NU271 Week 2 PrepU: Structure and Function of the Skin

Which component of immune function is absent in the dermis? O T cells O Lymph nodes O Mast cells O Macrophages

Lymph nodes Explanation: While macrophages, T cells, fibroblasts, and mast cells are all present in the dermis, lymph nodes are not present in this layer.

The nurse caring for a client with extreme xerosis applies which type of agent to minimize the loss of water from the skin?

Occlusives Explanation: Occlusives are thick creams that contain moisture-proof material to prevent water loss from the skin.

Which statement is the nurse's best description of a wheal?

"It is an elevated mass with irregular borders." Explanation: A wheal is an elevated mass with irregular or transient borders. Hives are often described as "wheals."

A nurse is assessing a client's apocrine sweat glands. Which locations should be looked at?

Axillae Anal area Genitals Explanation: The apocrine sweat glands are confined to the axillae and the anogenital area.

A 70-year-old client has needed to reduce the frequency of bathing due to dry skin. Which factor has resulted in this age-related change in skin function?

Change in composition of sebaceous secretions Explanation: The effects of aging on skin dryness include a change in the composition of sebaceous gland secretions and a decrease in the secretion of moisture from the sweat glands.

An older adult client asks the nurse why her skin is so dry. Which response is best for the nurse to give to this client?

Changes occur in the sebaceous gland. A decrease in skin capillaries occurs. Flattening of the dermal rete ridges occurs. Explanation: The effects of aging on skin dryness include a change in the composition of sebaceous gland secretions and a decrease in the secretion of moisture from the sweat glands. Aging is also accompanied by a decrease in skin capillaries as well as a flattening of the dermal rete ridges, resulting in less surface area for exchange of fluids between the dermis, epidermis, and skin surface.

What are the functions of the epidermis?

Cover the body Protect the body Provide pigment Provide sensory information Explanation: The epidermis covers and protects the body. It provides pigment through melanocyte cells. Melanocytes in the epidermis provide pigment through melanin.

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 Explanation: Given these new findings, it has been postulated that itch exists both locally and centrally and that, in addition to localized itch, an "itch center" exists in the somatosensory cortex.

What is the source of nutrition for the epidermis?

The dermis Explanation: The dermis is the connective tissue layer that separates the epidermis from the subcutaneous fat layer. It supports the epidermis and serves as its primary source of nutrition.

The skin is richly supplied with arteriovenous anastomoses in which blood flows directly between an artery and a vein, bypassing the capillary circulation. What is the primary significance of these structures?

They regulate body temperature. Explanation: Anastomoses are important for temperature regulation. They can open up, letting blood flow through the skin vessels when there is a need to dissipate body heat, or close off, conserving body heat if the environmental temperature is cold. Although goose bumps are a reaction to cold, they are actually caused by the contraction of the arrector pili muscles.

When explaining why some children have albinism, the science teacher explains that which enzyme is needed for synthesis of melanin?

Tyrosinase Explanation: Although there are more than 10 different types of albinism, the most common type is recessively inherited oculocutaneous albinism, in which there is a normal number of melanocytes; however, they lack tyrosinase, the enzyme needed for synthesis of melanin.

A client with a parathyroid tumor has elevated calcium levels and low vitamin D levels. The provider suggests that the client get 15 to 20 minutes of unprotected sunlight per day, if possible. How will the provider explain why this intervention will help raise vitamin D levels for this client?

"A substance called 7-dehydrocholesterol is converted to an inactive form of vitamin D by UV rays from the sun." Explanation: The skin functions as an endocrine organ, in which a substance called 7-dehydrocholesterol is converted to an inactive form of vitamin D by UV rays from the sun.

The nurse is caring for a group of clients in their 80s. How can the nurse best prevent skin tear injuries while caring for these clients?

Avoid manipulation that causes traction on the skin. Explanation: Skin tears result due to the loss of anchoring between the skin layers that occurs due to aging. This places the aging person at risk for shearing injuries when traction is applied to the skin (e.g., when a client's skin is dragged against a bed sheet when repositioning).

What term is usually associated with nail growth?

Continuously Explanation: Like hair, nails are the end product of dead matrix cells that are pushed outward from the nail matrix. Unlike hair, nails grow continuously rather than cyclically.

The nurse is recommending to a client ways to relieve the itching sensation of his uncontrollable pruritis. What should the nurse recommend?

Cool shower Explanation: Cold applications and cool showers/baths should be used for relief and not hot water, which will increase the itch related to vasodilation.

The nurse is caring for a client with pruritis. The nurse anticipates orders for which intervention? O Corticosteroids O Heating pad O Scratching O Glycerin soap

Corticosteroids Explanation: Corticosteroids can help to suppress itching. Glycerin soaps are drying and can exacerbate the symptoms, as can heat. Over time scratching the skin can lead to lichenification.

A client accidentally cuts his hand at work and comes to the clinic for stitches. The nurse understands that the client's immune system will be initially activated by which cells found in the dermis?

Dermal macrophages Explanation: Immune cells found in the dermis include macrophages, T cells, mast cells, and fibroblasts. Dermal macrophages may present antigens to T cells in the dermis. Most of these T cells are previously activated or memory T cells. T-cell responses to macrophage- or endothelium-associated antigens in the dermis are probably more important in generating an immune response to antigen challenge in previously exposed persons than in initiating a response to a new antigen. The major type of T-cell-mediated immune response in the skin is delayed-type hypersensitivity.

The nurse notes a blister on a client's skin. Which description best defines this area?

fluid-filled papule Explanation: A blister is a vesicle or fluid-filled papule. Petechiae are purplish red spot that appear on the skin as a result of intradermal or submucousal hemorrhage. A macular rash is composed of small, flat blemishes or discoloration that is flush with the skin surface. There are many types of raised lesions and this term does not accurately describe a blister.

Which statement concerning hair follicles is true?

Red hair has spherical melanosomes. Explanation: The only true statement is that red hair has spherical melanosomes.

A high school athlete has developed a fungal infection between the toes where it is red, sore, and cracked into the dermis. Which term is the most accurate for the nurse to document in the client's record?

A fissure Explanation: Athlete's foot is caused by a fungus that grows on or in the top layer of skin. Fungi (plural of fungus) grow best in warm, wet places, such as the area between the toes. The linear crack in the skin that extend into the dermis is called fissure, and should be documented as such. A vesicle is less than 0.5 cm, circumscribed, elevated, palpable mass containing serous fluid. Ulcers are classified as skin loss extending past the epidermis that bleed and cause scarring. A pustule is a lesion that is pus-filled.

