integument MED SURG EAQ

A patient is diagnosed with proliferative diabetic retinopathy and is scheduled for a surgical procedure. About which surgical procedure that will be used to relieve traction on the retina will the nurse educate the patient ? 1. Vitrectomy 2. Cryotherapy 3. Photodynamic therapy 4. Ocular coherence tomography

1 Vitrectomy is the surgical removal of the vitreous and is used to relieve traction on the retina caused especially by proliferative diabetic retinopathy. Cryotherapy is a procedure used to seal retinal breaks. Photodynamic therapy is a procedure used to treat age-related macular degeneration. Ocular coherence tomography is used to identify fluid in the central retina; it determines the need for continued intravitreal injections. Text Reference - p. 397

A patient is having a surgical procedure that involves using extreme cold to create an inflammatory response to produce a sealing scar. What procedure will the nurse educate the patient regarding? 1. Cryopexy 2. Scleral buckling 3. Pneumatic retinopexy 4. Laser photocoagulation

1 Cryopexy is a procedure used to seal retinal breaks. This procedure involves using extreme cold to create the inflammatory reaction that produces the sealing scar. Scleral buckling is an extraocular surgical procedure that involves indenting the globe so that the pigment epithelium, the choroid, and the sclera move toward the detached retina. It involves suturing a silicone implant against the sclera. Pneumatic retinopexy is the intravitreal injection of a gas to form a temporary bubble in the vitreous that closes retinal breaks and provides apposition of the separated retinal layers. Laser photocoagulation involves using an intense, precisely focused light beam to create an inflammatory reaction.

Which data would a nurse consider least important during an assessment of skin integrity? 1. Family history of pressure ulcers 2. Presence of existing pressure ulcers 3. Overall risk as indicated by a low Braden score 4. Areas at risk for the development of pressure ulcers

1 Family history is not an important factor in the development of pressure ulcers and general skin integrity. A patient deemed to be at risk on the basis of a validated tool such as the Braden scale and existing areas of skin breakdown requires immediate assessment and intervention

A patient with skin lesions is advised to have a patch test. The nurse applies the patch on the patient's skin and instructs the patient to come back after two days for further treatment. What is the likely reason the patch test was performed? 1. To determine the causative agents of allergies in the patient. 2. To determine the prognosis of skin cancer in the patient. 3. To determine the presence of skin infections in the patient. 4.To determine the presence of melanoma in the patient.

1 The patch test is done to identify the cause of ALLERGIES in patients. It is performed by applying the allergen on the skin of the patient and evaluating the skin after 48 hours. The presence of erythema, papules, and vesicles indicate an allergic reaction. A patch test is NOT useful to determine the presence or prognosis of skin cancer. The prognosis of skin cancer can be determined through Breslow and Clark measurements. The presence of skin infections can be determined through microscopic studies. The presence of melanoma can be determined through biopsies. Text Reference - p. 437

Which statement regarding auditory problems among different populations is correct? 1. Asian Americans have a higher incidence of hearing impairment. 2. Native Americans have an increased incidence of otitis media. 3. African Americans have a higher incidence of macular degeneration. 4. Individuals between 30 and 60 years of age show the symptom of otosclerosis.

1. Native Americans have an increased incidence of otitis media. Native Americans have an increased incidence of otitis media compared to whites. Whites have a higher incidence of hearing impairment when compared with Asian Americans. Whites have a higher incidence of macular degeneration than African Americans. Symptoms of endolymphatic hydrops usually begin between 30 and 60 years of age. Otosclerosis is the most common cause of hearing loss in young adults

A student nurse is assisting a patient who is blind using a sighted-guide technique. Which action by the student nurse requires immediate intervention? 1. Walking behind the patient holding the patient's back 2. Describing the environment to the patient while walking 3. Helping the patient to sit by placing the patient's hand on the seat of the chair 4. Standing slightly in front and to one side of the patient and providing elbow for support

1. Walking behind the patient holding the patient's back While assisting a blind patient using sighted-guide technique, the nurse should walk slightly ahead of the patient, with the patient holding the back of the nurse's arm. This action will help the blind patient to walk easily. The nurse should describe the environment while walking to help orient the patient. The student nurse should help the patient sit by placing one of his or her hands on the seat of the chair. The nurse should stand slightly in front and to one side of the patient and provide an elbow for the patient to hold.

