NCLEX Practice Exam for Skin and Integumentary Diseases Part 1

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1. When planning care for a male client with burns on the upper torso, which nursing diagnosis should take the highest priority?

  1. Ineffective airway clearance related to edema of the respiratory passages
  2. Impaired physical mobility related to the disease process
  3. Disturbed sleep pattern related to facility environment
  4. Risk for infection related to breaks in the skin

2. In a female client with burns on the legs, which nursing intervention helps prevent contractures?

  1. Applying knee splints
  2. Elevating the foot of the bed
  3. Hyperextending the client’s palms
  4. Performing shoulder range-of-motion exercises

3. A male client comes to the physician’s office for treatment of severe sunburn. The nurse takes this opportunity to discuss the importance of protecting the skin from the sun’s damaging rays. Which instruction would best prevent skin damage?

  1. “Minimize sun exposure from 1 to 4 p.m. when the sun is strongest.”
  2. “Use a sunscreen with a sun protection factor of 6 or higher.”
  3. “Apply sunscreen even on overcast days.”
  4. “When at the beach, sit in the shade to prevent sunburn.”

4. A female client is brought to the emergency department with second- and third-degree burns on the left arm, left anterior leg, and anterior trunk. Using the Rule of Nines, what is the total body surface area that has been burned?

  1. 18%
  2. 27%
  3. 30%
  4. 36%

5. Which nursing intervention can help a client maintain healthy skin?

  1. Keep the client well hydrated.
  2. Avoid bathing the client with mild soap.
  3. Remove adhesive tape quickly from the skin.
  4. Recommend wearing tight-fitting clothes in hot weather.

6. A male client with psoriasis visits the dermatology clinic. When inspecting the affected areas, the nurse expects to see which type of secondary lesion?

  1. Scale
  2. Crust
  3. Ulcer
  4. Scar

7. A female adult client with atopic dermatitis is prescribed a potent topical corticosteroid, to be covered with an occlusive dressing. To address a potential client problem associated with this treatment, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement, the nurse should add which “related-to” phrase?

  1. Related to potential interactions between the topical corticosteroid and other prescribed drugs
  2. Related to vasodilatory effects of the topical corticosteroid
  3. Related to percutaneous absorption of the topical corticosteroid
  4. Related to topical corticosteroid application to the face, neck, and intertriginous sites

8. A male client is diagnosed with herpes simplex. Which statement about herpes simplex infection is true?

  1. During early pregnancy, herpes simplex infection may cause spontaneous abortion or premature delivery.
  2. Genital herpes simplex lesions are painless, fluid-filled vesicles that ulcerate and heal in 3 to 7 days
  3. Herpetic keratoconjunctivitis usually is bilateral and causes systemic symptoms.
  4. A client with genital herpes lesions can have sexual contact but must use a condom.

9. A female client with a severe staphylococcal infection is receiving the aminoglycoside gentamicin sulfate (Garamycin) by the I.V. route. The nurse should assess the client for which adverse reaction to this drug?

  1. Aplastic anemia
  2. Ototoxicity
  3. Cardiac arrhythmias
  4. Seizures

10. A male client is diagnosed with primary herpes genitalis. Which instruction should the nurse provide?

  1. “Apply one applicator of terconazole intravaginally at bedtime for 7 days.”
  2. “Apply one applicator of tioconazole intravaginally at bedtime for 7 days.”
  3. “Apply acyclovir ointment to the lesions every 3 hours, six times a day for 7 days.”
  4. “Apply sulconazole nitrate twice daily by massaging it gently into the lesions.”

11. Nurse Bea plans to administer dexamethasone cream to a client who has dermatitis over the anterior chest How should the nurse apply this topical agent?

  1. With a circular motion, to enhance absorption
  2. With an upward motion, to increase blood supply to the affected area
  3. In long, even, outward, and downward strokes in the direction of hair growth
  4. In long, even, outward, and upward strokes in the direction opposite hair growth

12. Nurse Meredith is caring for a wheelchair-bound client. Which piece of equipment impedes circulation to the area it’s meant to protect?

  1. Polyurethane foam mattress
  2. Ring or donut
  3. Gel flotation pad
  4. Water bed

13. Nurse Rudolf documents the presence of a scab on a client’s deep wound. The nurse identifies this as which phase of wound healing?

  1. Inflammatory
  2. Migratory
  3. Proliferative
  4. Maturation

14. In an industrial accident, a male client that weighs 155 lb (70 kg) sustained full-thickness burns over 40% of his body. He’s in the burn unit receiving fluid resuscitation. Which observation shows that the fluid resuscitation is benefiting the client?

