Chapter 25: Care of Patients with Skin Problems

Chapter 25: Care of Patients with Skin Problems

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A nurse teaches a client who has very dry skin. Which statement should the nurse include in this client’s education?
   1. “Use lots of moisturizer several times a day to minimize dryness.”
   2. “Take a cold shower instead of soaking in the bathtub.”
   3. “Use antimicrobial soap to avoid infection of cracked skin.”
   4. “After you bathe, put lotion on before your skin is totally dry.”

ANS:   D

The client should bathe in warm water for at least 20 minutes and then apply lotion immediately because this will keep the moisture in the skin. Just using moisturizer will not be as helpful because the moisturizer is not what rehydrates the skin; it is the water. Bathing in warm water will rehydrate skin more effectively than a cold shower, and antimicrobial soaps are actually more drying than other kinds of soap.

DIF:     Applying/Application                         REF:    433                   KEY: Hygiene| skin breakdown             MSC:                                                  Integrated Process: Teaching/Learning NOT:             Client Needs Category: Physiological Integrity: Basic Care and Comfort

2. A nurse assesses clients on a medical-surgical unit. Which client is at greatest risk for pressure ulcer development?
   1. A 44-year-old prescribed IV antibiotics for pneumonia
   2. A 26-year-old who is bedridden with a fractured leg
   3. A 65-year-old with hemi-paralysis and incontinence
   4. A 78-year-old requiring assistance to ambulate with a walker

ANS:   C

Being immobile and being incontinent are two significant risk factors for the development of pressure ulcers. The client with pneumonia does not have specific risk factors. The young client who has a fractured leg and the client who needs assistance with ambulation might be at moderate risk if they do not move about much, but having two risk factors makes the 65-year-old the person at highest risk.

DIF:     Applying/Application                         REF:    436

KEY:   Skin breakdown| Braden Scale

MSC:   Integrated Process: Nursing Process: Assessment                 NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

3. When transferring a client into a chair, a nurse notices that the pressure-relieving mattress overlay has deep imprints of the client’s buttocks, heels, and scapulae. Which action should the nurse take next?
   1. Turn the mattress overlay to the opposite side.
   2. Do nothing because this is an expected occurrence.
   3. Apply a different pressure-relieving device.
   4. Reinforce the overlay with extra cushions.

ANS:           C

“Bottoming out,” as evidenced by deep imprints in the mattress overlay, indicates that this device is not appropriate for this client, and a different device or strategy should be implemented to prevent pressure ulcer formation.

DIF:            Applying/Application                         REF:    440                  KEY: Skin breakdown MSC:                     Integrated Process: Nursing Process: Evaluation                   NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

4. A nurse cares for a client who has a deep wound that is being treated with a wet-to-damp dressing. Which intervention should the nurse include in this client’s plan of care?
   1. Change the dressing every 6 hours.
   2. Assess the wound bed once a day.
   3. Change the dressing when it is saturated.
   4. Contact the provider when the dressing leaks.

ANS:           A

Wet-to-damp dressings are changed every 4 to 6 hours to provide maximum débridement. The wound should be assessed each time the dressing is changed. Dry gauze dressings should be changed when the outer layer becomes saturated. Synthetic dressings can be left in place for extended periods of time but need to be changed if the seal breaks and the exudate leaks.

DIF:            Applying/Application                         REF:    446

KEY:          Skin lesions/wounds

MSC:   Integrated Process: Nursing Process: Implementation            NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation