Chapter 22 - Integumentary Assessment (Med Surg) EAQ's

A nurse is obtaining a specimen of the epidermis for a skin test. What is the maximum thickness of skin that should be scraped off? Record your answer to the first decimal point. Record your answer using one decimal place. Use a leading zero if applicable. ____ mm

0.1 The epidermis is the outermost layer of the skin. The thickness of the epidermis is 0.05 to 0.1 mm. Therefore the nurse should scrape a very thin layer of the skin for the test, the thickness of which should not exceed 0.1 mm. Text Reference - p. 405

A nurse educator explains to a group of nursing students why skin becomes darker in color when exposed to sunlight. Which statement by a student indicates the teaching has been understood? 1 "The rays from the sun stimulate the production of melanin, giving a tan to the skin." 2 "The rays from the sun inhibit the production of melanin, causing the skin to darken." 3 "The rays from the sun burn the outer layer of the skin, making the skin dark and painful." 4 "The rays from the sun cause increased blood flow to the skin, giving a dark red color to the skin."

1 - "The rays from the sun stimulate the production of melanin, giving a tan to the skin." Sunlight stimulates an organelle known as melanosome, which is present in the melanocytes (the cells responsible for production of melanin). Stimulation of melanosome causes increased production of melanin, which gives the dark color (tan) to the skin. Extreme sun exposure can burn the skin, and the skin may become dark and painful due to sunburns. Heat in summer causes vasodilatation, which causes temporary reddening of the skin. Text Reference - p. 395

A nurse is performing a skin assessment on a patient. How should the nurse assess the turgor of the skin? 1 By palpating the skin of the patient 2 By pinching the patient's skin below the clavicle 3 By observing the patient's skin for any scaling or flaking 4 By placing the back of the hand over the patient's forehead

2 - By pinching the patient's skin below the clavicle Turgor refers to the elasticity of the skin. It is assessed by pinching the area under the clavicle. Scaling or flaking of the skin indicates skin dryness. The nurse can assess the texture of the skin by palpating the skin of the patient. The nurse can assess the body temperature of the patient by touching the patient's forehead using the back of the hand. Text Reference - p. 401

A nurse is teaching a group of nursing students about the perception of cold in obese people. Which statement should be included in the education? 1 Obese people have fewer cold receptors. 2 Obese people have better fat insulation. 3 Obese people have better cold tolerance. 4 Obese people have an abnormal hypothalamic functioning.

2 - Obese people have better fat insulation. Obese people have large amounts of subcutaneous adipose tissue. This tissue provides good thermal insulation. Obesity alone does not cause individuals to have fewer cold receptors, better cold tolerance, or abnormal hypothalamic functioning. Text Reference - p. 395

A nurse is caring for a patient who has taken a potassium hydroxide (KOH) skin test. The results of the test are positive. What would be the interpretation of this test? 1 The patient has a skin allergy. 2 The patient has a malignant skin condition. 3 The patient has a fungal infection of the skin. 4 The patient has systemic lupus erythematosus (SLE).

3 - The patient has a fungal infection of the skin. The KOH test indicates the presence of a fungal infection. The KOH test cannot be used to establish the presence of skin allergy, malignant skin condition, or SLE. A skin allergy is best tested with the patch test. The diagnosis of a malignant skin condition is done by a skin biopsy. Direct immunofluorescence is a special diagnostic technique used on a biopsy specimen to confirm SLE. Text Reference - p. 405

A nurse is assessing a male client who reports small papules and pustules in the beard area. The papules started appearing after he shaved his beard the previous day. Based on this information, what is the most likely patient diagnosis? 1 Acne 2 Moles 3 Comedo 4 Pseudofolliculitis

4 - Pseudofolliculitis Pseudofolliculitis is an inflammatory reaction that occurs in the beard area after shaving too closely. This inflammation is a response to the in-growth of hair after shaving and is manifested as pustules or papules. Acne is also characterized by papules and pustules but is unlikely to occur in the beard area after shaving. Acne is usually due to an infection or hormonal changes. Moles are small, dark lesions caused by benign overgrowth of melanocytes. Comedos (blackheads and whiteheads) are enlarged hair follicles that are plugged with sebum, bacteria, and skin cells. They may occur due to heredity, drugs, or hormonal changes. Text Reference - pp. 403, 405

Which of these techniques are appropriate when the nurse is performing a physical examination of a patient's skin? Select all that apply. 1 Assessing for skin color changes. 2 Using a flashlight in a poorly lit room. 3 Pressing on a lesion to check for blanching. 4 Checking skin temperature by palpating with the palm of the hand. 5 Performing a lesion-specific examination first and then a general inspection.

