NU271 Week 2 PrepU: Structure and Function of the Skin

Which statement might the nurse tell a client with pruritus? Select all that apply. "Maintain humidification of the home." "Increase the temperature of the home." "Take cool showers before bedtime." "Maintain cool temperatures in the home." "Assess the area for dry skin and apply moisturizing lotion."

"Assess the area for dry skin and apply moisturizing lotion." "Take cool showers before bedtime." "Maintain cool temperatures in the home." "Maintain humidification of the home." Explanation: In order to ease pruritus or itching, the nurse should assess for dry skin and apply cream to lubricate the area for the client. Cool temperatures and cool showers should help as will humidification of the home. Increasing the temperature of the home will not help the client and may lead to further drying of the skin and increased pruritus. Reference: Chapter 51: Structure and Function of the Skin - Page 1275

Which statement is the nurse's best description of a wheal? "It is an elevated mass with irregular borders." "It is a pus-filled area." "It is a bleeding lesion." "It is a dry area that itches."

"It is an elevated mass with irregular borders." Explanation: A wheal is an elevated mass with irregular or transient borders. Hives are often described as "wheals." Reference: Porth, C. M. Essentials of Pathophysiology: Concepts of Altered Health States, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 45: Structure and Function of the Skin, p. 1148. Chapter 51: Structure and Function of the Skin - Page 1148

Which statement concerning blood flow to the skin is true? The skin contains only veins. The skin contains only arteries. Arteriovenous anastomoses in the skin regulate temperature. Veins carry oxygenated blood to the skin.

Arteriovenous anastomoses in the skin regulate temperature. Explanation: The skin is supplied with arteriovenous anastomoses in which blood flows directly between an artery and a vein, bypassing the capillary circulation. These anastomoses are important for temperature regulation. Reference: Chapter 51: Structure and Function of the Skin - Page 1275

A 70-year-old client has needed to reduce the frequency of bathing due to dry skin. Which factor has resulted in this age-related change in skin function? Slower keratinization Increased production of bile salts Dehydration of epidermal cells Change in composition of sebaceous secretions

Change in composition of sebaceous secretions Explanation: The effects of aging on skin dryness include a change in the composition of sebaceous gland secretions and a decrease in the secretion of moisture from the sweat glands. Changes in the composition of keratinocytes and the process of keratinization do not account for the drier skin that accompanies aging. Deposition of bile salts on the skin surface causes pruritus and dry skin, but this is a pathologic process rather than an age-related change. Reference: Chapter 51: Structure and Function of the Skin - Page 1276

The basement membrane separates the epithelium from the underlying connective tissue. Which function does it play regarding skin disorders like blister formation? Complement deposition Type IV collagen The lamina lucida Melanocytes

Complement deposition Explanation: The basement membrane is also a major site of immunoglobulin and complement deposition in skin disease. Reference: Chapter 51: Structure and Function of the Skin - Page 1273

Which term is usually associated with nail growth? Cyclically Continuously Strata Outward

Continuously Explanation: Like hair, nails are the end product of dead matrix cells that are pushed outward from the nail matrix. Unlike hair, nails grow continuously rather than cyclically. The epidermis, the outermost layer of the skin, contains five layers, or strata. Reference: Chapter 51: Structure and Function of the Skin - Page 1276

Which fact accounts for the variation in skin tone that exists among individuals? Dark skin is associated with spherical melanosomes, which produce and "package" pigment differently. Greater numbers of keratinocytes result in darker skin tone. Darker-skinned individuals have melanosomes that produce melanin faster. Someone with dark skin has more melanocytes in his or her skin layers.

Darker-skinned individuals have melanosomes that produce melanin faster. Explanation: The amount of melanin in the keratinocytes determines a person's skin color. Dark-skinned and light-skinned people have the same amount of melanocytes. However, in dark-skinned people, larger melanosomes are produced and transferred to the keratinocyte individually. In light-skinned people, a number of smaller melanosomes are packaged together in a membrane and then transferred to the keratinocyte. The way the melanosomes are packaged is responsible for the pigmentation in darker-skinned persons. Darker-skinned people do not have more melanocytes than light-skinned people, but the production and packaging of pigment is different. Reference: Chapter 51: Structure and Function of the Skin - Page 1272

A child with strep throat is given a prescription for penicillin. After the first dose, the parents call to report the development of a skin rash. Which skin lesion description leads the provider to discontinue the medication and encourage them to seek help if the child has trouble breathing? Encapsulated, fluid-filled masses Pus-filled vesicle Flat, nonpalpable, circumscribed skin color change less than 1-cm diameter Elevated, irregular mass of varying sizes

Elevated, irregular mass of varying sizes Explanation: Elevated, irregular mass of varying sizes can describe urticaria (hives) and may be caused by an allergy to penicillin. Flat, nonpalpable, circumscribed skin color change less than 1-cm diameter is a characteristic of a macule. Pus-filled vesicle describes a pustule and usually associated with acne or impetigo. Encapsulated, fluid-filled masses usually describes a cyst. Reference: Chapter 51: Structure and Function of the Skin - Page 1270

A child arrives to the outpatient clinic with a high fever of 103°F (39.5°C). The parents have the child wrapped in many blankets to "keep them warm, since the child is shivering." What is the rationale for the health care provider to educate the parents that less blankets will help the child more? "We know you want to keep your child comfortable, but blankets will not help lower your child's fever." "Fever dilates vessels and results in sweating, the purpose of the eccrine sweat glands. Too many blankets are counterproductive and will actually help the temperature to go higher." "Let's remove the blankets and place ice packs under your child's arms instead." "Since your child is not coughing or throwing up, I think you just need to take him home and give him liquid acetaminophen."

Fever dilates vessels and results in sweating, the purpose of the eccrine sweat glands. Too many blankets are counterproductive and will actually help the temperature to go higher." Explanation: An example of negative feedback is body temperature regulation. If blood temperature rises too high, this is sensed by specialized neurons in the hypothalamus of the brain. They signal other nerve centers, which in turn send signals to the blood vessels of the skin. As these blood vessels dilate, more blood flows close to the body surface and excess heat radiates from the body. If this is not enough to cool the body back to its set point, the brain activates sweating. Evaporation of sweat from the skin has a strong cooling effect, as we feel when we are sweaty and stand in front of a fan. Shivering may occur. Each muscle tremor in shivering releases heat energy and helps warm the body back toward its 98.6°F (37°C) set point. Removing the blankets and placing ice packs under the child's arms instead does not teach the parents anything about fever control. Confirming the parents goal of keeping the child comfortable, but stating, "blankets will not help lower your child's fever" does not address the principle of evaporation of the sweat. Antipyretic drugs, such as aspirin, ibuprofen, and acetaminophen, often are used to alleviate the discomforts of fever and protect vulnerable organs, such as the brain, from extreme elevations in body temperature. However, the differential diagnosis of fever is quite broad and includes both infectious and noninfectious causes. These causes should be investigated rather than just sending the child home. Reference: Chapter 51: Structure and Function of the Skin - Page 1275

Which stratum layer of the epidermis has cells working to lose cytoplasm and DNA while synthesizing keratin? Corneum Spinosum Lucidum Granulosum

Granulosum Explanation: The stratum granulosum contain the most differentiated cells in the living skin, with some cells losing cytoplasm and DNA, while others in this layer synthesize keratin. The remaining options do not perform the described functions. Reference: Chapter 51: Structure and Function of the Skin - Page 1271

A client presents with pruritus of the lower extremities. What is the priority nursing assessment? Administration of antihistamines Microscopic evaluation of skin to determine presence of fungus Inspection for presence of dry skin Evaluation of vital signs

Inspection for presence of dry skin Explanation: People with dry skin often experience severe pruritus and discomfort, most commonly of the extremities. Other commonly involved areas include the back, abdomen, and waist. Dry skin appears rough and scaly and there may be increased wrinkles or lines. Skin drying also predisposes the skin to scratching, resulting in cracking. Reference: Porth CM (2015). Essentials of Pathophysiology: Concepts of Altered Health States 4th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, Chapter 45: Structure and Function of the Skin, p. 1150. Chapter 51: Structure and Function of the Skin - Page 1150

A client has dry skin, and scratching the dry regions causes some skin flakes to become dislodged. Which cell type makes up the dry skin? Langerhans cells Keratinocytes Melanocytes Merkel cells

Keratinocytes Explanation: The keratinocyte is the major cell of the epidermis, comprising 95% of the cells of this layer. The epidermis is composed of stratified squamous keratinized epithelium. Melanocytes produce pigments, Merkel cells are sensory cells, and Langerhans cells are immune cells. Reference: Chapter 51: Structure and Function of the Skin - Page 1271

student with a rash goes to the school nurse for evaluation. The nurse suspects the student has contact dermatitis. The primary cell responsible for this delayed-type hypersensitivity reaction is: Langerhans cells Merkel cells Reticular dermis Dermal dendrocytes

Langerhans cells Explanation: As antigen-presenting cells, the Langerhans cells are involved in delayed-type hypersensitivity reactions such as contact dermatitis and other cell-mediated immune responses in the skin; their dendritic processes extend through keratinocytes, forming a network to bind and process antigen. Merkel cells provide sensory information to the skin. In the dermis, the reticular dermis is a complex meshwork of three-dimensional collagen bundles that contain dermal dendrocytes, which have phagocytic properties. Reference: Chapter 51: Structure and Function of the Skin - Page 1272

With eyes closed, an object is placed in a student's hand. The instructor asks the student to identify the object. When he does so correctly, this is primarily the responsibility of: Conical projections Meissner corpuscles Prickle cell lesions Krause end bulbs

Meissner corpuscles Explanation: Meissner corpuscles are encapsulated mechanoreceptors specialized for tactile discrimination. They are concentrated on the fingertips and palms of the hands, where they account for about half of the tactile receptors. The skin is also supplied by Krause end bulbs, nerve endings contained in a cylindrical or oval capsule. They are found most frequently in the oral cavity, conjunctiva, and genitalia. Although their function is uncertain, they are thought to act as mechanoreceptors and heat detectors. The stratum spinosum is two to four layers thick, consisting of cells commonly referred to as prickle cells because they develop a spiny appearance as their cell borders interact. The papillary dermis lies adjacent to the epidermis and is densely covered with conical projections called dermal papillae. Reference: Chapter 51: Structure and Function of the Skin - Page 1273

A 51-year-old woman who was born congenitally blind and deaf is able to distinguish individuals by light touch of the individual's face. Which component of the woman's skin innervation likely contributes the most to this ability? Meissner corpuscles Nociceptors Pacinian corpuscles Ruffini corpuscles

Meissner corpuscles Explanation: Meissner corpuscles are rapidly adapting nerve endings located on the palmar surfaces of the fingers and hands; as such, they would be likely to be involved in fine distinction using the fingers. Ruffini corpuscles are located in the subcutaneous tissue of hairy and glabrous skin, while Pacinian corpuscles detect gross pressure and vibration. Nociceptors detect painful stimuli. Reference: Chapter 51: Structure and Function of the Skin - Page 1275

The nurse should rely on verbal history when assessing for which condition in clients with dark skin color? Select all that apply. Erythema Acne Cyanosis Pallor

Pallor Cyanosis Erythema Explanation: The darker pigmentation of people with dark skin color can make skin pallor, cyanosis, and erythema more difficult to observe and therefore it is important that the nurse also relies on verbal history when assessing for skin changes. The textures associated with rashes and acne are not as affected by skin color. Reference: Chapter 51: Structure and Function of the Skin - Page 1272

