CH 22: Integumentary System

Which statements are true about skin and skin care (select all that apply)? a. One of the detrimental effects of obesity on the skin is increased sweating. b. Ultraviolet (UV) exposure from tanning beds is safer and causes less damage than UV from the sun. c. The nutrient that is critical in maintaining and repairing the structure of epithelial cells is vitamin C. d. Exposure to UV rays is believed to be the most important factor in the development of skin cancer. e. The photosensitivity caused by various drugs can be blocked using topical hydrocortisone. f. Photosensitivity results when certain chemicals in body cells and tissues absorb light from the sun and release energy that harms the tissues and cells.

a, d, f. Obesity affects skin with increased sweating that causes inflammation and dry skin, poor wound healing, and problems in skin folds. Photosensitivity occurs when certain chemicals absorb light from the sun and harm the skin. Benzophenones block both UVA and UVB rays. Vitamin A, not vitamin C, is critical in maintaining and repairing the structure of epithelial cells. Exposure to UV is important in the development of skin cancer. Chronic UV exposure from tanning beds causes the same damage as UV from the sun.

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 herpes virus infections, potassium hydroxide slides are specific for fungal infections, and immunofluorescent studies are specific for infections that cause abnormal antibody proteins.

The patient is visiting the free clinic to refill her medications. During the generalized assessment, the nurse documents alopecia; an increased heart rate; warm, moist, flushed skin; and thin nails. The patient also says she is anxious and has lost weight lately. Which systemic problem will the nurse suspect and relate to the health care provider? a. Hyperthyroidism b. Systemic lupus erythematosus c. Vitamin B1 (thiamine) deficiency d. Human immunodeficiency virus (HIV) infection

a. These manifestations are all present with hyperthyroidism related to accelerated body processes. Alopecia, fatigue, and photosensitivity are seen with systemic lupus erythematosus. Tachycardia, redness of the soles of the feet, and edema are seen with vitamin B1 (thiamine) deficiency. Human immunodeficiency (HIV) infection would more likely manifest as Kaposi sarcoma or eosinophilic folliculitis.

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 sees 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. 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.

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

b. Fissures are linear cracks, such as athlete's foot. Scales are excess dead epidermal cells. A pustule is a circumscribed collection of leukocytes and free fluid. Comedo is associated with acne vulgaris

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, deematous area caused by fluid in the dermis is a wheal.

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.

When assessing a black patient, the nurse notes ashen color of the nail beds. What should the nurse do next? a. Palpate for rashes on the legs. b. Assess for jaundice in the sclera of the eye. c. Assess the mucous membranes for cyanosis. d. Assess for pallor of the skin on the buttocks

c. In dark-skinned persons, cyanosis is seen as ashen nail beds, conjunctiva, or mucous membranes. Vital signs, lung sounds, and cardiorespiratory history would be assessed after verifying cyanosis of mucous membranes. Palpating for rashes and assessing for jaundice and pallor would not be related to this patient's potential cyanosis.

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. Chronic ultraviolet light exposure

c. In older adults, there are decreased surface lipids, apocrine and eccrine sweat gland and sebaceous gland activity, and fewer blood vessels that all cause dry skin. Some older people do not drink enough fluids, and this can also contribute to dry skin. Increased bruising from capillary fragility does not contribute to dry skin. Chronic ultraviolet (UV) light exposure leads to wrinkles.

When obtaining important health information from a patient during assessment of the skin, it is most 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 OTC preparations to treat skin problems. Freckles are common in childhood and are not related to skin disease. Patterns of weight gain and loss are not significant, but the presence of obesity may cause skin problems in overlapping skin areas. Communicable childhood illnesses are not directly related to skin problems, although varicella viruses may affect the skin in adulthood.

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, while 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 that 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 assessed by pinching the skin on the back of the hand.