[Osborn] chapter 66

Learning Outcomes [Number and Title ]

Learning Outcome 1
Differentiate the etiology, pathophysiology, and interventions
for infections of the skin.
Learning Outcome 2
Identify preventive measures for skin disorders.
Learning Outcome 3
Identify the impact of the environment on the skin.
Learning Outcome 4
Describe the signs and symptoms, diagnostic tests, and
treatment of skin disorders.
Learning Outcome 5
Develop a nursing plan of care for a patient with a skin
disorder.
Learning Outcome 6
Differentiate the psychological and physical implications for
the patient with a skin disorder.
Learning Outcome 7
Describe the effects of aging on the skin.

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

1. A client has a lesion in the left axilla that is deep, painful, and contains pus. The nurse
measured the lesion and found it is 3 centimeters in diameter and is walled off. After the
assessment, the nurse determines the lesion is:
1. A furuncle.
2. Folliculitis.
3. A carbuncle.
4. Herpes varicella.
Correct Answer: A furuncle.
Rationale: A furuncle develops when the infection from folliculitis becomes deeper. A sebaceous
gland is obstructed, causing a deep inflammatory reaction and infection from staphylococcus.
The lesion is a walled-off, painful, firm mass that contains pus. It is usually 1 to 5 centimeters in
diameter. A carbuncle is a larger abscess that interconnects several hair follicles and is about 3 to
10 centimeters in diameter.
Cognitive Level: Application
Nursing Process: Diagnosis
Client Need: Physiological Integrity
LO: 1

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

2. A client is diagnosed with herpes zoster (shingles). The client feels the infection is a result of
exposure to an organism while traveling abroad. To correct the clients misconceptions, the nurse
must explain that herpes zoster:
1. Occurs because of the reactivation of the latent varicella-zoster virus.
2. Results from sharing personal items such as towels.
3. Occurs in only a few areas of the world.
4. Is caused by a bacteria normally found on the skin.
Correct Answer: Occurs because of the reactivation of the latent varicella-zoster virus.
Rationale: Herpes zoster (shingles) occurs because of the reactivation of latent vericella-zoster
virus (the virus that causes chickenpox). After having chickenpox, the virus remains dormant in
the dorsal root and cranial nerve ganglia, and becomes activated usually when a person is
immunocompromised due to age or some other disease process such as AIDS, Hodgkins
disease, and some cancers.
Cognitive Level: Application
Nursing Process: Implementation
Client Need: Physiological Integrity
LO: 1

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

3. A nursing consultant for a preschool diagnoses several children with tinea capitis. The nurse
convenes a meeting to educate the staff on control and prevention of this contagious infection.
The nurse explains that tinea capitis is spread by:
1. Contact with personal items such as hats and blankets.
2. Lack of proper hygiene practices.
3. Wearing woolen hats.
4. Children only.
Correct Answer: Personal contact with items such as hats and blankets.
Rationale: Tinea capitis (ringworm of the scalp) is a contagious fungal infection transmitted by
personal contact. It can be spread through combs, animals, hats, blankets, telephones, and theater
seats. It is more common in children because of their habits, but anyone can contract tinea
capitis.
Cognitive Level: Application
Nursing Process: Implementation
Client Need: Physiological Integrity
LO: 1

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

4. When educating clients and families about maintaining healthy skin, it is essential that the
nurse discuss the importance of:
Select all that apply.
1.
2.
3.
4.
5.

Adequate nutrition.
Regular exercise.
Hygiene practices.
Racial differences.
Annual skin inspections.

Correct Answers:
1. Adequate nutrition.
2. Regular exercise.
3. Hygiene practices.
4. Racial differences.
Rationale: Adequate nutrition. The skin needs protein, vitamin C, iron, and zinc to be healthy.
Protein and vitamin deficiencies, along with obesity, can decrease the skins ability to regenerate
and affect the circulation to the skin, leading to skin lesions and delayed would healing. Water is
important to maintain elasticity in the skin. Regular exercise. Regular exercise helps maintain
adequate circulation, providing oxygen and nutrients to the skin. Hygiene practices. Regular
bathing keeps the excess bacteria and oils in check so that the skin can remain healthy. However,
bathing more frequently than necessary can cause dryness of the skin. Racial differences. Racial
differences in skin may account for changes in skin response to daily care and environmental
irritants. Annual skin inspections. The skin should be inspected monthly for new growths or
changes in skin lesions.
Cognitive Level: Application
Nursing Process: Implementation
Client Need: Physiological Integrity
LO:2

