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Integumentary System

Total questions: 80

Worksheet time: 54mins

Name
Class
Date
1.

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?

a)

Patient always puts a moisturizing lotion on her hands after washing them

b)

Patient takes daily showers with soap & hot water

c)

Patient takes a daily multi-vitamin

d)

Patient spends time outside, reapplies sunscreen every 1.5-2 hours

2.

A nurse is teaching teenagers regarding the importance of protecting the skin from UV rays. What should the nurse include? (Select all that apply)

a)

Use a sunscreen with a SPF of at least 30

b)

Apply sunscreen thinly

c)

Wear light, loose clothing

d)

Gauge exposure while in the sun

e)

Wear sunglasses & a hat

3.

A patient with a suspicious skin lesion is scheduled for a punch skin biopsy. What is the most accurate description for the procedure?

a)

It is shaving a top layer off a lesion

b)

It is removing a core from the center

c)

It is removing the entire lesion

d)

It is aspirating a tissue sample

4.

A patient has a rash of unknown origin. Which assessment question(s) would help determine the underlying cause? (Select all that apply)

a)

When did the rash or lesion first appear?

b)

Can you think of any event or different food you ate or substance you were using just before it appeared?

c)

What drugs or OTC medications are you taking?

d)

Have you ever had radiation therapy?

e)

Do you have a history of any skin disorders in your family?

5.

What physiologic changes in aging predispose older adults to skin breakdown? (Select all that apply)

a)

Thickening of skin

b)

Loss of collagen

c)

Increased elastic fibers

d)

Decreased adipose tissue

e)

Reduced sebaceous gland activity

6.

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?

a)

Ask the provider to give specific orders for wound care

b)

Gently clean & apply a sterile transparent dressing

c)

Tape the dressing with paper tape & prevent tension

d)

Allow any tape & gauze dressing materials to fall off naturally

7.

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?

a)

Using soap & hot water every day to clean the patient’s body

b)

Alerting the nurse about a wet dressing

c)

Reporting redness & blanching over the sacral area

d)

Applying lotion while the skin is damp

8.

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:

a)

Gently handles the patient’s extremedies to prevent skin tears

b)

Observes the condition of the skin & measures the size of the lesions

c)

Removes the scales & crusts from the lesions to clean the skin

d)

Assesses for & documents any home remedies that the patient has tried

9.

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)

a)

Have the patient wear long sleeves & pants

b)

Lubricate the patient’s skin with lotion twice a day

c)

Massage the skin over bony prominences

d)

Never use a lift sheet to move or turn a patient

e)

Pad bed rails, wheelchair arms, leg supports, or other equipment where the patient may bump an extremity

10.

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)

A prescription for a topical medication for acne

b)

Isolation precautions for herpes zoster

c)

OTC antihistamine for an insect bite

d)

Patient education to self monitor the wart

11.

Which instruction should be included when providing health teaching about exposure to the sun?

a)

To obtain a slight tan, stay in the sun between 11am-3pm

b)

Wear light-colored, loose clothing to protect against the sun

c)

Use sunscreen even on cloudy days in you expect to be outdoors for extended periods of time

d)

Dark-skinned individuals do not have to be concerned about the amount of time spent in the sun

12.

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?

a)

Thinning

b)

Severe wrinkles

c)

Loss of hair follicles

d)

Loss of adipose tissue

13.

The nurse is providing education to a patient recently prescribed a topical medication. Which information would be appropriate to include?

a)

Ingest the medication by mouth

b)

Mix the medication in your bath water

c)

Inject the medication directly into the lesion

d)

Apply the medication directly to the surface of the affected area

14.

A patient is to have a culture & sensitivity test.

a)

The skin is inspected using a special light

b)

A sample of tissue is removed from the skin

c)

A sample of exudate is taken from the lesion

d)

Pressure will be applied to the lesion to determine the patient’s sensitivity level

15.

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?

a)

Carefully cleaning the affected area with soap and water

b)

Giving the patient a disinfecting tub bath

c)

Observing & recording the patient’s skin condition

d)

Applying a comforting lotion until the primary health provider writes the medical orders

16.

The primary health provider states the patient has several papular lesions, the nurse will likely observe:

a)

Small, solid elevation of the skin

b)

Small sac containing serous fluid

c)

Firm, raised, deep lesion of the skin

d)

Small elevation of the skin filled with purulent matter

17.

The nurse is caring for a patient with a skin tear. Which dressing is best to apply to the area?

a)

Paste

b)

Hydrocolloid

c)

Moist sterile gauze

d)

Petroleum-based ointment

18.