1 - Assessing for skin color changes. 3 - Pressing on a lesion to check for blanching. Assess the skin for changes in color; color change is a critical factor in assessment of the skin. For lesions, note the reaction to direct pressure. If a lesion blanches on direct pressure and then refills, the redness is caused by dilated blood vessels. If the discoloration remains, it is the result of subcutaneous or intradermal bleeding or a nonvascular lesion. The examination should take place in a private room with good lighting; exposure to daylight is preferred. Temperature of the patient's skin is best assessed using the back of your hand. Perform a general inspection and then a lesion-specific examination. Text Reference - p. 400

Which medication is most likely to have an effect on the patient's integumentary system? 1 Diuretic 2 Corticosteroid 3 Benzodiazepine 4 Calcium channel blocker

2 - Corticosteroid Corticosteroids can have unwanted integumentary side effects, such as telangiectasia. Integumentary effects are less likely to occur with benzodiazepines, calcium channel blockers, and diuretics. Text Reference - p. 398

A nurse is conducting a class on the physiology of the integumentary system for a group of nursing students. To test the students' knowledge, the nurse asks them the reason for the greying of hair. What are appropriate responses? Select all that apply. 1 Decrease in the production of melanin 2 Increase in the production of melanin 3 Increase in the number of melanocytes 4 Decrease in the number of melanocytes 5 Decreased exposure to sun in old age

1 - Decrease in the production of melanin 4 - Decrease in the number of melanocytes With aging, the number of melanocytes decreases, causing a decrease in melanin production. An increase in the number of melanocytes causes an increase in the production of melanin, which is characterized by tanning of skin and darkening of hair. Exposure to sun is not related to the greying of hair. Text Reference - p. 397

A nurse is discussing the health changes associated with aging with a group of older adults in a community clinic. One of the members of the group asks about dry skin and aging. The nurse explains that, in the elderly population, dry skin comes with aging due to what? Select all that apply. 1 Decreased production of sebum. 2 Decreased immunocompetence. 3 Decreased subcutaneous fat tissue. 4 Decreased blood supply to the skin. 5 Decreased water content in the body.

1 - Decreased production of sebum. 5 - Decreased water content in the body. Dry skin comes with aging because of decreased activity of the sweat and sebaceous glands. Sebum is a lipid-rich substance that prevents the skin and hair from becoming dry. Decreased water content in the skin is another important cause for drying of skin in old age. A decrease in immune functioning with aging increases the patient's susceptibility to infections. A decrease in subcutaneous fat content as a person ages causes wrinkling of skin and inelasticity of fibrous tissue of breasts and abdomen. A decreased blood supply causes a pale appearance and low temperature of the extremities. Text Reference - p. 397

Which data would a nurse consider least important during an assessment of skin integrity? 1 Family history of pressure ulcers 2 Presence of existing pressure ulcers 3 Overall risk as indicated by a low Braden score 4 Areas at risk for the development of pressure ulcers

1 - Family history of pressure ulcers Family history is not an important factor in the development of pressure ulcers and general skin integrity. A patient deemed to be at risk on the basis of a validated tool such as the Braden scale and existing areas of skin breakdown requires immediate assessment and intervention. Text Reference - p. 397

A patient is scheduled for a Wood's lamp test. What is the most appropriate way for the nurse to prepare the room? 1 Keep the room dark. 2 Soundproof the room. 3 Keep the room well lit. 4 Keep an infrared lamp in the room.

1 - Keep the room dark. Wood's lamp test involves the examination of the skin with long-wave ultraviolet light that gives a bright appearance to specific substances. This test is used to diagnose the presence of Pseudomonas infection, fungal infection, and vitiligo. The nurse should keep the room dark for this test. Keeping the room well lit or using an infrared lamp is not appropriate because it will make it harder for the nurse to conduct the diagnosis. There is no need to soundproof the room; the test being conducted is a skin exam, not an auditory exam. Text Reference - p. 405

The nurse is assessing a white patient's skin color and notices cyanosis. Where on the patient's body would the nurse most likely see this cyanosis? 1 Lips 2 Legs 3 Wrists 4 Sclera

1 - Lips On light-skinned individuals, cyanosis, or grayish blue tone, initially appears in lips, nail beds, earlobes, mucous membranes, palms of the hands, and soles of the feet. It is not as likely on the legs, wrists, or sclera. Text Reference - pp. 403, 404

To assess the skin turgor, the most appropriate technique for the nurse to use is which of these? 1 Palpation 2 Inspection 3 Percussion 4 Auscultation

1 - Palpation Turgor refers to the elasticity of the skin. Assess turgor by gently pinching an area of skin under the clavicle or on the back of the hand. Skin with good turgor should move easily when lifted and should immediately return to its original position when released. Inspection, percussion, and auscultation are not useful for assessing skin turgor. Text Reference - p. 401

Which process should a nurse follow when obtaining a wound culture from a surgical site? 1 Rolling a sterile swab from the center of the wound outward 2 Using a sterile swab, starting on the outer edge of the wound 3 Thoroughly irrigating the wound before collecting the culture 4 Using a sterile swab to wipe the crusted area around the outside of the wound

1 - Rolling a sterile swab from the center of the wound outward Rolling the swab from the center outward is the correct procedure for culturing a wound. Starting on the outer edge of the wound, irrigating the wound before collecting the culture specimen, and using a sterile swab to wipe the crusted area may contaminate the wound, produce inaccurate results, or both. Text Reference - p. 405