In teaching a patient with basal cell carcinoma (BCC) about this disorder, the nurse considers that which statement about this skin cancer is true? 1. BCC is the most deadly type of skin cancer. 2. BCC is the most common type of skin cancer. 3. Prognosis depends upon the thickness of the lesion. 4. The cancerous cells of BCC usually spread beyond the skin

2 BCC is a locally invasive malignancy arising from epidermal basal cells. It is the most common type of skin cancer and also the least deadly. The cancerous cells of BCC almost never spread beyond the skin. BCC is the least deadly type of skin cancer. Prognosis depends on other factors too, not just the thickness of the lesion. BCC does not generally spread beyond the skin. Text Reference - p. 431

A nurse is caring for a patient diagnosed with shingles. The primary health care provider prescribes acyclovir to be administered as soon as possible. The most likely reason for the medication is to prevent what? 1. To prevent pain 2. To prevent postherpetic neuralgia 3. To prevent worsening of symptoms 4. To prevent the patient from getting restless

2 Following the onset of symptoms of shingles (herpes zoster), antiviral agents such as acyclovir should be administered within 72 hours to prevent postherpetic neuralgia. Analgesics are given to relieve pain and mild sedatives to prevent restlessness. Symptomatic treatment is given to prevent worsening of symptoms. Text Reference - p. 436

The nurse assesses an elevated, dry, hyperkeratotic, scaly papule in an older adult patient. With what condition does the assessment data correlate? 1. Dysplastic nevus 2. Actinic keratosis 3.Basal cell carcinoma 4.Squamous cell carcinoma

2 Actinic keratosis manifests clinically as dry, scaly, hyperkeratotic papules, either flat or elevated. A dysplastic or atypical nevus is often larger than 5 mm. It features irregular borders, which may be notched; variegated color (e.g., tan, brown, black, red, or pink) within a single mole; and at least one flat portion, often at the edge of the mole. Basal cell carcinoma is characterized by a small, slowly enlarging papule with semitranslucent or pearly borders. Squamous cell carcinoma appears as a thin, scaly, erythematous plaque that does not invade the dermis. Text Reference - p. 432

A patient diagnosed with malignant melanoma has been prescribed vemurafenib. The nurse recalls that the medication was prescribed on the basis of what test? 1. Microdermabrasion 2. Genetic testing 3. Clark level testing 4. Breslow measurement

2 Genetic testing

The nurse assesses an eroded, ulcerative growths less than 1 cm wide on a patient's chest. The lesion is flat and variegated in color. What condition should be suspected related to this assessment finding? 1. Basal cell carcinoma 2. Malignant melanoma 3. Squamous cell carcinoma 4. Cutaneous T-cell lymphoma

2 Malignant melanoma is characterized by variegated color, including red, white, blue, black, gray, and brown. The growth may be flat or elevated; it is eroded or ulcerated and usually less than 1 cm. Basal cell carcinoma is characterized by a small, slowly enlarging papule with semitranslucent borders and overlying telangiectasia. Squamous cell carcinoma is marked by a thin, scaly, erythematous plaque that does not invade the dermis. Cutaneous T-cell lymphoma involves three stages; a patch is the characteristic feature of the early stage, and tumors are observed in the advanced stage. Text Reference - p. 432

A nurse is assessing a patient diagnosed with malignant melanoma. The nurse understands that the prognosis of the cancer can be assessed by using the Breslow measurement. How is the prognosis related to Breslow measurement? 1. The larger the tumor, the worse the prognosis 2. The deeper the tumor, the worse the prognosis 3. The darker the tumor, the worse the prognosis 4. The greater number of tumors, the worse the prognosis

2 The deeper the tumor, the worse the prognosis TUMOR THICKNESS is an important prognostic factor for melanoma. The Breslow's measurement is used to ASSESS THE DEPTH of the tumor in millimeters. The deeper the tumor, the worse will be the prognosis of melanoma. The CLARK level indicates the DEPTH of the invasion of the tumor; the higher the number, the deeper the melanoma Size of the tumor, color of the tumor, and an increase in the number of tumors are not determined using the Breslow's measurement.

When jaundice is suspected in a patient, which areas should the nurse check for skin color? Select all that apply. 1.Tongue 2.Nail beds 3.Earlobes 4..Conjunctiva 5.Buccal mucosa

2,4,5 Changes in skin color may vary from one person to another. The skin color depends on the amount of melanin, carotene, oxyhemoglobin, and reduced hemoglobin present at a particular time. The most reliable areas to assess for erythema, cyanosis, pallor, and jaundice are the sclerae, conjunctivae, nail beds, lips, and the buccal mucosa, as these areas are the least pigmented. The tongue and earlobes are not reliable areas to assess for skin color.

