Chapter 52: Skin Disorders Nursing School Test Banks

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. Dont worry about them. They will fade during the winter.
ANS: B
Lentigines on sun-exposed areas are called liver spots because of their color; they have nothing to do with the liver or any disease process. They are normal changes of aging.

DIF: Cognitive Level: Comprehension REF: p. 1184 OBJ: 2
TOP: Liver Spots KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Physiological Adaptation

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
ANS: B
Purpura are purple bruises that resolve very slowly and are usually the result of minor trauma.

DIF: Cognitive Level: Comprehension REF: p. 1184 OBJ: 2
TOP: Senile Purpura KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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
ANS: D
The functional assessment is a search for clues in the occupation and lifestyle of the patient. The other options all reference medical history and system review.

DIF: Cognitive Level: Application REF: p. 1185 OBJ: 5
TOP: Functional Assessment KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

4. A daughter of an older adult patient who has just returned from surgery is distressed about her fathers pale, cold hands and feet. What is the best response by the nurse after covering the patient with an extra blanket?
a. Dont 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 dads hands and feet very carefully.
ANS: C
The 10% of the blood network that is in the skin can be reduced by constriction and shunted to the vital organs.

DIF: Cognitive Level: Application REF: p. 1174 OBJ: 1
TOP: Skin Blood Reservoir KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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.
ANS: B
Eight hours before and after each treatment, the patient should wear protective clothing, sunglasses, and sunscreen to decrease added ultraviolet exposure from other sources.

DIF: Cognitive Level: Application REF: p. 1190 OBJ: 6
TOP: Phototherapy KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

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
ANS: A
Persons with lupus erythematosus should avoid exposure to UV light.

DIF: Cognitive Level: Comprehension REF: p. 1190 OBJ: 6
TOP: Phototherapy KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. A nurse is caring for a patient with pruritus. Which implementation can the nurse perform without a physicians 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.
ANS: C
Application of a lotion or lubricant to unbroken skin may be done without an order.

DIF: Cognitive Level: Application REF: p. 1194 OBJ: 7
TOP: Pruritus KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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.
ANS: A
Loose clothing and a cool atmosphere allow the skin to stay cool and reduce sweating. Alcohol is drying to the skin.

DIF: Cognitive Level: Application REF: p. 1195 OBJ: 7
TOP: Atopic Dermatitis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

9. Which sign or symptom suggests that a patient with impaired skin integrity is developing a systemic infection?
a. Lesion on the patients 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
ANS: B
A rise in temperature is a systemic response. Normal blood pressure, warmth, swelling, and itching are not evidence of a systemic skin infection.

DIF: Cognitive Level: Comprehension REF: p. 1195 OBJ: 3
TOP: Systemic Infection KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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
ANS: A
To touch, interact, and care attentively for a disfigured patient communicates acceptance.

DIF: Cognitive Level: Application REF: p. 1199 OBJ: 8
TOP: Psoriasis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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 dont know if it is used with patients with cancer, but the drug can be used when conditions are as severe as yours.
ANS: C
Methotrexate is an immunosuppressive drug used to treat psoriasis that is nonresponsive to other protocols. Periodic blood tests are performed to assess for leukopenia. The other options either do not answer the patients question or offer erroneous information.

DIF: Cognitive Level: Application REF: p. 1196 OBJ: 6
TOP: Methotrexate Sodium KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

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 wasnt careful enough. What is the best response by the nurse?
a. Dermatitis is not caused by poor hygiene.
b. Dont 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 shouldnt feel like the skin condition is your fault.
ANS: A
Dermatitis is not a condition of poor hygiene. Implying that the family member is responsible for the condition is belittling and not therapeutic.

DIF: Cognitive Level: Application REF: p. 1195 OBJ: 8
TOP: Dermatitis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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
ANS: B
C. albicans infection appears most often in skin folds.

DIF: Cognitive Level: Comprehension REF: p. 1198 OBJ: 3
TOP: Yeast Infection KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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
ANS: C
Accutane can cause severe fetal deformities.

DIF: Cognitive Level: Comprehension REF: p. 1200 OBJ: 6
TOP: Acne Treatment KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

15. An excited mother of a teenage boy with severe acne furiously reports to the nurse, Ive told him a thousand times he should bathe more often! Ive 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 boys acne?
a. Poor personal hygiene
b. Ingestion of junk food
c. Squeezing lesions
d. Need for facial scrubs
ANS: C
Squeezing the lesions may cause them to spread and push the infection deeper into the follicles. Poor personal hygiene, eating junk food, and the need for facial scrubs are myths.