Pallor is described in an African-America patient by:

a)

Bruising to the skin

b)

Ashen-gray tone to the skin

c)

Extremely pale color to the skin

d)

Inflammation of an area of the skin

19.

A patient asks the nurse about the expected changes that occur in the skin with age (select all that apply)

a)

Skin becomes thicker

b)

Skin is slower to heal

c)

Skin may become dry & itchy

d)

Skin becomes more wrinkled & saggy

e)

Skin is at increased risk for sunburn

20.

Which are the categories of skin tears based on the Payne-Martin classification? (Select all that apply)

a)

A skin tear without tissue loss

b)

A skin tear with partial tissue loss

c)

A skin tear with deep tissue exposure

d)

A skin tear with deep tissue & muscle exposure

e)

A skin tear with complete tissue loss in which the epidermal flap is missing

21.

A patient who is recovering from a severe burn is permitted oral feedings. Which diet is most appropriate for this patient?

a)

Low protein & low calorie

b)

Low protein & high calorie

c)

High protein & low calorie

d)

High protein & high calorie

22.

When a patient with burns has a full-thickness wound, which of these tissues are involved?

a)

Subcutaneous fat only

b)

The entire dermis & muscles

c)

The deeper layers of the dermis only

d)

The entire dermis & subcutaneous tissue

23.

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?

a)

Antibiotics to ward off infection

b)

Sedative injection to calm the patient

c)

Ample occlusive dressings to protect the patient’s damaged skin

d)

Isotonic balanced intravenous solution to maintain fluid balance

24.

When a patient has herpes zoster (shingles), the nurse should expect the patient to report:

a)

Severe pain

b)

A rash on arms

c)

Pustules on legs

d)

Respiratory involvement

25.

The nurse is preparing to care for a patient with psoriasis. The nurse should anticipate which skin assessment?

a)

Fluid-filled blisters

b)

Patches covered with silvery scales

c)

Slightly raised, zigzag lesions

d)

An area of local swelling & redness

26.

A 56 year old patient is admitted to the hospital with pneumonia & shingles. The nurse is aware that shingles is caused by:

a)

Reactivation of herpes simplex

b)

Compromised immune function

c)

Exposure to people with genital herpes

d)

Activation of varicella-zoster in individuals who have had varicella

27.

A patient’s burns have become infected with pseudomonas. The nurse should anticipate using which topical dressing?

a)

Silver nitrate

b)

Povidone-iodine

c)

Mafenide acetate

d)

Silver sulfadiazine

28.

The nurse is caring for a patient with an electrical burn. What should be monitored on this patient?

a)

Lungs

b)

Heart

c)

Kidneys

d)

Gastric mucosa

29.

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)

a)

Oatmeal baths

b)

Prescription tretinoin

c)

Topical hydrocortisone

d)

Use of salycylic skin cleanser

e)

Frequent exfoliation of the skin

30.

A patient has been diagnosed with acne rosacea. The nurse should educate the patient to avoid: (Select all that apply)

a)

Tea

b)

Milk

c)

Beer

d)

Juice

e)

Coffee

31.

In managing dermatitis, the nurse should provide which instructions? (Select all that apply)

a)

Avoid the irritant or allergen

b)

Provide adequate skin lubrication

c)

Wash skin frequently with germicidal soaps

d)

Maintain skin moisture

e)

Apply steroid-based preparations

32.

A major type of skin disorder is acne rosacea. Which information may be valuable for the patient education plan? (Select all that apply)

a)

Acne rosacea usually occurs in adolescence & begins to subside during adulthood

b)

Diet is important, & flare ups may be caused by caffeine containing & spicy food, sunlight, & alcohol

c)

Comedos may occur on the face, upper shoulders, & back

d)

The primary location for occupancy is on the face over the cheeks & bridge of the nose

e)

Treatments may include metronidazole, retinoids, & occasionally antibiotics

33.

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?

a)

What do you do for a living?

b)

How much do you smoke?

c)

Have you had an upper respiratory tract infection lately?

d)

Have you recently changed your laundry detergent?

34.

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?

a)

Altered body image

b)

Altered self-care ability

c)

Potential for infection

d)

Acute pain

35.

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)

a)

Machine wash clothes & bedding using the cold cycle

b)

Share combs & hair brushes with family, but not with friends

c)

Soak all combs & brushes in very hot water for more than 5 minutes

d)

Seal items that cannot be washed in air-expelled plastic bags for 14 days

e)

Reinfestation is unlikely if all family members are treated

36.

