NU271 Patho/Pharm-Skin Integrity
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?
"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.
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."
Which statement concerning blood flow to the skin is true?
Arteriovenous anastomoses in the skin regulate temperature.
The nurse has completed an assessment of a client and noted a hyperkeratotic plaque of skin that resulted from chronic pressure or friction. The nurse would document this as:
Callus
The basement membrane separates the epithelium from the underlying connective tissue. Which function does it play regarding skin disorders like blister formation?
Complement deposition
Which are the sparsest cells in the epidermis?
Merkel Cells
A nurse assesses a client with a 3-cm lipoma in the subcutaneous tissue. Which term would best describe this lesion?
Nodule
The nurse is assessing a client who has a small pinpoint rash. What is the best cause of this rash?
Pinpoint petechiae
Select the layer of dermis characterized by a complex meshwork of three-dimensional collagen bundles interconnected with large elastic fibers.
Reticular dermis
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?
Somatosensory cortex
A nurse educator is teaching students about the layers of the skin. Which layer is commonly referred to as prickle cells?
Stratum spinosum
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.
Sunlight Microorganisms Cigarette smoke
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
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?
rash
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:
regulate body temperature.
