Unit 7: Ch 52 (Porth's 5th Ed) - Disorders of Skin Integrity and Function Flashcards
- An 18-year-old female of Southeast Asian ancestry is distraught over the recent
appearance of white patches on her forearms and upper arms, which have been
subsequently confirmed as vitiligo. Which of the following statements by the woman
express an accurate understanding of her condition?
A) “I suppose it’s some comfort that my patches are small and will always stay out of
sight in the future.”
B) “I’m thankful that there are medications to cure this, but I’m nervous about the
side effects.”
C) “I suppose this shouldn’t come as too much of surprise, since this tends to run in
my family.”
D) “I’m surprised that I ended up contacting that fungus that caused this problem for
me.”
Ans: C
Feedback:
The incidence of vitiligo is thought to have a genetic component. Vitiligo worsens with
time, and treatments are not curative. The etiology is not infectious and does not involve
fungus.
- An 11-year-old boy with skin lesions on his trunk characteristic of ringworm has been
brought to the family’s primary care provider by his mother. Which of the following
aspects of the clinician’s assessment relates most directly to the suspected diagnosis?
A) Previous infection with other parasitic worms
B) Potential contact with the fungus from pets or other children
C) Allergic reactions to drugs and environmental substances
D) The child’s infant immunization history
Ans: B
Feedback:
Ringworm, or tinea, has a fungal etiology. Parasites, allergies, and immunizations would
be unlikely to relate directly to the etiology
- The father of an 18-month-old girl noticed a small vesicle on her face several days ago.
The lesion ruptured and left a straw-colored crust that remained on the girl’s face. The
eruption of new vesicles has prompted him to bring the child to the emergency
department. Which of the following treatments for the child’s skin problem is most
likely?
A) A topical antifungal ointment
B) An oral corticosteroid
C) An antiviral ointment
D) A topical antibiotic
Ans: D
Feedback:
The course and symptomatology of the child’s skin disorder is characteristic of
impetigo, which is bacterial in etiology and would likely be treated with a topical
antibiotic such as mupirocin
- An elderly patient has arrived at the physician’s office complaining of a rash. Upon
further investigation, the patient states that the rash feels like a burning pain but also has
some tingling. It is extreme sensitive to touch, and it’s “like crazy.” The nurse notes that
the rash is made up of vesicles and located on the right thoracic region. The nurse
suspects the patient has
A) chickenpox.
B) German measles.
C) herpes zoster.
D) human papillomavirus
Ans: C
Feedback:
All of the characteristics point to herpes zoster. The vesicles erupt for 3 to 5 days along
the nerve pathway (hence the reason for the burning pain). Eruptions usually are
unilateral in the thoracic region, trunk, or face. Rubella (German measles) is
characterized by a diffuse, punctuate, macular rash that begins on the trunk and spreads
to the arms and legs. Varicella (chickenpox) has a macular stage where it develops
within hours over the trunk, spreading to the limbs, mucosa, scalp, axillae, upper
respiratory tract, and conjunctiva. HPV causes genital warts and is a sexually
transmitted disease.
- Which of the following teaching points is most appropriate for a teenager who has
sought care for the treatment of his severe acne?
A) “Avoiding high-fat foods and chocolate won’t cure your acne, but it will likely
improve it a lot.”
B) “All the creams and ointments that you can buy have been shown to be no real
help for acne.”
C) “It’s important for you to vigorously wash your face several times a day.”
D) “You might need antibiotic pills in addition to a cream for your face.”
Ans: D
Feedback:
Combination treatments for acne often include a topical preparation in addition to oral
antibiotics. Avoiding certain foods has not been shown to be effective in acne treatment
or prevention, and the topical products available are effective in some, though not all,
cases. Care should be taken not to exacerbate lesions by washing the face too vigorously
or too often.
- A 30-year-old woman, who just found out that she is pregnant, seeks a treatment for her
severe acne. What is the most appropriate treatment for her skin condition?
A) Accutane
B) Low-dose tetracycline
C) Retin-A
D) A benzoyl peroxide agent
Ans: D
Feedback:
Benzoyl peroxide is a topical agent that has both antibacterial and comedolytic
properties. It is the topical agent most effective in reducing the P. acnes population.
Bacterial resistance does not develop to benzoyl peroxide. The irritant effect of the drug
also causes vasodilation and increased blood flow, which may hasten resolution of the
inflammatory lesions. Although Accutane, low-dose tetracycline, and Retin-A are often
used to treat severe acne, these drugs should not be given to those who are pregnant
because they can affect the development of the fetus.
- A 31-year-old man who has worked for several years installing fiberglass insulation has
developed itchy, irritating lesions on his wrists and forearms over the last several
months. He has applied moisturizing creams repeatedly and has taken antihistamines but
has experienced no significant improvement. He is understandably concerned about the
potential effect this could have on his livelihood and has asked his care provider when
treatment will resolve the problem. What is the care provider’s most appropriate
response?
A) “A steroid cream will likely help but often the skin problem lasts long after
contact with the product that irritates the skin.”
B) “You’re clearly allergic to the fiberglass in your insulation, and over-the-counter
allergy medications are likely to resolve the problem quite rapidly.”
C) “The problem is that your skin is producing and sloughing off cells prematurely;
this will respond well to a topical steroid.”
D) “There are medications I can prescribe that will cure this sensitivity, but they tend
to take many months to take full effect.”
Ans: A
Feedback:
Topical corticosteroids are often used in the treatment of irritant contact dermatitis, but
symptoms can persist long after contact with the irritant ceases. The course of the man’s
complaint is suggestive of irritant, not allergic, contact dermatitis. Hyperkeratinization
is characteristic of psoriasis, and a sensitivity can be treated but not cured.
