A
1. A nurse practitioner is seeing a 16-year-old client who has come to the dermatology
clinic for treatment of acne. The nurse practitioner would know that the treatment may
consist of which of the following medications?
A. Acyclovir
B. Benzoyl peroxide and erythromycin
C. Diphenhydramine
D. Triamcinolone
ANS: B
Rationale: Benzoyl peroxide and erythromycin gel is among the topical treatments
available for acne. Acyclovir is used in the treatment of herpes zoster as an oral antiviral
agent. Diphenhydramine is an oral antihistamine used in the treatment of pruritus.
Intralesional injections of triamcinolone have been utilized in the treatment of psoriasis.
A nurse is caring for a client who has been diagnosed with psoriasis. The nurse is
creating an education plan for the client. What information should be included in this
plan?
A. Lifelong management is likely needed.
B. Avoid public places until symptoms subside.
C. Wash skin frequently to prevent infection.
D. Liberally apply corticosteroids as needed.
ANS: A
Rationale: Psoriasis usually requires lifelong management. Psoriasis is not contagious.
Many clients need reassurance that the condition is not infectious, not a reflection of poor
personal hygiene, and not skin cancer. Excessive frequent washing of skin produces more
soreness and scaling. Overuse of topical corticosteroids can result in skin atrophy, striae,
and medication resistance.
3. A nurse is planning the care of a client with herpes zoster. What medication, if given within the first 24 hours of the initial eruption, can arrest herpes zoster?
A. Prednisone
B. Azathioprine
C. Triamcinolone
D. Acyclovir
ANS: D
Rationale: Acyclovir, if started early, is effective in significantly reducing the pain and
halting the progression of the disease. There is evidence that infection is arrested if oral
antiviral agents are given within the first 24 hours. Prednisone is an anti-inflammatory
agent used in a variety of skin disorders, but not in the treatment of herpes. Azathioprine
is an immunosuppressive agent used in the treatment of pemphigus. Triamcinolone is
utilized in the treatment of psoriasis.
A client with squamous cell carcinoma has been scheduled for treatment of this
malignancy. The nurse should anticipate that treatment for this type of cancer will
primarily consist of what intervention?
A. Chemotherapy
B. Radiation therapy
C. Surgical excision
D. Biopsy of sample tissue
ANS: C
Rationale: The primary goal of surgical management of squamous cell carcinoma is to
remove the tumor entirely. Radiation therapy is reserved for older clients, because x-ray
changes may be seen after 5 to 10 years, and malignant changes in scars may be induced
by irradiation 15 to 30 years later. Obtaining a biopsy would not be a goal of treatment;
it may be an assessment. Chemotherapy and radiation therapy are generally reserved for
clients who are not surgical candidates.
5. A client who has sustained third-degree facial burns and a facial fracture is undergoing
reconstructive surgery and implantation of a prosthesis. The nurse has identified a
nursing diagnosis of Low Self Esteem related to use of facial prosthetic secondary to
reconstructive surgery. Which nursing intervention would be appropriate for this
diagnosis?
A. Referring the client to a speech therapist
B. Gradually adding soft foods to diet
C. Administering analgesics as prescribed
D. Teaching the client how to use and care for the prosthesis
ANS: D
Rationale: The process of facial reconstruction is often slow and tedious. Because a
person's facial appearance affects self-esteem so greatly, this type of reconstruction is
often a very emotional experience for the client. Reinforcement of the client's successful
coping strategies improves self-esteem. If prosthetic devices are used, the client is
taught how to use and care for them to gain a sense of greater independence. This is an
intervention that relates to Disturbed Body Image in these clients. None of the other
listed interventions relate directly to the diagnosis of Disturbed Body Image.
While performing an initial assessment of a client admitted with appendicitis, the nurse
observes an elevated blue-black lesion on the client's ear. The nurse knows that this
lesion is consistent with what type of skin cancer?
