Medical Surgical: Dermatological
1. A client is prescribed 1% silver sulfadiazine cream (Silvadene) to be applied to her burn wounds
twice daily. After 3 days of treatment, the nurse suspects an adverse reaction to the medication
when the client develops which of the following?
Leukopenia
Transient leukopenia is a common adverse effect that appears after 2 to 3 days of treatment with
silver sulfadiazine cream.
2. A client with a large healing deep partial thickness burn of the forearm and wrist is being
discharged from the burn treatment clinic. Which of the following should the nurse tell the client
to avoid for a year?
Exposure to the sun
A deep partial thickness burn occurs when the first layer of skin, the epidermis, is burned all the
way through, and some level of burning occurs in the underlying layer of skin, called the dermis.
A deep partial thickness burn can cause permanent scars, much like a full thickness burn.
Exposure to sun of the newly formed and healing skin in the year following a burn injury can
cause more intense scarring.
3. A nurse on a surgical unit is caring for four clients with healing wounds. Which of the four clints
wounds should the nurse anticipate will heal by primary intention?
Gastroplasty incision
Would closure occurs by primary intention (surgical closure), secondary intention (left open to
close by the reparative process), and tertiary closure (left open and surgically closed at a later
date). With primary intention, a clean would is closed mechanically, leaving well approximated
edges and minimal scarring. A surgical incision is an example of a wound that heals by primary
intention.
4. A client is being discharged after surgical excision of a malignant melanoma. Which statement
indicated to the nurse an understanding of the danger of ultraviolet light?
I’ll reapply my sunscreen every 2 hours when I’m out in the sun.
Even water- resistant sunscreens should be reapplied at least every 2 hr after swimming or
during prolonged sun exposure.
5. A client is admitted for treatment of malignant melanoma of the left upper leg. Initially, the
nurse plans to prepare the client for which of the following?
Surgical excision
, the therapeutic approach to malignant melanoma depends on the level of invasion and the
depth of the lesion. Surgical excision is the treatment of choice for small, superficial lesions.
Deeper lesions require wide local excision, after which skin grafting may be needed.
6. A client is about to undergo a biopsy of a 6-mm, bluish- red lesion. In addition to a thorough skin
examination, the nurse knows the most critical assessment to be made at this time is the status
of the clients
Regional lymph nodes
The description of the lesion suggests a malignant melanoma. The assessment should include
not only a thorough skin examination, but also palpation of the regional lymph nodes that drain
the area near the lesion.
7. When targeting a group of clients for health teaching, the nurse should be aware that which
group is at greatest risk for developing malignant melanoma?
Clients who are fair- haired, fair- skinned, and of Celtic descent
Clients who have fair hair, fair skin, and blue eyes and are of Celtic descent are at the highest risk
for developing skin cancer.
8. A client with an undiagnosed lesion on the back of his right hand is concerned about the
possibility of skin cancer. When the client asks what the most serious type of skin cancer is, the
nurse responds based on the knowledge that most malignant tumors are
Melanomas
Melanomas are malignant neoplasms with atypical melanocytes in both the epidermis and the
dermis (and sometimes the subcutaneous cells). It is the most lethal type of skin cancer, often
causing metastases in bone, liver, lungs, spleen, the central nervous system, and lymph nodes.
9. A client is hospitalized with extensive full thickness burns of both legs. In response to the clients
questions, the nurse explains that during the acute phase of burn injury, biological dressings are
used primarily to
Promote healing
Biological dressings are temporary grafts used during the acute phase to increase the rate of
epithelialization, act as a barrier to protect the wound from contamination, and reduce fluid and
protein loss.
10. A nurse teaches a wheelchair bound client to reduce the risk of pressure ulcer formation by
instructing the client to do which of the following?
“Shift your weight in the wheelchair every 15 minutes.”
, This response addresses the safety issue of the risk of pressure ulcers. Pressure ulcers, wounds
that develop due to prolonged pressure on a particular point of the body, are most likely to
develop if the client does not shift position frequently.
11. A client had had a basal cell carcinoma removed by surgical excision. The nurse instructs the
client to watch for indications of potential malignancy in other moles, including which of the
following?
Ulceration
Ulceration, bleeding, or exudation are indications of a mole’s potential malignancy. Increasing
size is also a warning sign. The nurse should emphasize the importance of a lifetime follow- up
evaluations and the proper techniques for self- examination of the skin every month.
12. A nurse plans to teach a group of young adults health promotion techniques to reduce the risk of
skin cancer. Which of the following should the nurse include?
Avoid exposure to the midday sun.
Avoiding skin exposure, especially during the midday hours of 1000 to 1500 is crucial for
preventing skin cancer.
13. A client is brought to the emergency department with severe frostbite. The nurse assessing the
client knows the burned appearance of frostbitten tissue is a direct result of which of the
following?
Red blood cell aggregation with microvascular occlusion
As blood reaches freezing temperatures, red blood cells aggregate, or clump together. This
causes occlusion of small blood vessels and leads to a loss of superficial blood flow. This causes a
discoloration of the skin that resembles a superficial, partial- thickness burn.
