Question 1

An 18-year-old female of Southeast Asian ancestry is distraught over the recent appearance of white patches on her forearms and upper arms, which have been subsequently confirmed as vitiligo. Which of the following statements by the woman express an accurate understanding of her condition?

Accepted Answer

The incidence of vitiligo is thought to have a genetic component. Vitiligo worsens with time, and treatments are not curative. The etiology is not infectious and does not involve fungus.

Question 2

An 11-year-old boy with skin lesions on his trunk characteristic of ringworm has been brought to the family's primary care provider by his mother. Which of the following aspects of the clinician's assessment relates most directly to the suspected diagnosis?

Accepted Answer

Ringworm, or tinea, has a fungal etiology. Parasites, allergies, and immunizations would be unlikely to relate directly to the etiology.

Question 3

The father of an 18-month-old girl noticed a small vesicle on her face several days ago. The lesion ruptured and left a straw-colored crust that remained on the girl's face. The eruption of new vesicles has prompted him to bring the child to the emergency department. Which of the following treatments for the child's skin problem is most likely?

Accepted Answer

The course and symptomatology of the child's skin disorder is characteristic of impetigo, which is bacterial in etiology and would likely be treated with a topical antibiotic such as mupirocin.

Question 4

An elderly patient has arrived at the physician's office complaining of a rash. Upon further investigation, the patient states that the rash feels like a burning pain but also has some tingling. It is extreme sensitive to touch, and it's "like crazy." The nurse notes that the rash is made up of vesicles and located on the right thoracic region. The nurse suspects the patient has

Accepted Answer

All of the characteristics point to herpes zoster. The vesicles erupt for 3 to 5 days along the nerve pathway (hence the reason for the burning pain). Eruptions usually are unilateral in the thoracic region, trunk, or face. Rubella (German measles) is characterized by a diffuse, punctuate, macular rash that begins on the trunk and spreads to the arms and legs. Varicella (chickenpox) has a macular stage where it develops within hours over the trunk, spreading to the limbs, mucosa, scalp, axillae, upper respiratory tract, and conjunctiva. HPV causes genital warts and is a sexually transmitted disease.

Question 5

Which of the following teaching points is most appropriate for a teenager who has sought care for the treatment of his severe acne?

Accepted Answer

Combination treatments for acne often include a topical preparation in addition to oral antibiotics. Avoiding certain foods has not been shown to be effective in acne treatment or prevention, and the topical products available are effective in some, though not all, cases. Care should be taken not to exacerbate lesions by washing the face too vigorously or too often.

Question 6

A 30-year-old woman, who just found out that she is pregnant, seeks a treatment for her severe acne. What is the most appropriate treatment for her skin condition?

Accepted Answer

Benzoyl peroxide is a topical agent that has both antibacterial and comedolytic properties. It is the topical agent most effective in reducing the P. acnes population. Bacterial resistance does not develop to benzoyl peroxide. The irritant effect of the drug also causes vasodilation and increased blood flow, which may hasten resolution of the inflammatory lesions. Although Accutane, low-dose tetracycline, and Retin-A are often used to treat severe acne, these drugs should not be given to those who are pregnant because they can affect the development of the fetus.

Question 7

A 31-year-old man who has worked for several years installing fiberglass insulation has developed itchy, irritating lesions on his wrists and forearms over the last several months. He has applied moisturizing creams repeatedly and has taken antihistamines but has experienced no significant improvement. He is understandably concerned about the potential effect this could have on his livelihood and has asked his care provider when treatment will resolve the problem. What is the care provider's most appropriate response?

Accepted Answer

Topical corticosteroids are often used in the treatment of irritant contact dermatitis, but symptoms can persist long after contact with the irritant ceases. The course of the man's complaint is suggestive of irritant, not allergic, contact dermatitis. Hyperkeratinization is characteristic of psoriasis, and a sensitivity can be treated but not cured.

Question 8

A 44-year-old man has been diagnosed with chronic urticaria, the exact cause of which cannot be determined. What is the pharmacological treatment that is most likely to be of most use to the man?

Accepted Answer

While epinephrine may be of use during an acute episode of urticaria that affects the upper airway, antihistamines are the most common regular treatment modality.Retinoids and benzoyl peroxide are used for the treatment of acne.

Question 9

A female client who is suspected of having psoriasis. Which of the following aspects of the woman's history and her care provider's assessment would be potential contributors to her health problem? Select all that apply.

Accepted Answer

ACE inhibitors, arthritis, and skin trauma are all associated with psoriasis and acute episodes of the problem. Diabetes and dark skin tone are not noted to predispose to the condition.

Question 10

The nurse is caring for a patient in the hospital for pneumonia but also has a severe case of psoriasis that is being treated with methotrexate. During the morning assessments, which of the following lab values would alert the nurse that the patient may be experiencing a side effect to this medication? Select all that apply.

Accepted Answer

Methotrexate is an antimetabolite that inhibits DNA synthesis and prevents cell mitosis. Oral methotrexate has been effective in treating psoriasis when other approaches have failed. The side effects include nausea, leukopenia (low WBC count), thrombocytopenia (low platelet count), and liver function abnormalities. The low platelet count corresponds to thrombocytopenia, and the low WBC corresponds to leucopenia. The other lab values, K⁺and ALT, are within the normal adult range.

