Lewis: Medical-Surgical Nursing, 8th Edition Chapter 24: Nursing Management: Integumentary Problems Test Bank MULTIPLE CHOICE 1. To decrease the risk for sun damage to the skin, which information should the nurse include when teaching patients? a. Waterproof sunscreens will provide good protection when swimming. b. Use a sunscreen with an SPF of at least 8 to 10 for adequate protection. c. Try to stay out of the sun between the hours of 10 AM and 2 PM (regular time). d. Increase sun exposure by no more than 10 minutes a day to avoid skin damage. ANS: C The risk for skin damage from the sun is highest with exposure between 10 AM and 2 PM. 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. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation REF: 448-449 MSC: NCLEX: Health Promotion and Maintenance 2. Which information should the nurse include when teaching a patient who has just received a prescription for sulfamethoxazole and trimethoprim (Septra, Bactrim) to treat a urinary tract infection? 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 sulfamethoxazole. ANS: A The patient should wear sunscreen when taking medications that can cause photosensitivity. The other statements are not accurate. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation REF: 449 MSC: NCLEX: Health Promotion and Maintenance 3. A patient is diagnosed with basal cell carcinoma (BCC) of the face. Which information should be included in patient teaching? 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. ANS: D Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. Test Bank 24-2 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. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation REF: 451-452 MSC: NCLEX: Physiological Integrity 4. A patient in the dermatology clinic has a small, slow-growing papule with ulceration and a depression in the center of the lesion on the right cheek. The nurse will anticipate the need to a. prepare the patient for a biopsy. b. teach about the use of corticosteroid creams. c. educate the patient about use of tretinoin (Retin-A). d. discuss the need for topical application of antibiotics. ANS: A 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. DIF: Cognitive Level: Application Planning MSC: NCLEX: Physiological Integrity REF: 451 TOP: Nursing Process: 5. After the nurse determines that a patient has the following risk factors for melanoma, which risk factor should be the focus of patient teaching related to prevention? a. The patient has multiple dysplastic nevi. b. The patient is fair-skinned and has blue eyes. c. The patient’s mother died of a malignant melanoma. d. The patient uses a tanning booth throughout the winter. ANS: D Since 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. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation REF: 454-455 MSC: NCLEX: Health Promotion and Maintenance 6. The health care provider diagnoses impetigo for a patient who has crusty vesicopustular lesions on the lower face. Which topic will be included in the teaching plan for this patient? 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 ANS: B Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. Test Bank 24-3 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. DIF: Cognitive Level: Application Planning MSC: NCLEX: Physiological Integrity REF: 454 TOP: Nursing Process: 7. When examining a patient’s oral cavity, the nurse notes the presence of white lesions that resemble milk curds at the back of the throat. Which question by the nurse is appropriate at this time? a. Do you have a productive cough? b. How often do you brush your teeth? c. Are you taking any medications at present? d. Have you ever had an oral herpes infection? ANS: C 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: Application TOP: Nursing Process: Assessment REF: 457 MSC: NCLEX: Physiological Integrity 8. When examining a patient’s scalp, the nurse suspects the presence of pediculosis on finding 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: Comprehension TOP: Nursing Process: Assessment REF: 458 MSC: NCLEX: Physiological Integrity 9. The health care provider prescribes topical 5-FU for a patient with actinic keratosis on the nose. Which information will the nurse include in the patient 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 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. Test Bank 24-4 excised. ANS: C 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. DIF: Cognitive Level: Application Planning MSC: NCLEX: Physiological Integrity REF: 463 TOP: Nursing Process: 10. A patient with atopic dermatitis has been using a high-potency topical corticosteroid ointment for several weeks. Which finding 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 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/scaling of the skin are not adverse effects of topical corticosteroid use. DIF: Cognitive Level: Application Evaluation MSC: NCLEX: Physiological Integrity REF: 463 TOP: Nursing Process: 11. A patient is undergoing psoralen plus ultraviolet A light (PUVA) therapy for treatment of psoriasis. To minimize complications from this procedure, the nurse plans to a. cleanse the skin carefully with an antiseptic soap. b. shield any unaffected areas with lead-lined drapes. c. have the patient use protective eyewear while receiving PUVA. d. apply petroleum jelly to the areas surrounding the psoriatic lesions. ANS: C 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: Application TOP: Nursing Process: Implementation REF: 462 MSC: NCLEX: Physiological Integrity 12. A patient with an enlarging, irregular mole that is 6 mm in diameter is scheduled for outpatient treatment. The nurse should plan on teaching the patient about a. curettage. Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. Test Bank 24-5 b. cryosurgery. c. punch biopsy. d. surgical excision. 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: Application Planning MSC: NCLEX: Physiological Integrity REF: 452 TOP: Nursing Process: 13. Which information will the nurse include when teaching a 70-year-old patient 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. ANS: C Warm water and moisturizing soap will avoid overdrying the skin. Since 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: Application TOP: Nursing Process: Implementation REF: 450 MSC: NCLEX: Health Promotion and Maintenance 14. Which action will the nurse take when applying a wet dressing to an inflamed and pruritic area of skin on a patient’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. ANS: A 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. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation REF: 465-466 MSC: NCLEX: Physiological Integrity 15. Through interviewing a patient who has a history of contact dermatitis, the nurse obtains this information about over-the-counter (OTC) medication use. Which finding indicates a need for patient teaching? a. The patient applies corticosteroid cream to any pruritic areas. b. The patient uses Neosporin ointment on minor cuts or abrasions. Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. Test Bank 24-6 c. The patient adds oilated oatmeal (Aveeno) to the bath water every day. d. The patient takes diphenhydramine (Benadryl) at night if itching occurs. ANS: B Neosporin can cause contact dermatitis. The other medications are being used appropriately by the patient. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment REF: 462 MSC: NCLEX: Physiological Integrity 16. The nurse notes darker skin pigmentation in the skinfolds of a patient who has a body mass index of 40 kg/m2. Which action should the nurse take? a. Teach the patient about the risk for type 2 diabetes. b. Educate the patient about treatment of fungal infection. c. Discuss the use of drying agents to minimize infection risk. d. Instruct the patient about use of mild soap to clean skinfolds. ANS: A The presence of acanthosis nigricans in skinfolds suggests an increased risk for type 2 diabetes. The description of the patient’s skin does not indicate problems with fungal infection, poor hygiene, or the need to dry the skinfolds better. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation REF: 450 MSC: NCLEX: Health Promotion and Maintenance 17. When assessing a new patient at the outpatient clinic, the nurse notes dry, scaly skin; thin hair; and thick, brittle nails. Which action is best for the nurse to take at this time? a. Instruct the patient 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 patient about using moisturizing creams and lotions to decrease dry skin. 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 also may be needed, but the priority is to rule out underlying disease that may be causing these manifestations. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation REF: 461 MSC: NCLEX: Health Promotion and Maintenance 18. After a patient with a squamous cell carcinoma (SCC) has a Mohs procedure in the dermatology clinic, which nursing action will 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. Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. Test Bank 24-7 ANS: D 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. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation REF: 467 MSC: NCLEX: Physiological Integrity 19. A patient with atopic dermatitis has a new prescription for tacrolimus (Protopic). 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 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 Protopic.” d. “If the medication burns when I apply it, I will wipe it off and call the doctor.” ANS: D The patient 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 patient are accurate and indicate that patient teaching has been effective. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment REF: 463 | 466 MSC: NCLEX: Physiological Integrity 20. After the nurse has finished teaching a patient about application of corticosteroid cream to an area of contact dermatitis on the right leg, which patient action indicates that more teaching is needed? a. The patient spreads the cream using a downward motion. b. The patient takes a tepid bath before applying the cream. c. The patient applies a thick layer of the cream to the affected skin. d. The patient covers the area with a dressing after applying the cream. 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: Application Evaluation MSC: NCLEX: Physiological Integrity REF: 466 TOP: Nursing Process: 21. Which nursing action should the nurse delegate to nursing assistive personnel (NAP) who are assisting with the care of a patient with furunculosis? 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 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. Test Bank 24-8 Cleaning the skin is within the education and scope of practice for NAP. 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: Application REF: 468 OBJ: Special Questions: Delegation TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment 22. The nurse is assessing a patient who has just arrived in the postanesthesia recovery area (PACU) after a blepharoplasty. Which of the following assessment data is a priority? a. b. c. d. The patient complains of incisional pain. The patient’s heart rate is 110 beats/minute. The patient is unable to detect when the eyelids are touched. The skin around the incision is pale and cold when palpated. 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 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: Application OBJ: Special Questions: Prioritization MSC: NCLEX: Physiological Integrity REF: 468-469 TOP: Nursing Process: Assessment 23. A patient who has severe refractory psoriasis on the face, neck, and extremities has quit working and withdrawn from social activities because of the appearance of the lesions. Which action should the nurse take first? a. Discuss the possibility of enrolling in a worker-retraining program. b. Encourage the patient to volunteer to work on community projects. c. Suggest that the patient use cosmetics to cover the psoriatic lesions. d. Ask the patient to describe the impact of psoriasis on quality of life. 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: Application OBJ: Special Questions: Prioritization MSC: NCLEX: Psychosocial Integrity REF: 467 TOP: Nursing Process: Implementation MULTIPLE RESPONSE Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. Test Bank 24-9 1. When teaching a patient with contact dermatitis of the arms and lower legs about ways to decrease pruritis, which information will the nurse include (select all that apply)? a. Cool, wet cloths or dressings can be used to reduce itching. b. Take cool or tepid baths several times daily to decrease itching. c. Add oil to your bath water to aid in moisturizing the affected skin. d. Rub yourself dry with a towel after bathing to prevent skin maceration. e. Use of an over-the-counter (OTC) antihistamine with sedative effects can reduce scratching. ANS: A, B, E Cool or tepid baths, cool dressings, and OTC antihistamines all help reduce pruritus and scratching. Adding oil to bathwater is not recommended because of the increased risk for falls. The patient should use the towel to pat (not rub) the skin dry. DIF: Cognitive Level: Analysis REF: 465-466 OBJ: Special Questions: Alternate Item Format TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
