin of the face, the ears, the dorsa of the hands and forearms, and other sun-damaged areas. Early lesions appear as opaque, firm nodules with indistinct borders, scaling, and ulceration. Actinic keratosis is a premalignant skin lesion. Basal cell carcinoma presents as lesions that are lightly pigmented. As they enlarge, their centers become depressed and their borders become firm and elevated. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, melanoma, p. 1836.
The nurse teaches the client who demonstrates herpes zoster (shingles) that once the client has had shingles, they will not have it a second time. a person who has had chickenpox can contract it again upon exposure to a person with shingles. the infection results from reactivation of the chickenpox virus. no known medications affect the course of shingles.
the infection results from reactivation of the chickenpox virus. Explanation: It is assumed that herpes zoster represents a reactivation of latent varicella (chickenpox) virus and reflects lowered immunity. It is believed that the varicella zoster virus lies dormant inside nerve cells near the brain and spinal cord and is reactivated with weakened immune systems and cancers. A person who has had chickenpox is immune and therefore not at risk of infection after exposure to a client with herpes zoster. Some evidence indicates that infection is arrested if oral antiviral agents are administered within 24 hours of the initial eruption. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 61: Management of Patients with Dermatologic Disorders, p. 1819.
