Lewis- Chapter 24: Nursing Management Integumentary Problems

ANS: D The nurse's initial actions should be to assess the impact of the disease on the patient's life and to allow the patient to verbalize feelings about the psoriasis. Depending on the assessment findings, other actions may be appropriate.

A patient who has severe refractory psoriasis on the face, neck, and extremities is socially withdrawn because of the appearance of the lesions. Which action should the nurse take first? a. Discuss the possibility of enrolling in a worker-retraining program. b. Encourage the patient to volunteer to work on community projects. c. Suggest that the patient use cosmetics to cover the psoriatic lesions. d. Ask the patient to describe the impact of psoriasis on quality of life.

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, but lead-lined drapes, use of antiseptic soap, and petroleum jelly are not used to prevent skin damage.

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: D The description of the mole is consistent with malignancy, so excision and biopsy are indicated. Curettage and cryosurgery are not used if malignancy is suspected. A punch biopsy would not be done for a lesion greater than 5 mm in diameter.

A patient with an enlarging, irregular mole that is 7 mm in diameter is scheduled for outpatient treatment. The nurse should plan to prepare the patient for which procedure? a. Curettage b. Cryosurgery c. Punch biopsy d. Surgical excision

Which patient would be more likely to have the highest risk of developing malignant melanoma? A. A fair-skinned woman who uses a tanning booth regularly B. An African American patient with a family history of cancer C. An adult who required phototherapy as an infant for the treatment of hyperbilirubinemia D. A Hispanic male with a history of psoriasis and eczema that responded poorly to treatment

A. A fair-skinned woman who uses a tanning booth regularly Risk factors for malignant melanoma include a fair complexion and exposure to ultraviolet light. Psoriasis, eczema, short-duration phototherapy, and a family history of other cancers are less likely to be linked to malignant melanoma.

Describe what is indicated by the ABCDEs of malignant melanoma. A B C D E

Asymmetry: one half unlike the other half; Border: irregular and poorly circumscribed; Color: varied within lesion; Diameter: larger than 6 mm; Evolving: look and appearance is changing

A 19-year-old patient reports to the clinic nurse the following symptoms: a ring-like itchy rash on the upper leg, low-grade fever, nausea, and joint pain for the past 3 weeks. What question is important for the nurse to ask the patient? A. "Is the itching worse at night?" B. "Have you had a tick bite recently?" C. "Have you been exposed to pubic lice?" D. "Have you had unprotected sexual contact?"

B. "Have you had a tick bite recently?" Symptoms are consistent with Lyme disease caused by the organism Borrelia burgdorferi, which is transmitted by a tick bite.

The nurse is providing preoperative teaching for the patient having a face-lift (rhytidectomy) surgery. Which patient response indicates the patient understands the teaching? A. "I am afraid of the pain afterwards, while it is healing." B. "I can't wait to have my forehead and lip wrinkles eliminated." C. "I have some time off work so I will not look so bad when I go back." D. "Now I can be excited to go to my 50th high school reunion this week.

C. "I have some time off work so I will not look so bad when I go back." A rhytidectomy or face-lift surgery will not have immediate results and will take time to heal, so taking time off from work will allow more healing to be accomplished before returning to work. There is not much pain with most cosmetic surgeries. A rhytidectomy will not eliminate forehead lines and vertical lip wrinkles.

What practice should the nurse teach a patient to follow when the patient is applying topical medication? A. Avoid applying medications directly on to dressings. B. Use a tongue blade whenever the patient's skin integrity allows. C. Avoid covering skin regions that have topical medication in place. D. Apply a layer of medication that is just thick enough to ensure coverage.

D. Apply a layer of medication that is just thick enough to ensure coverage. Patients should be directed to avoid applying topical medications too thickly. Medications may be applied directly on to dressings, and regions with medications may be covered. A tongue blade is not normally used for the application of a thin coat.

ANS: B Neosporin can cause contact dermatitis. The other medications are being used appropriately by the patient.

The nurse is interviewing a patient with contact dermatitis. Which finding indicates a need for patient teaching? a. The patient applies corticosteroid cream to pruritic areas. b. The patient uses Neosporin ointment on minor cuts or abrasions. c. The patient adds oilated oatmeal (Aveeno) to the bath water every day. d. The patient takes diphenhydramine (Benadryl) at night if itching occurs.

ANS: D The presence of acanthosis nigricans in skinfolds suggests either having type 2 diabetes or being at an increased risk for it. The description of the patient's skin does not indicate problems with fungal infection, poor hygiene, or the need to dry the skinfolds better.

The nurse notes darker skin pigmentation in the skinfolds of a middle-aged patient who has a body mass index of 40 kg/m2. What is the nurse's best action? a. Teach the patient about the treatment of fungal infection. b. Discuss the use of drying agents to minimize infection risk. c. Instruct the patient about the use of mild soap to clean skinfolds. d. Ask the patient about type 2 diabetes or if there is a family history of it.

ANS: C The appearance of the lesions is consistent with an oral candidiasis (thrush) infection, which can occur in patients who are taking medications such as immunosuppressants or antibiotics. Candidiasis is not associated with poor oral hygiene or lower respiratory infections. The lesions do not look like an oral herpes infection.

The nurse notes the presence of white lesions that resemble milk curds in the back of a patient's throat. Which question by the nurse is appropriate at this time? a. "Do you have a productive cough?" b. "How often do you brush your teeth?" c. "Are you taking any medications at present?" d. "Have you ever had an oral herpes infection?"