A. Basal cell carcinoma
B. Squamous cell carcinoma
C. Dermatofibroma
D. Malignant melanoma
ANS: D
Rationale: A malignant melanoma presents itself as a superficial spreading melanoma
which may appear in a combination of colors, with hues of tan, brown, and black mixed
with gray, blue-black, or white. The lesion tends to be circular, with irregular outer
portions. BCC usually begins as a small, waxy nodule with rolled, translucent, pearly
borders; telangiectatic vessels may be present. SCC appears as a rough, thickened, scaly
tumor that may be asymptomatic or may involve bleeding. A dermatofibroma presents as
a firm, dome-shaped papule or nodule that may be skin colored or pinkish brown.
A nurse is providing care for a client who has developed Kaposi sarcoma secondary to
HIV infection. The nurse should be aware that this form of malignancy originates in what
part of the body?
A. Connective tissue cells in diffuse locations
B. Smooth muscle cells of the gastrointestinal and respiratory tract
C. Neural tissue of the brain and spinal cord
D. Endothelial cells lining small blood vessels
ANS: D
Rationale: Kaposi sarcoma (KS) is a malignancy of endothelial cells that line the small
blood vessels. It does not originate in connective tissue, smooth muscle cells of the GI
and respiratory tract, or in neural tissue.
8. A client requires a full-thickness graft to cover a chronic wound. How is the donor site
selected?
A. The largest area of the body without hair is selected.
B. Any area that is not normally visible can be used.
C. An area matching the color and texture of the skin at the surgical site is selected.
D. An area matching the sensory capability of the skin at the surgical site is
selected.
ANS: C
Rationale: The site where the intact skin is harvested is called the donor site. Selection of
the donor site is made to match the color and texture of skin at the surgical site and to
leave as little scarring as possible.
9. A client has just been told that he has deep malignant melanoma. The nurse caring for
this client should anticipate that the client will undergo what treatment?
A. Chemotherapy
B. Immunotherapy
C. Wide excision
D. Radiation therapy
ANS: C
Rationale: Wide excision is the primary treatment for malignant melanoma, which
removes the entire lesion and determines the level and staging. Chemotherapy may be
used after the melanoma is excised. Immunotherapy is experimental and radiation
therapy is palliative.
A nurse is leading a health promotion workshop that is focusing on cancer prevention.
What action is most likely to reduce participants' risks of basal cell carcinoma (BCC)?
A. Teaching participants to improve their overall health through nutrition
B. Encouraging participants to identify their family history of cancer
C. Teaching participants to limit their sun exposure
D. Teaching participants to control exposure to environmental and occupational
radiation
ANS: C
Rationale: Sun exposure is the best known and most common cause of BCC. BCC is not
commonly linked to general health debilitation, family history, or radiation exposure.
A client diagnosed with a stasis ulcer has been hospitalized. There is an order to
change the dressing and provide wound care. Which activity should the nurse first
perform when providing wound care?
A. Assess the drainage in the dressing.
B. Slowly remove the soiled dressing.
C. Perform hand hygiene.
D. Don nonlatex gloves.
ANS: C
Rationale: The nurse and health care provider must adhere to standard precautions and
wear gloves when inspecting the skin or changing a dressing. Use of standard
precautions and proper disposal of any contaminated dressing is carried out according to
Occupational Safety and Health Administration (OSHA) regulations. Hand hygiene must
precede other aspects of wound care.
12. A client comes to the clinic reporting a red rash of small, fluid-filled blisters and is
suspected of having herpes zoster. What presentation is most consistent with this
diagnosis?
A. Grouped vesicles occurring on lips and oral mucous membranes
B. Grouped vesicles occurring on the genitalia
C. Rough, fresh, or gray skin protrusions
D. Grouped vesicles in linear patches along a dermatome
ANS: D
Rationale: Herpes zoster, or shingles, is an acute inflammation of the dorsal root ganglia,
causing localized, vesicular skin lesions following a dermatome. Herpes simplex type 1 is
a viral infection affecting the skin and mucous membranes, usually producing cold sores
or fever blisters. Herpes simplex type 2 primarily affects the genital area, causing painful
clusters of small ulcerations. Warts appear as rough, fresh, or gray skin protrusions.
13. A nurse is preparing to assist a surgeon in a skin grafting procedure. What can a skin
graft can be used for?
