Integumentary

The nurse is providing education to a patient with new-onset type 2 herpes simplex genital lesions. Which statement regarding type 2 herpes simplex, if made by the patient, indicates a need for further education?

"With medication, I will be able to cure my herpesvirus infection."

The nurse is caring for a patient with eczema. During the patient's bath, the patient exclaims, "My skin is disgusting. I can't bear to look at it or touch it!" Which response by the nurse would be appropriate?

"You seem frustrated because of your eczema. What can I do to help?"

A patient with a history of asthma is receiving treatment for contact dermatitis. Which medication does the health care provider prescribe?

A patient with a history of asthma may have an acute asthmatic episode if he or she acquires contact dermatitis. Therefore, hydroxyzine is prescribed because it helps relieve the symptoms of asthma.

Which medications does the nurse expect the health care provider to prescribe for a patient with herpes zoster (shingles)? Select all that apply.

Acyclovir reduces the pain and duration of the outbreak if given within 72 hours of the onset of symptoms. Steroids, such as prednisone, are given to decrease inflammation and edema in the patient with shingles. Analgesics, such as hydrocodone/APAP, are given to alleviate the pain. Triamcinolone acetonide is a lotion used to relieve pruritus. Zostavax (PF) is a vaccine to prevent herpes zoster, which is effective only when used before the infection occurs.

Which statements regarding cellulitis are true? Select all that apply.

Although not considered to be contagious, the bacteria that cause cellulitis can be spread by direct contact with an open area on a person who has an infection. Cellulitis occurs when bacteria enter the body through a break in the skin, such as a cut, scratch, or insect bite, that is not cleansed with soap and water. Complications from cellulitis can include sepsis, meningitis, and lymphangitis. The primary treatment for cellulitis includes prompt administration of antibiotics. If the cellulitis is mild, oral antibiotics may be prescribed; if the cellulitis is rapidly spreading or the patient has evidence of a serious infection, intravenous antibiotics may be required. Untreated cellulitis can lead to an abscess.

The nurse is performing the admission assessment of an elderly patient. On assessment of the skin, the nurse notes full-thickness tissue loss over the right heel; however, bone is not exposed. The nurse would anticipate the diagnosis of which stage of pressure ulcer?

An area of full-thickness tissue loss that does not expose bone is most likely a stage III pressure ulcer. If bone is exposed, it is a stage IV pressure ulcer. A stage I pressure ulcer is characterized by an area of nonblanchable erythema. Partial-thickness loss characterizes a stage II pressure ulcer.

The nurse is caring for a patient with cellulitis of the lower leg. The patient asks the nurse why, after 4 days of antibiotics, his symptoms seem worse. The nurse bases her response on an understanding of which bacterial response to antibiotics?

Bacteria release substances that damage tissue.

A patient arrives in the clinic with severe burning pain along the right ribs. On assessment, the nurse notes serous vesicles arranged in a straight line, some of which have erupted to form a crust. To make the diagnosis, the nurse should ask about exposure to what?

Chickenpox

Which skin disorders are serious because of the possibility of an acute respiratory reaction? Select all that apply.

Contact dermatitis is caused by direct contact with an irritant that an individual is hypersensitive to, such as soap, chemicals, or plants. If the patient has a history of asthma, he or she may experience an acute asthmatic episode. Urticaria is an allergic reaction commonly caused by drugs, food, insect bites, inhalants, emotional stress, or exposure to heat or cold. It is caused by the release of histamine in an antigen-antibody reaction. Capillaries dilate, resulting in increased permeability; respiratory involvement may occur.

Tinea capitis, Microsporum audouinii infection, tinea corporis, and tinea pedis are examples of which type of infection?

Fungal skin infections

The nurse observes that a patient has a fever and erythema of the skin, which indicate cellulitis. Which diagnostic tests should the nurse evaluate to confirm the presence of the infection? Select all that apply.

Gram's stain is used to detect the type of bacteria that has caused the infection so that an appropriate antibiotic therapy can be started. Culture and sensitivity testing of blood, purulent exudate, or tissue specimens is needed for identification of the bacteria and to determine the antibiotic that the pathogen is sensitive to. CT is used to determine the extent of inflammation and to identify abscess formation. CBC is needed because it helps reveal leukocytosis. Serum IgE levels are elevated if a patient has contact dermatitis and helps rule out cellulitis.

Which drug is the nurse likely to find in the prescription for a patient with a fungal infection?

Griseofulvin is an oral antifungal drug that is usually prescribed to a patient with a fungal infection

Which characteristic would be associated with herpes simplex type 2?

