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Flashcards in Care of the Patient with an Integumentary Disorder (adult health) Deck (43)
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1

A patient has generalized macular-papular skin eruptions and complains of severe pruritus from contact dermatitis. When the nurse administers his therapeutic bath, it is important to remember that
a. using Burow’s solution helps promote healing.
b. rubbing the skin briskly decreases pruritus.
c. allowing 20 to 60 minutes to complete the bath will prevent pruritus.
d. sterilizing all equipment used will prevent pruritus.

using Burow’s solution helps promote healing.

Pruritus is responsible for most of the discomfort. Wet dressings, using Burow’s solution, help promote the healing process. A cool environment with increased humidity decreases the pruritus.

2

A patient, age 63, has cancer of the left breast. After a modified radical mastectomy, she has been receiving chemotherapy. Her grandson, who visited a few days ago, now has varicella (chickenpox). The nurse should observe her carefully for signs of
a. herpes zoster.
b. herpes simplex type I.
c. herpes simplex type II.
d. impetigo.

herpes zoster.

is caused by the same virus that causes chickenpox (Herpes varicella). The greatest risk occurs to patients who have a lowered resistance to infection, such as those on chemotherapy or large doses of prednisone, in whom the disease could be fatal because of the patient’s compromised immune system.

3

A patient has herpes zoster (shingles). A local antiviral agent, which is useful in delaying the progression of herpetic diseases, was prescribed. This medication is
a. lorazepam (Ativan).
b. hydroxyzine (Atarax).
c. acyclovir (Zovirax).
d. hydrocortisone (Solu-Cortef).

acyclovir (Zovirax).

Oral and intravenous acyclovir (Zovirax), when administered early, reduces the pain and duration of the virus.

4

A child has been sent home from school with pruritus and honey-colored crusts on his lower lip and chin. A probable diagnosis would be
a. chickenpox.
b. impetigo.
c. shingles.
d. herpes simplex type I.

impetigo.

Impetigo is seen at all ages, but is particularly common in children. The crust is honey-colored and easily removed.

5

A patient has an erythematous patch of vesicles on her scalp, and she complains of pain and pruritus. A diagnosis of tinea capitis is made. The causative organism is
a. bacterium.
b. virus.
c. worm.
d. fungus.

fungus.

Tinea capitis is commonly known as ringworm of the scalp. Microsporum audouinii is the major fungal pathogen.

6

A patient, age 46, reports to his physician’s office with urticaria and papules on his hands and arms. He says, “It itches so badly.” In assessing the patient, the nurse should gather data regarding recent
a. travel to foreign countries.
b. upper respiratory tract infection.
c. changes in medication.
d. contact with people who have an infectious disease.

changes in medication.

Urticaria is the term applied to the presence of wheals or hives in an allergic reaction commonly caused by drugs, food, insect bites, inhalants, emotional stress, or exposure to heat or cold.

7

A patient has been receiving penicillin, acetaminophen with codeine, and hydrochlorothiazide for 4 days. He now has a urinary tract infection. A sulfonamide has been prescribed to be taken three times per day. Several hours after the second dose , he complains of pruritus. The nurse observes a generalized erythema and rash. The most appropriate nursing intervention would be to hold
a. all medications, and notify the physician of the signs and symptoms.
b. the penicillin.
c. the acetaminophen with codeine.
d. the sulfonamide.

all medications, and notify the physician of the signs and symptoms.

If a patient develops wheals or hives in an allergic reaction to drugs (urticaria), then all medications should be held.

8

A patient has acne vulgaris. When the nurse explains this condition, it is most important to
a. stress the importance of strict hygiene.
b. discuss the connection of diet and stress.
c. explore how this condition is affecting his self-image and lifestyle.
d. describe in detail the proper use of prescribed medication.

explore how this condition is affecting his self-image and lifestyle.

The nurse must assess and consider what acne means to a person. Most patients acknowledge that acne affects their self-image.

