Deck 24: Nursing Management: Integumentary Problems

Question 1

A patient in the dermatology clinic has a small slow-growing papule with ulceration and a depression in the center of the lesion on the right cheek. The nurse will anticipate

A) preparing the patient for an excision and biopsy.
B) teaching about the use of over-the-counter (OTC) corticosteroid creams.
C) discussing the need for topical application of antibiotics.
D) educating the patient about use of tretinoin (Retin-A).

Answer 1

preparing the patient for an excision and biopsy.

Question 2

A patient with a large BCC on the face is seen in the dermatology clinic for the excision of the lesion. Which nursing action will be included in the postoperative plan of care?

A) Discuss reasons for referral to an oncologist for chemotherapy.
B) Teach how to use sterile technique to clean the suture line.
C) Educate about appropriate use of cold packs to reduce swelling.
D) Schedule daily appointments for wet-to-dry dressing changes.

Answer 2

Educate about appropriate use of cold packs to reduce swelling.

Question 3

When examining a patient's oral cavity, the nurse notes the presence of white lesions that resemble milk curds. Which question by the nurse is appropriate at this time?

A) Are you taking any medications at present?
B) How often do you brush your teeth?
C) Do you have a productive cough?
D) Have you ever had an oral herpes infection?

Answer 3

Are you taking any medications at present?

Question 4

A patient who is taking azithromycin (Zithromax) tells the nurse that the information provided by the pharmacy indicates this drug causes photosensitivity. The patient asks what will happen with exposure to sunlight while taking the drug. The best response by the nurse is that

A) heat from the sun is readily absorbed by the body and may lead to problems with heat intolerance.
B) the most common effect of photosensitivity is corneal damage because the drug causes corneal absorption of UV light.
C) sun exposure may cause an exaggerated sunburn with redness, swelling, and blistering on exposed areas.
D) photosensitivity causes abnormal melanocyte activity on exposure to UV light, resulting in splotchy, abnormally dark tanning.

Question 5

The nurse identifies a nursing diagnosis of risk for infection related to skin lesions and the presence of environmental pathogens for a patient with an allergic dermatitis. The nurse recognizes that the teaching regarding prevention of infection has been effective when the patient states

A) "I will take my temperature twice a day to detect the onset of any fever."
B) "I will use measures to keep from scratching at the inflamed areas."
C) "I will use antibiotic solutions to moisten dressings applied to the rash."
D) "I will use sterile technique when applying wet compresses to the rash."

Question 6

A patient is diagnosed with squamous cell carcinoma (SCC) of the face. Nursing action that is appropriate is to

A) explain that this is the least deadly type of skin cancer.
B) educate about minimizing sun exposure.
C) teach that recurrence of SCC is rare.
D) instruct about the systemic effects of chemotherapy.

Question 7

The health care provider prescribes topical 5-FU for a patient with actinic keratosis on the nose. Which information will the nurse include in the patient teaching plan?

A) You will need to avoid crowds because of the risk for infection caused by chemotherapy.
B) The nose will develop painful, eroded areas that will take weeks before completely healing.
C) You may develop nausea and anorexia, but good nutrition is important during treatment.
D) 5-FU is needed to shrink the lesion so that less scarring will occur once the lesion is excised.

Question 8

A patient is admitted to the hospital with a possible head injury following a fall at home. While examining the patient's scalp, the nurse suspects the presence of pediculosis on finding

A) red, hivelike papules and plaques with sharply circumscribed borders.
B) ringlike rashes with red, scaly borders over the entire scalp.
C) papular, wheal-like lesions with white deposits on the hair shaft.
D) patchy areas of alopecia with small vesicles and excoriated areas.

Question 9

A 46-year-old tells the nurse, "I'm thinking about having treatment with botulinum toxin (Botox) to get rid of my wrinkles." The most appropriate initial response by the nurse is

A) "Botox is an expensive therapy for someone your age."
B) "Botox injections are an excellent way to decrease your wrinkles."
C) "You should be aware of the side effects of Botox."
D) "Tell me what you know about how Botox works."

Question 10

A pressure dressing is applied to the face and neck of a patient following an elective rhytidectomy performed in an outpatient surgical center. The patient tells the nurse that the dressing feels very restrictive and asks whether it can be loosened. When explaining the purpose of the dressing, which response by the nurse is accurate?

A) "The dressing will reduce the risk for swelling and prolonged healing at the site."
B) "The dressing will protect against infection, a common problem after this type of surgery."
C) "The surgical site will be very painful if the dressing is removed too soon after surgery."
D) "The edges of the incisions will tend to come apart if the dressing is loosened too soon."

Question 11

The health care provider diagnoses impetigo and prescribes penicillin for a patient who has crusty vesicopustular lesions over the lower face and skin creases in the neck. Which information will be included in the teaching plan for this patient?

A) Appropriate use of alcohol-based lotions to decrease skin bacteria
B) How to clean the infected areas with soap and water
C) Daily use of a multiple vitamin with a high dose of vitamin A to improve skin integrity
D) Use of petroleum jelly (Vaseline) to soften crusty areas

Question 12

The nurse is assessing a patient who has just arrived in the postanesthesia recovery area (PACU) after a blepharoplasty. Which of these assessment data will require the most immediate action by the nurse?

