Deck 58: Severe Burns That Require Immediate Medical Attention

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?

A) "I suppose it's some comfort that my patches are small and will always stay out of sight in the future."
B) "I'm thankful that there are medications to cure this, but I'm nervous about the side effects."
C) "I suppose this shouldn't come as too much of surprise, since this tends to run in my family."
D) "I'm surprised that I ended up contacting that fungus that caused this problem for me."

Answer 1

"I suppose this shouldn't come as too much of surprise, since this tends to run in my family."

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?

A) Previous infection with other parasitic worms
B) Potential contact with the fungus from pets or other children
C) Allergic reactions to drugs and environmental substances
D) The child's infant immunization history

Answer 2

Potential contact with the fungus from pets or other children

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?

A) A topical antifungal ointment
B) An oral corticosteroid
C) An antiviral ointment
D) A topical antibiotic

Answer 3

A topical antibiotic

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

A) chickenpox.
B) German measles.
C) herpes zoster.
D) human papillomavirus.

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?

A) "Avoiding high-fat foods and chocolate won't cure your acne, but it will likely improve it a lot."
B) "All the creams and ointments that you can buy have been shown to be no real help for acne."
C) "It's important for you to vigorously wash your face several times a day."
D) "You might need antibiotic pills in addition to a cream for your face."

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?

A) Accutane
B) Low-dose tetracycline
C) Retin-A
D) A benzoyl peroxide agent

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?

A) "A steroid cream will likely help but often the skin problem lasts long after contact with the product that irritates the skin."
B) "You're clearly allergic to the fiberglass in your insulation, and over-the-counter allergy medications are likely to resolve the problem quite rapidly."
C) "The problem is that your skin is producing and sloughing off cells prematurely; this will respond well to a topical steroid."
D) "There are medications I can prescribe that will cure this sensitivity, but they tend to take many months to take full effect."

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?

A) topical retinoids
B) epinephrine
C) antihistamines
D) benzoyl peroxide

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.

A) The woman takes an angiotensin-converting enzyme inhibitor for the treatment of hypertension.
B) She has been diagnosed with arthritis.
C) The woman has a family history of diabetes.
D) Skin trauma of any kind often precedes an outbreak.
E) The woman has dark skin.

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.

A) Serum potassium (K⁺) level 3.6 mmol/L
B) Platelet count 37 × 10³/µL
C) Alanine aminotransferase (ALT) 28 units/L
D) White blood cell count 1.2 × 10³/µL

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?

A) Lichen planus
B) Pityriasis rosea
C) Rosacea
D) 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?

A) Continuing his antibiotics until the full course is completed
B) Treatment of individuals that he has been in close contact with
C) Applying corticosteroid creams for at least 8 weeks to prevent recurrence
D) Avoiding potentially irritating products such as dyes and perfumes

Question 13

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

A) extending into the subcutaneous tissue.
B) noting that blood vessels have clotted and can be seen under the burned skin.
C) redness or pinkness noted, but no blister formation is present on the epidermis.
D) extensive pain along with waxy white areas with blister formation.

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.

A) Systemic infection
B) Fluid volume deficit
C) Respiratory dysfunction
D) Hypermetabolic response
E) Constipation and bowel obstruction

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?

A) Residents with persistently low food intake are identified.
B) Immobilized residents are turned every 2 hours during both day and night.
C) Residents are frequently encouraged to increase their fluid intake.
D) Wound dressings are applied promptly to all identified or potential pressure ulcers.

Question 16

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

A) A 69-year-old man who has been diagnosed with stage IV malignant melanoma
B) A 70-year-old whose skin cancer has been identified as nodular ulcerative basal cell carcinoma
C) A 51-year-old women whose biopsy has revealed intraepidermal squamous cell carcinoma
D) A 59-year-old woman who has invasive squamous cell carcinoma

Question 17

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

A) A decrease in general sebaceous gland activity
B) Appearance of new skin tags on his chest
C) A new mole-like growth on his forearm
D) Appearance of a keratosis on the man's trunk

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.

A) Rash is macular and blotchy.
B) Maculopapular rash covering the trunk and spreading to the appendages.
C) The rash usually begins on the face and then spreads to the legs/arms.
D) The rash forms vesicles with depressed centers that are filled with yellow-colored fluid.
E) The painful rash follows a nerve root usually on only one side of the body.

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.

A) Thickening of the dermis layer.
B) Reduction in subcutaneous tissue.
C) Increased hair growth on back and legs.
D) Dry, scaly skin.

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.

A) Soft, flesh-colored papule located on the neck and "armpit."
B) Wart-like, tan-brown lesion that is sharply outlined and a few centimeters in diameter.
C) Several dry, brown, scaly lesions that are approximately 1 cm in diameter, and a few of the lesions are showing some ulcreation.
D) Tan to brown lesions commonly called "liver spots" are located on the forearm and hands.
E) Red-colored mark close to the skin surface located on the face.