Chapter 66
1. A client has a lesion in the left axilla that is deep, painful, and contains pus. The nurse
measured the lesion and found it is 3 centimeters in diameter and is walled off. After the
assessment, the nurse determines the lesion is:
1. A furuncle.
2. Folliculitis.
3. A carbuncle.
4. Herpes varicella.
Answer: A furuncle.
Rationale: A furuncle develops when the infection from folliculitis becomes deeper. A
sebaceous gland is obstructed, causing a deep inflammatory reaction and infection from
staphylococcus. The lesion is a walled-off, painful, firm mass that contains pus. It is usually 1
to 5 centimeters in diameter. A carbuncle is a larger abscess that interconnects several hair
follicles and is about 3 to 10 centimeters in diameter.
2. A client is diagnosed with herpes zoster (shingles). The client feels the infection is a result
of exposure to an organism while traveling abroad. To correct the client’s misconceptions, the
nurse must explain that herpes zoster:
1. Occurs because of the reactivation of the latent varicella-zoster virus.
2. Results from sharing personal items such as towels.
3. Occurs in only a few areas of the world.
4. Is caused by a bacteria normally found on the skin.
Answer: Occurs because of the reactivation of the latent varicella-zoster virus.
Rationale: Herpes zoster (shingles) occurs because of the reactivation of latent vericellazoster virus (the virus that causes chickenpox). After having chickenpox, the virus remains
dormant in the dorsal root and cranial nerve ganglia, and becomes activated usually when a
person is immunocompromised due to age or some other disease process such as AIDS,
Hodgkin’s disease, and some cancers.
3. A nursing consultant for a preschool diagnoses several children with tinea capitis. The
nurse convenes a meeting to educate the staff on control and prevention of this contagious
infection. The nurse explains that tinea capitis is spread by:
1. Contact with personal items such as hats and blankets.
2. Lack of proper hygiene practices.
3. Wearing woolen hats.
4. Children only.
Answer: Personal contact with items such as hats and blankets.
Rationale: Tinea capitis (ringworm of the scalp) is a contagious fungal infection transmitted
by personal contact. It can be spread through combs, animals, hats, blankets, telephones, and
theater seats. It is more common in children because of their habits, but anyone can contract
tinea capitis.
4. When educating clients and families about maintaining healthy skin, it is essential that the
nurse discuss the importance of:
Select all that apply.
1. Adequate nutrition.
2. Regular exercise.
3. Hygiene practices.
4. Racial differences.
5. Annual skin inspections.
Answer: 1. Adequate nutrition.
2. Regular exercise.
3. Hygiene practices.
4. Racial differences.
Rationale: Adequate nutrition. The skin needs protein, vitamin C, iron, and zinc to be healthy.
Protein and vitamin deficiencies, along with obesity, can decrease the skin’s ability to
regenerate and affect the circulation to the skin, leading to skin lesions and delayed would
healing. Water is important to maintain elasticity in the skin. Regular exercise. Regular
exercise helps maintain adequate circulation, providing oxygen and nutrients to the skin.
Hygiene practices. Regular bathing keeps the excess bacteria and oils in check so that the
skin can remain healthy. However, bathing more frequently than necessary can cause dryness
of the skin. Racial differences. Racial differences in skin may account for changes in skin
response to daily care and environmental irritants. Annual skin inspections. The skin should
be inspected monthly for new growths or changes in skin lesions.
5. An African American client has reoccurring folliculitis on the face. The nurse should
instruct the client to:
1. Use an electric razor.
2. Shave daily.
3. Shave very close.
4. Shave in the opposite direction of hair growth.
Answer: Use an electric razor.
Rationale: Folliculitis is inflammation of the hair follicles. African Americans are particularly
susceptible to folliculitis caused by ingrown hairs because of their curly hair. The client
should be instructed to shave every few days rather than daily. The client should avoid
shaving too close and shave in the direction of hair growth. Using an electric razor instead of
a straightedge blade may be helpful.
6. The nurse is counseling with a client who has atropic dermatitis (eczema) and has
developed a secondary Staphylococcus aureus infection. To prevent this type of infection
from reoccurring in the future, the nurse should stress:
1. Methods to prevent itching.
2. Continuous antibiotic treatment.
3. Frequent bathing.
4. Allergy testing.
Answer: Methods to prevent itching
Rationale: A secondary Staphylococcus aureus infection can develop due to skin trauma and
breakdown from scratching. Therefore, it is important to control the itching that occurs with
eczema. Antibiotics would be given to treat the infection but not prevent it. Frequent bathing
may dry out the skin, causing increased itching. It is important to identify the irritants that
cause the lesions, but this will not prevent a secondary infection.