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

5. An African American client has reoccurring folliculitis on the face. The nurse should instruct
the client to:
1. Use an electric razor.
2. Shave daily.
3. Shave very close.
4. Shave in the opposite direction of hair growth.
Correct Answer: Use an electric razor.
Rationale: Folliculitis is inflammation of the hair follicles. African Americans are particularly
susceptible to folliculitis caused by ingrown hairs because of their curly hair. The client should
be instructed to shave every few days rather than daily. The client should avoid shaving too close
and shave in the direction of hair growth. Using an electric razor instead of a straightedge blade
may be helpful.
Cognitive Level: Application
Nursing Process: Implementation
Client Need: Physiological Integrity
LO: 2

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

6. The nurse is counseling with a client who has atropic dermatitis (eczema) and has developed a
secondary Staphylococcus aureus infection. To prevent this type of infection from reoccurring in
the future, the nurse should stress:
1. Methods to prevent itching.
2. Continuous antibiotic treatment.
3. Frequent bathing.
4. Allergy testing.
Correct Answer: Methods to prevent itching
Rationale: A secondary Staphylococcus aureus infection can develop due to skin trauma and
breakdown from scratching. Therefore, it is important to control the itching that occurs with
eczema. Antibiotics would be given to treat the infection but not prevent it. Frequent bathing
may dry out the skin, causing increased itching. It is important to identify the irritants that cause
the lesions, but this will not prevent a secondary infection.
Cognitive Level: Application
Nursing Process: Implementation
Client Need: Physiological Integrity
LO: 2

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

7. A client develops inflammation of the skin after being exposed to poison oak. This reaction is:
1. Contact dermatitis.
2. Actinic keratosis.
3. Atopic dermatitis.
4. Urticaria.
Correct Answer: Contact dermatitis.
Rationale: Contact dermatitis is an inflammation of the skin related to exposure to an irritant or
allergen in the environment. The reaction to poison oak is an allergic contact dermatitis. Actinic
keratosis is related to skin exposure to the sun. Atopic dermatitis is a chronic, inflammatory skin
disorder. Urticaria is most often related to an allergic reaction to medications, foods, or insect
bites.
Cognitive Level: Application
Nursing Process: Implementation
Client Need: Physiological Integrity
LO: 3

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

8. The cause of photodermatitis that is not the result of a genetic immunologic reaction may be
the result of:
1. The use of certain medications.
2. Excessive sun exposure.
3. A vitamin deficiency.
4. Smoking.
Correct Answer: The use of certain medications.
Rationale: Photodermatitis is an inflammatory adverse reaction to sunlight. It is a
hypersensitivity to sun in which the individual sunburns more easily than usual or develops
papular or vesicular lesions with exposure to the sun. It may occur because of the use of certain
medication. It is not a reaction to excessive sun exposure, vitamin deficiency, or smoking.
Cognitive Level: Application
Nursing Process: Implementation
Client Need: Physiological Integrity
LO: 3

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

9. Urticaria (hives) commonly occurs:

1. As an allergic reaction to foods or insect bites.
2. Because of a familial predisposition.
3. And rarely resolves without treatment.
4. On the palms of the hands.
Correct Answer: As an allergic reaction to foods or insect bites.
Rationale: Urticaria commonly occurs as an allergic reaction to medication, foods, and insect
bites. There is not a familial predisposition to developing urticaria. The rash related to urticaria
does not usually appear in the mucous membranes, the palms of the hands, or the soles of the
feet. Most cases resolve spontaneously, but antihistamines may be given to block the action of
histamine.
Cognitive Level: Application
Nursing Process: Implementation
Client Need: Physiological Integrity
LO: 3

