Quiz #1: Integumentary System Disorders NCLEX Practice Exam (60 Questions)

It is crucial for nurses to have the knowledge of the normal anatomy, physiology, and assessments of the integument when providing nursing care for clients with disorders of the skin, hair, and nails. Dive skin-deep with this NCLEX-style exam containing 60 questions all about the Integumentary System and its disorders and diseases.

Strength of mind is exercise, not rest.
~ Alexander Pope

Topics

Included topics in this practice quiz are:

  • Integumentary Disorders
  • Burns
  • Psoriasis
  • Dermatitis
  • Herpes
  • Intertrigo
  • Pressure Ulcer
  • Scabies
  • Impetigo
  • Melanoma
  • Angioma
  • Paronychia
  • Frostbite
  • Acne
  • Fasciitis
  • Purpura
  • Petechiae
  • Ecchymosis
  • Erythema
  • Skin Grafting
  • Anatomy and Physiology of the Integumentary System

Guidelines

Follow the guidelines below to make the most out of this exam:

  • Read each question carefully and choose the best answer.
  • You are given one minute per question. Spend your time wisely!
  • Answers and rationales are given below. Be sure to read them.
  • If you need more clarifications, please direct them to the comments section.

Questions

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In Exam Mode: All questions are shown in random and the results, answers and rationales (if any) will only be given after you’ve finished the quiz. You are given 1 minute per question, a total of 60 minutes for this exam.

NCLEX Exam: Integumentary Disorders 1 (60 Items)

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NCLEX Exam: Integumentary Disorders 1 (60 Items)

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1. When planning care for a male client with burns on the upper torso, which nursing diagnosis should take the highest priority?

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A. Ineffective airway clearance related to edema of the respiratory passages
B. Impaired physical mobility related to the disease process
C. Disturbed sleep pattern related to facility environment
D. Risk for infection related to breaks in the skin

2. In a female client with burns on the legs, which nursing intervention helps prevent contractures?

A. Applying knee splints
B. Elevating the foot of the bed
C. Hyperextending the client’s palms
D. Performing shoulder range-of-motion exercises

3. A male client comes to the physician’s office for treatment of severe sunburn. The nurse takes this opportunity to discuss the importance of protecting the skin from the sun’s damaging rays. Which instruction would best prevent skin damage?

A. “Minimize sun exposure from 1 to 4 p.m. when the sun is strongest.”
B. “Use a sunscreen with a sun protection factor of 6 or higher.”
C. “Apply sunscreen even on overcast days.”
D. “When at the beach, sit in the shade to prevent sunburn.”

4. A female client is brought to the emergency department with second- and third-degree burns on the left arm, left anterior leg, and anterior trunk. Using the Rule of Nines, what is the total body surface area that has been burned?

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A. 18%
B. 27%
C. 30%
D. 36%

5. Which nursing intervention can help a client maintain healthy skin?

A. Keep the client well hydrated.
B. Avoid bathing the client with mild soap.
C. Remove adhesive tape quickly from the skin.
D. Recommend wearing tight-fitting clothes in hot weather.

6. A male client with psoriasis visits the dermatology clinic. When inspecting the affected areas, the nurse expects to see which type of secondary lesion?

A. Scale
B. Crust
C. Ulcer
D. Scar

7. A female adult client with atopic dermatitis is prescribed a potent topical corticosteroid, to be covered with an occlusive dressing. To address a potential client problem associated with this treatment, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement, the nurse should add which “related-to” phrase?

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A. Related to potential interactions between the topical corticosteroid and other prescribed drugs
B. Related to vasodilatory effects of the topical corticosteroid
C. Related to percutaneous absorption of the topical corticosteroid
D. Related to topical corticosteroid application to the face, neck, and intertriginous sites

8. A male client is diagnosed with herpes simplex. Which statement about herpes simplex infection is true?

A. During early pregnancy, herpes simplex infection may cause spontaneous abortion or premature delivery.
B. Genital herpes simplex lesions are painless, fluid-filled vesicles that ulcerate and heal in 3 to 7 days
C. Herpetic keratoconjunctivitis usually is bilateral and causes systemic symptoms.
D. A client with genital herpes lesions can have sexual contact but must use a condom.

9. A female client with a severe staphylococcal infection is receiving the aminoglycoside gentamicin sulfate (Garamycin) by the I.V. route. The nurse should assess the client for which adverse reaction to this drug?

