1. Which of the following individuals is least likely to be at risk of developing psoriasis?
a) a 32-year old African American
b) a woman experiencing menopause
c) a client with a family history of the disorder
d) an individual who has experienced a significant amount of emotional stress
2. Which of the following clients would least likely be at risk of developing skin breakdown?
a) a client incontinent of urine and feces
b) a client with chronic nutritional deficiencies
c) a client with decreased sensory perception
d) a client who is unable to move about and is confined to bed
3. The clinic nurse implements a teaching plan for the client who has complained of chronic dry skin and episodes of pruritus. Which of the following, if stated by the client, indicates a need for further teaching?
a) I should drink 8 to 10 glasses of water a day
b) I need to avoid using astringents on my skin
c) I should use a dehumidifier, especially during the winter months
d) I should limit myself to one shower a day and apply emollient to my skin after the shower
4. The nurse prepares to care for a client with acute cellulitis of the lower leg. The nurse anticipates that which of the following will be prescribed for the client?
a) cold compress to the affected area
b) warm compress to the affected area
c) intermittent heat lamp treatments four times a day
d) alternating hot and cold compresses continuously
5. Ultraviolet light therapy is prescribed as a component of the treatment plan for a client with psoriasis and the nurse provides instructions to the client regarding the treatment. Which statement by the client indicates a need for further instructions?
a) treatments are limited to two or three times a week
b) the ultraviolet lights treatments are given on consecutive days
c) eye goggles need to be worn to prevent exposure to ultraviolet light
d) just the area requiring treatment should be exposed to the ultraviolet light
ANSWERS AND RATIONALE
1) A
- Psoriasis occurs equally among women and men, although the incidence is lower in darker skinned races and ethnic groups. A genetic predisposition has been recognized in some cases. Emotional distress, trauma, systemic illness, seasonal changes, and hormonal changes are linked to exacerbation.
2) C
- Bed or chair confinement, inability to move, loss of bowel or bladder control, poor nutrition, absent or inconsistent caregiving, and decreased sensory perception can contribute to the development of skin breakdown. The least likely risk, as presented in the options, is the decreased sensory perception. Options A, B, and D identify physiological conditions, which are the risk priorities.
3) C
- The client should avoid using a dehumidifier because this will dry room air further. Instead, the client should use a room humidifier during the winter months or whenever the furnace is in use. The client should be taught to maintain a daily fluid intake of 3000 mL, unless contraindicated and should avoid alcohol and caffeine ingestion. The client should avoid applying rubbing alcohol, astringents, or other drying agents to the skin. One bath or one shower per day for 15 to 20 minutes with warm water and a mild soap should be followed immediately by the application of an emollient to prevent evaporation of water from the hydrated epidermis.
4) B
- Cellulitis is a skin infection into deeper dermal and subcutaneous tissues that results in a deep red erythema without sharp borders and spreads widely throughout tissue spaces. Warm compresses may be used to decrease the discomfort, erythema, and edema. After tissue and blood cultures are obtained, antibiotics will be initiated. The nurse should provide supportive care as prescribed to manage symptoms such as fatigue, fever, chills, headache, and myalgia. Heat lamps can cause more disruption to already inflamed tissue. Cold compresses and alternating cold and hot compresses are not the best measures.
5) B
- Ultraviolet light (UVL) treatments are limited to two or three times a week and are not given on consecutive days. Safety precautions are required during UVL therapy. Exposure of only those areas requiring treatment to the UVL is best. Protective wraparound goggles prevent exposure of the eyes to UVL. The face should be shielded with a loosely applied pillow case if it is unaffected. Direct contact with the light bulbs of the treatment unit should be avoided to prevent burning of the skin.
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