NCLEX Integumentary Disorders Practice Exam
A nurse is assessing a patient with a stage 2 pressure ulcer. Which of the following is the most appropriate description?
Full-thickness tissue loss with exposed bone
B. Partial-thickness skin loss with exposed dermis
C. Full-thickness tissue loss without exposed bone
D. Reddened skin without open wounds
A patient is admitted with a burn injury to 30% of the body. Which of the following is the priority in the immediate post-burn period?
Pain management
B. Fluid resuscitation
C. Wound debridement
D. Psychological support
Which of the following is the best indicator of tissue perfusion in a patient with a burn injury?
Blood pressure
B. Urine output
C. Heart rate
D. Respiratory rate
A nurse is caring for a patient with a fungal infection of the skin. Which of the following medications is commonly used to treat dermatophyte infections?
Amphotericin B
B. Clotrimazole
C. Acyclovir
D. Vancomycin
Which of the following is a common complication of third-degree burns?
Hypothermia
B. Hypervolemia
C. Respiratory distress
D. Hypertension
A patient with eczema has been prescribed a topical corticosteroid. Which of the following should the nurse monitor for?
Hypokalemia
B. Hyperglycemia
C. Hypotension
D. Bradycardia
The nurse is assessing a patient with shingles. Which area is most likely to be affected by the herpes zoster virus?
Chest and abdomen
B. Lower extremities
C. Upper arms
D. Face and ears
A nurse is educating a patient with psoriasis about the disease process. Which statement by the patient indicates understanding?
“Psoriasis is caused by a viral infection.”
B. “The rash will go away with antibiotics.”
C. “It is a chronic, autoimmune disease.”
D. “Psoriasis can be cured with topical creams.”
A nurse is teaching a patient with acne vulgaris about proper skin care. Which of the following statements is appropriate?
“You should wash your face with hot water to open up your pores.”
B. “You should use oil-based skin products to moisturize your face.”
C. “You should avoid scrubbing your skin aggressively.”
D. “You should apply strong astringents to dry out your skin.”
Which of the following is a characteristic of a basal cell carcinoma?
Irregular, raised border with a central ulcer
B. Flat, brown, or black lesions with irregular borders
C. Raised, scaly lesion with silvery appearance
D. Dark-colored, raised moles that itch
A nurse is caring for a patient with impetigo. Which of the following is the priority intervention?
Administering antibiotics
B. Keeping the patient isolated from others
C. Applying topical corticosteroids
D. Keeping the affected area moisturized
A patient presents with an erythematous rash, a fever, and fatigue. The patient’s history includes recent exposure to someone with measles. The nurse suspects measles. Which of the following is a classic sign of measles?
Koplik spots
B. Honey-colored crusts
C. Red, raised lesions on the face and neck
D. Scaly, silvery patches
A nurse is caring for a patient with a severe sunburn. Which of the following interventions should the nurse prioritize?
Apply ice packs to the affected areas
B. Administer analgesics as prescribed
C. Apply corticosteroid cream to the skin
D. Restrict fluid intake
A nurse is caring for a patient with a stage 3 pressure ulcer. Which of the following is the most important aspect of the plan of care?
Debriding the ulcer
B. Providing adequate nutrition
C. Keeping the ulcer dry and free from infection
D. Using hydrocolloid dressings
A nurse is caring for a patient who has been diagnosed with cellulitis. Which of the following is the priority nursing intervention?
Apply warm compresses to the affected area
B. Encourage increased fluid intake
C. Administer oral antibiotics as prescribed
D. Keep the affected area elevated
A patient with a history of chronic venous insufficiency has developed an ulcer on the lower leg. Which of the following is the most appropriate action to promote healing?
Keep the leg elevated to reduce swelling
B. Apply pressure to the ulcer with a tight bandage
C. Use a heating pad to increase blood flow
D. Massage the area to promote circulation
A nurse is caring for a patient with a suspected allergic contact dermatitis. Which of the following should the nurse avoid using on the patient’s skin?
Calamine lotion
B. Petroleum jelly
C. Aloe vera gel
D. Hydrocortisone cream
A patient has been diagnosed with scabies. Which of the following treatments is appropriate?
Oral acyclovir
B. Topical permethrin
C. Topical antifungal cream
D. Oral prednisone
A nurse is caring for a patient with a large mole that has irregular borders, asymmetry, and multiple colors. The nurse suspects melanoma. Which of the following is the next step in management?
Perform a biopsy of the mole
B. Apply a topical corticosteroid
C. Monitor the mole for changes
D. Remove the mole surgically
A nurse is educating a patient on how to prevent pressure ulcers. Which of the following is the most important recommendation?
Reposition the patient at least every 2 hours
B. Use a donut-shaped cushion when sitting
C. Massage bony prominences to improve circulation
D. Keep the patient in one position for long periods
A patient with a recent burn injury is at risk for infection. Which of the following should the nurse monitor for?
Hypotension
B. Decreased white blood cell count
C. Redness and warmth at the wound site
D. Decreased urine output
A patient with a deep partial-thickness burn (second-degree) is at risk for hypovolemic shock. Which of the following signs should the nurse prioritize monitoring?
Bradycardia
B. Increased blood pressure
C. Decreased urine output
D. Increased respiratory rate
A patient with a history of recurrent cold sores is diagnosed with herpes simplex virus. Which of the following treatments is most appropriate?
Topical antiviral creams
B. Systemic antibiotics
C. Antihistamines
D. Topical corticosteroids
A nurse is caring for a patient with a dermatological condition. The patient asks about using sunscreen. Which SPF level should the nurse recommend for adequate protection?
SPF 15
B. SPF 30
C. SPF 50
D. SPF 100
A nurse is educating a patient with eczema on proper skin care. Which of the following instructions is most important?
“Apply a thick layer of moisturizer immediately after bathing.”
B. “Avoid using soap, but use water instead.”
C. “Take long, hot showers to relieve itching.”
D. “Wear tight, synthetic fabrics to reduce irritation.”
A nurse is caring for a patient who has been diagnosed with tinea corporis. Which of the following is the most appropriate treatment?
Topical antifungal medications
B. Topical corticosteroids
C. Oral antibiotics
D. Oral antiviral medications
A nurse is caring for a patient with atopic dermatitis. Which of the following is the priority in the nursing plan of care?
Apply moisturizers frequently
B. Keep the skin exposed to sunlight
C. Use astringents to dry the skin
D. Limit fluid intake to reduce swelling
A patient with a history of basal cell carcinoma is at increased risk for which of the following?
Squamous cell carcinoma
B. Melanoma
C. Keloid formation
D. Fungal skin infections
A nurse is teaching a patient with a sunburn about the best approach to healing. Which of the following should the nurse emphasize?
Apply ice to the affected areas frequently
B. Take warm baths to soothe the skin
C. Drink plenty of fluids to rehydrate the body
D. Apply a topical corticosteroid cream immediately
A nurse is caring for a patient with a burn injury. Which of the following is a priority action?
Administer intravenous fluids
B. Apply topical antibiotics
C. Provide pain relief
D. Assess for signs of respiratory distress
A nurse is caring for a patient with a stage 1 pressure ulcer. Which of the following is the most appropriate action for the nurse to take?
Clean the area with hydrogen peroxide
B. Administer systemic antibiotics
C. Apply a moist dressing to the ulcer
D. Reposition the patient frequently to relieve pressure
A patient with melanoma has a lesion that is asymmetrical and irregularly bordered. Which of the following is the priority action?
Monitor the lesion for any changes
B. Perform a biopsy of the lesion
C. Apply topical steroids to reduce inflammation
D. Educate the patient on proper sun protection
A nurse is caring for a patient with impetigo. Which of the following interventions is the nurse’s priority?
Administering oral antibiotics as prescribed
B. Applying wet dressings to the skin
C. Providing education on skin hygiene
D. Initiating isolation precautions
A patient with psoriasis asks the nurse about triggers for flare-ups. Which of the following should the nurse include in the teaching?
Excessive exercise
B. Stress and illness
C. Overhydration
D. Low-fat diet
A nurse is caring for a patient with a fungal infection of the skin. Which of the following medications is most commonly prescribed?
Vancomycin
B. Clotrimazole
C. Acyclovir
D. Penicillin
A nurse is caring for a patient with an eczema flare-up. Which of the following interventions is most appropriate?
