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WorksheetsIntegumentary System
Total questions: 80
Worksheet time: 54mins
A nurse notes that a 55 year old, light-skinned patient has dry, flaky skin. Which action by the patient should alert the nurse to a problem?
Patient always puts a moisturizing lotion on her hands after washing them
Patient takes daily showers with soap & hot water
Patient takes a daily multi-vitamin
Patient spends time outside, reapplies sunscreen every 1.5-2 hours
A nurse is teaching teenagers regarding the importance of protecting the skin from UV rays. What should the nurse include? (Select all that apply)
Use a sunscreen with a SPF of at least 30
Apply sunscreen thinly
Wear light, loose clothing
Gauge exposure while in the sun
Wear sunglasses & a hat
A patient with a suspicious skin lesion is scheduled for a punch skin biopsy. What is the most accurate description for the procedure?
It is shaving a top layer off a lesion
It is removing a core from the center
It is removing the entire lesion
It is aspirating a tissue sample
A patient has a rash of unknown origin. Which assessment question(s) would help determine the underlying cause? (Select all that apply)
When did the rash or lesion first appear?
Can you think of any event or different food you ate or substance you were using just before it appeared?
What drugs or OTC medications are you taking?
Have you ever had radiation therapy?
Do you have a history of any skin disorders in your family?
What physiologic changes in aging predispose older adults to skin breakdown? (Select all that apply)
Thickening of skin
Loss of collagen
Increased elastic fibers
Decreased adipose tissue
Reduced sebaceous gland activity
A nurse needs to apply a dressing to a patient who has fragile skin. Which intervention would the nurse use to protect the patient from skin tears?
Ask the provider to give specific orders for wound care
Gently clean & apply a sterile transparent dressing
Tape the dressing with paper tape & prevent tension
Allow any tape & gauze dressing materials to fall off naturally
A nurse is observing a CNA provide skin care to an older adult patient. Which action by the CNA indicates a need for further training?
Using soap & hot water every day to clean the patient’s body
Alerting the nurse about a wet dressing
Reporting redness & blanching over the sacral area
Applying lotion while the skin is damp
A nurse is supervising a new graduate nurse (GN) who is examining a new patient with skin lesions. The nurse would intervene if the GN:
Gently handles the patient’s extremedies to prevent skin tears
Observes the condition of the skin & measures the size of the lesions
Removes the scales & crusts from the lesions to clean the skin
Assesses for & documents any home remedies that the patient has tried
A nurse is caring for a 75 year old patient who spends most of his time in bed. What steps prevent skin tears? (Select all that apply)
Have the patient wear long sleeves & pants
Lubricate the patient’s skin with lotion twice a day
Massage the skin over bony prominences
Never use a lift sheet to move or turn a patient
Pad bed rails, wheelchair arms, leg supports, or other equipment where the patient may bump an extremity
A nurse reads in a patient’s record that the provider observed “circumscribed, superficial vesicles with a collection of serous fluid.” The nurse anticipates that the provider will make which recommendation for the patient?
A prescription for a topical medication for acne
Isolation precautions for herpes zoster
OTC antihistamine for an insect bite
Patient education to self monitor the wart
Which instruction should be included when providing health teaching about exposure to the sun?
To obtain a slight tan, stay in the sun between 11am-3pm
Wear light-colored, loose clothing to protect against the sun
Use sunscreen even on cloudy days in you expect to be outdoors for extended periods of time
Dark-skinned individuals do not have to be concerned about the amount of time spent in the sun
A nurse is providing education to a group of teen girls on the importance of wearing skin protection. Overexposure to UV rays can cause which change in the skin?
Thinning
Severe wrinkles
Loss of hair follicles
Loss of adipose tissue
The nurse is providing education to a patient recently prescribed a topical medication. Which information would be appropriate to include?
Ingest the medication by mouth
Mix the medication in your bath water
Inject the medication directly into the lesion
Apply the medication directly to the surface of the affected area
A patient is to have a culture & sensitivity test.
The skin is inspected using a special light
A sample of tissue is removed from the skin
A sample of exudate is taken from the lesion
Pressure will be applied to the lesion to determine the patient’s sensitivity level
The nurse is caring for a patient who has been admitted to the acute care facility with painful, infected lesions of the skin. Which action would be the priority of the LVN?