Herpes simplex type 2 is accompanied by flulike symptoms 3 to 4 days after the vesicles erupt. Headache, fatigue, myalgia, elevated temperature, and anorexia are common. Herpes simplex type 1 is commonly known as a cold sore. Herpes simplex type 2 usually affects the cervix in women and the penis in men. Herpes simplex type 2 causes lesions in the genital area and is commonly known as genital herpes. The primary mode of transmission is through sexual contact. Herpes simplex type 1 is characterized by a vesicle at the corner of the mouth, lips, or nose.

A nurse is evaluating a pediatric patient who has a skin rash. The preliminary diagnosis is impetigo contagiosa. Which statement describes impetigo contagiosa?

Impetigo contagiosa is a highly contagious inflammatory disorder. It is highly contagious when a person comes into direct contact with the exudate of a lesion. Impetigo contagiosa is a bacterial skin infection, usually caused by Staphylococcus aureus, streptococci, or mixed bacteria. Impetigo contagiosa usually causes a rash on the patient's face, hands, arms, and legs. Impetigo contagiosa can be present in patients of all age groups, but especially children.

The nurse explains to the parents of a child who has impetigo how to manage the disease at home. Which instructions would be included for the parents?

Impetigo is a highly contagious streptococcal infection, and it could spread if the caregiver or anyone touches the patient. Therefore, the nurse instructs the parents to wash their hands every time they touch the child.

The nurse obtains a swab culture from a cellulitis infection of an adult patient. The nurse anticipates the culture will grow which causative species of bacteria?

In adults, Staphylococcus aureus is the most common cause of cellulitis. In children, Haemophilus influenzae is the most common.

The nurse observes that a patient with tinea pedis has increased moisture and pruritus around the toes. Which instructions does the nurse give? Select all that apply.

In tinea pedis, there are fissures and vesicles around and below the toes, which may cause increased moisture and pruritus. The nurse instructs the patient to use warm soaks to clean and dry the toes thoroughly to relieve discomfort. Burow's solution has antiseptic properties that relieve itching and aid in the reduction of bacterial and fungal growth. Cotton stockings are more comfortable because they absorb moisture and help keep the toes dry. Wearing open-toe sandals or going barefoot is encouraged because it helps decrease moisture.

A patient with urticaria is prescribed diphenhydramine therapy. Which medication effect best explains the purpose of prescribing this medication?

It blocks histamine at the H1 receptor site. Urticaria occurs as a result of the release of histamine in an antigen-antibody reaction. Therefore, diphenhydramine, an antihistamine, is prescribed because it blocks histamine at the H1 receptor site.

A patient with herpes zoster (shingles) is admitted to a medical facility. The nurse manager finds that one of the team members has not received both doses of the varicella vaccine. Which intervention should be the nurse manager's priority?

It is important to move the team member to another unit away from patient care because he or she has been exposed to shingles and poses a risk of transmitting the infection for 8 to 21 days. Asking the team member to wear gloves and a mask while providing care is not effective because the infection is not airborne. Team members who have received two doses of the varicella vaccine and are providing care for the patient need not be assessed for infection because the vaccine provides immunity. It is ineffective to administer the vaccine after exposure to the infection because the vaccine may not help prevent shingles.

A patient with herpes zoster (shingles) is extremely agitated because of the severe pain. Which medication may also be prescribed along with analgesics to reduce anxiety in the patient?

Lorazepam is a tranquilizer that is used to decrease the anxiety associated with severe pain in a patient with shingles.

The nurse is caring for a patient who is incontinent of urine and stool. On inspection, the nurse notes an area of skin breakdown on the perineum. The nurse should document this as which skin condition?

Maceration is caused by prolonged exposure to moisture. A laceration is a cut on the skin. Excoriation is an injury to the skin caused by scratching. A pressure ulcer is caused by prolonged pressure to the skin over a bony prominence.

The nurse is performing the admission assessment of a patient at the nursing home. The nurse notes the patient has widespread nevi across the body. Which characteristic, if demonstrated by one of the nevi, would cause the nurse to be concerned about malignancy?

Moles with an irregular border should be further assessed for malignancy. Other indicators of malignancy include raised surface, variations in color in the mole, and an irregular shape.

The nurse is caring for a 75-year-old patient. Which characteristics, if reported by the patient, would the nurse consider to be risk factors for a shingles outbreak? Select all that apply.

Patients who are stressed, are immunosuppressed, and had chickenpox in childhood are at an increased risk for a shingles outbreak. Latex allergy and arthritis are not risk factors for shingles.

A patient complains of excessive itching along the abdomen near the umbilicus. Which instructions should the nurse give to the patient to relieve the pruritus? Select all that apply.

