The nurse plans care for a patient with a newly diagnosed malignant melanoma based on the knowledge that initial treatment may involve (select all that apply)

Correct Answer: B;C

Rationale: The correct answers are B (Mohs' surgery) and C (Surgical excision). Mohs' surgery is used for precise removal of skin cancer layers, ensuring minimal damage to surrounding healthy tissue. Surgical excision involves removing the entire tumor along with a margin of healthy tissue to prevent cancer spread. Shave biopsy (A) is not ideal for melanoma as it may not provide accurate depth information. Localized radiation (D) is not typically used as initial treatment for melanoma, but rather for advanced cases or as adjuvant therapy.

Correct Answer: A

Rationale: Rationale for Correct Answer (A: Skin flap): 1. A skin flap involves transferring skin and subcutaneous tissue to repair extensive tissue loss. 2. Skin flaps have a direct blood supply, ensuring better survival in large areas of deep tissue destruction. 3. The term "skin graft" usually refers to a procedure where skin is transplanted without its own blood supply. 4. Therefore, a skin flap, with its vascular supply intact, is the appropriate choice. Summary of Incorrect Choices: B: Free graft - Incorrect because free grafts lack a direct blood supply and are more suitable for smaller areas. C: Soft tissue extension - Incorrect as it does not specifically describe the technique of transferring skin and subcutaneous tissue. D: Free graft with vascular anastomoses - Incorrect as this refers to a different technique involving connecting blood vessels, not commonly used for large areas of deep tissue destruction.

Correct Answer: C

Rationale: The correct answer is C: To leave the wound open. In the case of an infected wound, leaving it open allows for drainage of pus and promotes healing by secondary intention. Closing the wound with sutures (A) can trap bacteria and worsen the infection. Steri strips (B) may not be sufficient to hold the edges together in an infected wound. Covering with a loose dressing (D) can also trap bacteria and hinder healing. Overall, leaving the wound open is the most appropriate approach to manage an infected wound effectively.

Correct Answer: B

Rationale: The correct answer is B because a circular, brown-black lesion with elevated, palpable margins is characteristic of malignant melanoma. Melanomas often have irregular borders and colors, and they may be raised. Choice A is more indicative of a vascular lesion. Choice C describes a common mole. Choice D is more typical of a dermatofibroma. In summary, B is the correct choice due to its specific characteristics associated with malignant melanoma, while the other choices describe different types of skin lesions.

Correct Answer: D

Rationale: The correct answer is D: avoid unnecessary exposure to the sun. This is crucial because excessive sun exposure is a major risk factor for developing skin cancers like basal cell carcinoma. By avoiding the sun, Mrs. Reagan can reduce her risk of developing further skin cancers. Observing for recurrence (choice A) is important but not as immediate as sun protection. Systemic chemotherapy (choice B) is not typically used for basal cell carcinoma. While stopping smoking (choice C) is important for overall health, it is not directly related to preventing the recurrence of basal cell carcinoma.