Carefully cleaning the affected area with soap and water
Giving the patient a disinfecting tub bath
Observing & recording the patient’s skin condition
Applying a comforting lotion until the primary health provider writes the medical orders
The primary health provider states the patient has several papular lesions, the nurse will likely observe:
Small, solid elevation of the skin
Small sac containing serous fluid
Firm, raised, deep lesion of the skin
Small elevation of the skin filled with purulent matter
The nurse is caring for a patient with a skin tear. Which dressing is best to apply to the area?
Paste
Hydrocolloid
Moist sterile gauze
Petroleum-based ointment
Pallor is described in an African-America patient by:
Bruising to the skin
Ashen-gray tone to the skin
Extremely pale color to the skin
Inflammation of an area of the skin
A patient asks the nurse about the expected changes that occur in the skin with age (select all that apply)
Skin becomes thicker
Skin is slower to heal
Skin may become dry & itchy
Skin becomes more wrinkled & saggy
Skin is at increased risk for sunburn
Which are the categories of skin tears based on the Payne-Martin classification? (Select all that apply)
A skin tear without tissue loss
A skin tear with partial tissue loss
A skin tear with deep tissue exposure
A skin tear with deep tissue & muscle exposure
A skin tear with complete tissue loss in which the epidermal flap is missing
A patient who is recovering from a severe burn is permitted oral feedings. Which diet is most appropriate for this patient?
Low protein & low calorie
Low protein & high calorie
High protein & low calorie
High protein & high calorie
When a patient with burns has a full-thickness wound, which of these tissues are involved?
Subcutaneous fat only
The entire dermis & muscles
The deeper layers of the dermis only
The entire dermis & subcutaneous tissue
In the immediate care provided to a burn victim with 2nd & 3rd degree burns of the arms & legs, the LVN should expect the primary health provider to order which intervention?
Antibiotics to ward off infection
Sedative injection to calm the patient
Ample occlusive dressings to protect the patient’s damaged skin
Isotonic balanced intravenous solution to maintain fluid balance
When a patient has herpes zoster (shingles), the nurse should expect the patient to report:
Severe pain
A rash on arms
Pustules on legs
Respiratory involvement
The nurse is preparing to care for a patient with psoriasis. The nurse should anticipate which skin assessment?
Fluid-filled blisters
Patches covered with silvery scales
Slightly raised, zigzag lesions
An area of local swelling & redness
A 56 year old patient is admitted to the hospital with pneumonia & shingles. The nurse is aware that shingles is caused by:
Reactivation of herpes simplex
Compromised immune function
Exposure to people with genital herpes
Activation of varicella-zoster in individuals who have had varicella
A patient’s burns have become infected with pseudomonas. The nurse should anticipate using which topical dressing?
Silver nitrate
Povidone-iodine
Mafenide acetate
Silver sulfadiazine
The nurse is caring for a patient with an electrical burn. What should be monitored on this patient?
Lungs
Heart
Kidneys
Gastric mucosa
The patient presents to the clinic with severe dermatitis that is refractory to avoidance of irritants, maintenance of skin moisture, & skin lubrication. The nurse anticipates which treatments? (Select all that apply)
Oatmeal baths
Prescription tretinoin
Topical hydrocortisone
Use of salycylic skin cleanser
Frequent exfoliation of the skin
A patient has been diagnosed with acne rosacea. The nurse should educate the patient to avoid: (Select all that apply)
Tea
Milk
Beer
Juice
Coffee
In managing dermatitis, the nurse should provide which instructions? (Select all that apply)
Avoid the irritant or allergen
Provide adequate skin lubrication
Wash skin frequently with germicidal soaps
Maintain skin moisture
Apply steroid-based preparations
A major type of skin disorder is acne rosacea. Which information may be valuable for the patient education plan? (Select all that apply)
Acne rosacea usually occurs in adolescence & begins to subside during adulthood
Diet is important, & flare ups may be caused by caffeine containing & spicy food, sunlight, & alcohol
Comedos may occur on the face, upper shoulders, & back
The primary location for occupancy is on the face over the cheeks & bridge of the nose
Treatments may include metronidazole, retinoids, & occasionally antibiotics
A male patient has inflamed, edematous skin of the elbows & knees accompanied by swelling of the joints of the fingers & toes. On examination, the skin is found to be covered with adherent silvery white scales. Which question would provide more information?
What do you do for a living?
How much do you smoke?
Have you had an upper respiratory tract infection lately?
Have you recently changed your laundry detergent?
A patient has skin lesions on the face, trunk, palms, extensor surfaces of joints, soles of the feet, & dorsum of the hands. On inspection, the lesions are found to have irregular borders & blistered, necrotic centers. The provider makes a diagnosis of Steven Johnson’s Syndrome. What is the priority problem for this patient?
