Chapter 61: Management of Patients with Dermatologic Disorders

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?

"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.

Which assessment finding indicates an increased risk of skin cancer?

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.

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:

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 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?

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 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.

A patient visits a dermatologist for assessment of a rough, scaly patch on his arm that shows evidence of underlying erythema. The dermatologist asks the nurse to assist him in removing the lesion using cryotherapy. Which of the following is most likely the lesion in this scenario?

Actinic keratoses Explanation: Actinic keratoses are premalignant skin lesions that develop in chronically sun-exposed areas of the body. They appear as rough, scaly patches with underlying erythema. A small percentage of these lesions gradually transform into cutaneous squamous cell carcinoma.

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?

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.

Which medication classification may be used for contact dermatitis?

Corticosteroids Explanation: Corticosteroids are used for contact dermatitis. Antifungals, antivirals, and saline irrigations are not used in the treatment of contact dermatitis.

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 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.

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. 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 sedative medication is effective for treating pruritus?

Hydroxyzine Explanation: Hydroxyzine is a sedating medication effective in the treatment of pruritus. Benzoyl peroxide, fexofenadine, and tetracycline are not effective in treating pruritus.

Which drug is an oral retinoid used to treat acne?

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.

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." 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.

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 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 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?

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.

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?

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.

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?

Administer analgesic pain medication. Explanation: The patient with painful and extensive lesions should be premedicated with analgesic agents before skin care is initiated.

A client is receiving autolytic debridement therapy. It would be important for the nurse to complete which procedure?

Advise the client about the foul odor that will occur during therapy. Explanation: During autolytic debridement therapy, a foul odor will be produced by the breakdown of cellular debris. This odor does not indicate that the wound is infected. The wound is kept moist and covered with an occlusive dressing. Commercially available enzymatic debriding agents include Accuzyme, collagenase, Granulex, and Zymase.

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. 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).

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. Explanation: 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

A patient is diagnosed with seborrheic dermatitis on the face and is prescribed a corticosteroid preparation for use. What should the nurse educate the patient about regarding use of the steroid on the face?

Avoid using the medication around the eyelids because it may cause cataracts and glaucoma. Explanation: Seborrheic dermatitis of the body and face may respond to a topically applied corticosteroid cream, which allays the secondary inflammatory response. However, this medication should be used with caution near the eyelids because it can lead to glaucoma and cataracts.

A nurse is examining a client's scalp for evidence of lice. The nurse should pay particular attention to which part of the scalp?

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.

The nurse recommends which type of therapeutic bath for its antipruritic action?

Colloidal (oatmeal) Explanation: Colloidal oatmeal baths are recommended to decrease itching associated with a dermatologic disorder such as psoriasis. Water and saline baths have the same effect as wet dressings and are not known to counteract itching. Bath oils are used to clean and hydrate the skin.

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?

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.

Which of the following is an example of a topical anesthetic?

EMLA cream Explanation: EMLA cream is a topical anesthetic. Bacitracin, Silvadene, and Garamycin are topical antibiotics.

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 Explanation: Systemic disorders associated with generalized pruritus include chronic kidney disease

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?

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

A dermatologist recommends an over-the-counter suspension to relieve pruritus. The nurse advises the patient that the lotion should be applied:

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.

Which of the following nonsedating antihistamines is appropriate for daytime pruritus?

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.

Which term refers most precisely to a localized skin infection of a single hair follicle?

Furuncle Explanation: Furuncles 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 client with scabies has been prescribed a scabicide. Which of the following advice should the nurse give the client before beginning the treatment?

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.

Which skin condition is caused by staphylococci, streptococci, or multiple bacteria?

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.

When caring for a client in a prenatal clinic who has history of acne vulgaris, which client medication would the nurse advise against?

Isotretinoin Explanation: The nurse is correct to screen for the acne medication, isotretinoin (Accutane). It is contraindicated for pregnant females or those who may become pregnant due to the potential of first trimester miscarriages and congenital malformations.

A patient is being evaluated for nodular cystic acne. What systemic pharmacologic agent may be prescribed for the treatment of this disorder?

Isotretinoin (Accutane) Explanation: Synthetic vitamin A compounds (i.e., retinoids) are used with dramatic results in patients with nodular cystic acne unresponsive to conventional therapy. One compound is isotretinoin, which is used for active inflammatory popular pustular acne that has a tendency to scar. Isotretinoin reduces sebaceous gland size and inhibits sebum production. It also causes the epidermis to shed (epidermal desquamation), thereby unseating and expelling existing comedones.

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. 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.

The nurse prepares a patient with a benign skin lesion for surgical excision, intralesional corticosteroid therapy, and radiation. Which of the following is most likely the lesion described?

Keloid Explanation: Keloids are benign overgrowths of fibrous tissue at the site of a scar or trauma. They appear to be more common among dark-skinned people. Keloids are asymptomatic but may cause disfigurement and cosmetic concern. The treatment, which is not always satisfactory, consists of surgical excision, intralesional corticosteroid therapy, and radiation.

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?

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 procedure done for skin cancer conserves the most amount of normal tissue?

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?

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.

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 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.

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?

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.

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?

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 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 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

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.

Pruritus of the eyes Burning of the eyes Dryness of the eyes Explanation: 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).

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 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.

Which term describes a fungal infection of the scalp?

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.

To treat a client with acne vulgaris, the physician is most likely to order which topical agent for nightly application?

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.

The nurse working at a physician's office is providing teaching to the parent of a child diagnosed with Tinea capitis (ringworm of the head). How often should the nurse instruct the parent to shampoo the child's hair with ketoconazole or a selenium sulfide shampoo?

Twice weekly Explanation: The nurse should instruct the parent to shampoo the child's hair with ketoconazole or a selenium sulfide shampoo twice weekly.

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. 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.

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. 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 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.

The classic lesions of impetigo manifest as

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.

A client with a history of diabetes mellitus has recently developed furunculosis. What is causing the client's condition?

infection Explanation: Furuncles and carbuncles are caused by skin infections with organisms that usually exist harmlessly on the skin surface.

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:

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.

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

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.

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 Explanation: Photochemotherapy is used to treat psoriasis.

The nurse teaches the client who demonstrates herpes zoster (shingles) that

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.

The nurse teaches the client who demonstrates herpes zoster (shingles) that

the infection results from reactivation of the chickenpox virus. Explanation: It is assumed that herpes zoster represents a reactivation of the 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 clients with herpes zoster. Some evidence shows that infection is arrested if oral antiviral agents are administered within 24 hours of the initial eruption.

A client has been diagnosed with shingles. Which of the following medication classifications will reduce the severity and prevent development of new lesion

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.

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 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.

Which of the following uses the body's own digestive enzymes to break down necrotic tissues?

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.

The nurse is providing instruction to a client with acne. The nurse promotes avoidance of which food(s)? Select all that apply.

Chocolate Ice cream Explanation: The nurse should promote avoidance of foods associated with flare-up of acne, particularly those high in refined sugars, including chocolate, cola, and ice cream.

A nurse is admitting a client with toxic epidermal necrolysis. What is the nursing priority in preventing sepsis?

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 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?

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.

Which of the following is a local side effect of topical corticosteroids?

Telangiectasia Explanation: Inappropriate use of topical corticosteroids can result in local and systemic side effects. Local side effects may include skin atrophy and thinning, striae, and telangiectasia. Systemic side effects may include hyperglycemia and symptoms of Cushing's syndrome