EXAM 4 : Chapter 51 (Nursing Assessment: Integumentary Function)

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Production of melanin is controlled by a hormone secreted by which of the following?

Hypothalamus

A client with psoriasis visits the dermatology clinic. When inspecting the affected areas, the nurse expects to see which type of secondary lesion?

Scale

The nurse is reading the physician's report of an elderly client's physical examination. The client demonstrates xanthelasma, which refers to which symptom?

Yellowish waxy deposits on the eyelids

Which of the following pigments influences hair color?

Melanin

Which term describes the transfer of heat from the body to a cooler object in contact with it?

Conduction

A patient comes to the clinic and asks the nurse why the skin of the forehead, palms, and soles has a yellow-orange tint. There is no yellowing of the sclera or mucous membranes. What should the nurse question the patient regarding?

"Have you been eating a large amount of carotene-rich foods?"

A client is concerned about finding a few strands of hair on a pillow after sleeping and additional strands on the brush when styling the hair. Which response will the nurse make regarding the client's concern?

"There are approximately 100 strands of hair lost per day."

The hemoglobin level should be evaluated for a patient with cyanosis. The nurse is aware that one of the following levels of deoxygenated hemoglobin is considered a symptom of hypoxemia in an adult male with cyanosis. What is the level?

5 g/100 mL

The nurse has administered a subcutaneous injection of low-molecular-weight heparin to a patient who is recovering from surgery. This injection will be primarily deposited into:

Adipose tissue

While performing perineal care for a female patient who has been recently admitted to the hospital, the nurse notes that the patient's pattern of pubic hair growth is more characteristic of a male's pattern of hair growth. The nurse should know that this could possibly be attributed to:

An endocrine disorder

A 52-year-old client asks the nurse for interventions for the treatment and prevention of actinic ketatosis. The client is a construction foreman and has actinic ketatosis that is noted only on the right side of the face next to the nose. Which recommendation is appropriate for this client?

Avoidance of direct sunlight with protective clothing measures should be discussed with the client.

During a routine examination of a client's fingernails, the nurse notes a horizontal depression in each nail plate. When documenting this finding, the nurse should use which term?

Beau's line

A 29-year-old woman who gave birth to her first child yesterday had a particularly long labor but vaginally delivered a healthy infant. The nurse notes during this morning's assessment that the woman now has petechiae on her face. The nurse should understand that these lesions are a result of what process?

Broken blood capillaries

A little boy is brought to the school nurse after falling off a swing. The nurse is documenting that the boy has bruising on the lateral aspect of his right arm. What term will the nurse use to describe bruising on the skin in documentation?

Ecchymoses

A client has been diagnosed with liver disease. The nurse would expect which skin variation?

Jaundice

The nurse is performing a physical examination of a patient and observes a well-healed old scar on the right shoulder. The scar is hypertrophied, elevated, and irregular without any redness or irritation. The patient states, "I had shoulder surgery about 5 years ago." The nurse documents this finding as which of the following?

Keloid

A patient has contact dermatitis on the hand, and the nurse observes an area that is thickened and rough between the thumb and forefinger. What does the nurse know that this is significant of related to repeated scratching and rubbing?

Lichenification

During assessment of a light-skinned patient, the nurse notices a yellow color present in the sclera of both eyes and the mucous membranes. The nurse knows that this finding could be associated with the presence of:

Liver dysfunction.

Which factor causes wrinkles among older adults?

Loss of subcutaneous tissue

The nurse is preparing to perform a Wood's light examination. Which of the following would be most important for the nurse to do?

Make sure that the room is darkened.

A new patient has come to the dermatology clinic to be assessed for a reddened rash on his abdomen. What diagnostics would be completed to identify the causative allergen?

Patch testing

The nurse is assisting an older adult client with performing activities of daily living (ADL) and is brushing her hair. What does the nurse document as an abnormal finding?

Pearly white substance that is attached to the hair shaft that is not removed with brushing

A patient's skin is examined and the nurse notes the presence of herpes simplex/zoster skin lesions. The nurse describes the lesions as:

Pus-filled vesicles; circumscribed and elevated masses >0.5 cm.

An older adult client's skin has become dry and flaked. Which of the following is the cause of this condition?

Reduction in sebum production

Nursing students are reviewing information about various types of skin lesions. The students demonstrate understanding of the information when they identify which of the following as a vascular lesion?

Spider angioma

The nurse examines a patient and notices a herpes simplex/zoster skin lesion. How does the nurse document this lesion?

Vesicle

A 15 year-old pubescent boy is having a sports physical for school. Findings on the face and body indicate that the client is overproducing sebum, which is consistent with the client's age. What is the primary function of sebum?

prevents drying and cracking of the skin and hair


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