Question 1

The nurse is providing care to a client with a squamous cell carcinoma (SCC) that had a Mohs procedure in the dermatology clinic. Which of the following nursing actions would be included in the postoperative plan of care?
A)Describe the use of topical fluorouracil on the incision.
B)Teach how to use sterile technique to clean the suture line.
C)Schedule daily appointments for wet-to-dry dressing changes.
D)Educate about use of cold packs to reduce bruising and swelling.

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 2

The nurse is caring for a client who has basal cell carcinoma (BCC) of the face. Which of the following information should the nurse include when teaching this client?
A)Treatment plans include watchful waiting.
B)Screening for metastasis will be important.
C)Low-dose systemic chemotherapy is used to treat BCC.
D)Minimizing sun exposure will reduce risk for future BCC.

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 3

The nurse is assessing a client's scalp and suspects the presence of pediculosis when which of the following assessment findings are observed?
A)Ringlike rashes with red, scaly borders over the entire scalp
B)Papular, wheal-like lesions with white deposits on the hair shaft
C)Patchy areas of alopecia with small vesicles and excoriated areas
D)Red, hive-like papules and plaques with sharply circumscribed borders

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 4

A client with atopic dermatitis has a new prescription for tacrolimus. After teaching the client about the medication, which statement by the client indicates that further teaching is needed?
A)"After I apply the medication, I can go ahead and get dressed as usual."
B)"I will rub the medication gently onto the skin every morning and night."
C)"I will need to minimize my time in the sun while I am using the tacrolimus."
D)"If the medication burns when I apply it, I will wipe it off and call the doctor."

Accepted Answer

The client 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 client are accurate and indicate that client teaching has been effective.

Question 5

After the nurse determines that a client has the following risk factors for melanoma, which risk factor should be the focus of client teaching related to prevention?
A)The client has multiple dysplastic nevi.
B)The client is fair-skinned and has blue eyes.
C)The client's mother died of a malignant melanoma.
D)The client uses a tanning booth throughout the winter.

Accepted Answer

Since the only risk factor that the client 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 6

The health care provider diagnoses impetigo for a client who has crusty vesicopustular lesions on the lower face. Which of the following topics would the nurse include in the teaching plan for this client?
A)Avoidance of antibiotic ointments on the lesions
B)How to clean the infected areas with soap and water
C)Use of petroleum jelly (Vaseline) to soften crusty areas
D)Appropriate use of alcohol-based cleansers on the lesions

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 7

The nurse is caring for a client who has just received a diagnosis of a fungal infection and the client asks the nurse how this will be treated. The nurses' response is based upon knowledge that which of the following bases is the most common for antifungal treatment?
A)Gel
B)Paste
C)Lotion
D)Powder

Accepted Answer

Powder is the most common base for antifungal preparations. Gels are used for acute exudative inflammation. The paste is used when a drying effect is necessary because moisture is absorbed. A lotion is useful in treating subacute pruritic eruptions.

Question 8

The health care provider prescribes topical 5-fluorouracil (5-FU) for a client with actinic keratosis on the nose. Which of the following information would the nurse include in the client teaching plan?
A)You may develop nausea and anorexia, but good nutrition is important during treatment.
B)You will need to avoid crowds because of the risk for infection caused by chemotherapy.
C)The nose will develop painful, eroded areas that will take weeks before completely healing.
D)5-FU is needed to shrink the lesion so that less scarring occurs once the lesion is excised.

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 9

The nurse is teaching the client how to use wet compresses at home for treatment of poison ivy. Which of the following instructions would the nurse include in the teaching plan?
A)Use only sterile water as the solution for the dressing.
B)The material for the compress is to be 4-8 layers thick.
C)The compress should meet the edge of the area that is to be treated.
D)Use abdominal pads (gauze sponges) when covering odd-shaped body parts.

Accepted Answer

The material for wet compresses should be 4-8 layers thick and slightly larger than the area that is being treated. Abdominal pads are to be avoided as they hold too much fluid as well as fibres may be left in the wound if the skin is not intact. It is not necessary to use sterile water; tap water at room temperature is acceptable.

Question 10

The nurse is assessing a new client at the outpatient clinic and notes dry, scaly skin; thin hair; and thick, brittle nails. Which of the following actions is best for the nurse to take at this time?
A)Instruct the client about the importance of nutrition in skin heath.
B)Make a referral to a podiatrist so that the nails can be safely trimmed.
C)Consult with the health care provider about the need for further diagnostic testing.
D)Teach the client about using moisturizing creams and lotions to decrease dry skin.

Accepted Answer

The client has clinical manifestations that could be caused by systemic problems or interferences with nutrition (e.g., protein deficiency) so further diagnostic evaluation is indicated. Client teaching about nutrition, addressing the client'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

The nurse is caring for a client in the dermatology clinic who has a small, slow-growing papule with ulceration and a depression in the centre of the lesion on the right cheek. Which of the following nursing interventions will the nurse anticipate performing for this client?
A)Prepare the client for a biopsy.
B)Teach about the use of corticosteroid creams.
C)Educate the client about use of tretinoin (Retin-A).
D)Discuss the need for topical application of antibiotics.

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 12

Which of the following information would the nurse include when teaching an older-adult client about skin care?
A)Dry the skin thoroughly before applying lotions.
B)Bathe and shampoo daily with soap and shampoo.
C)Use warm water and a moisturizing soap when bathing.
D)Use antibacterial soaps when bathing to avoid infection.

Accepted Answer

Warm water and moisturizing soap will avoid overdrying of the skin. Since older clients 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 13

Which of the following actions would the nurse take when applying a wet dressing to an inflamed and pruritic area of skin on a client's ankle?
A)Use a cool solution to wet the dressing.
B)Change the dressing using sterile gloves.
C)Soak the dressing in sterile normal saline.
D)Apply the dressing from the knee to the foot.

