CH. 45 & 46 Pathophysiology
Papulosquamous dermatoses, such as psoriasis, are a group of skin disorders characterized by: A) Scaling papules B)Granular scabbing C) Raised red borders D) Nodular ulcerations
A
When asking pathophysiology students, "Why do sebaceous glands secrete sebum?" the student with the correct answer would be: A) To lubricate skin and hair B) To supply energy in the form of fibrous protein C) To increase water amounts released via perspiration D) To supply a nutritional source for vitamin D
A
When talking to a group of teenagers about ways to protect against skin damage from ultraviolet radiation, the nurse should discuss which of the following tissues/cells? A) Melanocytes B) Langerhans C) Subcutaneous fat D) Protein granule
A
Which of the following actions could result in pressure ulcer formation? A) Pulling a stroke client up in bed B) Turning a client from side to side every 2 hours C) Allowing a client to side up in a chair at mealtime D) Applying powder to buttocks area when diaphoresis has become a problem
A
Which of the following characteristics differentiates apocrine sweat glands from eccrine sweat glands? A) Apocrine secretions contain oils. B) Apocrine secretions help maintain skin pH. C) Apocrine glands are more numerous and widely distributed than eccrine glands. D) Apocrine glands are primarily thermoregulatory.
A
Which of the following disorders of the skin is most likely to respond to treatment with systemic antibiotics? A)Acne vulgaris B)Urticaria C)Atopic dermatitis D)Verrucae
A
While breaking in a new pair of shoes, a client develops a large (1.0 cm) blister filled with clear fluid. The dermatologist 18. diagnoses this as: A) Bullae B) Wheal C) Nodule D) V esicle
A
A 44-year-old man has been brought to the emergency department with severe electrical burns resulting from a workplace accident. The most immediate threat to this client's survival at this time is: A) Infection B) Hemodynamic instability C) Acute pain D) Decreased protein synthesis and impaired healing
B
A thermal burn described as involving the entire epidermis and dermis is classified as: A) Full third degree B) Deep first degree C) Partial second degree D) Full-thickness second degree
D
In science class, a group of sixth graders are "freaked out" when they learn that nails grow continuously and are the end product of which of the following components? A) Hypertrophy of arrector pili muscle B) Anagen follicles C) Telogen phase D) Dead cells pushed outward from the nail matrix
D
Dysplastic nevi are precursors of malignant melanoma that are: A) Larger than other nevi B) Oval epidermal nests C) Dermal cords of cells D) Brown, rounded papules
A
4. One of the best products for extremely dry skin on the elbows would be to apply which type of dressing? A) An occlusive with petroleum material mixed in the cream B) A humectant lotion that contains a á-hydroxy acid C) A lotion that has a corticosteroid in it D) A cream that has a lidocaine product mixed with it
A
A 5-year-old girl has been presented for care by her father due to her recent development of macules on her trunk, extremities, and mucous membranes. The child is mildly febrile, but her primary symptom is extreme pruritus. What disorder of the skin should the clinician who is assessing the child first suspect? A) V aricella B) Lichen planus C) Rosacea D) Impetigo.
A
A dermatologist is explaining to a client the advantages of using a lotion that can draw out water to the skin surface. The nurse knows the technical term for this lotion is a/an: A) Occlusive B) Humectant C) Emollient D) Xerosis
A
A teenager with bullous pemphigoid on the thighs asks, "What causes this blistering?" The best response by the nurse would be:" A) Your body has developed antibodies against basement membrane proteins." B) "You have been eating too much candy with large amounts of triglycerides." C) "The contraction of your arrector pili muscles causes this." D) "The lymph vessels are inflamed and responsible for this enlargement."
A
Dry, itchy plaques on her elbows and knees have prompted a 23-year-old woman to seek care. The clinician has subsequently diagnosed the client with psoriasis, a disorder that results from: A) Increased epidermal cell turnover B) An IgE-mediated immune reaction C) Hormonal influences on sebaceous gland activity D) Human papillomaviruses (HPV)
A
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: A) Meissner corpuscles D) Conical projections C) Prickle cell lesions D) Krause end bulbs
A
Atopic dermatitis can be described as: Select all that apply. A) Vesicle formation B)Oozing C)Round, erythematous papules that enlarge and coalesce D) Raised wheals with associated itching
A,B
A child has been admitted to the burn unit after pulling a pan of hot water off the stove. Given the fact that there is primarily second- and third-degree burns, the health care worker should prioritize care to focus on which of the following? Select all that apply. A) Focus on replacing fluids that have been lost from the vascular, interstitial, and cellular compartments. B) Assess for indications that the child's airway has been compromised by assessing breath sounds and voice quality. C) Maintain sterile field when doing dressing changes and debridement. D) Withhold foods/nutrition since the GI tract may have slowed down in response to stress. E) Minimize pain medication administration to not compromise the child's respiratory effort.