7. A client develops inflammation of the skin after being exposed to poison oak. This reaction
is:
1. Contact dermatitis.
2. Actinic keratosis.
3. Atopic dermatitis.
4. Urticaria.
Answer: Contact dermatitis.
Rationale: Contact dermatitis is an inflammation of the skin related to exposure to an irritant
or allergen in the environment. The reaction to poison oak is an allergic contact dermatitis.
Actinic keratosis is related to skin exposure to the sun. Atopic dermatitis is a chronic,
inflammatory skin disorder. Urticaria is most often related to an allergic reaction to
medications, foods, or insect bites.
8. The cause of photodermatitis that is not the result of a genetic immunologic reaction may
be the result of:
1. The use of certain medications.
2. Excessive sun exposure.
3. A vitamin deficiency.
4. Smoking.
Answer: The use of certain medications.
Rationale: Photodermatitis is an inflammatory adverse reaction to sunlight. It is a
hypersensitivity to sun in which the individual sunburns more easily than usual or develops
papular or vesicular lesions with exposure to the sun. It may occur because of the use of
certain medication. It is not a reaction to excessive sun exposure, vitamin deficiency, or
smoking.
9. Urticaria (hives) commonly occurs:
1. As an allergic reaction to foods or insect bites.
2. Because of a familial predisposition.
3. And rarely resolves without treatment.
4. On the palms of the hands.
Answer: As an allergic reaction to foods or insect bites.
Rationale: Urticaria commonly occurs as an allergic reaction to medication, foods, and insect
bites. There is not a familial predisposition to developing urticaria. The rash related to
urticaria does not usually appear in the mucous membranes, the palms of the hands, or the
soles of the feet. Most cases resolve spontaneously, but antihistamines may be given to block
the action of histamine.
10. A client has a small, red, scaling lesion that is sitting on an elevated base on the forehead.
The client states that lesion began several weeks before and will not heal. The nurse
recognized this lesion as possible:
1. Squamous cell carcinoma.
2. Melanoma.
3. Psoriases.
4. Seborrheic keratosis.
Answer: Squamous cell carcinoma.
Rationale: Squamous cell carcinoma consists of tumors of the outer epidermis that occur with
frequent exposure to the sun. The scaling lesions sit on an elevated base with an irregular
border that may itch or be a nonhealing lesion after minor trauma. Melanomas appear as
changing or unusual moles with an irregular border, an uneven surface, and are of varied size
and shape. Psoriasis lesions are erythematous papules and placques with silver-white scales
that are sharply demarcated. Seborrheic keratosis lesions are warty, dirty-yellow to black
papules with sharp margins.
11. A potassium hydroxide smear is used to determine if a client’s skin lesion is caused by a:
1. Fungus.
2. Bacteria.
3. Virus.
4. Parasite.
Answer: Fungus.
Rationale: A sample of the lesion is taken, wet with a solution of potassium hydroxide, and
placed on a slide for examination. The potassium chloride clears off debris and bacteria so
that fungi can be identified. The potassium chloride smear is used to identify a fungus.
Bacteria and viruses are identified by cultures, and parasites can be determined by looking at
skin scrapings under the microscope.
12. A client with psoriasis is being treated with topical corticosteroids. The nurse who is
teaching the client about the application of the medication should explain that the correct way
to apply the medication is to:
1. Apply the medication in a thin layer.
2. Avoid rubbing the medication into the skin.
3. Apply a thick layer of medication.
4. Continue medication even if lesions worsen, because it is only a temporary reaction.
Answer: Apply the medication in a thin layer.
Rationale: Topical corticosteroids should be applied in a thin layer and rubbed in thoroughly
on wet skin. Some infections may be made worse by corticosteroids. If the lesions worsen,
the medication should be discontinued and the health provider notified.
13. Discharge planning for a client with a dermatologic disorder usually begins at the same
time as diagnosis of the condition because:
1. Most are cared for at home.
2. Treatments are very complicated.
3. Most skin disorders have long-term effects.
4. Most require pain medications.
Answer: Most are cared for at home.
Rationale: Most clients of dermatologic disorders are cared for at home. Patient teaching
aimed at self-care is an important part of planning for discharge. Treatments for most skin
disorders are not very complicated; treatment usually consists of a topical medication and
occasionally an oral medication. Most skin disorders do not have long-term effects; most are
resolved with removal of cause and medication. Most skin disorders are not painful so pain
medication is not needed; medications for the relief of itching are often required.
14. When caring for a client with toxic epidermal necrolysis disorders that are life
threatening, it is essential that the plan of care be prioritized correctly. The first priority
should be:
1. Protection of airway.
2. Balanced fluid volume.
3. Effective thermoregulation.
4. Pain management.
Answer: Protection of airway.