A. Aplastic anemia
B. Ototoxicity
C. Cardiac arrhythmias
D. Seizures

10. A male client is diagnosed with primary herpes genitalis. Which instruction should the nurse provide?

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A. “Apply one applicator of terconazole intravaginally at bedtime for 7 days.”
B. “Apply one applicator of tioconazole intravaginally at bedtime for 7 days.”
C. “Apply acyclovir ointment to the lesions every 3 hours, six times a day for 7 days.”
D. “Apply sulconazole nitrate twice daily by massaging it gently into the lesions.”

11. 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

12. 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

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

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A. Inflammatory
B. Migratory
C. Proliferative
D. Maturation

14. 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

15. 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.

16. 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?

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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

17. 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.

18. 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.

19. 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:

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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.”

20. 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

21. A female client with second- and third-degree burns on the arms receives autografts. Two days later, the nurse finds the client doing arm exercises. The nurse knows that this client should avoid exercise because it may:

A. dislodge the autografts.
B. increase edema in the arms.
C. increase the amount of scarring.
D. decrease circulation to the fingers.

22. Nurse Tamara discovers scabies when assessing a client who has just been transferred to the medical-surgical unit from the day surgery unit. To prevent scabies infection in other clients, the nurse should:

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A. wash hands, apply a pediculicide to the client’s scalp, and remove any observable mites.
B. isolate the client’s bed linens until the client is no longer infectious.
C. notify the nurse in the day surgery unit of a potential scabies outbreak.
D. place the client on enteric precautions.

23. Dr. Martinez prescribes an emollient for a client with pruritus of recent onset. The client asks why the emollient should be applied immediately after a bath or shower. How should the nurse respond?

A. “This makes the skin feel soft.”
B. “This prevents evaporation of water from the hydrated epidermis.”
C. “This minimizes cracking of the dermis.”
D. “This prevents inflammation of the skin.”

24. Following a full-thickness (third-degree) burn of his left arm, a male client is treated with artificial skin. The client understands postoperative care of artificial skin when he states that during the first 7 days after the procedure, he will restrict:

A. range of motion.
B. protein intake.
C. going outdoors.
D. fluid ingestion.

25. A male client with a solar burn of the chest, back, face, and arms is seen in urgent care. The nurse’s primary concern should be:

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A. fluid resuscitation.
B. infection.
C. body image.
D. pain management.

26. The nurse is providing home care instructions to a client who has recently had a skin graft. It’s most important that the client remember to:

A. use cosmetic camouflage techniques.
B. protect the graft from direct sunlight.
C. continue physical therapy.
D. apply lubricating lotion to the graft site.

27. A male client is diagnosed with gonorrhea. When teaching the client about this disease, the nurse should include which instruction?

A. “Avoid sexual intercourse until you’ve completed treatment, which takes 14 to 21 days.”
B. “Wash your hands thoroughly to avoid transferring the infection to your eyes.”
C. “If you have intercourse before treatment ends, tell sexual partners of your status and have them wash well after intercourse.”
D. “If you don’t get treatment, you may develop meningitis and suffer widespread central nervous system (CNS) damage.”

28. A female client with atopic dermatitis is prescribed medication for photochemotherapy. The nurse teaches the client about the importance of protecting the skin from ultraviolet light before drug administration and for 8 hours afterward and stresses the need to protect the eyes. After administering medication for photochemotherapy, the client must protect the eyes for:

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A. 4 hours.
B. 8 hours.
C. 24 hours.
D. 48 hours.

29. A female client with genital herpes simplex is being treated in the outpatient department. The nurse teaches her about measures that may prevent herpes recurrences and emphasizes the need for prompt treatment if complications arise. Genital herpes simplex increases the risk of:

A. cancer of the ovaries.
B. cancer of the uterus.
C. cancer of the cervix.
D. cancer of the vagina.

30. Which of the following is the initial intervention for a male client with external bleeding?

A. Elevation of the extremity
B. Pressure point control
C. Direct pressure
D. Application of a tourniquet

31. Nurse JV is performing wound care. Which of the following practices violates surgical asepsis?

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A. Holding sterile objects above the waist
B. Considering a 1″ edge around the sterile field as being contaminated
C. Pouring solution onto a sterile field cloth
D. Opening the outermost flap of a sterile package away from the body

32. During the acute phase of a burn, the nurse in-charge should assess which of the following?

A. Client’s lifestyle
B. Alcohol use
C. Tobacco use
D. Circulatory status

33. Nurse Catherine is changing a dressing and providing wound care. Which activity should she perform first?

A. Assess the drainage in the dressing.
B. Slowly remove the soiled dressing
C. Wash hands thoroughly.
D. Put on latex gloves.

