WorksheetsMedical Case-Based Worksheet
Total questions: 86
Worksheet time: 43mins
A 45-year-old construction worker presents to the clinic with a 2cm lesion on his forearm that has irregular borders, multiple colors including brown and black areas, and has grown noticeably over the past 3 months. The patient reports the lesion sometimes bleeds when scratched. Based on the ABCDE criteria, which finding is MOST concerning for melanoma?
The lesion's location on a sun-exposed area
The patient's occupation involving outdoor work
The lesion's evolving characteristics over time
The lesion being larger than a pencil eraser
The nurse is caring for a patient with a Stage 3 pressure ulcer on the coccyx. Which interventions should be included in the care plan?
Reposition the patient every 4 hours
Consult with a wound care nurse for treatment planning
Use specialty mattresses to reduce pressure
Promote tissue granulation with specialized solutions
Administer prescribed antibiotic therapy
A 28-year-old patient presents with thick, scaling plaques with a silvery appearance on the elbows and knees, along with joint pain and reduced range of motion. The patient reports a family history of similar skin conditions. Which medication would be the FIRST-LINE systemic treatment for this condition?
Cyclosporine
Methotrexate
Infliximab (Remicade)
Topical corticosteroids
A school nurse is examining a 7-year-old child with honey-colored crusted lesions around the mouth and nose. The lesions started as fluid-filled blisters that ruptured and formed crusts. Which isolation precaution is MOST appropriate for this condition?
Droplet precautions
Airborne precautions
Contact precautions
Standard precautions only
A 65-year-old diabetic patient develops a deep, tender, raised area with a central core on the back of the neck. The area is warm to touch and appears to have pus formation. Which intervention should be the nurse's PRIORITY?
Apply topical antibiotic ointment
Encourage oral fluid intake
Apply warm compresses to the area
Prepare for incision and drainage
A patient with a history of chickenpox develops a painful, stripe-like rash along the left side of the torso with fluid-filled blisters. The patient reports severe burning pain that started before the rash appeared. Which medication regimen would be MOST effective if started within 72 hours of symptom onset?
A) Acyclovir 400mg orally twice daily for 10 days
B) Valacyclovir 1000mg orally three times daily for 7 days
C) Famciclovir 250mg orally twice daily for 7 days
D) Topical acyclovir cream applied four times daily
A 72-year-old patient has a Stage 1 pressure ulcer on the heel. The skin shows non-blanchable redness and feels warmer than surrounding tissue. Which intervention is MOST important to prevent progression to Stage 2?
Apply a moisture barrier cream
Reposition the patient off the affected heel
Rub the reddened area vigorously
Place a heat lamp over the area
A patient is diagnosed with basal cell carcinoma on the nose. The physician recommends Mohs surgery. The patient asks why this procedure is preferred over wide excision. Which response by the nurse is MOST accurate?
Mohs surgery is less expensive than wide excision.
Mohs surgery removes cancer layer by layer with the lowest recurrence rate.
Mohs surgery doesn't require any follow-up care.
Mohs surgery can be performed without anesthesia.
A patient presents with cellulitis of the right lower extremity. The physician has marked the borders of the infection with a pen. Eight hours later, the nurse notes the redness has extended beyond the marked borders. Which action should the nurse take FIRST?
Apply cold compresses to reduce inflammation
Notify the healthcare provider immediately
Increase the frequency of dressing changes
Administer prescribed pain medication
A patient with folliculitis asks what caused the condition. The nurse explains that folliculitis is commonly caused by which organism?
Streptococcus pyogenes
Staphylococcus aureus
Pseudomonas aeruginosa
Candida albicans
A 55-year-old patient has multiple actinic keratoses on sun-exposed areas. The dermatologist prescribes topical 5-fluorouracil (5-FU). Which patient education is MOST important?
Apply the medication three times daily for best results.
Expect extreme redness, oozing, and possible fever during treatment.
You can apply makeup over the medication to hide redness.
Stop the medication immediately if any side effects occur.
A patient is admitted with a suspected deep tissue injury (DTI) on the buttocks. The area appears purple-black with intact skin. Which statement about DTI is MOST accurate?
