Chapter 25 Care of Patients with Skin Problems PDF

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Chapter25:CareofPatientswithSkinProblems MULTIPLECHOICE 1.Anurseteachesaclientwhohasverydryskin.Whichstatementshouldthenurseincludeinthisclients education? a.

Uselotsofmoisturizerseveraltimesadaytominimizedryness.

b.

Takeacoldshowerinsteadofsoakinginthebathtub.

c.

Useantimicrobialsoaptoavoidinfectionofcrackedskin.

d.

Afteryoubathe,putlotiononbeforeyourskinistotallydry.

ANS:D Theclientshouldbatheinwarmwaterforatleast20minutesandthenapplylotionimmediatelybecausethis willkeepthemoistureintheskin.Justusingmoisturizerwillnotbeashelpfulbecausethemoisturizerisnot whatrehydratestheskin;itisthewater.Bathinginwarmwaterwillrehydrateskinmoreeffectivelythanacold shower,andantimicrobialsoapsareactuallymoredryingthanotherkindsofsoap. DIF:Applying/ApplicationREF:448 KEY:Hygiene|skinbreakdownMSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:BasicCareandComfort 2.Anurseassessesclientsonamedical-surgicalunit.Whichclientisatgreatestriskforpressureulcer development? a.

A44-year-oldprescribedIVantibioticsforpneumonia

b.

A26-year-oldwhoisbedriddenwithafracturedleg

c.

A65-year-oldwithhemi-paralysisandincontinence

d.

A78-year-oldrequiringassistancetoambulatewithawalker

ANS:C Beingimmobileandbeingincontinentaretwosignificantriskfactorsforthedevelopmentofpressureulcers. Theclientwithpneumoniadoesnothavespecificriskfactors.Theyoungclientwhohasafracturedlegandthe clientwhoneedsassistancewithambulationmightbeatmoderateriskiftheydonotmoveaboutmuch,but havingtworiskfactorsmakesthe65-year-oldthepersonathighestrisk. DIF:Applying/ApplicationREF:451 KEY:Skinbreakdown|BradenScale

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MSC:IntegratedProcess:NursingProcess:Assessment NOT:ClientNeedsCategory:PhysiologicalIntegrity:ReductionofRiskPotential 3.Whentransferringaclientintoachair,anursenoticesthatthepressure-relievingmattressoverlayhasdeep imprintsoftheclientsbuttocks,heels,andscapulae.Whichactionshouldthenursetakenext? a.

Turnthemattressoverlaytotheoppositeside.

b.

Donothingbecausethisisanexpectedoccurrence.

c.

Applyadifferentpressure-relievingdevice.

d.

Reinforcetheoverlaywithextracushions.

ANS:C Bottomingout,asevidencedbydeepimprintsinthemattressoverlay,indicatesthatthisdeviceisnot appropriateforthisclient,andadifferentdeviceorstrategyshouldbeimplementedtopreventpressureulcer formation. DIF:Applying/ApplicationREF:455KEY:Skinbreakdown MSC:IntegratedProcess:NursingProcess:Evaluation NOT:ClientNeedsCategory:SafeandEffectiveCareEnvironment:SafetyandInfectionControl 4.Anursecaresforaclientwhohasadeepwoundthatisbeingtreatedwithawet-to-dampdressing.Which interventionshouldthenurseincludeinthisclientsplanofcare? a.

Changethedressingevery6hours.

b.

Assessthewoundbedonceaday.

c.

Changethedressingwhenitissaturated.

d.

Contacttheproviderwhenthedressingleaks.

ANS:A Wet-to-dampdressingsarechangedevery4to6hourstoprovidemaximumdbridement.Thewoundshouldbe assessedeachtimethedressingischanged.Drygauzedressingsshouldbechangedwhentheouterlayer becomessaturated.Syntheticdressingscanbeleftinplaceforextendedperiodsoftimebutneedtobechanged ifthesealbreaksandtheexudateleaks. DIF:Applying/ApplicationREF:461 KEY:Skinlesions/wounds MSC:IntegratedProcess:NursingProcess:Implementation

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NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation 5.Anurseiscaringforaclientwhohasapressureulcerontherightankle.Whichactionshouldthenursetake first? a.

Drawbloodforalbumin,prealbumin,andtotalprotein.

b.

Prepareforandassistwithobtainingawoundculture.

c.

Placetheclientinbedandinstructtheclienttoelevatethefoot.

d.

Assesstherightlegforpulses,skincolor,andtemperature.