The nurse is caring for a patient with a superficial lesion. Which biopsy is best suited for this patient? 1 Shave biopsy 2 Punch biopsy 3 Incisional biopsy 4 Excisional biopsy

1 - Shave biopsy A shave biopsy is the process where a single-edged razor is used to shave off a superficial lesion. Because the lesion is not deep, a superficial, thin specimen is sufficient for the biopsy. A punch biopsy is used when the full thickness of the skin is needed for diagnostic purpose. The instrument is rotated to an appropriate level to include the dermis and some fat. An incisional biopsy is performed for lesions too large for an excisional biopsy. It useful when a larger specimen is needed than that obtained by a shave or punch biopsy. An excisional biopsy is the removal of the entire lesion. An excisional biopsy is done for cosmetic purposes or when removal of the entire lesion is not required. Text Reference - p. 405

A nurse is giving a lecture on nutrition to a group of nursing interns. The nurse says that sunlight is the best source of vitamin D. Based on their previous knowledge, what would be the most appropriate interpretation of this statement by the interns? 1 Sunlight stimulates the production of vitamin D in the body. 2 Sunlight contains vitamin D, which is easily absorbed by the skin. 3 Exposure to sunlight increases craving for foods rich in vitamin D. 4 Sunlight causes proliferation of the cells containing vitamin D precursors.

1 - Sunlight stimulates the production of vitamin D in the body. The ultraviolet (UV) rays present in sunlight act on the vitamin D precursors present in epidermal cells and form Vitamin D. Sunlight does not contain vitamin D. Exposure to sunlight does not increase craving for foods rich in Vitamin D. The UV rays do not help in proliferation of Vitamin D precursors but simply convert them to vitamin D. Text Reference - p. 396

A nurse educator is teaching a group of nursing students about skin assessments. The nurse asks the students the reason for assessment of cyanosis, pallor, and jaundice in the nail beds, sclera, and lips. What is the most appropriate response by the students? 1 These areas have the least pigmentation. 2 These areas have the highest blood flow. 3 These areas are rich in sensory receptors. 4 These areas are the most accessible to a nurse.

1 - These areas have the least pigmentation. Cyanosis, pallor, and jaundice all indicate the presence of systemic diseases. The most reliable areas for assessing these signs are nail beds, lips, sclerae, and conjunctivae, because these areas contain the least amount of pigmentation. As a result, changes in color can be easily identified. The nail beds, sclera, and lips are easily accessible; however, that is not a reason for the choice of the area during color assessment. These areas may not have high blood flow or a high amount of sensory receptors. Text Reference - p. 400

During the change-of-shift report, the outgoing nurse reports a new finding of petechiae in a new patient admitted with a yet-to-be diagnosed hematologic disorder. On assessment of this patient, what should the incoming nurse expect to find? 1 Tiny, purple spots on the skin 2 Large ecchymotic areas on the skin 3 Hyperkeratotic papules and plaques 4 Small, raised red areas on the soles of the feet

1 - Tiny, purple spots on the skin Petechiae present as tiny, purple spots on the skin. Large ecchymotic areas are purpura. Hyperkeratotic papules and plaques characterize actinic keratosis. Small, raised red areas on the soles of the feet signify Osler's nodes. Text Reference - p. 404

The nurse is teaching a patient about the skin's ability to synthesize vitamin D when exposed to sunlight. Which instructions should the nurse include? Select all that apply. 1 Vitamin D is synthesized by the action of ultraviolet (UV) light. 2 The papillary layer helps in activating the precursors to vitamin D. 3 Ultraviolet rays act on vitamin D precursors present in the epidermis. 4 The reticular layer of the dermis plays an important role in vitamin D synthesis. 5 Endogenous synthesis of vitamin D is critical for calcium and phosphorus balance.

1 - Vitamin D is synthesized by the action of ultraviolet (UV) light. 3 - Ultraviolet rays act on vitamin D precursors present in the epidermis. 5 - Endogenous synthesis of vitamin D is critical for calcium and phosphorus balance. Vitamin D can be synthesized endogenously by the skin on exposure to sunlight. Endogenous synthesis of vitamin D, which is critical to calcium and phosphorus balance, occurs in the epidermis. Vitamin D is synthesized by the action of UV light on vitamin D precursors in epidermal cells. The papillary and reticular layers of dermis make no contribution to the endogenous synthesis of vitamin D. Text Reference - p. 396

A nurse is reviewing a plan of care for a female patient with acne vulgaris. The plan includes a prescription for isotretinoin. The nurse is aware that before the patient begins taking the medication, what must be determined? 1 Whether the patient is pregnant 2 Whether the patient is over 50 years of age 3 Whether the patient is suffering from any systemic illness 4 Whether the patient's work involves prolonged exposure to the sun

1 - Whether the patient is pregnant The drug isotretinoin is teratogenic, which means that the drug can cause abnormal fetal development. Therefore, this drug is contraindicated in pregnant women. Patients who are over 50 years of age do not usually have acne, and the drug is not contraindicated in these patients. Isotretinoin can be safely used by patients having a systemic illness or by those who usually work outdoors in the sun. Text Reference - p. 400

While conducting a skin assessment, the nurse observes that the patient's skin does not return to its normal position after pinching. What is the appropriate nursing intervention in this situation? 1 Administer prescribed antibiotics to the patient. 2 Administer water and electrolytes to the patient. 3 Check the patient for abnormal levels of hormones. 4 Check the patient for abnormal levels of hemoglobin.

