Nokea
The nurse is caring for a patient who is undergoing psoralen plus ultraviolet A light (PUVA) therapy for treatment of psoriasis. Which of the following actions would the nurse plan to implement to minimize complications from this procedure?
- A. Cleanse the skin carefully with an antiseptic soap.
- B. Shield any unaffected areas with lead-lined drapes.
- C. Have the patient use protective eyewear while receiving PUVA.
- D. Apply petroleum jelly to the areas surrounding the psoriatic lesions.
Correct Answer: C
Rationale: The eyes should be shielded from UV light (UVL) during and after PUVA therapy to prevent the development of cataracts. The patient should be taught about the effects of UVL on unaffected skin, but lead-lined drapes, use of antiseptic soap, and petroleum jelly are not used to prevent skin damage.
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The nurse is teaching a patient with contact dermatitis of the arms and lower legs about ways to decrease pruritus. Which of the following information would the nurse include in the teaching plan? (Select all that apply.)
- A. Cool, wet cloths or dressings can be used to reduce itching.
- B. Take cool or tepid baths several times daily to decrease itching.
- C. Add oil to your bath water to aid in moisturizing the affected skin.
- D. Rub yourself dry with a towel after bathing to prevent skin maceration
- E. Use of an over-the-counter (OTC) antihistamine with sedative effects can reduce scratching.
Correct Answer: A,B,E
Rationale: Cool or tepid baths, cool dressings, and OTC antihistamines all help reduce pruritus and scratching. Adding oil to bath water is not recommended because of the increased risk for falls. The patient should use the towel to pat (not rub) the skin dry.
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.
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.
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.
Which of the following information would the nurse include when teaching an older-adult patient about skin care?
- A. Dry the skin thoroughly before applying lotons.
- B. Bathe and shampoo daily with soap and shampoo.
- C. Use warm water and a moisturizing soap when bathing.
- D. Use antibacterial soaps when bathing to avoid infection.
Correct Answer: C
Rationale: Warm water and moisturizing soap will avoid overdrying of the skin. Since older patients have dryer skin, daily bathing and shampooing are not necessary and may dry the skin unnecessarily. Antibacterial soaps are not necessary. Lotions should be applied while the skin is still damp to seal moisture in.