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.

Question 14

The nurse is caring for a client with a urinary tract infection and has been prescribed ciprofloxacin. Which of the following information should the nurse include when teaching this client?
A)Use a sunscreen with a high SPF when exposed to the sun.
B)Sun exposure may decrease the effectiveness of the medication.
C)Photosensitivity may result in an artificial-looking tan appearance.
D)Wear sunglasses to avoid eye damage while taking ciprofloxacin.

Accepted Answer

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

Question 15

To decrease the risk for sun damage to the skin, which information should the nurse include when teaching clients?
A)Waterproof sunscreens will provide good protection when swimming.
B)Use a sunscreen with an SPF of at least 8-10 for adequate protection.
C)Try to stay out of the sun between the hours of 1 000 and 1 600.
D)Increase sun exposure by no more than 10 minutes a day to avoid skin damage.

Accepted Answer

The risk for skin damage from the sun is highest with exposure between 1 000 and 1 500 during regular time and 1 100-1 600 during daylight savings time. 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 16

A client with atopic dermatitis has been using a high-potency topical corticosteroid ointment for several weeks. Which of the findings by the nurse indicates a possible adverse effect of the medication?
A)Thinning of the affected skin
B)Alopecia of the affected areas
C)Reddish-brown discoloration of the skin
D)Dryness and scaling in the areas of treatment

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 or scaling of the skin are not adverse effects of topical corticosteroid use.

Question 17

The nurse is caring for a client who is undergoing psoralen plus ultraviolet A light (PUVA) therapy for treatment of psoriasis. Which of the following actions would the nurse plan to implement to minimize complications from this procedure?
A)Cleanse the skin carefully with an antiseptic soap.
B)Shield any unaffected areas with lead-lined drapes.
C)Have the client use protective eyewear while receiving PUVA.
D)Apply petroleum jelly to the areas surrounding the psoriatic lesions.

Accepted Answer

The eyes should be shielded from UV light (UVL) during and after PUVA therapy to prevent the development of cataracts. The client 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 18

A client with an enlarging, irregular mole that is 6 mm in diameter is scheduled for outpatient treatment. Which of the following procedures would the nurse include in the teaching plan for this client?
A)Curettage
B)Cryosurgery
C)Punch biopsy
D)Surgical excision

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 19

The nurse notes darker skin pigmentation in the skin folds of a client who has a body mass index of 40 kg/m2. Which of the following topics would the nurse include in client teaching?
A)Teach the client about the risk for type 2 diabetes.
B)Educate the client about treatment of fungal infection.
C)Discuss the use of drying agents to minimize infection risk.
D)Instruct the client about use of mild soap to clean skin folds.

Accepted Answer

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

Question 20

After the nurse has finished teaching a client about application of corticosteroid cream to an area of contact dermatitis on the right leg, which of the following client actions indicates that more teaching is needed?
A)The client spreads the cream using a downward motion.
B)The client takes a tepid bath before applying the cream.
C)The client applies a thick layer of the cream to the affected skin.
D)The client covers the area with a dressing after applying the cream.

Accepted Answer

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

Quiz 26: Nursing Management Integumentary Problems

The nurse is providing care to a client with a squamous cell carcinoma (SCC) that had a Mohs procedure in the dermatology clinic. Which of the following nursing actions would be included in the postoperative plan of care?

The nurse is caring for a client who has basal cell carcinoma (BCC) of the face. Which of the following information should the nurse include when teaching this client?

The nurse is assessing a client's scalp and suspects the presence of pediculosis when which of the following assessment findings are observed?

A client with atopic dermatitis has a new prescription for tacrolimus. After teaching the client about the medication, which statement by the client indicates that further teaching is needed?

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

The health care provider diagnoses impetigo for a client who has crusty vesicopustular lesions on the lower face. Which of the following topics would the nurse include in the teaching plan for this client?

The nurse is caring for a client who has just received a diagnosis of a fungal infection and the client asks the nurse how this will be treated. The nurses' response is based upon knowledge that which of the following bases is the most common for antifungal treatment?

The health care provider prescribes topical 5-fluorouracil (5-FU) for a client with actinic keratosis on the nose. Which of the following information would the nurse include in the client teaching plan?

The nurse is teaching the client how to use wet compresses at home for treatment of poison ivy. Which of the following instructions would the nurse include in the teaching plan?

The nurse is assessing a new client at the outpatient clinic and notes dry, scaly skin; thin hair; and thick, brittle nails. Which of the following actions is best for the nurse to take at this time?

The nurse is caring for a client in the dermatology clinic who has a small, slow-growing papule with ulceration and a depression in the centre of the lesion on the right cheek. Which of the following nursing interventions will the nurse anticipate performing for this client?

Which of the following information would the nurse include when teaching an older-adult client about skin care?

Which of the following actions would the nurse take when applying a wet dressing to an inflamed and pruritic area of skin on a client's ankle?

The nurse is caring for a client with a urinary tract infection and has been prescribed ciprofloxacin. Which of the following information should the nurse include when teaching this client?

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

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

The nurse is caring for a client who is undergoing psoralen plus ultraviolet A light (PUVA) therapy for treatment of psoriasis. Which of the following actions would the nurse plan to implement to minimize complications from this procedure?

A client with an enlarging, irregular mole that is 6 mm in diameter is scheduled for outpatient treatment. Which of the following procedures would the nurse include in the teaching plan for this client?

The nurse notes darker skin pigmentation in the skin folds of a client who has a body mass index of 40 kg/m2. Which of the following topics would the nurse include in client teaching?

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