Lewis Chapter 23 Integumentary System

What is the most common diagnostic test used to determine a causative agent of skin infections? a. Culture b. Tzanck test c. Immunofluorescent studies d. Potassium hydroxide (KOH) slides

a. A culture can be performed to distinguish among fungal, bacterial, and viral infections. A Tzanck test is specific for herpesvirus infections, potassium hydroxide slides are specific for fungal infections, and immunofluorescent studies are specific for infections that cause abnormal antibody proteins.

A woman calls the health clinic and describes a rash that she has over the abdomen and chest. She tells the nurse it has raised, fluid-filled, small blisters that are distinct. a. Identify the type of primary skin lesion described by this patient. b. What is the distribution terminology for these lesions? c. What additional information does the nurse need to document the critical components of these lesions?

a. vesicles; b. discrete, localized to the chest and abdomen. c. color, size, and configuration

A home health nurse is visiting an older obese woman who has recently had hip surgery. She tells the patient's caregiver that the patient has intertrigo. When the caregiver asks what that is, the nurse should tell the caregiver that it is a. thickening of the skin. b. dermatitis in the folds of her skin. c. loss of color in diffuse areas of her skin. d. a firm plaque caused by fluid in the dermis.

b. Intertrigo is dermatitis in the folds of her skin. Thickening of the skin is lichenification. Loss of color in diffuse areas of skin is vitiligo. A firm plaque caused by fluid in the dermis is a wheal.

An active athletic person calls the clinic and describes her feet as having linear breaks through the skin. What is the most likely diagnosis of this problem? a. Scales b. Fissure c. Pustule d. Comedo

b. Scales are excess dead epidermal cells. A pustule is a circumscribed collection of leukocytes and free fluid. Comedo is associated with acne vulgaris.

The patient asks the nurse what telangiectasia looks like. Which is the best description for the nurse to give the patient? a. A circumscribed, flat discoloration b. Small, superficial, dilated blood vessels c. Benign tumor of blood or lymph vessels d. Tiny purple spots resulting from tiny hemorrhages

b. Telangiectasia looks like small, superficial, dilated blood vessels. A small circumscribed, flat discoloration describes a macule. A benign tumor of blood or lymph vessels describes an angioma. Tiny purple spots resulting from tiny hemorrhages describes petechiae.

A patient has a plaque lesion on the dorsal forearm. Which type of biopsy is most likely to be used for diagnosis of the lesion? a. Punch biopsy b. Shave biopsy c. Incisional biopsy d. Excisional biopsy

b. A shave biopsy is done for superficial lesions that can be scraped with a razor blade, removing the full thickness of the stratum corneum. An excisional biopsy is done when the entire removal of a lesion is desired. Punch biopsies are done with larger nodules to examine for pathology, as are incisional biopsies.

The nurse observes that redness remains after palpation of a discolored lesion on the patient's leg. This finding is characteristic of a. varicosities. b. intradermal bleeding. c. dilated blood vessels. d. erythematous lesions.

b. Discolored lesions that are caused by intradermal or subcutaneous bleeding do not blanch with pressure, whereas those caused by inflammation and dilated blood vessels will blanch and refill after palpation. Varicosities are engorged, dilated veins that may empty with pressure applied along the vein.

When the nurse is assessing the skin of an older adult, which factor is likely to contribute to dry skin? a. Increased bruising b. Excess perspiration c. Decreased extracellular fluid d. Decreased peripheral blood supply

c. In older adults the dermis loses volume and has fewer blood vessels, which contributes to decreased extracellular water. Some older people do not drink enough fluids and this can also contribute to dry skin. In older adults there are also decreased surface lipids and apocrine and sebaceous gland activity. Increased bruising from capillary fragility does not contribute to dry skin.

When obtaining important health information from a patient during assessment of the skin, it is important for the nurse to ask about a. a history of freckles as a child. b. patterns of weight gain and loss. c. communicable childhood illnesses. d. skin problems related to the use of medications.

d. A careful medication history is important because many medications cause dermatologic side effects and patients also use many over-the-counter preparations to treat skin problems. Freckles are common in childhood and are not related to skin disease. Communicable childhood illnesses are not directly related to skin problems, although varicella viruses may affect the skin in adulthood. Patterns of weight gain and loss are not significant but the presence of obesity may cause skin problems in overlapping skin areas.

What is the primary difference between an excoriation and an ulcer? a. Ulcers do not penetrate below the epidermal junction. b. Excoriations involve only thinning of the epidermis and dermis. c. Excoriations will form crusts or scabs whereas ulcers remain open. d. An excoriation heals without scarring because the dermis is not involved.

d. An excoriation is a focal loss of epidermis; it does not involve the dermis and, as such, does not scar with healing. Ulcers do penetrate into and through the dermis and scarring does occur with these deeper lesions. Epidermal and dermal thinning is atrophy of the skin but does not involve a break in skin integrity. Both excoriations and ulcers have a break in skin integrity and may develop crusts or scabs over the lesions.

Priority Decision: When performing a physical assessment of the skin, what should the nurse do first? a. Palpate the temperature of the skin with the fingertips. b. Assess the degree of turgor by pinching the skin on the forearm. c. Inspect specific lesions before performing a general examination of the skin. d. Ask the patient to undress completely so all areas of the skin can be inspected.

d. It is necessary for the patient to be completely undressed for an examination of the skin. Gowns should be provided and exposure minimized as the skin is inspected generally first, followed by a lesion-specific examination. Skin temperature is best assessed with the back of the hand and turgor is best assessed with the skin over the sternum.