Deck 16: Nursing Care of Patients With Integumentary Disorders

Question 1

A patient is recovering from surgery to remove a large skin cancer and has a skin graft in place to cover the wound area. Consider the following menus and select the one that would be most beneficial for this patient's healing. $$\begin{array} {| l | l |} \hline \text { Diet } 1 & \text { Diet } 2 \\\text { Baked chicken } & \text { Vegetable soup } \\\text { Sliced orange/spinach salad } & \text { Grilled cheese sandwich } \\\text { Baked beans } & \text { Brownie } \\\hline \text { Strawberries } & \text { Milk } \\\hline \text { Diet } 3 & \text { Diet 4 } \\\text { Sausage pizza } & \text { Macaroni \& cheese } \\\text { Tossed green salad } & \text { Hot dog with bun } \\\text { Pudding } & \text { Cole slaw }\\\hline\end{array}$$

A) Diet 1
B) Diet 2
C) Diet 3
D) Diet 4

Answer 1

Diet 1

Question 2

A patient at risk for the development of skin cancer is discussing sun exposure prevention with the nurse. What information should be included in the discussion?

A) A higher-rated sunscreen is needed between 10 a.m. and 3 p.m.
B) Sunscreen is needed even on cloudy days.
C) Apply a sunscreen with an SPF of 15 or more.
D) The higher the sunscreen rating, the less the protection provided.
E) When swimming, sunscreen should be reapplied every 4 hours.

Answer 2

A higher-rated sunscreen is needed between 10 a.m. and 3 p.m.
Sunscreen is needed even on cloudy days.
Apply a sunscreen with an SPF of 15 or more.

Question 3

The nurse is planning care for a patient with herpes zoster. Which problem should the nurse identify as being the priority for this patient?

A) managing pain
B) avoiding breakouts
C) relieving itchiness
D) improving hygiene

Answer 3

managing pain

Question 4

A patient asks the nurse about possible options regarding treatment for a malignant melanoma lesion on her arm. How should the nurse respond to this patient?

A) "The preferred method of treatment is to remove all the cancer surgically."
B) "An anti-cancer cream will be used to dissolve the lesion."
C) "You will receive radiation to the skin lesion as a first method of treatment."
D) "You will receive intravenous chemotherapy as a first method of treatment"

Question 5

A patient with a history of tinea pedis reports concerns about developing the disorder again. Which suggestion should the nurse make to reduce the likelihood of a reoccurrence?

A) Wear sandal-style footwear.
B) Begin to wear cotton undergarments.
C) Soak affected extremities in salted water nightly.
D) Apply lotions to moisturize potential areas of outbreak daily.

Question 6

The nurse is assessing a patient's risk for pressure ulcer development. Which factors should the nurse include in this assessment?

A) sensory perception
B) moisture
C) mobility
D) nutrition
E) social interaction

Question 7

The nurse understands that certain patients are more susceptible to pressure ulcer development. Which patients should the nurse identify as being at an increased risk for this health problem?

A) patient with restricted activity
B) patient with decreased sensation
C) patient who is very thin
D) patient with urinary and fecal incontinence
E) patient with good nutrition

Question 8

The mother of a teenage girl voices concerns about her daughter's acne. Which response by the nurse is best?

A) "The skin needs to be washed at least twice a day with mild soap and water to remove surface oil."
B) "The greatest culprit for acne is dietary habits, not inadequate hygiene."
C) "Are you embarrassed by her appearance?"
D) "What are your concerns about her hygiene practices?"

Question 9

A patient diagnosed with scabies asks the nurse how he "caught" the disorder. What information should be provided to the patient?

A) The disorder is transmitted by contact with infected persons or their possessions.
B) The disorder is transmitted by the feces of infected animals.
C) Scabies is a bacterial infection transmitted by direct contact with infected persons.
D) Scabies is a fungal infection transmitted by contact with infected respiratory secretions.

Question 10

A patient scheduled for Mohs surgery for basal cell skin cancer asks how long the procedure will take. How should the nurse respond to this patient?