A. Denuded skin after burns.
B. Slow healing wounds.
C. Uncomplicated wound closure.
D. Infected wounds.
ANS: A
Rationale: Skin grafts are commonly used to repair surgical defects such as those that
result from excision of skin tumors, to cover areas denuded of skin (e.g., burns), and to
cover wounds in which insufficient skin is available to permit wound closure. They are
also used when primary closure of the wound increases the risk of complications or when
primary wound closure would interfere with function. It is not used for uncomplicated
wound closure. Skin grafts are not used for infected wounds.
14. A client presents at the free clinic with a black, wart-like lesion on his face, stating,
"I've done some research, and I'm pretty sure I have malignant melanoma." Subsequent
diagnostic testing results in a diagnosis of seborrheic keratosis. The nurse should
recognize what significance of this diagnosis?
A. The client requires no treatment unless he finds the lesion to be cosmetically
unacceptable.
B. The client's lesion will be closely observed for 6 months before a plan of
treatment is chosen.
C. The client has one of the few dermatologic malignancies that respond to
chemotherapy.
D. The client will likely require wide excision.
ANS: A
Rationale: Seborrheic keratoses are benign, wart-like lesions of various sizes and colors,
ranging from light tan to black. There is no harm in allowing these growths to remain
because there is no medical significance to their presence.
A nurse is providing care for a client who has psoriasis. Following the appearance of
skin lesions, the nurse should prioritize what assessment?
A. Assessment of the client's stool for evidence of intestinal sloughing
B. Assessment of the client's apical heart rate for dysrhythmias
C. Assessment of the client's joints for pain and decreased range of motion
D. Assessment for cognitive changes resulting from neurologic lesions
ANS: C
Rationale: Asymmetric rheumatoid factor–negative arthritis of multiple joints occurs in
up to 42% of people with psoriasis, most typically after the skin lesions appear. The most
typical joints affected include those in the hands or feet, although sometimes larger joints
such as the elbow, knees, or hips may be affected. As such, the nurse should assess for
this musculoskeletal complication. GI, cardiovascular, and neurologic function are not
affected by psoriasis.
16. A client is admitted to the intensive care unit with what is thought to be toxic
epidermal necrolysis (TEN). When assessing the health history of the client, the nurse
would be alert to what precipitating factor?
A. Recent heavy ultraviolet exposure
B. Substandard hygienic conditions
C. Recent administration of new medications
D. Recent varicella infection
ANS: C
Rationale: In adults, TEN is usually triggered by a reaction to medications. Antibiotics,
anticonvulsant agents, butazones, and sulfonamides are the most frequent medications
implicated. TEN is unrelated to UV exposure, hygiene, or varicella infection.
A client has received a diagnosis of irritant contact dermatitis. What action should the
nurse prioritize in the client's subsequent care?
A. Teaching the client to safely and effectively administer immunosuppressants
B. Helping the client identify and avoid the offending agent
C. Teaching the client how to maintain meticulous skin hygiene
D. Helping the client perform wound care in the home environment
ANS: B
Rationale: A focus of care for clients with irritant contact dermatitis is identifying and
avoiding the offending agent. Immunosuppressants are not used to treat eczema and
wound care is not normally required, except in cases of open lesions. Poor hygiene has no
correlation with contact dermatitis.
A nurse is caring for a client whose chemical injury has necessitated a skin graft to the
client’s left hand. Which statement is true regarding skin graft use?
A. This use is not a type of reconstruction.
B. Skin grafts form their own blood supply.
C. They are only transplanted from another doner.
D. Skin is transferred from a distant site to the graft site.
ANS: D
Rationale: Skin grafting is a technique in which a section of skin is detached from its own
blood supply and transferred as free tissue to a distant (recipient) site. Skin grafting can
be used to repair almost any type of wound and is the most common form of
reconstructive surgery.
A school nurse has sent home four children who show evidence of pediculosis capitis.
What is an important instruction the nurse should include in the note being sent home to
parents?
A. The child's scalp should be monitored for 48 to 72 hours before starting
treatment.