A) The patient complains of incision discomfort at a level 5 of a 10-point scale.
B) The cardiac monitor shows a heart rate of 110 beats/minute.
C) The patient is unable to detect when the eyelids are touched.
D) The skin around the eye incisions is pale and cool to palpation.

Question 13

A patient with an enlarging, irregular mole that is 6 mm in diameter is scheduled for outpatient treatment. The nurse should plan on teaching the patient about

A) curettage.
B) cryosurgery.
C) punch biopsy.
D) surgical excision.

Question 14

The nurse is obtaining an initial assessment and health history for a new patient in the outpatient clinic. The patient has dry, scaly skin, thin hair, and thick, brittle nails. Which action by the nurse is most appropriate at this time?

A) Instruct the patient about the importance of nutrition in skin heath.
B) Consult with the health care provider about the need for further diagnostic testing.
C) Teach the patient about the use of creams and lotions for dry skin.
D) Make a referral to a podiatrist so that the nails can be safely trimmed.

Question 15

A topical corticosteroid ointment is prescribed for a home health patient who has atopic dermatitis in the antecubital and popliteal spaces. Which of these data noted by the nurse during a home visit indicates that the medication may need to be discontinued?

A) Thinning and bruising of the antecubital and popliteal skin
B) Alopecia of the affected areas
C) Reddish brown lesions
D) Dryness and scaling of the skin in the areas of treatment

Question 16

A patient who has severe refractory psoriasis on the face, neck, and extremities has quit a job as a bank teller and has withdrawn from all social activities. The patient tells the nurse, "I look like a monster. I can't think of a single reason to keep living." The most appropriate response by the nurse at this time is

A) "There are many resources that can teach you how to use cosmetics to improve your appearance."
B) "Have you thought about participating in community projects that might be of value to you?"
C) "Would you like me to spend some time listening to you express your sadness about the way you look?"
D) "Maybe we should talk to your doctor about having you see a professional who can help with your depression."

Question 17

A fair-skinned 32-year-old patient whose mother recently died from malignant melanoma asks the nurse, "What can I do to prevent malignant melanoma from developing?" The best response by the nurse is that

A) malignant melanoma is a relatively rare type of skin cancer.
B) the patient is at high risk for melanoma because of family history.
C) the avoidance of excessive sun exposure will decrease risk.
D) individuals with fair skin and blue eyes are at increased risk.

Question 18

A patient is undergoing psoralen plus UVA light (PUVA) therapy for treatment of psoriasis. To minimize complications from this procedure, the nurse plans to

A) shield any unaffected areas with lead-lined drapes.
B) cleanse the skin carefully with an antiseptic soap.
C) have the patient use protective eyewear during treatment.
D) apply petroleum jelly to the areas surrounding the lesions.

Question 19

A patient who is planning a vacation to the beach asks the nurse about precautions that should be taken to protect the skin while enjoying the sun and water. The nurse's best response is

A) "Sunscreens that contain metals like zinc or titanium provide a physical barrier and are the most effective at blocking ultraviolet rays."
B) "If you use a waterproof sunscreen with an SPF of 15 to the exposed areas of your skin, you won't have to apply it every time you swim."
C) "To avoid getting sunburn, gradually increase the time of sun exposure each day, starting with 30 minutes a day and adding 30 minutes each following day."
D) "Sunscreens with an SPF of 40 to 50 will provide full protection against both types of ultraviolet rays and should be applied before sun exposure."

Question 20

During application of a wet dressing to the skin of a patient with impetigo, it is most important for the nurse to

A) use cool solutions to debride the crusted-over areas of the lesions.
B) put on clean gloves to prevent the spread of the infection to others.
C) use sterile technique to prevent any further infection of the lesions.
D) apply a prescribed amount of antibiotic ointment before applying the dressings.

Question 21

A patient with atopic dermatitis has a new prescription for tacrolimus (Protopic). After teaching the patient about the medication, which statement by the patient indicates that further teaching is needed?

A) "If the medication burns when I apply it, I will wipe it off and call the doctor."
B) "I will need to minimize my time in the sun while I am using the Protopic."
C) "I will rub the medication gently onto the skin every morning and night."
D) "After I apply the medication, I can go ahead and get dressed as usual."

Question 22

A 21-year-old woman with cystic acne who has been taking isotretinoin (Accutane) for 2 weeks has a follow-up appointment at the dermatology clinic. Which information obtained by the nurse is of most concern?

A) The patient and her husband are using condoms as a birth control method.
B) The patient's skin is dry and she says that itching has interfered with her sleep.
C) The patient's acne appears to be increased since the Accutane was started.
D) The patient has been training for a marathon by running 18 to 20 hours a week.

Question 23

A patient who has developed a severe contact dermatitis of the hands, arms, and lower legs tells the nurse, "The itching is terrible. I just cannot keep from scratching." Which of the following suggestions will be appropriate for the nurse to include in teaching the patient? (Select all that apply.)

A) Take cool or tepid baths several times daily to decrease pruritus.
B) Cool, wet cloths or dressings can be used to reduce itching.
C) Expose the areas to the sun to promote healing of the lesions.
D) Add oil to your bath water to aid in moisturizing the affected skin.
E) Rub yourself dry with a towel after bathing to prevent skin maceration.
F) Use of an OTC antihistamine with sedative effects can reduce scratching.