Altered body image
Altered self-care ability
Potential for infection
Acute pain
A school-age girl with evidence of severe itching in the scalp is checked for pediculosis. The problem of insufficient knowledge regarding management of the disease is identified for the child & parent. Which instructions would the nurse include? (Select all that apply)
Machine wash clothes & bedding using the cold cycle
Share combs & hair brushes with family, but not with friends
Soak all combs & brushes in very hot water for more than 5 minutes
Seal items that cannot be washed in air-expelled plastic bags for 14 days
Reinfestation is unlikely if all family members are treated
The nurse is developing a plan of care for a wheelchair-bound patient. To prevent development of pressure ulcers, which nursing interventions mush be implemented? (Select all that apply)
Maintain postural alignment
Use pressure-relieving devices
Teach patient to shift weight every 15 minutes
Use donut-type devices
Reposition in the chair every hour
The nurse notes a reddened area on a patient’s sacral area & checks for blanching. What is the best rationale that supports this nursing action?
Blanching suggests that the redness is probably temporary & will resolve when the pressure to the area is relieved
Checking for blanching is part of the daily routine for assessing patients at high risk for pressure ulcers
Evidence of blanching indicates that the patient is at high risk for a pressure ulcer according to the Braden scale
Occurrence of blanching indicates that the redness is associated with a localized skin infection
The nurse makes a home health visit 1 year after a patient was burned over 30% of his body. What problem may the patient be experiencing at this stage? (Select all that apply)
Concern with body image due to scarring
Chronic pain due to contractures & nerve compartmentalization
Continued risk for infection due to reconstruction wounds
Increased risk for falls due to joint contractures
Which patient is at highest risk for developing a pressure ulcer based on the Braden scale?
Older adult who is NPO for a procedure; able to ambulate independently & accomplish ADLs
Patient who is paraplegic, well nourished, with strong upper body strength to self-transfer to wheelchair
Thin older adult patient who walks occasionally, but has limited mobility & cognitive impairments; reluctant to eat
Patient who is comatose & unresponsive after a near-drowning accident; receives enteral feedings & is incontinent
While the nurse is performing an initial assessment, a patient with extensive burn injuries suddenly develops increasing hoarseness & strider. Pulse oximetry is 86%. What is the priority nursing action?
Encourage the patient to take deep breaths
Provide humidified oxygen
Administer respiratory treatments
Suction respiratory secretions
A nurse is caring for a client who has a suspected fungal skin lesion. Which one of the following laboratory findings should the nurse expect to review to confirm this diagnosis?
Potassium hydroxide (KOH)
Diascopy
Tzanck smear report
Biopsy
A nurse is caring for a patient who has herpes zoster. Which of the following medications should the nurse expect to administer for treatment?
Clotrimazole
Acyclovir
Gabapentin
Penicillin
A nurse is reinforcing teaching with a patient on home care after a culture for a bacterial infection & cellulitis. Which of the following information should the nurse include?
Bathe daily with moisturizing soap
Apply antibacterial topical medication to the crusted exudate
Apply warm compresses to the affected area
Cover the affected area with snug fitted clothing
A nurse is reinforcing discharge instructions to a patient who had a skin biopsy with sutures. The nurse should identify which of the following patient statements indicates understanding?
I can expect redness around the site for 5-7 days
I will most likely have a fever for the first few days
I should apply an antibiotic ointment to the area
I will make a return appointment for 3 days to remove my sutures
A nurse is reinforcing teaching to a patient about a new prescription for clotrimazole topical cream. Which of the following statements should the nurse include?
It reduces the discomfort of a herpetic infection but does not cure the infection
This is a cream to treat a bacterial infection
Apply the topical medication for up to 2 weeks after the fungal lesions are gone
Apply the cream to lesions while they are moist
A nurse is reviewing information about a new prescription for corticosteroid cream with a client who has mild psoriasis. Which of the following instructions should the nurse include? (Select all that apply)
Apply an occlusive dressing after application
Apply 3-4 times per day
Wear gloves after application to hands
Avoid applying in skin folds
Use medication continuously over a period of several months
A nurse is reinforcing teaching with a patient on the use of calcipotriene topical medication for the treatment of psoriasis. Which of the following laboratory values should the nurse monitor?
Potassium
Calcium
Sodium
Chloride
A nurse is reinforcing teaching with a patient who has a history of psoriasis about photochemotherapy & UV light (PUVA) treatments. Which instructions should the nurse include?