DTI always indicates poor nursing care
The true extent of tissue damage cannot be determined by visual inspection
DTI only affects the superficial layers of skin
DTI will always progress to a Stage 4 pressure ulcer
A 30-year-old patient presents with intense itching that worsens at night, particularly between the fingers and on the wrists. Small burrow-like tracks are visible on examination. Which diagnostic test would CONFIRM the suspected diagnosis?
Complete blood count with differential
Skin biopsy for histopathological examination
Mineral oil skin scraping for microscopic examination
Bacterial culture of the affected areas
A patient with impetigo is prescribed topical mupirocin. The patient asks when they can return to work at a daycare center. Which response by the nurse is MOST appropriate?
You can return to work immediately since it's not contagious.
You must wait until all lesions have completely healed.
You can return 24 hours after starting antibiotic treatment.
You can return when the honey-colored crusts have fallen off.
A nurse is assessing a patient for melanoma risk factors. Which factors increase the patient's risk?
Family history of melanoma
Caucasian ethnicity with fair skin
More than 50 moles or atypical moles
Red or blonde hair with blue or green eyes
Age over 65 years
A patient with a carbuncle on the back of the scalp requires treatment. Which intervention is the PRIORITY for this condition?
Oral antibiotic therapy
Incision and drainage (I&D)
Topical antifungal cream
Warm compress application
A patient with herpes zoster (shingles) develops postherpetic neuralgia. Which medication would be MOST effective for managing this complication?
Acetaminophen 650mg every 6 hours
Ibuprofen 600mg every 8 hours
Gabapentin (Neurontin) 300mg three times daily
Topical lidocaine cream as needed
A patient has a Stage 4 pressure ulcer with exposed bone and signs of infection. Which interventions should be included in the care plan?
Wound vacuum therapy
Systemic antibiotic therapy
Specialty bed to reduce pressure
Monitoring for osteomyelitis
Surgical debridement of necrotic tissue
A patient presents with seborrheic keratosis lesions. The patient is concerned about cancer risk. Which statement by the nurse is MOST accurate?
These lesions frequently become malignant and require immediate removal.
These are benign lesions that rarely require treatment unless cosmetically bothersome.
These lesions are pre-cancerous and should be monitored closely.
These lesions are contagious and require isolation precautions.
A patient with psoriatic arthritis is prescribed methotrexate. Which laboratory value requires the MOST frequent monitoring?
Complete blood count
Liver function tests
Kidney function tests
Thyroid function tests
Which interventions are appropriate for treating a patient with scabies?
Apply permethrin to the entire body
Repeat treatment in 8 days
Leave permethrin on for 8+ hours
Treat all contacts
Wash bedding in hot water
What is the priority initial intervention for a patient with a furuncle (boil)?
Apply warm compresses to the area
Start oral antibiotics immediately without assessment
Cover the area with an ice pack
Incise and drain the boil at home
What is the correct dosing for herpes zoster?
Valacyclovir 500mg orally three times daily for 7 days
Valacyclovir 1000mg orally three times daily for 7 days
Valacyclovir 500mg orally once daily for 7 days
Topical valacyclovir for 7 days
Which findings are most consistent with necrotizing fasciitis?
Crepitus
Itching
Foul drainage
Severe pain
Slow progression
What is the best intervention to prevent pressure injury to the heels?
Massage reddened areas
Elevate the heels off the bed using pillows under the calves
Apply barrier cream
Use heel protectors only at night
Which procedure removes cancer layer by layer with the lowest recurrence rate?
Wide local excision
Mohs surgery
Cryotherapy
Radiation therapy
Which symptoms indicate severe systemic psoriasis requiring immediate attention?
Itchy plaques
Malaise
Scaly patches
Chills
Localized redness
What is the most appropriate action if a patient with psoriasis develops malaise, chills, and fever?
Increase topical therapy
Notify the healthcare provider immediately
Schedule a routine follow-up
Start oral antihistamines
Folliculitis is most commonly caused by which of the following?
Streptococcus pyogenes
Staphylococcus aureus
Pseudomonas aeruginosa
Escherichia coli
Which of the following are required for chickenpox precautions?