A person with severe lymphedema is asking the nurse where specifically the lymph vessels are located in the skin layers. What would the nurse would respond? Papillary dermis layer Basement membrane Merkel cell layer Subcutaneous tissue layer

Papillary dermis layer Explanation: Dermal papillae contain capillaries, end arterioles, and venules that nourish the epidermal layers of the skin. This layer of the dermis is richly vascularized. Lymph vessels and nerve tissue also are found in this layer. The basement membrane is a layer of intercellular and extracellular matrices that serves as an interface between the dermis and the epidermis. Merkel cells are connected to afferent nerve terminals, forming a Merkel disk. They are believed to be neuroendocrine cells. Subcutaneous tissue consists of fat cells and connective tissues that lend support to the vascular and neural structures. Reference: Chapter 51: Structure and Function of the Skin - Page 1273

A preschooler asks the parents at bath time, "Why are my nipples red?" Which form of melanin is responsible for the coloring of nipples and lips in humans? Desmosomes Pheomelanin Eumelanin Keratinocytes

Pheomelanin Explanation: Pheomelanin, the yellow to red pigment, is found in all humans. It is particularly concentrated in the lips, nipples, glans penis, and vagina. Eumelanin is abundant in humans. Exposure to the sun's rays increases the production of eumelanin, causing tanning to occur. A desmosome, also known as a macula adherens, is a cell structure specialized for cell-to-cell adhesion. Keratinocytes produce keratin, a complex protein that forms the surface of the skin and is also the structural protein of the hair and nails. Keratinocytes are now known to be active secretory cells that play an important role in the immunobiology of the skin by communicating and regulating cells of the immune response and secreting cytokines and inflammatory mediators. Reference: Chapter 51: Structure and Function of the Skin - Page 1272

Which statement concerning hair follicles is true? Gray hair has increased numbers of melanosomes. Small melanosomes are found in the hair of dark-skinned people. Large melanosomes are found in the hair of light-skinned people. Red hair has spherical melanosomes.

Red hair has spherical melanosomes. Explanation: The only true statement is that red hair has spherical melanosomes. Reference: Chapter 51: Structure and Function of the Skin - Page 1276

Pruritis, or the itch sensation, is a by-product of almost all skin disorders. However, we can itch without having a skin disorder. Itch then can be local or central in our bodies. Where is it postulated that a central "itch center" exists? Pons Medulla oblongata Somatosensory cortex Sensory area of the cerebrum

Somatosensory cortex Explanation: Given these new findings, it has been postulated that itch exists both locally and centrally and that, in addition to localized itch, an "itch center" exists in the somatosensory cortex. Reference: Chapter 51: Structure and Function of the Skin - Page 1277

What statement is true concerning the skin? The skin is not part of the immune response. The skin is the largest organ of the body. The skin does not contain veins. The skin is not susceptible to infection.

The skin is the largest organ of the body. Explanation: The only true statement is that the skin is the largest organ of the body. Reference: Chapter 51: Structure and Function of the Skin - Page 1277

The pars reticularis is characterized by what? Three-dimensional collagen bundles Its color Dendritic cells Its immunologic function

Three-dimensional collagen bundles Explanation: The reticular dermis (pars reticularis) is the thicker area of the dermis and forms the bulk of the dermal layer. The other three answers are part of the reticular dermis, but it is not characterized by them. Reference: Chapter 51: Structure and Function of the Skin - Page 1273

An older adult client has noticeable dry skin that is rough and scaly. The client is frequently scratching, resulting in cracking and other skin problems. Which intervention(s) would the nurse consider important to discuss with this client? Select all that apply. Apply emollients to the skin surface, applying frequently Use room humidifiers, especially in bed room Increase use of glycerin soap for bathing Use occlusive, petroleum-based creams every morning and night Keep room temperature high enough so the client does not need blankets

Use occlusive, petroleum-based creams every morning and night Use room humidifiers, especially in bed room Apply emollients to the skin surface, applying frequently Explanation: Emollients are fatty acid-containing lotions that replenish the oils on the skin surface, but usually do not leave a residue on the skin. They have short duration of action and need to be applied frequently. Using a room humidifier and keeping room temperatures as low as possible to prevent water loss from the skin may be helpful. Glycerin soaps, although popular and visually appealing, are drying and can exacerbate the symptoms. Occlusives are thick, petroleum-based creams that can form a barrier. They prevent water loss from the skin. They are most effective for relieving skin dryness, but because of their greasiness and lack of cosmetic appeal, some people do not wish to use them. Reference: Chapter 51: Structure and Function of the Skin - Page 1271

Which statement below would be a nurse's best description of a macule? Select all that apply. "A macule is less than 1 cm in diameter." "A petechia is often described as a macule." "A macule is always dark brown in color." "A macule is often fluid filled." "A freckle is often described as a macule."

"A freckle is often described as a macule." "A petechia is often described as a macule." "A macule is less than 1 cm in diameter." Explanation: A macule correctly describes a freckle and petechial and is less than 1 cm in diameter. It is not fluid filled or always dark brown. It is usually brown, white, tan, purple, or red in color. Reference: Porth, C. M. Essentials of Pathophysiology: Concepts of Altered Health States, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 45: Structure and Function of the Skin, p. 1148. Chapter 51: Structure and Function of the Skin - Page 1148

An adolescent, who is an athlete, asks the health care provider, "Why do I now have such awful body odor? What has changed in my body?" Which response is the best reply? "This is just a sign that you need to thoroughly wash and dry your skin, especially under your arms and your groin, more carefully." "Hormones, like androgens and testosterone change the chemicals in your body making it smell worse when one sweats." "Apocrine sweat glands open through a hair follicle and secrete an oily substance that mixes with bacteria on the skin, producing body odor." "As one develops more muscles and are able to work out longer and harder, more sweat mixes with body secretions making up 'body odor.'"

"Apocrine sweat glands open through a hair follicle and secrete an oily substance that mixes with bacteria on the skin, producing body odor." Explanation: Apocrine sweat glands open through a hair follicle and secrete an oily substance that mixes with bacteria on the skin, producing body odor. Bathing is not the cause since it is caused by increased sweat during exercise. The exercises produces more sweat, it is not because the muscles have more fully developed. The change in hormones are not the reason for body odor, even though the hormones do change at puberty. Reference: Chapter 51: Structure and Function of the Skin - Page 1275

The pathology instructor asks, "What function do keratinocytes perform in the epidermis?" Which student has the correct answer? "Keratinocytes are localized patches that hold two cells tight together." "Keratinocytes provide sensory information to the skin to send out messages when the skin is getting too many UV rays." "Keratinocytes in this layer secrete lamellar bodies to provide important water-impermeable properties." "Keratinocytes have a spiny appearance where their cell borders interconnect to form a layer called prickle cells."

"Keratinocytes in this layer secrete lamellar bodies to provide important water-impermeable properties." Explanation: Keratinocytes in the stratum granulosum layer secrete lamellar bodies into the next layer of the epidermis, the stratum lucidum to provide important water-impermeable properties. Desmosomes are localized patches that hold two cells tight together. The cells of the stratum spinosum become differentiated as they migrate toward the surface of the epidermis. They develop a spiny appearance where their cell borders interconnect to form a layer called prickle cells. Merkel cells provide sensory information. Reference: Chapter 51: Structure and Function of the Skin - Page 1271

A client has dry skin on both legs and a history of cardiovascular disease. Which interventions should the nurse include in the teaching plan for this client? Select all that apply. "Keep your room temperature as low as possible." "Wear cotton pajamas to cover your legs at night." "Avoid wearing stockings during the day." "Apply moisturizers to legs frequently." "Avoid glycerin soaps."

"Keep your room temperature as low as possible." "Avoid glycerin soaps." "Apply moisturizers to legs frequently." Explanation: Dry skin, also called xerosis, may be a natural occurrence, as in the drying of skin associated with aging, or it may be symptomatic of an underlying systemic disease. Moisturizing agents are the cornerstone of treatment for dry skin. These agents exert their effects by repairing the skin barrier, increasing the water content of the skin, reducing transepidermal water loss, and restoring the lipid barrier's ability to attract, hold, and redistribute water. Using room humidifiers and keeping room temperatures as low as possible to prevent water loss from the skin also may be helpful. Glycerin soaps are drying and can exacerbate the symptoms. Reference: Porth CM (2015). Essentials of Pathophysiology: Concepts of Altered Health States. 4th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins Porth, C. M. Essentials of Pathophysiology: Concepts of Altered Health States, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 45: Structure and Function of the Skin, p. 1151. Chapter 51: Structure and Function of the Skin - Page 1151

A client arrives with a very large blister on the heel from "new shoes" and fear having "damaged" the structures (ligaments and tendons) beyond repair and want to know "what caused this blister?" Which nursing response is best in this situation? "If you can still control movement of your foot, then that means no important structures are damaged. It just takes some time for healing to occur." "This blister should be aspirated so that we can put some antibiotic cream on it and a bandage. You should not wear any shoes with a back until it is completely healed." "This blister is caused by mechanical friction from repeated rubbing on this area. The fluid is in the basement membrane between the epidermis and dermis." "This damage is only on the epidermis layer which is the top layer of your skin. No underlying structures are damaged."

"This blister is caused by mechanical friction from repeated rubbing on this area. The fluid is in the basement membrane between the epidermis and dermis." Explanation: The basement membrane is a thin adhesive layer that cements the epidermis to the dermis. This is the layer involved in blister formation. A blister is a vesicle. It is caused by a mechanical origin from friction. Adhesive bandages and gauze can be used to prevent friction blisters. It is inadvisable to break the skin and remove the fluid from the blister because of the risk of secondary infection. Reference: Chapter 51: Structure and Function of the Skin - Page 1273

A client shows the nurse an area on his arm where he has repeatedly been giving insulin injections to himself. The nurse feels the area and the skin appears to be thin. The nurse feels a "valley" or indentation in the area. What would the nurse tell the client? "This is a keloid." "This is an area of atrophy." "This is a scar." "This is an area of hypertrophied skin."

"This is an area of atrophy." Explanation: The area of skin that feels like an indentation is most likely lipoatrophy or atrophied skin due to repeated insulin injections. A hypertrophied area would feel like a "lump." A scar is an actual mark left from a healing wound. Reference: Chapter 51: Structure and Function of the Skin - Page 1276

A client reports having pruritus. Which question is most appropriate for the nurse to ask first? "Where do you feel itching?" "Did you hit anything?" "Do you have a lesion in the area?" "Are you on any new medications?"

"Where do you feel itching?" Explanation: The first thing the nurse should ask is where the itching is occurring. The nurse could then inspect the area. Itching is not necessarily caused by being hit or having a lesion. Asking if the client is on new medications is not particularly helpful, as itching can have many causes. The nurse should first assess the area. Reference: Porth, C. M. Essentials of Pathophysiology: Concepts of Altered Health States, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 45: Structure and Function of the Skin, p. 1150. Chapter 51: Structure and Function of the Skin - Page 1150

Following laparoscopic gall bladder surgery, a client has a 2-in (5-cm) incision that is elevated, irregular, and a different color from the normal skin. The client asks, "What is wrong with this incision? It's been 2 years and I expected no visible sign of this surgery since it was laparoscopic." How will the nurse explain this condition? "Your body formed excessive collagen during the healing process." "It is normal for your scar to be reddish-purple. It will fade in a few years." "Your garments must have rubbed this area as it was trying to heal." "It is just dead epithelium that has adhered to the skin. Scrub it vigorously and it should go away."

