EAQ: MED SURGE Quiz: Chapter 52, Skin Disorders

1. The LPN is caring for a patient who is undergoing patch testing. Which is the first step in
assisting the patient to undergo this test?
a. Various common irritants are applied to the skin and covered with patches.
i. The first step in patch testing is to apply various common irritants to the
skin and cover it with patches. Then, areas are observed for evidence of
redness, swelling, and blistering at 48-, 72-, and 96-hour intervals, as well
as 1 week later.

2. A patient shows you a discharge summary that states the discharge diagnosis is
seborrheic dermatitis. The nurse would explain to the patient that this is the
medical term for which condition?

a. Dandruff
3. A patient has intertrigo. Why does the nurse explain to the patient that cornstarch should
not be applied to the affected area?
a. It supports the growth of C. albicans.
4. A patient is diagnosed with vaginal candidiasis. What nursing intervention
is appropriate for this patient?
a. Instruct the patient to keep the area clean and dry.

5. A patient presents with signs and/or symptoms of cracked skin, dermatitis, xerosis,
purpura, and petechiae. These skin changes are associated with which condition?

a. Malnutrition
i. Cracked skin, dermatitis, xerosis, purpura, and petechiae
are characterizations of malnutrition. These do not signify acne, food
allergies, or fungal infection. Pg.1188
6. A patient complains of excessive itching along the abdomen near the umbilicus. What
instruction is appropriate for the nurse to give to the patient to relieve pruritus?
a. Apply emollients to the area.
i. The patient can be advised to apply an emollient to the area that is
itching. Taking frequent hot baths can worsen symptoms of itching.
Moving to a drier environment would actually worsen the dryness and is
very impractical advice. Over-the-counter lotions should not be applied to
open skin areas. PG.1193
7. A patient had a deep skin biopsy. How should the nurse respond to the patient's concern
about post procedure care?
a. "An appointment will be made for you to return for suture removal."
i. Since deep skin biopsies require sutures, these must be removed at the
appropriate time. Skin biopsies do not usually require admission to a
hospital. Patch testing would require readings at intervals. Postprocedural
care is required, and the results are not immediately available.

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 8. A pregnant woman has requested a prescription for acitretin. Which instructions should
the patient receive concerning this medication?
a. Contraindicated during pregnancy due to risk to fetus.
9. The nurse is caring for a patient who is recovering from a full-thickness burn. The nurse
understands that the patient is in a hypermetabolic state and needs nutritional support to
promote wound healing and prevent malnutrition. What instructions should the nurse
provide to the patient?
a. Eat twice as many calories as baseline needs.
i. A patient with burns needs a high-calorie diet to compensate for the
energy loss and increased protein intake to avoid malnutrition and
delayed healing. The patient should eat twice as many calories as
baseline needs. The patient is encouraged to eat small meals frequently,
supplemented with between meal snacks. Drinking large amounts of
water is not encouraged because it does not have any caloric or protein
value. Tube feedings are frequently used to supplement dietary needs.

10. An older adult patient is complaining about her wrinkled skin. How could the nurse
explain this occurrence to her?

a. "This is due to thinning of the skin and degeneration of elastin fibers."

11. When jaundice is suspected in a patient who is dark skinned, which areas should the
nurse check for skin color? Select all that apply.
a. Conjunctiva
b. Palms of the hands
c. Oral mucous membranes

12. Which disease condition can be found more in fair-skinned patients than in
patients with more pigmentation in their skin?

a. Melanoma

13. When assessing the skin of an older adult, which findings would the nurse
consider normal? Select all that apply.

a. Dry skin
b. Wrinkling
c. Increased facial hair
i. Older adults do not have the same skin as younger adults, and there are
many skin changes associated with aging that are normal. These include
dry skin, wrinkling, and increased facial hair. Excoriation and fissures are
abnormal findings on the skin and need further evaluation. PG. 1184-
1185
14. To assess skin turgor, the most appropriate technique for the nurse to use is which
technique?
a. Palpation

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 15. The nurse is working in the postoperative area and just received a patient recovering
from a blepharoplasty. For which possible complications should the nurse
monitor? Select all that apply.
a. Hematoma
b. Corneal injury

16. An order is transcribed for the application of a dry dressing after an incisional
biopsy. The nurse knows that which is the purpose of a dry dressing?

a. Protects the wound and absorbs drainage

17. A patient requires a biopsy of tissue for microscopic examination. The planned
procedure will remove a wedge of tissue from the lesion and is most likely which
type of biopsy?

a. Incisional
i. A wedge of tissue is removed from the lesion in an incisional biopsy.
Excisional biopsy is performed for deep specimens. The entire lesion is
removed. Sutures are required to close the defect left by the procedure. A
shave biopsy involves obtaining a specimen with a scalpel or other
specialized instrument no deeper than the dermis. Bleeding is usually
minimal and controlled with pressure, cautery, or chemicals. A punch
biopsy uses a circular tool to cut around the lesion, which is then lifted up
and severed. Pressure or chemicals usually control bleeding, but suturing
may be needed to close the site. The excision is relatively shallow. PG.
1188
18. A patient presents with scalding burns on the chest and abdomen. On examination, the
nurse suspects that the patient has deep partial-thickness burns. What findings would
the nurse expect to find? Select all that apply.
a. Wounds that are red and painful
b. Weeping, cherry-red exposed dermis
c. A burned area sensitive to cold air

19. The nurse assessed the patient's skin lesions as raised, fluid-filled cavities less
than 1 cm in diameter. These lesions would be documented using which term?

a. Vesicles
i. Vesicles are raised, fluid-filled cavities less than 1 cm in diameter.
Examples include varicella (chickenpox), herpes zoster (shingles), and
second-degree burn. Wheals are firm, edematous areas such as insect
bites. Papules are solid lesions (warts). Pustules are pus-filled lesions
(acne or impetigo). Refer to Table 50-2 in your text for descriptions of
other skin lesions. PG. 1186

20. During an assessment interview of a female patient, the nurse finds that she is
taking isotretinoin to treat acne. On further assessment, the patient expresses that
she plans to conceive. Which is the most important nursing action?

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 a. Tell the patient to stop this medication, as it would have adverse effects on
the fetus.

21. A patient has received an order for ketoconazole. The nurse knows that this
medication is used for which purpose?

a. To treat a fungal infection

22. When assessing a patient suffering from inhalation burns on the face and chest,
which symptoms most closely correlate with inhalation burns? Select all that
apply.

a. Restlessness
b. Swelling of the pharynx
c. Productive cough with sooty sputum

23. Which image shows seborrheic keratoses?

a.
24. A patient has an order for anthralin for treatment for psoriasis. Which instructions should
the patient receive concerning this medication? Select all that apply.
a. Use gloves when applying to lesions.
b. The medication can stain hair, skin, fingernails, furniture, and bathroom
fixtures.

25. A 2-year-old male patient is brought into the emergency department after a burn
injury. The child's mother reports that the injury occurred when the child grabbed
the handle of a pot of boiling water and it spilled over his lower extremities. This
type of burn injury is described as which type?

a. Thermal
26. The nurse is caring for a patient who sustained a burn injury 1 week ago and has been
transferred to the nursing unit. The patient has a bounding pulse and hypertension. This
would signify which condition?
a. Excess fluid volume
27. The nurse is providing education to a patient about age-related changes in the skin. The
patient indicates a need for further teaching by stating that which characteristic is an
age-related change in the skin?
a. Increased production of sebum

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 28. A nurse is caring for a patient with extensive burns. What prophylactic treatment
will be included in the plan of care to prevent a Curling's ulcer in this
patient? Select all that apply.