A nurse is assessing a patient who has numerous nevi on the face. The nurse determines that the nevi are not cancerous. Which observations led the nurse to conclude that the nevi are normal? Select all that apply. 1. The nevi are larger than 5 mm in size. 2. The nevi are well circumscribed. 3. The nevi are dark in color. 4. The skin over the nevi is eroded. 5. There is discharge from the nevi

2. The nevi are well circumscribed. 3. The nevi are dark in color.

The nurse assesses an eroded, ulcerative growths less than 1 cm wide on a patient's chest. The lesion is flat and variegated in color. What condition should be suspected related to this assessment finding? 1.Cellulitis 2.Furuncle 3.Impetigo 4.Folliculitis

3 Impetigo is marked by vesiculopustular lesions that develop a thick, honey-colored crust surrounded by erythema. They are most common on the face as a primary infection. Cellulitis manifests clinically as a hot, tender, erythematous, edematous area with a diffuse border. Furuncle is marked by a tender erythematous area around a hair follicle. Small pustules at the hair follicle opening with minimal erythema and development of crusting are indicative of folliculitis. Text Reference - p. 434

The registered nurse is preparing to teach a group of nursing students about the use of verbal aids when communicating with hearing-impaired patients. Which information does the nurse include in the teaching plan? 1. Refrain from having light behind the patient. 2. Speak in a clear voice and shout at the patient. 3. Use simple sentences and rephrase sentences if required. 4. Maintain eye contact and draw the attention of the patient with hand movements.

3 The use of simple sentences is an example of a verbal aid that the nurse can use while communicating with a hearing-impaired patient. If required, the nurse should rephrase the sentence, and use different words to help the patient understand. As a nonverbal aid, the nurse should avoid light behind the speaker, not the patient. As a verbal aid, the nurse should speak in a normal voice directly into the better ear. The nurse should not shout to make the patient understand. As a nonverbal aid, the nurse should maintain eye contact and draw attention of the patient with hand movements. Text Reference - p. 410

A patient is diagnosed with proliferative retinopathy and is scheduled for treatment by the primary care provider. About what treatment option does the nurse educate the patient? 1. Filtration surgery 2. Photodynamic therapy 3. Laser photocoagulation 4. Argon laser trabeculoplast

3. Laser photocoagulation Proliferative retinopathy is a condition associated with the formation of fragile new abnormal blood vessels, which are predisposed to leaks, resulting in severe vision loss. This condition can be treated by laser photocoagulation. Filtration surgery is the treatment for chronic open-angle glaucoma. Photodynamic therapy is the treatment for age-related macular degeneration. Argon laser trabeculoplasty is a noninvasive procedure to lower intraocular pressure in glaucoma.

A patient in the dermatology clinic has a thin, scaly erythematous plaque on the right cheek. Which action should the nurse take? a.Prepare the patient for a biopsy. b.Teach about the use of corticosteroid creams. c.Explain how to apply tretinoin (Retin-A) to the face. d.Discuss the need for topical application of antibiotics.

ANS: A Because the appearance of the lesion suggests actinic keratosis or possible squamous cell carcinoma (SCC), the appropriate treatment would be excision and biopsy. Over-the-counter (OTC) corticosteroids, topical antibiotics, and Retin-A would not be used for this lesion. DIF: Cognitive Level: Apply (application) REF: 431-432

A teenaged male patient who wrestles in high school is examined by the nurse in the clinic. Which assessment finding would prompt the nurse to teach the patient about the importance of not sharing headgear to prevent the spread of pediculosis? a. Ringlike rashes with red, scaly borders over the entire scalp b. Papular, wheal-like lesions with white deposits on the hair shaft c. Patchy areas of alopecia with small vesicles and excoriated areas d. Red, hivelike papules and plaques with sharply circumscribed borders

ANS: B Pediculosis is characterized by wheal-like lesions with parasites that attach eggs to the base of the hair shaft. The other descriptions are more characteristic of other types of skin disorders.

A patient is undergoing psoralen plus ultraviolet A light (PUVA) therapy for treatment of psoriasis. What action should the nurse take to prevent adverse effects from this procedure? a. Cleanse the skin carefully with an antiseptic soap. b. Shield any unaffected areas with lead-lined drapes. c. Have the patient use protective eyewear while receiving PUVA. d. Apply petroleum jelly to the areas surrounding the psoriatic lesions.

ANS: C The eyes should be shielded from UV light (UVL) during and after PUVA therapy to prevent the development of cataracts. The patient should be taught about the effects of UVL on unaffected skin. Lead-lined drapes, use of antiseptic soap, and petroleum jelly are not used to prevent skin damage.