Apply vitamin A cream before treatment
Administer a psoralen medication before treatment
Use this treatment every evening
Remove the scales gently after treatment
A nurse is reinforcing teaching with the guardian of a child who has contact dermatitis. Which instructions should be included?
Use fabric softener dryer sheets
Apply a warm, dry compress to the rash
Place the child in a bath with colloidal oatmeal
Leave the child’s hands uncovered during the night
A nurse is caring for a client who has contact dermatitis & has a new prescription for diphenhydramine. Which adverse effects should the nurse monitor?
Elevated blood glucose levels
Anorexia
Increased salivation
Insomnia
A nurse in a doctor’s office is collecting data from a patient who has a severe sunburn. Which of the following classifications should the nurse use to document the burn?
Superficial thickness
Superficial partial thickness
Deep partial thickness
Full thickness
A nurse is caring for a patient who has sustained burns over 35% of total body surface area. The patient’s voice has become hoarse, has a brassy cough, & is drooling. The nurse should identify these findings as an indication of:
Pulmonary edema
Bacterial pneumonia
Inhalation injury
Carbon monoxide poisoning
A nurse is collecting data from a patient who sustained deep-partial thickness & full thickness burns over 40% of the body 24 hours ago. Which of the following findings are common at this phase? (Select all that apply)
Temperature of 97 degrees F
Bradycardia
Hyperkalemia
Hyponatremia
Decreased hematocrit
A nurse is assisting with the care of a patient who sustained deep-partial thickness & full thickness burns over 60% of their body 24 hours ago, patient is requesting pain medication. Which route should the nurse administer the medication?
Subcutaneous
Oral
Intravenous
Transdermal
A nurse is contributing to the plan of care for an adult patient who sustained severe burns. Which interventions should the nurse recommend? (Select all that apply)
Limit visitors in the patient’s room
Encourage fresh vegetables in the diet
Increase protein intake
Instruct the patient to consume 2,000 calories per day
Restrict fresh flowers in the room
An adult patient was burned as a result of an explosion. The burn initially affected the patient’s entire face & upper half of the anterior torso, & there were circumferential burns to the lower half of both arms. The patients clothes caught fire & he ran, causing burns on the posterior surface of the head & upper half of the posterior torso. According to the rule of 9’s, what is the extent of the burn injury?
36%
27%
32%
40%
The nurse, working in a LTC facility, is planning the clinical assignments for the day. The nurse knows not to assign which staff member to the patient with herpes zoster?
The staff member who has never had roseola
The staff member who has never had mumps
A CNA who has never had chickenpox
A CNA who has never had German measles
A patient returns to the clinic after a skin biopsy are they suspicious lesion was performed one week ago, the biopsy report indicates that the lesion is a melanoma. The nurse understands that which characteristics describe this type of lesion? (Select all that apply)
Metastasis is rare
It is encapsulated
It is highly metastatic
It is characterized by local invasion
Lesion is a nevus that has changed in color
A nurse is reviewing a healthcare record of a patient with a lesion that has been diagnosed as basal cell carcinoma. The nurse should expect which characteristics to be documented? (Select all that apply)
Lesion has a waxy border
An irregularly shaped lesion
Papule, with a red, central crater
A small papule with a dry, rough scale
A firm, nodular lesion topped with a crust
The nurse reinforces instructions to a group of patient’s regarding measures that will assist with the prevention of skin cancer. Which patient statement indicates the need for further teaching?
I need to wear sunscreen when participating in outdoor activities
I need to avoid sun exposure before 10am & after 4pm
I need to wear a hat, sunglasses, & opaque clothing when in the sun
I need to examine my body monthly for any lesions that may be suspicious
A patient arrives at the ER with frostbite to the right hand. What should the nurse expect to find?
A pink, edematous hand
Fiery, red skin with edema in the nail beds
Black fingertips & an erythematous rash
A white color of the skin which is insensitive to touch
The night nurse reviews the nursing documentation in the patient’s chart & notes that the day nurse documented that the patient has a stage 2 pressure injury in the sacral area. What should the nurse expect to find when checking the sacral area?
Intact skin
The presence of tunneling
A deep, craterlike appearance
Partial-thickness skin loss of the epidermis
The nurse inspects the skin of a patient who is suspected of having psoriasis. Which finding should the nurse note if this disorder is present?