Pruritus, or severe itching, needs to be controlled because an excoriated lesion may be difficult to assess. A variety of measures can be used to control pruritus. The pruritic area should always be moist because dry skin increases the itch sensation. Vaseline should never be applied unless it is prescribed by the care provider. Wearing loose fitting clothing with prevent further injury to the affected area by decreasing circulation or limiting movement. Applying moisturizers and moist linen can be helpful in controlling the itching.

The nurse in the emergency department is performing the admission assessment of an adult patient who sustained scalding burns on bilateral anterior legs, right anterior arm, and half of the anterior torso. Using the rule of nines, fill in the blank with the percentage of the body surface that has been burned. Record your answer using one decimal place. _____ %

Right anterior leg (9%) + left anterior leg (9%) + half anterior torso (9%) + right anterior arm (4.5%) = 31.5%

The nurse is caring for a patient with eczema. The nurse knows the treatment plan is centered on which concept?

The cornerstone of eczema treatment is limiting exposure. Medications may be used, but the majority of care focuses on limiting exposure.

A patient has been prescribed isotretinoin for severe acne. Which assessment(s) should the nurse perform before administering the drug? Select all that apply.

The drug isotretinoin is known to interfere with the liver functions and may also have teratogenic effects. Therefore, liver function tests should be conducted to test for abnormalities. The nurse should find out whether the patient is pregnant or is planning to conceive before administering the drug. The amount of fluid intake by the patient does not contribute to the patient's condition as a result of taking this medication

While interviewing a female patient, the senior nurse finds that the patient is taking isotretinoin (Accutane) to treat acne. On further assessment, the patient states that she plans to conceive. Which is the most important nursing action?

The drug isotretinoin is used for treating acne. Isotretinoin (Accutane) can cause abnormal fetal development and so, it should not be used by women who are pregnant or are planning to become pregnant.

Which explanation justifies why the nurse would first contact the health care provider when finding evidence of secondary infection in a patient with a patient problem statement of Potential for Infection, related to open lesion?

The immediate need is to contact the health care provider to obtain special instructions on how to proceed or about medications that may need to be given to the patient and that requires obtaining updated orders. Creating a new patient problem and intervention is not appropriate at this time and a complete blood count would be determined by the health care provider. The area may need to be cleaned, but the first step is to always contact the heath care provider.

The nurse is providing education to a patient on the self-examination of the moles on the skin. Which mnemonic would be most helpful to the patient?

The mnemonic ABCDE is helpful to the patient who is examining the skin for malignant moles. This mnemonic assesses whether the mole is asymmetric, has irregular borders, has irregular or uneven color, has grown in diameter, or has an elevated surface

The nurse is teaching a group of adolescents about different interventions to maintain healthy skin. Which teaching does the nurse include? Select all that apply.

The nurse instructs the adolescents to refrain from smoking because smoking causes circulation difficulties and refraining improves the skin color. Hair and skin need to be washed often to remove excess oil and excretions and prevent blemishes and odor. The use of a moisturizer after a shower when the skin is damp helps seal in the moisture. The nurse instructs the adolescents to drink eight glasses of water per day because this helps the skin to get rid of waste products. Use sunscreen lotions with the appropriate sun protection factor (SPF) while performing outdoor activities.

Which instructions are given to a patient with pityriasis rosea to prevent secondary infections related to pruritus? Select all that apply.

The nurse instructs the patient to apply moisturizing cream if the skin becomes dry. The patient needs to apply 1% hydrocortisone cream two or three times a day to treat the pruritus. Topical steroids are also used to control pruritus. Epsom salt baths would not be prescribed because they increase pain and pruritus. The nurse instructs the patient to sunbathe 30 minutes every day because sun exposure aids in the resolution of the lesions. The patient can be out in the sunlight.

Which interventions should the nurse implement while providing care for a patient with a herpes viral infection? Select all that apply

The nurse provides sitz baths, as prescribed, to decrease discomfort caused by the lesion. Frequent hand washing is important to prevent spread of the infection. The nurse can suggest that the patient use loose-fitting underclothing for additional comfort. The nurse does not ask the patient to abstain from sexual activity but encourages safe sex practices and the use of condoms. The nurse instructs the patient to use warm compresses to relieve pain and severe pruritus.

A patient comes to the clinic with a cluster of vesicles at the corner of the mouth. The nurse anticipates the patient will be diagnosed with an infection caused by which organism?

The patient demonstrates signs of a herpes simplex virus infection. Type 1 herpesvirus is more common than type 2, which generally affects the genitals.

A patient arrives in the emergency department with angioedema of the tongue and lips after accidental ingestion of shellfish at a restaurant. The patent's breathing is unlabored, and vital signs are within normal limits. The nurse anticipates administering which drug to this patient?