"Your body formed excessive collagen during the healing process." Explanation: Keloid is hypertrophied scar tissue secondary to excessive collagen formation during the healing process. Mature scars should be white or glistening as replacement of connective tissue forms over the injured tissue. Scales are flakes secondary to desquamated dead epithelium that has adhered to the skin surface. Reference: Chapter 51: Structure and Function of the Skin - Page 1273

A high school athlete has developed a fungal infection between the toes where it is red, sore, and cracked into the dermis. Which term is the most accurate for the nurse to document in the client's record? A pustule A fissure A vesicle An ulceration

A fissure Explanation: Athlete's foot is caused by a fungus that grows on or in the top layer of skin. Fungi (plural of fungus) grow best in warm, wet places, such as the area between the toes. The linear crack in the skin that extend into the dermis is called fissure, and should be documented as such. A vesicle is less than 0.5 cm, circumscribed, elevated, palpable mass containing serous fluid. Ulcers are classified as skin loss extending past the epidermis that bleed and cause scarring. A pustule is a lesion that is pus-filled. Reference: Chapter 51: Structure and Function of the Skin - Page 1273 - 1275

Which clients would experience an accelerated rate of cell division in the stratum germinativum layer? A pregnant client who has developed dark purple stretch marks on the abdomen A young athlete who experienced a torn cartilage in the knee A motorcycle accident client with large abrasions on the lower limbs A stroke client who is incontinent of stool and bladder

A motorcycle accident client with large abrasions on the lower limbs Explanation: The deepest layer, the stratum germinativum, consists of a single layer of basal cells that are attached to the basal lamina in the basement membrane zone. The basal cells are the only epidermal cells that are mitotically active. It normally takes 3 to 4 weeks for the epidermis to replicate itself. The rate of cell division in the stratum germinativum is greatly accelerated when the outer layers of the epidermis are stripped away as occurs in abrasions and burns. The outer epidermis, which is avascular, is composed of four to five layers of stratified squamous epithelial cells, predominantly keratinocytes, which are formed in the deepest layer of the epidermis and migrate to the skin surface to replace cells that are lost during normal skin shedding. These are most affected by incontinence. Stretch marks are similar to stratum granulosum cells that have a dark staining granule of keratohyalin. Reference: Chapter 51: Structure and Function of the Skin - Page 1271

A nurse educator is instructing individuals at a health fair about the body's natural defenses. Which potentially harmful environmental agent does the skin provide defense against on a daily basis? Select all that apply. Vitamin C Microorganisms Sunlight Oxygen Cigarette smoke

A nurse educator is instructing individuals at a health fair about the body's natural defenses. Which potentially harmful environmental agent does the skin provide defense against on a daily basis? Select all that apply. You Selected: Microorganisms Sunlight Cigarette smoke Correct response: Sunlight Microorganisms Cigarette smoke Explanation: As the body's first line of defense, the skin is continually subjected to potentially harmful environmental agents, including solid matter, liquids, gases, sunlight, and microorganisms. Reference: Chapter 51: Structure and Function of the Skin - Page 1276

The nurse assesses a rash on the client's skin. What statement concerning this is true? Rashes are uncommon findings. Rashes are the same color as the skin pigment. A rash is a temporary eruption of the skin. A rash is a small lesion.

A rash is a temporary eruption of the skin. Explanation: The only true statement is that rashes are temporary eruptions of the skin. Reference: Chapter 51: Structure and Function of the Skin - Page 1269

A client with a parathyroid tumor has elevated calcium levels and low vitamin D levels. The provider suggests that the client get 15 to 20 minutes of unprotected sunlight per day, if possible. How will the provider explain why this intervention will help raise vitamin D levels for this client? "Exposure to UV rays from sunlight exposes the blood, through vasodilation, to break down calcium and allow influx of vitamin D into the vessels." "It is something that occurs after exposure to sunlight that researchers are still studying since its a complex process." "A substance called 7-dehydrocholesterol is converted to an inactive form of vitamin D by UV rays from the sun." "Researchers are not sure, but they think it has something to do with the evaporation of moisture on the skin surface when exposed to sunlight."

A substance called 7-dehydrocholesterol is converted to an inactive form of vitamin D by UV rays from the sun." Explanation: The skin functions as an endocrine organ, in which a substance called 7-dehydrocholesterol is converted to an inactive form of vitamin D by UV rays from the sun. It has nothing to do with vasodilation and exposing more blood vessels to the sun rays. It also does not affect the amount of calcium in one's vessels. The rate at which heat is dissipated from the body is determined by constriction or dilation of the arterioles that supply blood to the skin and through evaporation of moisture and sweat from the skin surface. Reference: Chapter 51: Structure and Function of the Skin - Page 1277

Which statement about the structure of the skin is correct? All five layers of the epidermis lack a blood supply. Nerve fibers originate in the dermis and terminate in the stratum corneum of the epidermis. The epidermis is composed of connective tissue. The dermis is composed of skeletal muscle tissue.

All five layers of the epidermis lack a blood supply. Explanation: The epidermis is wholly avascular and lacks nerve endings. The epidermis is composed of stratified squamous epithelium, and the dermis is connective tissue. Reference: Chapter 51: Structure and Function of the Skin - Page 1270

A client has begun to have dry skin and has asked the nurse to recommend a moisturizing agent. The client wants a product that won't leave a greasy skin residue and is willing to apply the product frequently. Which product would be the nurse's best recommendation? An occlusive A humectant An emollient A hydrogel

An emollient Explanation: Emollients are fatty acid-containing lotions that replenish the oils on the skin surface, but usually do not leave a residue on the skin. They have a short duration of action and need to be applied frequently. Humectants are the additives in lotions, such as alpha-hydroxy acids and urea that draw out water from the deeper skin layers and hold it on the skin surface. Occlusives are thick creams that contain petroleum or some other moisture-proof material. They prevent water loss from the skin but leave a residue. Reference: Porth, C. M. Essentials of Pathophysiology: Concepts of Altered Health States, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 45: Structure and Function of the Integumentum, p. 1151. Chapter 51: Structure and Function of the Skin - Page 1151

Which structure would likely be present in a hair follicle in a man's groin but not in a follicle on his face? Sebaceous gland Apocrine gland Hair papilla Arrector pili muscle

Apocrine gland Explanation: Apocrine glands are only found in hair follicles in the underarms and groin. All hair follicles contain an erector pili muscle, sebaceous gland, and blood supply in the form of the hair papilla. Reference: Chapter 51: Structure and Function of the Skin - Page 1275

The nurse is caring for a client with an infection and fever. The client reports feeling chilled and having "goose bumps." The nurse will anticipate what change in the client's assessment findings as a result of this physiologic reaction? A decrease in blood pressure An increase in body temperature An increase in heart rate An increase in respiratory rate

An increase in body temperature Explanation: The physiologic response described results from the contraction of the arrector pili muscle, located deep to the sebaceous gland. This thermoregulatory function causes the contracting of skin, creating "goose bumps," thereby reducing the skin surface area that is available for the dissipation of body heat in an attempt to raise body temperature. While the other responses can be present during an active infection, they are not related to the presence of "goose bumps." Reference: Chapter 51: Structure and Function of the Skin - Page 1275

Which structure would likely be present in a hair follicle in a man's groin but not in a follicle on his face? Apocrine gland Arrector pili muscle Hair papilla Sebaceous gland

Apocrine gland Explanation: Apocrine glands are only found in hair follicles in the underarms and groin. All hair follicles contain an erector pili muscle, sebaceous gland, and blood supply in the form of the hair papilla. Reference: Chapter 51: Structure and Function of the Skin - Page 1275

A frustrated 26-year-old female has sought a referral to a dermatologist in an effort to resolve her sweating and body odor which persist despite good hygiene. Which facts would underlie the explanation that her health care provider provides about her problem? Apocrine sweat glands produce a substance that is more oily than sweat from other sources. Excess production by eccrine sweat glands, combined with bacteria, produces a characteristic odor in moist areas of the body. Occlusion of sebaceous glands in the axillae and groin results in proliferation of microorganisms. Sebaceous secretions vary in both quantity and consistency among individuals.

Apocrine sweat glands produce a substance that is more oily than sweat from other sources. Explanation: Body odor is the result of apocrine sweat gland secretions combining with bacteria to produce a characteristic odor. Neither eccrine sweat glands nor sebaceous glands are primarily involved. Reference: Chapter 51: Structure and Function of the Skin - Page 1275

Which statement about temperature regulation and skin is accurate? Since the skin is avascular, it is the subcutaneous layer that primarily is responsible for temperature control. Arteriovenous anastomoses between an artery and a vein within the skin layer are important for temperature regulation. The lymphatic system of the skin is primarily responsible for heating and cooling the skin. It is primarily the arteries that bring blood from the heart that keeps the body temperature within a normal range.

Arteriovenous anastomoses between an artery and a vein within the skin layer are important for temperature regulation. Explanation: The skin is richly supplied with arteriovenous anastomoses in which blood flows directly between an artery and a vein, bypassing the capillary circulation. These anastomoses are important for temperature regulation. The lymphatic system of the skin, which aids in combating certain skin infections, also is limited to the dermis. Reference: Chapter 51: Structure and Function of the Skin - Page 1275

The nurse is caring for a group of clients in their 80s. How can the nurse best prevent skin tear injuries while caring for these clients? Avoid manipulation that causes traction on the skin. Apply emollient lotions regularly after bathing. Provide optimal nutrition and hydration status. Ensure the client wears loose-fitting, unrestrictive clothing.

Avoid manipulation that causes traction on the skin. Explanation: Skin tears result due to the loss of anchoring between the skin layers that occurs due to aging. This places the aging person at risk for shearing injuries when traction is applied to the skin (e.g., when a client's skin is dragged against a bed sheet when repositioning). Good nutrition and moisturizing techniques can help with dry skin and wound healing but will not prevent skin tears. Loose-fitting clothing is not as important as avoiding shearing forces when trying to prevent skin tears.

A nurse is assessing a client's apocrine sweat glands. Which locations should be looked at? Select all that apply. Axillae Feet Anal area Genitals Neck

Axillae Anal area Genitals Explanation: The apocrine sweat glands are confined to the axillae and the anogenital area.

The basement membrane, the interface between the epidermis and dermis, is involved in formation of which skin disorders? Prickle cell lesions Hyperpigmentation Conical projections Blister formation

Blister formation Explanation: The basement membrane (formerly called basal lamina) is involved in skin disorders that cause bullae or blister formation. The stratum spinosum is two to four layers thick, consisting of cells commonly referred to as prickle cells because they develop a spiny appearance as their cell borders interact. The melanocytes are pigment-synthesizing cells that are located at or in the basal layer, functioning to produce pigment granules called melanin. The papillary dermis lies adjacent to the epidermis and is densely covered with conical projections called dermal papillae. Reference: Chapter 51: Structure and Function of the Skin - Page 1272-1273

While breaking in a new pair of shoes, a client develops a large (1 cm) lesion filled with clear fluid. Which term will the health care provider document in the client's chart? Wheal Vesicle Nodule Bullae

Bullae Explanation: Bullae are large (1 cm or larger in diameter) fluid-filled blisters, whereas vesicles are small (<1 cm in diameter). Nodules are solid marble-like lesions (>0.5 cm) that are deeper and firmer than a papule. A wheal is a somewhat irregular, relatively transient area of localized skin edema, such as a mosquito bite. Reference: Chapter 51: Structure and Function of the Skin - Page 1273

An older adult client asks the nurse why her skin is so dry. Which response is best for the nurse to give to this client? Select all that apply. Less surface area is available for fluid exchange. Changes occur in the sebaceous gland. An increase of secretions occurs in the sweat glands. Flattening of the dermal rete ridges occurs. A decrease in skin capillaries occurs.

