Chapter 52: Skin Disorders
Linton: Introduction to Medical-Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. Displaying her hands, a patient asks, “Do you think my liver is OK? Look at all these liver
spots!” What is the most appropriate nursing response?
a.
“The spots could mean something is wrong; I will make a note of it.”
b.
“The spots are normal aging changes and have nothing to do with your liver.”
c.
“Have you recently been exposed to hepatitis?”
d.
“Don’t worry about them. They will fade during the winter.”
2. A confused patient has been restrained because of combativeness and hyperactivity. What
skin assessment may occur as a result of the restraints?
a.
Lentigines
b.
Senile purpura
c.
Senile angiomas
d.
Seborrheic keratoses
3. What should a nurse ask about when taking the functional assessment of a patient with a skin
disorder?
a.
A sore that is slow to heal
b.
Unusual hair growth
c.
Previous skin disorders
d.
Exposure to chemicals or irritants
4. A daughter of an older adult patient who has just returned from surgery is distressed about her
father’s pale, cold hands and feet. What is the best response by the nurse after covering the
patient with an extra blanket?
a.
“Don’t be concerned. It is quite cold in the operating room. Your dad will be warm
in a minute.”
b.
“Older patients like your dad get a little shocky during surgery.”
c.
“When patients have blood loss during surgery, superficial vessels close off
temporarily, resulting in cold extremities.”
d.
“We are watching the disturbed circulation in your dad’s hands and feet very
carefully.”
5. What information should a nurse provide to a patient with vitiligo receiving phototherapy?
a.
“Expose yourself to the sun for several hours before treatment to acclimate the skin
surface.”
b.
“Wear protective clothing.”
c.
“Wear loose clothing such as sleeveless T–shirts and shorts after the treatment.”
d.
“Leave off sunglasses after treatment so your eyes can more quickly
accommodate.”
6. A nurse is screening patients that the plastic surgeon is considering for phototherapy. Which
patient should the nurse exclude?
a.
A 34-year-old woman with lupus erythematosus
b.
A 5-year-old child with pneumonia
c.
A 60-year-old man with a pacemaker
d.
A 23-year-old woman who is 3 months’ pregnant
7. A nurse is caring for a patient with pruritus. Which implementation can the nurse perform
without a physician’s order?
a.
Apply topical corticosteroids to affected areas.
b.
Administer an antihistamine.
c.
Apply lubricant to unbroken skin.
d.
Bathe the patient in an oatmeal bath.
8. Which action should a nurse implement to make a patient with atopic dermatitis more
comfortable?
a.
Instruct the patient to wear loose clothing.
b.
Add alcohol to the bath water.
c.
Provide a diet low in fat.
d.
Increase the room temperature between 78° F and 80° F.
9. Which sign or symptom suggests that a patient with impaired skin integrity is developing a
systemic infection?
a.
Lesion on the patient’s leg that is swollen and warm to the touch
b.
Temperature that has risen to 101° F
c.
Blood pressure that has risen from 126/84 to 130/86 mm Hg
d.
Request by the patient for medication for severe itching
10. Which is an appropriate implementation for a patient with severe psoriasis who has a nursing
diagnosis of “Disturbed body image, related to skin lesions”?
a.
Touching the patient often
b.
Reassuring the patient of a quick remission
c.
Reminding the patient to bathe often
d.
Promptly administering medications as needed
11. A patient with severe psoriasis who is to be treated with the systemic drug methotrexate
sodium anxiously asks, “Is this cancer drug safe? Are there some side effects I need to know
about?” What is the best response by the nurse?
a.
“Yes, methotrexate is used to treat cancer and psoriasis, and it has no severe side
effects.”
b.
“No, it is not a cancer drug, but you should ask your physician about concerns
regarding your therapy.”
c.
“We use this drug to treat many kinds of patients, including patients with cancer.
You will have periodic blood tests.”
d.
“I don’t know if it is used with patients with cancer, but the drug can be used when
conditions are as severe as yours.”
12. A family member of an older patient with severe dermatitis says, “I was always so careful to
bathe him every day. I guess I just wasn’t careful enough.” What is the best response by the
nurse?
a.
“Dermatitis is not caused by poor hygiene.”
b.
“Don’t worry; we will bathe him thoroughly while he is here.”
c.
“You will have a chance to do better when he is back at home.”
d.
“You shouldn’t feel like the skin condition is your fault.”
13. A nurse is caring for an obese patient who has been bedridden for a long time and who has a
nursing diagnosis of “Risk for infection, related to obesity.” Where is the best location for the
nurse to assess for the moist red lesions of Candida albicans?
a.
Scalp, behind the ears
b.
Abdominal skin folds
c.
Shaft of the penis
d.