ANS:D Aclientwithanulceronthefootshouldbeassessedforinterruptioninarterialflowtothearea.Thisbegins withtheassessmentofpulsesandcolorandtemperatureoftheskin.Thenursecanalsoassessforpulses noninvasivelywithaDopplerflowmeterifunabletopalpatewithhisorherfingers.Teststodetermine nutritionalstatusandriskassessmentwouldbecompletedaftertheinitialassessmentisdone.Woundcultures aredoneafterithasbeendeterminedthatdrainage,odor,andotherrisksforinfectionarepresent.Elevationof thefootwouldimpairtheabilityofarterialbloodtoflowtothearea. DIF:Applying/ApplicationREF:458KEY:Skinbreakdown MSC:IntegratedProcess:NursingProcess:Assessment NOT:ClientNeedsCategory:SafeandEffectiveCareEnvironment:ManagementofCare 6.Aftereducatingacaregiverofahomecareclient,anurseassessesthecaregiversunderstanding.Which statementindicatesthatthecaregiverneedsadditionaleducation? a.

Icanhelphimshifthispositioneveryhourwhenhesitsinthechair.

b.

Ifhistailboneisredandtenderinthemorning,Iwillmassageitwithbabyoil.

c.

Applyinglotiontohisarmsandlegseveryeveningwilldecreasedryness.

d.

Drinkinganutritionalsupplementbetweenmealswillhelpmaintainhisweight.

ANS:B Massageofreddenedareasoverbonyprominencessuchasthecoccyx,ortailbone,iscontraindicatedbecause thepressureofthemassagecancausedamagetotheskinandsubcutaneoustissuelayers.Theotherstatements areappropriateforthecareofaclientathome. DIF:Applying/ApplicationREF:453KEY:Skinbreakdown MSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:HealthPromotionandMaintenance

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7.Afterteachingaclientwhoisatriskfortheformationofpressureulcers,anurseassessestheclients understanding.Whichdietarychoicebytheclientindicatesagoodunderstandingoftheteaching? a.

Low-fatdietwithwholegrainsandcerealsandvitaminsupplements

b.

High-proteindietwithvitaminsandmineralsupplements

c.

Vegetariandietwithnutritionalsupplementsandfishoilcapsules

d.

Low-fat,low-cholesterol,high-fiber,low-carbohydratediet

ANS:B Thepreferreddietishighinproteintoassistinwoundhealingandpreventionofnewwounds.Fatisalso neededtoensureformationofcellmembranes,soanyoftheoptionswithlowfatwouldnotbegoodchoices. Avegetariandietwouldnotprovidefatandhighlevelsofprotein. DIF:Applying/ApplicationREF:461 KEY:Skinbreakdown|nutritionMSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:HealthPromotionandMaintenance 8.Anurseassessesclientsonamedical-surgicalunit.Whichclientshouldthenurseevaluateforawound infection? a.

Clientwithbloodculturespending

b.

Clientwhohasthin,serouswounddrainage

c.

Clientwithawhitebloodcellcountof23,000/mm3

d.

Clientwhosewoundhasdecreasedinsize

ANS:C Aclientwithanelevatedwhitebloodcellcountshouldbeevaluatedforsourcesofinfection.Pendingcultures, thindrainage,andadecreaseinwoundsizearenotindicationsthattheclientmayhaveaninfection. DIF:Applying/ApplicationREF:462 KEY:Skinlesions/wounds MSC:IntegratedProcess:NursingProcess:Planning NOT:ClientNeedsCategory:SafeandEffectiveCareEnvironment:ManagementofCare 9.Anursewhomanagesclientplacementspreparestoplacefourclientsonamedical-surgicalunit.Which clientshouldbeplacedinisolationawaitingpossiblediagnosisofinfectionwithmethicillin-resistant Staphylococcusaureus(MRSA)?

TestBank-Medical-SurgicalNursing:ConceptsforInterprofessionalCollaborativeCare9e

a.

Clientadmittedfromanursinghomewithfurunclesandfolliculitis

b.

Clientwithalegcutandothertraumafromamotorcyclecrash

c.

Clientwitharashnoticedafterparticipatinginsportingevents

d.

Clienttransferredfromintensivecarewithanelevatedwhitebloodcellcount

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ANS:A Theclientinlong-termcareandothercommunalenvironmentsisathighriskforMRSA.Thepresenceof furunclesandfolliculitisisalsoanindicationthatMRSAmaybepresent.Aclientwithanopenwoundfroma motorcyclecrashwouldhavethepotentialtodevelopMRSA,butnosignsarevisibleatpresent.Therash followingparticipationinasportingeventcouldbecausedbyseveraldifferentthings.Aclientwithan elevatedwhitebloodcellcounthasthepotentialforinfectionbutshouldbeatlowerriskforMRSAthanthe clientadmittedfromthecommunalenvironment. DIF:Applying/ApplicationREF:466 KEY:Transmission-BasedPrecautions|infection MSC:IntegratedProcess:NursingProcess:Implementation NOT:ClientNeedsCategory:SafeandEffectiveCareEnvironment:SafetyandInfectionControl 10.Afterteachingaclienthowtocareforafuruncleintheaxilla,anurseassessestheclientsunderstanding. Whichstatementindicatestheclientcorrectlyunderstandstheteaching? a.