An older adult patient with a squamous cell carcinoma (SCC) on the lower arm has a Mohs procedure in the dermatology clinic. Which nursing action will be included in the postoperative plan of care? a. Describe the use of topical fluorouracil on the incision. b. Teach how to use sterile technique to clean the suture line. c. Schedule daily appointments for wet-to-dry dressing changes. d. Teach about the use of cold packs to reduce bruising and swelling

ANS: D Application of cold packs to the incision after the surgery will help decrease bruising and swelling at the site. Since the Mohs procedure results in complete excision of the lesion, topical fluorouracil is not needed after surgery. After the Mohs procedure the edges of the wound can be left open to heal or the edges can be approximated and sutured together. The suture line can be cleaned with tap water. No debridement with wet-to-dry dressings is indicated. DIF: Cognitive Level: Apply (application) REF: 444

The health care provider prescribes topical 5-FU for a patient with actinic keratosis on the left cheek. The nurse should include which statement in the patient's instructions? a."5-FU will shrink the lesion so that less scarring occurs once the lesion is excised." b."You may develop nausea and anorexia, but good nutrition is important during treatment." c."You will need to avoid crowds because of the risk for infection caused by chemotherapy." d."Your cheek area will be painful and develop eroded areas that will take weeks to heal."

ANS: D Topical 5-FU causes an initial reaction of erythema, itching, and erosion that lasts 4 weeks after application of the medication is stopped. The medication is topical, so there are no systemic effects such as increased infection risk, anorexia, or nausea. DIF: Cognitive Level: Apply (application) REF: 441

A nurse is caring for a patient who has been diagnosed with psoriasis. The nurse is creating an education plan for the patient. What information should be included in this plan? A) Use caution when taking nonprescription medications. B) Avoid public places until symptoms subside. C) Wash skin frequently to prevent infection. D) Liberally apply corticosteroids as needed.

Ans: A Feedback: The patient should be cautioned about taking nonprescription medications because some may aggravate mild psoriasis. Psoriasis is not contagious. Many patients need reassurance that the condition is not infectious, not a reflection of poor personal hygiene, and not skin cancer. Excessively frequent washing of skin produces more soreness and scaling. Overuse of topical corticosteroids can result in skin atrophy, striae, and medication resistance.

A nurse is teaching a patient about self-examination of skin lesions. The skin should be examined for which characteristics? Select all that apply. 1.Depth of the lesion 2.Asymmetry of the lesion 3.Temperature of the lesion 4.Irregularity of the borders of the lesion 5.A change or evolution in appearance of the lesion

Asymmetry of the lesion Irregularity of the borders of the lesion A change or evolution in appearance of the lesion Self-examination of skin lesions is done by the ABCDE rule: A, Asymmetry; B, Border irregularity, C, Color change; D, Diameter of 6 mm or more; and E, Evolving in appearance. Depth and temperature of the lesion may be difficult to determine in a self-examination, and these characteristics are not included in the ABCDE rule.

What are steps for eye irrigation?

Explain, hand hygiene, apply anesthetic drops, irrigate by holding distal end of I V tubing at inner canthus of the eye, or Morgans lens may be attached, assess for tolerance, remove morgan lens, remove gloves, and document

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.

The nurse is conducting an integumentary assessment of an African American patient who has darkly pigmented skin and a history of chronic obstructive pulmonary disease (COPD). Which locations should the nurse inspect for cyanosis (select all that apply.)? Select all that apply. a. Patient's sclera b. Patient's nail beds c. Soles of the patient's feet d. Palms of the patient's hands e. Conjunctiva of the patient's eyes

b. Patient's nail beds e. Conjunctiva of the patient's eyes In patients with darkly pigmented skin, the conjunctiva and nail beds are often examined to assess for CYANOSIS The palms of the hands, soles of the feet, and the sclera are not the focus when assessing for cyanosis

A nurse is providing care for a patient who has psoriasis. The nurse is aware of the sequelae that can result from this health problem. Following the appearance of skin lesions, the nurse should prioritize what assessment? A) Assessment of the patient's stool for evidence of intestinal sloughing B) Assessment of the patient's apical heart rate for dysrhythmias C) Assessment of the patient's joints for pain and decreased range of motion D) Assessment for cognitive changes resulting from neurologic lesions

ns: C Feedback: Asymmetric rheumatoid factor negative arthritis of multiple joints occurs in up to 30 % of people with psoriasis, most typically after the skin lesions appear. The most typical joints affected include those in the hands or feet, although sometimes larger joints such as the elbow, knees, or hips may be affected. As such, the nurse should assess for this musculoskeletal complication. GI, cardiovascular, and neurologic function are not affected by psoriasis.