Question 1

An older patient has been treated for a small basal cell carcinoma on the face.What assessment finding indicates to the nurse that the goals for a priority diagnosis have been met?
A)The patient verbalizes relief there is no metastasis.
B)Wound edges are approximated without redness.
C)The patient expresses satisfaction with the cosmetic outcome.
D)The patient relates the need for proper sun protection.

Accepted Answer

All findings indicate positive resolution of various nursing diagnoses.However,physical diagnoses take priority,so the best response is the one that indicates lack of infection.

Question 2

An older adult patient has an open,draining wound on the lower medial aspect of the right leg.The skin surrounding the wound is reddish brown with surrounding erythema and edema.Based on this information,the nurse edits the patient's care plan to include impaired skin integrity:
A)related to altered venous circulation.
B)peripheral related to arterial insufficiency.
C)related to diabetic neuropathy.
D)open wound related to pressure ulcer.

Accepted Answer

Venous ulcers are usually on the medial aspect of the lower leg,with flat or shallow craters and irregular borders,accompanied by varicosities,liposclerosis (brown ruddy color and thickened skin),and itching.Venous ulcers generate a large amount of exudate and are usually surrounded by erythema and edema.Arterial insufficiency would produce shiny,taut,hairless skin.There is no indication the patient is a diabetic.There is no indication the patient has risks for pressure ulcers.

Question 3

For which patient does the nurse add compression therapy to the nursing care plan?
A)Taut,white,shiny skin
B)Faint pedal pulses
C)Brownish skin and edema
D)Large ulcer with skin graft

Accepted Answer

Compression is the mainstay of venous ulcer treatment,and it should be applied when there is brownish skin and edema.The taut white shiny skin and faint pulses indicate arterial insufficiency,and compression will compromise circulation in those extremities even further.A skin graft needs to be protected,as it is vulnerable until healed.

Question 4

An older diabetic patient reports a candidiasis infection.When asked,the patient states all blood sugars have been within the target range.What action by the nurse is best?
A)Facilitate having a hemoglobin A1c drawn.
B)Teach the patient preventive measures.
C)Teach the patient about the side effects of medications.
D)Review the patient's medication history.

Accepted Answer

Often candidiasis infections in diabetics indicate hyperglycemia.The patient may or may not be truthful about the blood sugar reports,or the patient may be missing periods of hyperglycemia when testing.The nurse should consult with the provider about checking an A1C.The other options are appropriate as well but do not give information as to the background cause.

Question 5

The presence of which skin assessment finding,if noted on an older adult patient,should cause the nurse to suspect a premalignancy?
A)Numerous small red papules on the chest and back
B)An oozing,rough,reddish macule on the ear
C)An irregularly shaped mole on the face or shoulders
D)Brown,greasy lesions on the neck

Accepted Answer

Actinic keratosis begins in vascular areas as a reddish macule or papule that has a rough,yellowish brown scale that may itch or cause discomfort.Actinic keratosis may evolve into squamous cell carcinoma (SCC)if not treated,so it should receive prompt attention.Red papules,irregularly shaped moles,and brown greasy lesions are not likely to be precancerous.

Question 6

The nurse explains that the plan of care for an older adult patient with seborrheic dermatitis of the scalp should include:
A)cleaning lesions with a weak hydrogen peroxide solution daily.
B)cleaning the scalp with a low-dose steroidal shampoo.
C)applying hydrocortisone 10% to scalp lesions.
D)applying selenium shampoo to the scalp.

Accepted Answer

A successful strategy is to wet the hair,apply selenium shampoo,and then proceed with the rest of the bath or shower.The other measures will not be successful.

Question 7

An older adult patient has been taught measures to prevent the development of skin cancer.Which statement,if made by the patient,indicates the need for more teaching?
A)"I will certainly miss my vegetable and flower gardening."
B)"I should buy a sunscreen with an SPF of 15 or higher."
C)"Now I have a good excuse to wear the straw hat my spouse hates."
D)"My cool long-sleeved shirts will work just fine while I'm golfing."

Accepted Answer

The patient is still able to garden as long as he or she takes appropriate sun precautions.The other statements show good understanding.

Question 8

The nurse plans to assess for candidiasis as a priority intervention for a:
A)60-year-old with a history of bacterial pneumonia.
B)72-year-old incontinence of urine and feces.
C)58-year-old with a casted left foot.
D)90-year-old receiving antihypertensives.

Accepted Answer

Candidiasis is most commonly seen in diaper-clad infants,incontinent patients,and bed-bound individuals and in moisture-prone areas of the body (e.g. ,skin folds and axillae).The other patients are not as likely to have this disorder as the incontinent patient.

Question 9

When assessing the older adult patient's skin for indications of melanoma,the nurse should inspect for a(n):
A)thick,adherent scale with a soft center.
B)small,inflamed lesion that bleeds easily.
C)irregularly shaped multicolored mole.
D)small,purple,hard nodule beneath the skin surface.

Accepted Answer

Melanoma's clinical hallmark is an irregularly shaped nevus (mole),papule,or plaque that has undergone a change,particularly in color.The other options do not display the characteristic signs.

Question 10

A 65-year-old man is seen in the outpatient clinic for treatment of psoriasis.The nurse educates the patient to the possibility of developing:
A)alopecia.
B)orange-tinged urine.
C)yellow-brown nails.
D)cherry angiomas.

Accepted Answer

Changes in the nails occur in approximately 30% of patients and consist of yellow-brown discoloration with pitting,dimpling,separation of the nail plate from the underlying bed (oncolysis),thickening,and crumbling.

Question 11

A patient has a purulent,foul-smelling leg wound.What wound care practice is most appropriate?
A)Leave the wound open to the air.
B)Administer systemic antibiotics.
C)Cleanse the wound with diluted povidone iodine.
D)Prepare the patient for operative débridement.

Accepted Answer

Antiseptics are not used on healthy granulating tissue.Povidone iodine must be diluted and only used short term.A moist environment is needed for healing;leaving the wound open to air will cause too much drying.The patient may eventually need operative débridement.Systemic antibiotics may or may not be needed.

Question 12

The nurse of a bedridden 74-year-old woman is evaluating whether the family members understand how to position the patient correctly.The nurse is confident the family is capable of effective positioning when it is observed that the patient's:
A)arms and legs are supported on two pillows.
B)position is changed at least every 2 hours.
C)neck is hyperflexed.
D)elbows rest on the bed.

Accepted Answer

In the 1950s,Kosiak (1958)found that pressure applied to rabbits' ears over 2 hours would result in ulceration.Thus,the universal recommendation of turning every 2 hours was established.The other observations do not show the family necessarily understands effective positioning if the patient is not turned.

Question 13

The nurse knows that several age-related changes in the integumentary system increase older adults' risk for pressure ulcers.Which factors does this include? (Select all that apply. )
A)Poor nutrition
B)Living in a nursing home
C)Thinning epidermis
D)Decreased skin elasticity
E)Vessel degeneration

Accepted Answer

Thinning epidermis,decreased elasticity of the skin,and deterioration of the vasculature are all age-related changes increasing risk of pressure ulcer development.Poor nutrition and living in a nursing home are not expected age-related changes.

Question 14

An older adult patient reports simple xerosis with mild pruritus.The nurse educates her on the importance of:
A)applying a lanolin-rich cream and avoiding scratching the areas.
B)taking warm baths and gently rubbing of affected areas with a terrycloth towel.
C)minimizing ingestion of fried foods and use of an antihistamine cream.
D)avoiding bath oils and allowing the skin to air-dry after bathing.

Accepted Answer

The nurse suggests that the patient apply emollients (e.g. ,Lubriderm,Moisturel,or Eucerin lotion or cream),which have more lanolin or oily substances than many commercial lotions.Time should be planned to teach the patient and family about etiologic factors and the importance of not scratching.The other options are not helpful and will not decrease the itching.

Question 15

An 87-year-old patient developed herpes zoster after surgical repair of a hip fracture.The priority nursing diagnosis is:
A)impaired skin integrity related to immunologic deficit.
B)self-care deficit related to severe pain and fatigue.
C)risk for infection related to impaired skin integrity.
D)pain related to inadequate pain relief from analgesia.

Accepted Answer

These vesicles are extremely vulnerable to secondary bacterial infections.The other diagnoses might be appropriate for some patients.

Question 16

An older diabetic patient has impaired mobility and decreased vision.The nurse examines the patient's feet at each clinical visit.The patient asks why this is necessary.What response by the nurse is best?
A)"It's part of our diabetic clinic visit protocol."
B)"You may not be able to see a sore on your feet."
C)"Limited mobility may keep you from checking your feet.
D)"You may get an ulcer and not be able to feel it."

Accepted Answer

A diabetic with peripheral neuropathy may not be able to feel injuries on the feet.The injury may progress to a nonhealing ulcer requiring amputation.If the patient had good sensation to the feet,not being able to see or limited mobility would not be as big of a barrier because the patient could report the symptoms.Foot assessment is part of a diabetic clinic protocol.