A) "The procedure occurs in steps, and time needed depends on your lesion."
B) "The time depends on how deep the lesion is."
C) "It is difficult to predict how long the procedure will take."
D) "This is a long, complicated procedure and may take all day."
E) "The procedure should be completed in an hour or less."

Question 11

The nurse is counseling a patient who has atopic dermatitis (eczema) and has developed a secondary infection. What should the nurse emphasize so that the patient can prevent this type of infections in the future?

A) methods to prevent itching
B) continuous antibiotic treatment
C) frequent bathing
D) allergy testing

Question 12

A patient has had cryosurgery to treat a skin lesion. What instructions should be given to the patient and family on discharge?

A) The effects may not be seen for 24 hours.
B) Apply a topical antibiotic as ordered.
C) Keep the treated areas clean.
D) Healing may take several weeks.
E) Healing should occur in a few days.

Question 13

The nurse is planning care for a patient at risk for pressure ulcer development. What should the nurse include in this patient's plan of care?

A) Initiate a frequent toileting schedule.
B) Turn the patient every 2 hours.
C) Massage pressure areas with lotion every 4 hours.
D) Use inflatable donut rings to reduce pressure on the sacrum.
E) Use hot water to cleanse the skin immediately after incontinence.

Question 14

The nurse is planning care for a patient who is at risk for pressure ulcer development. Which action should be included in this patient's plan of care?

A) Use pillows to offload pressure.
B) Turn at least every 2 hours.
C) Use a mild cleansing agent on the skin.
D) Keep on bed rest.
E) Pull up in bed every 2 hours or less.

Question 15

An African American patient has reoccurring folliculitis on the face. What should the nurse instruct the patient to do about this health problem?

A) Practice good hygiene.
B) Shave daily.
C) Shave very closely.
D) Shave in the opposite direction of hair growth.

Question 16

Several individuals from a homeless shelter have been diagnosed with pediculosis. The nurse, planning to train staff on the control and prevention of this contagious infection, should include what information?

A) Pediculosis is spread by contact with personal items such as hats and blankets.
B) Pediculosis is more common in people with lack of proper facilities for bathing and washing clothes.
C) Pediculosis is associated with wearing woolen hats.
D) Pediculosis affects children only.
E) Pediculosis is infestation by mites.

Question 17

A patient with a basal cell carcinoma of the nose will be having the lesion removed by curettage and electrodesiccation. The nurse knows that the lesion must meet what criteria for this type of procedure?

A) The lesion must measure less than 2 cm in diameter.
B) The lesion must be superficial.
C) The lesion must measure at least 4 cm in diameter.
D) The lesion must be in an area where the dermis is thin.
E) The lesion must extend into the subcutaneous tissue.

Question 18

A patient has a lesion in the left axilla that is deep, painful, and contains pus. It is 3 centimeters in diameter. After the assessment, what type of lesion should the nurse determine that the patient has?

A) furuncle
B) folliculitis
C) carbuncle
D) herpes varicella

Question 19

A patient has a small, red, scaling lesion that is sitting on an elevated base on the forehead. The patient states that lesion began several weeks before and will not heal. What type of lesion does the nurse consider the patient is experiencing?

A) squamous cell carcinoma
B) melanoma
C) psoriasis
D) seborrheic keratosis

Question 20

The patient with herpes zoster has pruritus and reports difficulty resting at night. Which intervention will best aid the patient?

A) Encourage the patient to take prescribed antipruritic agents approximately one hour before bedtime.
B) Massage the irritated skin areas with lotion.
C) Apply powder to the lesions.
D) Use heavy bed linens to avoid chilling at night.

Question 21

A 57-year-old female patient complains of "strange pimples" over her buttocks region. The nurse realizes that this patient might be experiencing which health problem?

A) acne conglobata
B) contact dermatitis
C) acne vulgaris
D) acne rosacea

Question 22

A patient in a wheelchair has a history of sacral pressure ulcer formation. What instruction should be included in the patient's teaching?