DIF: Cognitive Level: Application REF: p. 1200 OBJ: 7
TOP: Acne KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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.
ANS: D
The virus goes dormant but can recur. Herpes is always present.

DIF: Cognitive Level: Application REF: p. 1201 OBJ: 7
TOP: Herpes Simplex KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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
ANS: D
Chickenpox is a virus that lies latent in the neural sheath and can be activated as shingles in older adults.

DIF: Cognitive Level: Application REF: p. 1201-1202
OBJ: 7 TOP: Herpes Zoster
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

18. A physician asks a nurse to take a smear from herpetic lesions in an older patients 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
ANS: B
The Tzanck test rapidly confirms the specific virus. The results are available sooner than they would be from a culture.

DIF: Cognitive Level: Comprehension REF: p. 1202 OBJ: 7
TOP: Tzanck Smear KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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.
ANS: D
Ambulation certainly is not helpful for the pain. Very little helps the neuralgic pain except direct implementation.

DIF: Cognitive Level: Application REF: p. 1202 OBJ: 7
TOP: Herpes Zoster KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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
ANS: B
Cutaneous T-cell carcinoma appears in areas protected from the sun. All three neoplasms can metastasize, and all three neoplasms can be treated by radiation or topically.

DIF: Cognitive Level: Comprehension REF: p. 1205-1206
OBJ: 6 TOP: Cutaneous T-Cell Carcinoma
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

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%
ANS: D
Per the rule of nines, the front trunk equals 18%, the fronts of the legs equal 18%, and the genitalia equal 1%.

DIF: Cognitive Level: Analysis REF: p. 1207 OBJ: 5
TOP: Burn Estimate KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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
ANS: D
Sooty sputum is the most indicative. Facial burns and flaring nares are not conclusive in themselves. Respiration rate of 18 breaths/min is normal.

DIF: Cognitive Level: Application REF: p. 1200 OBJ: 5
TOP: Burns: Respiratory Impairment KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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
ANS: C
Eschar that encompasses a limb can compromise circulation.

DIF: Cognitive Level: Application REF: p. 1210 OBJ: 5
TOP: Eschar: Impaired Circulation KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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
ANS: B
Decreased urinary output indicates that poor perfusion to the kidney still remains. Temperature elevation and edema are to be expected. Crackles in a patient who is dormant are not causes for alarm.

DIF: Cognitive Level: Application REF: p. 1210 OBJ: 5
TOP: Burns: Fluid Replacement KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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
ANS: A, B, D, E
Increased hair in the nostrils and ear, flattened discolored nails, and seborrheic keratosis are common age-related skin changes. Macular lesions are abnormal.

DIF: Cognitive Level: Knowledge REF: p. 1184 OBJ: 2
TOP: Age-Related Skin Changes KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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
ANS: A, B, D
All ulcers, skin grafts, and dehisced wounds respond well to negative pressure therapy.

DIF: Cognitive Level: Comprehension REF: p. 1190 OBJ: 6
TOP: Negative Pressure Therapy KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

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

ANS:
E, D, A, B, C

Hypoproteinemia causes a fluid shift from the bloodstream to extracellular space, causing generalized edema; fluid volume deficit occurs; blood is shunted from the kidneys and gastrointestinal tract to make up for the fluid loss in the circulating volume; and urine output is decreased.

DIF: Cognitive Level: Comprehension REF: p. 1189 OBJ: 4
TOP: Tzanck Smear KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

28. When assessing the capillary refill, a nurse should document as normal a refill time of __________ seconds.

ANS:
3

Capillary refill is a method of quick assessment of perfusion to the extremities. A normal capillary refill time is 3 to 5 seconds or less.

DIF: Cognitive Level: Comprehension REF: p. 1189 OBJ: 7
TOP: Fluid Shift in Burn Patient KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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.

ANS:
D, A, C, B
The nurse washes the lesion, punctures the lesion with a needle, saturates a sterile cotton swab, places the swab in a culture tube, and takes the collected tissue to the laboratory. A pressure dressing is not needed.

DIF: Cognitive Level: Application REF: p. 1187 OBJ: 3
TOP: Capillary Refill KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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