34. Nurse Melinda is caring for an elderly bedridden adult. To prevent pressure ulcers, which intervention should the nurse include in the plan of care?

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A. Turn and reposition the client at least once every 8 hours.
B. Vigorously massage lotion into bony prominences.
C. Post a turning schedule at the client’s bedside.
D. Slide the client, rather than lifting, when turning.

35. Nurse Jody formulates a nursing diagnosis of Impaired physical mobility for a client with third-degree burns on the lower portions of both legs. To complete the nursing diagnosis statement, the nurse should add which “related-to” phrase?

A. Related to fat emboli
B. Related to infection
C. Related to femoral artery occlusion
D. Related to circumferential eschar

36. The nurse is assessing for the presence of cyanosis in a male dark-skinned client. The nurse understands that which body area would provide the best assessment?

A. Lips
B. Sacrum
C. Earlobes
D. Back of the hands

37. Which of the following individuals is least likely to be at risk of developing psoriasis?

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A. A 32 year-old-African American
B. A woman experiencing menopause
C. A client with a family history of the disorder
D. An individual who has experienced a significant amount of emotional distress

38. Which of the following clients would least likely be at risk of developing skin breakdown?

A. A client incontinent of urine feces
B. A client with chronic nutritional deficiencies
C. A client with decreased sensory perception
D. A client who is unable to move about and is confined to bed

39. The nurse prepares to care for a male client with acute cellulites of the lower leg. The nurse anticipates that which of the following will be prescribed for the client?

A. Cold compress to the affected area
B. Warm compress to the affected area
C. Intermittent heat lamp treatments four times daily
D. Alternating hot and cold compresses continuously

40. The clinic nurse is assessing the skin of a white client who is diagnosed with psoriasis. Which of the following characteristic is associated with this skin disorder? 

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A. Clear, thin nail beds
B. Red-purplish scaly lesions
C. Oily skin and no episodes of pruritus
D. Silvery-white scaly patches on the scalp, elbow, knees, and sacral regions

41. The clinic nurse notes that the physician has documented a diagnosis of herpes zoster (shingles) in the male 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. Patch test
B. Skin biopsy
C. Culture of the lesion
D. Woo’s light examination

42. The nurse is assigned to care for a female client with herpes zoster (Shingles). Which of the following characteristics would the nurse expect to note when assessing the lesions of this infection?

A. Clustered skin vesicles
B. A generalized body rash
C. Small blue-white spots with a red base
D. A fiery red, edematous rash on the cheeks

43. When assessing a lesion diagnosed as malignant melanoma, the nurse in-charge most likely expects to note which of the following?

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A. An irregular shaped lesion
B. A small papule with a dry, rough scale
C. A firm, nodular lesion topped with crust
D. A pearly papule with a central crater and a waxy border

44. The nurse prepares discharge instructions for a male client following cryosurgery for the treatment of a malignant skin lesion. Which of the following should the nurse include in the instruction?

A. Avoid showering for 7 to 10 days
B. Apply ice to the site to prevent discomfort
C. Apply alcohol-soaked dressing twice a day
D. Clean the site with hydrogen peroxide to prevent infection

45. Nurse Kevin reviews the client’s chart and notes that the physician has documented a diagnosis of paronychia. Based on this diagnosis, which of the following would the nurse expect to note during the assessment?

A. Red shiny skin around the nail bed
B. White taut skin in the popliteal area
C. White silvery patches on the elbows
D. Swelling of the skin near the parotid gland

46. A male client arrives at the emergency room and has experienced frostbites to the right hand. Which of the following would the nurse note on assessment of the client’s hand?

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A. A pink, edematous hand
B. A fiery red skin with edema in the nail beds
C. Black fingertips surrounded by an erythematous rash
D. A white color to the skin, which is insensitive to touch

47. The evening nurse reviews the nursing documentation in the male client’s chart and notes that the day nurse has documented that the client has a stage II pressure ulcer in the sacral area. Which of the following would the nurse expect to note on assessment of the client’s sacral area?

A. Intact skin
B. Full-thickness skin loss
C. Exposed bone, tendon, or muscle
D. Partial-thickness skin loss of the dermis

48. Nurse Imee is implementing a teaching plan to a group of adolescents regarding the causes of acne. Which of the following is an appropriate nursing statement regarding the cause of this disorder?