A) Shift the weight every 15 minutes to 1 hour.
B) Sit on a donut.
C) Stay in one position as long as possible.
D) Have a family pull the patient up in the wheelchair.

Question 23

A 35-year-old female patient is diagnosed with advanced malignant melanoma. The nurse realizes that this patient:

A) has an uncertain prognosis.
B) has a poor prognosis due to her age.
C) will be completely cured with surgery.
D) will need chemotherapy and radiation.

Question 24

A patient confined to bed has slid to the bottom of the bed. What should the nurse do to adjust this patient's body position?

A) Lift the patient up in bed.
B) Pull the patient up in bed.
C) Slide the patient up in bed.
D) Do nothing.

Question 25

The nurse is reading the history and physical records of a patient who has alopecia. What should the nurse recognize as possible causes for this disorder?

A) thyroid disorder
B) systemic lupus erythematosus
C) three months of chemotherapy for cancer
D) androgenic causes
E) an overactive pituitary

Question 26

A female patient is prescribed tretinoin (Retin-A). What should the nurse instruct the patient about this medication?

A) Wear protective clothing when out of doors.
B) Avoid the use of vitamin A supplements.
C) Use caution when driving at night.
D) Apply to clean, dry skin.
E) Use a reliable form of contraception one month prior to and during use of the medication.

Question 27

For several months a patient has been experiencing an infection of the cuticle involving several fingernails on both hands. The nurse should recognize this condition as being related to what type of employment?

A) dish washer
B) construction worker
C) painter
D) carpenter

Question 28

A 52-year-old male patient of English descent is diagnosed with basal cell cancer on the face and forehead. What should the nurse include when teaching this patient about his diagnosis?

A) This type of skin cancer tends to reoccur.
B) This is a virulent form of skin cancer.
C) This type of skin cancer should be left alone.
D) This type of skin cancer is rare.

Question 29

A 47-year-old female patient with a history of sun exposure is concerned that she has a disease because of broken blood vessels on the cheeks. What should the nurse realize this patient is describing?

A) telangiectases
B) nevus flammeus
C) venus lakes
D) skin tags

Question 30

A patient with skin cancer is recovering from a surgical procedure in which the layers of the lesion were shaved off. The nurse realizes that this patient most likely had which procedure?

A) Mohs surgery
B) complete surgical excision of the lesion
C) curettage
D) electrodesiccation

Question 31

The nurse is preparing a teaching plan about acne for a group of community teenagers. What should be included in this teaching plan?

A) Sun exposure is permitted when protected with sunscreen, but avoid sunburn.
B) Keep hair clean with frequent shampoos.
C) Avoid eating greasy foods.
D) Wash the affected skin area at least six times per day.
E) Squeeze pimples when they occur.

Question 32

A female patient comes into the clinic with eyelid redness and edema. What would be appropriate for the nurse to include in the assessment of this patient?

A) Ask the patient if she has been thoroughly removing all her eye makeup.
B) Ask if the patient has recently been in a public swimming pool.
C) Ask the patient if she shaves her legs.
D) Ask the patient if she has recently changed her facial soap.

Question 33

The nurse instructs a patient who is prescribed oral griseofulvin for a fungal infection of the nails to take the medication with food. Which foods should the nurse recommend to the patient?

A) ice cream
B) cheese
C) crackers
D) pretzels
E) alcohol

Question 34

A 68-year-old male patient comes into the clinic with a "strange painful rash" located on the left side of his upper chest. The nurse realizes that this patient might be experiencing what health problem?

A) herpes zoster
B) herpes simplex
C) verruca plana
D) condylomata acuminata

Question 35

The nurse instructs a patient with melanoma to "eat foods rich in protein and calories." For which health problem is this action most likely being directed?

A) changes in skin integrity
B) insufficient blood flow
C) altered oxygen to blood tissues
D) insufficient body fluid

Question 36

The mother of a 12-year-old child reports that her daughter frequently scratches her scalp and the hair "is clumpy and smells really bad." What should the nurse do to assist this mother?

