Integumentary System Disorders NCLEX Practice Quiz 2

1. Integumentary System Disorders NCLEX Practice Quiz 2

2. 1. Janet 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? A. Educating a newly admitted burn client regarding the use of pressure garments.B. Obtaining an anaerobic culture specimen from a superficial burn wound.C. Administering tetracycline with a glass of milk to a client with cellulitis.D. Discussing the use of herpes zoster vaccine with a 20-year-old client. 1. Answer: C. Administering tetracycline with a glass of milk to a client with cellulitis. 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.

3. 2. Nurse Sierra is assessing the skin of a client suffering from psoriasis. She understands that which characteristic is associated with this skin disorder? A. Red-purplish scaly lesions.B. Silvery-white scaly patches on the scalp, elbows, knees, and sacral regions.C. Clear, thin nail beds.D. Oily skin and absence of pruritus. 2. Answer: B. Silvery-white scaly patches on the scalp, elbows, knees, and sacral regions. 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.

4. 3. 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. A white color to the skin, which is insensitive to touch.B. A pink, edematous hand.C. A fiery red skin with edema in the nail beds.D. Black fingertips surrounded by an erythematous rash. 3. Answer: A. A white color to the skin, which is insensitive to touch. Assessment findings in frostbite include a white or blue color, the skin will be hard. cold, and insensitive to touch.

5. 4. Which assessment finding calls for the most immediate further assessment or interventions?. A. Bilateral erythema of the face and neck.B. Bluish color around the earlobes and lips.C. Dark brown spotting on the back and chest.D. Yellow color of the skin and sclera 4. Answer: B. Bluish color around the earlobes and lips. 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.

6. 5. 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? A. Remove jewelry and constricting clothing from the victim.B. Move the victim to a safe area away from the snake and encourage the victim to rest.C. Immobilize the affected extremity.D. Place the extremity in a position so that it is below the level of the heart. 5. Answer: B. Move the victim to a safe area away from the snake and encourage the victim to rest. 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.

7. . 6. 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? A. Wood’s light examination.B. Patch test.C. Skin biopsy.D. Culture of the lesion 6. Answer: D. Culture of the lesion. 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.

8. 7. 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? A. Monitoring the surgical site for swelling, bleeding or pain.B. Teaching the client about risk factors for squamous cell carcinoma.C. Discussing the reasons for avoiding aspirin use for a week after surgery.D. Showing the client how to take care for the surgical site at home. 7. Answer: A. Monitoring the surgical site for swelling, bleeding or pain. 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.

9. 8. When assessing a lesion diagnosed as malignant melanoma, the nurse most likely expects to note which of the following? A.. A firm, nodular lesion topped with crust.B. A pearly papule with a central crater and a waxy border.C. An irregularly shaped lesion.D. A small papule with a dry, rough scale 8. Answer: C. An irregularly shaped lesion. 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.

10. 9. Nurse Chael is performing a skin assessment on a new resident in a long-term care facility. Which finding is of most concern?. A. All the toenails are thickened and yellow.B. Silver scaling is present on the elbows and knees.C. An irregular border is seen on a black mole on the scalp.D. Numerous striae are noted across the abdomen and buttocks 9. Answer: C. An irregular border is seen on a black mole on the scalp. 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.

11. 10. 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? A. “Apply calamine lotion immediately to the exposed skin areas.”B. “It is not necessary to do anything if you cannot see anything on your skin.”C. “Come to the emergency department.”D. “Take a shower immediately, lathering, and rinsing several times.” 10. Answer: D. “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. 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.

12. 11. A client returns to the clinic for follow-up treatment following a skin biopsy of a suspicious lesion performed one (1) week ago. The biopsy report indicates that the lesion is a melanoma. The nurse understands that which of the following describes a characteristic of this type of a lesion? A. Melanoma is characterized by local invasion.B. Melanoma is highly metastatic.C. Metastasis is rare.D. Melanoma is encapsulated. 11. Answer: B. Melanoma is highly metastatic. Melanomas are pigmented malignant lesions originating in the melanin-producing cells of the epidermis. This cancer is highly metastatic, and prognosis depends on early diagnosis and treatment.

13. 12. A 30-year old woman who has been taking isotretinoin (Accutane) to treat severe cystic acne make all these statements while being seen for a follow-up examination. Which statement is of most concern? A. “Sometimes I get nauseated after taking the medication.”B. “My husband and I are thinking of starting a family soon.”C. “I have been having problems driving when it gets dark.”D. “I don’t think there has been much improvement in my skin.” 12. Answer: B. “My husband and I are thinking of starting a family soon.” Isotretinoin (Accutane) is associated with a high incidence of birth defects, it is important that the client stops using the medication at least a month before attempting to become pregnant. Options A and C: Poor night vision and nausea are possible adverse effects of isotretinoin that would require further assessment but are not as urgent as discussing but are not as urgent as discussing the fetal risks associated with this medication. Option D: The client’s concern about the effectiveness of the medication should be addressed, but this is a low-priority intervention.

