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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.
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The health care provider diagnoses impetigo for a patient who has crusty vesicopustular lesions on the lower face. Which of the following topics would the nurse include in the teaching plan for this patient?
- A. Avoidance of antibiotic ointments on the lesions
- B. How to clean the infected areas with soap and water
- C. Use of petroleum jelly (Vaseline) to soften crusty areas
- D. Appropriate use of alcohol-based cleansers on the lesions
Correct Answer: B
Rationale: The treatment for impetigo includes softening of the crusts with warm saline soaks and then soap-and-water removal. Alcohol-based cleansers and use of petroleum jelly are not recommended for impetigo. Antibiotic ointments may be applied to the lesions.
A patient with atopic dermatitis has been using a high-potency topical corticosteroid ointment for several weeks. Which of the findings by the nurse indicates a possible adverse effect of the medication?
- A. Thinning of the affected skin
- B. Alopecia of the affected areas
- C. Reddish-brown discoloration of the skin
- D. Dryness and scaling in the areas of treatment
Correct Answer: A
Rationale: Thinning of the skin indicates that atrophy, a possible adverse effect of topical corticosteroids, is occurring. The health care provider should be notified so that the medication can be changed or tapered. Alopecia, red-brown discoloration, and dryness or scaling of the skin are not adverse effects of topical corticosteroid use.
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 caring for a patient who has basal cell carcinoma (BCC) of the face. Which of the following information should the nurse include when teaching this patient?
- A. Treatment plans include watchful waiting.
- B. Screening for metastasis will be important.
- C. Low-dose systemic chemotherapy is used to treat BCC.
- D. Minimizing sun exposure will reduce risk for future BCC.
Correct Answer: D
Rationale: BCC is frequently associated with sun exposure. BCC spread locally, but do not metastasize to distant tissues. Since BCC can cause local tissue destruction, treatment is indicated. Local chemotherapy may be used to treat BCC.
Which of the following actions would the nurse take when applying a wet dressing to an inflamed and pruritic area of skin on a patient's ankle?
- A. Use a cool solution to wet the dressing.
- B. Change the dressing using sterile gloves.
- C. Soak the dressing in sterile normal saline.
- D. Apply the dressing from the knee to the foot.
Correct Answer: A
Rationale: Cool solutions are used when wet dressings are applied to inflamed areas. Wet dressings do not require sterile technique; tap water is the most common solution used. To avoid maceration of healthy skin, wet dressings should only be applied over the affected area.