A,B,C
A woman has just delivered a child with a hemangioma on his right cheek area. The mother clutches the nurse and asks, "What is that thing on his face?" The nurse will respond with which of the following facts? Select all that apply. A) "This is usually called a strawberry 'birth mark' and pretty common in newborns." B) "These hemangiomas may grow larger early on followed by a period where the growth is reversed." C) "Most of these hemangiomas will remain with the infant for the rest of his life. However, they are not cancerous." D) "If this birth mark develops ulceration, we will need to keep a close eye on it to prevent any infections." E) "We will keep a close watch on your infant's vision since they can develop malformation of the eye that could develop into glaucoma."
A,B,D
Which of the following would be considered functions of the skin? Select all that apply. A) Protection against physical injury B) Protection from an invasion of microbes C) Regulation of acid-base balance D) Regulation of metabolism E) Synthesis of vitamin D
A,B,E
A client is exhibiting manifestations of superficial dermatophytosis of the skin with skin scaling and nail disintegration. Based on these findings, the nurse can anticipate that the client will be prescribed: Select all that apply. A) An antifungal like ketoconazole B) An antibiotic like tetracycline C) Topical corticosteroid D) An antihistamine like Benadryl
A,C
Which of the following changes are normal in the elderly population? Select all that apply. A) The dermis and epidermis thin as one ages. B) An increase in the amount of subcutaneous tissue. C) A thickening of blood vessels. D) Increased amount of padding on the buttocks. E) Skin may become dry, rough, and scaly.
A,C,E
A client has just received the diagnosis of malignant melanoma, stage 3B. He asks the nurse what this means. The nurse should respond relaying which of the following information? Select all that apply. A) Malignant melanoma is a very rapid growing, aggressive cancer. B) This cancer usually extends wide and deep but rarely metastasize. C) This cancer is mainly contained to the head and neck area. D) Your cancer has grown into the deep tissues and quite likely into lymph nodes (stage 3B).
A,D
A 79-year-old client has been confined to bed after a severe hemorrhagic stroke that has caused hemiplegia. Which of the following measures should his care team prioritize in the prevention of pressure ulcers? A) Prophylactic antibiotics B) Repositioning the client on a scheduled basis C) Applying protective dressings to vulnerable areas D) Parenteral nutrition
B
A client complains to the health care provider that he keeps getting hard skin on the sides of the great and little toes19. when he wears certain pairs of shoes. This is probably caused by ill-fitting shoes putting pressure on certain areas of the foot and would be called a: A) Blister B) Corn C) Callus D) Hematoma
B
A teenager has just been told by the dermatologist that he is high risk for developing skin cancer since he has natural red hair and fair skin. The physiology behind this statement may be due to the: A) Oversecretion of eumelanin, a brown-black pigment that causes tans B) Enhanced photoreactivity of pheomalanin, as compared to eumelanin C) Lack of pheomelanin pigmentation, which protects against skin cancer formation D) Increased susceptibility to photosensitivity due to oversecretion of melanin
B
A teenager reports ugly warts that have invaded her hands. She wants them gone before prom season. The nurse will likely be explaining which of the following treatment measures to this teenager? A) How to apply steroid creams and Band-Aids B)Applying a keratolytic agent like salicylic acid C)Taking a pair of tweezers and pulling the wart off D)How to safely use cryotherapy at home
B
Due to the increasing dryness of her skin in recent years, a 70-year-old woman has needed to reduce the number of baths that she takes. Which of the following factors has resulted in this age-related change in skin function? A) Slower keratinization B) Changes in sebaceous secretions C) Dehydration of epidermal cells D) Increased production of bile salts
B
When asked to name the parts of the pilosebaceous unit of the skin, which student has the correct answer? A)Eccrine secretions B)Sebaceous glands C)Keratinized plates D) Connective tissues
B
When explaining why some children have albinism, the science teacher explains that which enzyme is needed for synthesis of melanin? A) Laminim B) Tyrosinase C) Bradykinin D) Pheomalanin
B
Which of the following clients would be predisposed to developing a yeast-like Candida albicans fungal infection? A) A diabetic male child with circular patches on the arms B) An immunosuppressed cancer client with maculopapular satellite lesions C) A high school football player with fungal spores cultured on the feet D) A dance instructor with a rash on the hands described as raised borders
B
Which of the following clients would experience an accelerated rate of cell division in the stratum germinativum layer? A) A stroke client who is incontinent of stool and bladder B) A motorcycle accident client with large abrasions on the lower limbs C) A young athlete who experienced a torn cartilage in the knee D) A pregnant client who has developed dark purple stretch marks on the abdomen
B
Which of the following statements about temperature regulation and skin is accurate? A) Since the skin is avascular, it is the subcutaneous layer that primarily is responsible for temperature control. B) Arteriovenous anastomoses between an artery and a vein within the skin layer are important for temperature regulation. C) It is primarily the arteries that bring blood from the heart that keeps the body temperature within a normal range. D) The lymphatic system of the skin is primarily responsible for heating and cooling the skin.
