Question 1

A client asks about the nature of the underlying problem in skin that leads to the development of atopic dermatitis. The nurse's response would include that the problem is caused by
A) a decrease in natural oils.
B) decreased resistance to skin infections.
C) decreased water content.
D) increased sensitivity to histamines.

Accepted Answer

Compared with normal skin, the dry skin of atopic dermatitis has a reduced water-binding capacity, a higher transepidermal water loss, and decreased water content.

Question 2

In the care of a client diagnosed with cutaneous T-cell lymphoma, the nurse's priority focus would be
A) control of pruritus.
B) pain management.
C) prevention of metastasis.
D) removal of the tumors.

Accepted Answer

Control of pruritus is essential at all stages of lymphoma and is accomplished by rehydration of the skin, various dry skin therapies, topical corticosteroids, and PUVA therapy.

Question 3

In teaching a client about sun protection, the nurse would make an accurate suggestion with the statement
A) "Sitting in the shade will protect you from sun exposure."
B) "Use sunscreen, even on overcast days."
C) "Use a sunscreen with the lowest SPF number."
D) "Wear light-colored, loosely woven clothes."

Accepted Answer

The sun's rays are as damaging to skin on cloudy, hazy days as on sunny days.

Question 4

A nurse is conducting community education classes on skin cancer. One participant says to the nurse: "I have read there are now vaccines to protect you from getting a melanoma." The nurse's most helpful response would be
A) "No, there is no vaccination for melanoma."
B) "The vaccines were so ineffective they were withdrawn."
C) "Vaccines are being developed against melanoma."
D) "Yes the vaccine is available, but it is very expensive."

Accepted Answer

Vaccines are in the process of being developed against primary melanoma. There is no cure for metastatic melanoma.

Question 5

To help decrease the threat of a melanoma in a client at risk, the nurse would suggest that the client's diet should include
A) fish oil capsules.
B) lemon grass tea.
C) oatmeal.
D) red meat.

Accepted Answer

Green tea, fish oil, soy products, and vitamin E are thought to be helpful in minimizing the risk of developing melanoma.

Question 6

After blepharoplasty the client complains of itching of the eyes. The nurse would
A) administer prescribed analgesia.
B) apply cold wet dressings.
C) irrigate the eyes with normal saline.
D) notify the physician immediately.

Accepted Answer

The post-blepharoplasty client may experience an itching sensation, similar to having dry eyes, because of slight corneal swelling. This can be relieved with cold wet dressings.

Question 7

A client is to have a basal cell carcinoma removed with Mohs' surgery. During preoperative teaching, it would be important for the nurse to explain that
A) liquid nitrogen will be applied to the lesion.
B) no dressing will be necessary.
C) scarring is rare.
D) the procedure may be long.

Accepted Answer

Mohs' technique involves a series of excisions. Careful microscopic tissue assessment "maps" the presence or absence of malignant cells within each specimen. The procedure may be lengthy.

Question 8

When caring for a client after rhytidectomy, the nurse notes that the left side of the client's face is drooping. The nurse would
A) apply cold compresses.
B) call the surgeon immediately.
C) perform a neurosensory assessment.
D) raise the head of the bed.

Accepted Answer

One complication of the face lift is hematoma formation, often first manifested by facial asymmetry associated with pain on tightness on the affected side of the face. Hematomas can cause tissue necrosis and must be surgically removed before they cause damage. Cold compresses are useful for routine postoperative swelling and bleeding. The client should already be in Fowler position to minimize edema. A neurosensory assessment might be needed if a neurologic event is suspected. But the most common cause of this manifestation is hematoma, so the nurse should notify the surgeon.

Question 9

Discharge teaching for a client following rhytidectomy would include the instruction to
A) sleep in the prone position only.
B) practice coughing and deep breathing.
C) maintain a liquid diet for 1 week.
D) exercise the facial muscles daily.

Accepted Answer

Postoperative instructions are to sleep with the head of bed elevated, minimize talking and chewing, control hypertension, and avoid coughing.

Question 10

Nursing care for a client with atopic dermatitis would focus primarily on
A) decreasing pain.
B) decreasing pruritus.
C) preventing infection.
D) promoting drying of lesions.

Accepted Answer

Pruritus is the major manifestation of atopic dermatitis and causes the greatest morbidity. The urge to scratch may be mild and self-limiting, or it may be intense, leading to severely excoriated lesions, infection, and scarring.

Question 11

A client has severe cellulitis on the arm. The nurse would anticipate orders to administer medications to eradicate
A) Candida albicans.
B) group A beta-hemolytic streptococci.
C) Staphylococcus aureus.
D) Streptococcus pyogenes.

Accepted Answer

Streptococcus pyogenes is the usual cause of cellulitis, although other pathogens may be responsible.

Question 12

The statement by a client with psoriasis vulgaris that would indicate to the nurse the need for further teaching regarding the client's illness is
A) "I could develop arthritis because of this disease."
B) "I will always have psoriasis."
C) "Psoriasis is caused by an infection."
D) "Stress can cause psoriasis to worsen."

Accepted Answer

Psoriasis vulgaris is a chronic, recurrent, erythematous, inflammatory disorder involving keratin synthesis. It is a genetic systemic disease with an immunologic basis. The cause of psoriasis vulgaris is unknown. Anxiety and stress often precede flare-ups. Up to one third of clients with moderate to severe psoriasis vulgaris develop psoriatic arthritis.

Question 13

When providing topical treatment of lesions for a client with intertrigo, the nurse would avoid the use of
A) Burrow's solution.
B) cornstarch.
C) talc-containing powder.
D) topical steroids.

