Integumentary System Disorders | NCLEX Quiz 174

1. Nurse Sierra is assessing the skin of a client suffering from psoriasis. She understands that which characteristic is associated with this skin disorder?

Red-purplish scaly lesions.

Silvery-white scaly patches on the scalp. elbows. knees. and sacral regions.

Clear. thin nail beds.

Oily skin and absence of pruritus.

Psoriatic patches are covered with silvery white scales. Affected areas include the scalp. elbows. knees. shins. sacral area. and trunk.Option A: The lesions in psoriasis are not red-purplish scaly lesions.Option C: Thickening. pitting. and discoloration of the nails occurs.Option D: Pruritus may occur.

Explanation

Psoriatic patches are covered with silvery white scales. Affected areas include the scalp. elbows. knees. shins. sacral area. and trunk.Option A: The lesions in psoriasis are not red-purplish scaly lesions.Option C: Thickening. pitting. and discoloration of the nails occurs.Option D: Pruritus may occur.

2. Nurse Luis is caring for a client who has just had a squamous cell carcinoma removed from the face. Which activities can you delegate to an experienced nursing LPN/LVN?

Monitoring the surgical site for swelling. bleeding or pain.

Teaching the client about risk factors for squamous cell carcinoma.

Discussing the reasons for avoiding aspirin use for a week after surgery.

Showing the client how to take care for the surgical site at home.

An LPN/LVN who is experienced with postoperative clients will know how to monitor for swelling. bleeding. or pain and will notify the supervising RN.

Explanation

An LPN/LVN who is experienced with postoperative clients will know how to monitor for swelling. bleeding. or pain and will notify the supervising RN.

3. Which assessment finding calls for the most immediate further assessment or interventions?

Bilateral erythema of the face and neck.

Bluish color around the earlobes and lips.

Dark brown spotting on the back and chest.

Yellow color of the skin and sclera.

A blue color or cyanosis may indicate that the client has significant problems with circulation or ventilation. More detailed assessments are needed immediately.Options A. C. and D: The other data may also indicate health problems in major body systems. but potential respiratory or circulatory abnormalities are the priority.

Explanation

A blue color or cyanosis may indicate that the client has significant problems with circulation or ventilation. More detailed assessments are needed immediately.Options A. C. and D: The other data may also indicate health problems in major body systems. but potential respiratory or circulatory abnormalities are the priority.

4. The client arrives at the emergency department and has experienced frostbite to the right hand. Which of the following would the nurse note on assessment of the client's hand?

A white color to the skin. which is insensitive to touch.

A pink. edematous hand.

A fiery red skin with edema in the nail beds.

Black fingertips surrounded by an erythematous rash.

Assessment findings in frostbite include a white or blue color. the skin will be hard. cold. and insensitive to touch.

Explanation

Assessment findings in frostbite include a white or blue color. the skin will be hard. cold. and insensitive to touch.

5. The clinic nurse notes that the physician has documented a diagnosis of herpes zoster (shingles) in the client's chart. Based on an understanding of the cause of this disorder. the nurse determines that this definitive diagnosis was made following which diagnostic test?

Wood’s light examination.

Patch test.

Skin biopsy.

Culture of the lesion.

With the classic presentation of shingles. the clinical examination is diagnostic. A viral culture of the lesion provides the definitive diagnosis. Herpes zoster is caused by a reactivation of the varicella-zoster virus. the virus that causes chickenpox.Option A: In a Wood’s light examination. the skin is viewed under ultraviolet light to identify superficial infections of the skin.Option B: A patch test is a skin test that involves the administration of an allergen to the surface of the skin to identify specific allergies.Option C: A biopsy would provide a cytological examination of tissue.

Explanation

With the classic presentation of shingles. the clinical examination is diagnostic. A viral culture of the lesion provides the definitive diagnosis. Herpes zoster is caused by a reactivation of the varicella-zoster virus. the virus that causes chickenpox.Option A: In a Wood’s light examination. the skin is viewed under ultraviolet light to identify superficial infections of the skin.Option B: A patch test is a skin test that involves the administration of an allergen to the surface of the skin to identify specific allergies.Option C: A biopsy would provide a cytological examination of tissue.

6. Nurse Chael is performing a skin assessment on a new resident in a long-term care facility. Which finding is of most concern?

All the toenails are thickened and yellow.

Silver scaling is present on the elbows and knees.

An irregular border is seen on a black mole on the scalp.

Numerous striae are noted across the abdomen and buttocks.

Irregular borders and a black mole or variegated color are characteristics associated with malignant skin lesions.Options A and D: Striae and toenail thickening are common with elderly individuals.Option B: Silver scaling is associated with psoriasis. which may need treatment but is not as urgent a concern as the appearance of the mole.