Oily skin
Silvery-white scaly lesions
Patchy hair loss & round, red macules with scales
The presence of wheal patches scattered about the trunk
The nurse is told that an assigned patient is suspected of having MRSA. Which precautions should the nurse implement?
Wear gloves only
Wear a mask & gloves
Wear a gown & gloves
Avoid touching the patient’s clothes
A patient arrives at the ER after a burn injury that occurred in their basement & inhalation injury is suspected. Which should the nurse anticipate to be prescribed to the client?
Oxygen via nasal cannula at 10L
Oxygen via nasal cannula at 15L
100% oxygen via an aerosol mask
100% oxygen via a tight-fitting nonrebreather mask
The nurse is caring for a patient who has just been admitted to the nursing unit after receiving flame burns to the face & chest. The nurse notes a hoarse cough, & the patient is expectorating sputum with black flecks. The patient suddenly becomes restless & his color is becoming dusky. Based on this data, which interpretation should the nurse make?
The patient is hypotensive
Pain is present from the burn injury
The burn has probably caused laryngeal edema, which has occluded the airway
The patient is afraid & having a panic attack due to the new environment
Which should be the expected therapeutic outcome of an escharectomy procedure performed on a circumferential arm burn?
The return of distal pulses
Decreasing edema formation
Brisk bleeding for the injury site
The formation of granulation tissue
The nurse is caring for a patient with circumferential burns of both legs. Which leg position is appropriate for this type of burn?
A dependent position
Elevation of the knees
Flat, without elevation
Elevation above the level of the heart
The nurse is assisting with caring for a patient who is receiving intravenous fluids & has sustained full-thickness burn injuries of he back & legs. The nurse understands that which would provide the most reliable indicator for determining the adequacy of the fluid resuscitation?
Vital signs
Urine output
Mental status
Peripheral pulses
The nurse is assigned to care for a patient with herpes zoster. Based on an understanding of the cause of this disorder, the nurse determines that this definitive diagnosis was made by which diagnostic test?
Positive patch test
Positive culture results
Abnormal biopsy results
Wood’s light examination indicative of infection
Salicylic acid is prescribed for a patient with a diagnosis of psoriasis. The nurse monitors the patient, knowing that which finding indicates the presence of systemic toxicity from this medication?
Tinnitus
Diarrhea
Constipation
Decreased respirations
The health education nurse provides instructions to a group of patients regarding measures that will prevent skin cancer. Which should be included? (Select all that apply)
Sunscreen should be applied every 8 hours
Use sunscreen when participating in outdoor activities
Wear a hat, sunglasses, & opaque clothing outside
Avoid sun exposure in the late afternoon & early evening hours
Examine your body monthly for suspicious lesions
Silver sulfadiazine is prescribed for a patient with a burn injury. Which lab finding requires the need for monitoring by the nurse?
Glucose level of 99mg/dL
Platelet level of 300,000 mm3
Magnesium level of 1.5 mEq/L
WBC count of 3000 mm3
A burn patient is receiving treatments of topical mafenide acetate to the site of injury. The nurse monitors the patient, knowing that which finding indicates the occurrence of a systemic effect?
Hyperventilation
Elevated blood pressure
Local rash at the burn site
Local pain at the burn site
Isotretinoin is prescribed for a patient with severe acne. Before the medication administration, the nurse anticipates that which lab test will be prescribed?
Potassium level
Triglyceride level
Hemoglobin A1C
Total cholesterol level
A patient with severe acne is seen in the clinic & the primary health care provider (PCHP) prescribes isotretinoin. The nurse reviews the patient’s medication record & would contact the PCHP if the client is also taking which medication?
Digoxin
Phenytoin
Vitamin A
Furosemide
The nurse is applying a topical corticosteroid to a patient with eczema. The nurse should apply the medication to which body area? (Select all that apply)
Back
Axilla
Eyelids
Soles of feet
Palms of hands
The clinic nurse is performing an admission assessment on a patient & notes that the patient is taking azelaic acid. The nurse determines that which patient complaint may be associated with the use of this medication?
Itching
Euphoria
Drowsiness
Frequent urination
Silver sulfadiazine is prescribed for a patient with a partial-thickness burn & the nurse provides teaching about the medication. Which patient statement indicates a need for further teaching?
The medication is an antibacterial
The medication will help heal the burn
The medication is likely to cause initial stinging
The medication should be applied directly to the wound
The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that sunscreens are most effective when applied at which times?
Immediately before swimming
5 minutes before swimming
Immediately before sun exposure
At least 30 minutes before sun exposure
