Question 1

A patient with atopic dermatitis has been using a high-potency topical corticosteroid ointment for several weeks. Which finding by the nurse indicates a possible adverse effect of the medication?

Accepted Answer

Thinning of the skin indicates that atrophy, a possible adverse effect of topical corticosteroids, is occurring. The health care provider should be notified so that the medication can be changed or tapered. Alopecia, red-brown discoloration, and dryness/scaling of the skin are not adverse effects of topical corticosteroid use.

Question 2

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 the need to

Accepted Answer

Because the appearance of the lesion is consistent with a possible basal cell carcinoma ( BCC ), the appropriate treatment would be excision and biopsy. Over-the-counter ( OTC ) corticosteroids, topical antibiotics, and Retin-A would not be used for this lesion unless the biopsy indicated that the lesion was nonmalignant.

Question 3

After a patient with a squamous cell carcinoma ( SCC ) has a Mohs procedure in the dermatology clinic, which nursing action will be included in the postoperative plan of care?

Accepted Answer

Application of cold packs to the incision after the surgery will help decrease bruising and swelling at the site. Since the Mohs procedure results in complete excision of the lesion, topical fluorouracil is not needed after surgery. The suture line is cleaned with tap water. No debridement with wet-to-dry dressings is indicated.

Question 4

A patient is diagnosed with basal cell carcinoma ( BCC ) of the face. Which information should be included in patient teaching?

Accepted Answer

BCC is frequently associated with sun exposure. BCC spread locally, but do not metastasize to distant tissues. Since BCC can cause local tissue destruction, treatment is indicated. Local chemotherapy may be used to treat BCC.

Question 5

The nurse notes darker skin pigmentation in the skinfolds of a patient who has a body mass index of 40 kg/m². Which action should the nurse take?

Accepted Answer

The presence of acanthosis nigricans in skinfolds suggests an increased risk for type 2 diabetes. The description of the patient's skin does not indicate problems with fungal infection, poor hygiene, or the need to dry the skinfolds better.

Question 6

To decrease the risk for sun damage to the skin, which information should the nurse include when teaching patients?

Accepted Answer

The risk for skin damage from the sun is highest with exposure between 10 AM and 2 PM. The term waterproof is misleading; no sunscreen is completely waterproof. Sunscreen with an SPF of at least 15 is recommended for people at normal risk for skin cancer. Although gradually increasing sun exposure may decrease the risk for burning, the risk for skin cancer is not decreased.

Question 7

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

Accepted Answer

The appearance of the lesions is consistent with an oral candidiasis (thrush) infection, which can occur in patients who are taking medications such as immunosuppressants or antibiotics. Candidiasis is not associated with poor oral hygiene or lower respiratory infections. The lesions do not look like an oral herpes infection.

Question 8

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?

Accepted Answer

The patient should be taught that transient burning at the application site is an expected effect of tacrolimus and that the medication should be left in place. The other statements by the patient are accurate and indicate that patient teaching has been effective.

Question 9

Through interviewing a patient who has a history of contact dermatitis, the nurse obtains this information about over-the-counter ( OTC ) medication use. Which finding indicates a need for patient teaching?

Accepted Answer

Neosporin can cause contact dermatitis. The other medications are being used appropriately by the patient.

Question 10

When assessing a new patient at the outpatient clinic, the nurse notes dry, scaly skin; thin hair; and thick, brittle nails. Which action is best for the nurse to take at this time?

Accepted Answer

The patient has clinical manifestations that could be caused by systemic problems such as malnutrition or hypothyroidism, so further diagnostic evaluation is indicated. Patient teaching about nutrition, addressing the patient's dry skin, and referral to a podiatrist also may be needed, but the priority is to rule out underlying disease that may be causing these manifestations.

Question 11

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

Accepted Answer

The description of the mole is consistent with malignancy, so excision and biopsy are indicated. Curettage and cryosurgery are not used if malignancy is suspected. A punch biopsy would not be done for a lesion greater than 5 mm in diameter.

Question 12

After the nurse has finished teaching a patient about application of corticosteroid cream to an area of contact dermatitis on the right leg, which patient action indicates that more teaching is needed?

Accepted Answer

Creams and ointments should be applied in a thin layer to avoid wasting the medication. The other actions by the patient indicate that the teaching has been successful.

Question 13

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

Accepted Answer

The eyes should be shielded from UV light ( UVL ) during and after PUVA therapy to prevent the development of cataracts. The patient should be taught about the effects of UVL on unaffected skin, but lead-lined drapes, use of antiseptic soap, and petroleum jelly are not used to prevent skin damage.

Question 14

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?

Accepted Answer

Topical 5-FU causes an initial reaction of erythema, itching, and erosion, which lasts 4 weeks after application of the medication is stopped. The medication is topical, so there are no systemic effects such as increased infection risk, anorexia, or nausea. Actinic keratosis is not usually treated with excision.

Question 15

The health care provider diagnoses impetigo for a patient who has crusty vesicopustular lesions on the lower face. Which topic will be included in the teaching plan for this patient?

Accepted Answer

The treatment for impetigo includes softening of the crusts with warm saline soaks and then soap-and-water removal. Alcohol-based cleansers and use of petroleum jelly are not recommended for impetigo. Antibiotic ointments may be applied to the lesions.

Question 16

Which information should the nurse include when teaching a patient who has just received a prescription for sulfamethoxazole and trimethoprim (Septra, Bactrim) to treat a urinary tract infection?

Accepted Answer

The patient should wear sunscreen when taking medications that can cause photosensitivity. The other statements are not accurate.

Question 17

Which information will the nurse include when teaching a 70-year-old patient about skin care?

Accepted Answer

Warm water and moisturizing soap will avoid overdrying the skin. Since older patients have dryer skin, daily bathing and shampooing are not necessary and may dry the skin unnecessarily. Antibacterial soaps are not necessary. Lotions should be applied while the skin is still damp to seal moisture in.

Question 18

After the nurse determines that a patient has the following risk factors for melanoma, which risk factor should be the focus of patient teaching related to prevention?

Accepted Answer

Since the only risk factor that the patient can change is the use of a tanning booth, the nurse should focus teaching about melanoma prevention on this factor. The other factors also will contribute to increased risk.

Question 19

When examining a patient's scalp, the nurse suspects the presence of pediculosis on finding

Accepted Answer

Pediculosis is characterized by wheal-like lesions with parasites that attach eggs to the base of the hair shaft. The other descriptions are more characteristic of other types of skin disorders.

Question 20

Which action will the nurse take when applying a wet dressing to an inflamed and pruritic area of skin on a patient's ankle?

Accepted Answer

Cool solutions are used when wet dressings are applied to inflamed areas. Wet dressings do not require sterile technique; tap water is the most common solution used. To avoid maceration of healthy skin, wet dressings should only be applied over the affected area.

Quiz 24: Nursing Management: Integumentary Problems