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Chapter 23: Integumentary Problems Lewis: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. Which information should the nurse include when teaching patients about decreasing the risk

for sun damage to the skin? Use a sunscreen with an SPF of at least 10 for adequate protection. Try to stay out of the direct sun between the hours of 10 AM and 2 PM. Water resistant sunscreens will provide good protection when swimming. Increase sun exposure by no more than 10 minutes a day to avoid skin damage.

a. b. c. d.

ANS: B

The risk for skin damage from the sun is highest with exposure between 10 AM and 2 PM. No sunscreen is completely water resistant. Sunscreens classified as water resistant still need to be reapplied after swimming. 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. DIF: Cognitive Level: Apply (application) REF: 408 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 2. Which information should the nurse include when teaching a patient who has just received a

prescription for ciprofloxacin (Cipro) to treat a urinary tract infection? Use a sunscreen with a high SPF when exposed to the sun. Sun exposure may decrease the effectiveness of the medication. Photosensitivity may result in an artificial-looking tan appearance. Wear sunglasses to avoid eye damage while taking this medication.

a. b. c. d.

ANS: A

The patient should stay out of the sun. If that is not possible, teach the patient to wear sunscreen when taking medications that can cause photosensitivity. The other statements are not accurate. DIF: Cognitive Level: Apply (application) REF: 408 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 3. Which information should the nurse include in the teaching plan for a patient diagnosed with

basal cell carcinoma (BCC)? Treatment plans include watchful waiting. Screening for metastasis will be important. Minimizing sun exposure reduces risk for future BCC. Low dose systemic chemotherapy is used to treat BCC.

a. b. c. d.

ANS: C

BCC is frequently associated with sun exposure, and preventive measures should be taken for future sun exposure. BCC spreads locally, and does not metastasize to distant tissues. Because BCC can cause local tissue destruction, treatment is indicated. Local (not systemic) chemotherapy may be used to treat BCC.

DIF: Cognitive Level: Apply (application) REF: 411 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 4. A patient in the dermatology clinic has a thin, scaly erythematous plaque on the right cheek.

Which action should the nurse take? Prepare the patient for a skin biopsy. Teach the use of corticosteroid cream. Explain how to apply tretinoin (Retin-A) to the face. Discuss the need for topical application of antibiotics.

a. b. c. d.

ANS: A

Because the appearance of the lesion is suggestive of actinic keratosis or possible squamous cell carcinoma, the appropriate treatment would be excision and biopsy. Over-the-counter corticosteroids, topical antibiotics, and Retin-A would not be used for this lesion. DIF: Cognitive Level: Apply (application) REF: 412 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 5. A patient has the following risk factors for melanoma. Which risk factor should the nurse

assign as the priority focus of patient teaching? The patient has multiple dysplastic nevi. The patient uses a tanning booth weekly. The patient is fair-skinned and has blue eyes. The patient’s mother died of a malignant melanoma.

a. b. c. d.

ANS: B

Because 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 for melanoma. DIF: Cognitive Level: Analyze (analysis) REF: 410 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 6. The health care provider diagnoses impetigo in a patient who has crusty vesicopustular lesions

on the lower face. Which instructions should the nurse include in the teaching plan? Clean the infected areas with soap and water. Apply alcohol-based cleansers on the lesions. Avoid use of antibiotic ointments on the lesions. Use petroleum jelly (Vaseline) to soften crusty areas.

a. b. c. d.

ANS: A

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, such as mupirocin (Bactroban), may be applied to the lesions. DIF: Cognitive Level: Apply (application) REF: 414 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 7. The nurse notes the presence of white lesions that resemble milk curds in the back of a

patient’s throat. Which question by the nurse is appropriate at this time? a. “Are you taking any medications?”

b. “Do you have a productive cough?” c. “How often do you brush your teeth?” d. “Have you had an oral herpes infection?” ANS: A

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. DIF: Cognitive Level: Apply (application) REF: 409 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 8. A teenaged male patient who is on a wrestling team is examined by the nurse in the clinic.