ANS: D Careful hand washing and the safe disposal of soiled dressings are the best means of preventing the spread of skin problems. Sterile glove and sterile saline use during wound care will not necessarily prevent spread of infection. Applying antibiotic ointment will treat the bacteria but not necessarily prevent the spread of infection.

What is the best method to prevent the spread of infection when the nurse is changing the dressing over a wound infected with Staphylococcus aureus? a. Change the dressing using sterile gloves. b. Soak the dressing in sterile normal saline. c. Apply antibiotic ointment over the wound. d. Wash hands and properly dispose of soiled dressings.

The patient has diabetes mellitus and chronic obstructive pulmonary disease that has been treated with high-dose corticosteroids for the past several years. Which dermatologic manifestations could be related to these systemic problems (select all that apply)? a. Acne b. Increased sweating c. Dry, coarse, brittle hair d. Impaired wound healing e. Erythematous plaques of the shins f. Decreased subcutaneous fat over extremities

a, d, e, f. Glucocorticoid excess can cause acne and decreased subcutaneous fat over the extremities. Diabetes mellitus can cause erythematous plaques of the shins and both the corticosteroids and diabetes can impair or delay wound healing. Increased sweating is seen with hyperthyroidism and coarse, brittle hair is seen with hypothyroidism

ANS: A The treatment for impetigo includes softening of the crusts with warm saline soaks and then soap-and-water removal. Alcohol-based cleansers and use of petroleum jelly are not recommended for impetigo. Antibiotic ointments, such as mupirocin (Bactroban), may be applied to the lesions.

The health care provider diagnoses impetigo in a patient who has crusty vesicopustular lesions on the lower face. Which instructions should the nurse include in the teaching plan? a. Clean the infected areas with soap and water. b. Apply alcohol-based cleansers on the lesions. c. Avoid use of antibiotic ointments on the lesions. d. Use petroleum jelly (Vaseline) to soften crusty areas.

What skin condition has keratotic and firm lesions, is a precursor of squamous cell carcinoma, and is treated with topical fluorouracil (5-FU)? a. Actinic keratosis b. Basal cell carcinoma c. Malignant melanoma d. Squamous cell carcinoma

a. Basal cell carcinoma is noduloulcerative with pearly borders. Malignant melanoma tumors arise in melanocytes. Malignant melanoma is the deadliest skin cancer and has an increased risk in people with dysplastic nevus syndrome. Squamous cell carcinoma is a malignant neoplasm of keratinizing epidermal cells.

What are the most appropriate dressings to use to promote comfort for a patient with an inflamed, pruritic dermatitis? a. Cool tap water dressings b. Cool acetic acid dressings c. Warm sterile saline dressings d. Warm potassium permanganate dressings

a. Dressings used to treat pruritic lesions should be cool to cause vasoconstriction and to have an antiinflammatory effect. Water is most commonly used and it does not need to be sterile. Acetic acid solutions are bacteriocidal and are used to treat skin infections.

What is the most common reason elective cosmetic surgery is requested by patients? a. Improve self-image c. Lighten the skin in pigmentation problems b. Remove deep acne scars d. Prevent skin changes associated with aging

a. Improvement of body image is the most common reason for undergoing cosmetic surgery; appearance is an important part of confidence and self-assurance. Acne scars, pigmentation problems, and wrinkling can be treated with cosmetic surgery but the surgery does not prevent the skin changes associated with aging.

Which skin condition occurs as an allergic reaction to mite eggs? a. Scabies c. Folliculitis b. Impetigo d. Pediculosis

a. In scabies mites penetrate the skin and deposits eggs. An allergic reaction can result from the presence of eggs, feces, and mite parts. Impetigo involves vesiculopustular lesions that develop a thick, honey-colored crust surrounded by erythema. Folliculitis is a small pustule at the hair follicle opening with minimal erythema. Pediculosis is lice.

Which statements characterize malignant melanomas (select all that apply)? a. Lesion is keratotic and firm b. Neoplastic growth of melanocytes c. Skin cancer with highest mortality rate d. Irregular color and asymmetric shape e. Frequently occurs on previously damaged skin

b, c, d. Actinic and firm lesions are actinic keratosis and squamous cell carcinoma. Squamous cell carcinoma frequently occurs in previously damaged skin.

The nurse plans care for a patient with a newly diagnosed malignant melanoma based on the knowledge that initial treatment may involve (select all that apply) a. shave biopsy. b. Mohs' surgery. c. surgical excision. e. localized radiation. f. fluorouracil (5-FU). g. topical nitrogen mustard.

b, c. In the early stages, surgical excision with a margin of 18. normal skin is the initial treatment for malignant melanoma. Mohs' surgery can also be used to treat malignant melanoma. Radiation may be used after excision for malignant melanoma, depending on staging of the disease. Topical nitrogen mustard may be used for treatment of cutaneous T-cell lymphoma.

What is the most common skin cancer and has pearly borders? a. Actinic keratosis b. Basal cell carcinoma c. Malignant melanoma d. Squamous cell carcinoma

b. Actinic keratosis is an irregularly shaped, flat, slightly erythematous papule with indistinct borders and an overlying hard keratotic scale or horn. Malignant melanoma tumors arise in melanocytes. Malignant melanoma is the deadliest skin cancer and has an increased risk in people with dysplastic nevus syndrome. Squamous cell carcinoma is a malignant neoplasm of keratinizing epidermal cells.