Keep the skin dry and cracked
B. Encourage the use of fragrance-free moisturizers
C. Apply hot compresses to the affected area
D. Wash the affected area with soap and water
Which of the following is a common complication of long-term steroid use in patients with dermatological conditions?
Hyperkalemia
B. Hypoglycemia
C. Osteoporosis
D. Hypertension
A nurse is educating a patient with scabies. Which of the following statements by the patient indicates understanding of the treatment plan?
“I will wash all clothing and bedding in hot water.”
B. “I will avoid using the topical medication.”
C. “The rash will go away without any treatment.”
D. “I can stop the treatment once the rash is gone.”
A nurse is caring for a patient who has developed a pressure ulcer. Which of the following is an important aspect of preventing further complications?
Maintain a moist environment to facilitate healing
B. Use hot compresses to stimulate circulation
C. Apply a topical antibiotic to the ulcer
D. Administer analgesics for pain relief only
A nurse is caring for a patient with acute urticaria (hives). Which of the following is the priority nursing action?
Administer an antihistamine as prescribed
B. Apply cold compresses to the skin
C. Encourage the patient to avoid scratching
D. Monitor for signs of airway obstruction
Which of the following is a hallmark characteristic of basal cell carcinoma?
Raised, pearly appearance with central ulceration
B. Scaly, red, and dry appearance
C. Smooth, firm, skin-colored nodule
D. Rough, irregular borders with multicolored patches
A nurse is caring for a patient with seborrheic dermatitis. Which of the following treatments is most commonly prescribed for this condition?
Topical antifungal creams
B. Oral antibiotics
C. Topical corticosteroids
D. Oral antivirals
A nurse is teaching a patient about wound care for a pressure ulcer. Which of the following is the most important instruction?
Clean the wound with soap and water daily
B. Use a dry dressing to keep the wound free from moisture
C. Reposition every 2 hours to relieve pressure
D. Apply ointment to the wound to speed up healing
A patient has been diagnosed with cellulitis. Which of the following signs and symptoms is most characteristic of this condition?
Localized redness, warmth, and swelling
B. Shiny, scaly, and itchy skin
C. Blisters filled with clear fluid
D. Dry, cracked skin with no redness
A nurse is caring for a patient with herpes zoster (shingles). Which of the following is the priority nursing intervention?
Administering an antiviral medication
B. Encouraging fluid intake to prevent dehydration
C. Applying cold compresses to the affected areas
D. Keeping the patient in a dark, quiet room to rest
A patient has been diagnosed with tinea cruris. Which of the following treatments is appropriate?
Oral antibiotics
B. Topical antifungal treatment
C. Topical corticosteroids
D. Oral corticosteroids
A nurse is caring for a patient with a deep partial-thickness burn. Which of the following should the nurse monitor for in the first 24 hours?
Fluid overload
B. Respiratory distress
C. Signs of shock
D. Hyperthermia
A nurse is caring for a patient with eczema. The patient is asking about the role of stress in the condition. Which of the following is the nurse’s most appropriate response?
“Stress is a major trigger for eczema flare-ups.”
B. “Stress does not affect eczema.”
C. “Stress can only affect other aspects of health, not eczema.”
D. “You should reduce stress, but it will not affect your eczema.”
A nurse is caring for a patient with a sunburn. Which of the following interventions should the nurse prioritize?
Apply topical corticosteroids to reduce inflammation
B. Encourage the patient to stay hydrated
C. Apply ice packs to the sunburned areas
D. Advise the patient to avoid moisturizers
A patient with a diagnosis of malignant melanoma has a lesion on the back. Which of the following features is most concerning for malignant melanoma?
Symmetrical shape
B. Single, uniform color
C. Asymmetry and irregular borders
D. Presence of a scabbed area
A nurse is caring for a patient with acne vulgaris. Which of the following should the nurse include in the patient education plan?
“You should wash your face with a harsh scrub every day.”
B. “You should avoid wearing makeup or oils on your skin.”
C. “Avoid using topical medications on the affected areas.”
D. “Oily foods can worsen acne and should be avoided.”
A nurse is educating a patient about the treatment for warts. Which of the following is most appropriate?
“You should apply topical antibiotics to the wart.”
B. “Warts can be treated with cryotherapy or topical salicylic acid.”
C. “You should ignore the wart; it will disappear on its own.”
D. “Topical corticosteroids should be applied to the wart.”
A nurse is caring for a patient with a history of frequent sunburns. The patient asks about skin cancer risks. Which of the following is the nurse’s best response?
“Skin cancer is common only in older adults, so you don’t need to worry yet.”
B. “You should protect your skin with sunscreen to reduce the risk of skin cancer.”
C. “Frequent sunburns do not increase the risk of skin cancer.”
D. “You need to get yearly skin exams, but it’s unlikely to develop skin cancer.”
A patient presents with a suspicious mole on the arm. Which of the following is a characteristic feature of a malignant melanoma?
Regular borders and uniform color
B. Asymmetry and varied colors
C. Small, round, smooth edges
D. Uniformly tan or brown color
A nurse is caring for a patient with a stage 4 pressure ulcer. Which of the following interventions is most important?
Reposition the patient every 2 hours
B. Administer an analgesic before dressing changes
C. Apply a topical corticosteroid to reduce inflammation
D. Keep the ulcer area dry to prevent infection
A nurse is caring for a patient with scabies. Which of the following interventions is most appropriate?
Apply oral corticosteroids to reduce inflammation
B. Apply permethrin cream to the affected areas
C. Use astringents to dry the lesions
D. Administer antibiotics to treat secondary infection
A patient with a history of herpes simplex virus (HSV) asks the nurse how to prevent flare-ups. Which of the following is the best advice?
“Avoid sunlight and stress, which can trigger outbreaks.”
B. “Herpes simplex virus cannot be triggered by external factors.”
C. “Using antibiotics will prevent outbreaks from occurring.”
D. “Avoid consuming foods that contain high amounts of sugar.”
A nurse is caring for a patient with a superficial partial-thickness burn. Which of the following findings is most indicative of a partial-thickness burn?
Red, painful, blisters with weeping fluid
B. White, charred appearance with no sensation
C. Skin is intact with mild redness
D. Dark, purple skin with severe swelling
A nurse is caring for a patient with a severe sunburn. Which of the following is the best way to prevent further injury?
Apply aloe vera gel to the affected areas
B. Apply a cold compress to relieve pain
C. Encourage the patient to continue sun exposure to promote healing
D. Use hot compresses to increase circulation to the area
A nurse is caring for a patient with a history of basal cell carcinoma. The nurse should teach the patient about which of the following?
The need for routine skin checks and sun protection
B. The importance of immediate biopsy of any new skin lesions
C. The necessity for aggressive systemic chemotherapy
D. The need for surgical removal of all moles
A nurse is assessing a patient with a skin infection. The patient has a reddened, warm, swollen area with possible drainage. What should the nurse suspect?
Cellulitis
B. Psoriasis
C. Herpes simplex virus
D. Eczema
A patient is diagnosed with a fungal infection of the foot. Which of the following is an appropriate nursing intervention?
Recommend a corticosteroid cream to reduce inflammation
B. Educate the patient to keep feet dry and wear breathable shoes
C. Apply wet compresses to the affected area for relief
D. Suggest using a topical antibiotic ointment
A nurse is caring for a patient with a second-degree burn. Which of the following findings should the nurse expect?
Intact skin with mild redness
B. Red, painful areas with blisters
C. Black, charred skin with no sensation
D. Dark purple skin with severe swelling
Which of the following should be included in the nursing care plan for a patient with a stage 2 pressure ulcer?
Keep the ulcer area dry to prevent further infection
B. Apply a dry, sterile dressing to the ulcer
C. Reposition the patient every 2 hours
D. Use hot compresses to increase circulation to the ulcer
A patient with eczema is prescribed a corticosteroid cream. Which of the following is most important for the nurse to include in teaching?
Apply the cream to broken skin to speed up healing
B. Use the cream sparingly and only for a short period of time
C. Apply the cream liberally to prevent recurrence of symptoms
D. Use the cream continuously for long periods to avoid flare-ups
A nurse is educating a patient with a history of sunburns on ways to prevent skin cancer. Which of the following is the most important advice?