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

10. A client has a small, red, scaling lesion that is sitting on an elevated base on the forehead. The
client states that lesion began several weeks before and will not heal. The nurse recognized this
lesion as possible:
1. Squamous cell carcinoma.
2. Melanoma.
3. Psoriases.
4. Seborrheic keratosis.
Correct Answer: Squamous cell carcinoma.
Rationale: Squamous cell carcinoma consists of tumors of the outer epidermis that occur with
frequent exposure to the sun. The scaling lesions sit on an elevated base with an irregular border
that may itch or be a nonhealing lesion after minor trauma. Melanomas appear as changing or
unusual moles with an irregular border, an uneven surface, and are of varied size and shape.
Psoriasis lesions are erythematous papules and placques with silver-white scales that are sharply
demarcated. Seborrheic keratosis lesions are warty, dirty-yellow to black papules with sharp
margins.
Cognitive Level: Application
Nursing Process: Diagnosis
Client Need: Physiological Integrity
LO: 4

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

11. A potassium hydroxide smear is used to determine if a clients skin lesion is caused by a:
1. Fungus.
2. Bacteria.
3. Virus.
4. Parasite.
Correct Answer: Fungus.
Rationale: A sample of the lesion is taken, wet with a solution of potassium hydroxide, and
placed on a slide for examination. The potassium chloride clears off debris and bacteria so that
fungi can be identified. The potassium chloride smear is used to identify a fungus. Bacteria and
viruses are identified by cultures, and parasites can be determined by looking at skin scrapings
under the microscope.
Cognitive Level: Comprehension
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 4

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

12. A client with psoriasis is being treated with topical corticosteroids. The nurse who is teaching
the client about the application of the medication should explain that the correct way to apply the
medication is to:
1. Apply the medication in a thin layer.
2. Avoid rubbing the medication into the skin.
3. Apply a thick layer of medication.
4. Continue medication even if lesions worsen, because it is only a temporary reaction.
Correct Answer: Apply the medication in a thin layer.
Rationale: Topical corticosteroids should be applied in a thin layer and rubbed in thoroughly on
wet skin. Some infections may be made worse by corticosteroids. If the lesions worsen, the
medication should be discontinued and the health provider notified.
Cognitive Level: Application
Nursing Process: Planning
Client Need: Physiological Integrity
LO: 4

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

13. Discharge planning for a client with a dermatologic disorder usually begins at the same time
as diagnosis of the condition because:
1. Most are cared for at home.
2. Treatments are very complicated.
3. Most skin disorders have long-term effects.
4. Most require pain medications.
Correct Answer: Most are cared for at home.
Rationale: Most clients of dermatologic disorders are cared for at home. Patient teaching aimed
at self-care is an important part of planning for discharge. Treatments for most skin disorders are
not very complicated; treatment usually consists of a topical medication and occasionally an oral
medication. Most skin disorders do not have long-term effects; most are resolved with removal
of cause and medication. Most skin disorders are not painful so pain medication is not needed;
medications for the relief of itching are often required.
Cognitive Level: Evaluation
Nursing Process: Planning
Client Need: Physiological Integrity
LO: 5

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

14. When caring for a client with toxic epidermal necrolysis disorders that are life threatening, it
is essential that the plan of care be prioritized correctly. The first priority should be:
1. Protection of airway.
2. Balanced fluid volume.
3. Effective thermoregulation.
4. Pain management.
Correct Answer: Protection of airway.
Rationale: Although all the answer choices are important, protection of the airway and
maintenance of normal oxygen levels is always the first priority. Edema and involvement of
mucous membranes can compromise the airway. With epidermal necrolysis disorders, it is also
important to monitor a clients hemodynamic status and electrolyte levels because there is
epithelial skin loss. The client will also have acute pain because of the exposed nerve endings.
Cognitive Level: Analysis
Nursing Process: Planning
Client Need: Physiological Integrity
LO: 5

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

15. The nurse is developing plan of care for a client with necrotizing fasciitis. One of the
outcomes should be to prevent worsening of the infection. An appropriate question for nurse to
ask when collecting subjective data during the assessment would be:
1.
2.
3.
4.

Where are the lesions located?

Do you have edema?
How active are you physically?
Is your pain constant or intermittent?

Correct Answer: Where are the lesions located?