Explanation

Irregular borders and a black mole or variegated color are characteristics associated with malignant skin lesions.Options A and D: Striae and toenail thickening are common with elderly individuals.Option B: Silver scaling is associated with psoriasis. which may need treatment but is not as urgent a concern as the appearance of the mole.

7. When assessing a lesion diagnosed as malignant melanoma. the nurse most likely expects to note which of the following?

A firm. nodular lesion topped with crust.

A pearly papule with a central crater and a waxy border.

An irregularly shaped lesion.

A small papule with a dry. rough scale.

Melanoma is an irregularly shaped pigmented papule or plaque with a red. white. or blue-toned color.Option A: Squamous cell carcinoma is a firm. nodular lesion topped with a crust or a central area of ulceration.Option B: Basal cell carcinoma appeared as a pearly papule with a central crater and rolled waxy border.Option D: Actinic keratosis. a premalignant lesion. appears as a small macule or papule with a dry. rough. adherent yellow or brown scale.

Explanation

Melanoma is an irregularly shaped pigmented papule or plaque with a red. white. or blue-toned color.Option A: Squamous cell carcinoma is a firm. nodular lesion topped with a crust or a central area of ulceration.Option B: Basal cell carcinoma appeared as a pearly papule with a central crater and rolled waxy border.Option D: Actinic keratosis. a premalignant lesion. appears as a small macule or papule with a dry. rough. adherent yellow or brown scale.

8. JT being the charge nurse for today is providing orientation to Nurse Brad, a newly hired employee. Which of the following action by Nurse Brad requires the most immediate action?

Educating a newly admitted burn client regarding the use of pressure garments.

Obtaining an anaerobic culture specimen from a superficial burn wound.

Administering tetracycline with a glass of milk to a client with cellulitis.

Discussing the use of herpes zoster vaccine with a 20-year-old client.

Tetracyclines should never be taken with milk or milk products since dairy products prevent the absorption of tetracycline.Option A: Pressure garments may be used after graft wounds heal and during the rehabilitation period after a burn injury, but this should be discussed when the client is ready for rehabilitation, now when the client is admitted.Option B: Anaerobic bacteria would not be likely to grow in a superficial wound.Option D: The herpes zoster vaccine is recommended for clients who are 60 years or older.

Explanation

Tetracyclines should never be taken with milk or milk products since dairy products prevent the absorption of tetracycline.Option A: Pressure garments may be used after graft wounds heal and during the rehabilitation period after a burn injury, but this should be discussed when the client is ready for rehabilitation, now when the client is admitted.Option B: Anaerobic bacteria would not be likely to grow in a superficial wound.Option D: The herpes zoster vaccine is recommended for clients who are 60 years or older.

9. A client calls the emergency department and tells the nurse that he had been cleaning a wooden area in the backyard and came directly into contact with poison ivy shrubs. The client tells the nurse that he cannot see anything on the skin and ask the nurse what to do. Which of the following is the appropriate nursing response?

“Apply calamine lotion immediately to the exposed skin areas.”

“It is not necessary to do anything if you cannot see anything on your skin.”

“Come to the emergency department.”

“Take a shower immediately. lathering. and rinsing several times.”

When an individual comes in contact with a poison ivy plant. the sap from the plants forms an invisible film on the human skin.The client should be instructed to cleanse the area with alcohol and then shower immediately and to lather the skin several times and rinse each time in running water.Option A: Calamine lotion may be one product recommended for use if dermatitis occurs.Option C: It is not yet necessary to be at the emergency unit at this time.

Explanation

When an individual comes in contact with a poison ivy plant. the sap from the plants forms an invisible film on the human skin.The client should be instructed to cleanse the area with alcohol and then shower immediately and to lather the skin several times and rinse each time in running water.Option A: Calamine lotion may be one product recommended for use if dermatitis occurs.Option C: It is not yet necessary to be at the emergency unit at this time.

10. Nurse Keith is conducting a session about the principles of first aid and is discussing the interventions for a snakebite to an extremity. He should inform those attending the session that the first priority intervention in the event of this occurrence is which of the following?

Remove jewelry and constricting clothing from the victim.

Move the victim to a safe area away from the snake and encourage the victim to rest.

Immobilize the affected extremity.

Place the extremity in a position so that it is below the level of the heart.

The first priority in case of a snakebite is to move the victim to a safe area away from the snake and encourage the client to rest to decrease venom circulation.

Explanation

The first priority in case of a snakebite is to move the victim to a safe area away from the snake and encourage the client to rest to decrease venom circulation.