1) The nurse performs an assessment on a client admitted
with contact dermatitis. Which signs and symptoms should
the nurse look for?
Lesions with well-defined geometric
margins
2) The nurse is providing home care
...
1) The nurse performs an assessment on a client admitted
with contact dermatitis. Which signs and symptoms should
the nurse look for?
Lesions with well-defined geometric
margins
2) The nurse is providing home care instructions to the
client who just had surgery for squamous cell carcinoma.
The nurse provides follow-up teaching and explains to the
client to watch for which characteristics of this type of
skin carcinoma?
Firm, nodular lesion topped with a crust
or with a central area of ulceration
3) The nurse is teaching the client about risk factors for
skin cancer. Which statements by the client indicate that
teaching was successful? Select all that apply.
"I have to avoid excessive exposure to
sunlight."
"I am at higher risk for skin cancer
because my mother had one."
4) The nurse is assessing a dark-skinned client for signs of
anemia. The nurse should focus the assessment on which
structures? Select all that apply.
Lips
Conjunctiva
Mucous membranes
5) The nurse is providing teaching to a client who will
undergo chemotherapy for cancer, and alopecia is expected
from the chemotherapeutic agent. Which statement made by
the client indicates a need for further teaching?
"I can't believe my hair loss will be
permanent."
6) The nurse is caring for a client with full-thickness
circumferential burns of the entire trunk of the body.
Which finding suggests that an escharotomy may be
necessary?
High pressure alarm keeps sounding on
the ventilator
7) A client with chloasma is extremely stressed about the
change in her facial appearance. Which integumentary
change observed by the nurse is consistent with this
problem?
Blotchy brown macules across the cheeks
and forehead
8) The nurse is planning care for a client who suffered a
burn injury and has a negative self-image related to
keloid formation at the burn site. The keloid formation
is indicative of which condition?
Hypertrophy of collagen fibers
9) The nurse observes the client's sacrum and notes the
following. How will the nurse document this in the
client's medical record? Refer to figure.
View Figure
Stage IV pressure ulcer
10) A client recently diagnosed with chronic kidney disease
requiring hemodialysis has an arteriovenous fistula for
access. The client asks the nurse what complications can
occur with the access site. What complications should the
nurse inform the client about? Select all that apply.
Hepatitis
Infection
11) The nurse has completed discharge teaching for a client
who was admitted for reticular skin lesions. Which
statement by the client indicates understanding of the
discharge instructions?
"I need to assess my skin for lesions
that appear net-like."
12) A client exhibits erythema of the skin. The nurse plans
care, knowing that which factors are responsible for this
finding? Select all that apply.
Fever
Vasodilation
Inflammation
Excessively high environmental
temperature
13) An older client's physical examination reveals the
presence of a fiery star-shaped marking with a circular,
solid center. The nurse recognizes that these findings,
which are caused by capillary radiations extending from
the central arterial body, are representative of which
lesions?
Spider angioma
14) An older client is lying in a supine position. The
nurse understands that the client is at least risk for
skin breakdown in which body area?
Greater trochanter
15) In planning care for the client with psoriasis, the
nurse understands that which represents a priority client
problem?
Altered body image
16) The nurse is performing an admission assessment on a
client diagnosed with paronychia. The nurse should plan
to assess which part of the integumentary system first?
Nails
17) A client exhibits a purplish bruise to the skin after a
fall. The nurse would document this finding in the health
record most accurately using which term?
Ecchymosis
18) A client is diagnosed with a full-thickness burn. What
should the nurse anticipate will be used for final
coverage of the client's burn wound?
Autograft
19) The nurse is providing instructions to a client with
psoriasis who will be receiving ultraviolet (UV) light
therapy. Which statement would be most appropriate for
the nurse to include in the client's instructions?
"You will need to wear dark eye goggles
during the treatment."
20) The nurse in the surgical care center will be assisting
the health care provider to perform a punch biopsy of a
client's skin lesion. Which interventions should be
included in the preprocedure plan of care? Select all
that apply.
Obtain an informed consent.
Prepare to apply direct pressure to the
biopsy site after the procedure.
Tell the client that a small piece of
tissue will be removed for examination.
21) The nurse is developing a teaching plan for a group of
adolescents regarding the causes of acne. The nurse
develops the plan based on which characteristics
associated with acne? Select all that apply.
The exact cause of acne is unknown.
Acne requires active treatment for
control until it resolves.
Oily skin and a genetic predisposition
may be contributing factors for acne.
The types of lesions in acne include
comedones (open and closed), pustules,
papules, and nodules.
22) The nurse is reviewing the health care records of
clients scheduled to be seen at a health care clinic. The
nurse determines that which client is at the greatest
risk for development of an integumentary disorder?
An outdoor construction worker
23) A client scheduled for a skin biopsy is concerned and
asks the nurse how painful the procedure is. Which
statement is the appropriate response by the nurse?
"The local anesthetic may cause a
burning or stinging sensation."
24) The nurse is preparing a client for punch biopsy. What
should the nurse do to prepare for this procedure?
Ensure that the consent form has been
signed.
25) The nurse prepares to assist a health care provider who
is examining a client's skin with a Wood's light. Which
step should the nurse include in the plan for this
procedure?
Darken the room for the examination.
26) The nurse prepares to treat a client with frostbite of
the toes. Which action should the nurse anticipate will
be prescribed for this condition?
Rapid and continuous rewarming of the
toes in a warm water bath until flushing
of the skin occurs
27) The presence of which finding leads the home health
nurse to suspect infestation of a client with scabies?
Multiple straight or wavy, threadlike
lines beneath the skin
28) The nurse suspects herpes zoster (shingles) when which
assessment finding is noted?
Clustered skin vesicles
29) Ultraviolet (UV) light therapy is prescribed as a
component of the treatment plan for a client with
psoriasis, and the nurse provides instructions to the
client regarding the treatment. Which statement by the
client indicates a need for further instruction?
"The UV light treatments are given on
consecutive days."
30) The nurse prepares to care for a client with acute
cellulitis of the lower leg. The nurse anticipates that
which interventions will be prescribed for the client?
Select all that apply.
Antibiotic therapy
Warm compresses to the affected area
31) Which individuals are most likely to be at risk for
development of psoriasis? Select all that apply.
A woman experiencing menopause
A client with a family history of the
disorder
An individual who has experienced a
significant amount of emotional distress
32) A 60-kg client has sustained third-degree burns over
40% of the body. Using the Parkland (Baxter) formula, the
minimum fluid requirements are which during the first 24
hours after the burn?
9600 mL of lactated
Ringer's solution
33) The nurse is evaluating fluid resuscitation attempts in
the burn client. Which finding indicates adequate fluid
resuscitation?
Heart rate of 95
beats/minute
34) The nurse is assessing a dark-skinned client for the
presence of petechiae. Which body area is the best for
the nurse to check in this client?
Oral mucosa
35) The nurse is caring for a client who has vesicles
filled with purulent fluid on the face and upper
extremities. On the basis of these findings, the nurse
should tell the client that the vesicles are consistent
with which condition?
Acne
36) The nurse is performing assessment of the client who is
admitted with left leg cellulitis. What does the nurse
anticipate finding on the assessment of the left lower
extremity?
Erythema
37) A client complains of chronic pruritus. Which diagnosis
should the nurse expect to note documented in the
client's medical record that would support this client's
complaint?
Chronic kidney disease
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