Changes occur in the sebaceous gland. A decrease in skin capillaries occurs. Flattening of the dermal rete ridges occurs. Explanation: The effects of aging on skin dryness include a change in the composition of sebaceous gland secretions and a decrease in the secretion of moisture from the sweat glands. Aging is also accompanied by a decrease in skin capillaries as well as a flattening of the dermal rete ridges, resulting in less surface area for exchange of fluids between the dermis, epidermis, and skin surface. Reference: Chapter 51: Structure and Function of the Skin - Page 1276

The nurse is recommending to a client ways to relieve the itching sensation of his uncontrollable pruritis. What should the nurse recommend? Hot bath Antibiotic ointment Cool shower Barrier cream

Cool shower Explanation: Cold applications and cool showers/baths should be used for relief and not hot water, which will increase the itch related to vasodilation. Barrier creams and antibiotic ointments will not relieve the itching sensation. Reference: Porth, C. M. Essentials of Pathophysiology: Concepts of Altered Health States, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 45: Structure and Function of the Skin, p. 1150. Chapter 51: Structure and Function of the Skin - Page 1150

The nurse is caring for a client with pruritis. The nurse anticipates orders for which intervention? Corticosteroids Heating pad Scratching Glycerin soap

Corticosteroids Explanation: Corticosteroids can help to suppress itching. Glycerin soaps are drying and can exacerbate the symptoms, as can heat. Over time scratching the skin can lead to lichenification. Reference: Porth, C. M. Essentials of Pathophysiology: Concepts of Altered Health States, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 45: Structure and Function of the Skin, p. 1150. Chapter 51: Structure and Function of the Skin - Page 1150

The nurse is caring for a client with pruritis. The nurse anticipates orders for which intervention? Scratching Corticosteroids Heating pad Glycerin soap

Corticosteroids Explanation: Corticosteroids can help to suppress itching. Glycerin soaps are drying and can exacerbate the symptoms, as can heat. Over time scratching the skin can lead to lichenification. Reference: Porth, C. M. Essentials of Pathophysiology: Concepts of Altered Health States, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 45: Structure and Function of the Skin, p. 1150. Chapter 51: Structure and Function of the Skin - Page 1150

What are the functions of the epidermis? Select all that apply. Cover the body Protect the body Provide blood flow route to internal organs Provide pigment Provide sensory information

Cover the body Protect the body Provide pigment Provide sensory information Explanation: The epidermis covers and protects the body. It provides pigment through melanocyte cells. Melanocytes in the epidermis provide pigment through melanin. Reference: Chapter 51: Structure and Function of the Skin - Page 1270

A client accidentally cuts his hand at work and comes to the clinic for stitches. The nurse understands that the client's immune system will be initially activated by which cells found in the dermis? B cells Dermal macrophages Mast cells Fibroblasts

Dermal macrophages Explanation: Immune cells found in the dermis include macrophages, T cells, mast cells, and fibroblasts. Dermal macrophages may present antigens to T cells in the dermis. Most of these T cells are previously activated or memory T cells. T-cell responses to macrophage- or endothelium-associated antigens in the dermis are probably more important in generating an immune response to antigen challenge in previously exposed persons than in initiating a response to a new antigen. The major type of T-cell-mediated immune response in the skin is delayed-type hypersensitivity. Reference: Chapter 51: Structure and Function of the Skin - Page 1274

A nurse assesses the skin of a client for xerosis based on the fact that it may occur in a susceptible person as a consequence of which case? Collagen-vascular disease Diabetes Hypertension Hyperlipidemia

Diabetes Explanation: Dry skin, also called xerosis, may be a natural occurrence, as in the drying of skin associated with aging, or it may be symptomatic of an underlying systemic disease or skin disorder such as contact dermatitis or diabetes mellitus. People with diabetes mellitus often experience xerosis especially on the extremities. It is often due to extreme winter weather when there is little humidity in the air. Most cases of dry skin are caused by dehydration of the stratum corneum. Reference: Chapter 51: Structure and Function of the Skin - Page 1275

A nurse assesses the skin of a client for xerosis based on the fact that it may occur in a susceptible person as a consequence of which case? Diabetes Hypertension Collagen-vascular disease Hyperlipidemia

Diabetes Explanation: Dry skin, also called xerosis, may be a natural occurrence, as in the drying of skin associated with aging, or it may be symptomatic of an underlying systemic disease or skin disorder such as contact dermatitis or diabetes mellitus. People with diabetes mellitus often experience xerosis especially on the extremities. It is often due to extreme winter weather when there is little humidity in the air. Most cases of dry skin are caused by dehydration of the stratum corneum. Reference: Chapter 51: Structure and Function of the Skin - Page 1275

Which definition of a plaque is most accurate? Small, flat discolored lesion Elevated, coalesced papules >0.5 cm Encapsulated, fluid-filled mass Flat, flaky, whitish, detachable fragment of epidermis

Elevated, coalesced papules >0.5 cm Explanation: Plaque may be coalesced papules greater than 0.5 cm. Small, flat discolored lesion is a macule patch. Encapsulated, fluid-filled mass is a cyst. Flat, flaky, whitish, detachable fragment of epidermis is related to dandruff, psoriasis, or dry skin. Reference: Chapter 51: Structure and Function of the Skin - Page 1273

Which factor is genetically determined and primarily responsible for dark skin tone? High production of melanin Superficial distribution of melanocytes Dense distribution of melanosomes High levels of tyrosinase

High production of melanin Explanation: Although the number of melanosomes in dark and light skin is the same, dark skin produces more melanin, and more quickly, than light skin. Dark-skinned persons do not possess a more superficial distribution of melanocytes or increased levels of tyrosinase. Reference: Chapter 51: Structure and Function of the Skin - Page 1271-1272

A teenager has just been told by the dermatologist that he may be at high risk for developing skin cancer since he has natural red hair and fair skin. What physiology behind this statement is most accurate? Too much eumelanin pigmentation, which protects against skin cancer formation Oversecretion of eumelanin, a brown-black pigment that causes tans Increased susceptibility to photosensitivity due to oversecretion of melanin Enhanced photoreactivity of pheomelanin, as compared to eumelanin

Enhanced photoreactivity of pheomelanin, as compared to eumelanin Explanation: There are two major forms of melanin: eumelanin and pheomelanin. Exposure to the sun's ultraviolet rays increases the production of eumelanin, a brownish black pigment, which causes tanning to occur. An enhanced photoreactivity of the red melanin (pheomelanin) compared to the black melanin (eumelanin) is commonly the explanation as to why fair-skinned individuals are more susceptible to skin cancers. The primary function of such melanin is to protect the skin by absorbing and scattering harmful ultraviolet rays, which are implicated in skin cancers. Localized concentrations of eumelanin are responsible for the formation of freckles and moles. This does not mean that they will develop skin cancer. Pheomelanin, a reddish yellow pigment, provides color to the body when it is concentrated, primarily in the lips, nipples, glans penis, and vaginal areas. Photosensitivity refers to abnormal sensitivity (not reactivity) of the skin to ultraviolet light, usually following exposure to certain oral or topical drugs or to other sensitizing chemicals and resulting in accelerated burning and blistering of the skin. Both types of melanin are found in hair, particularly red hair. It has been suggested that the reason fair-haired individuals are more susceptible to skin cancers may be due to the enhanced photoreactivity of pheomelanin, as compared to eumelanin. Reference: Chapter 51: Structure and Function of the Skin - Page 1271-1272

Which layer of the skin contains cells responsible for skin color, tanning, and protection from the sun's ultraviolet radiation? Subcutaneous fat layer Dermis Basement membrane layer Epidermis

Epidermis Explanation: The epidermis covers the body. It is specialized in areas to form skin appendages like hair, nails, and glandular structures. Melanocytes in the epidermis layer are responsible for skin color, tanning, and protection against ultraviolet radiation. The dermis layer supports the epidermis and serves as its primary source of nutrition. The basement membrane layer divides the epidermis and dermis layer. The subcutaneous tissue, a layer of loose connective and adipose connective tissues, binds the dermis to the underlying tissues of the body. Reference: Chapter 51: Structure and Function of the Skin - Page 1270

Following exposure to poison oak while camping, a 20-year-old male is experiencing pruritis as a consequence of his immune response to irritants in the plant. What physiologic process bestaccounts for his complaint? Ruffini corpuscles are transmitting the message of pruritus to the cerebral cortex. Local irritation of Langerhans cells is sending signals by way of myelinated type C nerve fibers. His body is communicating a low level pain response as a protective measure. Free nerve endings are initiating an itch-specific signal to the somatosensory cortex.

Free nerve endings are initiating an itch-specific signal to the somatosensory cortex. Explanation: It is generally agreed that itch is a sensation that originates in free nerve endings in the skin, is carried by small myelinated type C nerve fibers to the dorsal horn of the spinal cord, and is then transmitted to the somatosensory cortex via the spinothalamic tract. Itching is no longer considered to be a low-level pain response. Ruffini corpuscles and Langerhans cells are not noted to play a role in pruritus. Reference: Chapter 51: Structure and Function of the Skin - Page 1275

Age-related melanin deficiency leads to which manifestation? Wrinkled skin Stooped posture Graying hair Age spots

Graying hair Explanation: Gray hair is the result of a decreased number of melanosome-producing melanocytes. Melanin deficiency does not cause wrinkles or postural changes or increased pigmentation in age spots. Reference: Chapter 51: Structure and Function of the Skin - Page 1276

A parent calls the health care provider reporting the child has red sores on the face, especially around the nose and mouth that have pus/fluid inside and when the sores burst, they develop a honey-colored crust. The parent is asking whether to make an appointment. Which contagious skin lesion does the provider think the child has developed? Poison ivy Herpes simplex Sebaceous cyst Impetigo pustule

Impetigo pustule Explanation: Impetigo is a form of pustule and is primarily described as red sores on the face, especially around a child's nose and mouth, and on the hands and feet. The sores burst and form honey-colored crusts. This is the classic description of impetigo. A vesicle is less than 0.5 cm, circumscribed, elevated, and a palpable mass containing serous fluid. It may be cause by herpes simplex, a cold sore. Poison ivy develops after exposure to the plant out-of-doors and is described as circumscribed, elevated, palpable masses containing serous fluids. Poison ivy usually is a red, itchy rash with swelling, bumps and blisters that can spread by contact. A sebaceous cyst is an encapsulated, fluid-filled or semisolid mass in the subcutaneous tissue and is not considered contagious. Reference: Chapter 51: Structure and Function of the Skin - Page 1269

A 40-year-old male client has a congenital syndrome that affects the function of the Langerhans cells of his epidermis. The man's care provider would expect which manifestation of his condition? Increased susceptibility to infection Frequent separation between the dermal and epidermal layer of his skin High permeability of his epidermis to environmental materials Lighter skin tone than other individuals of the same ethnicity

Increased susceptibility to infection Explanation: Langerhans cells are the immunologic cells responsible for recognizing foreign antigens harmful to the body. They play an important role in defending the body against foreign antigens. A lack of Langerhans cells would not manifest in increased permeability of the skin, unexpected coloration, or separation between layers. Reference: Chapter 51: Structure and Function of the Skin - Page 1272

A client is concerned about developing melasma and asks the nurse about risk factors. Which responses are appropriate? Select all that apply. Frequently occurs in populations of Asian, Indian, or South American descent Will not occur during pregnancy Risk can be decreased by taking oral contraceptives Is common in women Symptoms can be prevented by sun exposure

Is common in women Frequently occurs in populations of Asian, Indian, or South American descent Explanation: Melasma is a disorder characterized by darkened macules on the face. It is common in all skin types but most prominent in brown-skinned people from Asia, India, and South America. It occurs in men but is more common in women, particularly during pregnancy or while using oral contraceptives. It may or may not resolve after giving birth or discontinuing hormonal birth control. Melasma is exacerbated by sun exposure.

