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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter61:ManagementsofPatientswithDermatologicProblems  1.

Anursepractitionerisseeinga16-year-oldmalepatientwhohascometothedermatologyclinicfor treatmentofacne.Thenursepractitionerwouldknowthatthetreatmentmayconsistofwhichofthe followingmedications?

A)

Acyclovir(Zovirax)

B)

Benzoylperoxideanderythromycin(Benzamycin)

C)

Diphenhydramine(Benadryl)

D)

Triamcinolone(Kenalog)

Ans:

B Feedback: Benzamycingelisamongthetopicaltreatmentsavailableforacne.Zoviraxisusedinthetreatmentof herpeszosterasanoralantiviralagent.Benadrylisanoralantihistamineusedinthetreatmentof pruritus.IntralesionalinjectionsofKenaloghavebeenutilizedinthetreatmentofpsoriasis.

2.

Anurseiscaringforapatientwhohasbeendiagnosedwithpsoriasis.Thenurseiscreatinganeducation planforthepatient.Whatinformationshouldbeincludedinthisplan?

A)

Usecautionwhentakingnonprescriptionmedications.

B)

Avoidpublicplacesuntilsymptomssubside.

C)

Washskinfrequentlytopreventinfection.

D)

Liberallyapplycorticosteroidsasneeded.

Ans:

A Feedback: Thepatientshouldbecautionedabouttakingnonprescriptionmedicationsbecausesomemayaggravate mildpsoriasis.Psoriasisisnotcontagious.Manypatientsneedreassurancethattheconditionisnot infectious,notareflectionofpoorpersonalhygiene,andnotskincancer.Excessivelyfrequentwashing ofskinproducesmoresorenessandscaling.Overuseoftopicalcorticosteroidscanresultinskinatrophy, striae,andmedicationresistance.

3.

Anurseisplanningthecareofapatientwithherpeszoster.Whatmedication,ifadministeredwithinthe

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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first24hoursoftheinitialeruption,canarrestherpeszoster? A)

Prednisone(Deltasone)

B)

Azanthioprine(Imuran)

C)

Triamcinolone(Kenalog)

D)

Acyclovir(Zovirax)

Ans:

D Feedback: Acyclovir,ifstartedearly,iseffectiveinsignificantlyreducingthepainandhaltingtheprogressionof thedisease.Thereisevidencethatinfectionisarrestediforalantiviralagentsareadministeredwithinthe first24hours.Prednisoneisananti-inflammatoryagentusedinavarietyofskindisorders,butnotinthe treatmentofherpes.Azanthioprineisanimmunosuppressiveagentusedinthetreatmentofpemphigus. Triamcinoloneisutilizedinthetreatmentofpsoriasis.

4.

Apatientwithsquamouscellcarcinomahasbeenscheduledfortreatmentofthismalignancy.Thenurse shouldanticipatethattreatmentforthistypeofcancerwillprimarilyconsistofwhatintervention?

A)

Chemotherapy

B)

Radiationtherapy

C)

Surgicalexcision

D)

Biopsyofsampletissue

Ans:

C Feedback: Theprimarygoalofsurgicalmanagementofsquamouscellcarcinomaistoremovethetumorentirely. Radiationtherapyisreservedforolderpatients,becausex-raychangesmaybeseenafter5to10years, andmalignantchangesinscarsmaybeinducedbyirradiation15to30yearslater.Obtainingabiopsy wouldnotbeagoaloftreatment;itmaybeanassessment.Chemotherapyandradiationtherapyare generallyreservedforpatientswhoarenotsurgicalcandidates.

5.

A)

Whenwritingaplanofcareforapatientwithpsoriasis,thenursewouldknowthatanappropriate nursingdiagnosisforthispatientwouldbewhat? ImpairedSkinIntegrityRelatedtoScalyLesions

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

AcutePainRelatedtoBlisteringandErosionsoftheOralCavity

C)

ImpairedTissueIntegrityRelatedtoEpidermalShedding

D)

AnxietyRelatedtoRiskforMelanoma

Ans:

A

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Feedback: AnappropriatediagnosisforapatientwithpsoriasiswouldincludeImpairedSkinIntegrityasitrelates toscalylesions.Psoriasiscausespainbutdoesnotnormallyaffecttheoralcavity.Similarly,tissue integrityisimpaired,butnotthroughtheprocessofepidermalshedding.Psoriasisisnotrelatedtoan increasedriskformelanoma. 6.