A female patient with chronic skin lesions of the face and arms tells the nurse that she cannot stand to look at herself in the mirror anymore because of her appearance. Based on this information, the nurse identifies which nursing diagnosis? a. Anxiety related to personal appearance b. Disturbed body image related to perception of unsightly lesions c. Social isolation related to decreased activities as a result of poor self-image d. Ineffective self-health management related to lack of knowledge of cover-up techniques

b. Defining characteristics for body image problems include verbalization of self-disgust and reluctance to look at lesions, as evidenced in this patient. Social isolation is indicated only if there is evidence of decreased social activities and of anxiety by verbalization of anxiety or frustration. Ineffective self-health management is indicated by evidence of a lack of self-care or understanding of the disease process.

Which description characterizes seborrheic keratosis? a. White patchy yeast infection b. Warty, irregular papules or plaques c. Excessive turnover of epithelial cells d. Deep inflammation of subcutaneous tissue

b. Seborrheic keratoses are irregularly round or oval shaped and are often verrucous papules or plaques. Candidiasis is a white patchy yeast infection. Cellulitis is a deep inflammation of subcutaneous tissue. Psoriasis is an excessive turnover of epithelial cells.

What is an appropriate intervention to promote debridement and removal of scales and crusts of skin lesions? a. Warm oatmeal baths b. Warm saline dressings c. Cool sodium bicarbonate baths d. Cool magnesium sulfate dressings

b. Tepid or warm solutions should be used when the purpose is debridement and saline is a common debridement solution. Baths are appropriate for debridement but sodium bicarbonate and oatmeal are used for pruritus.

Which skin condition would be treated with laser surgery? a. Preauricular lesion c. Obesity with subcutaneous fat accumulation b. Redundant soft tissue conditions d. Fine wrinkle reduction or facial lesion removal

d. A facelift is used for preauricular lesions and redundant soft tissue reduction. Liposuction is used for obesity with subcutaneous fat accumulation.

What is the name for papillomavirus infection seen on the skin? a. Furuncle b. Carbuncle c. Erysipelas d. Plantar wart

d. A plantar wart is caused by human papillomavirus (HPV). A furuncle is a deep skin infection with staphylococci around the hair follicle. A carbuncle is multiple, interconnecting furuncles. Erysipelas is superficial cellulitis primarily involving the dermis.

What characteristic is commonly seen with dysplastic nevus syndrome? a. Associated with sun exposure b. Precursor of squamous cell carcinoma c. Slow-growing tumor with rare metastasis d. Lesion has irregular color and asymmetric shape

d. Dysplastic nevus syndrome involves atypical moles with irregular borders and various shades of color.

ANS: D BCC is frequently associated with sun exposure and preventive measures should be taken for future sun exposure. BCC spreads locally, and does not metastasize to distant tissues. Since BCC can cause local tissue destruction, treatment is indicated. Local (not systemic) chemotherapy may be used to treat BCC.

A nurse develops a teaching plan for a patient diagnosed with basal cell carcinoma (BCC). Which information should the nurse include in the teaching plan? a. Treatment plans include watchful waiting. b. Screening for metastasis will be important. c. Low dose systemic chemotherapy is used to treat BCC. d. Minimizing sun exposure will reduce risk for future BCC.

ANS: A, B, E Cool or tepid baths, cool dressings, and OTC antihistamines all help reduce pruritus and scratching. Adding oil to bath water is not recommended because of the increased risk for falls. The patient should use the towel to pat (not rub) the skin dry.

A nurse is teaching a patient with contact dermatitis of the arms and legs about ways to decrease pruritus. Which information should the nurse include in the teaching plan (select all that apply)? a. Cool, wet cloths or dressings can be used to reduce itching. b. Take cool or tepid baths several times daily to decrease itching. c. Add oil to your bath water to aid in moisturizing the affected skin. d. Rub yourself dry with a towel after bathing to prevent skin maceration. e. Use of an over-the-counter (OTC) antihistamine can reduce scratching.

ANS: D Because the only risk factor that the patient can change is the use of a tanning booth, the nurse should focus teaching about melanoma prevention on this factor. The other factors also will contribute to increased risk for melanoma.

A patient has the following risk factors for melanoma. Which risk factor should the nurse assign as the priority focus of patient teaching? a. The patient has multiple dysplastic nevi. b. The patient is fair-skinned and has blue eyes. c. The patient's mother died of a malignant melanoma. d. The patient uses a tanning booth throughout the winter.

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.

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.

The nurse would assess a patient admitted with cellulitis for what localized manifestation? A. Pain B. Fever C. Chills D. Malaise

A. Pain Pain, redness, heat, and swelling are all localized manifestation of cellulitis. Fever, chills, and malaise are generalized, systemic manifestations of inflammation and infection.

ANS: D The patient should be taught that transient burning at the application site is an expected effect of pimecrolimus and that the medication should be left in place. The other statements by the patient are accurate and indicate that patient teaching has been effective.

A patient with atopic dermatitis has a new prescription for pimecrolimus (Elidel). After teaching the patient about the medication, which statement by the patient indicates that further teaching is needed? a. "After I apply the medication, I can go ahead and get dressed as usual." b. "I will need to minimize my time in the sun while I am using the Elidel." c. "I will rub the medication gently onto the skin every morning and night." d. "If the medication burns when I apply it, I will wipe it off and call the doctor."