9

A 30-year-old African American had surgery 6 months ago. Her incisional site is now raised, indurated, and shiny. This tissue growth is most likely a(n)
a. angioma.
b. keloid.
c. melanoma.
d. nevus.

keloid.

which originate in scars, are hard and shiny and are seen more often in African Americans than Caucasians.

10

A patient, age 37, sustained partial- and full-thickness burns to 26% of her body surface area. The greatest fluid loss resulting from her burns will usually occur
a. within 12 hours after burn trauma.
b. 24 to 36 hours after burn trauma.
c. 24 to 48 hours after burn trauma.
d. 48 to 72 hours after burn trauma.

within 12 hours after burn trauma.

In a burn injury, usually the greatest fluid loss occurs within the first 12 hours.

11

Most of the deaths from burn trauma in the emergent phase that require a referral to a burn center result from
a. infection.
b. dysrhythmias with cardiac arrest.
c. hypovolemic shock and renal failure.
d. adrenal failure.

infection.

A possible complication that should be addressed at the time of the burn is infection in the wound.

12

A patient, age 26, is admitted to the burn unit with partial- and full-thickness burns to 20% of his body surface area as well as smoke-inhalation injury. Carbon monoxide intoxication secondary to smoke inhalation is often fatal because carbon monoxide
a. binds with hemoglobin in place of oxygen.
b. interferes with oxygen intake.
c. is a respiratory depressant.
d. is a toxic agent.

binds with hemoglobin in place of oxygen.

Carbon monoxide poisoning is likely if the patient has been in an enclosed area. Carbon monoxide displaces oxygen by binding with the hemoglobin.

13

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

the likelihood of cardiac arrest.

Most electrical burns result in cardiac arrest, and the patient will require CPR or astute cardiac monitoring.

14

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 the most common cause of burn-related deaths, which is
a. shock.
b. respiratory arrest.
c. hemorrhage.
d. infection.

infection.

Infection is the most common complication and cause of death after the first 72 hours.

15

A duodenal ulcer may occur 8 to 14 days after severe burns. Usually, the first symptom is bright red emesis. Which condition matches this description?
a. Curling’s ulcer
b. Paralytic ileus
c. Hypoglycemia
d. ICU psychosis syndrome

Curling’s ulcer

is a duodenal ulcer that develops 8 to 14 days after severe burns on the surface of the body. The first sign is usually vomiting of bright red blood.

16

A nurse is providing the open method of treatment for a patient who is 52 years old with burns to her lower extremities. It would be important for the nurse to
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 (24.4° C) to prevent chilling.

keep the room temperature at 85° F (24.4° C) to prevent chilling.

Chilling may be controlled by keeping the room temperature at 85° F (24.4° C).

17

The nurse has initiated measures to promote suppuration of a carbuncle. Which assessment would indicate that these measures have been successful?
a. The area is erythematous and scaly.
b. The area has begun to drain exudate.
c. The area is not erythematous or edematous.
d. The area has stopped draining exudate.

The area has begun to drain exudate.

Warm soaks two to three times a day can be used to speed the process of suppuration (production of purulent material). Patients should be taught not to touch the exudate.

18

A patient, age 20, is admitted with severe eczema. In planning the care for her, the nurse should plan to
a. keep the skin well hydrated.
b. change the dressings every day.
c. keep the skin clean and dry.
d. administer antibiotics for the infection.

keep the skin well hydrated.

19

The nurse is caring for a 26-year-old patient who was burned 72 hours ago. He has partial-thickness burns to 24% of his body surface area. He begins to excrete large amounts of urine. The nurse should
a. slow the IV solution and monitor for burn shock.
b. monitor for signs of infection.
c. assess for signs of fluid overload.
d. raise the foot of the bed and apply blankets.

assess for signs of fluid overload.

As the blood volume increases, the cardiac output increases to increase renal perfusion. The result includes diuresis. However, a great risk for the patient includes fluid overload because of the rapid movement of fluid back into the intravascular space.

20

A patient, age 29, is diagnosed with genital herpes. She is receiving acyclovir (Zovirax). Which would indicate a therapeutic response?
a. Decrease in pruritus
b. Decrease in pain
c. Increase in WBC count
d. Increase in activity tolerance

Decrease in pain

Acyclovir (Zovirax) is an antiviral agent that can alter the course of the disease.