- A 44-year-old man has been diagnosed with chronic urticaria, the exact cause of which
cannot be determined. What is the pharmacological treatment that is most likely to be of
most use to the man?
A) topical retinoids
B) epinephrine
C) antihistamines
D) benzoyl peroxide
Ans: C
Feedback:
While epinephrine may be of use during an acute episode of urticaria that affects the
upper airway, antihistamines are the most common regular treatment modality.
Retinoids and benzoyl peroxide are used for the treatment of acne.
- A female client who is suspected of having psoriasis. Which of the following aspects of
the woman’s history and her care provider’s assessment would be potential contributors
to her health problem? Select all that apply.
A) The woman takes an angiotensin-converting enzyme inhibitor for the treatment of
hypertension.
B) She has been diagnosed with arthritis.
C) The woman has a family history of diabetes.
D) Skin trauma of any kind often precedes an outbreak.
E) The woman has dark skin.
Ans: A, B, D
Feedback:
ACE inhibitors, arthritis, and skin trauma are all associated with psoriasis and acute
episodes of the problem. Diabetes and dark skin tone are not noted to predispose to the
condition
- The nurse is caring for a patient in the hospital for pneumonia but also has a severe case
of psoriasis that is being treated with methotrexate. During the morning assessments,
which of the following lab values would alert the nurse that the patient may be
experiencing a side effect to this medication? Select all that apply.
A) Serum potassium (K+) level 3.6 mmol/L
B) Platelet count 37 × 103/μL
C) Alanine aminotransferase (ALT) 28 units/L
D) White blood cell count 1.2x10/μL
Ans: B, D
Feedback:
Methotrexate is an antimetabolite that inhibits DNA synthesis and prevents cell mitosis.
Oral methotrexate has been effective in treating psoriasis when other approaches have
failed. The side effects include nausea, leukopenia (low WBC count), thrombocytopenia
(low platelet count), and liver function abnormalities. The low platelet count
corresponds to thrombocytopenia, and the low WBC corresponds to leucopenia. The
other lab values, K+ and ALT, are within the normal adult range.
- A 13-year-old girl has presented to a clinic with her mother explaining that she had an
oval-shaped red patch on her chest a week ago but that more of the lesions are now
appearing on her back. On examination, the lesions on her back are in a “Christmas
tree” pattern. What is the girl’s most likely diagnosis?
A) Lichen planus
B) Pityriasis rosea
C) Rosacea
D) Melasma
Ans: B
Feedback:
The characteristic lesion of pityriasis rosea is an oval macule or papule with surrounding
erythema. This initial lesion is a solitary lesion called the herald patch and is usually on
the trunk or neck. As the lesion enlarges and begins to fade away (2 to 10 days),
successive crops of lesions appear on the trunk and neck. The lesions on the back have a
characteristic “Christmas tree” pattern. The girl’s history and symptomatology are not
characteristic of lichen planus, rosacea, or melasma
- A 22-year-old male who has been backpacking around Southeast Asia for several
months has responded well to treatment for scabies that he acquired while on his trip.
What follow-up measures should be taken?
A) Continuing his antibiotics until the full course is completed
B) Treatment of individuals that he has been in close contact with
C) Applying corticosteroid creams for at least 8 weeks to prevent recurrence
D) Avoiding potentially irritating products such as dyes and perfumes
Ans: B
Feedback:
Treatment of scabies should be extended to individuals with whom the affected person
has had close contact. Antibiotics and steroids are not used in treatment of scabies, and
irritants are of no particular threat.
- When trying to discern the extent of a burn, the nurse will note that second-degree
full-thickness burns are characterized by
A) extending into the subcutaneous tissue.
B) noting that blood vessels have clotted and can be seen under the burned skin.
C) redness or pinkness noted, but no blister formation is present on the epidermis.
D) extensive pain along with waxy white areas with blister formation
Ans: D
Feedback:
Second-degree full-thickness burns involve the entire epidermis and dermis. These
burns have extensive pain because the pain sensors remain intact. These burns appear as
mottled pink, red, or waxy white areas with blister formation and edema. Answers A
and B relate to third-degree full-thickness burns, whereas answer C is characteristic of
first-degree burns.
- A 17-year-old male experienced third-degree full-thickness burns 2 days ago to his
lower limbs after a fire at his workplace. Which of the following complications should
his care team foresee and regularly assess for? Select all that apply.
A) Systemic infection
B) Fluid volume deficit
C) Respiratory dysfunction
D) Hypermetabolic response
E) Constipation and bowel obstruction
Ans: A, B, C, D, E
Feedback:
Sepsis, hemodynamic instability, respiratory dysfunction, hypermetabolism, and bowel
obstructions are all demonstrated consequences of thermal injury.
- A care aide who works in a long-term care facility recognizes the high incidence and
prevalence of a stage I pressure ulcer in immobile older adults. Which of the following
protocols in the facility would the care aide advocate changing?
A) Residents with persistently low food intake are identified.
B) Immobilized residents are turned every 2 hours during both day and night.
C) Residents are frequently encouraged to increase their fluid intake.
D) Wound dressings are applied promptly to all identified or potential pressure
ulcers.
Ans: D
Feedback:
Early-stage pressure ulcers and potential pressure ulcers do not necessitate wound
dressings and are better treated by turning, keeping skin dry, and removing pressure.
Nutrition and hydration status are important factors, and individuals who cannot
reposition themselves independently should be turned regularly.
