Chapter 22: Integumentary System

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? A. "The rays from the sun stimulate the production of melanin, giving a tan to the skin." B. "The rays from the sun inhibit the production of melanin, causing the skin to darken." C. "The rays from the sun burn the outer layer of the skin, making the skin dark and painful." D. "The rays from the sun cause increased blood flow to the skin, giving a dark red color to the skin."

A. "The rays from the sun stimulate the production of melanin, giving a tan to the skin." Rationale 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. p. 395

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

A. Assessing for skin color changes. C. Pressing on a lesion to check for blanching. Rationale 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. p. 400

When performing a skin assessment on a patient, which principles should the nurse follow? Select all that apply. A. Be systematic and proceed from head to toe. B. Use the metric system when taking measurements. C. Ensure the patient is wearing a comfortable dress. D. Have a private examination room with a moderate temperature. E. Perform a lesion-specific examination followed by a general inspection.

A. Be systematic and proceed from head to toe. B. Use the metric system when taking measurements. D. Have a private examination room with a moderate temperature. Rationale Assessment should always be systematic and proceed from head to toe so that an area is not missed. Measurements should be taken using the metric system. A private examination room should be made available. The room should have a moderate temperature and exposure to sunlight. The patient should wear a dressing gown for easy access to all areas of the skin. A general inspection should be done first followed by lesion-specific examination. STUDY TIP: Establish your study priorities and the goals by which to achieve these priorities. Write them out and review the goals during each of your study periods to ensure focused preparation efforts. p. 400

A nurse is obtaining a sample for an indirect immunofluorescence test for a patient suspected of having systemic lupus erythematosus (SLE). Which type of sample does the nurse expect to collect? A. Blood B. Throat swab C. Punch biopsy specimen of the skin D. Shave biopsy specimen of the skin

A. Blood Rationale Indirect immunofluorescence is an investigation required to identify the abnormal antibodies causing diseases such as SLE. A blood sample is required for indirect immunofluorescence testing. A throat swab specimen is not required for this test. Throat swabs are generally required for identifying the causative organisms of throat infections. Punch biopsy and shave biopsy skin specimens are not useful for indirect immunofluorescence but can be used as a test sample for direct immunofluorescence. pp. 405-406

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. A. Decrease in the production of melanin B. Increase in the production of melanin C. Increase in the number of melanocytes D. Decrease in the number of melanocytes E. Decreased exposure to sun in old age

A. Decrease in the production of melanin D. Decrease in the number of melanocytes Rationale 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. 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. A. Decreased production of sebum. B. Decreased immunocompetence. C. Decreased subcutaneous fat tissue. D. Decreased blood supply to the skin. E. Decreased water content in the body.

A. Decreased production of sebum. E. Decreased water content in the body. Rationale 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. p. 397

Which data would a nurse consider least important during an assessment of skin integrity? A. Family history of pressure ulcers B. Presence of existing pressure ulcers C. Overall risk as indicated by a low Braden score D. Areas at risk for the development of pressure ulcers

A. Family history of pressure ulcers Rationale 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. p. 397

When assessing the cognitive-perceptual pattern in relation to the skin, the nurse questions the patient regarding which of these? A. Joint pain B. Changes in sleep habits C. Recent changes in wound healing D. Self-care habits related to daily hygiene

A. Joint pain Rationale When assessing the patient's cognitive-perceptual pattern in relation to the skin, assess the mobility of the joints because the patient's skin condition may cause alterations in mobility. Changes in sleep habits, recent changes in wound healing, and daily hygiene are not related to the cognitive-perceptual pattern in relation to the skin. p. 400

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

A. Keep the room dark. Rationale 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. 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? A. Lips B. Legs C. Wrists D. Sclera

A. Lips Rationale 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. pp. 403, 404

When assessing the patient's integumentary system, which dermatologic manifestations may indicate systemic problems? Select all that apply. A. Pallor B. Jaundice C. Skin tags D. Cyanosis E. Cherry angiomas

A. Pallor B. Jaundice D. Cyanosis Rationale Pallor, jaundice, and cyanosis are dermatologic manifestations that may indicate systemic problems. Jaundice is often an indication of a liver problem. Pallor indicates anemia, and cyanosis may be due to a respiratory disorder. Skin tags and cherry angiomas are benign neoplasms related to aging. pp. 403, 405

To assess the skin turgor, the most appropriate technique for the nurse to use is which of these? A. Palpation B. Inspection C. Percussion D. Auscultation