  1. A urine output consistently above 100 ml/hour
  2. A weight gain of 4 lb (2 kg) in 24 hours
  3. Body temperature readings all within normal limits
  4. An electrocardiogram (ECG) showing no arrhythmias

15. A female client with herpes zoster is prescribed acyclovir (Zovirax), 200 mg P.O. every 4 hours while awake. The nurse should inform the client that this drug may cause:

  1. palpitations.
  2. dizziness.
  3. diarrhea.
  4. metallic taste.

16. A female client sees a dermatologist for a skin problem. Later, the nurse reviews the client’s chart and notes that the chief complaint was intertrigo. This term refers to which condition?

  1. Spontaneously occurring wheals
  2. A fungus that enters the skin’s surface, causing infection
  3. Inflammation of a hair follicle
  4. Irritation of opposing skin surfaces caused by friction

17. A male client who has suffered a cerebrovascular accident (CVA) is too weak to move on his own. To help the client avoid pressure ulcers, the nurse should:

  1. turn him frequently.
  2. perform passive range-of-motion (ROM) exercises.
  3. reduce the client’s fluid intake.
  4. encourage the client to use a footboard.

18. A male client visits the physician’s office for treatment of a skin disorder. As a primary treatment, the nurse expects the physician to prescribe:

  1. an I.V. corticosteroid.
  2. an I.V. antibiotic.
  3. an oral antibiotic.
  4. a topical agent.

19. While in a skilled nursing facility, a male 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.”

20. When caring for a male client with severe impetigo, the nurse should include which intervention in the plan of care?

  1. Placing mitts on the client’s hands
  2. Administering systemic antibiotics as prescribed
  3. Applying topical antibiotics as prescribed
  4. Continuing to administer antibiotics for 21 days as prescribed

21. A female client with second- and third-degree burns on the arms receives autografts. Two days later, the nurse finds the client doing arm exercises. The nurse knows that this client should avoid exercise because it may:

  1. dislodge the autografts.
  2. increase edema in the arms.
  3. increase the amount of scarring.
  4. decrease circulation to the fingers.

22. Nurse Troy discovers scabies when assessing a client who has just been transferred to the medical-surgical unit from the day surgery unit. To prevent scabies infection in other clients, the nurse should:

  1. wash hands, apply a pediculicide to the client’s scalp, and remove any observable mites.
  2. isolate the client’s bed linens until the client is no longer infectious.
  3. notify the nurse in the day surgery unit of a potential scabies outbreak.
  4. place the client on enteric precautions.

23. Dr. Smith prescribes an emollient for a client with pruritus of recent onset. The client asks why the emollient should be applied immediately after a bath or shower. How should the nurse respond?

  1. “This makes the skin feel soft.”
  2. “This prevents evaporation of water from the hydrated epidermis.”
  3. “This minimizes cracking of the dermis.”
  4. “This prevents inflammation of the skin.”

24. Following a full-thickness (third-degree) burn of his left arm, a female 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.

25. A male client with a solar burn of the chest, back, face, and arms is seen in urgent care. The nurse’s primary concern should be:

  1. fluid resuscitation.
  2. infection.
  3. body image.
  4. pain management.

26. The nurse is providing home care instructions to a client who has recently had a skin graft. It’s most important that the client remember to:

  1. use cosmetic camouflage techniques.
  2. protect the graft from direct sunlight.
  3. continue physical therapy.
  4. apply lubricating lotion to the graft site.

27. A male client is diagnosed with gonorrhea. When teaching the client about this disease, the nurse should include which instruction?

  1. “Avoid sexual intercourse until you’ve completed treatment, which takes 14 to 21 days.”
  2. “Wash your hands thoroughly to avoid transferring the infection to your eyes.”
  3. “If you have intercourse before treatment ends, tell sexual partners of your status and have them wash well after intercourse.”
  4. “If you don’t get treatment, you may develop meningitis and suffer widespread central nervous system (CNS) damage.”

28. A female client with atopic dermatitis is prescribed medication for photochemotherapy. The nurse teaches the client about the importance of protecting the skin from ultraviolet light before drug administration and for 8 hours afterward and stresses the need to protect the eyes. After administering medication for photochemotherapy, the client must protect the eyes for:

  1. 4 hours.
  2. 8 hours.
  3. 24 hours.
  4. 48 hours.

29. A female client with genital herpes simplex is being treated in the outpatient department. The nurse teaches her about measures that may prevent herpes recurrences and emphasizes the need for prompt treatment if complications arise. Genital herpes simplex increases the risk of:

  1. cancer of the ovaries.
  2. cancer of the uterus.
  3. cancer of the cervix.
  4. cancer of the vagina.

30. Which of the following is the initial intervention for a male client with external bleeding?

  1. Elevation of the extremity
  2. Pressure point control
  3. Direct pressure
  4. Application of a tourniquet
Answers and Rationales
  1. Answer A. When caring for a client with upper torso burns, the nurse’s primary goal is to maintain respiratory integrity. Therefore, option A should take the highest priority. Option B isn’t appropriate because burns aren’t a disease. Option C and D may be appropriate, but don’t command a higher priority than option A because they don’t reflect immediately life-threatening problems.
  2. Answer A. Applying knee splints prevents leg contractures by holding the joints in a position of function. Elevating the foot of the bed can’t prevent contractures because this action doesn’t hold the joints in a position of function. Hyperextending a body part for an extended time is inappropriate because it can cause contractures. Performing shoulder range-of-motion exercises can prevent contractures in the shoulders, but not in the legs.
  3. Answer C. Sunscreen should be applied even on overcast days, because the sun’s rays are as damaging then as on sunny days. The sun is strongest from 10 a.m. to 2 p.m. (11 a.m. to 3 p.m. daylight saving time) — not from 1 to 4 p.m. Sun exposure should be minimized during these hours. The nurse should recommend sunscreen with a sun protection factor of at least 15. Sitting in the shade when at the beach doesn’t guarantee protection against sunburn because sand, concrete, and water can reflect more than half the sun’s rays onto the skin.
  4. Answer D. The Rule of Nines divides body surface area into percentages that, when totaled, equal 100%. According to the Rule of Nines, the arms account for 9% each, the anterior legs account for 9% each, and the anterior trunk accounts for 18%. Therefore, this client’s burns cover 36% of the body surface area.
  5. Answer A. Keeping the client well hydrated helps prevent skin cracking and infection because intact healthy skin is the body’s first line of defense. To help a client maintain healthy skin, the nurse should avoid strong or harsh detergents and should use mild soap. The nurse shouldn’t remove adhesive tape quickly because this action can strip or scrape the skin. The nurse should recommend wearing loose-fitting — not tight-fitting — clothes in hot weather to promote heat loss by evaporation.
  6. Answer A. A scale is the characteristic secondary lesion occurring in psoriasis. Although crusts, ulcers, and scars also are secondary lesions in skin disorders, they don’t accompany psoriasis.
  7. Answer C. A potent topical corticosteroid may increase the client’s risk for injury because it may be absorbed percutaneously, causing the same adverse effects as systemic corticosteroids. Topical corticosteroids aren’t involved in significant drug interactions. These preparations cause vasoconstriction, not vasodilation. A potent topical corticosteroid rarely is prescribed for use on the face, neck, or intertriginous sites because application on these areas may lead to increased adverse effects.
  8. Answer A. Herpes simplex may be passed to the fetus transplacentally and, during early pregnancy, may cause spontaneous abortion or premature delivery. Genital herpes simplex lesions typically are painful, fluid-filled vesicles that ulcerate and heal within 1 to 2 weeks. Herpetic keratoconjunctivitis usually is unilateral and causes localized symptoms, such as conjunctivitis. A client with genital herpes lesions should avoid all sexual contact to prevent spreading the disease.
  9. Answer B. The most significant adverse reactions to gentamicin and other aminoglycosides are ototoxicity (indicated by vertigo, tinnitus, and hearing loss) and nephrotoxicity (indicated by urinary cells or casts, oliguria, proteinuria, and reduced creatinine clearance). These adverse reactions are most common in elderly and dehydrated clients, those with renal impairment, and those receiving concomitant therapy with another potentially ototoxic or nephrotoxic drug. Gentamicin isn’t associated with aplastic anemia, cardiac arrhythmias, or seizures.
  10. Answer C. A client with primary herpes genitalis should apply topical acyclovir ointment in sufficient quantities to cover the lesions every 3 hours, six times a day for 7 days. Terconazole and tioconazole are used to treat vulvovaginal candidiasis. Sulconazole nitrate is used to treat tinea versicolor.
  11. Answer C. When applying a topical agent, the nurse should begin at the midline and use long, even, outward, and downward strokes in the direction of hair growth. This application pattern reduces the risk of follicle irritation and skin inflammation.
  12. Answer B. Rings or donuts aren’t to be used because they restrict circulation. Foam mattresses evenly distribute pressure. Gel pads redistribute with the client’s weight. The water bed also distributes pressure over the entire surface.
  13. Answer B. The scab formation is found in the migratory phase. It is accompanied by migration of epithelial cells, synthesis of scar tissue by fibroblasts, and development of new cells that grow across the wound. In the inflammatory phase, a blood clot forms, epidermis thickens, and an inflammatory reaction occurs in the subcutaneous tissue. During the proliferative phase, the actions of the migratory phase continue and intensify, and granulation tissue fills the wound. In the maturation phase, cells and vessels return to normal and the scab sloughs off.