Apatientwhohassustainedthird-degreefacialburnsandafacialfractureisundergoingreconstructive surgeryandimplantationofaprosthesis.ThenursehasidentifiedanursingdiagnosisofDisturbedBody ImageRelatedtoDisfigurement.Whatwouldbeanappropriatenursinginterventionrelatedtothis diagnosis?

A)

Referringthepatienttoaspeechtherapist

B)

Graduallyaddingsoftfoodstodiet

C)

Administeringanalgesicsasprescribed

D)

Teachingthepatienthowtouseandcarefortheprosthesis

Ans:

D Feedback: Theprocessoffacialreconstructionisoftenslowandtedious.Becauseapersonsfacialappearance affectsself-esteemsogreatly,thistypeofreconstructionisoftenaveryemotionalexperienceforthe patient.Reinforcementofthepatientssuccessfulcopingstrategiesimprovesself-esteem.Ifprosthetic devicesareused,thepatientistaughthowtouseandcareforthemtogainasenseofgreater independence.ThisisaninterventionthatrelatestoDisturbedBodyImageinthesepatients.Noneofthe otherlistedinterventionsrelatesdirectlytothediagnosisofDisturbedBodyImage.

7.

Whileperforminganinitialassessmentofapatientadmittedwithappendicitis,thenurseobservesan elevatedblue-blacklesiononthepatientsear.Thenurseknowsthatthislesionisconsistentwithwhat typeofskincancer?

A)

Basalcellcarcinoma

B)

Squamouscellcarcinoma

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

C)

Dermatofibroma

D)

Malignantmelanoma

Ans:

D

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Feedback: Amalignantmelanomapresentsitselfasasuperficialspreadingmelanomawhichmayappearina combinationofcolors,withhuesoftan,brown,andblackmixedwithgray,blue-black,orwhite.The lesiontendstobecircular,withirregularouterportions.BCCusuallybeginsasasmall,waxynodule withrolled,translucent,pearlyborders;telangiectaticvesselsmaybepresent.SCCappearsasarough, thickened,scalytumorthatmaybeasymptomaticormayinvolvebleeding.Adermatofibromapresents asafirm,dome-shapedpapuleornodulethatmaybeskincoloredorpinkish-brown. 8.

AnurseisprovidingcareforapatientwhohasdevelopedKaposissarcomasecondarytoHIVinfection. Thenurseshouldbeawarethatthisformofmalignancyoriginatesinwhatpartofthebody?

A)

Connectivetissuecellsindiffuselocations

B)

Smoothmusclecellsofthegastrointestinalandrespiratorytract

C)

Neuraltissueofthebrainandspinalcord

D)

Endothelialcellsliningsmallbloodvessels

Ans:

D Feedback: Kaposissarcoma(KS)isamalignancyofendothelialcellsthatlinethesmallbloodvessels.Itdoesnot originateinconnectivetissue,smoothmusclecellsoftheGIandrespiratorytract,orinneuraltissue.

9.

Apatientrequiresafull-thicknessgrafttocoverachronicwound.Howisthedonorsiteselected?

A)

Thelargestareaofthebodywithouthairisselected.

B)

Anyareathatisnotnormallyvisiblecanbeused.

C)

Anareamatchingthecolorandtextureoftheskinatthesurgicalsiteisselected.

D)

Anareamatchingthesensorycapabilityoftheskinatthesurgicalsiteisselected.

Ans:

C

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Feedback: Thesitewheretheintactskinisharvestediscalledthedonorsite.Selectionofthedonorsiteismadeto matchthecolorandtextureofskinatthesurgicalsiteandtoleaveaslittlescarringaspossible. 10. Apatienthasjustbeentoldthathehasmalignantmelanoma.Thenursecaringforthispatientshould anticipatethatthepatientwillundergowhattreatment? A)

Chemotherapy

B)

Immunotherapy

C)

Wideexcision

D)

Radiationtherapy

Ans:

C Feedback: Wideexcisionistheprimarytreatmentformalignantmelanoma,whichremovestheentirelesionand determinesthelevelandstaging.Chemotherapymaybeusedafterthemelanomaisexcised. Immunotherapyisexperimentalandradiationtherapyispalliative.

11. Anurseisleadingahealthpromotionworkshopthatisfocusingoncancerprevention.Whatactionis mostlikelytoreduceparticipantsrisksofbasalcellcarcinoma(BCC)? A)

Teachingparticipantstoimprovetheiroverallhealththroughnutrition

B)

Encouragingparticipantstoidentifytheirfamilyhistoryofcancer

C)

Teachingparticipantstolimittheirsunexposure

D)

Teachingparticipantstocontrolexposuretoenvironmentalandoccupationalradiation

Ans:

C Feedback: SunexposureisthebestknownandmostcommoncauseofBCC.BCCisnotcommonlylinkedto generalhealthdebilitation,familyhistory,orradiationexposure.

