Medsurg 56

1. A nurse practitioner is seeing a 16-year-old client 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
B. Benzoyl peroxide and erythromycin

C. Diphenhydramine
D. Triamcinolone

B. Benzoyl peroxide and erythromycin

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

A. Lifelong management is likely needed.
B. Avoid public places until symptoms subside.

C. Wash skin frequently to prevent infection.

D. Liberally apply corticosteroids as needed.

A. Lifelong management is likely needed.

3. A nurse is planning the care of a client with herpes zoster. What medication, if given within the first 24 hours of the initial eruption, can arrest herpes zoster?

A. Prednisone
B. Azathioprine

C. Triamcinolone

D. Acyclovir

D. Acyclovir

4. A client 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

C. Surgical excision

5. A client 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 Low Self Esteem related to use of facial prosthetic secondary to reconstructive surgery. Which nursing intervention would be appropriate for this diagnosis?

A. Referring the client to a speech therapist
B. Gradually adding soft foods to diet
C. Administering analgesics as prescribed
D. Teaching the client how to use and care for the prosthesis

D. Teaching the client how to use and care for the prosthesis

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

A. Basal cell carcinoma
B. Squamous cell carcinoma

C. Dermatofibroma
D. Malignant melanoma

D. Malignant melanoma

7. A nurse is providing care for a client who has developed Kaposi 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

D. Endothelial cells lining small blood vessels

8. A client 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.

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

9. A client has just been told that he has deep malignant melanoma. The nurse caring for this client should anticipate that the client will undergo what treatment?

A. Chemotherapy
B. Immunotherapy

C. Wide excision
D. Radiation therapy

C. Wide excision

10. 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

D. Teaching participants to control exposure to environmental and occupational radiation

C. Teaching participants to limit their sun exposure

11. A client 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?

A. Assess the drainage in the dressing.

B. Slowly remove the soiled dressing.

C. Perform hand hygiene.
D. Don nonlatex gloves

C. Perform hand hygiene.

12. A client comes to the clinic reporting a red rash of small, fluid-filled blisters and is suspected of having herpes zoster. What presentation is most consistent with this diagnosis?

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

D. Grouped vesicles in linear patches along a dermatome

13. A nurse is preparing to assist a surgeon in a skin grafting procedure. What can a skin graft can be used for?

A. Denuded skin after burns.
B. Slow healing wounds.
C. Uncomplicated wound closure.

D. Infected wounds.

A. Denuded skin after burns.

14. A client presents at the free clinic with a black, wart-like lesion on his face, stating, "I've done some research, and I'm 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 client requires no treatment unless he finds the lesion to be cosmetically unacceptable.
B. The client's lesion will be closely observed for 6 months before a plan of treatment is chosen.

C. The client has one of the few dermatologic malignancies that respond to chemotherapy.
D. The client will likely require wide excision.

A. The client requires no treatment unless he finds the lesion to be cosmetically unacceptable

15. A nurse is providing care for a client who has psoriasis. Following the appearance of skin lesions, the nurse should prioritize what assessment?

A. Assessment of the client's stool for evidence of intestinal sloughing
B. Assessment of the client's apical heart rate for dysrhythmias
C. Assessment of the client's joints for pain and decreased range of motion

D. Assessment for cognitive changes resulting from neurologic lesions

C. Assessment of the client's joints for pain and decreased range of motion

16. A client is admitted to the intensive care unit with what is thought to be toxic epidermal necrolysis (TEN). When assessing the health history of the client, 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

C. Recent administration of new medications

17. A client has received a diagnosis of irritant contact dermatitis. What action should the nurse prioritize in the client's subsequent care?

A. Teaching the client to safely and effectively administer immunosuppressants

B. Helping the client identify and avoid the offending agent
C. Teaching the client how to maintain meticulous skin hygiene
D. Helping the client perform wound care in the home environment

B. Helping the client identify and avoid the offending agent

18. A nurse is caring for a client whose chemical injury has necessitated a skin graft to the client’s left hand. Which statement is true regarding skin graft use?

A. This use is not a type of reconstruction.
B. Skin grafts form their own blood supply.
C. They are only transplanted from another doner.
D. Skin is transferred from a distant site to the graft site.