  14. Answer A. In a client with burns, the goal of fluid resuscitation is to maintain a mean arterial blood pressure that provides adequate perfusion of vital structures. If the kidneys are adequately perfused, they will produce an acceptable urine output of at least 0.5 ml/kg/hour. Thus, the expected urine output of a 155-lb client is 35 ml/hour, and a urine output consistently above 100 ml/hour is more than adequate. Weight gain from fluid resuscitation isn’t a goal. In fact, a 4-lb weight gain in 24 hours suggests third spacing. Body temperature readings and ECG interpretations may demonstrate secondary benefits of fluid resuscitation but aren’t primary indicators.
  15. Answer C. Oral acyclovir may cause such adverse GI effects as diarrhea, nausea, and vomiting. It isn’t associated with palpitations, dizziness, or a metallic taste.
  16. Answer D. Intertrigo refers to irritation of opposing skin surfaces caused by friction. Spontaneously occurring wheals occur in hives. A fungus that enters the skin surface and causes infection is a dermatophyte. Inflammation of a hair follicle is called folliculitis.
  17. Answer A. The most important intervention to prevent pressure ulcers is frequent position changes, which relieve pressure on the skin and underlying tissues. If pressure isn’t relieved, capillaries become occluded, reducing circulation and oxygenation of the tissues and resulting in cell death and ulcer formation. During passive ROM exercises, the nurse moves each joint through its range of movement, which improves joint mobility and circulation to the affected area but doesn’t prevent pressure ulcers. Adequate hydration is necessary to maintain healthy skin and ensure tissue repair. A footboard prevents plantar flexion and footdrop by maintaining the foot in a dorsiflexed position.
  18. Answer D. Although many drugs are used to treat skin disorders, topical agents — not I.V. or oral agents — are the mainstay of treatment.
  19. 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.
  20. Answer B. Impetigo is a contagious, superficial skin infection caused by beta-hemolytic streptococci. If the condition is severe, the physician typically prescribes systemic antibiotics for 7 to 10 days to prevent glomerulonephritis, a dangerous complication. The client’s nails should be kept trimmed to avoid scratching; however, mitts aren’t necessary. Topical antibiotics are less effective than systemic antibiotics in treating impetigo.
  21. Answer A. Because exercising the autograft sites may dislodge the grafted tissue, the nurse should advise the client to keep the grafted extremity in a neutral position. None of the other options results from exercise
  22. Answer B. To prevent the spread of scabies in other hospitalized clients, the nurse should isolate the client’s bed linens until the client is no longer infectious — usually 24 hours after treatment begins. Other required precautions include using good hand-washing technique and wearing gloves when applying the pediculicide and during all contact with the client. Although the nurse should notify the nurse in the day surgery unit of the client’s condition, a scabies epidemic is unlikely because scabies is spread through skin or sexual contact. This client doesn’t require enteric precautions because the mites aren’t found on feces.
  23. Answer B. Applying an emollient immediately after taking a bath or shower prevents evaporation of water from the hydrated epidermis, the skin’s upper layer. Although emollients make the skin feel soft, this effect occurs whether or not the client has just bathed or showered. An emollient minimizes cracking of the epidermis, not the dermis (the layer beneath the epidermis). An emollient doesn’t prevent skin inflammation.
  24. 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.
  25. Answer D. With a superficial partial thickness burn such as a solar burn (sunburn), the nurse’s main concern is pain management. Fluid resuscitation and infection become concerns if the burn extends to the dermal and subcutaneous skin layers. Body image disturbance is a concern that has lower priority than pain management.
  26. Answer B. To avoid burning and sloughing, the client must protect the graft from direct sunlight. The other three interventions are helpful to the client and his recovery but are less important.
  27. Answer B. Adults and children with gonorrhea may develop gonococcal conjunctivitis by touching the eyes with contaminated hands. The client should avoid sexual intercourse until treatment is completed, which usually takes 4 to 7 days, and a follow-up culture confirms that the infection has been eradicated. A client who doesn’t refrain from intercourse before treatment is completed should use a condom in addition to informing sex partners of the client’s health status and instructing them to wash well after intercourse. Meningitis and widespread CNS damage are potential complications of untreated syphilis, not gonorrhea.
  28. Answer D. To prevent eye discomfort, the client must protect the eyes for 48 hours after taking medication for photochemotherapy. Protecting the eyes for a shorter period increases the risk of eye injury.
  29. Answer C. A female client with genital herpes simplex is at increased risk for cervical cancer. Genital herpes simplex isn’t a risk factor for cancer of the ovaries, uterus, or vagina.
  30. Answer C. Applying direct pressure to an injury is the initial step in controlling bleeding. For severe or arterial bleeding, pressure point control can be used. Pressure points are those areas where large blood vessels can be compressed against bone: femoral, brachial, facial, carotid, and temporal artery sites. Elevation reduces the force of flow, but direct pressure is the first step. A tourniquet may further damage the injured extremity and should be avoided unless all other measures have failed.