14. A client comes to the clinic reporting skin lesions. The nurse assesses the lesions and notes that
they are 0.5 cm in size, elevated and solid, with very distinct borders. Based on the finding,
which of the following should the nurse document the presence of?
Papules
A papule is a small, solid, elevated lesion with distinct borders. It is usually smaller than 10 MM
in diameter. Papules are common lesions of acne, and warts can also be papules.
15. A nurse is bathing a client with burn injuries in a hydrotherapy tub. The nurse limits the clients
hydrotherapy sessions to no more than 30 min to
Minimize sodium loss
Water used in the hydrotherapy tubs is hypotonic. Prolonged periods of immersion increase the
, client’s risk of sodium loss.
16. A client arrives at the emergency department with a snakebite of the lower left leg. What should
the nurse do?
Immobilize the limb below the level of the heart.
The emergency management of a client with a snakebite focuses on preventing the spread of
venom. Any constrictive clothing of jewelry should be removed, and the affected limb should be
immobilized below the level of the heart.
17. A 15 year old girl was admitted with burns of her face and hands. Which statement indicated to
the nurse that the client has adapted to her changed body image?
“Can I go with my family to the visitor’s lounge?”
This demonstrates a positive self- image. The client is asking to visit with her family in a public
setting.
18. When assessing a bedridden client admitted from home, the nurse notes a shallow crater in the
epidermis of the clients sacral area. The nurse documents the presence of a pressure ulcer,
noting that it is stage
II
With a stage II ulcer, there is partial thickness skin loss involving the epidermis and the dermis.
The ulcer is visible and superficial and may appear as an abrasion, blister, or shallow crater.
Edema persists, and the ulcer may become infected. The client may report pain, and there may
be a small amount of drainage.
19. To promote healing for a client with a large wound healing by secondary intention, the nurse
recommends a diet high in protein and which of the following?
Vitamin C
Diets high in protein and Vitamin C are recommended because these nutrients promote wound
healing. A wound with little or no tissue loss (a surgical wound) heals by primary intention.
Wounds involving loss of tissue (severe lacerations or pressure ulcers) are left open until filled
with scar tissue. This healing by secondary intention takes longer.
20. A nurse is caring for a client who sustained a thermal burn 4 days ago. Most of the burns are
superficial partial- thickness and deep partial- thickness, but there are large areas of full-
thickness burns as well. Which assessment finding should the nurse report to the client’s
provider?
Temperature of 39.1 C (102.4 F)
1. A client is prescribed 1% silver sulfadiazine cream (Silvadene) to be applied to her burn wounds
twice daily. After 3 days of treatment, the nurse suspects an adverse reaction to the medication
when the client develops which of the following?
Leukopenia
Transient leukopenia is a common adverse effect that appears after 2 to 3 days of treatment with
silver sulfadiazine cream.
2. A client with a large healing deep partial thickness burn of the forearm and wrist is being
discharged from the burn treatment clinic. Which of the following should the nurse tell the client
to avoid for a year?
Exposure to the sun
A deep partial thickness burn occurs when the first layer of skin, the epidermis, is burned all the
way through, and some level of burning occurs in the underlying layer of skin, called the dermis.
A deep partial thickness burn can cause permanent scars, much like a full thickness burn.
Exposure to sun of the newly formed and healing skin in the year following a burn injury can
cause more intense scarring.
3. A nurse on a surgical unit is caring for four clients with healing wounds. Which of the four clints
wounds should the nurse anticipate will heal by primary intention?
Gastroplasty incision
Would closure occurs by primary intention (surgical closure), secondary intention (left open to
close by the reparative process), and tertiary closure (left open and surgically closed at a later
date). With primary intention, a clean would is closed mechanically, leaving well approximated
edges and minimal scarring. A surgical incision is an example of a wound that heals by primary
intention.
4. A client is being discharged after surgical excision of a malignant melanoma. Which statement
indicated to the nurse an understanding of the danger of ultraviolet light?
I’ll reapply my sunscreen every 2 hours when I’m out in the sun.
Even water- resistant sunscreens should be reapplied at least every 2 hr after swimming or
during prolonged sun exposure.
5. A client is admitted for treatment of malignant melanoma of the left upper leg. Initially, the
nurse plans to prepare the client for which of the following?
Surgical excision
, the therapeutic approach to malignant melanoma depends on the level of invasion and the
depth of the lesion. Surgical excision is the treatment of choice for small, superficial lesions.
Deeper lesions require wide local excision, after which skin grafting may be needed.
6. A client is about to undergo a biopsy of a 6-mm, bluish- red lesion. In addition to a thorough skin
examination, the nurse knows the most critical assessment to be made at this time is the status
of the clients
Regional lymph nodes
The description of the lesion suggests a malignant melanoma. The assessment should include
not only a thorough skin examination, but also palpation of the regional lymph nodes that drain
the area near the lesion.
7. When targeting a group of clients for health teaching, the nurse should be aware that which
group is at greatest risk for developing malignant melanoma?
