Chapter 43: Care of the Patient with an Integumentary Disorder Cooper: Foundations and Adult Health Nursing, 9th Edition

Which action will the nurse take when administering a therapeutic bath to a patient who has severe pruritus from contact

dermatitis?

a. Use Burow’s solution to help promote healing.

b. Rub the skin briskly to decrease pruritus.

c. Limit bathing to three times a week.

d. Ensure that bath area is at least 85 degrees and dehumidified.

ANS: A

A resident of an assisted living center reports having sharp pain on one side of the body, with patches of “blisters”. The nurse

notices vesicles on one side of the thorax, which follow a peripheral nerve pathway. Suspecting herpes zoster, the nurse

immediately contacts the health care provider. Which is the reason for the prompt notification?

a. Early recognition is essential to treat the disorder.

b. Prompt notification prevents sexual transmission.

c. Oral ulcers could prevent intake of adequate fluids.

d. Early administration of the varicella vaccine is needed.

ANS: A

Several residents in a long term care facility have been diagnosed with herpes zoster. Which resident will require the closest

observation for development of complications?

a. A resident who is sexually active

b. A resident recovering from a hip fracture

c. A resident with dementia who requires assistance eating.

d. A resident who is undergoing chemotherapy for breast cancer

ANS: D

A child has been sent to the school nurse with pruritus and honey-colored crusts on the lower lip and chin. The nurse believes these

lesions most likely are caused by which condition?:

a. chickenpox.

b. impetigo.

c. shingles.

d. herpes simplex type I.

ANS: B

A school nurse assesses a child who has an erythematous circular patch of vesicles on her scalp with alopecia and report spain and

pruritus. For which reason will the nurse use a Woods lamp?

a. To dry out the lesions.

b. To reduce the pruritus.

c. To kill the fungus.

d. To cause fluorescence of the infected hairs.

ANS: D

A patient, age 46, reports to the health care provider’s office with urticaria with elevated lesions that are white in the center with a

pale red border on hands and arms. He says, “It itches like crazy.” Which type of lesion would the nurse include in the

documentation?

a. Macules

b. Plaques

c. Wheals

d. Vesicles

ANS: C

The home health nurse assessing skin lesions uses the PQRST mnemonic as a guide. What does the S in this guide indicate?

a. Severity of the symptoms

b. Site of the lesions

c. Symptomatology of the lesions

d. Surface area of the lesions

ANS: A

Which instruction will the nurse give the patient taking isotretinoin to treat acne?

a. Do not take acetaminophen when using this medication.

b. This medication may cause dry skin or eczema to develop

c. Wear heavy makeup to cover up the acne until this medication takes effect

d. Stay away from school or your friends until this medication begins to take effect.

ANS: B

A 30-year-old African American had surgery 6 months ago and the incision site is now raised, indurated, and shiny. This is most

likely which type of tissue growth?

a. Angioma

b. Keloid

c. Melanoma

d. Nevus

ANS: B

A patient, age 37, sustained partial- and full-thickness burns to 26% of the body surface area. When would the greatest fluid loss

resulting from the burns occur?

a. Within 12 hours after burn trauma

b. 24 to 36 hours after burn trauma

c. 36 to 48 hours after burn trauma

d. 48 to 72 hours after burn trauma

ANS: A

Which is the greatest concern during the emergent phase of a burn injury?

a. joint contractures

b. Fluid overload

c. hypovolemic shock.

d. adrenal failure.

ANS: C

A nurse arrives at an accident scene where the victim has just received an electrical burn. Which is the nurse’s primary concern?

a. The extent and depth of the burn

b. The sites of entry and exit

c. The likelihood of cardiac arrest

d. Control of bleeding

ANS: C

A patient, age 27, sustained thermal burns to 18% of her body surface area. After the first 72 hours, the nurse will have to observe

for which most common cause of burn-related deaths?

a. shock.

b. respiratory arrest.

c. hemorrhage.

d. infection.

ANS: D

Two weeks after a severe burn of over 20% of the body, the patient vomits bright red blood. Which condition is most likely?

a. Curling ulcer

b. Paralytic ileus

c. Ruptured colon

d. Gastritis

ANS: A

When providing the open method of treatment for a patient who is 52 years old with burns to the lower extremities, which does the

nurse expect to see included in the nursing plan?

a. Change the dressing using good medical asepsis.

b. Provide an analgesic immediately after the dressing change.

c. Perform circulation checks every 2 to 4 hours.

d. Keep the room temperature at 85°F (29.4°C) to prevent chilling.

ANS: D

The nurse has staged a pressure injury that has a shallow crater with a dry pink wound bed in which way?

a. stage 1.

b. stage 2.

c. stage 3.

d. stage 4.

ANS: B

Which will the nurse dressing a necrotic pressure injury with a minimal exudate most likely use?

a. Hydrocolloid dressing

b. Alginate dressing

c. Hydrofiber dressing

d. Transparent film

ANS: A

The nurse is caring for a 26-year-old patient who was burned 72 hours ago. The patient has partial-thickness burns to 24% of the

body surface area and begins to excrete large amounts of urine. Which action should the nurse take?

a. Increase the IV rate and monitor for burn shock.

b. Monitor for signs of seizure activity.

c. Assess for signs of fluid overload.

d. Raise the foot of the bed and apply blankets.