A client with chronic renal disease has severe pruritus. Which interventions should the nurse include in the teaching plan for the client? Select all that apply. Keep fingernails trimmed Moisturize the skin frequently Take a cool shower before bed Drinking alcoholic beverages will decrease stimulation of the itch receptors Wear clothing to keep the skin warm

Keep fingernails trimmed Moisturize the skin frequently Take a cool shower before bed Explanation: Most treatment measures for pruritus are nonspecific. Measures such as using the entire hand to rub over large areas and keeping the fingernails trimmed often can relieve itch and prevent skin damage. Self-limited or seasonal cases of pruritus may respond to treatment measures such as moisturizing lotions, bath oils, and the use of humidifiers. Because vasodilation tends to increase itching, cold applications may provide relief. Cool showers before bed, light sleepwear, and cool home temperatures also may be helpful. Topical corticosteroids may be helpful in some cases, such as itch related to allergy-mediated urticaria. Reference: Porth CM (2015). Essentials of Pathophysiology: Concepts of Altered Health States. 4th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, Chapter 45: Structure and Function of the Skin, p. 1150. Chapter 51: Structure and Function of the Skin - Page 1150

A nurse is teaching a client about the role that skin plays in forming a barrier to environmental agents and microorganisms. The nurse would recognize that which type of cells/junctions are involved in the communication and regulation of the immune response and the secretions of cytokines? Adherens junctions Gap junctions Desmosomes Keratinocytes

Keratinocytes Explanation: Keratinocytes are now known to be active secretory cells that play an important role in the immunobiology of the skin by communicating and regulating cells of the immune response and secreting cytokines and inflammatory mediators. Gap junctions allow ions and molecules to pass between skin cells. Adherens junctions provide a mechanical connection between cells. Desmosomes are localized patches or plaques that hold two cells tightly together by proteins called cadherins. They are terminal endpoints on the cell walls of keratinocytes. Reference: Chapter 51: Structure and Function of the Skin - Page 1271

A client has dry skin, and scratching the dry regions causes some skin flakes to become dislodged. Which cell type makes up the dry skin? Melanocytes Langerhans cells Merkel cells Keratinocytes

Keratinocytes Explanation: The keratinocyte is the major cell of the epidermis, comprising 95% of the cells of this layer. The epidermis is composed of stratified squamous keratinized epithelium. Melanocytes produce pigments, Merkel cells are sensory cells, and Langerhans cells are immune cells. Reference: Chapter 51: Structure and Function of the Skin - Page 1271

Clinical investigation of a 40-year-old female client with diverse dermatologic signs and symptoms has focused on the woman's basement membrane. Which skin function would a clinician most likely attribute to a region of the integument other than the basement membrane? Lack of adhesion between the dermis and epidermis Large immunoglobulin deposits Formation of blisters on various skin surfaces Lack of sensory nerve impulse conduction

Lack of sensory nerve impulse conduction Explanation: While the basement membrane plays roles in adhering between skin layers and is a common site of immunoglobulin deposition and blister formation, it is not a major site of afferent nerve endings and consequent sensory transmission. Reference: Chapter 51: Structure and Function of the Skin - Page 1272 - 1273

What is a physiologic basis for albinism? Separation of the epidermis from the dermis Lack of tyrosinase Lichenification Accelerated keratinization

Lack of tyrosinase Explanation: Although there are more than 10 different types of albinism, the most common type is recessively inherited oculocutaneous albinism, in which there is a normal number of melanocytes but they lack tyrosinase, the enzyme needed for synthesis of melanin. Reference: Chapter 51: Structure and Function of the Skin - Page 1272

A physiology educator asks the students, "So what layers keep the epidermis and dermis adhere to each other, rather than freely floating in various directions at the same time?" Which student answer(s) correctly identify the zones between the dermis and epidermis responsible for this interface? Select all that apply. Lamina fibroreticularis Lamina dens Hemidesmosomes Collagen Lamina lucida

Lamina lucida Lamina fibroreticularis Lamina dens Explanation: Lamina lucida, lamina fibroreticularis, and lamina densa are the three distinct zones or layers of the basement membrane, all of which contribute to the adhesions of the two skin layers. Hemidesmosomes are like half desmosomes in both structure and function. They lie immediately at the basal plasma membrane. They are involved in relaying signals between the skin layers. Collagen is the most abundant protein in the body. It is the major component of connective tissues that make up several body parts, including tendons, ligaments, skin and muscles. Collagen has many important functions, including providing the skin with structure and strengthening ones bones.

Which type of cells form a network to bind and process antigens in the epidermis? Reticular dermis Langerhans cells Merkel cells Dermal dendrocytes

Langerhans cells Explanation: Langerhans cells, the only immune cells in the skin known to be capable of antigen presentation, are star-shaped macrophages in the epidermis; their dendritic processes extend through keratinocytes, forming a network to bind and process antigen. Merkel cells provide sensory information to the skin. In the dermis, the reticular dermis is a complex meshwork of three-dimensional collagen bundles that contain dermal dendrocytes, which have phagocytic properties. Reference: Chapter 51: Structure and Function of the Skin - Page 1272

During finals week, a college student notices an increase in the amount of acne on the face. Which physiological principal is responsible for this acne during times of added stress? Langerhans cells are innervated by sympathetic nerve fibers, which may explain why the skin's immune system is altered under stress. Adherens junctions provide strong mechanical connections between cells and communicate about the presence of neighboring cells. During times of stress, the tonofilaments disconnect, thereby breaking the underlying stability for the epidermis. Merkel cells are neuroendocrine cells that release hormones into the blood in response to neural stimuli.

Langerhans cells are innervated by sympathetic nerve fibers, which may explain why the skin's immune system is altered under stress. Explanation: Langerhans cells are the immunologic cells responsible for recognizing foreign antigens harmful to the body. Langerhans cells are innervated by sympathetic nerve fibers, which may explain why the skin's immune system is altered under stress. The other statements speak to various cells within the skin structures, but are not the reason why students, during times of stress, develop exacerbations of acne. Reference: Chapter 51: Structure and Function of the Skin - Page 1272

The health care provider has just completed a skin assessment on a client. The client asks what causes the numerous freckles that she has. The best response is: Localized collections of eumelanin contribute to the development. They are inherited. If you develop freckles, you will note develop moles. They are more prominent in males rather than females.

Localized collections of eumelanin contribute to the development. Explanation: Exposure to the sun's ultraviolet rays increases the production of eumelanin, a brownish black pigment, which causes tanning to occur. The primary function of such melanin is to protect the skin by absorbing and scattering harmful ultraviolet rays, which are implicated in skin cancers. Localized concentrations of eumelanin are also responsible for the formation of freckles and moles. Reference: Chapter 51: Structure and Function of the Skin - Page 1271-1272

Which component of immune function is absent in the dermis? T cells Lymph nodes Mast cells Macrophages

Lymph nodes Explanation: While macrophages, T cells, fibroblasts, and mast cells are all present in the dermis, lymph nodes are not present in this layer. Reference: Chapter 51: Structure and Function of the Skin - Page 1272

Which immune cells are found in the dermis? Select all that apply. Mast cells T cells Fibroblasts Macrophages Melanocytes

Macrophages T cells Mast cells Fibroblasts Explanation: Immune cells in the dermis include macrophages, T cells, mast cells, and fibroblasts. Melanocytes are not immune cells. Reference: Chapter 51: Structure and Function of the Skin - Page 1274

A nurse educator is instructing students on the importance of a skin assessment to help identify underlying systemic disease. Which assessments are correctly correlated to the identified disease? Select all that apply. Dry, silvery flakes associated with biliary obstruction Cyanosis associated with diabetes mellitus Bronze skin associated with Addison disease Malar rash associated with systemic lupus erythematosus Jaundice associated with liver disease

Malar rash associated with systemic lupus erythematosus Bronze skin associated with Addison disease Jaundice associated with liver disease Explanation: The skin may demonstrate outwardly what occurs inside the body. A number of systemic diseases are manifested by skin disorders (e.g., malar rash associated with systemic lupus erythematous, bronze skin with Addison disease, and jaundice with liver disease). Cyanosis is associated with hypoxia, not diabetes. Reference: Chapter 51: Structure and Function of the Skin - Page 1269

A client expresses concern to the nurse about an area of skin on the chest that has recently turned white and was diagnosed as vitiligo. Which principle best explains the cause of vitiligo to the client?

Melanocytes are destroyed, leading to a complete absence of melanin pigment. Explanation: Vitiligo is the complete absence of melanin pigment in patchy areas of white or light skin on the face, neck, hands, feet, body folds, and around orifices—otherwise the depigmented skin is normal. Reference: Chapter 51: Structure and Function of the Skin - Page 1272

A nurse assesses a client with a 3-cm lipoma in the subcutaneous tissue. Which term would best describe this lesion? Papule Patch Nodule Plaque

Nodule Explanation: A nodule is an elevated, palpable, solid mass with a circumscribed border. Reference: Porth CM (2015). Essentials of Pathophysiology: Concepts of Altered Health States. 4th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, Chapter 45: Structure and Function of the Skin, p. 1148. Chapter 51: Structure and Function of the Skin - Page 1148

A client has sought care for a serious sunburn that resulted from falling asleep at the beach. What physiologic process was involved in the client's overexposure to ultraviolet radiation?

Melanocytes were unable to sufficiently protect that client Explanation: Melanocytes produce a pigment called melanin that is responsible for skin color, tanning, and protecting against ultraviolet radiation. Keratinocytes in the epidermis provide external strength and protection. Merkel cells provide sensory information. Langerhans cells link the epidermis to the immune system. Reference: Chapter 51: Structure and Function of the Skin - Page 1272

Select the cells of the epidermis that are responsible for providing sensory information. Melanocyte cells Keratinocytes Langerhans cells Merkel cells

Merkel cells Explanation: The Merkel cells provide sensory information. Langerhans cells link the epidermis to the immune system, melanocytes provide pigmentation to the skin, and keratinocytes provide a protective function to the skin. Reference: Chapter 51: Structure and Function of the Skin - Page 1272

A client is instructed on the use of moisturizers to relieve dry skin. Which moisturizer is the most effective agent for relieving skin dryness? Creams Occlusives Lotions Humectants

Occlusives Explanation: Moisturizing agents are the cornerstone of treatment for dry skin. These agents exert their effects by repairing the skin barrier, increasing the water content of the skin, reducing transepidermal water loss, and restoring the lipid barrier's ability to attract, hold, and redistribute water. Occlusives are thick creams that contain petroleum or some other moisture-proof material that can form a barrier. They prevent water loss from the skin. They are the most effective agents for relieving skin dryness, but because of their greasiness and lack of cosmetic appeal, some people do not wish to use them. Reference: Porth CM (2015). Essentials of Pathophysiology: Concepts of Altered Health States 4th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, Chapter 45: Structure and Function of the Skin, p. 1151. Chapter 51: Structure and Function of the Skin - Page 1151

The nurse caring for a client with extreme xerosis applies which type of agent to minimize the loss of water from the skin? Occlusives Emollients Humectants Urea lotion

Occlusives Explanation: Occlusives are thick creams that contain moisture-proof material to prevent water loss from the skin. They would be the best treatment option since the other options are not directed toward this treatment goal. Reference: Chapter 51: Structure and Function of the Skin - Page 1276

A nurse is teaching a client about psoriasis. The nurse knows that teaching is effective when the client correctly identifies which lesions as being associated with psoriasis? Select all that apply. Plaques Pustules Cysts Scales Nodules

Plaques Scales Explanation: A plaque is an elevated, palpable, solid mass with a circumscribed border. Scales are flakes secondary to desquamated, dead epithelium that may adhere to skin surface. Their color varies (silvery, white) and their texture varies (thick, fine). Both types of skin lesions can be found with psoriasis. Reference: Chapter 51: Structure and Function of the Skin - Page 1273

While studying the skin in a science class, a student asks why all people have a pinkish color to their lips/mucous membranes. The instructor would respond by stating: Melanocytes are the pigment-synthesizing cells. Pheomelanin is the yellow to red pigment particularly concentrated in the lips and nipples in humans. A person with tiny melanocytes will have more concentrated pigment resulting in darker color. Tyrosinase is responsible for all colored cell production.