2 - Administer water and electrolytes to the patient. Tenting is a condition where the skin does not return to its normal state after pinching. It is caused by dehydration. Administering water and electrolytes to the patient will resolve the problem. Antibiotics and other medications must be administered when there is an infection. Conditions that occur due to infection include intertrigo, hypopigmentation, alopecia, and cysts. Hemoglobin levels are assessed in cases of cyanosis. Abnormal hormone levels cause abnormal hair growth. Hirsutism is an example of such a case. Text Reference - pp. 401-402

Inspection of an obese female patient reveals the presence of a foul odor that emanates from the patient's abdominal skin folds. What should the nurse most suspect to be the cause of the odor? 1 Ecchymosis 2 Colonization by yeast or bacteria 3 Age-related integumentary changes 4 Atrophy of the skin under the abdominal folds

2 - Colonization by yeast or bacteria Unusual foul odors, especially those found in intertriginous areas, are often the result of colonization by yeast or bacteria. Ecchymosis is the presence of bruising. An unusual odor would not normally be attributed to age-related changes or skin atrophy. Text Reference - p. 401

A nurse is performing a skin assessment on a female patient. The patient has excessive hair on the chest and the face. The nurse expects that what test will be performed? 1 Skin biopsy 2 Estrogen test 3 Thyroid function test 4 Blood test to determine clotting time

2 - Estrogen test The patient has excessive chest and facial hair. A male-pattern distribution of hair in women is known as hirsutism. This condition is caused by a reduction of estrogen levels in females. Thus the patient should be referred to take an estrogen test. Skin biopsy is required to detect skin cancer. Patients having a yellow skin indicative of carotenemia (without yellowing of the sclera) should take a thyroid test because carotenemia is caused by hypothyroidism. A patient who has a hematoma should be referred to take a blood test to determine the clotting time (prothrombin test) because hematoma can be caused by bleeding disorders. Text Reference - p. 403

A nurse is assessing a patient who has yellow skin and nails. Which chemical or pigment abnormality does the nurse expect the patient to have? 1 Excess melanin 2 Excess carotenes 3 Excess oxyhemoglobin 4 Excess deoxyhemoglobin

2 - Excess carotenes Excess carotene in the body gives a yellow color to the skin. Excess melanin in the body gives a brown color to the skin. Excess oxyhemoglobin gives a red color to the skin. Excess deoxyhemoglobin gives a blue color to the skin. Text Reference - p. 403

On assessment, a linear crack from the epidermis to the dermis is noted at the corner of the patient's mouth. How should the nurse document this finding? 1 Scar 2 Fissure 3 Atrophy 4 Excoriation

2 - Fissure The secondary skin lesion, called a fissure, is a linear crack or break from the epidermis to the dermis and can be dry as in athlete's foot or moist as in cracks at the corner of the mouth. A scar is an abnormal formation of connective tissue that replaces normal skin when a wound heals. Atrophy is a depression in skin resulting from thinning of the epidermis or dermis. Excoriation is an area in which the epidermis is missing, which exposes dermis (e.g., abrasion or scratch). Text Reference - pp. 399, 402

A teenaged patient reports having blackheads all over the face for the past year. The nurse recognizes that, for this patient, the blackheads are due to excessive sebum production most likely caused by what? 1 Infections 2 Hormonal alterations 3 Environmental changes 4 Sebaceous gland carcinoma

2 - Hormonal alterations Hormonal changes occurring during puberty stimulate the sebaceous glands to produce more sebum. This plays a major role in causing acne and the development of comedones (blackheads). Infections, environmental alterations, and sebaceous gland carcinoma may also cause comedones but are less likely in this case. Text Reference - p. 403

When assessing a dark-skinned patient, the nurse finds that there are dark longitudinal bands in the patient's nail beds. What is the most likely interpretation of this finding? 1 The patient may have psoriasis. 2 It is a normal finding in this patient. 3 Anemia may be present in this patient. 4 The patient may have a thyroid disorder.

2 - It is a normal finding in this patient. Dark longitudinal bands (melanonychia striata) in the nail bed are a common occurrence in people with darker skin pigmentation. In conditions related to thyroid disorders, anemia, and psoriasis, there are changes in the thickness and smoothness of the nail bed. Text Reference - p. 396

The patient has diffuse distribution of moles on the body. A biopsy of one on the patient's back will be done to assess for malignancy. The nurse knows that what is the rationale for doing a punch biopsy? 1 It is used for a superficial lesion. 2 It provides a full-thickness of skin. 3 It is used for good cosmetic results. 4 It is used because the lesion is too large to remove.