Clients who are fair- haired, fair- skinned, and of Celtic descent
Clients who have fair hair, fair skin, and blue eyes and are of Celtic descent are at the highest risk
for developing skin cancer.
8. A client with an undiagnosed lesion on the back of his right hand is concerned about the
possibility of skin cancer. When the client asks what the most serious type of skin cancer is, the
nurse responds based on the knowledge that most malignant tumors are
Melanomas
Melanomas are malignant neoplasms with atypical melanocytes in both the epidermis and the
dermis (and sometimes the subcutaneous cells). It is the most lethal type of skin cancer, often
causing metastases in bone, liver, lungs, spleen, the central nervous system, and lymph nodes.
9. A client is hospitalized with extensive full thickness burns of both legs. In response to the clients
questions, the nurse explains that during the acute phase of burn injury, biological dressings are
used primarily to
Promote healing
Biological dressings are temporary grafts used during the acute phase to increase the rate of
epithelialization, act as a barrier to protect the wound from contamination, and reduce fluid and
protein loss.
10. A nurse teaches a wheelchair bound client to reduce the risk of pressure ulcer formation by
instructing the client to do which of the following?
“Shift your weight in the wheelchair every 15 minutes.”
, This response addresses the safety issue of the risk of pressure ulcers. Pressure ulcers, wounds
that develop due to prolonged pressure on a particular point of the body, are most likely to
develop if the client does not shift position frequently.
11. A client had had a basal cell carcinoma removed by surgical excision. The nurse instructs the
client to watch for indications of potential malignancy in other moles, including which of the
following?
Ulceration
Ulceration, bleeding, or exudation are indications of a mole’s potential malignancy. Increasing
size is also a warning sign. The nurse should emphasize the importance of a lifetime follow- up
evaluations and the proper techniques for self- examination of the skin every month.
12. A nurse plans to teach a group of young adults health promotion techniques to reduce the risk of
skin cancer. Which of the following should the nurse include?
Avoid exposure to the midday sun.
Avoiding skin exposure, especially during the midday hours of 1000 to 1500 is crucial for
preventing skin cancer.
13. A client is brought to the emergency department with severe frostbite. The nurse assessing the
client knows the burned appearance of frostbitten tissue is a direct result of which of the
following?
Red blood cell aggregation with microvascular occlusion
As blood reaches freezing temperatures, red blood cells aggregate, or clump together. This
causes occlusion of small blood vessels and leads to a loss of superficial blood flow. This causes a
discoloration of the skin that resembles a superficial, partial- thickness burn.
14. A client comes to the clinic reporting skin lesions. The nurse assesses the lesions and notes that
they are 0.5 cm in size, elevated and solid, with very distinct borders. Based on the finding,
which of the following should the nurse document the presence of?
Papules
A papule is a small, solid, elevated lesion with distinct borders. It is usually smaller than 10 MM
in diameter. Papules are common lesions of acne, and warts can also be papules.
15. A nurse is bathing a client with burn injuries in a hydrotherapy tub. The nurse limits the clients
hydrotherapy sessions to no more than 30 min to
Minimize sodium loss
Water used in the hydrotherapy tubs is hypotonic. Prolonged periods of immersion increase the
, client’s risk of sodium loss.
16. A client arrives at the emergency department with a snakebite of the lower left leg. What should
the nurse do?
Immobilize the limb below the level of the heart.
The emergency management of a client with a snakebite focuses on preventing the spread of
venom. Any constrictive clothing of jewelry should be removed, and the affected limb should be
immobilized below the level of the heart.
17. A 15 year old girl was admitted with burns of her face and hands. Which statement indicated to
the nurse that the client has adapted to her changed body image?
“Can I go with my family to the visitor’s lounge?”
This demonstrates a positive self- image. The client is asking to visit with her family in a public
setting.
18. When assessing a bedridden client admitted from home, the nurse notes a shallow crater in the
epidermis of the clients sacral area. The nurse documents the presence of a pressure ulcer,
noting that it is stage
II
With a stage II ulcer, there is partial thickness skin loss involving the epidermis and the dermis.
The ulcer is visible and superficial and may appear as an abrasion, blister, or shallow crater.
Edema persists, and the ulcer may become infected. The client may report pain, and there may
be a small amount of drainage.
19. To promote healing for a client with a large wound healing by secondary intention, the nurse
recommends a diet high in protein and which of the following?
Vitamin C
Diets high in protein and Vitamin C are recommended because these nutrients promote wound
healing. A wound with little or no tissue loss (a surgical wound) heals by primary intention.
Wounds involving loss of tissue (severe lacerations or pressure ulcers) are left open until filled
with scar tissue. This healing by secondary intention takes longer.
20. A nurse is caring for a client who sustained a thermal burn 4 days ago. Most of the burns are
superficial partial- thickness and deep partial- thickness, but there are large areas of full-
thickness burns as well. Which assessment finding should the nurse report to the client’s
provider?
Temperature of 39.1 C (102.4 F)