ANS: C

A patient with severe eczema is starting a coal tar derivative treatment. Which will the nurse include in the teaching plan for the

patient relative to this treatment?

a. Drink at least 1000 mL of fluid daily.

b. Avoid exposure to sunlight for 72 hours after use.

c. Bathe with an astringent soap.

d. Reduce intake of high calcium foods.

ANS: B

Which will the nurse examine when assessing a patient for tinea corporis?

a. Soles of the feet

b. Scalp

c. Groin

d. Abdomen

ANS: D

Which is the initial intervention for relief of the pruritus of dermatitis venenata?

a. Apply baking soda to lesions.

b. Wash area with copious amounts of water.

c. Apply cool compresses continuously.

d. Expose area to air.

ANS: B

A patient who has sustained a burn injury will undergo wound debridement. The nurse includes which explanation when explaining

the purpose of burn wound debridement?

a. To increase the effectiveness of the skin graft.

b. Prevention of infection and promote healing.

c. Promoting suppuration of the wound.

d. Promoting movement in the affected area.

ANS: B

A patient has been admitted to the hospital with burns to the upper chest. The nurse notes singed nasal hairs. The nurse needs to

assess this patient frequently for which condition?

a. Decreased activity

b. Bradycardia

c. Respiratory complications

d. Hypertension

ANS: C

Which may indicate a malignant melanoma in a nevus on a patient’s arm?

a. Even coloring of the mole

b. Decrease in size of the mole

c. Irregular border of the mole

d. Symmetry of the mole

ANS: C

A nurse can assess cyanosis in a dark-skinned patient by assessing the color of which body part?

a. abdomen

b. sclera.

c. lips and mucous membranes.

d. soles of the feet.

ANS: C

A patient developed a severe contact dermatitis of the hands, arms, and lower legs after spending an afternoon picking strawberries.

The patient states that the itching is severe and cannot keep from scratching. Which instruction will be helpful in managing the

pruritus?

a. Use cool, wet dressings and baths to promote vasoconstriction.

b. Trim the fingernails short to prevent skin damage from scratching.

c. Expose the areas to the sun to promote drying and healing of the lesions.

d. Wear cotton gloves and cover all other affected areas with clothing to prevent

environmental irritation.

ANS: A

The nurse will provide which instruction regarding reducing the risk factors for melanoma?

a. Avoid exposure to the sun and use protective measures when exposure occurs.

b. Have all nevi removed.

c. Watch for changes in moles, especially on the back.

d. Use a sun lamp for tanning.

ANS: A

Which patient instruction will the nurse reinforce relative to the management of systemic lupus erythematosus (SLE)?

a. Maintain a balance between rest and activity.

b. Increase activity to promote mobility.

c. Increase exposure to the sun to increase vitamin D absorption.

d. Increase sodium consumption.

ANS: A

Which patient statement indicates that more teaching is needed regarding antibiotic therapy for the treatment of cellulitis?

a. “My skin is cleared up. I don’t think I need the medication anymore.”

b. “Cellulitis can come back at any time.”

c. “If I had washed that scratch with soap and water, I probably would not have

gotten cellulitis.”

d. “Cellulitis is contagious.”

ANS: A

Which will a patient be assessed for upon the diagnosis of genital herpes?

a. Hepatitis B

b. Syphilis

c. Human immunodeficiency virus (HIV).

d. Cirrhosis

ANS: C

The school nurse recognizes the signs of scabies when a child displays which symptom?

a. small fluid-filled blisters that sting when scratched.

b. dry scaly patches in body creases that itch.

c. wavy threadlike lines on the body and pruritus.

d. cluster of papular lesions with pruritus.

ANS: C

Melanocytes give rise to the pigment melanin, which is responsible for skin color. Where can the melanocytes be found?

a. Dermis

b. Superficial fascia

c. Epidermis

d. Loose connective tissue

ANS: C

The nurse arrives to the scene of a house fire. A victim is running out of the house, with flames on the arms. Which is the nurse’s

first action?

a. Transport victim to hospital.

b. Cover victim with clean cloth or sheet.

c. Stop, drop, and roll.

d. Remove all nonadherent clothing and jewelry.

ANS: C

What is the last intervention for a hospitalized severely burned victim during the emergent phase?

a. Tetanus prophylaxis.

b. Insert Foley catheter.

c. Insert nasogastric tube.

d. Establish airway.

e. Administer analgesics.

f. Initiate fluid therapy.

ANS: A

Which is a major function of the skin? (Select all that apply.)

a. Excretion of wastes

b. Protection

c. Vitamin C synthesis

d. Temperature regulation

e. Prevention of dehydration

ANS: A, B, D, E

Which is a nursing intervention and patient teaching item for the treatment of head lice and scabies? (Select all that apply.)

a. Clothing, linens, and bath articles thoroughly cleaned in hot water

b. Stress nature and transmission of the disease

c. Special carbohydrate diet to promote healing

d. Complete isolation from the public

e. removal of pets from the home

ANS: A, B

A patient has sustained a burn injury following a house fire. Which finding indicates the need to observe the patient for airway

complications? (Select all that apply.)

a. Bradypnea

b. Singed nasal hairs

c. Burns to the upper arms

d. Intercostal retractions

e. Grunting noted with respiration

ANS: B, D, E