14. 13. A client has been taking prednisone (Deltasone) 20 mg once a day to treat severe seborrheic dermatitis. Which of the following assessment findings is of most concern? A. Complaints of epigastric pain.B. Blood pressure 145/90 mm Hg.C. Blood glucose level 129 mg/dL.D. Complaints of increase appetite. 13. Answer: A. Complaints of epigastric pain. Complaints of epigastric pain indicate that the client might be suffering from peptic ulcers, which require the addition of the use of antacid such as proton pump inhibitor (Nexium). Options B, C, and D are symptoms related to the use of prednisone but are not clinically significant when steroids are used for limited periods and do not require treatment.

15. 14. A client is being admitted for the treatment of acute cellulitis of the thigh. The client asks the admitting nurse to explain what cellulitis means. The nurse bases the response on the understanding that the characteristics of cellulitis include: A. An epidermal and lymphatic infection caused by Staphylococcus.B. An inflammation of the epidermis only.C. A skin infection into the subcutaneous tissue and dermis.D. An acute superficial infection of the lymphatics and dermis. 14. Answer: C. A skin infection into the subcutaneous tissue and dermis. Cellulitis is an infection into deeper dermal and subcutaneous tissue that results in a deep red erythema without sharp borders and spreads widely throughout tissue spaces. Option D: Erysipelas is an acute, superficial, rapidly spreading inflammation of the dermis and lymphatics.

16. 15. The nurse manager is planning the clinical assignments for the day. Which staff members can be assigned to care for a client with herpes zoster? Select all that apply A. The nurse who never had German Measles.B. The nurse who never received the varicella zoster vaccine.C. The nurse who never had mumps.D. The nurse who never had roseola.E. The nurse who never had chicken pox. 15. Answer: A. The nurse who never had German Measles, C. The nurse who never had mumps, D. The nurse who never had roseola. Herpes zoster (shingles) is caused by a reactivation of the varicella-zoster virus, the causative virus for chicken pox. Individuals who have not been exposed to the varicella-zoster virus or who did not receive the varicella-zoster vaccine are susceptible to chickenpox. Health workers who are unsure of their immune status should have varicella titers done before exposure to a person with herpes zoster.

17. 16. A female client went to the emergency department states that she is having burning and intense itching on the skin. A further assessment made by the nurse notes that the client is having red and white patches in the mouth. Based on this, the nurse understand that the client is most likely is suffering from? A. Shingles.B. Erysipelas.C. Eczema.D. Candida Albicans. 16. Answer: D. Candida Albicans. Candida albicans is a superficial infection of the skin and mucous membranes. Assessment of this disorder includes red and irritated skin appearances that itches and burns & red and whitish patches on the mucous membranes of the mouth. Option A: Shingles appears as unilateral clustered skin vesicles. Option B: Erysipelas is characterized by a tender, intensely erythematous, indurated plaque with a sharply demarcated border. Option C: Eczema is a skin condition where patches of skin become inflamed, itchy, red, cracked, and rough.

18. 17. A nurse is developing a care plan for a client suffering from shingles. Which of the following cranial nerve should the nurse assess as part of the client’s care? A. Cranial nerve number IB. Cranial nerve number IVC. Cranial nerve number VIID. Cranial nerve number XI 17. Answer: C. Cranial nerve number VII A potential complication of shingles is Bell’s palsy which can be assessed by the seventh cranial nerve function.

19. 18. Nurse Jeff is performing skin assessment on a client with a facial lesion. It appears as a well-defined, red, scaling, thickened bump. This type of skin lesion refers to? A. Kaposi’s Sarcoma.B. Melanoma.C. Squamous cell.D. Basal cell. 18. Answer: C. Squamous cell. A squamous cell carcinoma is characterized by a well-defined, red, scaling, thickened bump on the sun-exposed skin such as the face, ears, neck, lips, and backs of the hands.

20. 19. The nurse is teaching a female client with a leg ulcer about tissue repair and wound healing. Which of the following statements by the client indicates effective teaching? A. “To make the bandage tightly wrapped .”B. “My foot should feel cold.”C. “I’ll include fruits and vegetables in my meal plan.”D. “I’ll restrict my intake of protein.” 19. Answer: C. “I’ll include fruits and vegetables in my meal plan.” The beneficial nutrients found in fruits and vegetables are essential in the wound healing process. Option A: The bandage should be secure but not too tight to impede circulation to the area (needed for tissue repair). Option B: If the client’s foot feels cold, circulation is impaired, thus inhibiting wound healing. Option D: For effective tissue healing, adequate intake of protein is needed.

21. 20. A client with a severe cellulitis on the left hand was ordered to have cultures done on the affected area. After few days, the culture report was released. The nurse understands that which of the following organisms is not part of the normal flora of the skin?. A. Staphylococcus aureus.B. Candida albicans.C. Campylobacter jejuni.D. Staphylococcus epidermidis 20. Answer: C. Campylobacter jejuni. Campylobacter jejuni is found in the intestines and is one of the most common causes of diarrheal illness.