A) Suggest that the daughter be checked for head lice.
B) Suggest that the daughter have a blood glucose level drawn.
C) Suggest that the daughter wash her hair.
D) Suggest that the daughter have a haircut.

Question 37

A patient with a history of pruritis says, "The itching seems to improve when I take my allergy medicine." The nurse realizes that this is most likely because

A) the allergy medication is reducing histamine release.
B) the patient is distracted from the itching because of the allergies.
C) the patient's pruritis is improving.
D) the patient is taking other medication the nurse is not aware of.

Question 38

A patient is receiving his first ultraviolet light therapy treatment for psoriasis. What should be included in this patient's teaching?

A) The skin will appear reddened approximately eight hours after the treatment.
B) The treatment will be the same length every time.
C) There is no anticipated damage to the eyes or mucous membranes.
D) This is the treatment of choice for patients with psoriasis on 10% of the body.

Question 39

A female patient comes into the clinic with an itchy reddened area on both hands. Which technique should the nurse use when assessing this patient?

A) Ask the patient if she has changed soap or perfume.
B) Ask the patient to remove her shoes and stockings.
C) Listen to the patient's lungs.
D) Assess the patient's hand grasp strength.

Question 40

A patient diagnosed with psoriasis is being treated with topical corticosteroids. What should the nurse instruct the patient about the use of this medication?

A) Apply in a thin layer.
B) Avoid rubbing into the skin.
C) Apply a thick layer.
D) Continue medication even if lesions worsen

Question 41

A patient with a skin disorder is prescribed a therapeutic bath to be used at home. What should the nurse include when teaching the patient about this treatment?

A) Place a bath mat in the tub.
B) Stay in the tub bath for 1 hour.
C) Keep the bathroom well-ventilated.
D) Rub the skin vigorously with a dry towel.
E) Expect the skin to be itchy after the bath.

Question 42

A 40-year-old male patient says, "I wish I could have all of these tattoos removed." What solution should the nurse suggest to this patient?

A) dermabrasion
B) chemical peeling
C) skin graft
D) blepharoplasty

Question 43

A patient with a history of basal cell skin cancer asks the nurse what to do to avoid having the cancer recur. What should the nurse instruct this patient?

A) Always use a sunscreen of SPF 15 or higher.
B) Avoid the sun at all costs.
C) Sun exposure between the hours of 10:00 am and 3:00 pm is best.
D) Sunscreen is not needed on cloudy days.

Question 44

A patient is being scheduled for diagnostic tests to determine the presence of pemphigus vulgaris. Which tests should the nurse expect to schedule for this patient?

A) curettage
B) skin biopsy
C) Wood's lamp
D) Mohs procedure
E) immunofluorescence microscopy

Question 45

A 55-year-old patient who is recovering from a facelift says, "I think this was a waste of time and money. I look horrible!" How should the nurse respond to this patient?

A) "It takes a while for the skin to heal."
B) "You could use makeup."
C) "I would complain to the doctor."
D) "What did you expect?"

Question 46

A patient who was stranded during a snowstorm is admitted for frostbite of the fingers and toes. Which actions should the nurse expect to perform for this patient?

A) Elevate the feet and hands.
B) Provide pain medication as prescribed.
C) Apply elastic compression bandages to the feet and hands.
D) Massage the fingers and toes for 10 minutes after warming.
E) Warm the digits with circulating water for 20 to 30 minutes.

Question 47

A patient with a skin infection is diagnosed with methicillin-resistant Staphylococcus aureus (MRSA). What mediations should the nurse expect to be prescribed for this patient?

A) penicillin (Pen-V-K)
B) clindamycin (Cleocin)
C) minocycline (Minocin)
D) doxycycline (Vibramycin)
E) trimethoprimsulfamethoxazole (Bactrim)

Question 48

A patient with psoriasis is prescribed photochemotherapy treatments. What should the nurse teach the patient about future health risks caused by this treatment?

A) It can accelerate aging.
B) It can exacerbate psoriasis.
C) It can alter immune functions.
D) It can induce cataract development.
E) It can increase the risk of melanoma.