Rationale: Although all the answer choices are important, protection of the airway and
maintenance of normal oxygen levels is always the first priority. Edema and involvement of
mucous membranes can compromise the airway. With epidermal necrolysis disorders, it is
also important to monitor a client’s hemodynamic status and electrolyte levels because there
is epithelial skin loss. The client will also have acute pain because of the exposed nerve
endings.
15. The nurse is developing plan of care for a client with necrotizing fasciitis. One of the
outcomes should be to prevent worsening of the infection. An appropriate question for nurse
to ask when collecting subjective data during the assessment would be:
1. Where are the lesions located?
2. Do you have edema?
3. How active are you physically?
4. Is your pain constant or intermittent?
Answer: Where are the lesions located?
Rationale: “Where are the lesions located?” would aid the nurse is assessing the skin integrity
of the client and determine evaluation parameters. “Do you have edema?” would relate to
assessment of fluid status. “How active are you physically?” would aid the nurse in assessing
physical mobility. “Is your pain constant or intermittent?” would aid the nurse in assessing
the client’s pain.
16. Blepharoplasty is sometimes performed at the same time a face-lift or brow-lift is done
because the client does not like the appearance of the eyes. This procedure may also be done
because:
1. There is an interference with vision.
2. The procedure improves the results of the face-lift or brow-lift.
3. The procedure improves the client’s ability to blink sufficiently.
4. The client wants to remove ethnic characteristics of the eye.
Correct Answer There is an interference with vision.
Rationale: Blepharoplasty is often performed for cosmetic reasons when the client does not
like the appearance of the eyes. This reason would include removing ethnic characteristics
and improving the results of a face-lift or brow-lift. It may be also performed because there is
an interference with the client’s vision; with aging, there is location of fat, loss of skin
elasticity, and excess muscle around the eye. The excess skin and fat, and occasionally a
portion of the orbicularis oculi muscle around the eye, are removed. Blepharoplasty is not
related to the client’s ability to blink.
17. A client with a skin disorder may have many physiological needs and psychological
needs. The nurse should:
1. Provide an open, supportive environment.
2. Address the physiological needs first.
3. Stress that the psychological needs will be resolved with treatment.
4. Put more emphasis on the psychological needs first.
Answer: Provide an open, supportive environment.
Rationale: Psychological assessment needs to be uppermost in the mind of the nurse as care is
given to patients with skin disorders. The appearance of the skin affects self-esteem and body
image. Patients should be provided with an open, supportive environment in which they are
comfortable voicing their concerns. Psychological and physiological needs are best addressed
within an open, supportive environment. Psychological needs may or may not be resolved
with treatment.
18. The major concern for clients with skin disorders such as hyperpigmentation of the skin is
typically the:
1. Cosmetic effect.
2. Cause.
3. Scarring.
4. Treatment.
Answer: Cosmetic effect.
Rationale: The major concern for clients with these types of lesions is the cosmetic effect.
They can be diffuse or limited to a specific space. They may occur in areas that are exposed
to the sun and therefore are visible in areas usually not covered with clothing. Clients may
also be concerned about the cause, treatment, or scarring related to hyperpigmentation, but
these are not usually the major concern.
19. An elderly client is concerned that he has more wrinkles on the face than a friend who
smokes and does not use sunscreen. The nurse should explain that ___________ can also
play role in loss of skin elasticity.
1. Genetics
2. Medications
3. Exposure to toxins
4. Facial structure
Answer: Genetics
Rationale: Genetics can contribute to loss of skin elasticity and wrinkle formation as an
individual ages. This is one factor over which the individual has no control. Facial structure is
not related to skin elasticity. Medications and exposure to toxins are not normally related to
skin elasticity.
20. A client is concerned because his face appears to be getting longer. The nurse should
explain that this change is:
1. A normal part of aging.
2. Rare and needs follow up.
3. More common in certain ethnic groups.
4. An optical illusion.
Answer: A normal part of aging.
Rationale: The face becomes elongated and flattened as a normal part of the aging process. It
is not an illusion, nor is it more common in specific ethnic groups.
21. Darker-skinned individuals are less prone to the signs of aging because of:
1. Melanin.
2. Skin products used.
3. Dermabrasion.
4. Alopecia.
Answer: Melanin.
Rationale: Darker-skinned individuals are less prone to the signs of aging due the
photoprotective nature of the melanin in darker skin. Alopecia is related to loss of hair. The
use of dermabrasion and skin products may affect the signs of aging in individuals of all skin
pigmentations.