“You should apply sunscreen with SPF 15 every 2 hours.”
B. “Avoid exposure to the sun between 10 AM and 4 PM.”
C. “Wear sunscreen only when going outside for long periods.”
D. “Sun exposure is only harmful if you have fair skin.”
A nurse is caring for a patient with herpes zoster (shingles). Which of the following precautions is necessary?
Airborne precautions
B. Droplet precautions
C. Contact precautions
D. No precautions are necessary
A nurse is assessing a patient with psoriasis. Which of the following findings is most likely?
Red patches with silver-white scales
B. Yellowish, flaky skin with itching
C. Deep cracks in the skin with exudate
D. Circular patches with clear centers
A patient presents with a suspicious mole that has irregular borders, asymmetry, and multiple colors. The nurse should suspect which of the following?
Squamous cell carcinoma
B. Basal cell carcinoma
C. Malignant melanoma
D. Actinic keratosis
A nurse is teaching a patient about the use of topical antifungal medications. Which of the following statements indicates that the patient understands the teaching?
“I will stop using the medication when my symptoms go away.”
B. “I should apply the medication until the infection is completely healed.”
C. “I will only apply the medication to the infected area for 1 week.”
D. “I can apply the medication in the morning and forget about it for the rest of the day.”
A nurse is caring for a patient with a stage 3 pressure ulcer. Which of the following findings is expected?
Shallow ulcer with intact skin
B. Full-thickness loss with exposed bone or muscle
C. Blisters and erythema
D. Nonblanchable redness
A nurse is assessing a patient with impetigo. Which of the following is a key characteristic of this condition?
Red, crusted lesions with honey-colored exudate
B. Painful, ulcerative lesions with clear fluid
C. A flat, scaly rash without exudate
D. Vesicles with clear fluid and pruritus
Which of the following is the most effective treatment for a patient with scabies?
Oral antibiotics
B. Permethrin cream applied to the entire body
C. Corticosteroid cream to reduce inflammation
D. Antihistamine for pruritus
A patient with a stage 1 pressure ulcer is being repositioned. Which of the following is the priority nursing intervention?
Reposition the patient every 4 hours
B. Massage the area around the ulcer to stimulate circulation
C. Keep the skin clean and dry
D. Apply a wet dressing to the ulcer
A patient with tinea corporis (ringworm) is prescribed antifungal cream. Which of the following actions should the nurse recommend to promote healing?
Apply the cream only when symptoms worsen
B. Keep the affected area moist to encourage faster healing
C. Wash and dry the affected area thoroughly before applying the cream
D. Apply the cream and cover it with a tight dressing
A nurse is caring for a patient with a stage 4 pressure ulcer. Which of the following interventions is most appropriate?
Apply a dry dressing to the ulcer to promote healing
B. Keep the ulcer area covered with an occlusive dressing
C. Reposition the patient every 2 hours to reduce pressure
D. Use hot compresses to promote circulation in the area
A nurse is educating a patient with acne about lifestyle changes. Which of the following should be included in the teaching?
“Avoid touching your face to prevent the spread of bacteria.”
B. “Exfoliate your skin regularly to remove the excess oil.”
C. “Use harsh soaps to dry out the acne lesions.”
D. “Eat more sugary foods to boost your energy levels.”
A nurse is caring for a patient with a sunburn. Which of the following should the nurse prioritize?
Apply topical steroids to reduce inflammation
B. Educate the patient on preventing further sun exposure
C. Apply ice packs to reduce redness
D. Instruct the patient to continue sun exposure in moderation
A nurse is caring for a patient with a second-degree burn. Which of the following is the most appropriate intervention?
Apply a sterile nonstick dressing and elevate the limb
B. Apply ice directly to the burn to cool the area
C. Apply a topical antibiotic ointment to prevent infection
D. Encourage the patient to massage the burn area to promote healing
A nurse is caring for a patient with a suspicious mole. Which of the following characteristics is most concerning for melanoma?
Uniform color and round shape
B. Smooth surface with no irregularities
C. Asymmetry with irregular borders and color variations
D. Small size and absence of itching
A patient with psoriasis is being prescribed a topical corticosteroid. Which of the following should the nurse monitor for as a potential side effect?
Hyperglycemia
B. Skin thinning
C. Increased hair growth
D. Hypotension
A nurse is caring for a patient with eczema. Which of the following interventions should be included in the care plan?
Keep the skin dry and cracked
B. Use scented lotions to keep the skin moisturized
C. Avoid hot showers to prevent skin irritation
D. Apply harsh soaps to clean the affected areas
A nurse is assessing a patient with basal cell carcinoma. Which of the following is a common characteristic of this type of skin cancer?
A raised, pearly lesion with a central ulcer
B. A scaly, red patch that may bleed
C. A dark, unevenly pigmented mole
D. A firm, fixed nodule with a shiny surface
A nurse is educating a patient with chronic hives (urticaria). Which of the following should the nurse include in the teaching?
“Avoid allergens and triggers, such as certain foods or medications.”
B. “You should avoid taking antihistamines, as they can worsen the condition.”
C. “Use topical corticosteroids to alleviate the symptoms.”
D. “Take a hot shower to relieve the itching.”
A patient presents with a yellowish, scaly rash on the scalp. The nurse suspects seborrheic dermatitis. Which of the following is the most appropriate treatment?
Topical antifungal agents
B. Topical corticosteroids
C. Oral antibiotics
D. Oral antiviral agents
A nurse is assessing a patient with a pressure ulcer. Which of the following is the most important factor in preventing pressure ulcers?
Applying topical antibiotics to the ulcer
B. Repositioning the patient regularly
C. Keeping the ulcer moist
D. Using a heating pad to increase circulation
A patient is diagnosed with contact dermatitis after exposure to poison ivy. Which of the following is the most appropriate treatment?
Oral steroids to reduce inflammation
B. Topical antifungals for skin lesions
C. Use of a cold compress to relieve itching
D. Topical antibiotics for skin infection
A nurse is teaching a patient with a history of squamous cell carcinoma about prevention. Which of the following should be included in the teaching?
“Avoid prolonged sun exposure and always use sunscreen.”
B. “Avoid eating foods rich in antioxidants to prevent recurrence.”
C. “Wear tight-fitting clothing to protect your skin from the sun.”
D. “Use tanning beds to get vitamin D safely.”
A nurse is caring for a patient with a burn injury. Which of the following is the priority nursing intervention?
Assess the depth of the burn
B. Provide pain relief and wound care
C. Monitor for signs of shock
D. Administer IV fluids
A nurse is educating a patient with a new diagnosis of melanoma. Which of the following should be included in the teaching?
“You should expect surgery to remove the tumor as the primary treatment.”
B. “Melanoma can often be treated with antibiotics.”
C. “You will need a skin graft after melanoma removal.”
D. “Chemotherapy is rarely used for melanoma treatment.”
A nurse is caring for a patient with a stage 2 pressure ulcer. Which of the following interventions is most appropriate?
Apply a hydrocolloid dressing to the ulcer
B. Massage the area around the ulcer to improve circulation
C. Use a foam dressing to maintain a moist wound environment
D. Keep the ulcer area dry to prevent further damage
A patient with a history of sun exposure presents with a new, irregular mole. What is the most important factor for the nurse to assess?
The size, shape, and color of the mole
B. The presence of pain in the mole
C. The patient’s family history of skin cancer
D. The location of the mole on the body
A nurse is caring for a patient with a history of psoriasis. Which of the following interventions should the nurse include in the plan of care?
Encourage the patient to frequently apply a thick layer of ointment to the affected areas
B. Teach the patient to avoid using moisturizers on the affected skin
C. Recommending frequent exposure to sunlight to reduce symptoms
D. Apply a topical corticosteroid only during flare-ups
A nurse is caring for a patient with a wound infected with methicillin-resistant Staphylococcus aureus (MRSA). Which of the following precautions is necessary?
Airborne precautions
B. Contact precautions
C. Droplet precautions
D. No special precautions are required
A nurse is assessing a patient with a deep burn injury. Which of the following is a priority intervention?
Administer pain relief and IV fluids
B. Apply ice to the burn area
C. Assess for signs of infection at the burn site
D. Promote deep breathing and relaxation techniques
A patient with eczema asks the nurse about using a new moisturizing lotion. Which of the following is the best response?
