chamberlain college of nursing nr 602 dermatology qbank questions and answers with explanationsdocx
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CHAMBERLAIN COLLEGE OF NURSING NR 602
DERMATOLOGY QBANK QUESTIONS AND
ANSWERS WITH EXPLANATIONS
1. A microscopic examination of the sample taken from a skin lesion
indicates hyphae. What type of infection might this indicate? (Fungal)
Under microscopic exam, hyphae are long, thin and branching and indicate dermatophytic
infections. Hyphae are typical in tinea pedis, tinea cruris, and tinea corporis.
2. A child with a sandpaper-textured rash probably has: (Strep infection)
Streptococcal infections can present as a sandpaper-textured rash that initially is felt on
the trunk. Rubeola, measles, produces a blanching erythematous “brick-red”
maculopapular rash that begins on the back of the neck and spreads around the trunk and
then extremities. Varicella infection produces the classic crops of eruptions on the trunk
that spread to the face. The rash is maculopapular initially and then crusts. Roseola
produces a generalized maculopapular rash preceded by 3 days of high fever.
3. A 40-year-old female patient presents to the clinic with multiple, painful
reddened nodules on the anterior surface of both legs. She is concerned.
These are probably associated with her history of: (ulcerative colitis)
These nodules describe erythema nodosum. These are most common in women aged 15-40
years old. They are typically found in pretibial locations and can be associated with
infectious agents, drugs, or systemic inflammatory disease like ulcerative colitis. They
probably occur as a result of a delayed hypersensitivity reaction to antigens. It is not
unusual to find polyarthralgia, fever, and/or malaise that precede or accompany the skin
nodules.
4. A patient is diagnosed with tinea pedis. A microscopic examination of
the sample taken from the infected area would likely demonstrate:
(hyphae)
Under microscopic exam, hyphae are long, thin and branching, and indicate dermatophytic
infections. Hyphae are typical in tinea pedis, tinea cruris, and tinea corporis. Yeasts are
usually seen in candidal infections. Cocci and rods are specific to bacterial infections.
5. When can a child with chickenpox return to daycare? (After all lesions
have crusted)
Chickenpox is highly contagious and can be spread via respiratory secretions from an
infected person or by direct contact from the vesicle fluid from lesions on the skin or
mucus membranes. The usual incubation period is about 2 weeks but can be as long as 21
days or
,as short as 10 days. The greatest period of infectivity is 48 hours prior to the onset of the
rash and until all the skin lesions have crusted over.
6. A patient with a primary case of scabies was probably infected: (3-4
weeks ago)
The incubation period for scabies is about 3-4 weeks after primary infection. Patients with
subsequent infections with scabies will develop symptoms in 1-3 days. The classic
symptom is itching that is worse at night, coupled with a rash that appears in new areas
over time.
7. The nurse practitioner examines a patient who has had poison ivy for 3
days. She asks if she can spread it to her family members. The nurse
practitioner replies: (“No, transmission does not occur from the blister’s
contents”)
The skin reaction seen after exposure to poison ivy (or any other skin irritant), takes place
because of contact with the offending substance. In the case of poison ivy, the harmful
exposure occurs from contact with oil from the plant. The eruptions seen are NOT able to
transmit the reaction to other people unless oil from the plant remains on the skin and
someone touches the oil. The fluid found in the blisters is NOT able to transmit poison ivy
to anyone; only the oil from the plant can do that. After oil has touched the skin, some time
must pass for the reaction to occur. Therefore, reaction times vary depending on skin
thickness and quantity of oil contacting the skin.
8. Which chronic skin disorder primarily affects hairy areas of the
body? (Seborrheic dermatitis)
Seborrheic dermatitis causes flaking of the skin, usually the scalp. In adolescents and
adults, when it affects the scalp, it is termed dandruff. When this occurs in young children
or infants, it is termed “cradle cap”. The exact cause is unknown; however it has a
propensity for hairy areas of the body such as the scalp, face, chest, and legs. It appears
greasy and flaky. This may be seen in patients with Parkinson’s disease.
9. A patient with diabetes has right anterior shin edema, erythema, warmth,
and tenderness to touch. This developed over the past 3 days. There is no
visible pus. What is the most likely diagnosis to consider? (Cellulitis)
This description is one of cellulitis. Cellulitis involves an infection of the subcutaneous
layers of the skin. It must be treated with an oral antibiotic. In a patient with diabetes, it is
particularly important to identify, and aggressively treat cellulitis early, because elevated
blood sugar levels will make eradication more difficult. Buerger’s disease involves
inflammation of the medium-sized arteries and does not present on the anterior shin
only. DVT seldom presents on the anterior shin, so this is not likely. Venous disease does
not present acutely, as in this situation.
, 10.The agent commonly used to treat patients with scabies is permethrin.
How often should it be applied to eradicate scabies? (Once)
A single whole-body application of permethrin is usually successful in eradicating infection
with scabies. It is applied over the entire body from the neck down. The lotion is left on and
then showered off 8-12 hours later. All contacts must be treated at the same time and all
potential fomites (bed linen, mattresses, cloth furniture, etc.) must be treated as well.
Permethrin can be sprayed on cloth fomites, or the fomite can be bagged for several
days, washed and dried in a washing machine and dryer. Ironing clothes after washing
them is acceptable.
11.Impetigo is characterized by: (honey-colored crusts)
Impetigo is a superficial bacterial infection of the skin characterized by honey-colored
crusts. Another form of impetigo is characterized by the presence of bullae. These
infections are treated with topical antibiotics, good hygiene, and frequent hand washing. It
is usually caused by Staphylococcus or Group A Streptococcus.
12.A 60-year-old patient is noted to have rounding of the distal phalanx of
the fingers. What might have caused this? (Hepatic cirrhosis)
Rounding of the distal phalanx describes clubbing. Clubbing of fingers is most often
associated with chronic hypoxia as seen in cigarette smokers and patients with COPD or
lung cancer. Other causes are cirrhosis, cystic fibrosis, pulmonary fibrosis and cyanotic
heart disease.
13.A patient has suspected scarlet fever. He likely has a sandpaper rash and:
(a positive rapid Strep test)
A patient with scarlet fever (scarlatina) has a common childhood disease that is
characterized by sore throat, fever, and a scarlet “sandpaper” rash. The causative
organism is Group A beta hemolytic Streptococcus pyogenes. The patient’s rapid Strep
test will likely be positive. Diarrhea with abdominal cramps is not specific to scarlet fever.
Petechiae represent an extravasation of blood under the skin and are not present with
scarlet fever unless some other disease process is present. Petechiae should be considered
to be a serious finding.
14.A patient with a positive history of a tick bite about 2 weeks ago and
erythema migrans has a positive ELISA for Borrelia burgdorferi. The Western
blot is positive. How should he be managed? (He should receive doxycycline
for Lyme disease)
The first serologic test for Lyme disease is the ELISA. If this is positive, it should be
confirmed. In this case, it was confirmed by a Western blot and it is positive. This patient
can be diagnosed with Lyme disease. The appropriate treatment for erythema migrans is
doxycycline, amoxicillin, or cefuroxime for 21 days. All three medications were found to be
of equal efficacy.
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