Question 17

A patient has a wound that is a shallow crater with surrounding erythema and warmth.What stage pressure ulcer does the nurse chart?
A)Stage I
B)Stage II
C)Stage III
D)Stage IV

Accepted Answer

Stage II is a partial thickness ulcer that looks like an abrasion,blister,or shallow crater.A stage I pressure ulcer is redness or mottled skin that does not blanch.Stage III ulcers are full thickness deep craters.Stage IV ulcers may extend into the fascia and may be necrotic.

Question 18

An older adult patient newly diagnosed with peripheral vascular disease (PVD)is being educated on the possibility of developing a foot ulcer.What assessment finding indicates the patient may have an ulcer resulting from this disease?
A)Deep,necrotic,and painless sore
B)Shiny,dry,cyanotic skin surrounding the ulcer
C)Ulcer appears shallow,crusty with warm skin
D)Sore that has dull pain and is oozing

Accepted Answer

As the disease advances,the extremity develops a cyanotic hue and becomes cool.The skin becomes thin,shiny,and dry and has an associated loss of hair and thickened nails,all of which results from the diminished blood supply.This assessment finding indicates PVD.

Question 19

In creating community education on various types of skin cancer,the nurse places the highest priority on early diagnosis of melanoma because:
A)it accounts for the largest number of mortalities.
B)extensive surgery can be avoided if caught early.
C)once it has spread there is no chance of curing it.
D)it is the most commonly occurring skin cancer.

Accepted Answer

Melanoma only accounts for 5% of skin cancer diagnoses but causes 75% of skin cancer mortality.Therefore,it is critical that the condition is diagnosed promptly.

Question 20

When assessing for squamous cell cancer (SCC),a home health nurse is particularly concerned about a suspicious lesion on the:
A)leg of a 60-year-old Asian female.
B)neck of a 73-year-old Hispanic female.
C)Lower lip of a 70-year-old African American male.
D)back of a 90-year-old Caucasian male.

Accepted Answer

SCC is skin cancer arising from the epidermis and is found most often on the scalp,outer ears,lower lip,and dorsum of the hands.Approximately 90% of lip lesions can be attributed to squamous cell carcinoma.SCC is more common in men and older adults.SCC is the most common skin cancer in African-Americans.

Quiz 28: Integumentary Function

An older patient has been treated for a small basal cell carcinoma on the face.What assessment finding indicates to the nurse that the goals for a priority diagnosis have been met?

An older adult patient has an open,draining wound on the lower medial aspect of the right leg.The skin surrounding the wound is reddish brown with surrounding erythema and edema.Based on this information,the nurse edits the patient's care plan to include impaired skin integrity:

For which patient does the nurse add compression therapy to the nursing care plan?

An older diabetic patient reports a candidiasis infection.When asked,the patient states all blood sugars have been within the target range.What action by the nurse is best?

The presence of which skin assessment finding,if noted on an older adult patient,should cause the nurse to suspect a premalignancy?

The nurse explains that the plan of care for an older adult patient with seborrheic dermatitis of the scalp should include:

An older adult patient has been taught measures to prevent the development of skin cancer.Which statement,if made by the patient,indicates the need for more teaching?

The nurse plans to assess for candidiasis as a priority intervention for a:

When assessing the older adult patient's skin for indications of melanoma,the nurse should inspect for a(n) :

A 65-year-old man is seen in the outpatient clinic for treatment of psoriasis.The nurse educates the patient to the possibility of developing:

A patient has a purulent,foul-smelling leg wound.What wound care practice is most appropriate?

The nurse of a bedridden 74-year-old woman is evaluating whether the family members understand how to position the patient correctly.The nurse is confident the family is capable of effective positioning when it is observed that the patient's:

The nurse knows that several age-related changes in the integumentary system increase older adults' risk for pressure ulcers.Which factors does this include? (Select all that apply. )

An older adult patient reports simple xerosis with mild pruritus.The nurse educates her on the importance of:

An 87-year-old patient developed herpes zoster after surgical repair of a hip fracture.The priority nursing diagnosis is:

An older diabetic patient has impaired mobility and decreased vision.The nurse examines the patient's feet at each clinical visit.The patient asks why this is necessary.What response by the nurse is best?

A patient has a wound that is a shallow crater with surrounding erythema and warmth.What stage pressure ulcer does the nurse chart?

An older adult patient newly diagnosed with peripheral vascular disease (PVD) is being educated on the possibility of developing a foot ulcer.What assessment finding indicates the patient may have an ulcer resulting from this disease?

In creating community education on various types of skin cancer,the nurse places the highest priority on early diagnosis of melanoma because:

When assessing for squamous cell cancer (SCC) ,a home health nurse is particularly concerned about a suspicious lesion on the: