1.            A 38-year-old female patient states that she is using topical fluorouracil to treat actinic keratoses on her face. Which additional assessment information will be most important for the nurse to obtain?

a.            History of sun exposure by the patient

b.            Method of birth control used by the patient

c.             Length of time the patient has used fluorouracil

d.            Appearance of the treated areas on the patients face

ANS: B

Because fluorouracil is teratogenic, it is essential that the patient use a reliable method of birth control. The other information is also important for the nurse to obtain, but lack of reliable birth control has the most potential for serious adverse medication effects.

2.            Which integumentary assessment data from an older patient admitted with bacterial pneumonia is of most concern for the nurse?

a.            Reports a history of allergic rashes

b.            Scattered macular brown areas on extremities

c.             Skin brown and wrinkled, skin tenting on forearm

d.            Longitudinal nail bed ridges noted; sparse scalp hair

ANS: A

Because the patient will be receiving antibiotics to treat the pneumonia, the nurse should be most concerned about her history of allergic rashes. The nurse needs to do further assessment of possible causes of the allergic rashes and whether she has ever had allergic reactions to any drugs, especially antibiotics. The assessment data in the other response would be normal for an older patient.

3.            The nurse assesses a circular, flat, reddened lesion about 5 cm in diameter on a middle-aged patients ankle. How should the nurse determine if the lesion is related to intradermal bleeding?

a.            Elevate the patients leg.

b.            Press firmly on the lesion.

c.             Check the temperature of the skin around the lesion.

d.            Palpate the dorsalis pedis and posterior tibial pulses.

ANS: B

If the lesion is caused by intradermal or subcutaneous bleeding or a nonvascular cause, the discoloration will remain when direct pressure is applied to the lesion. If the lesion is caused by blood vessel dilation, blanching will occur with direct pressure.

The other assessments will assess circulation to the leg, but will not be helpful in determining the etiology of the lesion.

4.            When examining an older patient in the home, the home health nurse notices irregular patterns of bruising at different stages of healing on the patients body. Which action should the nurse take first?

a.            Discourage the use of throw rugs throughout the house.

b.            Ensure the patient has a pair of shoes with non-slip soles.

c.             Talk with the patient alone and ask about what caused the bruising.

d.            Notify the health care provider so that x-rays can be ordered as soon as possible.

ANS: C

The nurse should note irregular patterns of bruising, especially in the shapes of hands or fingers, in different stages of resolution. These may be indications of other health problems or abuse, and should be further investigated. It is important that the nurse interview the patient alone because, if mistreatment is occurring, the patient may not

disclose it in the presence of the person who may be the abuser. Throw rugs and shoes with slippery surfaces may contribute to falls. X-rays may be needed if the patient has fallen recently and also has complaints of pain or decreased mobility. However, the nurses first nursing action is to further assess the patient.

5.            A dark-skinned patient has been admitted to the hospital with chronic heart failure. How would the nurse best assess this patient for cyanosis?

a.            Assess the skin color of the earlobes.

b.            Apply pressure to the palms of the hands.

c.             Check the lips and oral mucous membranes.

d.            Examine capillary refill time of the nail beds.

ANS: C

Cyanosis in dark-skinned individuals is more easily seen in the mucous membranes. Earlobe color may change in light-skinned individuals, but this change in skin color is difficult to detect on darker skin. Application of pressure to the palms of the hands and nail bed assessment would check for adequate circulation but not for skin color.

6.            The nurse prepares to obtain a culture from a patient who has a possible fungal infection on the foot. Which items should the nurse gather for this procedure?

a.            Sterile gloves

b.            Patch test instruments

c.             Cotton-tipped applicators

d.            Local anesthetic, syringe, and intradermal needle

ANS: C

Fungal cultures are obtained by swabbing the affected area of the skin with cotton- tipped applicators. Sterile gloves are not needed because it is not a sterile procedure. Local injection is not needed because the swabbing is not usually painful. The patch

test is done to determine whether a patient is allergic to specific testing material, not for obtaining fungal specimens.

7.            When performing a skin assessment, the nurse notes several angiomas on the chest of an older patient. Which action should the nurse take next?

a.            Assess the patient for evidence of liver disease.

b.            Discuss the adverse effects of sun exposure on the skin.

c.             Teach the patient about possible skin changes with aging.

d.            Suggest that the patient make an appointment with a dermatologist.

ANS: A

Angiomas are a common occurrence as patients get older, but they may occur with systemic problems such as liver disease. The patient may want to see a dermatologist to have the angiomas removed, but this is not the initial action by the nurse. The nurse may need to teach the patient about the effects of aging on the skin and about the effects of sun exposure, but the initial action should be further assessment.