Illapplycortisonecreamtoreducetheinflammation.

b.

Illapplyacleandressingaftersqueezingoutthepus.

c.

Illkeepmyarmdownatmysidetopreventspread.

d.

Illcleansetheareapriortoapplyingantibioticcream.

ANS:D Cleansingandtopicalantibioticscaneliminatetheinfection.Warmcompressesenhancecomfortandopenthe lesion,allowingbetterpenetrationofthetopicalantibiotic.Cortisonecreamreducestheinflammatoryresponse butincreasestheinfectiousprocess.Squeezingthelesionmayintroduceinfectiontodeepertissuesandcause cellulitis.Keepingthearmdownincreasesmoistureintheareaandpromotesbacterialgrowth. DIF:Applying/ApplicationREF:465 KEY:Skinlesions/woundsMSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:HealthPromotionandMaintenance 11.Anurseassessesanolderclientwhoisscratchingandrubbingwhiteridgesontheskinbetweenthefingers

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andonthewrists.Whichactionshouldthenursetake? a.

Placetheclientinasingleroom.

b.

Administeranantihistamine.

c.

Assesstheclientsairway.

d.

Applyglovestominimizefriction.

ANS:A Theclientspresentationismostlikelytobescabies,acontagiousmiteinfestation.Theclientneedstobe admittedtoasingleroomandtreatedfortheinfestation.Secondaryinterventionsmayincludemedicationto decreasetheitching.Thisisnotanallergicmanifestation;therefore,antihistamineandairwayassessmentsare notindicated.Glovesmaydecreaseskinbreakdownbutwouldnotaddresstheclientsinfectiousdisorder. DIF:Applying/ApplicationREF:469 KEY:Skinlesions/wounds|infection|Transmission-BasedPrecautions MSC:IntegratedProcess:NursingProcess:Implementation NOT:ClientNeedsCategory:SafeandEffectiveCareEnvironment:SafetyandInfectionControl 12.Anurseassessesaclientwhohasachronicwound.Theclientstates,Idonotcleanthewoundandchange thedressingeverydaybecauseitcoststoomuchforsupplies.Howshouldthenurserespond? a.

Youcanusetapwaterinsteadofsterilesalinetocleanyourwound.

b.

Ifyoudontcleanthewoundproperly,youcouldendupinthehospital.

c.

Sterileprocedureisnecessarytokeepthiswoundfromgettinginfected.

d.

Goodhandhygieneistheonlythingthatreallymatterswithwoundcare.

ANS:A Forchronicwoundsinthehome,cleantapwaterandnonsterilesuppliesareacceptableandserveascheaper alternativestosterilesupplies.Ofcourse,ifthewoundbecomesgrosslyinfected,theclientmayendupinthe hospital,butthisresponsedoesnotprovideanyhelpfulinformation.Goodhandwashingisimportant,butitis nottheonlyconsideration. DIF:Understanding/ComprehensionREF:464 KEY:Skinlesions/wounds|casemanagement MSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation

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13.Afterteachingaclientwhohaspsoriasis,anurseassessestheclientsunderstanding.Whichstatement indicatestheclientneedsadditionalteaching? a.

Atthenextfamilyreunion,Imgoingtoaskmyrelativesiftheyhavepsoriasis.

b.

IhavetomakesureIkeepmylesionscovered,soIdonotspreadthistoothers.

c.

IexpectthatthesepatcheswillgetsmallerwhenIlieoutinthesun.

d.

Ishouldcontinuetousethecortisoneointmentasthepatchesshrinkanddryout.

ANS:B Psoriasisisnotacontagiousdisorder.Theclientdoesnothavetoworryaboutspreadingtheconditionto others.Itisaconditionthathashereditarylinks,thepatcheswilldecreaseinsizewithultravioletlight exposure,andcortisoneointmentshouldbeapplieddirectlytolesionstosuppresscelldivision. DIF:Applying/ApplicationREF:471 KEY:Skinlesions/wounds MSC:IntegratedProcess:NursingProcess:Evaluation NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation 14.Anurseperformsaskinscreeningforaclientwhohasnumerousskinlesions.Whichlesiondoesthenurse evaluatefirst? a.

Beigefrecklesonthebacksofbothhands

b.

Irregularbluemolewithwhitespecksonthelowerleg

c.

