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1. Which nursing intervention can help a client maintain healthy skin? a. Keep the client well hydrated. b.

Avoid bathing the client with mild soap. c. Remove adhesive tape quickly from the skin. d. Recommend wearing tight-fitting clothes in hot weather.
Answer A. Keeping the client well hydrated helps prevent skin cracking and infection because intact healthy skin is the bodys first line of defense. To help a client maintain healthy skin, the nurse should avoid strong or harsh detergents and should use mild soap. The nurse shouldnt remove adhesive tape quickly because this action can strip or scrape the skin. The nurse should recommend wearing loosefitting not tight-fitting clothes in hot weather to promote heat loss by evaporation.

2. A male client with psoriasis visits the dermatology clinic. When inspecting the affected areas, the nurse expects to see which type of secondary lesion? a. Scale b. Crust c. Ulcer d. Scar
Answer A. A scale is the characteristic secondary lesion occurring in psoriasis. Although crusts, ulcers, and scars also are secondary lesions in skin disorders, they dont accompany psoriasis. 3. A female adult client with atopic dermatitis is prescribed a potent topical corticosteroid, to be

covered with an occlusive dressing. To address a potential client problem associated with this treatment, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement, the nurse should add which related-to phrase? a. Related to potential interactions between the topical corticosteroid and other prescribed drugs b. Related to vasodilatory effects of the topical corticosteroid c. Related to percutaneous absorption of the topical corticosteroid d. Related to topical corticosteroid application to the face, neck, and intertriginous sites
Answer C. A potent topical corticosteroid may increase the clients risk for injury because it may be absorbed percutaneously, causing the same adverse effects as systemic corticosteroids. Topical corticosteroids arent involved in significant drug interactions. These preparations cause vasoconstriction, not vasodilation. A potent topical corticosteroid rarely is prescribed for use on the face, neck, or intertriginous sites because application on these areas may lead to increased adverse effects. 4. Nurse Bea plans to administer dexamethasone cream to a client who has dermatitis over the

anterior chest How should the nurse apply this topical agent?

a. With a circular motion, to enhance absorption b. With an upward motion, to increase blood supply to the affected area c. In long, even, outward, and downward strokes in the direction of hair growth d. In long, even, outward, and upward strokes in the direction opposite hair growth
Answer C. When applying a topical agent, the nurse should begin at the midline and use long, even, outward, and downward strokes in the direction of hair growth. This application pattern reduces the risk of follicle irritation and skin inflammation. 5. A female client sees a dermatologist for a skin problem. Later, the nurse reviews the clients

chart and notes that the chief complaint was intertrigo. This term refers to which condition? a. Spontaneously occurring wheals b. A fungus that enters the skins surface, causing infection c. Inflammation of a hair follicle d. Irritation of opposing skin surfaces caused by friction
Answer D. Intertrigo refers to irritation of opposing skin surfaces caused by friction. Spontaneously occurring wheals occur in hives. A fungus that enters the skin surface and causes infection is a dermatophyte. Inflammation of a hair follicle is called folliculitis. 6. A male client visits the physicians office for treatment of a skin disorder. As a primary

treatment, the nurse expects the physician to prescribe: a. an I.V. corticosteroid. b. an I.V. antibiotic. c. an oral antibiotic. d. a topical agent.
Answer D. Although many drugs are used to treat skin disorders, topical agents not I.V. or oral agents are the mainstay of treatment. 7. The nurse is providing home care instructions to a client who has recently had a skin graft. Its

most important that the client remember to: a. use cosmetic camouflage techniques. b. protect the graft from direct sunlight. c. continue physical therapy. d. apply lubricating lotion to the graft site.
Answer B. To avoid burning and sloughing, the client must protect the graft from direct sunlight. The other three interventions are helpful to the client and his recovery but are less important.

8. A female client with atopic dermatitis is prescribed medication for photochemotherapy. The

nurse teaches the client about the importance of protecting the skin from ultraviolet light before drug administration and for 8 hours afterward and stresses the need to protect the eyes. After administering medication for photochemotherapy, the client must protect the eyes for: a. 4 hours. b. 8 hours. c. 24 hours. d. 48 hours.
Answer D. To prevent eye discomfort, the client must protect the eyes for 48 hours after taking medication for photochemotherapy. Protecting the eyes for a shorter period increases the risk of eye injury. 9. . A male client schedule for a skin biopsy is concerned and asks the nurse how painful the