Question 11

A 13-year-old girl has presented to a clinic with her mother explaining that she had an oval-shaped red patch on her chest a week ago but that more of the lesions are now appearing on her back. On examination, the lesions on her back are in a "Christmas tree" pattern. What is the girl's most likely diagnosis?

Accepted Answer

The characteristic lesion of pityriasis rosea is an oval macule or papule with surrounding erythema. This initial lesion is a solitary lesion called the herald patch and is usually on the trunk or neck. As the lesion enlarges and begins to fade away (2 to 10 days), successive crops of lesions appear on the trunk and neck. The lesions on the back have a characteristic "Christmas tree" pattern. The girl's history and symptomatology are not characteristic of lichen planus, rosacea, or melasma.

Question 12

A 22-year-old male who has been backpacking around Southeast Asia for several months has responded well to treatment for scabies that he acquired while on his trip. What follow-up measures should be taken?

Accepted Answer

Treatment of scabies should be extended to individuals with whom the affected person has had close contact. Antibiotics and steroids are not used in treatment of scabies, and irritants are of no particular threat.

Question 13

When trying to discern the extent of a burn, the nurse will note that second-degree full-thickness burns are characterized by

Accepted Answer

Second-degree full-thickness burns involve the entire epidermis and dermis. These burns have extensive pain because the pain sensors remain intact. These burns appear as mottled pink, red, or waxy white areas with blister formation and edema. Answers A and B relate to third-degree full-thickness burns, whereas answer C is characteristic of first-degree burns.

Question 14

A 17-year-old male experienced third-degree full-thickness burns 2 days ago to his lower limbs after a fire at his workplace. Which of the following complications should his care team foresee and regularly assess for? Select all that apply.

Accepted Answer

Sepsis, hemodynamic instability, respiratory dysfunction, hypermetabolism, and bowel obstructions are all demonstrated consequences of thermal injury.

Question 15

A care aide who works in a long-term care facility recognizes the high incidence and prevalence of a stage I pressure ulcer in immobile older adults. Which of the following protocols in the facility would the care aide advocate changing?

Accepted Answer

Early-stage pressure ulcers and potential pressure ulcers do not necessitate wound dressings and are better treated by turning, keeping skin dry, and removing pressure. Nutrition and hydration status are important factors, and individuals who cannot reposition themselves independently should be turned regularly.

Question 16

Which of the following clients of an oncologist is likely to have the poorest prognosis?

Accepted Answer

Late detection of malignant melanoma is associated with particularly poor outcomes. Basal cells carcinomas often have strong treatment success rates. While invasive SCC has worse outcomes than intraepidermal SCC, these are both exceeded in mortality by late-stage malignant melanoma.

Question 17

Which of the following changes in an 86-year-old male's skin would necessitate further examination and possible medical treatment?

Accepted Answer

Appearance of a new mole or a change in the size or shape of an existing mole can be indicative of malignant melanoma. Decreased sebaceous gland secretions, skin tags, and keratoses are normal age-related changes.

Question 18

A nurse practitioner student is trying to distinguish the various rashes they will be seeing in their pediatric rotation. Their nurse preceptor is assisting by describing the rash associated with rubeola. Which of the following characteristics would apply to rubeola? Select all that apply.

Accepted Answer

Rubeola is highly communicable. The characteristic rash is macular and blotchy. The rash usually begins on the face and then spreads to the legs/arms (appendages). A maculopapular rash covering the trunk and spreading to the appendages is noted in roseola infantum. Varicella begins as a macular stage and then proceeds to the second stage where the rash forms vesicles with depressed centers that are filled withyellow-colored fluid. A painful rash follows a nerve root usually on only one side of the body is usually characteristic of shingles.

Question 19

A few of the more experienced nurses are sitting around a lunch table discussing the changes they are seeing in their skin. Which of the following would be considered normal age-related changes? Select all that apply.

Accepted Answer

Normal skin changes associated with aging are seen on areas of the body that have not been exposed to the sun. They include thinning of the dermis and the epidermis, diminution in subcutaneous tissue, a decrease and thickening of blood vessels, and a decrease in the number of melanocytes, Langerhans cells, and Merkel cells. Hair growth is reduced. The skin becomes dry, rough, scaly, and itchy.

Question 20

A patient is showing the nurse some changes in his skin that he found while taking a shower. Which of the following lesions would give the nurse concern that it might be a precancerous lesion? Select all that apply.

Accepted Answer

Actinic keratoses are the most common premalignant skin lesion that develops on sun-exposed areas. The lesions are often multiple and more easily felt than seen. Thelesions are described as dry, brown, and scaly approximately 1 cm in diameter. A few of the lesions may be showing some ulceration. Tan to brown lesions commonly called "liver spots" are located on the forearm and hands. Liver spots are considered risks for the development of skin cancer and should be treated. Keratoses are a horny growth or an abnormal growth of the keratinocytes. A seborrheic keratosis is a benign, sharply circumscribed, wartlike lesion that has a stuck-on appearance. Soft, flesh-colored papule located on the neck, axilla ("armpit"), and intertriginous areas are skin tags. A seborrheic keratosis is a wartlike, tan brown or black lesion that is sharply outlined and a few centimeters in diameter. Strawberry nevus, or hemangioma, is named for its color. This red tinge to your skin comes from a collection of blood vessels close to your skin's surface. While the hemangioma can be anywhere, the most common locations are the face, scalp, back, or chest. It is very common and noncancerous.

Quiz 58: Severe Burns That Require Immediate Medical Attention