The nurse is caring for a client with an infection and fever. The client reports feeling chilled and having "goose bumps." The nurse will anticipate what change in the client's assessment findings as a result of this physiologic reaction?

An increase in body temperature Explanation: The physiologic response described results from the contraction of the arrector pili muscle, located deep to the sebaceous gland. This thermoregulatory function causes the contracting of skin, creating "goose bumps," thereby reducing the skin surface area that is available for the dissipation of body heat in an attempt to raise body temperature.

Which structure would likely be present in a hair follicle in a man's groin but not in a follicle on his face?

Apocrine gland Explanation: Apocrine glands are only found in hair follicles in the underarms and groin. All hair follicles contain an erector pili muscle, sebaceous gland, and blood supply in the form of the hair papilla.

The basement membrane, the interface between the epidermis and dermis, is involved in formation of which skin disorders?

Blister formation Explanation: The basement membrane (formerly called basal lamina) is involved in skin disorders that cause bullae or blister formation. The stratum spinosum is two to four layers thick, consisting of cells commonly referred to as prickle cells because they develop a spiny appearance as their cell borders interact. The melanocytes are pigment-synthesizing cells that are located at or in the basal layer, functioning to produce pigment granules called melanin. The papillary dermis lies adjacent to the epidermis and is densely covered with conical projections called dermal papillae.

While breaking in a new pair of shoes, a client develops a large (1 cm) lesion filled with clear fluid. Which term will the health care provider document in the client's chart?

Bullae Explanation: Bullae are large (1 cm or larger in diameter) fluid-filled blisters, whereas vesicles are small (<1 cm in diameter). Nodules are solid marble-like lesions (>0.5 cm) that are deeper and firmer than a papule. A wheal is a somewhat irregular, relatively transient area of localized skin edema, such as a mosquito bite.

A nurse assesses the skin of a client for xerosis based on the fact that it may occur in a susceptible person as a consequence of which case? O Collagen-vascular disease O Diabetes O Hypertension O Hyperlipidemia

Diabetes Explanation: Dry skin, also called xerosis, may be a natural occurrence, as in the drying of skin associated with aging, or it may be symptomatic of an underlying systemic disease or skin disorder such as contact dermatitis or diabetes mellitus. People with diabetes mellitus often experience xerosis especially on the extremities. It is often due to extreme winter weather when there is little humidity in the air. Most cases of dry skin are caused by dehydration of the stratum corneum.

Which definition of a plaque is most accurate?

Elevated, coalesced papules >0.5 cm Explanation: Plaque may be coalesced papules greater than 0.5 cm. Small, flat discolored lesion is a macule patch. Encapsulated, fluid-filled mass is a cyst. Flat, flaky, whitish, detachable fragment of epidermis is related to dandruff, psoriasis, or dry skin.

A 42-year-old female client complains of extreme xerosis and states nothing seems to work for her skin. The most appropriate treatment would be to apply:

Emollients or occlusives, as they are the most effective treatment. Explanation: Emollients and occlusives are thick creams or ointments that contain moisture-proof ingredients to prevent water loss from the skin.

Which layer of the skin contains cells responsible for skin color, tanning, and protection from the sun's ultraviolet radiation?

Epidermis Explanation: The epidermis covers the body. It is specialized in areas to form skin appendages like hair, nails, and glandular structures. Melanocytes in the epidermis layer are responsible for skin color, tanning, and protection against ultraviolet radiation. The dermis layer supports the epidermis and serves as its primary source of nutrition. The basement membrane layer divides the epidermis and dermis layer. The subcutaneous tissue, a layer of loose connective and adipose connective tissues, binds the dermis to the underlying tissues of the body.

Following exposure to poison oak while camping, a 20-year-old male is experiencing pruritis as a consequence of his immune response to irritants in the plant. What physiologic process best accounts for his complaint?

Free nerve endings are initiating an itch-specific signal to the somatosensory cortex. Explanation: It is generally agreed that itch is a sensation that originates in free nerve endings in the skin, is carried by small myelinated type C nerve fibers to the dorsal horn of the spinal cord, and is then transmitted to the somatosensory cortex via the spinothalamic tract.

Age-related melanin deficiency leads to which manifestation?

Graying hair Explanation: Gray hair is the result of a decreased number of melanosome-producing melanocytes.

A parent calls the health care provider reporting the child has red sores on the face, especially around the nose and mouth that have pus/fluid inside and when the sores burst, they develop a honey-colored crust. The parent is asking whether to make an appointment. Which contagious skin lesion does the provider think the child has developed?

Impetigo pustule Explanation: Impetigo is a form of pustule and is primarily described as red sores on the face, especially around a child's nose and mouth, and on the hands and feet. The sores burst and form honey-colored crusts. This is the classic description of impetigo. A vesicle is less than 0.5 cm, circumscribed, elevated, and a palpable mass containing serous fluid. It may be cause by herpes simplex, a cold sore. Poison ivy develops after exposure to the plant out-of-doors and is described as circumscribed, elevated, palpable masses containing serous fluids. Poison ivy usually is a red, itchy rash with swelling, bumps and blisters that can spread by contact. A sebaceous cyst is an encapsulated, fluid-filled or semisolid mass in the subcutaneous tissue and is not considered contagious.

A 40-year-old male client has a congenital syndrome that affects the function of the Langerhans cells of his epidermis. The man's care provider would expect which manifestation of his condition?

Increased susceptibility to infection Explanation: Langerhans cells are the immunologic cells responsible for recognizing foreign antigens harmful to the body. They play an important role in defending the body against foreign antigens.

A client presents with pruritus of the lower extremities. What is the priority nursing assessment?

Inspection for presence of dry skin Explanation: People with dry skin often experience severe pruritus and discomfort, most commonly of the extremities. Other commonly involved areas include the back, abdomen, and waist. Dry skin appears rough and scaly and there may be increased wrinkles or lines. Skin drying also predisposes the skin to scratching, resulting in cracking.

A client is concerned about developing melasma and asks the nurse about risk factors. Which responses are appropriate?