2 - It provides a full-thickness of skin. The punch biopsy provides full-thickness skin for diagnostic purposes. A shave biopsy is used for a superficial lesion or when only a small sample is needed for diagnostic purposes. An excisional biopsy is used when a good cosmetic result is desired. An incisional biopsy is a wedge-shaped incision made in a lesion that is too large for an excisional biopsy. It is useful when a larger specimen is needed than a shave or punch biopsy can provide. Text Reference - p. 405

Which disease condition can be found more in fair-skinned patients than in patients with more pigmentation in their skin? 1 Keloids 2 Melanoma 3 Nevus of ota 4 Traction alopecia

2 - Melanoma Fair-skinned people are more prone to developing melanoma as compared to people with more pigment in their skin. People with darker skin have an increased amount of melanin pigment produced by the melanocytes. This increased melanin forms a natural sun shield for darker skin tones and results in a decreased incidence of skin cancer in these individuals. However, individuals with dark skin may have increased incidence of keloids, nevus of ota, and traction alopecia. Text Reference - p. 399

When jaundice is suspected in a patient, which areas should the nurse check for skin color? Select all that apply. 1 Tongue 2 Nail beds 3 Earlobes 4 Conjunctiva 5 Buccal mucosa

2 - Nail beds 4 - Conjunctiva 5 - Buccal mucosa Changes in skin color may vary from one person to another. The skin color depends on the amount of melanin, carotene, oxyhemoglobin, and reduced hemoglobin present at a particular time. The most reliable areas to assess for erythema, cyanosis, pallor, and jaundice are the sclerae, conjunctivae, nail beds, lips, and the buccal mucosa, as these areas are the least pigmented. The tongue and earlobes are not reliable areas to assess for skin color. Text Reference - p. 404

The nurse is conducting an integumentary assessment of an African American patient who has darkly pigmented skin and a history of chronic obstructive pulmonary disease (COPD). Which locations should the nurse inspect for cyanosis? Select all that apply. 1 Patient's sclera 2 Patient's nail beds 3 Soles of the patient's feet 4 Palms of the patient's hands 5 Conjunctiva of the patient's eyes

2 - Patient's nail beds 5 - Conjunctiva of the patient's eyes In patients with darkly pigmented skin, the conjunctiva and nail beds often are examined to assess for cyanosis. Palms of the hands, soles of the feet, and the sclera are not the focus when assessing for cyanosis. Text Reference - p. 400

A patient is examined by the nurse and found to have pink-purple, nonblanching macular pinpoint lesions. Which term best describes these findings? 1 Purpura 2 Petechiae 3 Hematoma 4 Ecchymosis

2 - Petechiae Petechiae are small pink-to-purplish macular lesions 1 to 3 mm in diameter, usually caused by minor hemorrhage of capillary blood vessels. Purpura are red or purple discolorations of the skin that do not blanch when pressure is applied. Purpura are associated with bleeding under the skin and are seen in various bleeding disorders. A hematoma is a localized collection of blood outside blood vessels that is generally the result of hemorrhage. Ecchymosis is a collection of blood under the skin, larger than a petechiae, with diffuse borders. Text Reference - p. 401

The nurse is assessing an older patient. When assessing the hair and nails, the nurse will recognize that age-related changes in the hair and nails include which of these? Select all that apply. 1 Thicker hair 2 Scaly scalp 3 Thinner nails 4 Longitudinal ridging on nails 5 Prolonged blood return when nails are blanched

2 - Scaly scalp 4 - Longitudinal ridging on nails 5 - Prolonged blood return when nails are blanched Decreased oil leads to dry, coarse hair and a scaly scalp. The hair becomes thinner. Decreased peripheral blood supply leads to thick, brittle nails. Longitudinal ridging in the nails also may occur with aging. There is prolonged blood return to the nails when they are blanched because of decreased circulation. Thicker hair and thinner nails are not normal age-related changes. Text Reference - p. 397

A nurse scrapes off the superficial layer of the skin lesion of the patient. This specimen is sent to the laboratory for culture. What is the purpose of this culture? 1 To identify an allergen 2 To identify a fungal infection 3 To identify a viral infection 4 To identify a bacterial infection

2 - To identify a fungal infection Culture of the skin lesion specimen is used to identify the fungal, bacterial, or viral infection. Scraping or swab of the skin is performed to obtain the specimen for identification of fungal infection. For bacteria, the sample for culture is obtained from intact pustules, bullae, or abscesses. For a virus, the vesicle or bulla and exudates are taken from the base of the lesion. Culture cannot be used to determine the agent causing skin allergies. The patch test is used to determine the allergen causing the skin lesions. Text Reference - p. 405

A nurse is assessing a patient with chalky, white patches on the face. The nurse learns that the patient's parent and grandparent have had similar signs. On the basis of this information, what is the most likely patient diagnosis? 1 Keloid 2 Vitiligo 3 Intertrigo 4 Hypopigmentation

2 - Vitiligo Vitiligo is a skin condition characterized by complete loss of melanin in the affected area, which results in chalky, white patches. This condition is usually inherited. Keloid is an overgrowth of scar tissue at the site of skin injury. Intertrigo is characterized by presence of rashes in intertriginous areas, such as the axillae and the area under the breast. It is usually due to inflammation of the overlying surface of skin. Hypopigmentation also occurs due to loss of pigmentation but is not an inherited disorder. Hypopigmentation is usually due to chemical agents, nutritional factors, burns, inflammation, or infection. Text Reference - p. 403