A. “Acne is caused by oily skin”
B. “The actual cause is not known”
C. “Acne is caused by eating chocolate”
D. “Acne is caused as a result of exposure to heat and humidity”

49. The nurse is reviewing the healthcare record of a male clients scheduled to be seen at the health care clinic. The nurse determines that which of the following individuals is at the greatest risk for development of an integumentary disorder?

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A. An adolescent
B. An older female
C. A physical education teacher
D. An outdoor construction worker

50. A male client schedule for a skin biopsy is concerned and asks the nurse how painful the procedure is. The appropriate response by the nurse is:

A. “There is no pain associated with this procedure”
B. “The local anesthetic may cause a burning or stinging sensation”
C. A preoperative medication will be given so you will be sleeping and will not feel any pain”
D. “There is some pain, but the physician will prescribe an opioid analgesic following the procedure”

51. 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. “I’ll limit my intake of protein.”
B. “I’ll make sure that the bandage is wrapped tightly.”
C. “My foot should feel cold.”
D. “I’ll eat plenty of fruits and vegetables.”

52. Following a full-thickness (third-degree) burn of his left arm, a male client is treated with artificial skin. The client understands postoperative care of artificial skin when he states that during the first 7 days after the procedure, he will restrict:

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A. range of motion.
B. protein intake.
C. going outdoors.
D. fluid ingestion.

53. Following a small-bowel resection, a male client develops fever and anemia. The surface surrounding the surgical wound is warm to the touch and necrotizing fasciitis is suspected. Another manifestation that would most suggest necrotizing fasciitis is:

A. erythema.
B. leukocytosis.
C. pressure-like pain.
D. swelling.

54. While in a skilled nursing facility, a female 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.”

55. The nurse is assessing a male client admitted with second- and third-degree burns on the face, arms, and chest. Which finding indicates a potential problem?

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A. Partial pressure of arterial oxygen (PaO2) value of 80 mm Hg
B. Urine output of 20 ml/hour
C. White pulmonary secretions
D. Rectal temperature of 100.6° F (38° C)

56. A female client exhibits s purplish bruise to the skin after a fall. The nurse would document this finding most accurately using which of the following terms?

A. Purpura
B. Petechiae
C. Ecchymosis
D. Erythema

57. An older client’s physical examination reveals the presence of a number of bright red-colored lesions scattered on the trunk and tights. The nurse interprets that this indicates which of the following lesions due to alterations in blood vessels of the skin?

A. Cherry angioma
B. Spider angioma
C. Venous star
D. Purpura

58. A nurse is reviewing the medical record of a male client to be admitted to the nursing unit and notes documentation of reticular skin lesions. The nurse expects that these lesions will appear to be:

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A. Ring-shaped
B. Linear
C. Shaped like an arc
D. Net-like appearance

59. A male client seen in an ambulatory clinic has a butterfly rash across the nose. The nurse interprets that this finding is consistent with early manifestations of which of the following disorders?

A. Hyperthyroidism
B. Pernicious anemia
C. Cardiopulmonary disorders
D. Systemic lupus erythematosus (SLE)

60. A female client with cellulites of the lower leg has had cultures done on the affected area. The nurse reading the culture report understands that which of the following organisms is not part of the normal flora of the skin?

A. Staphylococcus epidermidis
B. Staphylococcus aureus
C. Escherichia coli (E. coli)
D. Candida albicans

Answers and Rationale

1. Answer: A. Ineffective airway clearance related to edema of the respiratory passages

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When caring for a client with upper torso burns, the nurse’s primary goal is to maintain respiratory integrity. Therefore, option A should take the highest priority. Option B isn’t appropriate because burns aren’t a disease. Option C and D may be appropriate, but don’t command a higher priority than option A because they don’t reflect immediately life-threatening problems.

2. Answer: A. Applying knee splints

Applying knee splints prevents leg contractures by holding the joints in a position of function. Elevating the foot of the bed can’t prevent contractures because this action doesn’t hold the joints in a position of function. Hyperextending a body part for an extended time is inappropriate because it can cause contractures. Performing shoulder range-of-motion exercises can prevent contractures in the shoulders, but not in the legs.

