NUR 211 Exam 1 Skin Cancer

A patient is undergoing psoralen plus ultraviolet A light (PUVA) therapy. 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, but lead-lined drapes, use of antiseptic soap, and petroleum jelly are not used to prevent skin damage.

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.

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: 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.

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: 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.

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.

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: 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.

5. 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: 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 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

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.

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: 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.

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.

The school nurse is preparing to teach a health promotion class to high school seniors. Which information regarding self-care should be included when teaching?A. Wear sunscreen with a protection factor of 10 or less when in the sunB. Try to stay out of the sun between 0300 and 0500 dailyC. Perform a thorough skin check monthlyD. Remember caps and long sleeves do not help prevent skin cancer

C

The epidermis consists of ________ layers with the innermost layer of the epidermis being known as the __________. A. five, stratum lucidum B. three, stratum spinosum C. five, stratum basale D. three, stratrum granulosum

C. The epidermis consists of FIVE layers with the innermost layer of the epidermis being known as the stratum basale.

Identify the patients below who are at a HIGH risk for developing skin cancer. Select all that apply: A. A 22-year-old female who reports using a tanning bed three times per week. B. A 55-year-old male with dark skin that reports always wearing sunscreen while outdoors. C. A 35-year-old female with light-colored skin and eyes that reports frequent sunburns as a child. D. A 29-year-old who reports a family history of melanoma.

The answers are A, C, and D. Risk factors for skin cancer include too much exposure to the sun, usage of tanning beds, family history, light-colored skin and eyes, exposure to toxic chemicals on the skin, and frequent sunburns as a child.

True or False: Basal and squamous cell carcinoma are both considered nonmelanoma types of skin cancer.* True False

TRUE

You're providing teaching to a patient diagnosed with squamous cell carcinoma on the face. In your teaching, you are providing education on how this type of skin cancer develops. What information will you include in your patient education? A. "Squamous cell skin cancer develops in the stratum spinosum layer of the epidermis and occurs due to mutated keratinocytes." B. "Squamous cell skin cancer develops in the stratum corneum layer of the epidermis and occurs due to mutated basal cells." C. "Squamous cell skin cancer develops in the stratum basale layer of the epidermis and occurs due to mutated melanocytes." D. Squamous cell skin cancer develops in the stratum granulosum layer of the epidermis and occurs due to mutated squamous cells."The answer is A. Squamous cell skin cancer develops in the stratum spinosum layer of the epidermis and occurs due to mutated keratinocytes.

The answer is A. Squamous cell skin cancer develops in the stratum spinosum layer of the epidermis and occurs due to mutated keratinocytes.

Which statement is true regarding the pathophysiology of melanoma? A. "Melanoma develops when keratinocytes mutate in the stratum germinativum." B. "Melanoma of the skin originates from melanocytes found in the stratum basale." C. "Melanoma only occurs on the skin and is the most aggressive type of skin cancer." D. Melanoma arises from the squamous cells in the stratum spinosum."

The answer is B. This is the only correct statement about melanoma. It can occur anywhere in the body where there are melanocytes (example: middle layer of the eyes (uvea), epidermis etc.) and it originates from the melanocytes.

A patient has an electrodessication and curettage (EDC) performed to remove a skin cancer lesion. How will the nurse educate the patient on how to care for the surgical site? A. Apply dry, sterile gauze with a nonstick bandage. B. Apply a saline sterile gauze with a bandage. C. Apply petroleum jelly to the site with a nonstick bandage. D. Allow the site to stay open to air.

The answer is C. The site should be covered with petroleum jelly and nonstick bandage.

You're assessing a patient's understanding about how to prevent skin cancer. Select all the statements that demonstrate the patient understood the education provided to them: A. "I will try to avoid direct sun exposure at 11 am-5pm when the sunrays are the strongest." B. "I will use a broad-spectrum sunscreen that has an SPF of 15 or higher." C. "I will limit my tanning bed usage to two times per week." D. "It is very important I wear a hat, sunglasses, and long-sleeves to avoid too much sun exposure."

The answers are B and D. Option A is wrong because the sunrays are the strongest from 10 am - 4 pm, and option B is wrong because tanning beds should be avoided all together to prevent skin cancer.

You're providing an in-service on skin cancer prevention to a local group of parents and grandparents. One topic you discuss is the identification of melanoma. Select all the characteristics of this type of skin cancer you will educate the participants about: A. Diameter of 8 mm or higher B. Red, purple, and black color C. Dissimilar borders D. Uniform appearance E. Increase in size, shape, color

The answers are B, C, and E. When educating about how to identify melanoma using the ABCDE acronym. A: asymmetrical, B: borders uneven (dissimilar), C: color dark or multiple colors, D: diameter greater than 6 mm (NOT 8 mm). E: evolution (lesion increases in size, shape, color)