Pheomelanin is the yellow to red pigment particularly concentrated in the lips and nipples in humans. Explanation: Pheomelanin, the yellow to red pigment, is found in all humans. It is particularly concentrated in the lips, nipples, glans penis, and vagina. Melanocytes are pigment-synthesizing cells that are scattered in the basal layer and are responsible for skin color (not mucous membranes). Tyrosinase converts the amino acid tyrosine to a precursor of melanin. If a person lacks tyrosinase, the end result will be albinism. In dark-skinned people, larger melanin-containing melanosomes are produced and transferred individually to the keratinocyte. Reference: Chapter 51: Structure and Function of the Skin - Page 1271 - 1272

A boy has arrived home after experiencing his first outdoor camping trip with his Boy Scout troop. Upon arrival at home, he is very uncomfortable and scratches a rash. It appears that he has poison ivy and that it has spread to many areas on his body. The nurse in the clinic will likely prescribe which treatment for this child? Select all that apply. Occlusive ointments with high petroleum content Cool showers, especially right before bedtime Prescription for corticosteroids Over-the-counter antihistamines

Prescription for corticosteroids Cool showers, especially right before bedtime Over-the-counter antihistamines Explanation: Most treatment measures for pruritus are nonspecific. Rubbing using the entire hand helps prevent scratching. Because vasodilation tends to increase itching, cold applications may provide relief. Cool showers before bed may be helpful. Topical corticosteroids may be helpful in some cases. However, systemic antihistamines and corticosteroids may be indicated for people with severe pruritus. Occlusive dressings are thick creams that contain petroleum and can act as a barrier to prevent water loss from the skin. They usually are prescribed for dry skin. Reference: Chapter 51: Structure and Function of the Skin - Page 1277

The first-line treatment for dry skin is moisturizing agents. How do these agents work? Repairing the skin barrier Decreasing pruritis Increasing transepidermal water loss Penetrating the lipid barrier of the skin

Repairing the skin barrier Explanation: Moisturizing agents are the cornerstone of treatment for dry skin. These agents exert their effects by repairing the skin barrier, increasing the water content of the skin, reducing transepidermal water loss, and restoring the lipid barrier's ability to attract, hold, and redistribute water. Reference: Chapter 51: Structure and Function of the Skin - Page 1271fg

Which type of cell is characterized by a complex meshwork of dense collagen bundles interconnected with large elastic fibers and a viscid gel that is rich in mucopolysaccharides? Squamous cells Melanocytes Dendritic cells Reticular cells

Reticular cells Explanation: The reticular dermis (pars reticularis) is the thicker area of the dermis and forms the bulk of the dermal layer. The other three answers are part of the reticular dermis, but it is not characterized by them. Reference: Chapter 51: Structure and Function of the Skin - Page 1273

Select the layer of dermis characterized by a complex meshwork of three-dimensional collagen bundles interconnected with large elastic fibers. Papillary dermis Epidermis Subcutaneous tissue Reticular dermis

Reticular dermis Explanation: The reticular dermis is a complex meshwork of three-dimensional collagen bundles interconnected with large elastic fibers and is the thicker area of the dermis, which forms the bulk of the dermal layer. The papillary layer of the dermis is a thin superficial layer that interdigitates directly with the epidermis. Reference: Chapter 51: Structure and Function of the Skin - Page 1273

While lecturing about frostbite, the instructor asks the students, "Which substance prevents undue evaporation from the stratum corneum during the cold winter weather, which then helps conserve body heat?" The best answer is: A nerve ending Sebum, secreted by the sebaceous gland An eccrine sweat gland A Langerhans cell, which produces antigen-presenting cells

Sebum, secreted by the sebaceous gland Explanation: Sebum lubricates the hair and skin, prevents undue evaporation of moisture from the stratum corneum during cold weather, and helps to conserve body heat. Langerhans cells are dendritic cells that reside principally in the stratum spinosum of the epidermis and play a major role in the functioning of the skin's immune system. Their major function is to phagocytose and process foreign antigens. Most hair follicles are associated with sebaceous glands, and these structures combine to form the pilosebaceous unit. Langerhans cells are not paired with hair follicles, and apocrine, not eccrine, glands are often associated with a hair follicle. Nerve endings are widely distributed throughout the skin, but these are not paired with hair follicles. Reference: Chapter 51: Structure and Function of the Skin - Page 1275

The basement membrane between the epidermis and dermis provides for adhesion and serves which function regarding molecule transportation? Nutritional source Pressure receptor Ground substance Selective filter

Selective filter Explanation: The basal lamina (basement membrane) is a layer of intercellular and extracellular matrices that provides for adhesion and serves as a selective filter for molecules moving between the two layers. The papillary dermis and reticular dermis are composed of cells, fibers, ground substances, nerves, and blood vessels. The dermis supports the epidermis, serves as its primary source of nutrition, and contains encapsulated pressure-sensitive receptors that detect pressure and touch. Reference: Chapter 51: Structure and Function of the Skin - Page 1273

The nurse planning a sun safety community education class should include the information that the increased melanin produced by dark-colored skin decreases the risk for: Skin cancer Acne vulgaris Pruritis Lichenification

Skin cancer Explanation: The increased melanin produced by dark skin decreases the risk for skin cancer, premature wrinkling, and aging of the skin that occurs with sun exposure. Skin color is not a factor when considering the other options. Reference: Chapter 51: Structure and Function of the Skin - Page 1272

Mitosis that results in the production of new epidermal cells occurs in which layer of the epidermis? Stratum spinosum Stratum germinativum Stratum granulosum Stratum lucidum

Stratum germinativum Explanation: The deepest layer of the epidermis, the stratum germinativum (sometimes referred to as stratum basale), consists of a single layer of basal cells that are attached to the basal lamina in the basement membrane. The basal cells are the only epidermal cells that are mitotically active. Reference: Chapter 51: Structure and Function of the Skin - Page 1270

A nurse educator is teaching students about the layers of the skin. Which layer is commonly referred to as prickle cells? Stratum lucidum Stratum granulosum Stratum corneum Stratum spinosum

Stratum spinosum Explanation: The stratum spinosum is formed as the progeny of the basal cell layer move outward toward the skin surface. The stratum spinosum is two to four layers thick, and its cells become differentiated as they migrate outward. Because they develop a spiny appearance where their cell borders interconnect, the cells of this layer are commonly referred to as prickle cells. Reference: Chapter 51: Structure and Function of the Skin - Page 1271

In assessing a client's integumentary system, what assessment finding does the nurse report as "normal"? Increased hair on the inner arms Thin dermis on the back Increased hair on the abdomen Sweat glands in the axillae

Sweat glands in the axillae Explanation: Sweat glands are in the axillae and the anogenital area, and this is a normal finding. There should be decreased or sparse hair on the inner arms and abdomen. The back should have the thickest dermis. Reference: Chapter 51: Structure and Function of the Skin - Page 1275

Most of the skin's blood vessels are innervated by which component of the nervous system? Oculomotor nerve Parasympathetic nervous system Vagus nerve Sympathetic nervous system

Sympathetic nervous system Explanation: Most of the skin's blood vessels are innervated by the sympathetic nervous system. The sweat glands are innervated by cholinergic fibers but controlled by the sympathetic nervous system. Likewise, the sympathetic nervous system controls the arrector pili (pilomotor) muscles that cause elevation of hairs on the skin (pilo- means hair). The parasympathetic nervous system is one of three divisions of the autonomic nervous system. Sometimes called the rest and digest system, the parasympathetic system conserves energy as it slows the heart rate, increases intestinal and gland activity, and relaxes sphincter muscles in the gastrointestinal tract. The vagus nerve (also known as the 10th cranial nerve) is a very long nerve that originates in the brain stem and extends down through the neck and into the chest and abdomen. It supplies innervation to the heart, major blood vessels, airways, lungs, esophagus, stomach, and intestines. The oculomotor nerve is the third of 12 pairs of cranial nerves in the brain. This nerve is responsible for eyeball and eyelid movement. Reference: Chapter 51: Structure and Function of the Skin - Page 1275

Which clients are most likely to have a rash? Select all that apply. A client who has a musculoskeletal disease A client who is in a hot room and has a fever A client who has diabetes A baby that wears a diaper The client with an infectious disease

The client with an infectious disease A baby that wears a diaper A client who is in a hot room and has a fever Explanation: The clients most likely to have a rash of the noted clients are those with an infectious disease, with a fever in a hot room, and the baby with a diaper. Clients with diabetes or a musculoskeletal disease may form a rash; however, they are not the most likely of these choices to have a rash. Reference: Porth, C. M. Essentials of Pathophysiology: Concepts of Altered Health States, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 45: Structure and Function of the Skin, p. 1148. Chapter 51: Structure and Function of the Skin - Page 1148

What is the source of nutrition for the epidermis? Pigment membranes Bullae Melanocytes The dermis

The dermis Explanation: The dermis is the connective tissue layer that separates the epidermis from the subcutaneous fat layer. It supports the epidermis and serves as its primary source of nutrition. Reference: Chapter 51: Structure and Function of the Skin - Page 1273

Which statement best conveys an aspect of the process of keratinization? The basal cells of the epidermis migrate to the skin surface at a rate that matches superficial losses of skin cells. The stratum germinativum continuously produces new keratinocytes to replace losses. Keratin cells synthesized in the dermis migrate to the surface over 20 to 30 days. Mitosis that begins with the cells of the stratum granulosum results in a continual supply of new keratinocytes.

The stratum germinativum continuously produces new keratinocytes to replace losses. Explanation: The stratum germinativum, or stratum basale, consists of a single layer of basal cells that are attached to the basal lamina. The basal cells, which are columnar, undergo mitosis to produce new keratinocytes that move toward the skin surface to replace cells lost during normal skin shedding. Keratinization does not originate in the dermis or stratum granulosum, and the basal cells of the epidermis do not migrate to the surface. Reference: Chapter 51: Structure and Function of the Skin - Page 1271

Which statements are true regarding the skin disorder referred to as a corn? Select all that apply. They result in hyperkeratosis. Their medical name is helomas. They can be either hard or soft. Their location determines whether they are painful. They are well circumscribed.