Is common in women Frequently occurs in populations of Asian, Indian, or South American descent Explanation: Melasma is a disorder characterized by darkened macules on the face. It is common in all skin types but most prominent in brown-skinned people from Asia, India, and South America. It occurs in men but is more common in women, particularly during pregnancy or while using oral contraceptives. It may or may not resolve after giving birth or discontinuing hormonal birth control. Melasma is exacerbated by sun exposure.

The nurse is assessing a client with darker skin. The nurse is aware that:

It will be difficult to assess skin pallor. Erythema will be difficult to observe. Verbal histories are important in skin assessment. Explanation: Normal variations in skin structure and skin tones often make evaluation of dark skin difficult. The darker pigmentation can make skin pallor, cyanosis, and erythema more difficult to observe. Therefore, verbal histories must be relied on to assess skin changes.

What is a physiologic basis for albinism?

Lack of tyrosinase Explanation: Although there are more than 10 different types of albinism, the most common type is recessively inherited oculocutaneous albinism, in which there is a normal number of melanocytes but they lack tyrosinase, the enzyme needed for synthesis of melanin.

A client has dry skin, and scratching the dry regions causes some skin flakes to become dislodged. Which cell type makes up the dry skin?

Keratinocytes Explanation: The keratinocyte is the major cell of the epidermis, comprising 95% of the cells of this layer. The epidermis is composed of stratified squamous keratinized epithelium. Melanocytes produce pigments, Merkel cells are sensory cells, and Langerhans cells are immune cells.

A student with a rash goes to the school nurse for evaluation. The nurse suspects the student has contact dermatitis. The primary cell responsible for this delayed-type hypersensitivity reaction is:

Langerhans cells Explanation: As antigen-presenting cells, the Langerhans cells are involved in delayed-type hypersensitivity reactions such as contact dermatitis and other cell-mediated immune responses in the skin; their dendritic processes extend through keratinocytes, forming a network to bind and process antigen. Merkel cells provide sensory information to the skin. In the dermis, the reticular dermis is a complex meshwork of three-dimensional collagen bundles that contain dermal dendrocytes, which have phagocytic properties.

A client is instructed on the use of moisturizers to relieve dry skin. Which moisturizer is the most effective agent for relieving skin dryness?

Occlusives Explanation: Moisturizing agents are the cornerstone of treatment for dry skin. These agents exert their effects by repairing the skin barrier, increasing the water content of the skin, reducing transepidermal water loss, and restoring the lipid barrier's ability to attract, hold, and redistribute water. Occlusives are thick creams that contain petroleum or some other moisture-proof material that can form a barrier. They prevent water loss from the skin. They are the most effective agents for relieving skin dryness, but because of their greasiness and lack of cosmetic appeal, some people do not wish to use them.

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 Explanation: A rash is a temporary eruption of the skin that can result in excoriation or lichenization if rubbed or scratched excessively. Corns, calluses, and blisters are not noted to share these characteristics.

In explaining a papule to a client, a nurse defines it as being a:

Small, raised solid mass with a circumscribed border.

Mitosis that results in the production of new epidermal cells occurs in which layer of the epidermis?

Stratum germinativum Explanation: The deepest layer of the epidermis, the stratum germinativum (sometimes referred to as stratum basale), consists of a single layer of basal cells that are attached to the basal lamina in the basement membrane. The basal cells are the only epidermal cells that are mitotically active.

Lichenified skin is defined as being:

Thickened skin with exaggerated markings Explanation: Lichenified skin is thickening and roughening of the skin or accentuated skin markings that may be secondary to repeated rubbing, irritation, or scratching.

What is the purpose of the basement membrane?

To interface between the dermis and epidermis Explanation: The basement membrane is an interface between the dermis and epidermis.

An adolescent, who is an athlete, asks the health care provider, "Why do I now have such awful body odor? What has changed in my body?" Which response is the best reply?

"Apocrine sweat glands open through a hair follicle and secrete an oily substance that mixes with bacteria on the skin, producing body odor." Explanation: Apocrine sweat glands open through a hair follicle and secrete an oily substance that mixes with bacteria on the skin, producing body odor.

Which statements might the nurse tell a client with pruritus?

"Assess the area for dry skin and apply moisturizing lotion." "Take cool showers before bedtime." "Maintain cool temperatures in the home." "Maintain humidification of the home." Explanation: In order to ease pruritus or itching, the nurse should assess for dry skin and apply cream to lubricate the area for the client. Cool temperatures and cool showers should help as will humidification of the home.

A client has dry skin on both legs and a history of cardiovascular disease. Which interventions should the nurse include in the teaching plan for this client?

"Keep your room temperature as low as possible." "Avoid glycerin soaps." "Apply moisturizers to legs frequently." Explanation: Dry skin, also called xerosis, may be a natural occurrence, as in the drying of skin associated with aging, or it may be symptomatic of an underlying systemic disease. Moisturizing agents are the cornerstone of treatment for dry skin. These agents exert their effects by repairing the skin barrier, increasing the water content of the skin, reducing transepidermal water loss, and restoring the lipid barrier's ability to attract, hold, and redistribute water. Using room humidifiers and keeping room temperatures as low as possible to prevent water loss from the skin also may be helpful. Glycerin soaps are drying and can exacerbate the symptoms.

The pathology instructor asks, "What function do keratinocytes perform in the epidermis?" Which student has the correct answer?

"Keratinocytes in this layer secrete lamellar bodies to provide important water-impermeable properties." Explanation: Keratinocytes in the stratum granulosum layer secrete lamellar bodies into the next layer of the epidermis, the stratum lucidum to provide important water-impermeable properties. Desmosomes are localized patches that hold two cells tight together. The cells of the stratum spinosum become differentiated as they migrate toward the surface of the epidermis. They develop a spiny appearance where their cell borders interconnect to form a layer called prickle cells. Merkel cells provide sensory information.

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." Explanation: The basement membrane is a thin adhesive layer that cements the epidermis to the dermis. This is the layer involved in blister formation. A blister is a vesicle. It is caused by a mechanical origin from friction. Adhesive bandages and gauze can be used to prevent friction blisters. It is inadvisable to break the skin and remove the fluid from the blister because of the risk of secondary infection.

A client shows the nurse an area on his arm where he has repeatedly been giving insulin injections to himself. The nurse feels the area and the skin appears to be thin. The nurse feels a "valley" or indentation in the area. What would the nurse tell the client?