3. Answer: C. “Apply sunscreen even on overcast days.”

Sunscreen should be applied even on overcast days, because the sun’s rays are as damaging then as on sunny days. The sun is strongest from 10 a.m. to 2 p.m. (11 a.m. to 3 p.m. daylight saving time) — not from 1 to 4 p.m. Sun exposure should be minimized during these hours. The nurse should recommend sunscreen with a sun protection factor of at least 15. Sitting in the shade when at the beach doesn’t guarantee protection against sunburn because sand, concrete, and water can reflect more than half the sun’s rays onto the skin.

4. Answer: D. 36%

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The Rule of Nines divides body surface area into percentages that, when totaled, equal 100%. According to the Rule of Nines, the arms account for 9% each, the anterior legs account for 9% each, and the anterior trunk accounts for 18%. Therefore, this client’s burns cover 36% of the body surface area.

5. Answer: A. Keep the client well hydrated.

Keeping the client well hydrated helps prevent skin cracking and infection because intact healthy skin is the body’s first line of defense. To help a client maintain healthy skin, the nurse should avoid strong or harsh detergents and should use mild soap. The nurse shouldn’t remove adhesive tape quickly because this action can strip or scrape the skin. The nurse should recommend wearing loose-fitting — not tight-fitting — clothes in hot weather to promote heat loss by evaporation.

6. Answer: A. Scale

A scale is the characteristic secondary lesion occurring in psoriasis. Although crusts, ulcers, and scars also are secondary lesions in skin disorders, they don’t accompany psoriasis.

7. Answer: C. Related to percutaneous absorption of the topical corticosteroid

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A potent topical corticosteroid may increase the client’s risk for injury because it may be absorbed percutaneously, causing the same adverse effects as systemic corticosteroids. Topical corticosteroids aren’t involved in significant drug interactions. These preparations cause vasoconstriction, not vasodilation. A potent topical corticosteroid rarely is prescribed for use on the face, neck, or intertriginous sites because application on these areas may lead to increased adverse effects.

8. Answer: A. During early pregnancy, herpes simplex infection may cause spontaneous abortion or premature delivery.

Herpes simplex may be passed to the fetus transplacentally and, during early pregnancy, may cause spontaneous abortion or premature delivery. Genital herpes simplex lesions typically are painful, fluid-filled vesicles that ulcerate and heal within 1 to 2 weeks. Herpetic keratoconjunctivitis usually is unilateral and causes localized symptoms, such as conjunctivitis. A client with genital herpes lesions should avoid all sexual contact to prevent spreading the disease.

9. Answer: B. Ototoxicity

The most significant adverse reactions to gentamicin and other aminoglycosides are ototoxicity (indicated by vertigo, tinnitus, and hearing loss) and nephrotoxicity (indicated by urinary cells or casts, oliguria, proteinuria, and reduced creatinine clearance). These adverse reactions are most common in elderly and dehydrated clients, those with renal impairment, and those receiving concomitant therapy with another potentially ototoxic or nephrotoxic drug. Gentamicin isn’t associated with aplastic anemia, cardiac arrhythmias, or seizures.

10. Answer: C. “Apply acyclovir ointment to the lesions every 3 hours, six times a day for 7 days.”

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A client with primary herpes genitalis should apply topical acyclovir ointment in sufficient quantities to cover the lesions every 3 hours, six times a day for 7 days. Terconazole and tioconazole are used to treat vulvovaginal candidiasis. Sulconazole nitrate is used to treat tinea versicolor.

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

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.

12. Answer: B. Ring or donut

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.

13. Answer: B. Migratory

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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.

14. Answer: A. A urine output consistently above 100 ml/hour

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.

15. Answer: C. diarrhea.

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

16. Answer: D. Irritation of opposing skin surfaces caused by friction

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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.

17. Answer: A. turn him frequently.

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.

18. Answer: D. a topical agent.

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

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

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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.

20. Answer: B. Administering systemic antibiotics as prescribed

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.

21. Answer: A. dislodge the autografts.

Because exercising the autograft sites may dislodge the grafted tissue, the nurse should advise the client to keep the grafted extremity in a neutral position. None of the other options results from exercise

22. Answer: B. isolate the client’s bed linens until the client is no longer infectious.

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To prevent the spread of scabies in other hospitalized clients, the nurse should isolate the client’s bed linens until the client is no longer infectious — usually 24 hours after treatment begins. Other required precautions include using good hand-washing technique and wearing gloves when applying the pediculicide and during all contact with the client. Although the nurse should notify the nurse in the day surgery unit of the client’s condition, a scabies epidemic is unlikely because scabies is spread through skin or sexual contact. This client doesn’t require enteric precautions because the mites aren’t found on feces.