12. Apatientdiagnosedwithastasisulcerhasbeenhospitalized.Thereisanordertochangethedressing andprovidewoundcare.Whichactivityshouldthenursefirstperformwhenprovidingwoundcare?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Assessthedrainageinthedressing.

B)

Slowlyremovethesoileddressing.

C)

Performhandhygiene.

D)

Donnon-latexgloves.

Ans:

C

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Feedback: Thenurseandphysicianmustadheretostandardprecautionsandweargloveswheninspectingtheskin orchangingadressing.Useofstandardprecautionsandproperdisposalofanycontaminateddressingis carriedoutaccordingtoOccupationalSafetyandHealthAdministration(OSHA)regulations.Hand hygienemustprecedeotheraspectsofwoundcare. 13. Apatientcomestothecliniccomplainingofaredrashofsmall,fluid-filledblistersandissuspectedof havingherpeszoster.Whatpresentationismostconsistentwithherpeszoster? A)

Groupedvesiclesoccurringonlipsandoralmucousmembranes

B)

Groupedvesiclesoccurringonthegenitalia

C)

Rough,fresh,orgrayskinprotrusions

D)

Groupedvesiclesinlinearpatchesalongadermatome

Ans:

D Feedback: Herpeszoster,orshingles,isanacuteinflammationofthedorsalrootganglia,causinglocalized, vesicularskinlesionsfollowingadermatome.Herpessimplextype1isaviralinfectionaffectingthe skinandmucousmembranes,usuallyproducingcoldsoresorfeverblisters.Herpessimplextype2 primarilyaffectsthegenitalarea,causingpainfulclustersofsmallulcerations.Wartsappearasrough, fresh,orgrayskinprotrusions.

14. Apatientwithachronicdiabeticwoundisbeingdischargedafterreceivingaskingrafttoaidwound healing.Whatdirectionshouldthenurseincludeinhomecareinstructions? A)

Gentlymassagethegraftsitedailytopromoteperfusion.

B)

Protectthegraftfromdirectsunlightandtemperatureextremes.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

C)

Protectthegraftsitefromanyformofmoistureforatleast12weeks.

D)

Applyantibioticointmenttothegraftsiteanddonorsitedaily.

Ans:

B

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Feedback: Boththedonorsiteandthegraftedareamustbeprotectedfromexposuretoextremesintemperature, externaltrauma,andsunlightbecausetheseareasaresensitive,especiallytothermalinjuries.Antibiotic ointmentsarenottypicallyprescribedandmassagemaydamagethesefragilesites.Thereisnoneedto protectthesitesfromallformsofmoistureforthelongterm. Apatientpresentsatthefreeclinicwithablack,wart-likelesiononhisface,stating,Ivedonesome 15. research,andImprettysureIhavemalignantmelanoma.Subsequentdiagnostictestingresultsina diagnosisofseborrheickeratosis.Thenurseshouldrecognizewhatsignificanceofthisdiagnosis? A)

Thepatientrequiresnotreatmentunlesshefindsthelesiontobecosmeticallyunacceptable.

B)

Thepatientslesionwillbecloselyobservedfor6monthsbeforeaplanoftreatmentischosen.

C)

Thepatienthasoneofthefewdermatologicmalignanciesthatrespondtochemotherapy.

D)

Thepatientwilllikelyrequirewideexcision.

Ans:

A Feedback: Seborrheickeratosesarebenign,wartlikelesionsofvarioussizesandcolors,rangingfromlighttanto black.Thereisnoharminallowingthesegrowthstoremainbecausethereisnomedicalsignificanceto theirpresence.