A. Palpation Rationale 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. STUDY TIP: You have a great resource in your classmates. We all have different learning styles, strengths, and perspectives on the material. Participating in a study group can be a valuable addition to your nursing school experience. p. 401

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

A. Rolling a sterile swab from the center of the wound outward Rationale 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. p. 405

The nurse is caring for a patient with a superficial lesion. Which biopsy is best suited for this patient? A. Shave biopsy B. Punch biopsy C. Incisional biopsy D. Excisional biopsy

A. Shave biopsy Rationale 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. 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? A. Sunlight stimulates the production of vitamin D in the body. B. Sunlight contains vitamin D, which is easily absorbed by the skin. C. Exposure to sunlight increases craving for foods rich in vitamin D. D. Sunlight causes proliferation of the cells containing vitamin D precursors.

A. Sunlight stimulates the production of vitamin D in the body. Rationale 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. 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? A. These areas have the least pigmentation. B. These areas have the highest blood flow. C. These areas are rich in sensory receptors. D. These areas are the most accessible to a nurse.

A. These areas have the least pigmentation. Rationale 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. 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? A. Tiny, purple spots on the skin B. Large ecchymotic areas on the skin C. Hyperkeratotic papules and plaques D. Small, raised red areas on the soles of the feet

A. Tiny, purple spots on the skin Rationale 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. p. 404

While explaining the structure of the skin to a patient, the nurse says that the outermost layer of the skin consists mainly of dead cells. The patient asks the nurse, "Why do our bodies need these dead cells?" What is the most appropriate answer for the nurse to give? A. To protect the viable cells underneath B. To preserve water for the viable cells underneath C. To provide nutrition to the viable cells underneath D. To provide antiseptic properties that prevent infection in the body

A. To protect the viable cells underneath Rationale The outermost layer of the skin is known as the epidermis. This layer is composed primarily of dead cells, which act as a protective layer for the deeper viable skin tissue. Because this layer is composed mainly of dead cells, these are not useful to provide nutrition to the deeper skin tissues (dermis). The epidermis is a dry layer of cells; it does not preserve water. The epidermal layer has no antiseptic properties. p. 394

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. A. Vitamin D is synthesized by the action of ultraviolet (UV) light. B. The papillary layer helps in activating the precursors to vitamin D. C. Ultraviolet rays act on vitamin D precursors present in the epidermis. D. The reticular layer of the dermis plays an important role in vitamin D synthesis. E. Endogenous synthesis of vitamin D is critical for calcium and phosphorus balance.

A. Vitamin D is synthesized by the action of ultraviolet (UV) light. C. Ultraviolet rays act on vitamin D precursors present in the epidermis. E. Endogenous synthesis of vitamin D is critical for calcium and phosphorus balance Rationale 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. 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? A. Whether the patient is pregnant B. Whether the patient is over 50 years of age C. Whether the patient is suffering from any systemic illness D. Whether the patient's work involves prolonged exposure to the sun

A. Whether the patient is pregnant Rationale 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. p. 400

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

A: 0.1mm Rationale 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. p. 405

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? A. Administer prescribed antibiotics to the patient. B. Administer water and electrolytes to the patient. C. Check the patient for abnormal levels of hormones. D. Check the patient for abnormal levels of hemoglobin.

B. Administer water and electrolytes to the patient. Rationale 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. pp. 401-402

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

B. By pinching the patient's skin below the clavicle Rationale 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. p. 401

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? A. Ecchymosis B. Colonization by yeast or bacteria C. Age-related integumentary changes D. Atrophy of the skin under the abdominal folds

B. Colonization by yeast or bacteria Rationale 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. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses. p. 401

Which medication is most likely to have an effect on the patient's integumentary system? A. Diuretic B. Corticosteroid C. Benzodiazepine D. Calcium channel blocker

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

When assessing the skin of an older adult, which findings would the nurse consider normal? Select all that apply. A. Fissure B. Dry skin C. Wrinkling D. Excoriation E. Decreased turgor

B. Dry skin C. Wrinkling E. Decreased turgor Rationale Older adults do not have the same skin as younger adults, and there are many skin changes associated with aging that are normal. These include dry skin, wrinkling, and a decrease in turgor. Older adults may have decreased extracellular water, surface lipids, and sebaceous gland activity, leading to dry skin. Decreased subcutaneous fat, muscle laxity, degeneration of elastic fibers, and collagen stiffening may lead to wrinkling and decreased turgor. Excoriation and fissures are abnormal findings on the skin and need further evaluation. p. 397

