13.) Skin Disorders

Front 1

1. The nurse is teaching a patient diagnosed with basal cell carcinoma. The most common cause of basal cell carcinoma is:

A. immunosuppression.

B. radiation exposure.

C. sun exposure.

D. burns.

Back 1

Correct answer: C

Sun exposure is the best known and most common cause of basal cell carcinoma. Immunosuppression (Option A), radiation (Option B), and burns (Option D) are less common causes.

Front 2

2. A patient received burns to his entire back and left arm. Using the Rule of Nines, the nurse can calculate that he has sustained burns on what percentage of his body?

A. 9%

B. 18%

C. 27%

D. 36%

Back 2

Correct answer: C

According to the Rule of Nines, each of the posterior and anterior trunks and legs makes up 18% of the total body surface, each of the arms makes up 9%, the head and neck make up 9%, and the perineum makes up 1%. In this case, the patient received burns to his back (18%) and one arm (9%), totaling 27% of his body.

Front 3

3. A patient is admitted to a burn intensive care unit with extensive full-thickness burns. The nurse is most concerned about the patient’s:

A. fluid and electrolyte status.

B. risk of infection.

C. body image.

D. level of pain.

Back 3

Correct answer: A

During the early phase of burn care, the nurse is most concerned with fluid resuscitation and electrolyte balance, to correct large-volume fl uid loss through the damaged skin. Infection (Option B), body image (Option C), and pain (Option D) are signifi cant areas of concern, but are less urgent than fluid status.

Front 4

4. A patient undergoes a biopsy to confi rm a diagnosis of skin cancer. Immediately following the procedure, the nurse should observe the site for:

A. infection.

B. dehiscence.

C. hemorrhage.

D. swelling.

Back 4

Correct answer: C

The nurse’s main concern following a skin biopsy procedure is bleeding. Infection (Option A) is a later possible consequence of a biopsy. Dehiscence (Option B) is more likely in larger wounds such as surgical wounds of the abdomen or thorax. Swelling (Option D) is a normal reaction associated with any event that traumatizes the skin.

Front 5

5. The nurse is caring for a patient with malignant melanoma. The nurse explains that the fi rst and most important treatment for malignant melanoma is:

A. chemotherapy.

B. immunotherapy.

C. radiation therapy.

D. wide excision.

Back 5

Correct answer: D

Wide excision is the primary treatment for malignant melanoma and removes the entire lesion and determines the level and staging. Chemotherapy (Option A) may be used after the melanoma is excised. Immunotherapy (Option B) is experimental. Radiation therapy (Option C) is palliative.

Front 6

6. A 19-year-old patient comes to the clinic with dark red lesions on her hands, wrist, and waistline. She has scratched several of the lesions so that they are open and bleeding. The nurse instructs the patient to try pressing on the itchy lesions. What is the rationale for this intervention?

A. Pressing the skin spreads the benefi cial microorganisms.

B. Pressing is suggested before scratching. C. Pressing the skin promotes breaks in the skin.

D. Pressing the skin stimulates nerve endings.

Back 6

Correct answer: D Pressing the skin stimulates nerve endings and can reduce the sensation of itching. Pressing the skin (Option A) doesn’t spread microorganisms; instead, scratching the skin opens portals of entry for harmful bacteria. Scratching (Option B) isn’t recommended at all. Pressing the skin doesn’t promote breaks in the skin (Option C).

Front 7

7. A patient arrives at the offi ce of his physician complaining of a rash. The nurse assesses the patient and notes several palpable, elevated masses, each about 0.5 cm in diameter. What term would the nurse use to accurately describe these masses?

A. Erosions

B. Macules

C. Papules

D. Vesicles

Back 7

Correct answer: C

Papules are fi rm, palpable raised lesions of up to 0.6 cm in diameter. Erosions (Option A) are characterized as a loss of some or all of the epidermal layer. Macules (Option B) are nonpalpable, fl at changes in skin color. Vesicles (Option D) are fluid-filled lesions.

Front 8

8. A patient has thick, discolored nails with splintered hemorrhages, easily separated from the nail bed. There are also “ice pick” pits and ridges. The nurse explains to the patient that these fi ndings are most closely associated with:

A. paronychia.

B. psoriasis.

C. seborrhea.

D. scabies.

Back 8

Correct answer: B

Psoriasis, a chronic skin disorder with an unknown cause, can result in these characteristic changes in the nails. A paronychia (Option A) is a bacterial infection of the nail bed. Seborrhea (Option C), also called cradle cap, is a chronic infl ammatory dermatitis that typically affects the scalp. Scabies (Option D) are mites that burrow under the skin, generally between the webbing of the fi ngers and toes.

Front 9

9. After the initial phase of a burn injury, the primary focus of a patient’s cure is:

A. enhancing self-esteem.

B. promoting hygiene.

C. reducing anxiety.

D. preventing infection.

Back 9

Correct answer: D

Because the body’s protective barrier is damaged and the immune system is compromised, preventing infection is the primary goal. Enhancing self-esteem (Option A), promoting hygiene (Option B), and reducing anxiety (Option C) are important, but they’re not the primary focus of treatment.

Front 10

10. Which patient is at greatest risk for impaired wound healing after surgery?

A. A 65-year-old patient with hypertension B. A 60-year-old patient who is slightly overweight

C. A 78-year-old patient in general good health

D. A 75-year-old patient with poorly controlled diabetes mellitus

Back 10

Correct answer: D

Poorly controlled diabetes is a serious risk factor for impaired wound healing. Other factors that delay wound healing include advanced age, inadequate blood supply, nutritional deficiencies, and obesity. Hypertension (Option A), being slightly overweight (Option B), and being older but in generally good health (Option C) aren’t as serious risk factors in wound healing.