procedure is. The appropriate response by the nurse is: a. There is no pain associated with this procedure b. The local anesthetic may cause a burning or stinging sensation c. A preoperative medication will be given so you will be sleeping and will not feel any pain d. There is some pain, but the physician will prescribe an opioid analgesic following the procedure
Answer B. Depending on the size and location of the lesion, a biopsy is usually a quick and almost painless procedure. The most common source of pain is the initial local anesthetic, which can produce a burning or stinging sensation. Preoperative medication is not necessary with this procedure. 10. An older clients physical examination reveals the presence of a number of bright red-colored

lesions scattered on the trunk and tights. The nurse interprets that this indicates which of the following lesions due to alterations in blood vessels of the skin? a. Cherry angioma b. Spider angioma c. Venous star d. Purpura
Answer A. Cherry angioma occurs with increasing age and has no clinical significance. It appears as a small, round, bright redcolored lesion on the trunk or extremities. Spider angiomas have a bright red center with legs that radiate outward. These lesions commonly are seen in liver disease and vitamin B deficiency, although they occasionally can occur without underlying pathology. A venous star results from increased pressure in veins, usually in the lower legs, and has an irregularly shaped bluish center with radiating branches. Purpura results from hemorrhage into the skin.

11. A nurse is reviewing the medical record of a male client to be admitted to the nursing unit

and notes documentation of reticular skin lesions. The nurse expects that these lesions will appear to be: a. Ring-shaped b. Linear c. Shaped like an arc d. Net-like appearance
Answer D. Reticular skin lesions resemble a net in appearance. Annular lesions are ring-shaped, whereas linear lesions appear in a straight line. Arciform lesions are shaped like an arc. 12. The clinic nurse assesses the skin of a white characteristic is associated with this skin

disorder? a. Clear, thin nail beds b. Red-purplish scaly lesions c. Oily skin and no episodes of pruritus d. Silvery-white scaly patches on the scalp, elbow, knees, and sacral regions
Answer D. Cellulitis is a skin infection into deeper dermal and subcutaneous tissues that results in a deep red erythema without sharp borders and spreads widely throughout tissue spaces. Warm compresses may be used to decrease the discomfort, erythema, and edema. After tissue and blood cultures are obtained, antibiotics will be initiated. The nurse should provide supportive care as prescribed to manage symptoms such as fatigue, fever, chills, headache, and myalgia. Heat lamps can cause more disruption to already inflamed tissue. Cold compresses and alternating cold and hot compresses are not the best measures. 13. A client is admitted to the hospital with an exacerbation of her chronic systemic lupus

erythematosus (SLE). She gets angry when her call bell isnt answered immediately. The most appropriate response to her would be: A. You seem angry. Would you like to talk about it? B. Calm down. You know that stress will make your symptoms worse. C. Would you like to talk about the problem with the nursing supervisor? D. I can see youre angry. Ill come back when youve calmed down.
ANSWER: A Verbalizing the observed behavior is a therapeutic communication technique in which the nurse acknowledges what the client is feeling. Offering to listen to the client express her anger can help the nurse and the client understand its cause and begin to deal with it. Although stress can exacerbate the symptoms of SLE, telling the client to calm down doesnt acknowledge her feelings. Offering to get

the nursing supervisor also doesnt acknowledge the clients feelings. Ignoring the clients feelings suggest that the nurse has no interest in what the client has said. 14. A 28 yr-old nurse has complaints of itching and a rash of both hands. Contact dermatitis is

initially suspected. The diagnosis is confirmed if the rash appears: A. erythematous with raised papules B. dry and scaly with flaking skin C. inflamed with weeping and crusting lesions D. excoriated with multiple fissures
ANSWER: A Contact dermatitis is caused by exposure to a physical or chemical allergen, such as cleaning products, skin care products, and latex gloves. Initial symptoms of itching, erythema, and raised papules occur at the site of the exposure and can begin within 1 hour of exposure. Allergic reactions tend to be red and not scaly or flaky. Weeping, crusting lesions are also uncommon unless the reaction is quite severe or has been present for a long time. Excoriation is more common in skin disorders associated with a moist environment. 15. a 45-yr-old auto mechanic comes to the physicians office because an exacerbation of his

psoriasis is making it difficult to work. He tells the nurse that his finger joints are stiff and sore in the morning. The nurse should respond by: A. Inquiring further about this problem because psoriatic arthritis can accompany psoriasis vulgaris B. Suggesting he take aspirin for relief because its probably early rheumatoid arthritis C. Validating his complaint but assuming its an adverse effect of his vocation D. Asking him if he has been diagnosed or treated for carpal tunnel syndrome
ANSWER: A Anyone with psoriasis vulgaris who reports joint pain should be evaluated for psoriaic arthritis. Approximately 15% to 20% of individuals with psoriasis will also develop psoriatic arthritis, which can be painful and cause deformity. It would be incorrect to assume that his pain is caused by early rheumatoid arthritis or his vocation without asking more questions or performing diagnostic studies. Carpal tunnel syndrome causes sensory and motor changes in the fingers rather than localized pain in the joints. 16. You give an intradermal injection of allergen to a patient who is undergoing skin testing for