They are well circumscribed. They can be either hard or soft. Their location determines whether they are painful. Their medical name is helomas. Explanation: Corns (helomas) are small, well-circumscribed, conical, keratinous thickenings of the skin. The corn may be either hard (heloma durum) with a central hard, horny core, or soft (heloma molle), as commonly seen between the toes. Corns on the feet often are painful, whereas corns on the hands may be asymptomatic. A callus is a hyperkeratotic plaque of skin due to chronic pressure or friction. Reference: Chapter 51: Structure and Function of the Skin - Page 1271

The skin is richly supplied with arteriovenous anastomoses in which blood flows directly between an artery and a vein, bypassing the capillary circulation. What is the primarysignificance of these structures? They combat skin infections. They control the formation of "goose bumps." They regulate body temperature. They process sensory information.

They regulate body temperature. Explanation: Anastomoses are important for temperature regulation. They can open up, letting blood flow through the skin vessels when there is a need to dissipate body heat, or close off, conserving body heat if the environmental temperature is cold. Although goose bumps are a reaction to cold, they are actually caused by the contraction of the arrector pili muscles. Reference: Chapter 51: Structure and Function of the Skin - Page 1275

Lichenified skin is defined as being: Chronically irritated, oily, scaly skin Thickened skin with exaggerated markings Depigmentation Oozing, crusted vesiculated skin

Thickened skin with exaggerated markings Explanation: Lichenified skin is thickening and roughening of the skin or accentuated skin markings that may be secondary to repeated rubbing, irritation, or scratching. Reference: Porth, C. M. Essentials of Pathophysiology: Concepts of Altered Health States, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 45: Structure and Function of the Skin, p. 1148. Chapter 51: Structure and Function of the Skin - Page 1148

Lichenified skin is defined as being: Oozing, crusted vesiculated skin Chronically irritated, oily, scaly skin Depigmentation Thickened skin with exaggerated markings

Thickened skin with exaggerated markings Explanation: Lichenified skin is thickening and roughening of the skin or accentuated skin markings that may be secondary to repeated rubbing, irritation, or scratching. Reference: Porth, C. M. Essentials of Pathophysiology: Concepts of Altered Health States, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 45: Structure and Function of the Skin, p. 1148. Chapter 51: Structure and Function of the Skin - Page 1148

The public health nurse is hosting a well-baby clinic. A client with a 1-month old infant asks, "Why are there pimples on my child's forehead? Should I be washing the area more often?" What is the nurse's best response? You should only use mild, nondrying soaps. The acne in newborns is often related to the use of drying soaps and lotions. This type of acne is related to being exposed to the maternal hormones in utero and should begin clearing up soon. These are due to the soft hair called lanugo on your child's forehead. Once the hair transitions, the acne will clear up. Do you keep a hat on your child? Early sun exposure can exacerbate acne forming on newborns, so a hat should be worn.

This type of acne is related to being exposed to the maternal hormones in utero and should begin clearing up soon. Explanation: Acne in newborns is due to maternal hormones that stimulate the sebaceous glands, disappearing after the first few months of life. This skin condition is not related to the presence of lanugo, though both can be present at this age. Sun exposure and type of soap are important teaching points but not likely related to the facial acne that appears at birth. Reference: Chapter 51: Structure and Function of the Skin - Page 1276

What is the purpose of the basement membrane? To protect against infection To nourish the skin To interface between the dermis and epidermis To support the skin surface

To interface between the dermis and epidermis Explanation: The basement membrane is an interface between the dermis and epidermis. Reference: Chapter 51: Structure and Function of the Skin - Page 1273

Why do sebaceous glands secrete sebum? To increase water amounts released via perspiration To supply energy in the form of fibrous protein To supply a nutritional source for vitamin D To lubricate skin and hair

To lubricate skin and hair Explanation: Sebaceous glands secrete sebum—an oily mixture consisting of lipids, including triglycerides, cholesterol, and wax—that lubricates hair and skin. Keratinocytes of the epidermis produce a fibrous protein called keratin, which is essential to the protective function of skin. Sweat glands produce watery secretions. The dermis supports the epidermis and serves as its primary source of nutrition. Reference: Chapter 51: Structure and Function of the Skin - Page 1276

A client of Asian descent requests treatment suggestions for the darkened macules on the face. Which treatment measures for melasma should be recommended? Select all that apply. Consult with a physician about the possibility of surgically removing the macules Try to limit amount of time in the sun Use sunscreen regularly Apply corticosteroid creams to the effective areas at least twice/day Consult a health care provider about using a bleaching agent

Try to limit amount of time in the sun Use sunscreen regularly Consult a health care provider about using a bleaching agent Explanation: Melasma is a disorder characterized by darkened macules on the face. It is common in all skin types, but most prominent in brown-skinned people from Asia, India, and South America. It occurs in men but is more common in women, particularly during pregnancy. It may or may not resolve after giving birth or discontinuing hormonal birth control. Melasma is exacerbated by sun exposure. Treatment measures are palliative, mostly consisting of limiting exposure to the sun and using sunscreens. Bleaching agents containing 2% to 4% hydroquinone are standard treatments. Corticosteroids do not cause the macules to disappear. Surgical treatment is not a standard of care for this skin condition. Reference: Chapter 51: Structure and Function of the Skin - Page 1272

A client of Asian descent requests treatment suggestions for the darkened macules on the face. Which treatment measures for melasma should be recommended? Select all that apply. Use sunscreen regularly Apply corticosteroid creams to the effective areas at least twice/day Try to limit amount of time in the sun Consult with a physician about the possibility of surgically removing the macules Consult a health care provider about using a bleaching agent

Try to limit amount of time in the sun Use sunscreen regularly Consult a health care provider about using a bleaching agent Explanation: Melasma is a disorder characterized by darkened macules on the face. It is common in all skin types, but most prominent in brown-skinned people from Asia, India, and South America. It occurs in men but is more common in women, particularly during pregnancy. It may or may not resolve after giving birth or discontinuing hormonal birth control. Melasma is exacerbated by sun exposure. Treatment measures are palliative, mostly consisting of limiting exposure to the sun and using sunscreens. Bleaching agents containing 2% to 4% hydroquinone are standard treatments. Corticosteroids do not cause the macules to disappear. Surgical treatment is not a standard of care for this skin condition. Reference: Chapter 51: Structure and Function of the Skin - Page 1272

When explaining why some children have albinism, the science teacher explains that which enzyme is needed for synthesis of melanin? Tyrosinase Laminin Pheomelanin Bradykinin

Tyrosinase Explanation: Although there are more than 10 different types of albinism, the most common type is recessively inherited oculocutaneous albinism, in which there is a normal number of melanocytes; however, they lack tyrosinase, the enzyme needed for synthesis of melanin. The lamina lucida consists of fine anchoring filaments and a cell adhesion glycoprotein, called laminin, which plays a role in the organization of the macromolecules in the basement membrane zone and promotes attachment of cells to the extracellular matrix. Many chemicals have been found to produce the itch sensation, including histamine, serotonin, and cytokines. Substances such as bradykinin and bile salts act locally to stimulate the itch sensation. Localized concentrations of eumelanin are also responsible for the formation of freckles and moles. Pheomelanin, a reddish yellow pigment, is particularly concentrated in the lips, nipples, glans penis, and vagina. Reference: Chapter 51: Structure and Function of the Skin - Page 1272

A client visiting the family medical physician is reporting her skin itching [pruritus]. Given that this is severe enough to causing excessive scratching that has broken the skin, the health care provider may want to educate the client to try which intervention? Utilize a heating pad on the worst area to vasodilate vessels, which will bring protective cells to the area faster. Keep the area covered, especially at night. You should wear pajamas so you can't scratch the actual skin while sleeping. Limit taking showers or baths since this will keep the skin dry and could cause more itching. Utilize topical antihistamines or corticosteroids for cutaneous disorders mediated by histamine.

Utilize topical antihistamines or corticosteroids for cutaneous disorders mediated by histamine. Explanation: Mild cutaneous disorders, such as bug bites, are mediated by histamine; therefore, topical antihistamines tend to be the treatment of choice. Topical corticosteroids are effective as antipruritics, particularly when used for urticaria (hives) or insect bites. Because vasodilation tends to increase itching, cold applications may provide relief. Cool showers before bed, light sleepwear, and cool home temperatures also may be helpful. Reference: Porth, C. M. Essentials of Pathophysiology: Concepts of Altered Health States, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Ch. 45: Structure and Function of the Integumentum, p. 1150. Chapter 51: Structure and Function of the Skin - Page 1150

An adolescent reports a small (0.2 cm), round, serous-filled spot at the corner of the mouth. How should the nurse document this finding? Cyst Ulceration Vesicle Fissure

Vesicle Explanation: A vesicle is less than 0.5 cm, circumscribed, elevated, palpable mass containing serous fluid. In this situation, it is caused by herpes simplex, a cold sore. Cysts are encapsulated fluid-filled masses in the subcutaneous tissue. Ulcers are classified as skin loss extending past the epidermis that bleed and cause scarring. Fissure is a linear crack in the skin. Reference: Chapter 51: Structure and Function of the Skin - Page 1271 - 1272

A nurse is preparing for a certification course in wound care and needs to be able to identify various lesions that may be identified when assessing the skin. Which definitions are correctly identified with their skin lesion? Select all that apply. Nodule: Solid, elevated, hard or soft, larger than 0.5 cm circumscribed Bulla: An elevated, circumscribed lesion filled with turbid fluid (pus) Petechiae: Tiny punctate hemorrhages, encapsulated with fluid-filled mass in subcutaneous tissue Papule: A hypertrophic scar Vesicle: A circumscribed, elevated, palpable mass containing serous fluid, <0.5 cm

Vesicle: A circumscribed, elevated, palpable mass containing serous fluid, <0.5 cm Nodule: Solid, elevated, hard or soft, larger than 0.5 cm circumscribed Explanation: Pinpoint spots of petechiae may be blanched (white), erythematous (reddened), hemorrhagic or purpuric (containing blood), or pigmented (colored). A papule is an elevated, palpable, solid mass with a circumscribed border. A bulla is a circumscribed, elevated, palpable mass containing serous fluid. Vesicle: <0.5 cm; Bulla: >0.5 cm. Nodule is an elevated, palpable, solid mass that extends deeper into the dermis than a papule 0.5-2 cm circumscribed.

Which skin disorder is likely to result from the localized lack of melanin production by melanocytes? Bullae Rash Melasma Vitiligo

Vitiligo Explanation: In cases of vitiligo, depigmented areas may contain no melanocytes, greatly altered or decreased amounts of melanocytes, or, in some cases, melanocytes that no longer produce melanin. Melasma results from increased pigmentation. Neither bullae nor rashes are consequences of alteration in melanocyte function. Reference: Chapter 51: Structure and Function of the Skin - Page 1272

An adolescent client of African descent arrives at the dermatology clinic asking, "Why do I have these white (light) patches of skin all over my body. I try sun tanning, but it does not get darker?" The health care provider suspects the teen has developed which skin condition? Albinism caused by a lack of pigmentation in the skin Malignant melanoma due to sun exposure Contact dermatitis caused by using different laundry detergent Vitiligo, lighten skin due to decreased pigment or melanin.