Which assessment finding would prompt the nurse to teach the patient about the importance of not sharing headgear to prevent the spread of pediculosis? 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, hivelike papules and plaques with sharply circumscribed borders ANS: B

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. DIF: Cognitive Level: Apply (application) REF: 416 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 9. The health care provider prescribes topical 5-FU for a patient with actinic keratosis on the left

cheek. The nurse should include which statement in the patient’s instructions? a. “5-FU will shrink the lesion to prepare for surgical excision.” b. “Your cheek area will be eroded and it will take several weeks to heal.” c. “You may develop nausea and anorexia, but good nutrition is important during

treatment.” d. “You will need to avoid crowds because of the risk for infection caused by

chemotherapy.” ANS: B

Topical 5-FU causes an initial reaction of erythema, itching, and erosion that 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. DIF: Cognitive Level: Apply (application) REF: 421 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 10. A patient with atopic dermatitis has been using a high-potency topical corticosteroid ointment

for several weeks. The nurse should assess for which adverse effect? a. Thinning of the affected skin c. Dryness and scaling in the area b. Alopecia of the affected areas d. Reddish-brown skin discoloration ANS: A

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 and scaling of the skin are not adverse effects of topical corticosteroid use. DIF: Cognitive Level: Apply (application) REF: 421 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 11. A patient is undergoing psoralen plus ultraviolet A light (PUVA) therapy for treatment of

psoriasis. What action should the nurse take to prevent adverse effects from this procedure? Shield any unaffected areas with lead-lined drapes. Apply petroleum jelly to the areas around the lesions. Cleanse the skin carefully with antiseptic soap prior to PUVA. Have the patient use protective eyewear while receiving PUVA.

a. b. c. d.

ANS: D

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. DIF: Cognitive Level: Apply (application) REF: 420 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 12. A patient with an enlarging, irregular mole that is 7 mm in diameter is scheduled for

outpatient treatment. The nurse should plan to prepare the patient for which procedure? c. Punch biopsy d. Surgical excision

a. Curettage b. Cryosurgery ANS: D

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. DIF: Cognitive Level: Apply (application) REF: 411 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 13. Which information will the nurse include when teaching an older patient about skin care? a. Dry the skin thoroughly before applying lotions. b. Bathe and wash hair daily with soap and shampoo. c. Use warm water and a moisturizing soap when bathing. d. Use antibacterial soaps when bathing to avoid infection. ANS: C

Warm water and moisturizing soap will avoid overdrying the skin. Because 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. DIF: Cognitive Level: Apply (application) REF: 409 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

14. What is the best method to prevent the spread of infection to others when the nurse is

changing the dressing over a wound infected with Staphylococcus aureus? Change the dressing using sterile gloves. Apply antibiotic ointment over the wound. Wash hands and properly dispose of soiled dressings. Soak the dressing in sterile normal saline before removal.

a. b. c. d.

ANS: C

Careful hand washing and the safe disposal of soiled dressings are the best means of preventing the spread of skin problems. Sterile glove and sterile saline use during wound care will not necessarily prevent spread of infection. Applying antibiotic ointment will treat the bacteria but not necessarily prevent the spread of infection. DIF: Cognitive Level: Apply (application) REF: 407 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 15. The nurse is interviewing a patient with contact dermatitis. Which finding indicates a need for

patient teaching? The patient applies corticosteroid cream to pruritic areas. The patient adds oilated oatmeal to the bath water every day. The patient uses bacitracin-neomycin-polymyxin on minor abrasions. The patient takes diphenhydramine at night if persistent itching occurs.

a. b. c. d.

ANS: C

Neosporin can cause contact dermatitis. The other medications are being used appropriately by the patient. DIF: Cognitive Level: Apply (application) REF: 421 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 16. When assessing a new patient at the outpatient clinic, the nurse notes dry, scaly skin; thin hair;

and thick, brittle nails. What is the nurse’s most important action? Instruct the patient about the importance of nutrition for skin health. Make a referral to a podiatrist so that the nails can be safely trimmed. Consult with the health care provider about the need for further diagnostic testing. Teach the patient about using moisturizing creams and lotions to decrease dry skin.

a. b. c. d.