"This is an area of atrophy." Explanation: The area of skin that feels like an indentation is most likely lipoatrophy or atrophied skin due to repeated insulin injections. A hypertrophied area would feel like a "lump." A scar is an actual mark left from a healing wound.

A client reports having pruritus. Which question is most appropriate for the nurse to ask first?

"Where do you feel itching?" Explanation: The first thing the nurse should ask is where the itching is occurring. The nurse could then inspect the area.

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." Explanation: Keloid is hypertrophied scar tissue secondary to excessive collagen formation during the healing process. Mature scars should be white or glistening as replacement of connective tissue forms over the injured tissue. Scales are flakes secondary to desquamated dead epithelium that has adhered to the skin surface.

A skin care consultant informs the client that he needs to bathe and use a soft cloth to remove dead cells on the skin surface. The rationale for this action is based on the fact that:

A basal cell is mitotically active and pushes older dead cells to the skin's surface. Explanation: The basal cells are the only epidermal cells that are mitotically active. All cells of the epidermis arise from this layer. As new cells form in the basal layer, the older cells change shape and are pushed upward toward the skin surface. The second layer, the stratum spinosum, is two to four layers thick. The cells of this layer are commonly referred to as prickle cells because they develop a spiny appearance as their cell borders interact. The keratinocytes are the predominant cell type of the epidermis. They produce a fibrous protein called keratin, which is essential to the protective function of skin and may be involved in the immune system and wound healing.

Which clients would experience an accelerated rate of cell division in the stratum germinativum layer? O A pregnant client who has developed dark purple stretch marks on the abdomen O A young athlete who experienced a torn cartilage in the knee O A motorcycle accident client with large abrasions on the lower limbs O A stroke client who is incontinent of stool and bladder

A motorcycle accident client with large abrasions on the lower limbs Explanation: The deepest layer, the stratum germinativum, consists of a single layer of basal cells that are attached to the basal lamina in the basement membrane zone. The basal cells are the only epidermal cells that are mitotically active. It normally takes 3 to 4 weeks for the epidermis to replicate itself. The rate of cell division in the stratum germinativum is greatly accelerated when the outer layers of the epidermis are stripped away as occurs in abrasions and burns. The outer epidermis, which is avascular, is composed of four to five layers of stratified squamous epithelial cells, predominantly keratinocytes, which are formed in the deepest layer of the epidermis and migrate to the skin surface to replace cells that are lost during normal skin shedding. These are most affected by incontinence. Stretch marks are similar to stratum granulosum cells that have a dark staining granule of keratohyalin.

The nurse assesses a rash on the client's skin. What statement concerning this is true?

A rash is a temporary eruption of the skin. Explanation: The only true statement is that rashes are temporary eruptions of the skin.

Which statement about the structure of the skin is correct?

All five layers of the epidermis lack a blood supply. Explanation: The epidermis is wholly avascular and lacks nerve endings. The epidermis is composed of stratified squamous epithelium, and the dermis is connective tissue.

A frustrated 26-year-old female has sought a referral to a dermatologist in an effort to resolve her sweating and body odor which persist despite good hygiene. Which facts would underlie the explanation that her health care provider provides about her problem?

Apocrine sweat glands produce a substance that is more oily than sweat from other sources. Explanation: Body odor is the result of apocrine sweat gland secretions combining with bacteria to produce a characteristic odor.

What regulates skin temperature?

Arteriovenous anastomoses in the skin regulate temperature. Explanation: The skin is supplied with arteriovenous anastomoses in which blood flows directly between an artery and a vein, bypassing the capillary circulation. These anastomoses are important for temperature regulation.

Which factor is genetically determined and primarily responsible for dark skin tone?

High production of melanin Explanation: Although the number of melanosomes in dark and light skin is the same, dark skin produces more melanin, and more quickly, than light skin.

Which fact accounts for the variation in skin tone that exists among individuals?

Darker-skinned individuals have melanosomes that produce melanin faster. Explanation: The amount of melanin in the keratinocytes determines a person's skin color. Dark-skinned and light-skinned people have the same amount of melanocytes. However, in dark-skinned people, larger melanosomes are produced and transferred to the keratinocyte individually. In light-skinned people, a number of smaller melanosomes are packaged together in a membrane and then transferred to the keratinocyte. The way the melanosomes are packaged is responsible for the pigmentation in darker-skinned persons. Darker-skinned people do not have more melanocytes than light-skinned people, but the production and packaging of pigment is different.

A child with strep throat is given a prescription for penicillin. After the first dose, the parents call to report the development of a skin rash. Which skin lesion description leads the provider to discontinue the medication and encourage them to seek help if the child has trouble breathing? O Encapsulated, fluid-filled masses O Pus-filled vesicle O Flat, nonpalpable, circumscribed skin color change less than 1-cm diameter O Elevated, irregular mass of varying sizes

Elevated, irregular mass of varying sizes Explanation: Elevated, irregular mass of varying sizes can describe urticaria (hives) and may be caused by an allergy to penicillin. Flat, nonpalpable, circumscribed skin color change less than 1-cm diameter is a characteristic of a macule. Pus-filled vesicle describes a pustule and usually associated with acne or impetigo. Encapsulated, fluid-filled masses usually describes a cyst.

A teenager has just been told by the dermatologist that he may be at high risk for developing skin cancer since he has natural red hair and fair skin. What physiology behind this statement is most accurate?

Enhanced photoreactivity of pheomelanin, as compared to eumelanin Explanation: There are two major forms of melanin: eumelanin and pheomelanin. Exposure to the sun's ultraviolet rays increases the production of eumelanin, a brownish black pigment, which causes tanning to occur. An enhanced photoreactivity of the red melanin (pheomelanin) compared to the black melanin (eumelanin) is commonly the explanation as to why fair-skinned individuals are more susceptible to skin cancers. The primary function of such melanin is to protect the skin by absorbing and scattering harmful ultraviolet rays, which are implicated in skin cancers. Localized concentrations of eumelanin are responsible for the formation of freckles and moles. This does not mean that they will develop skin cancer. Pheomelanin, a reddish yellow pigment, provides color to the body when it is concentrated, primarily in the lips, nipples, glans penis, and vaginal areas. Photosensitivity refers to abnormal sensitivity (not reactivity) of the skin to ultraviolet light, usually following exposure to certain oral or topical drugs or to other sensitizing chemicals and resulting in accelerated burning and blistering of the skin. Both types of melanin are found in hair, particularly red hair. It has been suggested that the reason fair-haired individuals are more susceptible to skin cancers may be due to the enhanced photoreactivity of pheomelanin, as compared to eumelanin.