a. Antacids
b. H2-histamine blockers
i. Antacids are used prophylactically to neutralize the acids present in the
stomach. H2-histamine blockers (e.g., ranitidine [Zantac]) are used to
inhibit histamine, which causes an increase in acid levels. An antidiarrheal
is useful in providing symptomatic relief for diarrhea. It cannot prevent a
Curling's ulcer. Beta-adrenergic blockers and calcium channel blockers
have no effect on protecting the gastrointestinal tract or on preventing
development of Curling's ulcers. p. 1209
29. A nurse is caring for a patient with partial-thickness burns on the hands and legs. What
actions should the nurse perform as a part of the wound care for the emergent phase of
treatment? Select all that apply.
a. Administer a tetanus antitoxin.
b. Assess the extent and depth of the burns.
c. Perform debridement if at a major burn center.

30. An older adult patient has a diagnosis of herpes zoster. The nurse should observe
the patient for which complications? Select all that apply.

a. Postherpetic neuralgia
b. Ophthalmic involvement
c. Trigeminal herpes zoster
31. Following reconstructive surgery, a patient questions the nurse concerning the
instruction for no smoking. Which is the nurse's best response?
a. "Nicotine causes vasoconstriction, which interferes with healing."

32. The licensed practical nurse (LPN) is checking on a patient and notices that his
skin tone appears to have changed from normal to bluish in color. What is
the likely cause of this?

a. Excess deoxygenated blood in the tissue

i. The patient is exhibiting cyanosis, a bluish coloring, which is caused by
excess deoxygenated blood in the tissue because of anemia, respiratory
disorders, or cardiovascular disorders. Vasoconstriction is the cause of
pallor, which is evidenced by white or pale skin in light-skinned people,
yellowish-brown in brown-skinned people, and ashen in black-skinned
people. Increased bilirubin in the blood causes jaundice, which occurs
because of liver disease or destruction of red blood cells. An increase in
local blood flow because of inflammation, fever, or emotion is referred to
as erythema. P1186

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 33. The LPN is caring for a patient who is being treated with crotamiton. Which is
the priority instruction that the nurse should give the patient regarding the
prevention of reinfection?

a. Treat the clothing and bed linens.

i. Crotamiton is used to treat a scabies infection. The priority instruction is
to treat the clothing and bed linens; if the linens are not treated,
reinfection will occur. The nurse would also instruct the patient to repeat
the treatment if recommended, recognize that great improvement occurs
with one application, and avoid contact with eyes.

34. A patient is scheduled to undergo a biopsy of a skin lesion.

Which priority preprocedural instruction would the LPN give the patient?

a. Avoid aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) for 48

hours.
35. Which disease condition can be found more in fair-skinned patients than in patients with
more pigmentation in their skin?
a. Melanoma

36. A patient has been administered a patch test to determine the patient's allergy to
rubber. What is an important nursing intervention for this patient?

a. Instruct the patient to return in 48 to 72 hours for examination.

37. When assessing the skin of an older adult patient, a few small, soft, raised, flesh-colored
lesions are noticed by the nurse on the upper back area. These skin lesions are most likely
which disorder?
a. Acrochordons
i. Acrochordons are small, soft-raised lesions; they are flesh-colored or pigmented.
Lentigines are pigmented spots on sun-exposed areas; they are commonly called
liver spots, although they have no relationship with the liver. Senile angiomas are
bright-red papules. Seborrheic keratoses are waxy, raised lesions; they are flesh-
colored to dark brown or black and appear in various sizes from small and nearly
flat to large and prominent. Pg. 1184

38.A patient reveals the use of angelica as an alternative therapy. Which

instruction should the nurse provide for this patient?

a. The agent can cause a skin rash if a patient is exposed to sunlight.

i. Angelica can cause a skin rash if the patient is exposed to sunlight, thus some
side effects have been noted. Angelica does not cause skin atrophy or require
the use of an occlusive dressing.
39. Which of these techniques are appropriate when the nurse is performing a physical
examination of a patient's skin? Select all that apply.
a. Assess for skin color changes.
b. Document dilated blood vessels.
40. The nurse is determining the presence of jaundice in a dark-skinned patient. Observation of
which areas would assist in the visual evaluation? Select all that apply.