16. Anurseisprovidingcareforapatientwhohaspsoriasis.Thenurseisawareofthesequelaethatcan resultfromthishealthproblem.Followingtheappearanceofskinlesions,thenurseshouldprioritize whatassessment? A)

Assessmentofthepatientsstoolforevidenceofintestinalsloughing

B)

Assessmentofthepatientsapicalheartratefordysrhythmias

C)

Assessmentofthepatientsjointsforpainanddecreasedrangeofmotion

D)

Assessmentforcognitivechangesresultingfromneurologiclesions

Ans:

C

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Feedback: Asymmetricrheumatoidfactornegativearthritisofmultiplejointsoccursinupto30%ofpeoplewith psoriasis,mosttypicallyaftertheskinlesionsappear.Themosttypicaljointsaffectedincludethosein thehandsorfeet,althoughsometimeslargerjointssuchastheelbow,knees,orhipsmaybeaffected.As such,thenurseshouldassessforthismusculoskeletalcomplication.GI,cardiovascular,andneurologic functionarenotaffectedbypsoriasis. 17. Apatientisadmittedtotheintensivecareunitwithwhatisthoughttobetoxicepidermalnecrolysis (TEN).Whenassessingthehealthhistoryofthepatient,thenursewouldbealerttowhatprecipitating factor? A)

Recentheavyultravioletexposure

B)

Substandardhygienicconditions

C)

Recentadministrationofnewmedications

D)

Recentvaricellainfection

Ans:

C Feedback: Inadults,TENisusuallytriggeredbyareactiontomedications.Antibiotics,antiseizureagents, butazones,andsulfonamidesarethemostfrequentmedicationsimplicated.TENisunrelatedtoUV exposure,hygiene,orvaricellainfection.

18. Apatienthasreceivedadiagnosisofirritantcontactdermatitis.Whatactionshouldthenurseprioritize inthepatientssubsequentcare? A)

Teachingthepatienttosafelyandeffectivelyadministerimmunosuppressants

B)

Helpingthepatientidentifyandavoidtheoffendingagent

C)

Teachingthepatienthowtomaintainmeticulousskinhygiene

D)

Helpingthepatientperformwoundcareinthehomeenvironment

Ans:

B Feedback: Afocusofcareforpatientswithirritantcontactdermatitisisidentifyingandavoidingtheoffending agent.Immunosuppressantsarenotusedtotreateczemaandwoundcareisnotnormallyrequired, exceptincasesofopenlesions.Poorhygienehasnocorrelationwithcontactdermatitis.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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19. Anurseiscaringforapatientwhosechemicalinjuryhasnecessitatedaskingrafttohislefthand.The nurseenterstheroomandobservesthatthepatientisperformingactiverangeofmotion(ROM) exerciseswiththeaffectedhand.Howshouldthenursebestrespond? A)

Liaisewiththephysicaltherapisttoensurethatthepatientisperformingexercisessafely.

B)

Validatethepatientseffortstoincreasebloodperfusiontothegraftsite.

C)

RemindthepatientthatROMexercisesshouldbepassive,notactive.

D)

Remindthepatientoftheneedtoimmobilizethegrafttofacilitatehealing.

Ans:

D Feedback: Thenurseshouldinstructthepatienttokeeptheaffectedpartimmobilizedasmuchaspossibleinorder tofacilitatehealing.PassiveROMexercisescanbeequallyasdamagingasactiveROM.

Aschoolnursehassenthomefourchildrenwhoshowevidenceofpediculosiscapitis.Whatisan 20. importantinstructionthenurseshouldincludeinthenotebeingsenthometoparents? A)

Thechildsscalpshouldbemonitoredfor48to72hoursbeforestartingtreatment.

B)

Nitsmayhavetobemanuallyremovedfromthechildshairshafts.

C)

Thediseaseisself-limitingandsymptomswillabatewithin1week.

D)

Effortsshouldbemadetoimprovethechildslevelofhygiene.

Ans:

B Feedback: Treatmentforheadliceshouldbeginpromptlyandmayrequiremanualremovalofnitsfollowing medicatingshampoo.Headlicearenotrelatedtoalackofhygiene.Treatmentisnecessarybecausethe conditionwillnotlikelyresolvespontaneouslywithin1week.

21. Apatienthasjustbeendiagnosedwithpsoriasisandfrequentlyhaslesionsaroundhisrighteye.What shouldthenurseteachthepatientabouttopicalcorticosteroiduseontheselesions? A)

Cataractdevelopmentispossible.

B)

Theointmentislikelytocauseweeping.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

C)

Corticosteroiduseiscontraindicatedontheselesions.

D)

Thepatientmaydevelopglaucoma.

Ans:

A

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Feedback: Patientsusingtopicalcorticosteroidpreparationsrepeatedlyonthefaceandaroundtheeyesshouldbe awarethatcataractdevelopmentispossible.Weepingandglaucomaarelesslikely.Thereisno consequentriskofglaucoma. 22. Anurseiscaringforapatientwhohasadiagnosisofbullouspemphigoidandwhoisbeingtreatedon themedicalunit.Whenprovidinghygieneforthispatient,thenurseshouldp...