Rationale: Where are the lesions located? would aid the nurse is assessing the skin integrity of
the client and determine evaluation parameters. Do you have edema? would relate to
assessment of fluid status. How active are you physically? would aid the nurse in assessing
physical mobility. Is your pain constant or intermittent? would aid the nurse in assessing the
clients pain.
Cognitive Level: Application
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 5

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

16. Blepharoplasty is sometimes performed at the same time a face-lift or brow-lift is done
because the client does not like the appearance of the eyes. This procedure may also be done
because:
1. There is an interference with vision.
2. The procedure improves the results of the face-lift or brow-lift.
3. The procedure improves the clients ability to blink sufficiently.
4. The client wants to remove ethnic characteristics of the eye.
Correct Answer There is an interference with vision.
Rationale: Blepharoplasty is often performed for cosmetic reasons when the client does not like
the appearance of the eyes. This reason would include removing ethnic characteristics and
improving the results of a face-lift or brow-lift. It may be also performed because there is an
interference with the clients vision; with aging, there is location of fat, loss of skin elasticity, and
excess muscle around the eye. The excess skin and fat, and occasionally a portion of the
orbicularis oculi muscle around the eye, are removed. Blepharoplasty is not related to the clients
ability to blink.
Cognitive Level: Application
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 6

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

17. A client with a skin disorder may have many physiological needs and psychological needs.
The nurse should:
1. Provide an open, supportive environment.
2. Address the physiological needs first.
3. Stress that the psychological needs will be resolved with treatment.
4. Put more emphasis on the psychological needs first.
Correct Answer: Provide an open, supportive environment.
Rationale: Psychological assessment needs to be uppermost in the mind of the nurse as care is
given to patients with skin disorders. The appearance of the skin affects self-esteem and body
image. Patients should be provided with an open, supportive environment in which they are
comfortable voicing their concerns. Psychological and physiological needs are best addressed
within an open, supportive environment. Psychological needs may or may not be resolved with
treatment.
Cognitive Level: Application
Nursing Process: Assessment
Client Need: Psychosocial l Integrity
LO: 6

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

18. The major concern for clients with skin disorders such as hyperpigmentation of the skin is
typically the:
1. Cosmetic effect.
2. Cause.
3. Scarring.
4. Treatment.
Correct Answer: Cosmetic effect.
Rationale: The major concern for clients with these types of lesions is the cosmetic effect. They
can be diffuse or limited to a specific space. They may occur in areas that are exposed to the sun
and therefore are visible in areas usually not covered with clothing. Clients may also be
concerned about the cause, treatment, or scarring related to hyperpigmentation, but these are not
usually the major concern.
Cognitive Level: Application
Nursing Process: Assessment
Client Need: Psychosocial Integrity
LO: 6

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

19. An elderly client is concerned that he has more wrinkles on the face than a friend who
smokes and does not use sunscreen. The nurse should explain that ___________ can also play
role in loss of skin elasticity.
1. Genetics
2. Medications
3. Exposure to toxins
4. Facial structure
Correct Answer: Genetics
Rationale: Genetics can contribute to loss of skin elasticity and wrinkle formation as an
individual ages. This is one factor over which the individual has no control. Facial structure is
not related to skin elasticity. Medications and exposure to toxins are not normally related to skin
elasticity.
Cognitive Level: Application
Nursing Process: Assessment
Client Need: Psychological Integrity
LO: 7

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

20. A client is concerned because his face appears to be getting longer. The nurse should explain
that this change is:
1. A normal part of aging.
2. Rare and needs follow up.
3. More common in certain ethnic groups.
4. An optical illusion.
Correct Answer: A normal part of aging.
Rationale: The face becomes elongated and flattened as a normal part of the aging process. It is
not an illusion, nor is it more common in specific ethnic groups.
Cognitive Level: Application
Nursing Process: Assessment
Client Need: Psychological Integrity
LO: 7

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.

21. Darker-skinned individuals are less prone to the signs of aging because of:
1.
2.
3.
4.

Melanin.
Skin products used.
Dermabrasion.
Alopecia.

Correct Answer: Melanin.

Rationale: Darker-skinned individuals are less prone to the signs of aging due the
photoprotective nature of the melanin in darker skin. Alopecia is related to loss of hair. The use
of dermabrasion and skin products may affect the signs of aging in individuals of all skin
pigmentations.
Cognitive Level: Application
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 7

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation

for Practice Copyright 2010 by Pearson Education, Inc.