23. Answer: B. “This prevents evaporation of water from the hydrated epidermis.”

Applying an emollient immediately after taking a bath or shower prevents evaporation of water from the hydrated epidermis, the skin’s upper layer. Although emollients make the skin feel soft, this effect occurs whether or not the client has just bathed or showered. An emollient minimizes cracking of the epidermis, not the dermis (the layer beneath the epidermis). An emollient doesn’t prevent skin inflammation.

24. Answer: A. range of motion.

To prevent disruption of the artificial skin’s adherence to the wound bed, the client should restrict range of motion of the involved limb. Protein intake and fluid intake are important for healing and regeneration and shouldn’t be restricted. Going outdoors is acceptable as long as the left arm is protected from direct sunlight.

25. Answer: D. pain management.

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With a superficial partial thickness burn such as a solar burn (sunburn), the nurse’s main concern is pain management. Fluid resuscitation and infection become concerns if the burn extends to the dermal and subcutaneous skin layers. Body image disturbance is a concern that has lower priority than pain management.

26. Answer: B. protect the graft from direct sunlight.

To avoid burning and sloughing, the client must protect the graft from direct sunlight. The other three interventions are helpful to the client and his recovery but are less important.

27. Answer: B. “Wash your hands thoroughly to avoid transferring the infection to your eyes.”

Adults and children with gonorrhea may develop gonococcal conjunctivitis by touching the eyes with contaminated hands. The client should avoid sexual intercourse until treatment is completed, which usually takes 4 to 7 days, and a follow-up culture confirms that the infection has been eradicated. A client who doesn’t refrain from intercourse before treatment is completed should use a condom in addition to informing sex partners of the client’s health status and instructing them to wash well after intercourse. Meningitis and widespread CNS damage are potential complications of untreated syphilis, not gonorrhea.

28. Answer: D. 48 hours.

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To prevent eye discomfort, the client must protect the eyes for 48 hours after taking medication for photochemotherapy. Protecting the eyes for a shorter period increases the risk of eye injury.

29. Answer: C. cancer of the cervix.

A female client with genital herpes simplex is at increased risk for cervical cancer. Genital herpes simplex isn’t a risk factor for cancer of the ovaries, uterus, or vagina.

30. Answer: C. Direct pressure

Applying direct pressure to an injury is the initial step in controlling bleeding. For severe or arterial bleeding, pressure point control can be used. Pressure points are those areas where large blood vessels can be compressed against bone: femoral, brachial, facial, carotid, and temporal artery sites. Elevation reduces the force of flow, but direct pressure is the first step. A tourniquet may further damage the injured extremity and should be avoided unless all other measures have failed.

31. Answer: C. Pouring solution onto a sterile field cloth

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Pouring solution onto a sterile field cloth violates surgical asepsis because moisture penetrating the cloth can carry microorganisms to the sterile field via capillary action. The other options are practices that help ensure surgical asepsis.

32. Answer: D. Circulatory status

During the acute phase of a burn, the nurse should assess the client’s circulatory and respiratory status, vital signs, fluid intake and output, ability to move, bowel sounds, wounds, and mental status. Information about the client’s lifestyle and alcohol and tobacco use may be obtained later when the client’s condition has stabilized.

33. Answer: C. Wash hands thoroughly.

When caring for a client, the nurse must first wash her hands. Putting on gloves, removing the dressing, and observing the drainage are all parts of performing a dressing change after hand washing is completed.

34. Answer: C. Post a turning schedule at the client’s bedside.

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A turning schedule with a signing sheet will help ensure that the client gets turned and, thus, help prevent pressure ulcers. Turning should occur every 1 to 2 hours — not every 8 hours — for clients who are in bed for prolonged periods. The nurse should apply lotion to keep the skin moist but should avoid vigorous massage, which could damage capillaries. When moving the client, the nurse should lift — rather than slide — the client to avoid shearing.

35. Answer: D. Related to circumferential eschar

As edema develops on circumferential burns, eschar forms a tight, constricting band, compromising circulation to the extremity distal to the circumferential site and impairing physical mobility. This client isn’t likely to develop fat emboli unless long bone or pelvic fractures are present. Infection doesn’t alter physical mobility. A client with burns on the lower portions of both legs isn’t likely to have femoral artery occlusion.

