Nokea
A patient with an enlarging, irregular mole that is $6 \mathrm{mm}$ in diameter is scheduled for outpatient treatment. Which of the following procedures would the nurse include in the teaching plan for this patient?
- A. Curettage
- B. Cryosurgery
- C. Punch biopsy
- D. Surgical excision
Correct Answer: D
Rationale: The description of the mole is consistent with malignancy, so excision and biopsy are indicated. Curettage and cryosurgery are not used if malignancy is suspected. A punch biopsy would not be done for a lesion greater than $5 \mathrm{mm}$ in diameter.
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The nurse is providing care to a patient with a squamous cell carcinoma (SCC) that had a Mohs procedure in the dermatology clinic. Which of the following nursing actions would be included in the postoperative plan of care?
- A. Describe the use of topical fluorouracil on the incision.
- B. Teach how to use sterile technique to clean the suture line.
- C. Schedule daily appointments for wet-to-dry dressing changes.
- D. Educate about use of cold packs to reduce bruising and swelling.
Correct Answer: D
Rationale: Application of cold packs to the incision after the surgery will help decrease bruising and swelling at the site. Since the Mohs procedure results in complete excision of the lesion, topical fluorouracil is not needed after surgery. The suture line is cleaned with tap water. No debridement with wet-to-dry dressings is indicated.
The nurse is teaching a patient about the use of a wet dressing to reduce pruritus. Which of the following time frames would the nurse instruct the patient to leave the dressing on for?
- A. 5-15 minutes
- B. 10-30 minutes
- C. 30-45 minutes
- D. 45-60 minutes
Correct Answer: B
Rationale: Wet dressings can be used effectively to relieve pruritus. Thin cotton sheets or thermal underwear is placed in warm water, wrung out, and placed over the pruritic area. After 10-30 minutes, the dressing is removed and the skin is patted dry (not rubbed) and a lubricant or medication applied. This can be done two to four times per day.
The nurse notes darker skin pigmentation in the skin folds of a patient who has a body mass index of $40 \mathrm{kg} / \mathrm{m}^2$. Which of the following topics would the nurse include in patient teaching?
- A. Teach the patient about the risk for type 2 diabetes.
- B. Educate the patient about treatment of fungal infection.
- C. Discuss the use of drying agents to minimize infection risk.
- D. Instruct the patient about use of mild soap to clean skin folds.
Correct Answer: A
Rationale: Obesity and the presence of acanthosis nigricans in skin folds suggest an increased risk for type 2 diabetes. The description of the patient's skin does not indicate problems with fungal infection, poor hygiene, or the need to dry the skin folds better.
The nurse is assessing a patient who has just arrived in the postanesthesia recovery area (PACU) after a blepharoplasty. Which of the following assessment data is a priority?
- A. The patient complains of incisional pain.
- B. The patient 's heart rate is 110 beats/minute.
- C. The patient is unable to detect when the eyelids are touched
- D. The skin around the incision is pale and cold when palpated.
Correct Answer: D
Rationale: Pale, cool skin indicates a possible decrease in circulation, so the surgeon should be notified immediately. Warm, pink skin that blanches with pressure indicates that adequate circulation is present in the surgical area. The other assessment data indicate a need for ongoing assessment or nursing action. A heart rate of 110 may be related to the stress associated with surgery, assessment of other vital signs and continued monitoring are appropriate. Because local anaesthesia would be used for the procedure, numbness of the incisional area is expected immediately after surgery. The nurse should monitor for return of feeling.
The nurse is assessing a new patient at the outpatient clinic and notes dry, scaly skin; thin hair; and thick, brittle nails. Which of the following actions is best for the nurse to take at this time?
- A. Instruct the patient about the importance of nutrition in skin heath.
- B. Make a referral to a podiatrist so that the nails can be safely trimmed.
- C. Consult with the health care provider about the need for further diagnostic testing.
- D. Teach the patient about using moisturizing creams and lotions to decrease dry skin.
Correct Answer: C
Rationale: The patient has clinical manifestations that could be caused by systemic problems or interferences with nutrition (e.g. protein deficiency) so further diagnostic evaluation is indicated. Patient teaching about nutrition, addressing the patient's dry skin, and referral to a podiatrist also may be needed, but the priority is to rule out underlying disease that may be causing these manifestations.