ANS: A Thinning of the skin indicates that atrophy, a possible adverse effect of topical corticosteroids, is occurring. The health care provider should be notified so that the medication can be changed or tapered. Alopecia, red-brown discoloration, and dryness/scaling of the skin are not adverse effects of topical corticosteroid use.

A patient with atopic dermatitis has been using a high-potency topical corticosteroid ointment for several weeks. The nurse should assess for which adverse effect? a. Thinning of the affected skin b. Alopecia of the affected areas c. Reddish-brown discoloration of the skin d. Dryness and scaling in the areas of treatment

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 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

Which nursing intervention would be most helpful in managing a patient newly admitted with cellulitis of the right foot? A. Applying warm, moist heat B. Wrapping the foot snugly in blankets C. Limiting ambulation to three times daily D. Keeping the foot at or below heart level

A. Applying warm moist heat The application of warm, moist heat speeds the resolution of inflammation and infection when accompanied by appropriate antibiotic therapy. It does this by increasing local circulation to the affected area to bring macrophages to the area and carry off cellular debris. Immobilization and elevation is also used. Snug blankets would not be helpful and could decrease circulation to this sensitive tissue.

The patient is in the hospital for a surgical procedure and has dry skin and pruritis on her legs that causes her to scratch at the skin uncontrollably. What measures can the nurse use to help stop the itch/scratch cycle 0?(select all that apply)? A. Moisturize the skin on the legs. B. Provide a warm blanket and room. C. Administer antihistamines at bedtime. D. Use careful hand washing after rubbing her legs. E. Cleanse the legs with a saline solution twice daily.

A. Moisturize the skin on the legs. C. Administer antihistamines at bedtime. Moisturizing the skin to decrease the dryness and the itch sensation and bedtime antihistamines to decrease a potential allergic reaction and provide some sedation will help the patient sleep since pruritis is often worse at night and the patient needs sleep for healing. Using nonallergic sheets may also help. Anything causing vasodilation, such as warmth or rubbing, should be avoided. Saline solution would only further dry the skin so would not be used on the patient's legs.

The patient has been diagnosed with tinea unguium (Onychomycosis) under her nails. She does not like the oral antifungal medication. What is the best alternate treatment the nurse should describe for her? A. Nail avulsion B. Antifungal cream C. Thinning of fingernails D. Soaking nails in salt water

A. Nail avulsion Nail avulsion is the best alternate treatment to the oral antifungal medication. Antifungal cream is minimally effective. Thinning fingernails is not needed if the tinea unguium is under her toenails. Soaking the nails will not be helpful.

The patient with a stage IV pressure ulcer on the coccyx will need a skin graft to close the wound. What postoperative care should the nurse expect to use to facilitate healing? A. No straining of the grafted site B. The wound will be exposed to air. C. Soft tissue expansion will be done daily. D. The pressure dressing will not be removed.

A. No straining of the grafted site Straining or stretching of the grafted site must be avoided to allow the graft to be vascularized and fixed to the new site for healing. The wound may or may not be exposed to air depending on the type of graft, and the donor site will be covered with a protective dressing to prevent further damage. Soft tissue expansion and pressure dressings will not be used after this wound's skin graft.

In a patient admitted with cellulitis of the left foot, which clinical manifestation would the nurse expect to find on assessment of the left foot? A. Redness and swelling B. Pallor and poor turgor C. Cyanosis and coolness D. Edema and brown skin discoloration

A. Redness and swelling Cellulitis is a diffuse, acute inflammation of the skin. It is characterized by redness, swelling, heat, and tenderness in the affected area. These changes accompany the processes of inflammation and infection.

The nurse should teach a patient who is taking which drug to avoid prolonged sun exposure? A. Tetracycline B. Ipratropium C. Morphine sulfate D. Oral contraceptives

A. Tetracycline Several antibiotics, including tetracycline, may cause photosensitivity. This is not the case with ipratropium, morphine, or oral contraceptives.

A 67-year-old woman admitted with heart failure is also diagnosed with herpes zoster (shingles) and draining vesicles. Which action, if observed by the nurse, would require additional teaching for that individual? A. The dietitian wears a mask when entering the patient's room. B. The patient keeps the draining vesicles covered with a dressing. C. The student nurse who takes prednisone requests a different patient assignment. D. The nursing assistant washes hands frequently and wears gloves when in the room.

A. The dietitian wears a mask when entering the patient's room. Herpes zoster (shingles) is spread by contact with fluid draining from the vesicles (not by coughing, sneezing, or casual contact). Shingles is not contagious before the vesicles appear or after the vesicles have crusted over. The risk of a person with shingles spreading the virus is low if the rash is covered. Wearing a mask would not prevent the spread of infection. Until the rash develops crusts, the patient should not have contact with an immune compromised person (e.g., a person taking prednisone). Frequent hand washing helps to prevent the spread of varicella zoster virus.

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.

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.

The nurse teaches a 50-year-old woman with chronic kidney disease several interventions to reduce pruritus associated with dry skin and uremia. Which statement, if made by the patient to the nurse, indicates further teaching is required? A. "I will avoid taking hot showers." B. "I can rub my skin instead of scratching." C. "Menthol can be used to numb the itch sensation." D. "A lubricating lotion right after bathing will help."

B. "I can rub my skin instead of scratching." Any activity that causes vasodilation, such as rubbing or bathing and showering in hot water should be avoided as vasodilation leads to increased itching. Menthol in skin products provides a sensation that may distract the patient from the sensation of itchiness. Applying lotion right after bathing helps retain moisture in the skin.

The nurse should recognize which patient as likely to have the poorest prognosis? A. A 60-year-old diagnosed with nodular ulcerative basal cell carcinoma B. A 59-year-old man who is being treated for stage IV malignant melanoma C. A 70-year-old woman who has been diagnosed with late squamous cell carcinoma D. A 51-year-old woman whose biopsy has revealed superficial squamous cell carcinoma

B. A 59-year-old man who is being treated for stage IV malignant melanoma Late detection of malignant melanoma is associated with a poor outcome. Basal cell carcinomas often have very effective treatment success rates. Although late squamous cell carcinoma (SCC) has worse outcomes than superficial SCC, these are both exceeded in mortality by late-stage malignant melanoma.

Which assessment finding of a 70-year-old male patient's skin should the nurse prioritize? A. The patient's complaint of dry skin that is frequently itchy B. The presence of an irregularly shaped mole that the patient states is new C. The presence of veins on the back of the patient's leg that are blue and tortuous D. The presence of a rash on the patient's hand and forearm to which the patient applies a corticosteroid ointment

B. The presence of an irregularly shaped mole that the patient states is new Although all of the noted assessment findings are significant, the presence of an irregular mole that is new is suggestive of a neoplasm and warrants immediate follow-up.

The patient has had rashes and alopecia. What vitamin in which foods should be encouraged as a nutritional aid to these problems? A. Vitamin A in sweet potatoes, carrots, dark leafy greens B. Vitamin B7 (biotin) in liver, cauliflower, salmon, carrots C. Vitamin C in peppers, dark leafy greens, broccoli, and kiwi D. Vitamin D in canned salmon, sardines, fortified dairy, and eggs

B. Vitamin B7 (biotin) in liver, cauliflower, salmon, carrots A deficiency of Vitamin B7 (biotin) may result in rashes and alopecia. Eating foods with biotin will help decrease these problems. Vitamins A and C are needed for wound healing. Vitamin D is needed for bone and body health.

Which laboratory result is the best indicator that a patient with cellulitis is recovering from this infection? A. WBC of 2900/μL B. WBC of 8200/μL C. WBC of 12,700/μL D. WBC of 16,300/μL

B. WBC of 8200/μL The normal white blood cell count is generally 4000 to 11,000/μL. For this reason, the patient's level would be returning to normal if it was 8200/μL, indicating recovery from cellulitis. The 2900/µL is too low and indicates another problem is occurring. The 12,700/µL and 16,300/µL are evidence of continuing infection.

The nurse cares for a 41-year-old male patient admitted for uncontrolled seizures who is also diagnosed with impetigo on the face and neck. Which action is appropriate for the nurse to take? A. Put on a protective gown before entering the room. B. Wash hands for 1 to 2 minutes when leaving the room. C. Wear gloves to leave a diet menu on the patient's table. D. Wear a particulate mask when within 3 feet of the patient.

B. Wash hands for 1 to 2 minutes when leaving the room. Impetigo is a bacterial skin infection with group A β-hemolytic streptococci or staphylococci. Meticulous hygiene (including hand washing) is essential to prevent the spread of infection. A particulate mask or a gown would not be necessary to prevent the spread of impetigo. Gloves would not be needed to make a delivery to the room.

The nurse is teaching about skin cancer prevention at the community center. Which individual is most at risk for developing skin cancer? A. A 67-year-old bald-headed man with psoriasis and type 2 diabetes mellitus B. A 76-year-old Hispanic man who has a latex allergy and numerous acrochordons C. A 55-year-old woman with fair skin and red hair who has a family history of skin cancer D. A 62-year-old woman with chronic kidney disease who has blond hair with dry, pale skin and pruritus

C. A 55-year-old woman with fair skin and red hair who has a family history of skin cancer Risk factors for skin cancer include having fair skin (with red hair) and a family history of skin cancer. Allergies, acrochordons (skin tags), psoriasis, type 2 diabetes mellitus, and chronic kidney disease are not risk factors associated with the development of skin cancer.

The patient with diabetes mellitus has peripheral vascular disease. Knowing this, for which dermatologic manifestations should the nurse expect to assess? A. Redness of exposed areas of the skin on the hand, foot, face, or neck and infected dermatitis B. Leathery, brownish skin on lower leg, pruritis, concave lesions with edema, scar tissue with healing C. Loss of hair in periphery, delayed capillary filling, dependent rubor, neuropathy, and delayed wound healing D. Atrophy, epidermal thinning, increased vascular fragility, impaired wound healing, thin loose dermis, and excess fat at the back of the neck

C. Loss of hair in periphery, delayed capillary filling, dependent rubor, neuropathy, and delayed wound healing The patient with diabetes mellitus and peripheral vascular disease is likely to have loss of peripheral hair, delayed capillary filling, dependent rubor, neuropathy, and delayed wound healing. The patient with a nicotinic acid (niacin) deficiency manifests redness of exposed areas of the skin on the hand or foot, face, or neck and infected dermatitis. The patient with venous ulcers will have leathery, brownish skin on the lower leg, pruritus, concave lesions with edema, and scar tissue with healing. The patient with glucocorticoid excess (Cushing syndrome) may have atrophy, epidermal thinning, increased vascular fragility, impaired wound healing, thin loose dermis, and excess fat at the back of the neck, clavicles, abdomen, and face.