Accepted Answer

Cornstarch should never be used because it encourages Candida albicans overgrowth. Burrow's solution (an antiseptic), talc-containing powders, and topical steroids are all possible treatments.

Question 14

The physician ordered colloidal oatmeal baths followed by application of an occlusive ointment for a client with pruritus. The nurse's teaching plan would include explaining the need to
A) apply the ointment to damp skin.
B) bathe several times a day.
C) soak for at least 30 minutes.
D) use hot water in the bath.

Accepted Answer

Immediate application of the occlusive substance to the damp skin is the most important detail, because if the skin is not occluded within 3 to 5 minutes, evaporation will begin to occur.

Question 15

Before a client has blepharoplasty, the nurse would assess the client for
A) ability to close eyes completely.
B) extraocular movement in each eye.
C) facial symmetry and muscle strength.
D) near and distant vision in each eye.

Accepted Answer

Preoperative near and distant vision in each eye is assessed by asking the client to read from a book and from something in the distance while one eye is covered. These baseline data are critical to assess postoperative visual changes.

Question 16

The client is to apply topical 5-fluorouracil to a lesion diagnosed as actinic keratosis. The nurse would explain that the client should expect the skin to develop
A) desquamation.
B) dryness.
C) erosion and necrosis.
D) itching.

Accepted Answer

Medication should be continued until the inflammatory response reaches the erosion, necrosis, and ulceration stage, at which time the medication should be stopped.

Question 17

Methotrexate is prescribed for a female client with psoriasis. When teaching the client about this medication, the nurse would explain that the client should avoid
A) aged cheese.
B) alcohol.
C) birth control pills.
D) milk products.

Accepted Answer

To prevent liver damage, the client should avoid alcohol while taking methotrexate. Effective birth control is needed during treatment and for 3 months following completion of treatment. Milk products and aged cheese do not have interactions with this drug.

Question 18

Before initiation of photochemotherapy (PUVA), the nurse instructs a client suspected of having lupus erythematosus about the diagnostic study that will be performed first, which is a(n)
A) antinuclear antibody test.
B) chest x-ray study.
C) complete blood cell count.
D) platelet count.

Accepted Answer

The skin changes of clients with lupus erythematosus are aggravated by sun exposure, so photochemotherapy is contraindicated. Before therapy is initiated, an ANA test should rule out this condition when suspected.

Question 19

A nurse would instruct a client who experienced widespread first-degree sunburn to
A) apply a water-based emollient after bathing.
B) avoid the use of aspirin or ibuprofen.
C) soak in cold baths for 20 minutes at a time.
D) use over-the-counter local anesthetics.

Accepted Answer

Tepid tap water baths are indicated for large sunburned areas. After a bath or soak, the client should apply water-based emollients. Over-the-counter remedies containing local anesthetics, such as benzocaine, dibucaine (Nupercaine), and lidocaine (Xylocaine), should be avoided because they are rarely effective and can induce contact sensitivity. A prostaglandin inhibitor such as aspirin may be used to reduce the erythema and inflammation in adults.

Question 20

A client had a nodule removed from his face that was diagnosed as basal cell carcinoma. In teaching this client, the nurse should include information on the need for future
A) chemotherapy.
B) frequent examinations.
C) further assessment.
D) radiation therapy.

Accepted Answer

Clients who have had one basal cell carcinoma are at greater risk of developing others. Recurrences of previously treated basal cell carcinomas are also possible but more unusual. The possible recurrence generally is within the first 2 years after removal or therapy.

Quiz 49: Management of Clients with Integumentary Disorders

A client asks about the nature of the underlying problem in skin that leads to the development of atopic dermatitis. The nurse's response would include that the problem is caused by

In the care of a client diagnosed with cutaneous T-cell lymphoma, the nurse's priority focus would be

In teaching a client about sun protection, the nurse would make an accurate suggestion with the statement

A nurse is conducting community education classes on skin cancer. One participant says to the nurse: "I have read there are now vaccines to protect you from getting a melanoma." The nurse's most helpful response would be

To help decrease the threat of a melanoma in a client at risk, the nurse would suggest that the client's diet should include

After blepharoplasty the client complains of itching of the eyes. The nurse would

A client is to have a basal cell carcinoma removed with Mohs' surgery. During preoperative teaching, it would be important for the nurse to explain that

When caring for a client after rhytidectomy, the nurse notes that the left side of the client's face is drooping. The nurse would

Discharge teaching for a client following rhytidectomy would include the instruction to

Nursing care for a client with atopic dermatitis would focus primarily on

A client has severe cellulitis on the arm. The nurse would anticipate orders to administer medications to eradicate

The statement by a client with psoriasis vulgaris that would indicate to the nurse the need for further teaching regarding the client's illness is

When providing topical treatment of lesions for a client with intertrigo, the nurse would avoid the use of

The physician ordered colloidal oatmeal baths followed by application of an occlusive ointment for a client with pruritus. The nurse's teaching plan would include explaining the need to

Before a client has blepharoplasty, the nurse would assess the client for

The client is to apply topical 5-fluorouracil to a lesion diagnosed as actinic keratosis. The nurse would explain that the client should expect the skin to develop

Methotrexate is prescribed for a female client with psoriasis. When teaching the client about this medication, the nurse would explain that the client should avoid

Before initiation of photochemotherapy (PUVA) , the nurse instructs a client suspected of having lupus erythematosus about the diagnostic study that will be performed first, which is a(n)

A nurse would instruct a client who experienced widespread first-degree sunburn to

A client had a nodule removed from his face that was diagnosed as basal cell carcinoma. In teaching this client, the nurse should include information on the need for future