36. Answer: A. Lips

In a dark-skinned client, the nurse examines the lips, tongue, nail beds, conjunctivae, and palms of the hands and soles of the feet at regular intervals for subtle color changes. In a client with cyanosis, the lips and tongue are gray; the palms, soles, conjunctivae, and nail beds have a bluish tinge.

37. Answer: A. A 32 year-old-African American

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Psoriasis occurs equally among women and men, although the incidence is lower in darker skinned races and ethnic groups. A genetic predisposition has been recognized in some cases. Emotional distress, trauma, systemic illness, seasonal changes, and hormonal changes are linked to exacerbations.

38. Answer: C. A client with decreased sensory perception

Bed or chair confinement, inability to move, loss of bowel or bladder control, poor nutrition, absent or inconsistent caregiving, and decreased sensory perception can contribute to the development of skin breakdown. The least likely risk, as presented in the options, is the decreased sensory perception. Options A, B, and D identify physiological conditions, which are the risk priorities.

39. Answer: B. Warm compress to the affected area

Cellulitis is a skin infection into deeper dermal and subcutaneous tissues that results in a deep red erythema without sharp borders and spreads widely throughout tissue spaces. Warm compresses may be used to decrease the discomfort, erythema, and edema. After tissue and blood cultures are obtained, antibiotics will be initiated. The nurse should provide supportive care as prescribed to manage symptoms such as fatigue, fever, chills, headache, and myalgia. Heat lamps can cause more disruption to already inflamed tissue. Cold compresses and alternating cold and hot compresses are not the best measures.

40. Answer: D. Silvery-white scaly patches on the scalp, elbow, knees, and sacral regions

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Psoriatic patches are covered with silvery-white scales. Affected areas include the scalp, elbows, knees, shins, trunk, and sacral area.

41. Answer: C. Culture of the lesion

With the classic presentation of herpes zoster, the clinical examination is diagnostic. A viral culture of the lesion provides the definitive diagnosis. Herpes zoster (shingles) is caused by a reactivation of the varicella-zoster virus, the virus that causes chickenpox. A patch test is a skin test that involves the administration of an allergen to the surface of the skin to identify specific allergies. A biopsy would provide a cytological examination of tissue. In a Wood’s light examination, the skin is viewed under ultraviolet light to identify superficial infections of the skin.

42. Answer: A. Clustered skin vesicles

The primary lesion of herpes zoster is a vesicle. The classic presentation is grouped vesicles on an erythematous base along a dermatome. Because the lesions follow nerve pathways, they do not cross the midline of the body. Options B, C, and D are incorrect descriptions of herpes zoster.

43. Answer: A. An irregular shaped lesion

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A melanoma is an irregularly shaped pigmented papule or plaque with a red-, white-, or blue-toned color. Basal cell carcinoma appears as a pearly papule with a central crater and rolled waxy border. Squamous cell carcinoma is a firm, nodular lesion topped with a crust or a central area of ulceration. Actinic keratosis, a premalignant lesion, appears as a small macule or papule with a dry, rough, adherent yellow or brown scale.

44. Answer: D. Clean the site with hydrogen peroxide to prevent infection

Cryosurgery involves the local application of liquid nitrogen to isolated lesions and causes cell death and tissue destruction. The nurse informs the client that swelling and increased tenderness of the treated area can occur when the skin thaws. Tissue freezing is followed by hemorrhagic blister formation in 1 to 2 days. The nurse instructs the client to clean the treatment site with hydrogen peroxide to prevent secondary infection. A topical antibiotic also may be prescribed. Application of a warm, damp washcloth intermittently to the site will provide relief from any discomfort. Alcohol-soaked dressings will cause irritation. The client does not need to avoid showering.

45. Answer: A. Red shiny skin around the nail bed

Paronychia, or infection around the nail, is characterized by red, shiny skin, often associated with painful swelling. These infections frequently result from trauma, picking at the nail, or disorders such as dermatitis. Often, these become secondarily infected with bacteria or fungus, which later involves the nail. Warm soaks three or four times a day may reduce pain and pressure; however, incision and drainage of the inflamed site frequently are required. Options B, C, and D are incorrect.

46. Answer: D. A white color to the skin, which is insensitive to touch

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Assessment findings in frostbite include a white or blue color; the skin will be hard, cold, and insensitive to touch. As thawing occurs, flushing of the skin, the development of blisters or blebs, or tissue edema appears. Options A, B, and C are incorrect.