A patient is having a diagnostic test performed to check a skin rash for a possible fungal infection. The nurse will prepare for which test? 1 A patch test 2 A shave biopsy 3 A potassium hydroxide (KOH) microscopic test 4 The Tzanck test (Wright's and Giemsa's stain)

3 - A potassium hydroxide (KOH) microscopic test A KOH test is done to examine hair, scales, or nails for superficial fungal infection. A patch test is done to check for allergic reactions. A shave biopsy is done to provide a thin specimen for diagnostic purposes. The Tzanck test is done to assess for the presence of the herpes virus. Text Reference - p. 405

A nurse asks a nursing student to determine the skin color of a patient whose skin is tanned in the exposed areas. Where is the best place on a patient's body to accurately determine skin color? 1 Face 2 Palms 3 Buttocks 4 Nail beds

3 - Buttocks In order to find out the actual skin color of the patient, the nursing student should observe the skin color in photo-protected areas such as the buttocks. The face is not a reliable area to assess skin color because it is exposed to the sun. The nail beds and palms have less melanin content and are therefore not reliable areas to assess skin color. Text Reference - pp. 402-403

Which laboratory test would be most important to check in the patient presenting with purpura? 1 Urinalysis 2 Serum electrolytes 3 Coagulation studies 4 White blood cell count

3 - Coagulation studies Purpura are areas of ecchymoses that may signify a bleeding disorder. Therefore it is most important for the nurse to assess the patient's coagulation studies. Electrolytes, urinalysis, and white blood cells would not reveal a reason for why purpura are present. Text Reference - pp. 399, 401

During an initial assessment of an obese female patient, what specific question should the nurse ask to determine the metabolic pattern related to her skin? 1 Is your sleep being disturbed by any skin condition? 2 Is there any specific food that also causes a skin allergy? 3 Do you have any chafing or a rash in areas where skin overlaps? 4 Are there any skin changes during exercise or other activities?

3 - Do you have any chafing or a rash in areas where skin overlaps? The nurse should ask the obese female patient about areas of chafing or a rash in intertriginous areas. These are the areas where skin surfaces overlap and rub on each other, for example below the breasts, axillae, and groin. These areas are more prone to skin breakdown and rashes. Other questions related to elimination, exercise activity, and sleep-rest pattern are not directly related to the metabolic pattern of skin. Text Reference - p. 399

A nurse is performing skin assessment on a patient. The patient is obese and a security guard by profession. The patient's skin on the sole of the feet is extremely hard and thick. What is the most likely cause for this finding? 1 Injury to the sole 2 Diminished blood supply to the feet 3 Excessive pressure due to weight bearing 4 Infection of the feet causing lesions in the soles

3 - Excessive pressure due to weight bearing Thickened calluses over the heels are normal and occur due to pressure of weight bearing. The patient is obese and a watchman by profession; therefore, the patient may spend more time standing. Thus the most likely cause of thickened skin of the sole is excessive pressure due to weight bearing. Injury, diminished blood supply, and foot infections are less likely causes of thickening and hardening of the skin of the sole. Text Reference - p. 402

When assessing a 73-year-old female patient, the nurse found wrinkles, sagging breasts, and tenting of the skin, gray hair, and thick, brittle toenails. The nurse knows that what normal changes of aging occur that can cause these changes in the integumentary system? 1 Decreased activity of apocrine and sebaceous glands, decreased density of hair, and increased keratin in nails 2 Decreased extracellular water, surface lipids, and sebaceous gland activity, decreased scalp oil, and decreased circulation 3 Muscle laxity, degeneration of elastic fibers, collagen stiffening, decreased melanin, and decreased peripheral blood supply 4 Increased capillary fragility and permeability, cumulative androgen effect and decreasing estrogen levels, and decreased circulation

3 - Muscle laxity, degeneration of elastic fibers, collagen stiffening, decreased melanin, and decreased peripheral blood supply The normal changes of aging include muscle laxity, degeneration of elastic fibers, and collagen stiffening that contribute to the wrinkles, sagging breasts, and tenting of the skin. Decreased melanin and melanocytes in the hair lead to gray hair, and decreased peripheral blood supply leads to thick, brittle nails with diminished growth. Decreased apocrine and sebaceous glands would lead to dry skin with minimal to no perspiration and uneven skin color. Decreased density of hair leads to thinning and loss of hair. Increased keratin in nails leads to longitudinal ridging of the nails. The decreased extracellular water, surface lipids, and sebaceous gland activity lead to dry flaking skin. Decreased scalp oil leads to dry coarse hair and a scaly scalp, and decreased circulation leads to prolonged return of blood to nails on blanching. Increased capillary fragility and permeability in aging leads to bruising. A cumulative androgen effect and decreased estrogen levels lead to facial hirsutism in women and baldness in men. Decreased circulation leads to prolonged return of blood to nails on blanching. Text Reference - p. 397

