Integumentary System Disorders | NCLEX Quiz 169

1.

Nurse Bea plans to administer dexamethasone cream to a client who has dermatitis over the anterior chest How should the nurse apply this topical agent?

A.

With a circular motion. to enhance absorption
B.

With an upward motion. to increase blood supply to the affected area
C.

In long. even. outward. and downward strokes in the direction of hair growth
D.

In long. even. outward. and upward strokes in the direction opposite hair growth

Correct Answer
C. In long. even. outward. and downward strokes in the direction of hair growth

Explanation
When applying a topical agent. the nurse should begin at the midline and use long. even. outward. and downward strokes in the direction of hair growth. This application pattern reduces the risk of follicle irritation and skin inflammation.

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2.

Nurse Mary is caring for a wheelchair-bound client. Which piece of equipment impedes circulation to the area it’s meant to protect?

A.

Polyurethane foam mattress
B.

Ring or donut
C.

Gel flotation pad
D.

Water bed

Correct Answer
B. Ring or donut

Explanation
Rings or donuts aren’t to be used because they restrict circulation. Foam mattresses evenly distribute pressure. Gel pads redistribute with the client’s weight. The water bed also distributes pressure over the entire surface.

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3.

Nurse Harry documents the presence of a scab on a client’s deep wound. The nurse identifies this as which phase of wound healing?

A.

Inflammatory
B.

Migratory
C.

Proliferative
D.

Maturation

Correct Answer
B. Migratory

Explanation
The scab formation is found in the migratory phase. It is accompanied by migration of epithelial cells. synthesis of scar tissue by fibroblasts. and development of new cells that grow across the wound. In the inflammatory phase. a blood clot forms. epidermis thickens. and an inflammatory reaction occurs in the subcutaneous tissue. During the proliferative phase. the actions of the migratory phase continue and intensify. and granulation tissue fills the wound. In the maturation phase. cells and vessels return to normal and the scab sloughs off.

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4.

In an industrial accident. a male client that weighs 155 lb (70 kg) sustained full-thickness burns over 40% of his body. He’s in the burn unit receiving fluid resuscitation. Which observation shows that the fluid resuscitation is benefiting the client?

A.

A urine output consistently above 100 ml/hour
B.

A weight gain of 4 lb (2 kg) in 24 hours
C.

Body temperature readings all within normal limits
D.

An electrocardiogram (ECG) showing no arrhythmias

Correct Answer
A. A urine output consistently above 100 ml/hour

Explanation
In a client with burns. the goal of fluid resuscitation is to maintain a mean arterial blood pressure that provides adequate perfusion of vital structures. If the kidneys are adequately perfused. they will produce an acceptable urine output of at least 0.5 ml/kg/hour. Thus. the expected urine output of a 155-lb client is 35 ml/hour. and a urine output consistently above 100 ml/hour is more than adequate. Weight gain from fluid resuscitation isn’t a goal. In fact. a 4-lb weight gain in 24 hours suggests third spacing. Body temperature readings and ECG interpretations may demonstrate secondary benefits of fluid resuscitation but aren’t primary indicators.

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5.

A female client with herpes zoster is prescribed acyclovir (Zovirax). 200 mg P.O. every 4 hours while awake. The nurse should inform the client that this drug may cause:

A.

Palpitations.
B.

Dizziness.
C.

Diarrhea.
D.

Metallic taste.

Correct Answer
C. Diarrhea.

Explanation
Oral acyclovir may cause such adverse GI effects as diarrhea. nausea. and vomiting. It isn’t associated with palpitations. dizziness. or a metallic taste.

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6.

A female client sees a dermatologist for a skin problem. Later. the nurse reviews the client’s chart and notes that the chief complaint was intertrigo. This term refers to which condition?

A.

Spontaneously occurring wheals
B.

A fungus that enters the skin’s surface. causing infection
C.

Inflammation of a hair follicle
D.

Irritation of opposing skin surfaces caused by friction

Correct Answer
D. Irritation of opposing skin surfaces caused by friction

Explanation
Intertrigo refers to irritation of opposing skin surfaces caused by friction. Spontaneously occurring wheals occur in hives. A fungus that enters the skin surface and causes infection is a dermatophyte. Inflammation of a hair follicle is called folliculitis.

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7.

A male client who has suffered a cerebrovascular accident (CVA) is too weak to move on his own. To help the client avoid pressure ulcers. the nurse should:

A.

Turn him frequently.
B.

Perform passive range-of-motion (ROM) exercises.
C.

Reduce the client’s fluid intake.
D.

Encourage the client to use a footboard.

Correct Answer
A. Turn him frequently.

Explanation
The most important intervention to prevent pressure ulcers is frequent position changes. which relieve pressure on the skin and underlying tissues. If pressure isn’t relieved. capillaries become occluded. reducing circulation and oxygenation of the tissues and resulting in cell death and ulcer formation. During passive ROM exercises. the nurse moves each joint through its range of movement. which improves joint mobility and circulation to the affected area but doesn’t prevent pressure ulcers. Adequate hydration is necessary to maintain healthy skin and ensure tissue repair. A footboard prevents plantar flexion and footdrop by maintaining the foot in a dorsiflexed position.

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8.

A male client visits the physician’s office for treatment of a skin disorder. As a primary treatment. the nurse expects the physician to prescribe:

A.

An I.V. corticosteroid.
B.

An I.V. antibiotic.
C.

An oral antibiotic.
D.

A topical agent.

Correct Answer
D. A topical agent.

Explanation
Although many drugs are used to treat skin disorders. topical agents — not I.V. or oral agents — are the mainstay of treatment.

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9.

While in a skilled nursing facility. a male client contracted scabies. which is diagnosed the day after discharge. The client is living at her daughter’s home. where six other persons are living. During her visit to the clinic. she asks a staff nurse. “What should my family do?” The most accurate response from the nurse is:

A.

“All family members will need to be treated.”
B.

“If someone develops symptoms. tell him to see a physician right away.”
C.

“Just be careful not to share linens and towels with family members.”
D.

“After you’re treated. family members won’t be at risk for contracting scabies.”

Correct Answer
A. “All family members will need to be treated.”

Explanation
When someone in a group of persons sharing a home contracts scabies. each individual in the home needs prompt treatment whether he’s symptomatic or not. Towels and linens should be washed in hot water. Scabies can be transmitted from one person to another before symptoms develop.

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10.

When caring for a male client with severe impetigo. the nurse should include which intervention in the plan of care?

A.

Placing mitts on the client’s hands
B.

Administering systemic antibiotics as prescribed
C.

Applying topical antibiotics as prescribed
D.

Continuing to administer antibiotics for 21 days as prescribed

Correct Answer
B. Administering systemic antibiotics as prescribed

Explanation
Impetigo is a contagious. superficial skin infection caused by beta-hemolytic streptococci. If the condition is severe. the physician typically prescribes systemic antibiotics for 7 to 10 days to prevent glomerulonephritis. a dangerous complication. The client’s nails should be kept trimmed to avoid scratching; however. mitts aren’t necessary. Topical antibiotics are less effective than systemic antibiotics in treating impetigo.

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