allergies. A few minutes later, the patient complains about feeling anxious, short of breath, and dizzy. You notice that the patient has reddened blotches on the face and arms. All of these therapies are available on your emergency cart. Which action should you take first? a. Start oxygen at 4 L/min using a nasal cannula. b. Obtain IV access with a large-bore IV catheter.

c. Administer epinephrine (Adrenalin) 0.3 mL subcutaneously d. Give albuterol (Proventil) with a nebulizer
ANSWER C Epinephrine given rapidly at the onset of an anaphylactic reaction may prevent or reverse cardiovascular collapse as well as airway narrowing caused by bronchospasm and inflammation. Oxygen use is also appropriate, but generally is administered using a non-rebreather mask at 90%-100% Fio2 Albuterol may also be used to decrease airway narrowing, but would not be the first therapy used for anaphylaxis. An IV access will take longer to establish and should not be the first intervention. 17. An 18-year-old college student with an exacerbation of systemic lupus erythematosus (SLE)

has been receiving prednisone (Deltasone) 20 mg daily for 4 hours. Which of these medical orders should you question? a. Discontinue prednisone after todays dose. b. Administer first dose of varicella vaccine. c. Check patients C-reactive protein (CRP). d. Give Ibuprofen (Advil) 800 mg every 6 hours.
ANSWER B The varicella (chickenpox) vaccine is a live-virus vaccine and should not be administered to patients who are receiving immunosuppressive medications such as prednisone. The other medical orders are appropriate. Prednisone dose should be tapered gradually when patients have been on longterm steroid therapy, but tapering is not necessary for short-term prednisone use. CRP levels are not the most specific test for monitoring treatment but are inexpensive and frequently used. High does of NSAIDs such as ibuprofen are more likely to cause side effects such as gastrointestinal bleeding but are useful in treating the joing pain associated with SLE exacerbations. 18. While caring for an HIV-positive patient who is hospitalized with Pneumocystis carinii

pneumonia, you note that all of these drug therapies are scheduled for 10:00 AM. Which nursing action is most essential to accomplish at the scheduled time? a. Administer the protease inhibitor indinavir (Crixivan) 800 mg PO. b. Infuse pentamidine (Pentam-300) 300 mg IV over 60 minutes. c. Have the patient swish and swallow nystatin (Mycostatin) 5 mL. d. Apply acyclovir (Zovirax) cream to oral herpes simplex lesions.
ANSWER A - Taking antiretroviral medications such as indinavir on a rigid time schedule is essential for effective treatment of HIV infection and to avoid development of drug resistant-strains of the virus. The other medications should also be given within the time frame indicated in the hospital policy (usually within 30 minutes of the scheduled time). 19. You are working in an AIDS hospice facility that is also staffed with LPNs and nursing

assistants. Which of these nursing actions is best to delegate to an LPN you are supervising?

a. Assess patients nutritional needs and individualize diet plans to improve nutrition. b. Collect data about the patients response to medications used for pain and anorexia. c. Teach the nursing assistants about how to lower the risk for spreading infections. d. Assist patients with personal hygiene and other activities of daily living as needed.
ANSWER B Collecting data used to evaluate the therapeutic and adverse effects of medications is included in LPN/LVN education and scope of practice. Assessment, planning, and teaching are more complex skills that will require RN education. Assistance with hygiene and activities of daily living should be delegated to the nursing assistants. 20. You are completing an assessment and health history for an HIV-positive patient who is

considering starting antiretroviral therapy with several medications. Which patient information concerns you the most? a. Patient has been HIV positive for 8 years and has never been on any drug therapy for the HIV infection. b. Patient tells you that he never has been very consistent about taking medications in the past. c. Patient continues to be sexually active with multiple partners and says that he is careful to use condoms. d. Patient has many questions and concerns regarding how effective and safe the medications are.
ANSWER B Drug therapy for HIV infection requires taking multiple medications on a very consistent schedule. Failure to take the medications consistently can lead to mutations and the emergence of more virulent forms of the virus. Although the other data indicate the need for further assessments or interventions, they will not affect the decision to initiate antiretroviral therapy for this patient.