The patient is having an allergic reaction to shellfish. At this time, the patient's airway is patent, and epinephrine is not indicated. Benadryl will work to decrease the histamine reaction in the patient's face and lip.

Which treatment instruction does the nurse give the patient with eczema to do before applying petrolatum ointment to the affected area?

The patient needs to soak the area in warm water for 15 to 20 minutes to hydrate the affected area. The petrolatum ointment is then applied to the damp area to retain the water. A moisturizing lotion is applied to add moisture to the skin when the lesions begin to heal. The affected area is washed with an antiseptic soap; however, the ointment is applied when the skin is damp to increase hydration. PsoriGel is applied once a day at bedtime with a moisturizer.

The patient with herpes zoster is asking the nurse about her condition. Which information will the nurse provide?

The rash usually occurs in the thorax region; vesicles erupt in a line along the involved nerve. The pain experienced by most patients is typically described as burning and knifelike. Herpes zoster does not cause permanent disability in healthy adults. The greatest risk occurs in patients who with lower resistance to infection, such as those on chemotherapy or patients receiving large doses of prednisone; in such patients, the disease could be fatal because of the patient's compromised immune system. Analgesics, including opioid analgesics, are often prescribed for pain. Steroids may be given to decrease inflammation and edema. Lotions may be used to relieve pruritus, and corticosteroids may be used to relieve pruritus and inflammation.

Which statement by the student nurse about the function of skin indicates a need for further learning?

The skin assists the body in maintaining a constant temperature, even if the internal and external conditions vary. Melanin is a skin protein that forms a protective shield and protects the keratinocytes and nerve endings from the harmful effects of ultraviolet light. The skin aids in the elimination of waste products, prevents dehydration, and serves as a reservoir for food and water. Cholesterol compounds in the skin are converted to vitamin D when exposed to the sun's harmful ultraviolet rays.

Which assessment finding would indicate that the patient has a stage II ulcer?

The ulcer is a shallow red-pink wound bed with partial-thickness loss of dermis.

The nurse is providing education to a patient with a vitamin D deficiency. Which statement, if made by the patient, indicates an understanding of the relationship between sun exposure and vitamin D levels?

The ultraviolet rays from the sun convert the cholesterol compounds in the skin to vitamin D

A patient arrives at the clinic complaining of a patch of skin that itches on the right forearm. On assessment, the nurse notes a well-defined circular rash with a red border and clear center. The nurse anticipates a diagnosis of which skin disorder?

Tinea corporis is ringworm infestation, which is a fungal infection that presents itself with a circular rash with red border and clear center. Tinea pedis is athlete's foot. Tinea cruris is jock itch. Tinea capitis is ringworm infestation that occurs on the head.

Cultural and ethnic considerations for skin assessment include which statement?

To assess rashes and skin inflammation in dark-skinned individuals, the nurse should rely on palpation for warmth and induration rather than on observation. Baseline skin color should be assessed in areas with the least pigmentation. Examples are the palms of the hands, soles of the feet, undersides of the forearms, abdomen, and buttocks. Pallor in black-skinned individuals will appear as ashen or gray. The darker the patient's skin, the more difficult it is to assess for color change. A baseline needs to be established in natural lighting, if possible, or with at least a 60-watt light bulb.

A patient with a herpes viral infection has frequent outbreaks of cold sores and is prescribed suppressive therapy with valacyclovir. The nurse finds that the patient is also prescribed ibuprofen for which purpose?

To manage inflammation

The home health nurse is assessing the skin of an immobile patient. The nurse notes that the skin covering the sacrum appears to have full-thickness loss, but the wound base is covered in black eschar. How should the nurse document this finding?

Unstageable pressure ulcer Because the wound base is covered in eschar, the pressure ulcer is unstageable. Once the eschar is removed or falls off, the wound should be staged as either stage III or stage IV. Because the patient has full-thickness tissue loss, this would not be considered a stage II pressure ulcer.

The nurse is providing education to a patient recently diagnosed with shingles. The patient asks why the rash has occurred in one line. The nurse's response refers to which structure that is inflamed by the virus?

Varicella zoster attacks the spinal ganglia, causing inflammation along the nerve.

While evaluating a patient with a sore throat, the nurse notices obvious small bruising and "pinch" marks around the neck. Which action should the nurse take next to determine cause when evaluating this patient? Select all that apply.

When evaluating a patient with odd or differing markings, the nurse would determine if these markings are present in other areas of the body and then ask the patient about cultural practices that are used to promote health and healing. Bat gio is the practice of pinching the temples or neck to treat headaches or sore throat.