MSN Exam for Dermatitis

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1) 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

2) In the past, doctors thought which of these caused atopic dermatitis?

  1. Too much sun
  2. An emotional disorder
  3. Food allergies
  4. None of the above

3) 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

4) 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.

5) A 5-month-old is diagnosed with atopic dermatitis. Nursing interventions will focus on:

  1. Preventing infection
  2. Administering antipyretics
  3. Keeping the skin free of moisture
  4. Limiting oral fluid intake

6) People who have atopic dermatitis also may have:

  1. Asthma
  2. Allergies
  3. Acne
  4. A and B

7) A 28 yr-old nurse has complaints of itching and a rash of both hands. Contact dermatitis is initially suspected. The diagnosis is confirmed if the rash appears:

  1. erythematous with raised papules
  2. dry and scaly with flaking skin
  3. inflamed with weeping and crusting lesions
  4. excoriated with multiple fissures

8) Which of the following measures would be appropriate for the nurse to teach the parent of a nine month-old infant about diaper dermatitis?

  1. Use only cloth diapers that are rinsed in bleach
  2. Do not use occlusive ointments on the rash
  3. Use commercial baby wipes with each diaper change
  4. Discontinue a new food that was added to the infant’s diet just prior to the rash

9) Atopic dermatitis is also often called:

  1. Acne
  2. Eczema
  3. Psoriasis
  4. Pimples

10) When the nurse observes diffuse swelling involving the deeper skin layers in the patient who has experienced an allergic reaction, the nurse records the finding as

  1. angioneurotic edema.
  2. urticaria.
  3. contact dermatitis.
  4. pitting edema.

11) One characteristic of atopic dermatitis is:

  1. It affects the face more than the rest of the body
  2. It can leave pockmarks on the skin
  3. It cycles through periods of flares and remissions
  4. It is worse in autumn

12) Which nutrient deficiency is associated with the development of Pellagra, Dermatitis and Diarrhea?

  1. Vitamin B1
  2. Vitamin B2
  3. Vitamin B3
  4. Vitamin B6

13) What is caused by exposure to an allergen or by direct chemical or mechanical irritation of the skin followed by a subsequent exposure rash?

  1. Contact dermatitis
  2. Scleroderma

14) Which group of people is more likely to develop atopic dermatitis?

  1. Infants and young children
  2. Teenagers
  3. Adults 20 to 49
  4. Older adults

15) A contraindication for topical corticosteroid usage in a male patient with atopic dermatitis (eczema) is:

  1. Parasite infection.
  2. Viral infection.
  3. Bacterial infection.
  4. Spirochete infection.
Answers and Rationales
  1. C. Related to percutaneous absorption of the topical corticosteroid. 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.
  2. B. An emotional disorder. Today, medical experts know stress can make the disease worse, but stress does not cause it. Atopic dermatitis appears to result from a combination of genetic and environmental factors. It is not contagious and can’t be passed from one person to another.
  3. C. In long, even, outward, and downward strokes in the direction of hair growth. 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.
  4. D. 48 hours. 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.
  5. A. Preventing infection . The nurse should prevent the infant with atopic dermatitis (eczema) from scratching, which can lead to skin infections. Answer B is incorrect because fever is not associated with atopic dermatitis. Answers C and D are incorrect because they increase dryness of the skin, which worsens the symptoms of atopic dermatitis.
  6. D. A and B 
  7. A. erythematous with raised papules . Contact dermatitis is caused by exposure to a physical or chemical allergen, such as cleaning products, skin care products, and latex gloves. Initial symptoms of itching, erythema, and raised papules occur at the site of the exposure and can begin within 1 hour of exposure. Allergic reactions tend to be red and not scaly or flaky. Weeping, crusting lesions are also uncommon unless the reaction is quite severe or has been present for a long time. Excoriation is more common in skin disorders associated with a moist environment.
  8. D. Discontinue a new food that was added to the infant’s diet just prior to the rash. The addition of new foods to the infant”s diet may be a cause of diaper dermatitis.
  9. B. Eczema . Eczema is a general term for many types of dermatitis (inflammation of the skin). Atopic dermatitis is the most common type of eczema. Acne is a different kind of skin disease; pimples are a symptom of acne. Like eczema, psoriasis is a chronic skin disease, but it is caused by a different disorder of the immune system.
  10. A. angioneurotic edema. The area of skin demonstrating angioneurotic edema may appear normal but often has a reddish hue and does not pit.
  11. C. It cycles through periods of flares and remissions . When the condition worsens, that period is called a flare or exacerbation. When it improves or clears up entirely, that period is called a remission. In some people, this cycle of flares and remissions may be seasonal.
  12. C. Vitamin B3 
  13. A. Contact dermatitis 
  14. A. Infants and young children . Sixty-five percent of patients with atopic dermatitis develop symptoms in the first year of life, and 90 percent develop symptoms before the age of 5. Atopic dermatitis can go into permanent remission by the time a child reaches adulthood. In about 60 percent of cases, however, it continues into adulthood. Occasionally, it shows up for the first time later in life. In adults, atopic dermatitis can show up after the skin is exposed to harsh conditions.
  15. B. Viral infection. Topical agents produce a localized, rather than systemic effect. When treating atopic dermatitis with a steroidal preparation, the site is vulnerable to invasion by organisms. Viruses, such as herpes simplex or varicella-zoster, present a risk of disseminated infection. Educate the patient using topical corticosteroids to avoid crowds or people known to have infections and to report even minor signs of an infection. Topical corticosteroid usage results in little danger of concurrent infection with these agents.