C H A P T E R
Nursing Management:
Chapter 24 Nursing Management: Integumentary Problems 89 9. A patient is a 78-year-old woman who has had chronic respiratory disease for 30 years. She weighs 212 lb
(96.4 kg) and is 5 ft, 1 in (152.5 cm) tall. She has recently completed corticosteroid and antibiotic treatment for an exacerbation of her respiratory disease. Identify four specific predisposing factors for bacterial skin infection in this patient.
a. c.
b. d.
10. What is the name for papillomavirus infection seen on the skin?
a. Furuncle c. Erysipelas
b. Carbuncle d. Plantar wart
11. Which description characterizes seborrheic keratosis?
a. White patchy yeast infection c. Excessive turnover of epithelial cells b. Warty, irregular papules or plaques d. Deep inflammation of subcutaneous tissue 12. Which skin condition occurs as an allergic reaction to mite eggs?
a. Scabies c. Folliculitis
b. Impetigo d. Pediculosis
13. Which skin conditions are more common in immunosuppressed patients (select all that apply)?
a. Acne d. Herpes zoster
b. Lentigo e. Herpes simplex 1
c. Candidiasis f. Kaposi sarcoma
14. What should the nurse include in the instructions for a patient with urticaria?
a. Apply topical benzene hexachloride.
b. Avoid contact with the causative agent.
c. Gradually expose the area to increasing amounts of sunlight.
d. Use over-the-counter antihistamines routinely to prevent the condition.
15. A nurse caring for a disheveled patient with poor hygiene observes that the patient has small red lesions flush with the skin on the head and body. The patient complains of severe itching at the sites. For what should the nurse further assess the patient?
a. Nits on the shafts of his head hair b. A history of sexually transmitted diseases c. The presence of ticks attached to the scalp d. The presence of burrows in the interdigital webs
16. A patient with a contact dermatitis is treated with calamine lotion. What is the rationale for using this base for a topical preparation?
a. A suspension of oil and water to lubricate and prevent drying b. An emulsion of oil and water used for lubrication and protection
c. Insoluble powders suspended in water that leave a residual powder on the skin d. A mixture of a powder and ointment that causes drying when moisture is absorbed
17. A patient with psoriasis is being treated with psoralen plus UVA light (PUVA) phototherapy. During the course of therapy, for what duration should the nurse teach the patient to wear protective eyewear that blocks all UV rays?
a. Continuously for 6 hours after taking the medication b. Until the pupils are able to constrict on exposure to light c. For 12 hours following treatment to prevent retinal damage
d. For 24 hours following treatment when outdoors or when indoors near a bright window
90 Chapter 24 Nursing Management: Integumentary Problems
18. Identify one instruction the nurse should provide to a patient receiving the following medications for dermatologic problems.
Medication Nursing Instruction
Topical antibiotics Topical corticosteroids Systemic antihistamines Topical fluorouracil
19. Match the surgical interventions with conditions that they are used to treat (interventions may be used for more than one condition).
_______ a. Electrodessication or electrocoagulation 1. Malignant melanoma
_______ b. Excision 2. Common and genital warts
_______ c. Mohs’ surgery 3. Basal and squamous cell carcinomas
_______ d. Curettage 4. Telangiectasia
_______ e. Cryosurgery 5. Lesions involving the dermis
6. Seborrheic keratoses
20. What are the most appropriate dressings to use to promote comfort for a patient with an inflamed, pruritic dermatitis?
a. Cool tap water dressings b. Cool acetic acid dressings c. Warm sterile saline dressings
d. Warm potassium permanganate dressings
21. What is an appropriate intervention to promote debridement and removal of scales and crusts of skin lesions?
a. Warm oatmeal baths b. Warm saline dressings
c. Cool sodium bicarbonate baths d. Cool magnesium sulfate dressings
22. Identify the rationale for using the following interventions to control pruritus.
Intervention Rationale
Cool environment
Topical menthol, camphor, or phenol Soaks and baths
23. A female patient with chronic skin lesions of the face and arms tells the nurse that she cannot stand to look at herself in the mirror anymore because of her appearance. Based on this information, the nurse identifies which nursing diagnosis?
a. Anxiety related to personal appearance
b. Disturbed body image related to perception of unsightly lesions
c. Social isolation related to decreased activities as a result of poor self-image
d. Ineffective self-health management related to lack of knowledge of cover-up techniques
24. To prevent lichenification related to chronic skin problems, what does the nurse encourage the patient to do?
a. Use measures to control itching.
b. Wear sterile gloves when touching the lesions.
c. Use careful hand washing and safe disposal of soiled dressings.
d. Use topical antibiotics with wet-to-dry dressings over the lesions.
Chapter 24 Nursing Management: Integumentary Problems 91 25. What is the most common reason elective cosmetic surgery is requested by patients?
a. Improve self-image c. Lighten the skin in pigmentation problems b. Remove deep acne scars d. Prevent skin changes associated with aging 26. Which skin condition would be treated with laser surgery?
a. Preauricular lesion c. Obesity with subcutaneous fat accumulation b. Redundant soft tissue conditions d. Fine wrinkle reduction or facial lesion removal 27. What is a skin graft that is used to transfer skin and subcutaneous tissue to large areas of deep tissue destruction
called?
a. Skin flap c. Soft tissue extension
b. Free graft d. Free graft with vascular anastomoses
28. Priority Decision: A patient is receiving chemotherapy. She calls the physician’s office and says she is experiencing itching in her groin and under her breasts. What is the first nursing assessment that would be done before the nurse makes an appointment for the patient with the physician to determine the treatment?
a. Her height and weight c. If chemotherapy was completed b. What the areas look like d. Culture and sensitivity of the areas
29. The patient has diabetes mellitus and chronic obstructive pulmonary disease that has been treated with high-dose corticosteroids for the past several years. Which dermatologic manifestations could be related to these systemic problems (select all that apply)?
a. Acne d. Impaired wound healing
b. Increased sweating e. Erythematous plaques of the shins
c. Dry, coarse, brittle hair f. Decreased subcutaneous fat over extremities
Discussion Questions
Using a separate sheet of paper, answer the following questions:
1. What other assessment data are needed before treatment begins?
2. What care of the wound should W.B. have taken to prevent the occurrence of cellulitis?
3. What are the usual etiologies of this type of infection?
4. What would you tell W.B. about the usual treatment of cellulitis?
5. What could result if treatment is not initiated and maintained?
6. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems?
CASE STUDY Cellulitis Patient Profile
W.B., a 72-year-old man, cut his lower arm on a kitchen knife. At the time of the injury he did not seek medical attention. On the third day following the injury he began to be concerned about the condition of the wound and the way he was feeling.
Subjective Data
• States he has a fever and has had a general feeling of malaise
• Has pain in the area of the cut and the entire lower arm Objective Data
• 4-cm area around cut is hot, erythematous, and edematous with redness extending both up and down his arm
• Temp: 100.8°F (38.2°C)