prep U 14
Connecting the skin to underlying structures is/are the
SubQ tissue
T/F: Local redness of the skin warns of impending necrosis.
T
What is the most important focus area for the integumentary system?
UV radiation exposure
A golden yellow pigment that is heavily keratinized and is found in subcutaneous fat is called what?
carotene
What abnormal physical response should the nurse be prepared to manage after noting pallor in a client?
fainting
A client tells the nurse about a raised lesion on the client's leg. What is the nurse's first nursing action?
inspect the area
While assessing an adult client, the nurse observes freckles on the client's face. The nurse should document the presence of
macules
A nurse in a dermatology clinic cares for an adolescent client with multiple purulent, fluid-filled lesions on her face, shoulders, back, and chest. What is the most likely medical diagnosis for this client?
pustular acne
To assess an adult client's skin turgor, the nurse should
use two fingers to pinch under the clavicle
A nurse observes the presence of hirsutism on a female client. The nurse should perform further assessment on this client for findings associated with which disease process?
Cushing's disease
Recommended protective measures to avoid skin cancer include which of the following?
avoiding sun exposure
The nurse should use which assessment tool to assess the client's risk for skin breakdown?
braden scale
While assessing the skin of an older adult client, the nurse observes that the client has small yellowish brown patches on her hands. The nurse should instruct the client that these spots are
caused by aging skin in older adults
A nurse is working with a 13-year-old boy who complains that he has begun to sweat a lot more than he used to. He asks the nurse where sweat comes from. The nurse knows that sweat glands are located in which layer of skin?
dermis
Hair follicles, sebaceous glands, and sweat glands originate from the
dermis
Which layer of the skin contains blood vessels, nerves, sebaceous glands, lymphatic vessels, hair follicles, and sweat glands?
dermis
The terms "generalized," "exposed surfaces," "upper arm," and "skin folds" are used to describe which major characteristic of skin lesions?
distribution/location
A nurse cares for a client of Asian descent and notices that the client sweats very little and produces no body odor. What is an appropriate action by the nurse in regards to this finding?
normal finding
A client tells the clinic nurse that his feet and lower legs turn a blue color. On assessment, the nurse notes that the client's oxygenation level is within normal levels. The nurse knows that the blue color the client described is caused by what?
peripheral cyanosis
A young man comes to the clinic with an extremely pruritic rash over his knees and elbows, which has come and gone for several years. It seems to be worse in the winter and improves with some sun exposure. Examination reveals scabbing and crusting with some silvery scales. The nurse also notices small "pits" in the nails. What would account for these findings?
psoriasis
An adult client is having his skin assessed. The client tells the nurse he has been a heavy smoker for the last 40 years. The client has clubbing of the fingernails. What does this finding tell the nurse?
the client has chronic hypoxia
Which area of the body should a nurse inspect for possible loss of skin integrity when performing a skin examination on a female who is obese?
under the breast
Which of the following is an important function of the skin?
vitamin D synthesis
To assess for anemia in a dark-skinned client, the nurse should observe the client's skin for a color that appears
ashen
The apocrine glands are dormant until puberty and are concentrated in the axillae, the perineum, and the
areola of the breast
A nurse inspects a client's skin and notices several flat, brown color change areas on the forearms. What is the proper term for documentation of this finding by the nurse?
macule
A client visits the clinic for a routine physical examination. The nurse prepares to assess the client's skin. The nurse asks the client if there is a family history of skin cancer and should explain to the client that there is a genetic component with skin cancer, especially
malignant melanoma
An adult male client visits the outpatient center and tells the nurse that he has been experiencing patchy hair loss. The nurse should further assess the client for:
symptoms of stress
What light should the nurse use to inspect a lesion on the thigh of a client for the presence of fungus?
woods light
The nurse is preparing to perform a physical examination of a client who is an Orthodox Jew. Which of the following accommodations should the nurse be prepared to make for this client, based on his religious beliefs?
have a nurse who is the same sex as him examine him
What clinical manifestation of the nails should the nurse anticipate assessing in a client with iron deficiency anemia?
spooning
T/F: A decrease in oxyhemoglobin will result in documentation of pallor.
t
A client recovering from a burn injury is told by the health care provider that hair will no longer grow on the body part that was burned. When the client questions why this is true, the nurse will base the response on what physiological event that occurred as a result of the burn?
destruction of hair follicles in dermis layer
The nurse is beginning the examination of the skin of a 25-year-old teacher. She previously visited the office for evaluation of fatigue, weight gain, and hair loss. The previous clinician had a strong suspicion that the client has hypothyroidism. What is the expected moisture and texture of the skin of a client with hypothyroidism?
dry and rough
An adult white client visits the clinic for the first time. During assessment of the client's skin, the nurse should assess for central cyanosis by observing the client's
oral mucosa
The nurse is conducting a skin assessment on a client who suffered a burn injury. The client's wound exhibits rapid capillary refill, is moist, red, and painful. What depth of burn should the nurse document?
superficial
The nurse is admitting a 79-year-old man for outpatient surgery. The client has bruises in various stages of healing all over his body. Why is it important for the nurse to promptly document and report these findings?
the client may have been abused
A nurse is interviewing a client regarding her lifestyle and health practices to obtain subjective information to assist in her assessment of her skin. She asks her, "Do you spend long periods of time sitting or lying in one position?" Which of the following is the best rationale for asking this question?
to determine risk for pressure ulcers
Short, pale, and fine hair that is present over much of the body is termed
vellus