B
Which one of the following skin disorders seen in elderly persons is considered a premalignant lesion? A) Cherry angiomas B) Actinic keratosis C) Solar lentigines D) Telangiectases
B
A teenager with rosacea should be educated that in addition to the "blush appearance" on the face, she should also assess for which of the following additional complications? Select all that apply. A)Inflamed and tender axillary lymph nodes B)Eye problems C)Edema of the eyelids D)Large abscesses on the upper arms and neck
B,C
Following a camping trip, a client returns with multiple "bug bites" and skin rashes. The nurse should encourage which of the following interventions to decrease pruritus to prevent further spread of the rashes? Select all that apply. A) Obtain a prescription for opioids, so the client can sleep uninterrupted. B) Rub areas with the hand rather than using long fingernails. C) Take lots of very warm, soothing oatmeal baths. D) Use topical corticosteroid creams. E) Take antihistamines like Benadryl, especially at bedtime.
B<D<E
A 22-year-old male college student has presented to his campus medical clinic distraught at the emergence of numerous 17. small blisters on the shaft of his penis. On examination, the clinician notes that the lesions are between 2 and 4 mm in diameter and are filled with serous fluid. The clinician would document the presence of: A) Pustules B) Macules C) V esicles D) Papules
C
A school 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: A) Merkel cells B) Reticular dermis C) Langerhans cells D) Dermal dendrocytes
C
A skin care consultant informs the client that he needs to bath and use a soft cloth to remove dead cells on the skin surface. The rationale for this action is based on the fact that A) All layers of epidermis undergo rapid mitosis. B) Cells of the stratum spinosum will turn into prickle cells if not removed by bathing. C) A basal cell is mitotically active and pushes older dead cells to the skin's surface. D)Keratinocytes will turn to fibrous protein tissue if not removed by bathing.
C
In third-world countries, many children experience uncontrolled itching and scratching, which may develop into: A) Blisters B) V esicles C) Lichenification D) Ulcers
C
The clinic health care worker notices that a client has a fungal infection on her nails that looks like the fungus is digesting the nail keratin. The nail appears opaque and white in color. The client states she has had this for years. The health care worker suspects the client has: A) Candidiasis B) Cellulitis C) Onychomycosis D) Tinea corporis
C
What process accounts for the damaging effects of the sun's radiation? A) Initiation of an autoimmune response B) Compensatory increases in melanin production C) Damage to epidermal cell DNA and free radical production D) Hyperkeratinization and the formation of microscopic, subcutaneous lesions
C
Which of the following actions involves the greatest risk of skin shearing? A) Inserting a peripheral intravenous catheter B) Rolling the client from a supine to side-lying position C) Pulling the client up in bed D) Helping the client ambulate after surgery
C
Which of the following clinical manifestations would lead the health care provider to diagnose the sunburn as severe? A) Skin is red and warm to touch. B) Some peeling and itching occur several days after the initial burn. C) There is blistering of the skin and associated fever and chills. D) There is a pruritic rash over the sunburned skin area.
C
Which of the following skin disorders is likely to result from the localized lack of melanin production by melanocytes? A) Rash B) Bullae C) Vitiligo D) Melasma
C
The nurse caring for a client with a malignant melanoma should prepare the client for which of the following treatments? Select all that apply. A) Cosmetic surgery to remove the mole without leaving a scar B) Immediate radiation therapy to shrink the tumors C) Surgical excision with lymph node biopsy D) Biologic therapy with interferon alfa-2B
C,D
A 14-year-old presents to the dermatologist clinic with a severe case of acne. The nurse explains that this acne is a result of inflamed A) Follicular bulbs B) Dermal papillae C) Apocrine glands D) Sebaceous glands
D
A client has been admitted to the intensive care unit of the hospital after developing toxic epidermal necrolysis (TEN) consequent to the administration of a sulfonamide antibiotic. What pathophysiologic phenomenon is likely the greatest immediate threat to this client's health? A) The development of bacterial cellulitis on compromised skin surfaces B) Fluid and electrolyte imbalances resulting from the loss skin integrity C) A cascading autoimmune response that may result in shock D) The presence of diffuse lesions and skin sloughing on the client's mucous membranes
D
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 most correct student answer is: A) A Langerhans cell, which produces antigen-presenting cells B) An eccrine sweat gland C) A nerve ending D) Sebum, secreted by the sebaceous gland
D