Airborne precautions
Negative pressure room
Contact precautions
Droplet precautions
N95 respirator
What should you expect during 5-FU treatment?
Mild redness only
Expect extreme redness, oozing, and possible fever during treatment
No visible reaction
Immediate healing
Which of the following is true about deep tissue injury (DTI)?
The true extent of tissue damage can be determined by visual inspection
The true extent of tissue damage cannot be determined by visual inspection
DTI never extends to bone
DTI always presents with open wounds
Which of the following are true about Mohs surgery?
Highest cure rates
Preserves healthy tissue
Immediate microscopic examination
Involves layer-by-layer removal
Used for all high-risk areas
What confirms the diagnosis of scabies?
Clinical appearance only
Blood test
Mineral oil skin scraping for microscopic examination
Skin biopsy
When can a child with impetigo return to school after starting antibiotic treatment?
Immediately
After lesions heal completely
You can return 24 hours after starting antibiotic treatment
After 1 week
Which of the following are risk factors for melanoma?
Fair skin
Light hair/eyes
Family history
Multiple/atypical moles
Previous skin cancer
Carbuncles are collections of multiple boils requiring surgical drainage. This is the priority treatment, followed by antibiotics if needed. What is the priority treatment for carbuncles?
Antibiotics only
Incision and drainage (I&D)
Topical ointment
Warm compresses
Postherpetic neuralgia is neuropathic pain requiring anticonvulsants like gabapentin or pregabalin. Traditional analgesics are ineffective. What is the recommended medication for postherpetic neuralgia?
Acetaminophen
Ibuprofen
Gabapentin (Neurontin) 300mg three times daily
Morphine
Stage 4 ulcers require aggressive treatment including surgical debridement, systemic antibiotics, wound vac therapy, specialty beds, and monitoring for osteomyelitis. Repositioning should be every 2 hours, not 4. Which of the following are required for Stage 4 ulcer treatment?
Specialty beds
Wound vac therapy
Systemic antibiotics
Monitoring for osteomyelitis
Surgical debridement
Seborrheic keratoses are benign "age spots" and the most common skin growth in elderly patients. They're not pre-cancerous or contagious. What is true about seborrheic keratoses?
They are contagious
These are benign lesions that rarely require treatment unless cosmetically bothersome
They are pre-cancerous
They require immediate removal
Methotrexate is hepatotoxic and requires frequent liver function monitoring. While CBC and kidney function are also monitored, liver toxicity is the primary concern requiring most frequent assessment. What test is most important to monitor in patients taking methotrexate?
CBC
Liver function tests
Kidney function tests
Blood glucose
A nurse is using the Braden Scale to assess a patient's risk for pressure ulcers. Which factor is NOT evaluated as part of this assessment tool?
A) Sensory perception
B) Moisture exposure
C) Age and gender
D) Friction and shear
A patient has a Stage 2 pressure ulcer on the sacrum that appears as a shallow open ulcer with clear drainage. Which assessment findings are consistent with this stage?
C) Appearance similar to a blister
D) Swollen and warm to touch
A) Partial-thickness skin loss
B) Visible subcutaneous fat
F) May contain clear fluid or pus
A patient with melanoma is scheduled for sentinel lymph node biopsy. The patient asks about the procedure. Which explanation by the nurse is MOST accurate?
Radioactive dye is injected to track the first lymph nodes that drain the tumor site.
All lymph nodes in the region will be surgically removed for examination.
A biopsy needle will be inserted into suspicious lymph nodes under CT guidance.
The procedure uses ultrasound to identify enlarged lymph nodes for removal.
A patient with basal cell carcinoma is prescribed Aldara (imiquimod) cream. Which mechanism of action should the nurse explain to the patient?
It directly destroys cancer cells through chemical burns
It freezes the tumor tissue causing cell death
It stimulates the immune system to attack tumor cells
It blocks blood supply to the tumor
A patient with an unstageable pressure ulcer has thick yellow slough covering the wound bed. The nurse understands that this wound:
Is definitely a Stage 2 pressure ulcer
Cannot be staged until the slough is removed
Should be debrided immediately for staging purposes
Will never progress beyond Stage 2
A patient with psoriasis is experiencing severe itching that interferes with sleep. Which medication would be MOST appropriate for symptom management?