“Avoid using moisturizers; they can worsen the condition.”
B. “Use unscented lotions or ointments to prevent irritation.”
C. “You should apply the lotion before showering for maximum benefit.”
D. “Choose lotions with a strong fragrance to keep your skin hydrated.”
A nurse is caring for a patient with a superficial burn. Which of the following should the nurse expect?
Blackened, charred skin with no pain
B. Painful red skin with minimal swelling
C. Deep tissue damage with loss of sensation
D. Yellowish, necrotic tissue and a foul odor
A nurse is teaching a patient about the use of sunscreen. Which of the following is the most important teaching point?
“Apply sunscreen only when you’re outdoors for long periods.”
B. “Sunscreen with SPF 15 provides adequate protection.”
C. “Reapply sunscreen every 2 hours, especially after swimming.”
D. “Sunscreen should be applied after sun exposure to prevent burns.”
A nurse is caring for a patient with impetigo. Which of the following is the most effective treatment?
Oral antiviral medications
B. Oral antifungal agents
C. Topical corticosteroid cream
D. Topical antibiotics such as mupirocin
A patient is receiving treatment for a stage 3 pressure ulcer. Which of the following actions should the nurse take to promote healing?
Keep the ulcer dry to prevent infection
B. Use a vacuum-assisted closure (VAC) to help promote wound healing
C. Keep the patient immobilized to prevent further injury
D. Apply heat to the ulcer site to increase blood flow
A nurse is caring for a patient with a skin infection caused by Staphylococcus aureus. Which of the following should the nurse prioritize in the plan of care?
Administering oral antibiotics as prescribed
B. Instructing the patient to apply a corticosteroid ointment
C. Encouraging the patient to soak in warm baths
D. Avoiding the use of any topical treatments
A nurse is assessing a patient for risk factors related to skin cancer. Which of the following is a significant risk factor for developing basal cell carcinoma?
A history of frequent sun exposure
B. A history of smoking
C. Use of oral contraceptives
D. A family history of breast cancer
A nurse is caring for a patient with a second-degree burn. The nurse should anticipate which of the following findings?
Blisters and severe pain
B. Blackened, charred tissue
C. No sensation in the affected area
D. Bright red skin with minor swelling
A nurse is caring for a patient with a fungal infection of the scalp (tinea capitis). Which of the following interventions is most appropriate?
Recommend the patient use a topical antifungal shampoo
B. Instruct the patient to avoid contact with other people to prevent transmission
C. Encourage the patient to wear a tight-fitting hat to prevent spread
D. Advise the patient to treat with an oral antibiotic
A patient with a wound infection is receiving antibiotic therapy. Which of the following should the nurse monitor for as a potential complication of the infection?
Hyperkalemia
B. Nephrotoxicity
C. Hypotension
D. Respiratory distress
A nurse is teaching a patient about proper foot care to prevent diabetic foot ulcers. Which of the following is the most important instruction?
“Check your feet for cuts or blisters every day.”
B. “Wear tight-fitting shoes to prevent slipping.”
C. “Use hot water to soak your feet every night.”
D. “Wear sandals to reduce friction.”
A nurse is caring for a patient with a stage 1 pressure ulcer. Which of the following is the most important intervention?
Cleanse the wound with hydrogen peroxide
B. Reposition the patient at least every 2 hours
C. Apply a wet-to-dry dressing to the ulcer
D. Keep the ulcer covered with an occlusive dressing
A nurse is caring for a patient with scabies. Which of the following treatments should the nurse expect to be prescribed?
Topical antifungal cream
B. Oral antibiotics
C. Permethrin cream
D. Oral corticosteroids
A nurse is teaching a patient with a new diagnosis of squamous cell carcinoma. Which of the following should the nurse include in the teaching?
“You will likely need chemotherapy or radiation therapy.”
B. “This type of cancer typically spreads rapidly and needs urgent treatment.”
C. “You will likely need to have the tumor surgically removed.”
D. “Squamous cell carcinoma rarely requires treatment.”
A nurse is educating a patient with acne vulgaris about the use of oral antibiotics. Which of the following is an important point to include in the teaching?
“You should avoid sun exposure while on oral antibiotics.”
B. “You should stop taking the antibiotics once the acne begins to improve.”
C. “You will need to apply the antibiotics topically to the affected areas.”
D. “Oral antibiotics may cause you to gain weight.”
A nurse is teaching a patient with psoriasis about managing flare-ups. Which of the following should the nurse recommend?
“Avoid using any moisturizing lotions on affected areas.”
B. “Apply a topical corticosteroid as prescribed.”
C. “Expose your skin to sun for several hours each day.”
D. “Use only harsh soaps to cleanse your skin.”
A nurse is assessing a patient with a superficial burn. Which of the following findings would the nurse expect?
Painful, red skin with some swelling
B. Blackened skin with charred tissue
C. Deep tissue damage with loss of sensation
D. Yellowish, purulent drainage
A nurse is caring for a patient with a stage 3 pressure ulcer. Which of the following is an appropriate dressing to promote healing?
Transparent film dressing
B. Hydrocolloid dressing
C. Gauze dressing
D. Wet-to-dry dressing
A nurse is educating a patient with a diagnosis of squamous cell carcinoma. Which of the following is the most important preventive measure?
Applying sunscreen with a high SPF
B. Engaging in daily sunbathing
C. Using tanning beds sparingly
D. Wearing tight clothing to protect the skin
A patient with eczema is being taught how to manage flare-ups. Which of the following is an appropriate recommendation?
Use hot water when bathing to open pores
B. Apply thick creams immediately after bathing
C. Scratch the affected areas to relieve itching
D. Avoid moisturizing the skin during flare-ups
A nurse is caring for a patient with a superficial partial-thickness burn. Which of the following is a typical characteristic of this type of burn?
White, leathery skin with no pain
B. Blister formation and redness
C. Charred black skin with a dry appearance
D. Deep tissue damage with loss of sensation
A nurse is caring for a patient with impetigo. Which of the following is the priority nursing action?
Apply topical antifungal agents to the affected area
B. Administer oral antibiotics as prescribed
C. Place the patient on contact precautions
D. Instruct the patient to avoid using soap on the affected area
A nurse is assessing a patient with suspected melanoma. Which of the following is a characteristic of melanoma?
Raised, irregular borders
B. A symmetrical appearance with a uniform color
C. Small, round, and light-colored moles
D. Even edges with no changes in size
A nurse is teaching a patient about preventing pressure ulcers. Which of the following should be included in the teaching?
Reposition the patient every 4 hours
B. Keep the skin dry at all times
C. Use a specialized cushion for sitting
D. Massage bony prominences to increase circulation
A nurse is caring for a patient with a fungal infection of the skin. Which of the following interventions is most appropriate?
Apply a topical antifungal cream as prescribed
B. Keep the area moist to promote healing
C. Wash the affected area with soap and water twice daily
D. Encourage the patient to avoid wearing shoes
A patient with a history of chronic psoriasis is seeking advice on managing flare-ups. Which of the following is a recommended intervention?
Avoid moisturizers to prevent irritation
B. Take hot baths to remove dead skin cells
C. Apply topical corticosteroids as prescribed
D. Expose the skin to prolonged sunlight
A nurse is assessing a patient with a deep partial-thickness burn. Which of the following findings is most likely?
Skin is dry and blackened
B. Blisters and painful red skin
C. Skin appears red, with possible scarring
D. Loss of sensation in the affected area
A patient with a diagnosis of basal cell carcinoma asks the nurse how to prevent recurrence. Which of the following should the nurse emphasize?
Limit sun exposure and apply sunscreen regularly
B. Use topical antibiotics on the skin daily
C. Get regular chemical peels to remove damaged skin
D. Always use moisturizers to prevent dryness
A nurse is educating a patient about the importance of wound care for a stage 4 pressure ulcer. Which of the following should the nurse emphasize?
Keep the wound dry and avoid any moisture
B. Apply an occlusive dressing to keep the wound covered
C. Reposition the patient every 2 hours to relieve pressure
D. Use heat therapy to enhance circulation to the wound site
A nurse is caring for a patient with a diagnosis of cellulitis. Which of the following is the priority nursing intervention?
Apply a topical antibiotic ointment to the affected area
B. Administer intravenous antibiotics as prescribed
C. Place the patient on contact precautions
D. Elevate the affected extremity to reduce swelling
A nurse is caring for a patient with a stage 2 pressure ulcer. Which of the following is an appropriate dressing choice?
Wet-to-dry dressing
B. Hydrocolloid dressing
C. Dry gauze dressing
D. Transparent film dressing
A patient with a history of chronic skin conditions asks the nurse about the use of corticosteroids. Which of the following is the most important teaching point?
“Apply the ointment liberally to the affected areas.”
B. “Avoid using corticosteroids on open wounds or broken skin.”
C. “You can use the medication for as long as you want.”
D. “You should expect rapid relief from symptoms after using the cream.”
A nurse is teaching a patient with a new diagnosis of rosacea. Which of the following is a key point in managing this condition?
“Avoid sun exposure and use sunscreen daily.”
B. “Use topical corticosteroids to control flare-ups.”
C. “Wash your face with hot water to remove skin oils.”
D. “It is safe to use harsh scrubs to exfoliate the skin.”
A nurse is educating a patient with a history of herpes zoster (shingles). Which of the following is an important teaching point?
“You should keep the rash moist to prevent scabbing.”
B. “Avoid close contact with people who have not had chickenpox or the vaccine.”
C. “Shingles is not contagious, so you can resume normal activities immediately.”
D. “Apply hot compresses to the rash area to promote healing.”
A nurse is caring for a patient with a stage 1 pressure ulcer. Which of the following is the priority intervention?
Debride the wound and apply a moist dressing
B. Reposition the patient every 2 hours
C. Apply a hydrocolloid dressing to the ulcer
D. Administer pain medication to the patient
A nurse is caring for a patient with a superficial partial-thickness burn. Which of the following is the best way to manage the patient’s pain?
Administer an opioid analgesic
B. Apply cool compresses to the burned area
C. Encourage the patient to take a warm bath
D. Apply a topical corticosteroid ointment
A nurse is caring for a patient with scabies. Which of the following instructions is essential for the patient to prevent the spread of the infection?
Wash all clothing, bedding, and towels in hot water
B. Take an oral antibiotic daily for 2 weeks
C. Avoid using any topical creams or lotions
D. Refrain from applying lotion after bathing
A nurse is assessing a patient with a pressure ulcer on the sacrum. Which of the following is a characteristic of a stage 2 pressure ulcer?
The skin is intact with non-blanchable redness
B. The ulcer appears as a shallow, open wound with a red-pink wound bed
C. The ulcer involves full-thickness tissue loss with exposed muscle
D. The wound appears black with eschar formation
A nurse is teaching a patient with a diagnosis of herpes simplex virus about the management of the condition. Which of the following statements indicates the patient needs further education?
“I should keep my affected area dry and clean.”
B. “I can share towels and personal items once the sores are healed.”
C. “I need to avoid touching the blisters and wash my hands frequently.”
D. “I should use an antiviral cream to help reduce the frequency of outbreaks.”
A patient with a deep partial-thickness burn asks the nurse how long it will take for the burn to heal. Which of the following is the best response?
“The healing process usually takes about 2-3 days.”
B. “The healing process can take 2-3 weeks, depending on the severity.”
C. “Healing time for this type of burn can be up to 6 months.”
D. “The burn will heal on its own without any need for treatment.”
A nurse is caring for a patient with a stage 3 pressure ulcer. Which of the following is the best treatment for this wound?
Wet-to-dry dressing
B. Hydrocolloid dressing
C. Moist sterile gauze dressing
D. Transparent film dressing
A nurse is caring for a patient with a new diagnosis of alopecia areata. Which of the following should the nurse emphasize in teaching the patient?
“This condition is permanent and irreversible.”
B. “The condition is likely caused by stress or poor nutrition.”
C. “This type of hair loss is related to an autoimmune disorder.”
D. “It is important to use gentle shampoo to avoid further hair loss.”
A nurse is caring for a patient with a skin rash and suspected contact dermatitis. Which of the following is the most appropriate intervention?
Apply a topical corticosteroid to reduce inflammation
B. Bathe the patient in oatmeal to soothe the skin
C. Administer an oral antibiotic to prevent infection
D. Apply a heating pad to the affected area for relief
A nurse is educating a patient with seborrheic dermatitis. Which of the following recommendations is appropriate?
“Wash your hair with a gentle shampoo and avoid harsh chemicals.”
B. “Use a medicated shampoo containing ketoconazole or selenium sulfide.”
C. “Avoid using any hair care products to prevent flare-ups.”
D. “Brush your scalp vigorously to remove dead skin flakes.”
A nurse is assessing a patient with a basal cell carcinoma. Which of the following is a characteristic finding of this condition?
A smooth, pearly bump with visible blood vessels
B. A raised, red nodule with a crusted surface
C. A dark, irregularly shaped mole with an asymmetrical border
D. A thickened, wart-like growth that is dry and scaly
A nurse is teaching a patient with a history of melanoma about prevention strategies. Which of the following should the nurse include in the teaching?
“Avoid sun exposure and wear sunscreen with at least SPF 15.”
B. “Use a tanning bed to maintain a healthy glow.”
C. “Reapply sunscreen only after swimming or sweating.”
D. “Wear protective clothing and seek shade when outdoors.”
A nurse is caring for a patient who has undergone debridement for a stage 4 pressure ulcer. Which of the following is the priority nursing action?
Encourage the patient to ambulate frequently to promote circulation
B. Administer prescribed pain medication before dressing changes
C. Apply a dry sterile dressing to the wound
D. Instruct the patient to keep the wound open to prevent infection
A nurse is caring for a patient with a deep second-degree burn. Which of the following is the priority intervention in the initial phase of care?
Administering pain medications as prescribed
B. Maintaining a sterile environment for wound care
C. Applying a cold compress to the burn area
D. Encouraging the patient to drink plenty of fluids
A nurse is caring for a patient with a stage 1 pressure ulcer. Which of the following interventions is most important?
Reposition the patient every 2 hours
B. Apply a hydrocolloid dressing to the ulcer
C. Administer pain medication before repositioning
D. Use a heat pad to increase blood flow to the area
A nurse is caring for a patient with a diagnosis of rosacea. Which of the following should the nurse recommend to minimize flare-ups?
“Use astringents and harsh soaps to cleanse the skin.”
B. “Avoid sun exposure and use sunscreen regularly.”
C. “Exfoliate the skin often to remove dead skin cells.”
D. “Apply thick moisturizers to prevent dryness.”
A nurse is caring for a patient with a diagnosis of impetigo. Which of the following interventions is the priority?
Administering an oral antibiotic as prescribed
B. Applying a topical corticosteroid to the affected area
C. Keeping the area clean and dry to prevent further spread
D. Encouraging the patient to wear loose clothing to avoid irritation
A nurse is providing care for a patient with psoriasis. Which of the following treatments should the nurse anticipate for this patient?
Topical corticosteroids
B. Systemic antibiotics
C. Antifungal creams
D. Oral antihistamines
A nurse is caring for a patient who has been diagnosed with a venous ulcer. Which of the following is an appropriate intervention?
Elevate the affected leg to reduce swelling
B. Keep the ulcer moist with a wet-to-dry dressing
C. Apply a dry dressing to the ulcer to prevent infection
D. Encourage the patient to remain in bed to reduce pressure on the ulcer
A nurse is assessing a patient with suspected squamous cell carcinoma. Which of the following findings is most indicative of this condition?
A pearly, raised lesion with a smooth surface
B. A red, scaly patch that may bleed
C. A black, irregular-shaped mole
D. A white patch on the mucous membranes
A nurse is caring for a patient with a deep partial-thickness burn. Which of the following signs indicates that the wound is healing?
The wound is covered with thick, dry eschar.
B. There is an increase in the production of serous exudate.
C. The wound area is covered with granulation tissue.
D. The burn site is turning bright red in color.
A nurse is caring for a patient with cellulitis. Which of the following is the priority nursing intervention?
Administering pain medications as prescribed
B. Applying warm compresses to the affected area
C. Administering antibiotics as prescribed
D. Elevating the affected limb
A nurse is providing care for a patient with a stage 2 pressure ulcer. Which of the following interventions is the most appropriate for wound care?
Applying a hydrocolloid dressing to promote moisture retention
B. Using an occlusive dressing to prevent air exposure
C. Using a dry dressing to absorb exudate and prevent infection
D. Applying topical antibiotics to prevent infection
A nurse is educating a patient with a history of keloid scarring. Which of the following statements indicates a need for further teaching?
“Keloid scars are more common in individuals with dark skin.”
B. “Surgical removal of the keloid is the best way to prevent recurrence.”
C. “The use of silicone gel sheets can help prevent keloid formation.”
D. “Keloids can be treated with corticosteroid injections.”
A nurse is assessing a patient with a suspected drug-induced skin reaction. Which of the following is a common symptom of this condition?
Intense itching and redness following sun exposure
B. A widespread, symmetric rash that includes the palms and soles
C. A circular lesion with a clear center and a raised border
D. A painful, swollen area with blisters that breaks open
A nurse is caring for a patient with a diagnosis of tinea corporis (ringworm). Which of the following is the most effective treatment?
Topical antifungal medication
B. Oral corticosteroids
C. Topical antibiotic ointment
D. Oral antihistamines
A nurse is caring for a patient with a diagnosis of basal cell carcinoma. Which of the following interventions is essential for the patient?
Administering radiation therapy
B. Applying a topical antifungal medication
C. Removing the tumor via surgical excision
D. Treating with high-dose systemic steroids
A nurse is caring for a patient with a wound infection. The patient develops systemic signs of infection. Which of the following is the nurse’s priority action?
Notify the healthcare provider about the infection
B. Increase the frequency of dressing changes
C. Administer prescribed antibiotics
D. Encourage fluid intake
A nurse is educating a patient with eczema about self-care. Which of the following should the nurse include in the teaching?
“Avoid scratching the affected areas, as this can worsen the condition.”
B. “Use soap with strong fragrances to cleanse the skin.”
C. “Apply topical steroids only when symptoms worsen.”
D. “Use hot water to bathe to open the pores and reduce irritation.”
A nurse is caring for a patient who is receiving topical treatment for a severe case of atopic dermatitis. Which of the following should the nurse monitor for?
Excessive dryness and cracking of the skin
B. Symptoms of an allergic reaction to the topical medication
C. Decreased immune response to infection
D. Overgrowth of bacteria in the skin folds
A nurse is caring for a patient with a stage 4 pressure ulcer. Which of the following is a characteristic of this stage of ulcer?
Shallow, open wound with a red-pink wound bed
B. Full-thickness tissue loss with exposed bone, tendon, or muscle
C. Non-blanchable redness without skin breakdown
D. Blister formation with partial-thickness loss of dermis
Questions and Answers for Study Guide
Discuss the pathophysiology, clinical manifestations, and nursing management of a patient with cellulitis.
Answer:
Pathophysiology:
Cellulitis is a bacterial skin infection, most commonly caused by Streptococcus or Staphylococcus aureus. The infection begins when bacteria enter through a break in the skin, such as a cut, insect bite, or surgical wound. Once in the dermis and subcutaneous tissue, the bacteria cause inflammation, leading to redness, warmth, and swelling. In severe cases, the infection may spread to the bloodstream (sepsis) or adjacent tissues.
Clinical Manifestations: The clinical signs of cellulitis include:
- Redness, warmth, and swelling in the affected area
- Pain or tenderness
- Fever and chills
- Swollen lymph nodes
- Pus or drainage from an open wound (in severe cases)
Nursing Management: The primary goal of nursing management is to prevent the infection from spreading and promote healing. This includes:
- Administering prescribed antibiotics as soon as possible (oral or intravenous, depending on the severity)
- Monitoring vital signs, especially temperature, to detect signs of systemic infection
- Elevating the affected area to reduce swelling and improve circulation
- Applying warm compresses to relieve pain and promote circulation
- Educating the patient on proper wound care and the importance of completing the full course of antibiotics
- Monitoring for complications such as abscess formation or systemic infection
Explain the risk factors, clinical features, and treatment options for a patient with psoriasis.
Answer:
Risk Factors: Psoriasis is a chronic, autoimmune disorder that leads to rapid skin cell turnover. Risk factors include:
- Family history of psoriasis or autoimmune diseases
- Environmental triggers such as stress, infections, and certain medications
- Smoking and alcohol use
- Obesity and metabolic syndrome
- Cold, dry weather conditions
Clinical Features: Psoriasis typically presents with:
- Red, raised plaques covered with silvery scales, often found on the elbows, knees, scalp, and lower back
- Itching, burning, or soreness in affected areas
- Nail changes, such as pitting or discoloration
- Joint pain or swelling, indicating psoriatic arthritis in some cases
Treatment Options: Treatment for psoriasis aims to control symptoms and reduce flare-ups. Management strategies include:
- Topical Treatments: Corticosteroids, vitamin D analogs (calcipotriene), and coal tar preparations to reduce inflammation and cell turnover.
- Systemic Treatments: For moderate to severe cases, oral medications like methotrexate or biologics (e.g., adalimumab) may be prescribed to suppress the immune system.
- Phototherapy: Ultraviolet (UV) light therapy can help slow the rapid skin cell turnover associated with psoriasis.
- Lifestyle Modifications: Stress reduction techniques, smoking cessation, and avoiding triggers such as alcohol or certain medications are crucial in managing the condition.
- Patient Education: Teaching the patient to apply topical treatments correctly, the importance of moisturizing the skin, and avoiding scratching or irritating the plaques.
Describe the assessment, diagnostic, and nursing interventions for a patient with a pressure ulcer.
Answer:
Assessment: A thorough assessment of the skin is essential to identify the presence, stage, and severity of a pressure ulcer. The nurse should assess:
- Location and size of the ulcer (length, width, depth)
- Stage of the ulcer (from Stage 1 to Stage 4)
- Exudate (amount, type, and odor)
- Surrounding skin condition (redness, warmth, maceration)
- Pain level and presence of infection
Diagnostic: The diagnosis of a pressure ulcer is primarily clinical, based on visual inspection. However, the healthcare provider may order:
- Wound cultures to identify any infection
- Blood tests (e.g., complete blood count) to detect signs of systemic infection or anemia
- Nutritional assessment to evaluate if the patient’s diet contributes to poor wound healing.
Nursing Interventions: Effective nursing interventions focus on pressure relief, wound care, and preventing complications:
- Repositioning: Regularly reposition the patient to relieve pressure on vulnerable areas, using pillows, wedges, or specialized mattresses.
- Wound Care: Cleanse the ulcer with a mild saline solution and apply an appropriate dressing (e.g., hydrocolloid, foam dressing) that promotes healing and absorbs exudate.
- Nutrition: Ensure adequate nutrition, including protein, vitamins (particularly vitamin C), and hydration, to promote wound healing.
- Pain Management: Administer analgesics as prescribed to manage pain related to the ulcer.
- Infection Control: Monitor for signs of infection, such as increased redness, warmth, or drainage, and initiate antibiotic therapy if required.
- Patient Education: Educate the patient and family on proper skin care, the importance of repositioning, and ways to minimize pressure. Additionally, teach the patient about the significance of nutrition in wound healing.
Explain the management and prevention strategies for skin cancer, specifically basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).
Answer:
Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC): Both BCC and SCC are common forms of non-melanoma skin cancer, often caused by prolonged sun exposure or tanning bed use. While BCC tends to be slow-growing and less likely to metastasize, SCC is more aggressive and can spread to other body parts if untreated.
Management:
- Surgical Excision: The primary treatment for both BCC and SCC is surgical removal of the tumor. In some cases, Mohs micrographic surgery may be used for more complex cases.
- Cryotherapy: Cryosurgery involves freezing the tumor with liquid nitrogen, often used for superficial BCC or SCC.
- Topical Treatments: For early or superficial lesions, topical medications such as imiquimod or 5-fluorouracil (5-FU) can be applied to the skin to treat the cancer.
- Radiation Therapy: Radiation may be used in cases where surgery is not feasible or when cancer has spread to nearby lymph nodes.
- Photodynamic Therapy: This treatment involves applying a photosensitizing agent to the skin followed by exposure to a light source to destroy cancer cells.
Prevention: Preventing skin cancer focuses on reducing sun exposure and promoting healthy skin practices:
- Sun Protection: Encourage the use of broad-spectrum sunscreen (SPF 30 or higher), wearing protective clothing, and seeking shade during peak sun hours (10 AM – 4 PM).
- Avoidance of Tanning Beds: Advise patients to avoid tanning beds, as they increase the risk of skin cancer.
- Regular Skin Checks: Encourage patients to perform monthly self-skin exams and schedule yearly dermatological check-ups for early detection of suspicious lesions.
- Education: Teach patients about recognizing early signs of skin cancer, such as changes in mole size, color, or shape, and the importance of seeking medical attention if these occur.
Explain the management of a patient with third-degree burns, including the stages of healing and nursing interventions.
Answer:
Management of Third-Degree Burns: Third-degree burns, also known as full-thickness burns, involve the epidermis, dermis, and subcutaneous tissue. The damage may extend to underlying structures such as muscles, tendons, or bones. Immediate management focuses on preventing shock, managing pain, and initiating wound care.
Stages of Healing:
- Acute Phase (First 24-48 hours): The body is focused on fluid resuscitation and stabilization of the patient’s vital signs. During this phase, the nurse ensures that the patient receives intravenous fluids (e.g., lactated Ringer’s solution) to prevent hypovolemic shock. Pain management with opioids is crucial.
- Proliferation Phase (2-3 weeks): This phase involves re-epithelialization and granulation tissue formation. The patient may undergo debridement to remove dead tissue and prevent infection.
- Maturation Phase (Months to Years): Collagen remodeling occurs, and scar tissue forms. Pressure garments may be used to reduce hypertrophic scarring and improve cosmetic outcomes.
Nursing Interventions:
- Airway Management: In cases of burns to the face or neck, airway management is a priority to prevent respiratory compromise. Intubation or supplemental oxygen may be required.
- Fluid Resuscitation: The nurse must monitor the patient’s fluid balance carefully, using formulas like the Parkland formula to determine the required volume of fluid replacement.
- Wound Care: Apply topical antimicrobial agents such as silver sulfadiazine to prevent infection. The nurse should change dressings regularly and observe for signs of infection (e.g., increased redness, foul odor).
- Pain Management: Administer prescribed analgesics, such as opioids, as burns are extremely painful. Non-pharmacological interventions, such as relaxation techniques, may also be used.
- Nutritional Support: The patient’s metabolic rate increases significantly following a burn injury. Enteral or parenteral nutrition may be necessary to meet the patient’s increased caloric needs.
- Psychosocial Support: Provide emotional support and counseling for the patient, as burns can have a significant psychological impact, including body image disturbances.
Describe the nursing management and patient education for a patient with a fungal infection, such as tinea corporis (ringworm).
Answer:
Nursing Management: Fungal infections such as tinea corporis are caused by dermatophytes, which thrive on keratinized skin layers. These infections are common and highly contagious. The nurse’s role is to prevent the spread of the infection, manage symptoms, and educate the patient on proper treatment.
- Diagnosis: The diagnosis is typically made through clinical presentation and confirmed by scraping skin samples for microscopic examination or fungal culture.
- Antifungal Treatment: Topical antifungals such as clotrimazole, miconazole, or terbinafine are the first-line treatments for tinea corporis. In severe cases, oral antifungals like griseofulvin or terbinafine may be prescribed.
- Wound Care: Keep the affected area clean and dry. Instruct the patient to avoid tight clothing and keep the skin exposed to air when possible to promote healing.
- Prevention of Spread: Since fungal infections are highly contagious, emphasize the importance of maintaining good hygiene, using separate towels, and avoiding sharing personal items such as combs or razors.
Patient Education:
- Medication Adherence: Teach the patient to apply the antifungal cream as directed and to complete the entire course of treatment, even if symptoms resolve before the medication is finished.
- Hygiene Practices: Encourage frequent hand washing and cleaning of the affected area. Suggest that the patient wear loose-fitting clothing and avoid scratching, which can spread the infection.
- Environmental Considerations: Instruct the patient to wash bedding, towels, and clothing in hot water to kill fungal spores and prevent reinfection. Recommend vacuuming carpets and cleaning surfaces in common areas to avoid spread.
Discuss the pathophysiology, risk factors, and clinical management of atopic dermatitis (eczema).
Answer:
Pathophysiology: Atopic dermatitis (eczema) is a chronic inflammatory skin condition characterized by pruritus, dry skin, and red, scaly patches. It occurs due to a combination of genetic predisposition and environmental factors that disrupt the skin’s barrier function. Inflammation in the skin leads to increased histamine release, causing itching and further exacerbating the condition. A defect in the filaggrin protein, which helps maintain the skin’s moisture barrier, plays a significant role in the development of eczema.
Risk Factors:
- Genetic Factors: Family history of atopic dermatitis, asthma, or hay fever increases the risk of developing eczema.
- Environmental Triggers: Exposure to irritants (e.g., soaps, detergents), allergens (e.g., pollen, pet dander), and extreme weather conditions can exacerbate symptoms.
- Immune System Dysfunction: An overactive immune response leads to chronic inflammation in the skin, which is characteristic of atopic dermatitis.
Clinical Management:
- Topical Therapies: First-line treatment includes topical corticosteroids (e.g., hydrocortisone) to reduce inflammation and relieve itching. Non-steroidal creams like tacrolimus or pimecrolimus may be used for sensitive areas or long-term management.
- Moisturization: Regular application of emollients is crucial to keep the skin hydrated and prevent dryness, which can trigger flare-ups.
- Antihistamines: Oral antihistamines such as diphenhydramine can be used to alleviate itching, particularly at night.
- Avoiding Triggers: Patient education is essential to identify and avoid environmental triggers, such as harsh soaps, hot showers, or allergens like dust mites and pet dander.
- Systemic Medications: In severe cases, oral corticosteroids or immunosuppressive agents (e.g., methotrexate) may be prescribed to manage inflammation.
Nursing Interventions:
- Educate the patient on proper skin care, including the importance of moisturizing regularly and using lukewarm water for bathing.
- Teach the patient to apply medications as prescribed and monitor for side effects, such as skin thinning with prolonged use of topical steroids.
- Promote emotional support as eczema can impact the patient’s quality of life, especially in children or individuals with visible lesions.
Discuss the nursing care for a patient with herpes zoster (shingles), including the pathophysiology, management, and complications.
Answer:
Pathophysiology: Herpes zoster, also known as shingles, is caused by the reactivation of the varicella-zoster virus (VZV), the same virus that causes chickenpox. After an initial chickenpox infection, the virus remains dormant in the dorsal root ganglia of sensory nerves. Reactivation of the virus occurs years later, usually due to aging, stress, or immunocompromised states, leading to painful, localized rashes along a dermatome (nerve pathway).
Clinical Features:
- A unilateral, painful rash that typically presents as vesicles on an erythematous base.
- The rash is usually confined to one side of the body and follows the pattern of a specific nerve.
- The rash is often preceded by a prodromal phase of burning, itching, or pain in the affected area.
Management:
- Antiviral Therapy: Early treatment with antiviral drugs such as acyclovir, valacyclovir, or famciclovir can shorten the duration of the illness and reduce the severity of symptoms.
- Pain Management: Analgesics, such as acetaminophen or NSAIDs, are used to manage pain. For severe pain, opioids or nerve-blocking agents (e.g., gabapentin) may be prescribed.
- Topical Treatments: Cool compresses and calamine lotion may help relieve itching.
- Vaccination: The Zostavax or Shingrix vaccine is recommended for adults over 50 years of age to reduce the risk of developing shingles and complications.
Complications:
- Postherpetic Neuralgia: Persistent pain in the area where the rash was located is a common complication of shingles. This chronic pain can last for months or years.
- Secondary Bacterial Infection: The open lesions can become infected with bacteria, leading to further complications.
- Vision Loss: If the eye is affected (herpes zoster ophthalmicus), the patient may be at risk for permanent vision loss.
Nursing Interventions:
- Pain Assessment: Regularly assess pain levels and administer pain relief as prescribed.
- Infection Control: Implement precautions to prevent the spread of the virus, including contact precautions and educating the patient on proper hygiene and lesion care.
- Emotional Support: Provide emotional support as the rash and pain can be distressing, especially for older adults.
Discuss the pathophysiology, clinical features, and nursing management of a patient with psoriasis.