Sacrum and bony prominences
14. What information is most essential for a nurse to gather when interviewing a young woman
who is taking the drug isotretinoin (Accutane) for acne?
a.
Usual weight
b.
Family history of breast cancer
c.
Current method of birth control
d.
Drugs previously used
15. An excited mother of a teenage boy with severe acne furiously reports to the nurse, “I’ve told
him a thousand times he should bathe more often! I’ve kept after him about all that junk food
he eats. I jump on him when I see him squeezing his zits. I tried to get him to scrub his face
three times a day!” Which statement indicates the most likely cause of the boy’s acne?
a.
Poor personal hygiene
b.
Ingestion of junk food
c.
Squeezing lesions
d.
Need for facial scrubs
16. A patient who has undergone treatment for herpes simplex virus type 2 (HSV type 2)
expresses relief that she is cured. What should the nurse include in her teaching?
a.
Daily douches of Burow solution are needed.
b.
HSV is permanently cured by acyclovir (Zovirax).
c.
Sexual partners are now safe from infection from her.
d.
HSV lies dormant and can be triggered without any sexual contact.
17. An 80-year-old patient comes to the emergency department with extreme pain and itching in
the hip and leg and has herpetic vesicular lesions on the left hip. What should the nurse
inquire about patient exposure to?
a.
HSV, type 1
b.
HSV, type 2
c.
Smallpox
d.
Chickenpox
18. A physician asks a nurse to take a smear from herpetic lesions in an older patient’s hip to
diagnose the disorder. What is the most probable test that will be performed?
a.
Culture and sensitivity test to a bactericide
b.
Tzanck smear to test for viral culture
c.
Complete blood count to assess the white blood count for response to a pathogen
d.
Titration for the strength of the pathogen
19. A nurse organizes a nursing care plan on the nursing diagnosis of “Acute pain, related to
postherpetic neuralgia.” Which is the least appropriate implementation?
a.
Give antiviral medication as prescribed.
b.
Generously administer pain medication.
c.
Offer guided imagery or distraction techniques.
d.
Have the patient ambulate several times daily.
20. How does cutaneous T-cell lymphoma differ from squamous cell and basal cell carcinomas?
a.
Does not metastasize
b.
Has a cause unrelated to sun exposure
c.
Can be treated with radiation
d.
Can be treated topically
21. A nurse is caring for an adult patient with extensive burns on the front of the trunk, including
the genitalia, and the fronts of both legs. How should the nurse document the burn size using
the rule of nines?
a.
13%
b.
17%
c.
25%
d.
37%
22. Which assessment by an emergency department nurse most indicates that a burn patient might
be at risk for respiratory impairment?
a.
Burns on the face and neck
b.
Respiration of 18 breaths/min
c.
Flaring nares
d.
Sooty sputum
23. What should a nurse be sure to frequently assess when caring for a burn patient with eschar
formation around an entire arm?
a.
Urine output
b.
Pain level
c.
Capillary refill
d.
Breath sounds
24. During the first 24 hours after a burn, fluid replacement is the treatment priority. Which
assessment should alert the nurse that the fluid protocol is ineffective?
a.
Rectal temperature of 101° F
b.
Urine output of 20 mL/hr
c.
Crackles in the lower left lobe
d.
Significant edema in the burn area
MULTIPLE RESPONSE
25. Which age-related skin changes should a nurse anticipate when performing a physical
assessment on an 80-year-old man? (Select all that apply.)
a.
Increased nasal hair
b.
Flattened nails
c.
Small macular lesions at the hairline
d.
Increased hair on the helix of the ear
e.
Presence of seborrheic keratosis
26. Which conditions can be improved with negative pressure therapy? (Select all that apply.)
a.
Pressure ulcers
b.
Skin grafts
c.
Burns
d.
Dehisced surgical wounds
e.
Eczema
COMPLETION
27. A nurse is alert for the expected fluid shift in the patient who was burned 24 hours earlier.
(Place the events in the appropriate sequence. Separate letters by a comma and space as
follows: A, B, C, D.)
a. Fluid volume deficit occurs.
b. Blood is shunted from the kidneys to compensate for a loss of fluid volume.
c. Urine output decreases.
d. Generalized edema occurs.
e. Hypoproteinemia causes fluid to move from the bloodstream to extracellular space
28. When assessing the capillary refill, a nurse should document as normal a refill time of
__________ seconds.
OTHER
29. A nurse collecting tissue for a Tzanck smear should (Select the appropriate interventions and
place the steps in sequence. Separate letters by a comma and space as follows: A, B, C, D.)
A. Open the lesion with a hypodermic needle.
B. Place the specimen in a culture tube and take it to the laboratory.
C. Saturate the sterile swab with exudates.
D. Wash the lesion.
E. Place a pressure dressing on the lesion.