A child arrives to the outpatient clinic with a high fever of 103°F (39.5°C). The parents have the child wrapped in many blankets to "keep them warm, since the child is shivering." What is the rationale for the health care provider to educate the parents that less blankets will help the child more?

Fever dilates vessels and results in sweating, the purpose of the eccrine sweat glands. Too many blankets are counterproductive and will actually help the temperature to go higher." Explanation: An example of negative feedback is body temperature regulation. If blood temperature rises too high, this is sensed by specialized neurons in the hypothalamus of the brain. They signal other nerve centers, which in turn send signals to the blood vessels of the skin. As these blood vessels dilate, more blood flows close to the body surface and excess heat radiates from the body. If this is not enough to cool the body back to its set point, the brain activates sweating. Evaporation of sweat from the skin has a strong cooling effect, as we feel when we are sweaty and stand in front of a fan. Shivering may occur. Each muscle tremor in shivering releases heat energy and helps warm the body back toward its 98.6°F (37°C) set point.

Which stratum layer of the epidermis has cells working to lose cytoplasm and DNA while synthesizing keratin?

Granulosum Explanation: The stratum granulosum contain the most differentiated cells in the living skin, with some cells losing cytoplasm and DNA, while others in this layer synthesize keratin.

A client with chronic renal disease has severe pruritus. Which interventions should the nurse include in the teaching plan for the client?

Keep fingernails trimmed Moisturize the skin frequently Take a cool shower before bed Explanation: Most treatment measures for pruritus are nonspecific. Measures such as using the entire hand to rub over large areas and keeping the fingernails trimmed often can relieve itch and prevent skin damage. Self-limited or seasonal cases of pruritus may respond to treatment measures such as moisturizing lotions, bath oils, and the use of humidifiers. Because vasodilation tends to increase itching, cold applications may provide relief. Cool showers before bed, light sleepwear, and cool home temperatures also may be helpful. Topical corticosteroids may be helpful in some cases, such as itch related to allergy-mediated urticaria.

A nurse is teaching a client about the role that skin plays in forming a barrier to environmental agents and microorganisms. The nurse would recognize that which type of cells/junctions are involved in the communication and regulation of the immune response and the secretions of cytokines?

Keratinocytes Explanation: Keratinocytes are now known to be active secretory cells that play an important role in the immunobiology of the skin by communicating and regulating cells of the immune response and secreting cytokines and inflammatory mediators. Gap junctions allow ions and molecules to pass between skin cells. Adherens junctions provide a mechanical connection between cells. Desmosomes are localized patches or plaques that hold two cells tightly together by proteins called cadherins. They are terminal endpoints on the cell walls of keratinocytes.

Clinical investigation of a 40-year-old female client with diverse dermatologic signs and symptoms has focused on the woman's basement membrane. Which skin function would a clinician most likely attribute to a region of the integument other than the basement membrane?

Lack of sensory nerve impulse conduction Explanation: While the basement membrane plays roles in adhering between skin layers and is a common site of immunoglobulin deposition and blister formation, it is not a major site of afferent nerve endings and consequent sensory transmission.

A physiology educator asks the students, "So what layers keep the epidermis and dermis adhere to each other, rather than freely floating in various directions at the same time?" Which student answer(s) correctly identify the zones between the dermis and epidermis responsible for this interface?

Lamina lucida Lamina fibroreticularis Lamina dens Explanation: Lamina lucida, lamina fibroreticularis, and lamina densa are the three distinct zones or layers of the basement membrane, all of which contribute to the adhesions of the two skin layers. Hemidesmosomes are like half desmosomes in both structure and function. They lie immediately at the basal plasma membrane. They are involved in relaying signals between the skin layers. Collagen is the most abundant protein in the body. It is the major component of connective tissues that make up several body parts, including tendons, ligaments, skin and muscles. Collagen has many important functions, including providing the skin with structure and strengthening ones bones.

Which type of cells form a network to bind and process antigens in the epidermis?

Langerhans cells Explanation: Langerhans cells, the only immune cells in the skin known to be capable of antigen presentation, are star-shaped macrophages in the epidermis; their dendritic processes extend through keratinocytes, forming a network to bind and process antigen. Merkel cells provide sensory information to the skin. In the dermis, the reticular dermis is a complex meshwork of three-dimensional collagen bundles that contain dermal dendrocytes, which have phagocytic properties.

During finals week, a college student notices an increase in the amount of acne on the face. Which physiological principal is responsible for this acne during times of added stress?

Langerhans cells are innervated by sympathetic nerve fibers, which may explain why the skin's immune system is altered under stress. Explanation: Langerhans cells are the immunologic cells responsible for recognizing foreign antigens harmful to the body. Langerhans cells are innervated by sympathetic nerve fibers, which may explain why the skin's immune system is altered under stress.

The health care provider has just completed a skin assessment on a client. The client asks what causes the numerous freckles that she has. The best response is:

Localized collections of eumelanin contribute to the development. Explanation: Exposure to the sun's ultraviolet rays increases the production of eumelanin, a brownish black pigment, which causes tanning to occur. The primary function of such melanin is to protect the skin by absorbing and scattering harmful ultraviolet rays, which are implicated in skin cancers. Localized concentrations of eumelanin are also responsible for the formation of freckles and moles.

Which immune cells are found in the dermis?

Macrophages T cells Mast cells Fibroblasts Explanation: Immune cells in the dermis include macrophages, T cells, mast cells, and fibroblasts.

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 Explanation: A macule is a flat, nonpalpable skin color change that is brown, white, tan, purple, or red and less than 1 cm with a circumscribed border.

A nurse educator is instructing students on the importance of a skin assessment to help identify underlying systemic disease. Which assessments are correctly correlated to the identified disease?

Malar rash associated with systemic lupus erythematosus Bronze skin associated with Addison disease Jaundice associated with liver disease Explanation: The skin may demonstrate outwardly what occurs inside the body. A number of systemic diseases are manifested by skin disorders (e.g., malar rash associated with systemic lupus erythematous, bronze skin with Addison disease, and jaundice with liver disease).