A 56-year-old white patient presents with a flat, dry, scaly area on her eyebrows that is treated with a chemical peel. What should the nurse include in the discharge teaching? A. Metastasis of this type of cancer is rare. B. The patient has an increased risk for melanoma. C. Recurrence of the premalignant lesion is possible. D. Untreated lesions may metastasize to regional lymph nodes.

C. Recurrence of the premalignant lesion is possible. The flat or elevated dry scaly area is actinic keratosis from sun damage and is a premalignant skin lesion common in older whites with possible recurrence even with adequate treatment. Metastasis of basal cell carcinoma is rare; it is a small slowly enlarging papule. There is an increased risk for melanoma with atypical or dysplastic nevi. With squamous cell carcinoma, untreated lesions may metastasize to regional lymph nodes and distant organs, but it has a high cure rate with early detection and treatment.

A 26-year-old patient is looking down as she tells the nurse that she is afraid to use the treatment recommended for her psoriasis because her mother had a lot of problems with all the creams she used to try to treat her psoriasis. How should the nurse respond to the patient? A. "You will only know if you try it and see." B. "You may need to get counseling to help you cope." C. "No treatment is medically necessary, but it can be removed." D. "Topical, light therapy, and systemic medications are now available."

D. "Topical, light therapy, and systemic medications are now available." Treatment of psoriasis usually involves a combination of strategies including topical treatments, phototherapy, and/or systemic medications including biologic drugs. Telling her that she will only know if she tries or that she may need counseling is denying the patient's concern. Psoriasis is treated to manage the disease as the patient may have a weakened immune system and be at risk for cardiovascular disease.

To the nurse, a patient describes small, firm, reddened raised lesions with flat, rough patches that are causing intense pruritus. What should be the nurse's next assessment? A. History of seasonal allergies B. Initiation of new medication C. Previous pruritic skin lesions D. Activities in past 2 to 7 days

D. Activities in past 2 to 7 days The patient's lesions are papules and plaques characteristic of contact dermatitis. The nurse should ask the patient about activities over the past 2 to 7 days to identify potential allergens because contact dermatitis has a delayed onset. Even if an offending agent is not identified, the nurse can provide patient teaching about managing the pruritus and preventing infection by decreasing scratching. Seasonal allergies and new medications are more likely to cause urticaria than papules and plaque. The nurse should also ask about pruritic rashes in the past to determine potential illnesses that can cause dermatologic manifestations.

The nurse is teaching the residents of an independent living facility about preventing skin infections and infestations. What should be included in the teaching? A. Use cool compresses if an infection occurs. B. Oral antibiotics will be needed for any skin changes. C. Antiviral agents will be needed to prevent outbreaks. D. Inspect skin for changes when bathing with mild soap.

D. Inspect skin for changes when bathing with mild soap. Individuals living in independent living facilities are usually older, which means their skin does not need cleaning with hot water and vigorous scrubbing or as often as a younger person. Mild soap (e.g., Ivory) should be used to avoid loss of protection from neutralization of the skin's surface. The skin should be inspected for changes with bathing. Cool compresses are used with ringworm or stings for the antiinflammatory effect. Oral antibiotics are used for Lyme disease from ticks. Antiviral agents are used for viral infections but not to prevent outbreaks.

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.

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 Pale, cool skin indicates a possible decrease in circulation, so the surgeon should be notified immediately. The other assessment data indicate a need for ongoing assessment or nursing action. A heart rate of 110 beats/minute may be related to the stress associated with surgery. Assessment of other vital signs and continued monitoring are appropriate. Because local anesthesia would be used for the procedure, numbness of the incisional area is expected immediately after surgery. The nurse should monitor for return of feeling.

The nurse assesses a patient who has just arrived in the postanesthesia recovery area (PACU) after a blepharoplasty. Which assessment data should be reported to the surgeon immediately? a. The patient complains of incisional pain. b. The patient's heart rate is 110 beats/minute. c. The patient is unable to detect when the eyelids are touched. d. The skin around the incision is pale and cold when palpated.

ANS: C Creams and ointments should be applied in a thin layer to avoid wasting the medication. The other actions by the patient indicate that the teaching has been successful

The nurse instructs a patient about application of corticosteroid cream to an area of contact dermatitis on the right leg. Which patient action indicates that further teaching is needed? a. The patient takes a tepid bath before applying the cream. b. The patient spreads the cream using a downward motion. c. The patient applies a thick layer of the cream to the affected skin. d. The patient covers the area with a dressing after applying the cream.

ANS: D Cleaning the skin is within the education and scope of practice for UAP. Administration of medication, obtaining cultures, and evaluation are higher-level skills that require the education and scope of practice of licensed nursing personnel.

The nurse is caring for a patient diagnosed with furunculosis. Which nursing action could the nurse delegate to unlicensed assistive personnel (UAP)? a. Applying antibiotic cream to the groin. b. Obtaining cultures from ruptured lesions. c. Evaluating the patient's personal hygiene. d. Cleaning the skin with antimicrobial soap.

ANS: A Because isotretinoin is teratogenic, contraception is required for women who are using this medication. The nurse will need to determine whether the patient is using other birth control methods. More information about the other patient data may also be needed, but the other data do not indicate contraindications to isotretinoin use.