Largeclusterofpustulesintherightaxilla

d.

Thick,reddenedpapulescoveredbywhitescales

ANS:B Thismolefitstwoofthecriteriaforbeingcancerousorprecancerous:variationofcolorwithinonelesion,and anindistinctorirregularborder.Melanomaisaninvasivemalignantdiseasewiththepotentialforafatal outcome.Frecklesareabenigncondition.Pustulescouldmeananinfection,butitismoreimportanttotake careofthepotentiallycancerouslesionfirst.Psoriasisvulgarismanifestsasthickreddenedpapulescoveredby whitescales.Thisisachronicdisorderandisnotthepriority. DIF:Applying/ApplicationREF:475 KEY:Skinlesions/wounds MSC:IntegratedProcess:NursingProcess:Assessment

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NOT:ClientNeedsCategory:HealthPromotionandMaintenance 15.Anursecaresforaclientwhoisprescribedvancomycin(Vancocin)500mgIVevery6hoursfora methicillin-resistantStaphylococcusaureus(MRSA)infection.Whichactionshouldthenursetake? a.

Administeritover30minutesusinganIVpump.

b.

Givetheclientdiphenhydramine(Benadryl)beforethedrug.

c.

AssesstheIVsiteatleastevery2hoursforthrombophlebitis.

d.

Ensurethattheclienthasincreasedoralintakeduringtherapy.

ANS:C Vancomycinisveryirritatingtotheveinsandcaneasilycausethrombophlebitis.Thisdrugisgivenoverat least60minutes;althoughitcancausehistaminerelease(leadingtoredmansyndrome),itisnotcustomaryto administerdiphenhydraminebeforestartingtheinfusion.Increasingoralintakeisnotspecifictovancomycin therapy. DIF:Applying/ApplicationREF:466 KEY:Infection|antibiotic|medicationadministration MSC:IntegratedProcess:NursingProcess:Implementation NOT:ClientNeedsCategory:PhysiologicalIntegrity:PharmacologicalandParenteralTherapies 16.Anurseassessesayoungfemaleclientwhoisprescribedisotretinoin(Accutane).Whichquestionshould thenurseaskpriortostartingthistherapy? a.

Doyouspendagreatdealoftimeinthesun?

b.

Haveyouoranyfamilymemberseverhadskincancer?

c.

Whichmethodofcontraceptionareyouusing?

d.

Doyoudrinkalcoholicbeverages?

ANS:C Isotretinoinhasmanysideeffects.Itisaknownteratogenandcancauseseverebirthdefects.Apregnancytest isrequiredbeforetherapyisinitiated,andstrictbirthcontrolmeasuresmustbeusedduringtherapy.Sun exposure,alcoholingestion,andfamilyhistoryofcancerarecontraindicationsforisotretinoin. DIF:Applying/ApplicationREF:472 KEY:Medicationadministration MSC:IntegratedProcess:NursingProcess:Assessment

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NOT:ClientNeedsCategory:PhysiologicalIntegrity:PharmacologicalandParenteralTherapies 17.Anursecaresforclientswhohavevariousskininfections.Whichinfectionispairedwiththecorrect pharmacologictreatment? a.

ViralinfectionClindamycin(Cleocin)

b.

BacterialinfectionAcyclovir(Zovirax)

c.

YeastinfectionLinezolid(Zyvox)

d.

FungalinfectionKetoconazole(Nizoral)

ANS:D Ketoconazoleisanantifungal.Clindamycinandlinezolidareantibiotics.Acyclovirisanantiviraldrug. DIF:Remembering/KnowledgeREF:468 KEY:Medication|infection MSC:IntegratedProcess:NursingProcess:Analysis NOT:ClientNeedsCategory:PhysiologicalIntegrity:PharmacologicalandParenteralTherapies 18.Anursepreparestodischargeaclientwhohasawoundandisprescribedhomehealthcare.Which informationshouldthenurseincludeinthehand-offreporttothehomehealthnurse? a.

Recentwoundassessment,includingsizeandappearance

b.

Insuranceinformationforbillingandcodingpurposes

c.

Completehealthhistoryandphysicalassessmentfindings

d.

Resourcesavailabletotheclientforwoundcaresupplies

ANS:A Thehospitalnurseshouldprovidedetailsaboutthewound,includingsizeandappearanceandanyspecial woundneeds,inahand-offreporttothehomehealthnurse.Insuranceinformationisimportanttothehome healthagencyandmanager,butthisisnotappropriateduringthishand-offreport.Thenurseshouldreport focusedassessmentfindingsinsteadofacompletehealthhistoryandphysicalassessment.Thehomehealth nurseshouldworkwiththe...