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 a. Soles of feet
b. Conjunctivae
c. Palms of hands
d. Oral mucous membranes

41.A patient is admitted to the burn unit with partial thickness burns.
Which characteristics of a partial thickness burn should the nurse
expect to find during the physical assessment? Select all that apply.

a. Fluid-filled blisters
b. Severe pain
c. Mild edema

42.A patient is admitted with an inhalation injury associated with a burn

injury. For which signs and/or symptoms would the nurse monitor this
patient? Select all that apply.

a. Cough
b. Dyspnea
c. Restlessness
d. Sooty sputum
i. With an inhalation burn injury, the patient may present with signs and/or
symptoms of cough, dyspnea, restlessness, sooty sputum, as well as facial burns
and swelling of the pharynx. Ileus and decreased urine output may occur with
burns, but they are not directly related to inhalation burn injuries.

43.A patient is suspected of having a viral skin infection. The nurse would
expect which study of skin specimens to be ordered to diagnose this
patient's skin condition?

a. Tzanck smear
i. A Tzanck smear is used to diagnose viral skin infections. A scabies scraping is
used to detect scabies (mites), eggs, or feces excreted by mites. In a Wood light
examination, a black light is used to assess for pigmentation changes and
superficial skin infections. It also may be used to examine the vulva after a
sexual assault because it may reveal traces of saliva or semen. A KOH
examination is performed to diagnose fungal infections of the skin, hair, or nails
by studying a skin specimen.

44.Choose the treatment measures used for patients with pruritus. Select
all that apply.

a. Stress management
b. Avoidance of irritants
c. Avoidance of sudden temperature changes
d. Avoidance of alcohol, tea, and coffee
i. Stress management, avoidance of irritants, avoidance of sudden temperature
changes, and avoidance of alcohol, tea, and coffee are medical treatment

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 measures for patients with pruritus. Avoidance of oatmeal baths and washing
linens in hot water are not considered treatment measures for patients with
pruritus.

45.The history and physical examination of a patient being admitted to a

long-term care facility indicates the diagnosis of an inflammatory
disorder characterized by abnormal proliferation of skin cells. The nurse
recognizes these symptoms as correlating with which disease process?

a. Psoriasis
i. Psoriasis is an inflammatory disorder characterized by an abnormal proliferation
of skin cells. The classic sign of psoriasis is the appearance of bright-red lesions
that may be covered with silvery scales. Intertrigo is an inflammation of the skin
where two skin surfaces touch (e.g., axillae, abdominal skin folds, under the
breasts). The affected area is usually red and weeping with clear margins and
may be surrounded by vesicles and pustules. A malignant melanoma arises from
the pigment-producing cells in the skin and is the most serious form of skin
cancer because it can be fatal if it metastasizes. Herpes zoster infection is
commonly called shingles. It is caused by the varicella-zoster virus, which is the
same organism that causes chickenpox.
46. A patient is brought to the emergency department (ED) with severe burns on the legs and
feet. Which factors lead the nurse to believe the patient may have full-thickness
burns? Select all that apply.
a. Touch sensation is impaired.
b. Fat, muscle, and bone are involved.
c. Wounds appear white, dark brown, or charred.
i. Touch sensation is impaired due to impaired nerve endings in full-thickness
burns. The fat, muscle, and bone are involved. Wounds appear white, dark
brown, or charred in full-thickness burns, as all skin elements and local nerve
endings are destroyed, and coagulation necrosis is present. Large weeping
blisters are observed in partial-thickness burns because varying degrees of both
the epidermis and dermis are involved, and skin elements of regeneration are
viable. Wounds appear mottled white, pink to cherry-red in a partial-thickness
burn. P1208
47.

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