NCLEX Practice Exam for Skin and Integumentary Diseases Part 2

1. Nurse Jay is performing wound care. Which of the following practices violates surgical asepsis?

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

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

1. Client’s lifestyle
2. Alcohol use
3. Tobacco use
4. Circulatory status

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

1. Assess the drainage in the dressing.
2. Slowly remove the soiled dressing
3. Wash hands thoroughly.
4. Put on latex gloves.

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

1. Turn and reposition the client at least once every 8 hours.
2. Vigorously massage lotion into bony prominences.
3. Post a turning schedule at the client’s bedside.
4. Slide the client, rather than lifting, when turning.

5. Nurse Jane 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?

1. Related to fat emboli
2. Related to infection
3. Related to femoral artery occlusion
4. Related to circumferential eschar

6. 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?

1. Lips
2. Sacrum
3. Earlobes
4. Back of the hands

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

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

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

1.  A client incontinent of urine feces
2. A client with chronic nutritional deficiencies
3. A client with decreased sensory perception
4. A client who is unable to move about and is confined to bed

9. 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?

1. Cold compress to the affected area
2. Warm compress to the affected area
3. Intermittent heat lamp treatments four times daily
4. Alternating hot and cold compresses continuously

10. The clinic nurse assesses the skin of a white characteristic is associated with this skin disorder?

1. Clear, thin nail beds
2. Red-purplish scaly lesions
3. Oily skin and no episodes of pruritus
4.  Silvery-white scaly patches on the scalp, elbow, knees, and sacral regions

11. 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?

1. Patch test
2. Skin biopsy
3.  Culture of the lesion
4. Woo’s light examination

12. 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?

1. Clustered skin vesicles
2. A generalized body rash
3. Small blue-white spots with a red base
4. A fiery red, edematous rash on the cheeks

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

1. An irregular shaped lesion
2. A small papule with a dry, rough scale
3. A firm, nodular lesion topped with crust
4. A pearly papule with a central crater and a waxy border

14. 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?

1. Avoid showering for 7 to 10 days
2. Apply ice to the site to prevent discomfort
3. Apply alcohol-soaked dressing twice a day
4. Clean the site with hydrogen peroxide to prevent infection

15. Nurse Carl 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?

1. Red shiny skin around the nail bed
2. White taut skin in the popliteal area
3. White silvery patches on the elbows
4. Swelling of the skin near the parotid gland

16. 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?

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

17. 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?

1. Intact skin
2. Full-thickness skin loss
3. Exposed bone, tendon, or muscle
4. Partial-thickness skin loss of the dermis

18. Nurse Ivy 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?

1. “Acne is caused by oily skin”
2.  “The actual cause is not known”
3.  “Acne is caused by eating chocolate”
4.  “Acne is caused as a result of exposure to heat and humidity”

19. The nurse is reviewing the health care 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?

1. An adolescent
2. An older female
3. A physical education teacher
4. An outdoor construction worker

20. 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:

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

21. 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?

1. “I’ll limit my intake of protein.”
2. “I’ll make sure that the bandage is wrapped tightly.”
3. “My foot should feel cold.”
4.  “I’ll eat plenty of fruits and vegetables.”

22. 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:

1. range of motion.
2. protein intake.
3. going outdoors.
4. fluid ingestion.

23. 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:

1. erythema.
2. leukocytosis.
3. pressurelike pain.
4. swelling.

24. 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:

1. “All family members will need to be treated.”
2. “If someone develops symptoms, tell him to see a physician right away.”
3.  “Just be careful not to share linens and towels with family members.”
4.  “After you’re treated, family members won’t be at risk for contracting scabies.”

25. 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?

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

26. 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?

1. Purpura
2. Petechiae
3. Ecchymosis
4. Erythema

27. 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?

1. Cherry angioma
2. Spider angioma
3. Venous star
4. Purpura

28. 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:

1. Ring-shaped
2. Linear
3. Shaped like an arc
4. Net-like appearance

29. 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?

1. Hyperthyroidism
2. Perncious anemia
3. Cardiopulmonary disorders
4. Systemic lupus erythematosus (SLE)

30. 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?

1. Staphylococcus epidermidis
2.  Staphylococcus aureus
3. Escherichia coli (E. coli)
4. Candida albicans

Answers and Rationales

1. Answer C. 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.
   
2. Answer D. 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.
3. Answer C. 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.
4. Answer C. 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.
5. Answer D. 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.
6. Answer A. 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.
7. Answer A. 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.
8. Answer C. 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.
9. Answer B. 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.
10. Answer D. 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.
11. Answer C. 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.
12. Answer A. 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.
13. Answer A. 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.
14. Answer D. 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.
15. Answer A. 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.
16. Answer D. 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.
17. Answer D. 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.
18. Answer B. 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.
19. Answer D. 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.
20. Answer B. 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.
21. Answer D. 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.
22. Answer A. 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.
23. Answer C. 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.
24. Answer A. 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.
25. Answer B. 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.
26. Answer C. 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.
27. Answer A. 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.
28. Answer D. 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.
29. Answer D. 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.
30. Answer C. 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.