A 51-year-old woman who was born congenitally blind and deaf is able to distinguish individuals by light touch of the individual's face. Which component of the woman's skin innervation likely contributes the most to this ability?

Meissner corpuscles Explanation: Meissner corpuscles are rapidly adapting nerve endings located on the palmar surfaces of the fingers and hands; as such, they would be likely to be involved in fine distinction using the fingers. Ruffini corpuscles are located in the subcutaneous tissue of hairy and glabrous skin, while Pacinian corpuscles detect gross pressure and vibration. Nociceptors detect painful stimuli.

With eyes closed, an object is placed in a student's hand. The instructor asks the student to identify the object. When he does so correctly, this is primarily the responsibility of:

Meissner corpuscles Explanation: Meissner corpuscles are encapsulated mechanoreceptors specialized for tactile discrimination. They are concentrated on the fingertips and palms of the hands, where they account for about half of the tactile receptors. The skin is also supplied by Krause end bulbs, nerve endings contained in a cylindrical or oval capsule. They are found most frequently in the oral cavity, conjunctiva, and genitalia. Although their function is uncertain, they are thought to act as mechanoreceptors and heat detectors. The stratum spinosum is two to four layers thick, consisting of cells commonly referred to as prickle cells because they develop a spiny appearance as their cell borders interact. The papillary dermis lies adjacent to the epidermis and is densely covered with conical projections called dermal papillae.

A client expresses concern to the nurse about an area of skin on the chest that has recently turned white and was diagnosed as vitiligo. Which principle best explains the cause of vitiligo to the client?

Melanocytes are destroyed, leading to a complete absence of melanin pigment. Explanation: Vitiligo is the complete absence of melanin pigment in patchy areas of white or light skin on the face, neck, hands, feet, body folds, and around orifices—otherwise the depigmented skin is normal.

A client has sought care for a serious sunburn that resulted from falling asleep at the beach. What physiologic process was involved in the client's overexposure to ultraviolet radiation?

Melanocytes were unable to sufficiently protect that client Explanation: Melanocytes produce a pigment called melanin that is responsible for skin color, tanning, and protecting against ultraviolet radiation. Keratinocytes in the epidermis provide external strength and protection. Merkel cells provide sensory information. Langerhans cells link the epidermis to the immune system.

What are the cells of the epidermis that are responsible for providing sensory information.

Merkel cells Explanation: The Merkel cells provide sensory information. Langerhans cells link the epidermis to the immune system, melanocytes provide pigmentation to the skin, and keratinocytes provide a protective function to the skin.

A nurse assesses a client with a 3-cm lipoma in the subcutaneous tissue. Which term would best describe this lesion?

Nodule Explanation: A nodule is an elevated, palpable, solid mass with a circumscribed border.

The nurse should rely on verbal history when assessing for which condition in clients with dark skin color?

Pallor Cyanosis Erythema Explanation: The darker pigmentation of people with dark skin color can make skin pallor, cyanosis, and erythema more difficult to observe and therefore it is important that the nurse also relies on verbal history when assessing for skin changes. The textures associated with rashes and acne are not as affected by skin color.

A person with severe lymphedema is asking the nurse where specifically the lymph vessels are located in the skin layers. What would the nurse would respond?

Papillary dermis layer Explanation: Dermal papillae contain capillaries, end arterioles, and venules that nourish the epidermal layers of the skin. This layer of the dermis is richly vascularized. Lymph vessels and nerve tissue also are found in this layer. The basement membrane is a layer of intercellular and extracellular matrices that serves as an interface between the dermis and the epidermis. Merkel cells are connected to afferent nerve terminals, forming a Merkel disk. They are believed to be neuroendocrine cells. Subcutaneous tissue consists of fat cells and connective tissues that lend support to the vascular and neural structures.

A preschooler asks the parents at bath time, "Why are my nipples red?" Which form of melanin is responsible for the coloring of nipples and lips in humans?

Pheomelanin Explanation: Pheomelanin, the yellow to red pigment, is found in all humans. It is particularly concentrated in the lips, nipples, glans penis, and vagina. Eumelanin is abundant in humans. Exposure to the sun's rays increases the production of eumelanin, causing tanning to occur. A desmosome, also known as a macula adherens, is a cell structure specialized for cell-to-cell adhesion. Keratinocytes produce keratin, a complex protein that forms the surface of the skin and is also the structural protein of the hair and nails. Keratinocytes are now known to be active secretory cells that play an important role in the immunobiology of the skin by communicating and regulating cells of the immune response and secreting cytokines and inflammatory mediators.

While studying the skin in a science class, a student asks why all people have a pinkish color to their lips/mucous membranes. The instructor would respond by stating:

Pheomelanin is the yellow to red pigment particularly concentrated in the lips and nipples in humans. Explanation: Pheomelanin, the yellow to red pigment, is found in all humans. It is particularly concentrated in the lips, nipples, glans penis, and vagina. Melanocytes are pigment-synthesizing cells that are scattered in the basal layer and are responsible for skin color (not mucous membranes). Tyrosinase converts the amino acid tyrosine to a precursor of melanin. If a person lacks tyrosinase, the end result will be albinism. In dark-skinned people, larger melanin-containing melanosomes are produced and transferred individually to the keratinocyte.

The nurse is assessing a client who has a small pinpoint rash. What is the best cause of this rash?

Pinpoint petechiae Explanation: Small pinpoint spots are usually petechiae. Lesions are traumatic or pathologic loss of normal tissue structure and would not be appropriate to document as a rash.

A nurse is teaching a client about psoriasis. The nurse knows that teaching is effective when the client correctly identifies which lesions as being associated with psoriasis?

Plaques Scales Explanation: A plaque is an elevated, palpable, solid mass with a circumscribed border. Scales are flakes secondary to desquamated, dead epithelium that may adhere to skin surface. Their color varies (silvery, white) and their texture varies (thick, fine). Both types of skin lesions can be found with psoriasis.

A boy has arrived home after experiencing his first outdoor camping trip with his Boy Scout troop. Upon arrival at home, he is very uncomfortable and scratches a rash. It appears that he has poison ivy and that it has spread to many areas on his body. The nurse in the clinic will likely prescribe which treatment for this child?