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? A. Skin biopsy B. Estrogen test C. Thyroid function test D. Blood test to determine clotting time

B. Estrogen test Rationale 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. 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? A. Excess melanin B. Excess carotenes C. Excess oxyhemoglobin D. Excess deoxyhemoglobin

B. Excess carotenes Rationale 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. 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? A. Scar B. Fissure C. Atrophy D. Excoriation

B. Fissure Rationale 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). Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Example: If the item relates to and identifies stroke rehabilitation as its focus and only one of the options contains the word stroke in relation to rehabilitation, you are safe in identifying this choice as the correct response. 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? A. Infections B. Hormonal alterations C. Environmental changes D. Sebaceous gland carcinoma

B. Hormonal alterations Rationale 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. p. 403

A patient has been administered a patch test to determine the patient's allergy to rubber. What is an important nursing intervention for this patient? A. Keep the patient in the health care facility for close observation. B. Instruct the patient to return in 48 to 72 hours for removal of allergens. C. Teach the patient how to administer an epinephrine injection, if required. D. Instruct the patient to come back after a week for a preliminary evaluation.

B. Instruct the patient to return in 48 to 72 hours for removal of allergens. Rationale Following a patch test, the nurse should instruct the patient to return after 48 to 72 hours for the removal of the allergen, and again after 96 hours for a preliminary evaluation of the test. The patient should be monitored for some time and can be sent home if comfortable. It is not necessary to teach the patient about an epinephrine injection. p. 405

A patient with a long history of sun exposure has been diagnosed with skin cancer. The nurse recognizes that chronic exposure to ultraviolet (UV) rays has what effects on the skin that increase the risk for skin cancer? Select all that apply. A. It increases blood flow to the skin. B. It increases the rate of cell multiplication. C. It decreases the water content of the skin. D. It causes degeneration of elastic fibers in skin tissue. E. It decreases the skin's ability to repair cellular damage.

B. It increases the rate of cell multiplication. E. It decreases the skin's ability to repair cellular damage. Rationale Chronic exposure to the sun decreases the skin's capacity to repair cellular damage, which could predispose an individual to skin cancer. Prolonged exposure also damages the DNA within the cell. This leads to abnormal multiplication of skin cells. Increased blood flow to the skin does not cause skin cancer. Increased blood flow is manifested as increase in skin temperature and reddening of skin. Decrease in the water content of the skin and degeneration of elastic fibers are brought about by aging and do not predispose an individual to cancer. p. 397

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? A. The patient may have psoriasis. B. It is a normal finding in this patient. C. Anemia may be present in this patient. D. The patient may have a thyroid disorder.

B. It is a normal finding in this patient. Rationale 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. 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? A. It is used for a superficial lesion. B. It provides a full-thickness of skin. C. It is used for good cosmetic results. D. It is used because the lesion is too large to remove.

B. It provides a full-thickness of skin. Rationale 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. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses. p. 405

Which disease condition can be found more in fair-skinned patients than in patients with more pigmentation in their skin? A. Keloids B. Melanoma C. Nevus of ota D. Traction alopecia

B. Melanoma Rationale 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. p. 399

When jaundice is suspected in a patient, which areas should the nurse check for skin color? Select all that apply. A. Tongue B. Nail beds C. Earlobes D. Conjunctiva E. Buccal mucosa

B. Nail beds D. Conjunctiva E. Buccal mucosa Rationale 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. p. 404

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? A. Obese people have fewer cold receptors. B. Obese people have better fat insulation. C. Obese people have better cold tolerance. D. Obese people have an abnormal hypothalamic functioning.

B. Obese people have better fat insulation. Rationale 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. p. 395

The nurse is caring for a patient with dark skin. The nurse suspects that the patient might have jaundice. Which areas should the nurse check to confirm the physical manifestations of jaundice? Select all that apply. A. Fingernails B. Oral mucosa C. Color of the skin D. Soles and palms E. Sclera of the eye

B. Oral mucosa D. Soles and palms E. Sclera of the eye Rationale Jaundice is associated with yellow discoloration of the oral mucosa, soles, and palms. The sclerae in dark-skinned patients with jaundice appear a yellowish green color. Therefore the nurse should check the patient's oral mucosa, soles, palms, and sclera. The fingernails of 90 percent of dark-skinned people show melanonychia striata, or pigmented longitudinal bands. Therefore yellow discoloration of the fingernails might not be clear. Yellow coloration of the skin might not be clear or visible in patients with dark skin. p. 404