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)

a)

Maintain postural alignment

b)

Use pressure-relieving devices

c)

Teach patient to shift weight every 15 minutes

d)

Use donut-type devices

e)

Reposition in the chair every hour

37.

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?

a)

Blanching suggests that the redness is probably temporary & will resolve when the pressure to the area is relieved

b)

Checking for blanching is part of the daily routine for assessing patients at high risk for pressure ulcers

c)

Evidence of blanching indicates that the patient is at high risk for a pressure ulcer according to the Braden scale

d)

Occurrence of blanching indicates that the redness is associated with a localized skin infection

38.

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)

a)

Concern with body image due to scarring

b)

Chronic pain due to contractures & nerve compartmentalization

c)

Continued risk for infection due to reconstruction wounds

d)

Increased risk for falls due to joint contractures

39.

Which patient is at highest risk for developing a pressure ulcer based on the Braden scale?

a)

Older adult who is NPO for a procedure; able to ambulate independently & accomplish ADLs

b)

Patient who is paraplegic, well nourished, with strong upper body strength to self-transfer to wheelchair

c)

Thin older adult patient who walks occasionally, but has limited mobility & cognitive impairments; reluctant to eat

d)

Patient who is comatose & unresponsive after a near-drowning accident; receives enteral feedings & is incontinent

40.

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?

a)

Encourage the patient to take deep breaths

b)

Provide humidified oxygen

c)

Administer respiratory treatments

d)

Suction respiratory secretions

41.

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?

a)

Potassium hydroxide (KOH)

b)

Diascopy

c)

Tzanck smear report

d)

Biopsy

42.

A nurse is caring for a patient who has herpes zoster. Which of the following medications should the nurse expect to administer for treatment?

a)

Clotrimazole

b)

Acyclovir

c)

Gabapentin

d)

Penicillin

43.

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?

a)

Bathe daily with moisturizing soap

b)

Apply antibacterial topical medication to the crusted exudate

c)

Apply warm compresses to the affected area

d)

Cover the affected area with snug fitted clothing

44.

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?

a)

I can expect redness around the site for 5-7 days

b)

I will most likely have a fever for the first few days

c)

I should apply an antibiotic ointment to the area

d)

I will make a return appointment for 3 days to remove my sutures

45.

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?

a)

It reduces the discomfort of a herpetic infection but does not cure the infection

b)

This is a cream to treat a bacterial infection

c)

Apply the topical medication for up to 2 weeks after the fungal lesions are gone

d)

Apply the cream to lesions while they are moist

46.

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)

a)

Apply an occlusive dressing after application

b)

Apply 3-4 times per day

c)

Wear gloves after application to hands

d)

Avoid applying in skin folds

e)

Use medication continuously over a period of several months

47.

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?

a)

Potassium

b)

Calcium

c)

Sodium

d)

Chloride

48.

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?

a)

Apply vitamin A cream before treatment

b)

Administer a psoralen medication before treatment

c)

Use this treatment every evening

d)

Remove the scales gently after treatment

49.

A nurse is reinforcing teaching with the guardian of a child who has contact dermatitis. Which instructions should be included?

a)

Use fabric softener dryer sheets

b)

Apply a warm, dry compress to the rash

c)

Place the child in a bath with colloidal oatmeal

d)

Leave the child’s hands uncovered during the night

50.

A nurse is caring for a client who has contact dermatitis & has a new prescription for diphenhydramine. Which adverse effects should the nurse monitor?

a)

Elevated blood glucose levels

b)

Anorexia

c)

Increased salivation

d)

Insomnia

51.

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?

a)

Superficial thickness

b)

Superficial partial thickness

c)

Deep partial thickness

d)

Full thickness

52.

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:

a)

Pulmonary edema

b)

Bacterial pneumonia

c)

Inhalation injury

d)

Carbon monoxide poisoning

53.

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)

a)

Temperature of 97 degrees F

b)

Bradycardia

c)

Hyperkalemia

d)

Hyponatremia

e)

Decreased hematocrit

54.

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?

a)

Subcutaneous

b)

Oral

c)

Intravenous

d)

Transdermal

55.

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)

a)

Limit visitors in the patient’s room

b)

Encourage fresh vegetables in the diet

c)

Increase protein intake

d)

Instruct the patient to consume 2,000 calories per day

e)

Restrict fresh flowers in the room

56.

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?

a)

36%

b)

27%

c)

32%

d)

40%

57.

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?

a)

The staff member who has never had roseola

b)

The staff member who has never had mumps

c)

A CNA who has never had chickenpox

d)

A CNA who has never had German measles

58.