The nurse working in the dermatology clinic assesses a young adult female patient who is taking isotretinoin (Accutane) to treat severe cystic acne. Which assessment finding is most indicative of a need for further questioning of the patient? a. The patient recently had an intrauterine device removed. b. The patient already has some acne scarring on her forehead. c. The patient has also used topical antibiotics to treat the acne. d. The patient has a strong family history of rheumatoid arthritis.

ANS: A The description of the lesion is consistent with possible malignant melanoma. This patient should be assessed as soon as possible by the health care provider. Itching is common after using topical fluorouracil and redness is an expected finding a few days after a chemical peel. Skin tags are common, benign lesions after midlife.

There is one opening in the schedule at the dermatology clinic, and 4 patients are seeking appointments today. Which patient will the nurse schedule for the available opening? a. 38-year old with a 7-mm nevus on the face that has recently become darker b. 62-year-old with multiple small, soft, pedunculated papules in both axillary areas c. 42-year-old with complaints of itching after using topical fluorouracil on the nose d. 50-year-old with concerns about skin redness after having a chemical peel 3 days ago.

ANS: C The patient has clinical manifestations that could be caused by systemic problems such as malnutrition or hypothyroidism, so further diagnostic evaluation is indicated. Patient teaching about nutrition, addressing the patient's dry skin, and referral to a podiatrist may also be needed, but the priority is to rule out underlying disease that may be causing these manifestations.

When assessing a new patient at the outpatient clinic, the nurse notes dry, scaly skin; thin hair; and thick, brittle nails. What is the nurse's best action? a. Instruct the patient about the importance of nutrition in skin health. b. Make a referral to a podiatrist so that the nails can be safely trimmed. c. Consult with the health care provider about the need for further diagnostic testing. d. Teach the patient about using moisturizing creams and lotions to decrease dry skin.

ANS: A The patient should stay out of the sun. If that is not possible, teach them to wear sunscreen when taking medications that can cause photosensitivity. The other statements are not accurate.

Which information should the nurse include when teaching a patient who has just received a prescription for ciprofloxacin (Cipro) to treat a urinary tract infection? a. Use a sunscreen with a high SPF when exposed to the sun. b. Sun exposure may decrease the effectiveness of the medication. c. Photosensitivity may result in an artificial-looking tan appearance. d. Wear sunglasses to avoid eye damage while taking this medication.

ANS: D The risk for skin damage from the sun is highest with exposure between 10 AM and 2 PM. No sunscreen is completely water resistant. Sunscreens classified as water resistant sunscreens still need to be reapplied after swimming. Sunscreen with an SPF of at least 15 is recommended for people at normal risk for skin cancer. Although gradually increasing sun exposure may decrease the risk for burning, the risk for skin cancer is not decreased.

Which information should the nurse include when teaching patients about decreasing the risk for sun damage to the skin? a. Use a sunscreen with an SPF of at least 8 to 10 for adequate protection. b. Water resistant sunscreens will provide good protection when swimming. c. Increase sun exposure by no more than 10 minutes a day to avoid skin damage. d. Try to stay out of the sun between the hours of 10 AM and 2 PM (regular time)

ANS: C Warm water and moisturizing soap will avoid overdrying the skin. Because older patients have dryer skin, daily bathing and shampooing are not necessary and may dry the skin unnecessarily. Antibacterial soaps are not necessary. Lotions should be applied while the skin is still damp to seal moisture in.

Which information will the nurse include when teaching an older patient about skin care? a. Dry the skin thoroughly before applying lotions. b. Bathe and wash hair daily with soap and shampoo. c. Use warm water and a moisturizing soap when bathing. d. Use antibacterial soaps when bathing to avoid infection.

Which statements are true about skin and skin care (select all that apply)? a. One of the detrimental effects of obesity on the skin is increased sweating. b. The nutrient that is critical in maintaining and repairing the structure of epithelial cells is vitamin C. c. Exposure to UVA rays is believed to be the most important factor in the development of skin cancer. d. The photosensitivity caused by various drugs can be blocked by the use of topical hydrocortisone. e. Photosensitivity results when certain chemicals in body cells and tissues absorb light from the sun and release energy that harms the tissues and cells. f. When teaching a patient about the use of sunscreens that protect against exposure to both UVA and UVB rays, the nurse advises the patient to look for the inclusion of benzophenones.

a, e, f. Vitamin A, not vitamin C, is critical in maintaining and repairing the structure of epithelial cells. Exposure to UVB rays, not UVA rays, is believed to be the most important factor in the development of skin cancer. Sunscreen, not topical hydrocortisone, can block the photosensitivity caused by various drugs.

To prevent lichenification related to chronic skin problems, what does the nurse encourage the patient to do? a. Use measures to control itching. b. Wear sterile gloves when touching the lesions. c. Use careful hand washing and safe disposal of soiled dressings. d. Use topical antibiotics with wet-to-dry dressings over the lesions.

a. Lichenification is thickening of the skin caused by chronic scratching or rubbing and can be prevented by controlling itching. It is not an infection, nor is it contagious, as the other options indicate.