Prescription for corticosteroids Cool showers, especially right before bedtime Over-the-counter antihistamines Explanation: Most treatment measures for pruritus are nonspecific. Rubbing using the entire hand helps prevent scratching. Because vasodilation tends to increase itching, cold applications may provide relief. Cool showers before bed may be helpful. Topical corticosteroids may be helpful in some cases. However, systemic antihistamines and corticosteroids may be indicated for people with severe pruritus. Occlusive dressings are thick creams that contain petroleum and can act as a barrier to prevent water loss from the skin. They usually are prescribed for dry skin.

What are the functions of the skin?

Protection against physical injury Protection from an invasion of microbes Synthesis of vitamin D Explanation: Besides providing a covering for the entire body surface, the skin performs many other functions, including protection against physical injury, sunlight, and microorganisms; prevention of loss of fluids from the internal environment; regulation of body temperature; continual reception of sensations from the environment, such as touch, temperature, and pain; and synthesis of vitamin D through the action of sunlight on the skin.

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. Explanation: Anastomoses are important for temperature regulation. They can open up, letting blood flow through the skin vessels when there is a need to dissipate body heat, or close off, conserving body heat if the environmental temperature is cold. Although goose bumps are a reaction to cold, they are actually caused by the contraction of the arrector pili muscles. They are not involved specifically in oxygenation.

The first-line treatment for dry skin is moisturizing agents. How do these agents work?

Repairing the skin barrier Explanation: Moisturizing agents are the cornerstone of treatment for dry skin. These agents exert their effects by repairing the skin barrier, increasing the water content of the skin, reducing transepidermal water loss, and restoring the lipid barrier's ability to attract, hold, and redistribute water.

A client reports "terrible itching" to the skin regions that are affected by eczema. This client's unpleasant sensation is best understood as a:

Result of stimulation of free nerve endings. Explanation: Itch is a sensation that originates in free nerve endings in the skin, is carried by small myelinated type C nerve fibers to the dorsal horn of the spinal cord, and is then transmitted to the somatosensory cortex through the spinothalamic tract.

Which type of cell is characterized by a complex meshwork of dense collagen bundles interconnected with large elastic fibers and a viscid gel that is rich in mucopolysaccharides?

Reticular cells Explanation: The reticular dermis (pars reticularis) is the thicker area of the dermis and forms the bulk of the dermal layer.

What is the layer of dermis characterized by a complex meshwork of three-dimensional collagen bundles interconnected with large elastic fibers?

Reticular dermis Explanation: The reticular dermis is a complex meshwork of three-dimensional collagen bundles interconnected with large elastic fibers and is the thicker area of the dermis, which forms the bulk of the dermal layer. The papillary layer of the dermis is a thin superficial layer that interdigitates directly with the epidermis.

While lecturing about frostbite, the instructor asks the students, "Which substance prevents undue evaporation from the stratum corneum during the cold winter weather, which then helps conserve body heat?" The best answer is:

Sebum, secreted by the sebaceous gland Explanation: Sebum lubricates the hair and skin, prevents undue evaporation of moisture from the stratum corneum during cold weather, and helps to conserve body heat. Langerhans cells are dendritic cells that reside principally in the stratum spinosum of the epidermis and play a major role in the functioning of the skin's immune system. Their major function is to phagocytose and process foreign antigens. Most hair follicles are associated with sebaceous glands, and these structures combine to form the pilosebaceous unit. Langerhans cells are not paired with hair follicles, and apocrine, not eccrine, glands are often associated with a hair follicle. Nerve endings are widely distributed throughout the skin, but these are not paired with hair follicles.

The basement membrane between the epidermis and dermis provides for adhesion and serves which function regarding molecule transportation?

Selective filter Explanation: The basal lamina (basement membrane) is a layer of intercellular and extracellular matrices that provides for adhesion and serves as a selective filter for molecules moving between the two layers. The papillary dermis and reticular dermis are composed of cells, fibers, ground substances, nerves, and blood vessels. The dermis supports the epidermis, serves as its primary source of nutrition, and contains encapsulated pressure-sensitive receptors that detect pressure and touch.

The nurse planning a sun safety community education class should include the information that the increased melanin produced by dark-colored skin decreases the risk for:

Skin cancer Explanation: The increased melanin produced by dark skin decreases the risk for skin cancer, premature wrinkling, and aging of the skin that occurs with sun exposure.

A nurse educator is teaching students about the layers of the skin. Which layer is commonly referred to as prickle cells?

Stratum spinosum Explanation: The stratum spinosum is formed as the progeny of the basal cell layer move outward toward the skin surface. The stratum spinosum is two to four layers thick, and its cells become differentiated as they migrate outward. Because they develop a spiny appearance where their cell borders interconnect, the cells of this layer are commonly referred to as prickle cells.

In assessing a client's integumentary system, what assessment finding does the nurse report as "normal"?

Sweat glands in the axillae Explanation: Sweat glands are in the axillae and the anogenital area, and this is a normal finding. There should be decreased or sparse hair on the inner arms and abdomen. The back should have the thickest dermis.

Most of the skin's blood vessels are innervated by which component of the nervous system?

Sympathetic nervous system Explanation: Most of the skin's blood vessels are innervated by the sympathetic nervous system. The sweat glands are innervated by cholinergic fibers but controlled by the sympathetic nervous system. Likewise, the sympathetic nervous system controls the arrector pili (pilomotor) muscles that cause elevation of hairs on the skin (pilo- means hair). The parasympathetic nervous system is one of three divisions of the autonomic nervous system. Sometimes called the rest and digest system, the parasympathetic system conserves energy as it slows the heart rate, increases intestinal and gland activity, and relaxes sphincter muscles in the gastrointestinal tract. The vagus nerve (also known as the 10th cranial nerve) is a very long nerve that originates in the brain stem and extends down through the neck and into the chest and abdomen. It supplies innervation to the heart, major blood vessels, airways, lungs, esophagus, stomach, and intestines. The oculomotor nerve is the third of 12 pairs of cranial nerves in the brain. This nerve is responsible for eyeball and eyelid movement.

Which clients are most likely to have a rash? Select all that apply. O A client who has a musculoskeletal disease O A client who is in a hot room and has a fever O A client who has diabetes O A baby that wears a diaper O The client with an infectious disease

The client with an infectious disease A baby that wears a diaper A client who is in a hot room and has a fever Explanation: The clients most likely to have a rash of the noted clients are those with an infectious disease, with a fever in a hot room, and the baby with a diaper.