Ibuprofen 400mg every 6 hours
Diphenhydramine (Benadryl) 25mg at bedtime
Acetaminophen 650mg every 4 hours
Gabapentin 300mg three times daily
A patient asks about the difference between wide excision and Mohs surgery for skin cancer treatment. Which statement by the nurse is MOST accurate?
Wide excision is always preferred because it's less expensive.
Mohs surgery has lower recurrence rates but removes more tissue.
Wide excision is faster but has higher recurrence rates than Mohs surgery.
Both procedures have identical outcomes and cure rates.
A patient with chickenpox asks when their child can return to school. The nurse should explain that the child is no longer contagious when:
The fever has been gone for 24 hours
All lesions have crusted over
The child has been on antiviral medication for 48 hours
The rash has completely disappeared
A patient with a pressure ulcer requires wound photography for documentation. When should this documentation occur?
Only when the wound shows signs of infection
Once weekly during dressing changes
Upon admission and when skin breakdown is first discovered
Only before and after surgical procedures
A patient with actinic keratosis is scheduled for cryotherapy with liquid nitrogen. Which side effect should the nurse warn the patient to expect?
Permanent hair loss in the treated area
Blistering and peeling of the skin
Immediate relief of all symptoms
No visible changes to the skin
A patient with necrotizing fasciitis requires immediate intervention. Which treatments are indicated for this condition?
Pain management protocols
Contact isolation precautions
Immediate fasciotomy or debridement
Frequent wound vacuum changes
Aggressive IV antibiotic therapy
A patient with scabies is prescribed lindane lotion. Which patient characteristic would be a CONTRAINDICATION for this medication?
Age over 65 years
Pregnancy or breastfeeding
History of diabetes
Male gender
A nurse is caring for a patient with a Stage 4 pressure ulcer that shows black eschar and exposed bone. Which complication is the patient at HIGHEST risk for developing?
Contact dermatitis
Osteomyelitis
Folliculitis
Seborrheic keratosis
A patient is receiving interferon therapy following melanoma surgery. Which patient education points should the nurse include?
Side effects may include flu-like symptoms
The medication promotes apoptosis of abnormal cells
The medication stimulates the immune system to fight remaining cancer cells
Subcutaneous injections will be administered as prescribed
This therapy is used in combination with surgery, not as a replacement
A patient with psoriasis asks about phototherapy treatment. The nurse explains that this treatment involves:
Surgical removal of affected skin areas
Application of chemical peeling agents
Exposure to controlled UVA light
Injection of biologic medications
A patient has a deep tissue injury that appears purple and feels boggy to touch. The nurse understands that the MOST important characteristic of this injury is:
It only affects the superficial skin layers
The depth of tissue damage cannot be determined visually
It will always heal without intervention
It indicates poor nursing care
A patient with a furuncle (boil) on the face is prescribed oral antibiotics. The nurse understands that antibiotics are specifically indicated for facial furuncles because:
Facial furuncles are more painful than those in other locations
The risk of systemic complications is higher with facial infections
Facial furuncles are caused by different bacteria
Insurance requires antibiotic use for facial lesions
A patient with cellulitis asks why alcohol should not be used to clean the affected area. The MOST appropriate response by the nurse is:
Alcohol can dry and irritate the skin, delaying healing.
Alcohol is not effective against bacteria.
Alcohol causes allergic reactions in all patients.
Alcohol increases the risk of infection.
A patient is being evaluated for skin cancer risk factors. Which factors specifically increase the risk for developing melanoma?
History of breast or thyroid cancer
Indoor tanning bed exposure
Having more than 50 moles
Family history of melanoma
Outdoor occupation with UV exposure
A nurse is providing care for a patient with multiple pressure ulcers. The nurse notes that a Stage 3 ulcer appears to be developing granulation tissue and decreasing in size. This finding indicates:
The ulcer is worsening and becoming a Stage 4
Poor nursing care and inadequate treatment
Improvement in the healing process
The need for immediate surgical intervention
A patient with herpes zoster is prescribed gabapentin for postherpetic neuralgia. The patient asks why this specific medication is used instead of regular pain relievers. Which explanation by the nurse is MOST accurate?