ANS: C

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 may also be needed, but the priority is to rule out underlying disease that may be causing these manifestations. DIF: Cognitive Level: Analyze (analysis) REF: 409 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 17. An older adult patient with a squamous cell carcinoma (SCC) on the lower arm has a Mohs

procedure in the dermatology clinic. Which nursing action will be included in the postoperative plan of care? a. Schedule daily appointments for dressing changes.

b. Describe the use of topical fluorouracil on the incision. c. Teach how to use sterile technique to clean the suture line. d. Teach the use of cold packs to reduce bruising and swelling. ANS: D

Application of cold packs to the incision after the surgery will help decrease bruising and swelling at the site. Because the Mohs procedure results in complete excision of the lesion, topical fluorouracil is not needed after surgery. After the Mohs procedure, the edges of the wound can be left open to heal, or the edges can be approximated and sutured together. The suture line can be cleaned with tap water. No debridement with wet-to-dry dressings is indicated. DIF: Cognitive Level: Apply (application) REF: 422 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 18. A patient with atopic dermatitis has a new prescription for pimecrolimus (Elidel). After

teaching the patient about the medication, which statement by the patient indicates that further teaching is needed? a. “After I apply the medication, I can get dressed as usual.” b. “If the medication burns when I apply it, I will wipe it off.” c. “I need to minimize time in the sun while using the Elidel.” d. “I will rub the medication in gently every morning and night.” ANS: B

The patient should be taught that transient burning at the application site is an expected effect of pimecrolimus 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. DIF: Cognitive Level: Apply (application) REF: 421 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 19. The nurse instructs a patient about application of corticosteroid cream to an area of contact

dermatitis on the right leg. Which patient action indicates that further teaching is needed? The patient takes a tepid bath before applying the cream. The patient spreads the cream using a downward motion. The patient applies a thick layer of the cream to the affected skin. The patient covers the area with a dressing after applying the cream.

a. b. c. d.

ANS: C

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. DIF: Cognitive Level: Apply (application) REF: 421 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 20. The nurse is caring for a patient diagnosed with furunculosis. Which nursing action could the

nurse delegate to unlicensed assistive personnel (UAP)? a. Applying antibiotic cream to the groin b. Obtaining cultures from ruptured lesions c. Evaluating the patient’s personal hygiene d. Cleaning the skin with antimicrobial soap

ANS: D

Cleaning the skin is within the education and scope of practice for UAP. Administration of medication, obtaining cultures, and evaluation are higher level skills that require the education and scope of practice of licensed nursing personnel. DIF: Cognitive Level: Apply (application) REF: 425 OBJ: Special Questions: Delegation TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment 21. The nurse assesses a patient who has just arrived in the postanesthesia recovery area (PACU)

after a blepharoplasty. Which assessment data should be reported to the surgeon immediately? The patient complains of incisional pain. The patient’s heart rate is 110 beats/min. The patient is unable to detect when the eyelids are touched. The skin around the incision is pale and cold when palpated.

a. b. c. d.

ANS: D

Pale, cool skin indicates a possible decrease in circulation, so the surgeon should be notified immediately. The other assessment data indicate a need for ongoing assessment or nursing action. A heart rate of 110 beats/min may be related to the stress associated with surgery. Assessment of other vital signs and continued monitoring are appropriate. Because local anesthesia would be used for the procedure, numbness of the incisional area is expected immediately after surgery. The nurse should monitor for return of feeling. DIF: Cognitive Level: Analyze (analysis) REF: 425 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 22. A patient who has severe refractory psoriasis on the face, neck, and extremities is socially

withdrawn because of the appearance of the lesions. Which action should the nurse take first? Discuss the possibility of participating in an online support group. Encourage the patient to volunteer to work on community projects. Suggest that the patient use cosmetics to cover the psoriatic lesions. Ask the patient to describe the impact of psoriasis on quality of life.

a. b. c. d.

ANS: D

The nurse’s initial actions should be to assess the impact of the disease on the patient’s life and to allow the patient to verbalize feelings about the psoriasis. Depending on the assessment findings, other actions may be appropriate. DIF: Cognitive Level: Analyze (analysis) REF: 417 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 23. The nurse working in the dermatology clinic assesses a young adult female patient who has.

severe cystic acne. Which assessment finding is of concern related to the patient’s prescribed isotretinoin ? a. The patient recently had an intrauterine device removed. b. The patient already has some acne scarring on her forehead. c. The patient has also used topical antibiotics to treat the acne. d. The patient has a strong family history of rheumatoid arthritis.

ANS: A

Because isotretinoin is teratogenic, contraception is required for women who are using this medication. The nurse will need to determine whether the patient is using other birth control methods. More information about the other patient data may also be needed, but the other data do not indicate contraindications to isotretinoin use. DIF: Cognitive Level: Apply (application) REF: 419 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 24. There is one opening in the schedule at the dermatology clinic, and four patients are seeking

appointments today. Which patient will the nurse schedule for the available opening? 50-yr-old with skin redness after having a chemical peel 3 days ago 38-y...