A nurse caring for a disheveled patient with poor hygiene observes that the patient has small red lesions flush with the skin on the head and body. The patient complains of severe itching at the sites. For what should the nurse further assess the patient? a. Nits on the shafts of his head hair b. A history of sexually transmitted diseases c. The presence of ticks attached to the scalp d. The presence of burrows in the interdigital webs

a. Pediculosis (head lice and body lice) causes very small, red, noninflammatory lesions that progress to papular wheal-like lesions and cause severe itching. Lice live on the body as nits (tiny white eggs) that are firmly attached to hair shafts on the head and body. Burrows, especially in interdigital webs, are found with scabies.

What is a skin graft that is used to transfer skin and subcutaneous tissue to large areas of deep tissue destruction called? a. Skin flap c. Soft tissue extension b. Free graft d. Free graft with vascular anastomoses

a. Skin flaps as grafts include moving skin and subcutaneous tissue to another part of the body and are used to cover wounds with poor vascular beds, add padding, and cover wounds over cartilage and bone. Both types of free grafts include just skin and soft tissue extension involves placement of an expander under the skin, which stretches the skin over time to provide extra skin to cover the desired area.

A patient is a 78-year-old woman who has had chronic respiratory disease for 30 years. She weighs 212 lb (96.4 kg) and is 5 ft, 1 in (152.5 cm) tall. She has recently completed corticosteroid and antibiotic treatment for an exacerbation of her respiratory disease. Identify four specific predisposing factors for bacterial skin infection in this patient. a. b. c. d.

a. chronic disease; b. obesity; c. recent antibiotic therapy; d. recent corticosteroid therapy

Priority Decision: A patient is receiving chemotherapy. She calls the physician's office and says she is experiencing itching in her groin and under her breasts. What is the first nursing assessment that would be done before the nurse makes an appointment for the patient with the physician to determine the treatment? a. Her height and weight c. If chemotherapy was completed b. What the areas look like d. Culture and sensitivity of the areas

b. The appearance of candidiasis on the skin shows diffuse papular erythematous rash with pinpoint satellites around the affected area. Height and weight could show if the patient is obese but it would be better to ask if the areas affected are moist. The chemotherapy could contribute to candidiasis but it does not matter if the chemotherapy treatments are finished. Culture and sensitivity of the area may be ordered by the physician at the patient's appointment.

Priority Decision: A 46-year-old African American patient is scheduled to have a basal cell carcinoma on his cheek excised in the health care provider's office. What factor is most important for the nurse to obtain in the patient's history? a. Protected sun exposure b. Radiation treatment for acne c. Prior treatments for the lesion d. Exposure to harsh irritants such as ammonia

b. Thirty years ago, when the patient was a teenager, radiation therapy was used to treat cystic acne with the result that many of these patients now have developed basal cell carcinoma. For a person with dark skin, radiation therapy is a higher risk factor for skin cancer than exposure to the sun or other irritants.

What should the nurse include in the instructions for a patient with urticaria? a. Apply topical benzene hexachloride. b. Avoid contact with the causative agent. c. Gradually expose the area to increasing amounts of sunlight. d. Use over-the-counter antihistamines routinely to prevent the condition.

b. Urticaria is inflammation and edema in the upper dermis, most commonly caused by histamine released during an antibody-allergen reaction. The best treatment for all types of allergic dermatitis is avoidance of the allergen. Sunlight and warmth would increase the edema and inflammation. Antihistamines may be used for an acute outbreak but not to prevent the dermatitis. Topical benzene hexachloride is used to treat pediculosis.

Which skin conditions are more common in immunosuppressed patients (select all that apply)? a. Acne b. Lentigo c. Candidiasis d. Herpes zoster e. Herpes simplex 1 f. Kaposi sarcoma

c, e, f. Patients who are immunocompromised are at an increased risk for candidiasis (a fungal infection), herpes simplex 1 (caused by a virus), and Kaposi sarcoma (vascular 22. lesions on the skin, mucous membranes, and viscera with wide range of presentation). The other options are not at increased risk with immunosuppression. Acne is caused by inflammation of sebaceous glands. Lentigo (also called "liver spots" or "age spots") is caused by an increased number of normal melanocytes in the basal layer of epidermis. Herpes zoster, which is caused by an activation of the varicella- zoster virus, is a group of vesicles and pustules resembling chickenpox located in a linear distribution along a dermatome.

A patient with a contact dermatitis is treated with calamine lotion. What is the rationale for using this base for a topical preparation? a. A suspension of oil and water to lubricate and prevent drying b. An emulsion of oil and water used for lubrication and protection c. Insoluble powders suspended in water that leave a residual powder on the skin d. A mixture of a powder and ointment that causes drying when moisture is absorbed

c. A lotion is a suspension of insoluble powders in water, which has cooling and drying properties, useful when itching is present. Creams and ointments have an oil and water base that lubricates and protects skin whereas a paste is a mixture of powder and ointment.

A patient with psoriasis is being treated with psoralen plus UVA light (PUVA) phototherapy. During the course of therapy, for what duration should the nurse teach the patient to wear protective eyewear that blocks all UV rays? a. Continuously for 6 hours after taking the medication b. Until the pupils are able to constrict on exposure to light c. For 12 hours following treatment to prevent retinal damage d. For 24 hours following treatment when outdoors or when indoors near a bright window

d. Psoralen is absorbed by the lens of the eye and eyewear that blocks 100% of UV light must be used for 24 hours after taking the medication. Because UVA penetrates glass, the eyewear must also be worn indoors when near a bright window. Psoralen does not affect the accommodative ability of the eye.