Gabapentin is less expensive than other pain medications.
This medication specifically treats nerve pain, which is different from regular pain.
Gabapentin has fewer side effects than traditional pain relievers.
Regular pain relievers are contraindicated with antiviral medications.
Which of the following are characteristics of Stage 2 pressure ulcers? Select all that apply.
May contain clear fluid or pus
Swollen/warm
Full-thickness loss
May appear as blisters
Partial-thickness skin loss
Which statement is true about sentinel lymph node biopsy?
Radioactive dye is injected to track the first lymph nodes that drain the tumor site.
All regional nodes are removed
It is used for all types of cancer
It does not use radioactive dye
What is the mechanism of action of Imiquimod (Aldara)?
Direct cytotoxic agent
Antihistamine
It stimulates the immune system to attack tumor cells
Analgesic
Which of the following are biologic agents for psoriasis? Select all that apply.
Methotrexate
Cyclosporine
Infliximab (Remicade)
Rituximab (Rituxan)
Etanercept (Enbrel)
How should unstageable pressure ulcers with full-thickness tissue loss and slough/eschar be staged?
Stage as full-thickness loss
Cannot be staged until the slough is removed
Stage as partial-thickness loss
Stage as Stage 2
Which medication is best for controlling itching and promoting sleep in psoriasis patients?
Acetaminophen
Diphenhydramine (Benadryl) 25mg at bedtime
Ibuprofen
Methotrexate
Which of the following are appropriate environmental cleaning measures for scabies? Select all that apply.
Using bleach
Vacuuming
Washing in hot water
Bagging non-washable items for 2-3 days
Pets don't get human scabies
Which statement is true regarding wide excision versus Mohs surgery?
Mohs surgery is faster
Wide excision has lower recurrence rates
Wide excision is faster but has higher recurrence rates than Mohs surgery.
Mohs surgery removes more healthy tissue
Chickenpox is contagious until which of the following occurs?
Fever subsides
All lesions have crusted over
Medication is started
Rash appears
Which of the following statements about interferon and surgery are correct?
Interferon stimulates immune response
Interferon causes flu-like symptoms
Interferon is given subcutaneously
Interferon is adjuvant to surgery
Interferon promotes apoptosis
When should wound photography occur for baseline documentation?
Only when wound is healed
Only when wound is infected
Upon admission and when skin breakdown is first discovered
Only at discharge
What is the expected mechanism of action of liquid nitrogen cryotherapy?
Causes infection
Blistering and peeling of the skin
Causes scarring
Causes bleeding
Which of the following are required for necrotizing fasciitis management?
Aggressive IV antibiotics
Topical antibiotics
Wound vac therapy
Surgical debridement/fasciotomy
Isolation
Lindane is contraindicated in which of the following?
Age over 65
Pregnancy or breastfeeding
Diabetes
Gender
Stage 4 pressure ulcers with exposed bone have high risk for which of the following?
Superficial skin conditions
Osteomyelitis
Diabetes
Gender
Which of the following are true about interferon?
Promotes apoptosis
Causes flu-like symptoms
Adjuvant to surgery
Given subcutaneously
Stimulates immune response
What is the treatment for certain skin conditions involving light exposure?
Oral antibiotics
Topical steroids
Exposure to controlled UVA light
Surgical excision
The depth of tissue damage cannot be determined visually.
True
False
Impeptigo discharge teaching includes which of the following?
Gentle cleaning
Using separate personal items
Avoiding scratching
Using makeup immediately
Completing antibiotics
The risk of systemic complications is higher with facial infections.
True
False
Alcohol can worsen the infection and delay healing.
True
False
Melanoma risk factors include which of the following?
Tanning bed use
Previous cancer history (breast/thyroid)
Multiple moles
UV exposure
Family history
Granulation tissue formation and decreasing ulcer size indicate:
Worsening in the healing process
No change in the healing process
Improvement in the healing process
This medication specifically treats nerve pain, which is different from regular pain.
True
False