To obtain information about temperature, turgor, moisture, and texture, which assessment technique should the nurse use? 1 Inspection of skin color 2 Examination for vascularity 3 Palpation of skin with the hand 4 Percussion of the skin on the back

3 - Palpation of skin with the hand Palpation of the skin with the back of the hand will assess temperature. Turgor is assessed by gently pinching the skin on the back of the hand and observing its return to original position when released. Moisture and texture of skin is assessed by touching it to assess it. Percussion does not assess the skin, but the organs beneath the skin. Text Reference - p. 401

The nurse is reviewing the function of the skin layers. Which of these is the primary function of the epidermis layer of the skin? 1 Insulation 2 Excretion 3 Protection 4 Absorption

3 - Protection The epidermis, the thin avascular superficial layer of the skin, is made up of an outer dead cornified portion that serves as a protective barrier and a deeper, living portion that folds into the dermis. The subcutaneous layer of the skin provides insulation. The primary function of the skin is not to insulate, to excrete sweat, or to absorb. Text Reference - p. 394

During an assessment interview of a female patient, the nurse finds that she is taking isotretinoin to treat acne. On further assessment, the patient expresses that she plans to conceive. Which is the most important nursing action? 1 Teach the patient to take the drug with food to minimize the side effects. 2 Inform the patient she can continue this medication because the acne has reduced. 3 Tell the patient to stop this medication because it would have adverse effects on the fetus. 4 Inform the patient that an overdose of Accutane can have serious consequences during pregnancy and tell her to reduce the dose.

3 - Tell the patient to stop this medication because it would have adverse effects on the fetus. The drug isotretinoin is used for treating acne. The drug can cause abnormal fetal development and should not be used by women who are pregnant or are planning to become pregnant. Whereas a nurse would normally discuss the drug's side effects and effectiveness, these issues are not relevant if the patient is instructed to discontinue the medication while trying to conceive. Text Reference - p. 400

A patient had an infection underneath the toenail, and the entire nail was removed. The patient asks the nurse how long it will take the toenail to grow back to its normal size. What should be the nurse's answer? 1 1-2 months 2 3-6 months 3 6-12 months 4 12-24 months

4 - 12-24 months Sometimes toenails may be removed due to ingrowth and infection. Toenails grow at a rate of 30% to 50% slower than fingernails. The nail growth may vary depending upon the person's age and health. A toenail would usually fully regenerate in 12 months or longer. Fingernails grow back in 3-6 months. Text Reference - p. 396

The nurse is caring for a patient who has yellow discoloration of the skin. The nurse also observes that the patient's sclerae are not yellow in color. What is the best nursing action in this situation? 1 Advise the patient to undergo a diagnostic test for jaundice. 2 Advise the patient to decrease the intake of food rich in Vitamin B12. 3 Advise the patient to undergo an immunofluorescent microscopic test. 4 Advise the patient to decrease consumption of vegetables rich in carotene.

4 - Advise the patient to decrease consumption of vegetables rich in carotene. Carotenemia is a condition that occurs due to excessive consumption of vegetables rich in carotene. It is characterized by yellow discoloration of the skin, mostly noticeable on the palms and soles, but not in the sclerae. Jaundice also causes yellow discoloration of skin but is best observed in the sclerae. There is no need for the patient to undergo a diagnostic test for jaundice because the patient shows no yellow discoloration of the sclerae. Vitamin B12 is a water-soluble vitamin responsible for the functioning of the brain and nervous system. Decreasing intake of Vitamin B12 will not reduce the symptoms of carotenemia. An immunofluorescent test is used to identify the specific, abnormal antibody proteins that cause certain skin diseases. Carotenemia is caused due to an increase in carotene levels, not due to the production of abnormal antibodies. Therefore an immunofluorescent test is not required for this patient. Text Reference - p. 403

The nurse is assessing a patient who has dark skin for cyanosis. What assessment findings would indicate cyanosis in individuals with dark skin? 1 Reddish skin tone 2 Deeper brown or purple skin tone 3 Grayish blue tone noted in nail beds, earlobes, lips, mucous membranes, palms, and soles 4 Ashen or gray color noted in the conjunctiva of the eye, mucous membranes, and nail beds

4 - Ashen or gray color noted in the conjunctiva of the eye, mucous membranes, and nail beds In dark-skinned individuals, cyanosis may be noted as an ashen or gray color most easily seen in the conjunctiva of the eye, mucous membranes, and nail beds. Reddish, deep brown, purple, and grayish blue skin tones are not signs of cyanosis in dark-skinned individuals. The grayish blue tone noted in nail beds, earlobes, lips, mucous membranes, and so forth indicates cyanosis in light-skinned individuals. Text Reference - p. 404

A 30-year-old patient has been diagnosed with hypothyroidism. What should the nurse expect to assess in this patient's integumentary system? 1 Warm, flushed skin, alopecia, and thin nails 2 General hyperpigmentation and loss of body hair 3 Pale skin, pale mucous membranes, hair loss, and nail dystrophy 4 Cold, dry, pale skin; dry, coarse hair; and brittle, slow growing nails