47. Answer: D. Partial-thickness skin loss of the dermis

In a stage II pressure ulcer, the skin is not intact. Partial-thickness skin loss of the dermis has occurred. It presents as a shallow open ulcer with a red-pink wound bed, without slough. It may also present as an intact, open or ruptured, serum-filled blister. The skin is intact in stage I. Full-thickness skin loss occurs in stage 3. Exposed bone, tendon, or muscle is present in stage 4.

48. Answer: B. “The actual cause is not known”

The actual cause of acne is unknown. Oily skin or the consumption of foods such as chocolate, nuts, or fatty foods are not causes of acne. Exacerbations that coincide with the menstrual cycle result from hormonal activity. Heat, humidity, and excessive perspiration may play a role in exacerbating acne but does not cause it.

49. Answer: D. An outdoor construction worker

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Prolonged exposure to the sun, unusual cold, or other conditions can damage the skin. The outdoor construction worker would fit into a high-risk category for the development of an integumentary disorder. An adolescent may be prone to the development of acne, but this does not occur in all adolescents. Immobility and lack of nutrition would increase the older person’s risk but the older client is not at as high a risk as the outdoor construction worker. The physical education teacher is at low or no risk of developing an integumentary problem.

50. Answer: B. “The local anesthetic may cause a burning or stinging sensation”

Depending on the size and location of the lesion, a biopsy is usually a quick and almost painless procedure. The most common source of pain is the initial local anesthetic, which can produce a burning or stinging sensation. Preoperative medication is not necessary with this procedure.

51. Answer: D. “I’ll eat plenty of fruits and vegetables.”

For effective tissue healing, adequate intake of protein, vitamin A, B complex, C, D, E, and K are needed. Therefore, the client should eat a high protein diet with plenty of fruits and vegetables to provide these nutrients. The bandage should be secure but not too tight to impede circulation to the area (needed for tissue repair). If the client’s foot feels cold, circulation is impaired, thus inhibiting wound healing.

52. Answer: A. range of motion.

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To prevent disruption of the artificial skin’s adherence to the wound bed, the client should restrict range of motion of the involved limb. Protein intake and fluid intake are important for healing and regeneration and shouldn’t be restricted. Going outdoors is acceptable as long as the left arm is protected from direct sunlight.

53. Answer: C. pressure-like pain.

Severe pressure like pain out of proportion to visible signs distinguishes necrotizing fasciitis from cellulitis. Erythema, leukocytosis, and swelling are present in both cellulitis and necrotizing fasciitis.

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

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.

55. Answer: B. Urine output of 20 ml/hour

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A urine output of less than 40 ml/hour in a client with burns indicates a fluid volume deficit. This client’s PaO2 value falls within the normal range (80 to 100 mm Hg). White pulmonary secretions also are normal. The client’s rectal temperature isn’t significantly elevated and probably results from the fluid volume deficit.

56. Answer: C. Ecchymosis

Ecchymosis is a type of purpuric lesion and also is known as a bruise. Purpura is an umbrella term that incorporates ecchymoses and petechiae. Petechiae are pinpoint hemorrhages and are another form of purpura. Erythema is an area of redness on the skin.

57. Answer: A. Cherry angioma

Cherry angioma occurs with increasing age and has no clinical significance. It appears as a small, round, bright red–colored lesion on the trunk or extremities. Spider angiomas have a bright red center with legs that radiate outward. These lesions commonly are seen in liver disease and vitamin B deficiency, although they occasionally can occur without underlying pathology. A venous star results from increased pressure in veins, usually in the lower legs, and has an irregularly shaped bluish center with radiating branches. Purpura results from hemorrhage into the skin.

58. Answer: D. Net-like appearance

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Reticular skin lesions resemble a net in appearance. Annular lesions are ring-shaped, whereas linear lesions appear in a straight line. Arciform lesions are shaped like an arc.

59. Answer: D. Systemic lupus erythematosus (SLE)

An early sign of SLE is the appearance of a butterfly rash across the nose. Hyperthyroidism often leads to moist skin and increased perspiration. Pernicious anemia would be manifested by pallor of the skin. Cardiopulmonary disorders may lead to clubbing of the fingers.

60. Answer: C. Escherichia coli (E. coli)

E. coli normally is found in the intestines and constitutes a common source of infection of wounds and the urinary system. The other microbes listed are part of the normal flora of the skin.

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