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After the nurse determines that a patient has the following risk factors for melanoma, which risk factor should be the focus of patient teaching related to prevention?
- A. The patient has multiple dyplastic nevi.
- B. The patient is fair-skinned and has blue eyes.
- C. The patient s mother died of a malignant melanoma.
- D. The patient uses a tanning booth throughout the winter.
Correct Answer: D
Rationale: Since the only risk factor that the patient can change is the use of a tanning booth, the nurse should focus teaching about melanoma prevention on this factor. The other factors also will contribute to increased risk.
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The nurse is caring for a patient in the dermatology clinic who has a small, slow-growing papule with ulceration and a depression in the centre of the lesion on the right cheek. Which of the following nursing interventions will the nurse anticipate performing for this patient?
- A. Prepare the patient for a biopsy.
- B. Teach about the use of corticosteroid creams.
- C. Educate the patient about use of tretinion (Retin-A).
- D. Discuss the need for topical application of antibiotics.
Correct Answer: A
Rationale: Because the appearance of the lesion is consistent with a possible basal cell carcinoma (BCC), the appropriate treatment would be excision and biopsy. Over-the-counter (OTC) corticosteroids, topical antibiotics, and Retin-A would not be used for this lesion unless the biopsy indicated that the lesion was nonmalignant.
A patient who has severe refractory psoriasis on the face, neck, and extremities has quit working and withdrawn from social activities because of the appearance of the lesions. Which of the following actions should the nurse take first?
- A. Discuss the possibility of enrolling in a worker-retraining program.
- B. Encourage the patient to volunteer to work on community projects.
- C. Suggest that the patient use cosmetics to cover the psoriatic lesions
- D. Ask the patient to describe the impact of psoriasis on quality of life.
Correct Answer: D
Rationale: The nurse's initial actions should be to assess the impact of the disease on the patient's life and to allow the patient to verbalize feelings about the psoriasis. Depending on the assessment findings, other actions may be appropriate.
A patient with atopic dermatitis has a new prescription for tacrolimus. After teaching the patient about the medication, which statement by the patient indicates that further teaching is needed?
- A. After I apply the medication, I can go ahead and get dressed as usual.
- B. I will rub the medication gently onto the skin every morning and night.
- C. I will need to minimize my time in the sun while I am using the tacrolimus.
- D. If the medication burns when I apply it, I will wipe it off and call the doctor.
Correct Answer: D
Rationale: The patient should be taught that transient burning at the application site is an expected effect of tacrolimus and that the medication should be left in place. The other statements by the patient are accurate and indicate that patient teaching has been effective.
After the nurse has finished teaching a patient about application of corticosteroid cream to an area of contact dermatitis on the right leg, which of the following patient actions indicates that more teaching is needed?
- A. The patient spreads the cream using a downward motion.
- B. The patient takes a tepid bath before applying the cream.
- C. The patient applies a thick layer of the cream to the affected skin.
- D. The patient covers the area with a dressing after applying the cream.
Correct Answer: C
Rationale: Creams and ointments should be applied in a thin layer to avoid wasting the medication. The other actions by the patient indicate that the teaching has been successful.
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.