4 - Cold, dry, pale skin; dry, coarse hair; and brittle, slow growing nails With hypothyroidism the patient will manifest with cold, dry, pale skin; dry, coarse, brittle hair; and brittle, slow growing nails. With hyperthyroidism the patient will have warm, flushed skin, alopecia with fine soft hair, and thin nails. With Addison's disease the patient will have loss of body hair and generalized hyperpigmentation, especially in folds. With anemia, the patient will display pallor, pale mucous membranes, hair loss, and nail dystrophy. Text Reference - p. 399

A patient reports excessive itchiness all over the body that has caused an inability to sleep for three days. What nursing assessment finding indicates a lack of proper sleep? 1 Dry, scaly skin 2 Supple, moist skin 3 Reddening of the skin 4 Dark circles under the eyes

4 - Dark circles under the eyes Excessive tiredness or sleeplessness causes dark circles under the eyes because of dullness and dehydration. Dry and scaly skin causes itching but is not directly associated with sleeplessness. Reddening of the skin and the presence of supple, moist skin are not indicative of disturbed sleep. Reddening of skin is a manifestation of dilated blood vessels. Suppleness and good hydration are indicators of healthy skin. Text Reference - p. 400

The patient has been snacking on carrots each day and has developed carotenemia. The nurse knows that improvement in this condition will be most evident on which part of the patient's body? 1 Face 2 Chest 3 Sclera 4 Palms of hands

4 - Palms of hands Carotenemia or carotenosis is yellow discoloration of the skin without yellowing sclera. It is most noticeable on the palms of the hands and the soles of the feet. It is not noticeable on the face, chest, or sclera. Text Reference - p. 403

A 14-year-old girl and her mother come to see the nurse practitioner for treatment of the daughter's acne. For what should the nurse assess the patient to show the existence of acne? 1 Ulcers 2 Wheals 3 Vesicles 4 Pustules

4 - Pustules Pustules are elevated, superficial lesions filled with purulent fluid, such as those commonly associated with acne. Wheals, ulcers, and vesicles are not common manifestations of acne. Text Reference - pp. 401, 405

On inspection of a patient's skin, the nurse notes dilated, superficial, cutaneous small blood vessels on the patient's face. What is this assessment finding called? 1 Vitiligo 2 Intertrigo 3 Petechiae 4 Telangiectasia

4 - Telangiectasia Telangiectasia are visibly dilated, superficial, cutaneous small blood vessels, commonly found on face and thighs. Vitiligo is a chalky, white patch that occurs because of a complete absence of melanin (pigment). Petechiae are pinpoint, discrete deposits of blood less than 1 to 2 mm in the extravascular tissues and visible through the skin or mucous membrane. Intertrigo is a dermatitis of overlying surfaces of the skin. Text Reference - p. 403

While performing a capillary refill test, the nurse observes that a patient's nail beds become blanched and remain discolored even when the pressure on the nail beds is released. What can the nurse interpret from this finding? 1 The findings are normal. 2 Jaundice may be present. 3 The patient may have a thyroid disorder. 4 The patient may have subcutaneous bleeding.

4 - The patient may have subcutaneous bleeding. If blanching of the nail persists in spite of removing pressure from the nail bed, it may indicate subcutaneous bleeding. It is not a normal finding because the nail bed should turn back to pink once the pressure is removed. In jaundice, the nail bed is yellow in color. In thyroid disorders, the nail becomes uneven and thick. Text Reference - p. 401

A nurse is assessing a patient with psoriasis. The nurse explains the pathology of psoriasis, stating that it occurs due to abnormal changes in the cell cycle of the skin layers. Which change in the cell cycle is the nurse referring to? 1 The outer dead layer of skin cells is not shed. 2 The inner layer of skin stops producing new skin cells. 3 The rate of removal of outer dead skin is much more than the rate of production of new skin cells. 4 The rate of new skin cell production is much more than the rate of removal of outer dead skin cells.

4 - The rate of new skin cell production is much more than the rate of removal of outer dead skin cells. In psoriasis, new skin cells are formed faster than old cells are shed. This causes the skin in psoriasis patients to become scaly and thickened. In psoriasis, the outer layer of the dead skin is shed at a normal rate. The inner layer of the skin does not stop producing new skin cells but produces new skin cells at a much faster rate. If the rate of removal of outer dead skin is much more than the rate of production of new skin cells, the skin becomes too thin. Text Reference - pp. 394-395

The nurse assessed the patient's skin lesions as circumscribed, with a superficial collection of serous fluid, and less than 0.5 cm in diameter. What term describes these lesions? 1 Wheals 2 Papules 3 Pustules 4 Vesicles

4 - Vesicles Vesicles are circumscribed, with superficial collection of serous fluid, less than 0.5 cm in diameter. Examples include varicella (chickenpox), herpes zoster (shingles), and second-degree burn. Wheals are firm, edematous areas such as insect bites. Papules are solid lesions (warts). Pustules are fluid-filled lesions (acne or impetigo). Text Reference - p. 401