D. Skin is transferred from a distant site to the graft site.

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

A. The child's scalp should be monitored for 48 to 72 hours before starting treatment.
B. Nits may have to be manually removed from the child's hair shafts.
C. The disease is self-limiting and symptoms will abate within 1 week.

D. Efforts should be made to improve the child's level of hygiene.

B. Nits may have to be manually removed from the child's hair shafts.

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

A. Cataract development is possible.
B. The ointment is likely to cause weeping.
C. Corticosteroid use is contraindicated on these lesions.

D. The client may develop glaucoma.

A. Cataract development is possible.

21. A nurse is caring for a client who has a diagnosis of bullous pemphigoid and who is being treated on the medical unit. The nurse knows that systemic treatment will most likely include which element?

A. Corticosteroid therapy

B. Skin biopsy
C. Topical corticosteroids

D. Penicillin therapy

A. Corticosteroid therapy

22. A client's blistering disorder has resulted in the formation of multiple lesions in the client's mouth. What intervention should be included in the client's plan of care?

A. Provide chlorhexidine solution for rinsing the client's mouth.
B. Avoid providing regular mouth care until the client's lesions heal.
C. Liaise with the primary provider to arrange for parenteral nutrition.
D. Encourage the client to gargle with a hypertonic solution after each meal.

A. Provide chlorhexidine solution for rinsing the client's mouth.

23. When caring for a client with toxic epidermal necrolysis (TEN), the critical care nurse assesses frequently for high fever, tachycardia, and extreme weakness and fatigue. The nurse is aware that these findings are potential indicators of what condition(s)? Select all that apply.

A. Possible malignancy

B. Epidermal necrosis

C. Neurologic involvement
D. Increased metabolic needs
E. Possible gastrointestinal mucosal sloughing

B. Epidermal necrosis

D. Increased metabolic needs
E. Possible gastrointestinal mucosal sloughing

24. A nurse is assessing a teenage client with acne vulgaris. The client's mother states, "I keep telling him that this is what happens when you eat as many french fries as he does." What aspect of the pathophysiology of acne should inform the nurse's response?

A. A sudden change in client's diet may exacerbate, rather than alleviate, the client's symptoms.
B. French fries are one of the foods that are known to directly cause acne.
C. Elimination of fried foods from the client's diet will likely lead to resolution within several months.

D. Diet is thought to play a minimal role in the development of acne.

D. Diet is thought to play a minimal role in the development of acne.

25. A nurse is providing self-care education to a client who has been receiving treatment for acne vulgaris. What instruction should the nurse provide to the client?

A.“Wash your face with water and gentle soap each morning and evening.”"
B. "Before bedtime, clean your face with rubbing alcohol on a cotton pad."
C. "Gently burst new pimples before they form a visible 'head'."
D. "Set aside some time each day to squeeze blackheads and remove the plug."

A. "Wash your face with water and gentle soap each morning and evening."

26. A nurse is caring for a client whose skin cancer will soon be removed by excision. Which of the following actions should the nurse perform?

A. Teach the client about early signs of secondary blistering diseases.

B. Teach the client about self-care after treatment.
C. Assess the client's risk for recurrent malignancy.
D. Assess the client for adverse effects of radiotherapy.

B. Teach the client about self-care after treatment.

27. A client has just undergone surgery for malignant melanoma. Which of the following nursing actions should be prioritized?

A. Maintain the client on bed rest for the first 24 hours postoperative.
B. Apply distraction techniques to relieve pain.
C. Provide soft or liquid diet that is high in protein to assist with healing.
D. Anticipate the need for, and administer, appropriate analgesic medications.

D. Anticipate the need for, and administer, appropriate analgesic medications.

28. A nurse educator is teaching a group of nurses about Kaposi sarcoma. What would the educator identify as characteristics of endemic Kaposi sarcoma? Select all that apply.

A. Affects people predominantly in the eastern half of Africa

B. Affects men more than women
C. Does not affect children
D. Cannot infiltrate

E. Can progress to lymphadenopathic forms

A. Affects people predominantly in the eastern half of Africa

B. Affects men more than women

E. Can progress to lymphadenopathic forms

29. A 35-year-old kidney transplant client comes to the clinic exhibiting new skin lesions. The diagnosis is Kaposi sarcoma. The nurse caring for this client recognizes that this is what type of Kaposi sarcoma?

A. Classic
B. AIDS related

C. Iatrogenic

D. Endemic

C. Iatrogenic

30. A 65-year-old man presents at the clinic reporting nodules on both legs. The man tells the nurse that his son, who is in medical school, encouraged him to seek prompt care and told him that the nodules are related to the fact that he is Jewish. What health problem should the nurse suspect?

A. Stasis ulcers
B. Bullous pemphigoid
C. Psoriasis
D. Classic Kaposi sarcoma

D. Classic Kaposi sarcoma

31. A 55-year-old woman is scheduled to have a chemical face peel. The nurse is aware that the client is likely seeking treatment for which of the following?

A. Wrinkles near the lips and eyes
B. Removal of acne scars
C. Vascular lesions on the cheeks
D. Real or perceived misshaping of the eyes

A. Wrinkles near the lips and eyes

32. A client comes to the dermatology clinic requesting the removal of epidermal nevi on the client’s right cheek. The nurse knows that the procedure especially useful in treating such lesions is what?

A. Skin graft
B. Laser treatment
C. Chemical face peeling

D. Free flap

B. Laser treatment

33. A 30-year-old client has just returned from the operating room after having a "flap" done following a motorcycle accident. The client's spouse asks the nurse about the major complications following this type of surgery. What would be the nurse's best response?

A. "The major complication is when the client develops chronic pain."
B. "The major complication is when the client loses sensation in the flap."
C. "The major complication is when the pedicle tears loose and the“The major complication is when the blood supply fails and the tissue in the flap dies.” the flap dies."

D. "The major complication is when the blood supply fails and the tissue in the flap dies."

34. A public health nurse is participating in a health promotion campaign that has the goal of improving outcomes related to skin cancer in the community. What action has the greatest potential to achieve this goal?

A. Educating participants about the relationship between general health and the risk of skin cancer
B. Educating participants about treatment options for skin cancer
C. Educating participants about the early signs and symptoms of skin cancer

D. Educating participants about the health risks associated with smoking and assisting with smoking cessation

C. Educating participants about the early signs and symptoms of skin cancer

35. An older adult resident of a long-term care facility has been experiencing generalized pruritus that has become more severe in recent weeks. What intervention should the nurse add to this resident's plan of care?

A. Avoid the application of skin emollients
B. Apply antibiotic ointment, as prescribed, following baths

C. Avoid using hot water during the clien’'s baths
D. Administer acetaminophen four times daily as prescribed

C. Avoid using hot water during the client's baths

36. A client has a diagnosis of seborrhea and has been referred to the dermatology clinic, where the nurse contributes to care. When planning this client's care, the nurse should include what nursing diagnosis?

A. Risk for deficient fluid volume related to excess sebum synthesis
B. Ineffective thermoregulation related to occlusion of sebaceous glands

C. Disturbed body image related to excess sebum production
D. Ineffective tissue perfusion related to occlusion of sebaceous glands

C. Disturbed body image related to excess sebum production

37. A nurse is working with a family whose 5-year-old child has been diagnosed with impetigo. What educational intervention should the nurse include in this family's care?

A. Ensuring that the family knows that impetigo is not contagious
B. Teaching about the safe and effective use of topical corticosteroids
C. Teaching about the importance of maintaining high standards of hygiene

D. Ensuring that the family knows how to safely burst the child's vesicles

C. Teaching about the importance of maintaining high standards of hygiene

38. The nurse is caring for a client who developed a pressure injury as a result of decreased mobility. The nurse on the previous shift has provided client teaching about pressure injuries and healing promotion. The nurse determines that the client has understood the teaching by observing the client:

A. perform range-of-motion exercises.
B. avoid placing body weight on the healing site.
C. elevate body parts that are susceptible to edema.
D. demonstrate the technique for massaging the wound site.

B. avoid placing body weight on the healing site.

39. An older adult client, who is bedridden, is admitted to the unit because of a pressure injury that can no longer be treated in a community setting. During assessment, the nurse finds that the ulcer extends into the muscle and bone. At what stage should the nurse document this injury?

A. I

B. II

C. III

D. IV

D. IV