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)

a)

Metastasis is rare

b)

It is encapsulated

c)

It is highly metastatic

d)

It is characterized by local invasion

e)

Lesion is a nevus that has changed in color

59.

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)

a)

Lesion has a waxy border

b)

An irregularly shaped lesion

c)

Papule, with a red, central crater

d)

A small papule with a dry, rough scale

e)

A firm, nodular lesion topped with a crust

60.

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?

a)

I need to wear sunscreen when participating in outdoor activities

b)

I need to avoid sun exposure before 10am & after 4pm

c)

I need to wear a hat, sunglasses, & opaque clothing when in the sun

d)

I need to examine my body monthly for any lesions that may be suspicious

61.

A patient arrives at the ER with frostbite to the right hand. What should the nurse expect to find?

a)

A pink, edematous hand

b)

Fiery, red skin with edema in the nail beds

c)

Black fingertips & an erythematous rash

d)

A white color of the skin which is insensitive to touch

62.

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?

a)

Intact skin

b)

The presence of tunneling

c)

A deep, craterlike appearance

d)

Partial-thickness skin loss of the epidermis

63.

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?

a)

Oily skin

b)

Silvery-white scaly lesions

c)

Patchy hair loss & round, red macules with scales

d)

The presence of wheal patches scattered about the trunk

64.

The nurse is told that an assigned patient is suspected of having MRSA. Which precautions should the nurse implement?

a)

Wear gloves only

b)

Wear a mask & gloves

c)

Wear a gown & gloves

d)

Avoid touching the patient’s clothes

65.

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?

a)

Oxygen via nasal cannula at 10L

b)

Oxygen via nasal cannula at 15L

c)

100% oxygen via an aerosol mask

d)

100% oxygen via a tight-fitting nonrebreather mask

66.

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?

a)

The patient is hypotensive

b)

Pain is present from the burn injury

c)

The burn has probably caused laryngeal edema, which has occluded the airway

d)

The patient is afraid & having a panic attack due to the new environment

67.

Which should be the expected therapeutic outcome of an escharectomy procedure performed on a circumferential arm burn?

a)

The return of distal pulses

b)

Decreasing edema formation

c)

Brisk bleeding for the injury site

d)

The formation of granulation tissue

68.

The nurse is caring for a patient with circumferential burns of both legs. Which leg position is appropriate for this type of burn?

a)

A dependent position

b)

Elevation of the knees

c)

Flat, without elevation

d)

Elevation above the level of the heart

69.

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?

a)

Vital signs

b)

Urine output

c)

Mental status

d)

Peripheral pulses

70.

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?

a)

Positive patch test

b)

Positive culture results

c)

Abnormal biopsy results

d)

Wood’s light examination indicative of infection

71.

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?

a)

Tinnitus

b)

Diarrhea

c)

Constipation

d)

Decreased respirations

72.

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)

a)

Sunscreen should be applied every 8 hours

b)

Use sunscreen when participating in outdoor activities

c)

Wear a hat, sunglasses, & opaque clothing outside

d)

Avoid sun exposure in the late afternoon & early evening hours

e)

Examine your body monthly for suspicious lesions

73.

Silver sulfadiazine is prescribed for a patient with a burn injury. Which lab finding requires the need for monitoring by the nurse?

a)

Glucose level of 99mg/dL

b)

Platelet level of 300,000 mm3

c)

Magnesium level of 1.5 mEq/L

d)

WBC count of 3000 mm3

74.

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?

a)

Hyperventilation

b)

Elevated blood pressure

c)

Local rash at the burn site

d)

Local pain at the burn site

75.

Isotretinoin is prescribed for a patient with severe acne. Before the medication administration, the nurse anticipates that which lab test will be prescribed?

a)

Potassium level

b)

Triglyceride level

c)

Hemoglobin A1C

d)

Total cholesterol level

76.

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?

a)

Digoxin

b)

Phenytoin

c)

Vitamin A

d)

Furosemide

77.

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)

a)

Back

b)

Axilla

c)

Eyelids

d)

Soles of feet

e)

Palms of hands

78.

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?

a)

Itching

b)

Euphoria

c)

Drowsiness

d)

Frequent urination

79.

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?

a)

The medication is an antibacterial

b)

The medication will help heal the burn

c)

The medication is likely to cause initial stinging

d)

The medication should be applied directly to the wound

80.

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?

a)

Immediately before swimming

b)

5 minutes before swimming

c)

Immediately before sun exposure

d)

At least 30 minutes before sun exposure