Vitiligo, lighten skin due to decreased pigment or melanin. Explanation: Vitiligo is associated with lighten skin due to decreased pigment or melanin. The melanocytes have been destroyed. Albinism is a genetic lack of tyrosinase, which converts the amino acid tyrosine to a precursor of melanin. Clients with albinism lack of pigmentation in the skin, hair, and iris of the eye. It affects all the skin, not just a patch. Malignant melanoma, which is skin cancer, is a tumor of melanocytes. It presents as a raised area that has irregular borders and is black or brown in color. Contact dermatitis are thickening and roughening of the skin. It itches, so the individual scratches and causes irritation to the skin. Reference: Chapter 51: Structure and Function of the Skin - Page 1271 - 1272

During a physical assessment, a nurse determines that a client has excessively dry skin. Which term would the nurse use to document this condition? Seborrhea Alopecia Pruritus Xerosis

Xerosis Explanation: Dry skin, also called xerosis, may be a natural occurrence, as in the drying of skin associated with aging, or it may be symptomatic of an underlying systemic disease or skin disorder such as contact dermatitis or diabetes mellitus. Reference: Porth CM (2015). Essentials of Pathophysiology: Concepts of Altered Health States. 4th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, Chapter 45: Structure and Function of the Skin, p. 1150. Chapter 51: Structure and Function of the Skin - Page 1150

A skin care consultant informs the client that he needs to bathe and use a soft cloth to remove dead cells on the skin surface. The rationale for this action is based on the fact that: all layers of epidermis undergo rapid mitosis. cells of the stratum spinosum will turn into prickle cells if not removed by bathing. Keratinocytes will turn to fibrous protein tissue if not removed by bathing. a basal cell is mitotically active and pushes older dead cells to the skin's surface.

a basal cell is mitotically active and pushes older dead cells to the skin's surface. Explanation: The basal cells are the only epidermal cells that are mitotically active. All cells of the epidermis arise from this layer. As new cells form in the basal layer, the older cells change shape and are pushed upward toward the skin surface. The second layer, the stratum spinosum, is two to four layers thick. The cells of this layer are commonly referred to as prickle cells because they develop a spiny appearance as their cell borders interact. The keratinocytes are the predominant cell type of the epidermis. They produce a fibrous protein called keratin, which is essential to the protective function of skin and may be involved in the immune system and wound healing. Reference: Chapter 51: Structure and Function of the Skin - Page 1271

A skin care consultant informs the client that he needs to bathe and use a soft cloth to remove dead cells on the skin surface. The rationale for this action is based on the fact that: cells of the stratum spinosum will turn into prickle cells if not removed by bathing. Keratinocytes will turn to fibrous protein tissue if not removed by bathing. all layers of epidermis undergo rapid mitosis. a basal cell is mitotically active and pushes older dead cells to the skin's surface.

a basal cell is mitotically active and pushes older dead cells to the skin's surface. Explanation: The basal cells are the only epidermal cells that are mitotically active. All cells of the epidermis arise from this layer. As new cells form in the basal layer, the older cells change shape and are pushed upward toward the skin surface. The second layer, the stratum spinosum, is two to four layers thick. The cells of this layer are commonly referred to as prickle cells because they develop a spiny appearance as their cell borders interact. The keratinocytes are the predominant cell type of the epidermis. They produce a fibrous protein called keratin, which is essential to the protective function of skin and may be involved in the immune system and wound healing. Reference: Chapter 51: Structure and Function of the Skin - Page 1271

A 42-year-old female client complains of extreme xerosis and states nothing seems to work for her skin. The most appropriate treatment would be to apply: alpha-hydroxy acids to help draw water to the surface. exfoliation products to remove dry skin. emollients or occlusives, as they are the most effective treatment. urea lotion.

emollients or occlusives, as they are the most effective treatment. Explanation: Emollients and occlusives are thick creams or ointments that contain moisture-proof ingredients to prevent water loss from the skin. The other options will increase water loss. Reference: Porth, C. M. Essentials of Pathophysiology: Concepts of Altered Health States, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 45: Structure and Function of the Skin, p. 1151. Chapter 51: Structure and Function of the Skin - Page 1151

A 42-year-old female client complains of extreme xerosis and states nothing seems to work for her skin. The most appropriate treatment would be to apply: emollients or occlusives, as they are the most effective treatment. urea lotion. exfoliation products to remove dry skin. alpha-hydroxy acids to help draw water to the surfac

emollients or occlusives, as they are the most effective treatment. Explanation: Emollients and occlusives are thick creams or ointments that contain moisture-proof ingredients to prevent water loss from the skin. The other options will increase water loss. Reference: Porth, C. M. Essentials of Pathophysiology: Concepts of Altered Health States, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 45: Structure and Function of the Skin, p. 1151. Chapter 51: Structure and Function of the Skin - Page 1151

The nurse notes a blister on a client's skin. Which description best defines this area? fluid-filled papule flat macular rash raised lesion elevated petechiae

fluid-filled papule Explanation: A blister is a vesicle or fluid-filled papule. Petechiae are purplish red spot that appear on the skin as a result of intradermal or submucousal hemorrhage. A macular rash is composed of small, flat blemishes or discoloration that is flush with the skin surface. There are many types of raised lesions and this term does not accurately describe a blister. Reference: Chapter 51: Structure and Function of the Skin - Page 1273

The nurse is assessing a client with darker skin. The nurse is aware that: Select all that apply. verbal histories are important in skin assessment. cyanosis will be easily observed. normal variations in skin tone will not alter the evaluation. it will be difficult to assess skin pallor. erythema will be difficult to observe.

it will be difficult to assess skin pallor. erythema will be difficult to observe. verbal histories are important in skin assessment. Explanation: Normal variations in skin structure and skin tones often make evaluation of dark skin difficult. The darker pigmentation can make skin pallor, cyanosis, and erythema more difficult to observe. Therefore, verbal histories must be relied on to assess skin changes. Reference: Chapter 51: Structure and Function of the Skin - Page 1272

The skin assessment of a black client reveals the presence of white areas on the skin that are flat, nonpalpable, less than 1 cm in diameter, and have a circumscribed border. How does the nurse document the finding? erosion melasma macule petechiae

macule Explanation: A macule is a flat, nonpalpable skin color change that is brown, white, tan, purple, or red and less than 1 cm with a circumscribed border. Reference: Porth, C. M. Essentials of Pathophysiology: Concepts of Altered Health States, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 45: Structure and Function of the Skin, p. 1148. Chapter 51: Structure and Function of the Skin - Page 1148

The skin assessment of a black client reveals the presence of white areas on the skin that are flat, nonpalpable, less than 1 cm in diameter, and have a circumscribed border. How does the nurse document the finding? macule melasma petechiae erosion

macule Explanation: A macule is a flat, nonpalpable skin color change that is brown, white, tan, purple, or red and less than 1 cm with a circumscribed border. Reference: Porth, C. M. Essentials of Pathophysiology: Concepts of Altered Health States, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 45: Structure and Function of the Skin, p. 1148. Chapter 51: Structure and Function of the Skin - Page 1148

The nurse is assessing a client who has a small pinpoint rash. What is the best cause of this rash? Pinpoint lesions Pinpoint petechiae Purpuric lesions Macular papular lesion

pinpoint petechiae Explanation: Small pinpoint spots are usually petechiae. Lesions are traumatic or pathologic loss of normal tissue structure and would not be appropriate to document as a rash. Reference: Porth, C. M. Essentials of Pathophysiology: Concepts of Altered Health States, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 45: Structure and Function of the Skin, p. 1148. Chapter 51: Structure and Function of the Skin - Page 1148

The health care provider has characterized a client's skin lesion as being a temporary eruption but has cautioned the client against repeated rubbing or scratching to avoid lichenization. What is the most likely categorization of the client's skin lesion? corn rash callus blister

rash Explanation: A rash is a temporary eruption of the skin that can result in excoriation or lichenization if rubbed or scratched excessively. Corns, calluses, and blisters are not noted to share these characteristics. Reference: Chapter 51: Structure and Function of the Skin - Page 1270

The skin is richly supplied with arteriovenous anastomoses in which blood flows directly between an artery and a vein, bypassing the capillary circulation. This particular vascular structure allows a client to: prevent localized hypoxia. maximize skin perfusion. form "goose bumps" when cold. regulate body temperature.

regulate body temperature. Explanation: Anastomoses are important for temperature regulation. They can open up, letting blood flow through the skin vessels when there is a need to dissipate body heat, or close off, conserving body heat if the environmental temperature is cold. Although goose bumps are a reaction to cold, they are actually caused by the contraction of the arrector pili muscles. They are not involved specifically in oxygenation. Reference: Chapter 51: Structure and Function of the Skin - Page 1275

A client reports "terrible itching" to the skin regions that are affected by eczema. This client's unpleasant sensation is best understood as a: low-level pain response to noxious stimuli. result of stimulation of free nerve endings. normal adaptive response to a disease process. type IV hypersensitivity reaction.

result of stimulation of free nerve endings. Explanation: Itch is a sensation that originates in free nerve endings in the skin, is carried by small myelinated type C nerve fibers to the dorsal horn of the spinal cord, and is then transmitted to the somatosensory cortex through the spinothalamic tract. Until recently, it was believed that pain and itch traveled along the same nerve pathways and that itch was a low-level pain response, but this is not the case. Pruritus is not considered to be a normal adaptive response and it is not specifically a type IV (delayed) hypersensitivity reaction. Reference: Porth, C. M. Essentials of Pathophysiology: Concepts of Altered Health States, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 45: Structure and Function of the Integumentum, p. 1150. Chapter 51: Structure and Function of the Skin - Page 1150

Which are considered functions of the skin? Select all that apply. Protection from an invasion of microbes Synthesis of vitamin D Regulation of acid-base balance Protection against physical injury Regulation of metabolism

rotection against physical injury Protection from an invasion of microbes Synthesis of vitamin D Explanation: Besides providing a covering for the entire body surface, the skin performs many other functions, including protection against physical injury, sunlight, and microorganisms; prevention of loss of fluids from the internal environment; regulation of body temperature; continual reception of sensations from the environment, such as touch, temperature, and pain; and synthesis of vitamin D through the action of sunlight on the skin. Acid-base regulation occurs primarily in the lungs and kidneys. Metabolic rate is regulated by many hormones, not the skin. Reference: Chapter 51: Structure and Function of the Skin - Page 1276

An older adult client has noticeable dry skin that is rough and scaly. The client is frequently scratching, resulting in cracking and other skin problems. Which intervention(s) would the nurse consider important to discuss with this client? Select all that apply. Use occlusive, petroleum-based creams every morning and night Increase use of glycerin soap for bathing Keep room temperature high enough so the client does not need blankets Use room humidifiers, especially in bed room Apply emollients to the skin surface, applying frequently

se occlusive, petroleum-based creams every morning and night Use room humidifiers, especially in bed room Apply emollients to the skin surface, applying frequently Explanation: Emollients are fatty acid-containing lotions that replenish the oils on the skin surface, but usually do not leave a residue on the skin. They have short duration of action and need to be applied frequently. Using a room humidifier and keeping room temperatures as low as possible to prevent water loss from the skin may be helpful. Glycerin soaps, although popular and visually appealing, are drying and can exacerbate the symptoms. Occlusives are thick, petroleum-based creams that can form a barrier. They prevent water loss from the skin. They are most effective for relieving skin dryness, but because of their greasiness and lack of cosmetic appeal, some people do not wish to use them. Reference: Chapter 51: Structure and Function of the Skin - Page 1271

In explaining a papule to a client, a nurse defines it as being a: small, raised solid mass with a circumscribed border. flat-topped, solid lesion. small abscess. closed, rounded space containing fluid.

small, raised solid mass with a circumscribed border. Explanation: Reference: Porth CM (2015). Essentials of Pathophysiology: Concepts of Altered Health States. 4th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, Chapter 45: Structure and Function of the Skin, p. 1148. Chapter 51: Structure and Function of the Skin - Page 1148