21

A female patient is seen by the school nurse because of flat lesions that are clear in the center with erythematous borders. In assessing a patient for tinea corporis, the nurse would check
a. soles of the feet.
b. back of the scalp.
c. groin area.
d. anterior abdomen.

anterior abdomen.

Tinea corporis is known as ringworm of the body. It occurs on parts of the body with little or no hair.

22

A patient has been walking in the woods. He complains of severe pruritus. The nurse notes an erythematous area on his lower legs. The first nursing intervention for dermatitis venenata would be to
a. administer Benadryl, 50 mg IM.
b. wash area with copious amounts of water.
c. apply cool compresses continuously.
d. expose area to heat and air.

wash area with copious amounts of water.

In dermatitis venenata (poison oak or ivy), the patient should wash the affected part immediately after contact with the offending allergen.

23

The nurse debriding a wound explains the purpose of debridement is to:
a. increase the effectiveness of the skin graft.
b. prevent infection and promote healing.
c. promote suppuration of the wound.
d. promote movement in the affected area.

prevent infection and promote healing.

Débridement is the removal of damaged tissue and cellular debris from a wound or burn to prevent infection and to promote healing.

24

A patient has been admitted to the hospital with burns to his upper chest. The nurse notes singed nasal hairs. It would be important for the nurse to assess this patient frequently for
a. decreased activity.
b. bradycardia.
c. respiratory complications.
d. hypertension.

respiratory complications.

Signs and symptoms of inhalation injury include singed nasal hairs. Breathing difficulties may take several hours to occur.

25

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

Irregular border of the mole

Any change in color, size, or texture and any bleeding or pruritus of a nevus deserves investigation. A malignant melanoma is a cancerous neoplasm in which pigment cells or melanocytes invade the epidermis, dermis, and sometimes the subcutaneous tissue.

26

A dark-skinned patient has been admitted to the hospital in severe respiratory distress. To determine whether the patient is cyanotic, the nurse uses what knowledge of skin assessment?
a. It is not possible to assess color changes in patients with dark skin.
b. Cyanosis in patients with dark skin can be seen only in the sclera.
c. Cyanosis can be seen in the lips and mucous membranes of patients with dark skin.
d. Cyanosis will blanch out with direct pressure to the soles of the feet in dark-skinned patients.

Cyanosis can be seen in the lips and mucous membranes of patients with dark skin.

27

A patient developed a severe contact dermatitis of her hands, arms, and lower legs after spending an afternoon picking strawberries. She states that the itching is severe and she cannot keep from scratching. Which instruction by the nurse will be most helpful in managing the pruritus?

Use cool, wet dressings and baths to promote vasoconstriction.

28

A patient is a 32-year-old woman whose mother recently died from malignant melanoma. She asks the nurse about what she can do to prevent the development of malignant melanoma in herself and her children. The best response by the nurse includes which information regarding 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. There is nothing that prevents malignant melanoma, but it is curable if detected early.

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

Encourage the patient to protect skin from the sun by wearing protective clothing including a hat with 4-inch brim, applying sunscreen all over the body, and avoiding the midday sun from 10 am to 4 pm.

29

In addition to medication management of systemic lupus erythematosus, which supportive therapy would help control the disease?
a. Balanced diet and balance between rest and activity
b. Increase in activity to promote mobility
c. Exposure to the sun to increase vitamin D absorption
d. Increased sodium consumption

Balanced diet and balance between rest and activity

30

Cellulitis is a potentially serious infection. In adults Staphylococcus aureus can cause which complications?
a. Sepsis and meningitis
b. Appendicitis and vasculitis
c. Tinea pedis and tinea corporis
d. Urticaria and psoriasis

Sepsis and meningitis

Sepsis, meningitis, and lymphangitis are the most common complications of cellulitis for adults caused by Staphylococcus aureus bacteria. Tinea pedis/corporis are fungal infections. Urticaria and psoriasis are noninfectious skin disorders.