What statement is true concerning the skin?

The skin is the largest organ of the body. Explanation: The only true statement is that the skin is the largest organ of the body.

Which statement best conveys an aspect of the process of keratinization?

The stratum germinativum continuously produces new keratinocytes to replace losses. Explanation: The stratum germinativum, or stratum basale, consists of a single layer of basal cells that are attached to the basal lamina. The basal cells, which are columnar, undergo mitosis to produce new keratinocytes that move toward the skin surface to replace cells lost during normal skin shedding.

Describe the skin disorder referred to as a corn.

They are well circumscribed. They can be either hard or soft. Their location determines whether they are painful. Their medical name is helomas. Explanation: Corns (helomas) are small, well-circumscribed, conical, keratinous thickenings of the skin. The corn may be either hard (heloma durum) with a central hard, horny core, or soft (heloma molle), as commonly seen between the toes. Corns on the feet often are painful, whereas corns on the hands may be asymptomatic. A callus is a hyperkeratotic plaque of skin due to chronic pressure or friction.

The public health nurse is hosting a well-baby clinic. A client with a 1-month old infant asks, "Why are there pimples on my child's forehead? Should I be washing the area more often?" What is the nurse's best response?

This type of acne is related to being exposed to the maternal hormones in utero and should begin clearing up soon. Explanation: Acne in newborns is due to maternal hormones that stimulate the sebaceous glands, disappearing after the first few months of life.

The pars reticularis is characterized by what?

Three-dimensional collagen bundles Explanation: The reticular dermis (pars reticularis) is the thicker area of the dermis and forms the bulk of the dermal layer.

Why do sebaceous glands secrete sebum?

To lubricate skin and hair Explanation: Sebaceous glands secrete sebum—an oily mixture consisting of lipids, including triglycerides, cholesterol, and wax—that lubricates hair and skin. Keratinocytes of the epidermis produce a fibrous protein called keratin, which is essential to the protective function of skin. Sweat glands produce watery secretions. The dermis supports the epidermis and serves as its primary source of nutrition.

A client of Asian descent requests treatment suggestions for the darkened macules on the face. Which treatment measures for melasma should be recommended?

Try to limit amount of time in the sun Use sunscreen regularly Consult a health care provider about using a bleaching agent Explanation: Melasma is a disorder characterized by darkened macules on the face. It is common in all skin types, but most prominent in brown-skinned people from Asia, India, and South America. It occurs in men but is more common in women, particularly during pregnancy. It may or may not resolve after giving birth or discontinuing hormonal birth control. Melasma is exacerbated by sun exposure. Treatment measures are palliative, mostly consisting of limiting exposure to the sun and using sunscreens. Bleaching agents containing 2% to 4% hydroquinone are standard treatments.

An older adult client has noticeable dry skin that is rough and scaly. The client is frequently scratching, resulting in cracking and other skin problems. Which intervention(s) would the nurse consider important to discuss with this client?

Use occlusive, petroleum-based creams every morning and night Use room humidifiers, especially in bed room Apply emollients to the skin surface, applying frequently Explanation: Emollients are fatty acid-containing lotions that replenish the oils on the skin surface, but usually do not leave a residue on the skin. They have short duration of action and need to be applied frequently. Using a room humidifier and keeping room temperatures as low as possible to prevent water loss from the skin may be helpful. Glycerin soaps, although popular and visually appealing, are drying and can exacerbate the symptoms. Occlusives are thick, petroleum-based creams that can form a barrier. They prevent water loss from the skin. They are most effective for relieving skin dryness, but because of their greasiness and lack of cosmetic appeal, some people do not wish to use them.

A client visiting the family medical physician is reporting her skin itching [pruritus]. Given that this is severe enough to causing excessive scratching that has broken the skin, the health care provider may want to educate the client to try which intervention?

Utilize topical antihistamines or corticosteroids for cutaneous disorders mediated by histamine. Explanation: Mild cutaneous disorders, such as bug bites, are mediated by histamine; therefore, topical antihistamines tend to be the treatment of choice. Topical corticosteroids are effective as antipruritics, particularly when used for urticaria (hives) or insect bites. Because vasodilation tends to increase itching, cold applications may provide relief. Cool showers before bed, light sleepwear, and cool home temperatures also may be helpful.

An adolescent client of African descent arrives at the dermatology clinic asking, "Why do I have these white (light) patches of skin all over my body. I try sun tanning, but it does not get darker?" The health care provider suspects the teen has developed which skin condition?

Vitiligo, lighten skin due to decreased pigment or melanin. Explanation: Vitiligo is associated with lighten skin due to decreased pigment or melanin. The melanocytes have been destroyed. Albinism is a genetic lack of tyrosinase, which converts the amino acid tyrosine to a precursor of melanin. Clients with albinism lack of pigmentation in the skin, hair, and iris of the eye. It affects all the skin, not just a patch. Malignant melanoma, which is skin cancer, is a tumor of melanocytes. It presents as a raised area that has irregular borders and is black or brown in color. Contact dermatitis are thickening and roughening of the skin. It itches, so the individual scratches and causes irritation to the skin.

An adolescent reports a small (0.2 cm), round, serous-filled spot at the corner of the mouth. How should the nurse document this finding?

Vesicle Explanation: A vesicle is less than 0.5 cm, circumscribed, elevated, palpable mass containing serous fluid. In this situation, it is caused by herpes simplex, a cold sore. Cysts are encapsulated fluid-filled masses in the subcutaneous tissue. Ulcers are classified as skin loss extending past the epidermis that bleed and cause scarring. Fissure is a linear crack in the skin.

Which skin disorder is likely to result from the localized lack of melanin production by melanocytes?

Vitiligo Explanation: In cases of vitiligo, depigmented areas may contain no melanocytes, greatly altered or decreased amounts of melanocytes, or, in some cases, melanocytes that no longer produce melanin. Melasma results from increased pigmentation. Neither bullae nor rashes are consequences of alteration in melanocyte function.

During a physical assessment, a nurse determines that a client has excessively dry skin. Which term would the nurse use to document this condition?

Xerosis Explanation: Dry skin, also called xerosis, may be a natural occurrence, as in the drying of skin associated with aging, or it may be symptomatic of an underlying systemic disease or skin disorder such as contact dermatitis or diabetes mellitus.