Answer:
Pathophysiology: Psoriasis is a chronic autoimmune disorder that results in the rapid turnover of skin cells. This condition is characterized by the abnormal proliferation of keratinocytes (skin cells), leading to thick, scaly plaques. The exact cause of psoriasis is not fully understood, but it involves genetic factors and an overactive immune response, which leads to inflammation and increased cell turnover. T-cell activation in the skin triggers the inflammatory response, which results in the formation of plaques that are typically silver or white in appearance.
Clinical Features:
- Plaque Psoriasis: The most common type, characterized by raised, red patches with silvery-white scales, typically found on the scalp, elbows, and knees.
- Nail Psoriasis: Involves pitting, discoloration, and thickening of the nails.
- Guttate Psoriasis: Small, drop-shaped lesions that may appear after a streptococcal infection.
- Inverse Psoriasis: Smooth, red lesions found in skin folds such as the armpits or groin.
Nursing Management:
- Topical Treatments: First-line therapy for psoriasis includes corticosteroids to reduce inflammation, vitamin D analogs (e.g., calcipotriene) to slow skin cell turnover, and coal tar preparations to relieve scaling and itching.
- Phototherapy: Exposure to ultraviolet (UV) light, specifically UVB light, can slow down the rapid skin cell turnover.
- Systemic Medications: In severe cases, immunosuppressive medications such as methotrexate, cyclosporine, or biologics (e.g., TNF inhibitors) may be used to control inflammation.
- Moisturization: The nurse should emphasize the importance of regular moisturizing to prevent dry, cracked skin and minimize discomfort.
Patient Education:
- Avoiding Triggers: Educate the patient on avoiding common psoriasis triggers such as stress, infections, and skin injury.
- Sun Exposure: Encourage safe sun exposure as UV light can help reduce symptoms, but patients should use sunscreen to protect from further skin damage.
- Lifestyle Modifications: Discuss stress reduction techniques, such as yoga or meditation, and suggest maintaining a healthy lifestyle with proper diet and exercise.
Explain the clinical presentation and management of a patient with a pressure ulcer, focusing on staging, risk factors, and treatment options.
Answer:
Clinical Presentation: A pressure ulcer, also known as a bedsore or decubitus ulcer, is a localized injury to the skin and underlying tissue caused by prolonged pressure. Common areas include the sacrum, heels, and elbows. The clinical presentation varies based on the stage of the ulcer:
- Stage I: Non-blanchable erythema of intact skin, often with localized warmth, edema, and induration.
- Stage II: Partial-thickness loss of dermis, presenting as an open, shallow ulcer with a red-pink wound bed, without slough.
- Stage III: Full-thickness tissue loss, with visible subcutaneous fat, but no bone, tendon, or muscle exposure.
- Stage IV: Full-thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present.
- Unstageable: Full-thickness tissue loss with obscured depth due to eschar or slough.
Risk Factors:
- Immobility: Patients who are bedridden, wheelchair-bound, or have limited mobility are at higher risk due to the inability to relieve pressure on certain body areas.
- Moisture: Incontinence or excessive perspiration can increase the risk by macerating the skin, making it more vulnerable to injury.
- Malnutrition: Inadequate nutrition weakens the skin, making it less resilient to pressure.
- Age: Older adults have thinner, less elastic skin, increasing susceptibility to pressure ulcers.
- Chronic Conditions: Conditions like diabetes and vascular disease impair circulation and delay wound healing, increasing the risk of pressure ulcers.
Management:
- Relieving Pressure: Frequent repositioning (every 2 hours) and the use of pressure-relieving devices such as foam cushions, air mattresses, or specialized bed linens.
- Wound Care: Clean the wound with saline and apply appropriate dressings such as hydrocolloid, alginate, or foam dressings, depending on the stage of the ulcer. Stage III and IV ulcers may require debridement of necrotic tissue.
- Nutritional Support: High-protein diets, vitamins, and supplements like zinc may help promote wound healing.
- Infection Control: Monitor for signs of infection (e.g., increased redness, warmth, drainage) and treat with antibiotics as prescribed.
Patient Education:
- Teach the patient and caregivers how to manage incontinence, use moisture barriers, and ensure proper nutrition.
- Encourage mobility and repositioning to prevent sustained pressure on vulnerable areas.
- Educate about proper wound care techniques, including how to clean the wound and change dressings to prevent infection.
Discuss the clinical features and treatment of acne vulgaris, including its impact on the patient’s psychosocial well-being.
Answer:
Clinical Features: Acne vulgaris is a common skin condition characterized by the development of pimples, blackheads, whiteheads, and cysts, primarily on the face, chest, and back. The condition results from the blockage of hair follicles with sebum, dead skin cells, and bacteria. It can present as:
- Comedones (blackheads and whiteheads): Non-inflammatory lesions that form when pores are clogged.
- Papules: Small, red, raised lesions.
- Pustules: Lesions filled with pus, typically more inflamed than papules.
- Cysts: Large, painful, and deep lesions that can cause scarring.
Treatment:
- Topical Treatments: First-line therapy for mild to moderate acne includes topical agents such as benzoyl peroxide, salicylic acid, and topical retinoids (e.g., adapalene). These help to reduce oil production, exfoliate the skin, and prevent pore blockage.
- Oral Medications: For moderate to severe acne, oral antibiotics (e.g., tetracyclines) are commonly prescribed to reduce inflammation and bacterial growth. In cases of severe acne, oral isotretinoin (Accutane) may be considered to target all the pathophysiological aspects of acne, including sebum production and inflammation.
- Hormonal Therapy: In female patients, oral contraceptives may help regulate hormone levels and reduce acne.
- Light and Laser Therapy: Certain light treatments may target acne-causing bacteria or reduce inflammation.
Psychosocial Impact: Acne vulgaris can significantly affect a patient’s self-esteem and psychosocial well-being. Adolescents and young adults, who are often affected by acne, may experience embarrassment, shame, or social anxiety due to the visible nature of the condition. These emotional responses can lead to depression, social withdrawal, and decreased quality of life. Nurses should assess the emotional impact of acne and provide emotional support, referring the patient to a counselor or support groups if necessary.
Nursing Management:
- Education: Instruct patients on the proper use of acne medications, emphasizing the importance of consistency and patience as results may take several weeks to become apparent.
- Skin Care: Teach patients how to clean their skin gently, avoid harsh scrubbing, and use non-comedogenic skincare products.
- Support: Acknowledge the emotional distress caused by acne and offer counseling or refer to a dermatologist for more severe cases. Discuss the potential benefits of treatment options and provide reassurance about the effectiveness of treatment over time.
Describe the nursing care and treatment options for a patient with a second-degree burn.
Answer:
Pathophysiology of Second-Degree Burns: Second-degree burns, or partial-thickness burns, involve the epidermis and part of the dermis. The skin will appear red, blistered, and swollen, with pain often being severe due to the involvement of nerve endings. These burns can result from contact with hot liquids, flames, or chemicals.
Clinical Features:
- Blisters: The skin may form blisters, which can be large and filled with clear fluid.
- Edema and Erythema: The affected area is typically red and swollen, with a moist appearance.
- Pain: These burns are often very painful, as they involve nerve endings in the dermis.
Treatment:
- Pain Management: Analgesics such as acetaminophen or ibuprofen may be used for mild pain. For more severe pain, opioids may be prescribed. Cooling measures such as cold compresses or immersion in cool (not cold) water can help relieve pain.
- Wound Care: The blisters should be carefully monitored. If they are intact, they may be left undisturbed to prevent infection. If they burst, the area should be cleaned with mild soap and water, and a sterile dressing should be applied.
- Antibiotic Ointments: Topical antibiotics like silver sulfadiazine can be applied to prevent infection. The nurse should assess the wound daily for signs of infection, including redness, warmth, or purulent drainage.
- Hydration and Nutrition: Fluid resuscitation may be necessary if a large area of the body is burned. The patient may also need a high-calorie, high-protein diet to promote healing.
Nursing Management:
- Wound Monitoring: Regularly assess the burn site for signs of infection or complications. Ensure the patient is repositioned frequently to avoid additional pressure on the burned areas.
- Psychological Support: Provide emotional support and reassurance, particularly for children or individuals with extensive burns. Educate the patient and family members about the healing process, expected outcomes, and the importance of follow-up care.