HSN PrepU
The nails, located on the distal phalanges of the fingers and toes, are composed of
keratinized epidermal cells
While assessing an adult client, the nurse observes freckles on the client's face. The nurse should document the presence of
macules
When assessing for apocrine gland function, the nurse would assess for moisture where on the client's body?
underarms
A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after being in the hospital for 6 weeks. She was treated for sepsis and respiratory failure and had to be on a ventilator for 3 weeks. The nurse is completing an initial assessment and evaluating the client's skin condition. On her sacrum there is full-thickness skin loss that is 5 cm in diameter with damage to the subcutaneous tissue. The underlying muscle is not affected. What is the stage of this pressure ulcer?
3
A nurse is teaching a client how to assess her own skin for possible signs of malignant melanoma. Which of the following should the nurse point out as danger signs associated with skin lesions indicating this disease? Select all that apply.
Asymmetrical Change in size Itching Bleeding of a mole
A mother brings her 5-year-old son who is of African descent to the clinic. The mother is concerned about recent changes in her child's hair color from black to a copper-red. What is the best response by the nurse?
This could be a sign of malnutrition.
A nurse is performing an assessment on a client with a long history of hypothyroidism. What findings would the nurse expect with this client?
patchy, thin hair
A client presents to the health care clinic with reports of changes in the skin. Which data should the nurse document as objective with regards to the skin?
Skin warm and dry to the touch
A client asks a nurse to look at a raised lesion on the skin that has been present for about 5 years. Which is an "ABCDE" characteristic of malignant melanoma?
Asymmetrical shape
A nurse is instructing a client on how to assess himself for herpes simplex lesions by their configuration. Which configuration should the nurse tell the client to look for?
Clustered
When inspecting the hair, what would the nurse note? (Select all that apply.)
Color Condition of hair shaft Hair shafts that are shiny
A nurse receives report from the shift nurse that a client has new onset of peripheral cyanosis. Where should the nurse focus the assessment of the skin to detect the presence of this condition?
Fingers and toes
The student nurse learns that examining the skin can do all of the following except?
Allow early identification of neurologic deficits
A nurse has been assigned a group of clients. Which client is at highest risk for developing skin cancer?
67-year-old White female
Jacob, a 33-year-old construction worker, complains of a "lump on his back" over his scapula. It has been there for about 1 year and is getting larger. He says his wife has been able to squeeze out a cheesy textured substance on occasion. He worries this may be cancer. When gently pinched from the side, a prominent dimple forms in the middle of the mass. What is most likely?
A sebaceous cyst
The terms "generalized," "exposed surfaces," "upper arm," and "skin folds" are used to describe which major characteristic of skin lesions?
Distribution
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
The nurse is caring for a female client with hormone disorder producing excessive testosterone. Which of the following is an expected finding when assessing this client?
Hirsutism
When assessing a client's terminal hair distribution, the nurse inspects all the following areas except:
Palmar surfaces
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 nurse has been assigned several clients on the hospital unit. Which of the following clients is at highest risk for skin breakdown?
a 30-year-old male who sustained a spinal cord injury who is now paraplegic
The nurse is assessing a dark-skinned client who has been transported to the emergency room by ambulance. When the nurse observes that the client's skin appears pale, with blue-tinged lips and oral mucosa, the nurse should document the presence of
a great degree of cyanosis
The apocrine glands are dormant until puberty and are concentrated in the axillae, the perineum, and the
areola of the breast
To assess for anemia in a dark-skinned client, the nurse should observe the client's skin for a color that appears
ashen
What abnormal physical response should the nurse be prepared to manage after noting pallor in a client?
fainting
An adult male client visits the clinic and tells the nurse that he believes he has athletes foot. The nurse observes that the client has linear cracks in the skin on both feet. The nurse should document the presence of
fissures
A nurse performs a focused assessment on a new client. The nurse observes pustules and erythema around the client's hair follicles. The nurse recognizes these are signs and symptoms of which of the following disorders?
folliculitis
The nurse assesses an older adult bedridden client in her home. While assessing the client's buttocks, the nurse observes that a small area of the skin is broken and resembles an erosion. The nurse should document the client's pressure ulcer as
stage II
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