B. Nits may have to be manually removed from the child's hair shafts.
C. The disease is self-limiting and symptoms will abate within 1 week.
D. Efforts should be made to improve the child's level of hygiene.
ANS: B
Rationale: Treatment for head lice should begin promptly and may require manual
removal of nits following medicating shampoo. Head lice are not related to a lack of
hygiene. Treatment is necessary because the condition will not likely resolve
spontaneously within 1 week.
A client has just been diagnosed with psoriasis and frequently has lesions around his
right eye. What should the nurse teach the client about topical corticosteroid use on these
lesions?
A. Cataract development is possible.
B. The ointment is likely to cause weeping.
C. Corticosteroid use is contraindicated on these lesions.
D. The client may develop glaucoma.
ANS: A
Rationale: Clients using topical corticosteroid preparations repeatedly on the face and
around the eyes should be aware that cataract development is possible. Weeping and
glaucoma are less likely. There is no consequent risk of glaucoma.
A nurse is caring for a client who has a diagnosis of bullous pemphigoid and who is
being treated on the medical unit. The nurse knows that systemic treatment will most
likely include which element?
A. Corticosteroid therapy
B. Skin biopsy
C. Topical corticosteroids
D. Penicillin therapy
ANS: A
Rationale: Treatment for bullous pemphigoid includes system corticosteroid therapy.
This would not include skin biopsy as this is for diagnostics. Topical corticosteroids don't
treat systemically. The goal of therapy is to respond to inflammation, not to treat infection.
22. A client's blistering disorder has resulted in the formation of multiple lesions in the
client's mouth. What intervention should be included in the client's plan of care?
A. Provide chlorhexidine solution for rinsing the client's mouth.
B. Avoid providing regular mouth care until the client's lesions heal.
C. Liaise with the primary provider to arrange for parenteral nutrition.
D. Encourage the client to gargle with a hypertonic solution after each meal.
ANS: A
Rationale: Frequent rinsing of the mouth with chlorhexidine solution is prescribed to rid
the mouth of debris and to soothe ulcerated areas. A hypertonic solution would be likely
to cause pain and further skin disruption. Meticulous mouth care should be provided and
there is no reason to provide nutrition parenterally.
When caring for a client with toxic epidermal necrolysis (TEN), the critical care nurse
assesses frequently for high fever, tachycardia, and extreme weakness and fatigue. The
nurse is aware that these findings are potential indicators of what condition(s)? Select all
that apply.
A. Possible malignancy
B. Epidermal necrosis
C. Neurologic involvement
D. Increased metabolic needs
E. Possible gastrointestinal mucosal sloughing
ANS: B, D, E
Rationale: Assessment for high fever, tachycardia, and extreme weakness and fatigue is
essential because these factors indicate the process of epidermal necrosis, increased
metabolic needs, and possible gastrointestinal and respiratory mucosal sloughing. These
factors are less likely to suggest malignancy or neurologic involvement, as these are not
common complications of TEN.
24. A nurse is assessing a teenage client with acne vulgaris. The client's mother states, "I
keep telling him that this is what happens when you eat as many french fries as he does."
What aspect of the pathophysiology of acne should inform the nurse's response?
A. A sudden change in client's diet may exacerbate, rather than alleviate, the
client's symptoms.
B. French fries are one of the foods that are known to directly cause acne.
C. Elimination of fried foods from the client's diet will likely lead to resolution within
several months.
D. Diet is thought to play a minimal role in the development of acne.
ANS: D
Rationale: Diet is not believed to play a major role in acne therapy. A change in diet is not
known to exacerbate symptoms. However, there does appear to be a correlation between
foods high in refined sugars and acne; therefore, these foods should be avoided.
25. A nurse is providing self-care education to a client who has been receiving treatment
for acne vulgaris. What instruction should the nurse provide to the client?
A. "Wash your face with water and gentle soap each morning and evening."
B. "Before bedtime, clean your face with rubbing alcohol on a cotton pad."
C. "Gently burst new pimples before they form a visible 'head'."
D. "Set aside some time each day to squeeze blackheads and remove the plug."
ANS: A
Rationale: The nurse should inform the client to wash the face and other affected areas
with mild soap and water twice each day to remove surface oils and prevent obstruction
of the oil glands. Cleansing with rubbing alcohol is not recommended and all forms of
manipulation should be avoided.