The nurse is assessing the integumentary systems of four patients. Which patient does the nurse warn about Candida infection? A. Patient 1: Benign overgrowth of melanocytes B. Patient 2: Dermatitis of the overlying skin surfaces C. Patient 3: Extravasation of blood causing visible swelling D. Patient 4: Lighter patches of skin due to loss of pigmentation

B. Patient 2: Dermatitis of the overlying skin surfaces Rationale Intertrigo is dermatitis of the overlying surfaces of the skin, which is caused by moisture and irritation. This condition may be complicated with Candida infection. Therefore the nurse should warn patient 2 about Candida infection. A mole is a benign overgrowth of melanocytes and is unrelated to Candida infection (Patient 1). Hematoma is a condition characterized by extravasation of blood of sufficient size to cause visible swelling (Patient 3). It occurs due to trauma or bleeding disorder and is not affected by Candida infection. Hypopigmentation is a loss of pigmentation resulting in lighter than normal patches of skin; it is not affected by Candida infection (Patient 4). pp. 401, 403

The nurse is assessing the integumentary system of four female geriatric patients. In which patient does the nurse expect to find a cumulative androgen effect? A. Patient 1: Gray hair B. Patient 2: Facial hirsutism with baldness C. Patient 3: Dry, course hair with scaly scalp D. Patient 4: Thinning of hair in the outer third eyebrows

B. Patient 2: Facial hirsutism with baldness Rationale Geriatric female patients with cumulative androgen effect or decreased estrogen levels will have facial hirsutism and baldness. Therefore the nurse expects to find a cumulative androgen effect with patient 2. Gray or white hair indicates that patient 1 has low levels of melanin and melanocytes. A scaly scalp with dry, coarse hair indicates that patient 3 has decreased production of oil. Thinning or loss of hair in the outer half or outer third of eyebrows and backs of the legs is not caused by low estrogen levels. Therefore patient 4 does not show a cumulative androgen effect. p. 397

The nurse is assessing four adolescent female patients. Which patient does the nurse suspect to have low estrogen levels? A. Patient 1: Presence of a cyst B. Patient 2: Hair growth resembling that of a male C. Patient 3: Presence of blackheads and whiteheads D. Patient 4: Loss of pigmentation resulting in lighter patches of skin

B. Patient 2: Hair growth resembling that of a male Rationale Male distribution of hair in women is called hirsutism. It occurs due to a decrease in estrogen levels or abnormality in the adrenal glands or ovaries. Therefore the nurse suspects that patient 2 has low estrogen levels. In patient 1, a cyst is a sac containing fluid or semisolid material. It is formed by the obstruction of a duct or a gland, or because of a parasitic infection. The presence of blackheads or whiteheads, enlarged hair follicles plugged with sebum, bacteria, and skin cells, is called comedo. It is caused by hormonal changes during puberty or pregnancy. Therefore the nurse suspects that patient 3 has high estrogen levels. Loss of pigmentation resulting in lighter patches of skin may be caused by a decrease in melanin levels, not low estrogen levels, as seen in patient 4. p. 403

The nurse is assessing the integumentary manifestations of four geriatric patients. Which patient does the nurse suspect to have decreased immunocompetence? A. Patient 1: Dry, flaking skin B. Patient 2: Increased neoplasms C. Patient 3: Solar lentigines on face D. Patient 4: Decreased rate of wound healing

B. Patient 2: Increased neoplasms Rationale Decreased immunocompetence in geriatric patients leads to an increase in neoplasms. Therefore patient 2 has decreased immunocompetence. Dry, flaking skin with possible signs of excoriation caused by scratching is caused due to decreased extracellular water, surface lipids, and sebaceous gland activity in elderly patients. Therefore patient 1's manifestations do not indicate decreased immunocompetence. In elderly patients, solar lentigines on the face and backs of the hands are caused by increased focal melanocytes in the basal layer with pigment accumulation. Therefore patient 3 has hyperpigmentation, not compromised immunocompetence. A decreased rate of wound healing indicates that patient 4 has decreased proliferative capacity, not decreased immunocompetence. p. 397

The nurse is assessing the integumentary system of four patients who have dark skin. Which patient does the nurse identify as having petechiae? A. Patient 1: Keloid development B. Patient 2: Lesion in the buccal mucosa of the mouth C. Patient 3: Increased skin temperature along with inflammation D. Patient 4: Ashen color seen in the conjunctiva of the eye and mucous membrane

B. Patient 2: Lesion in the buccal mucosa of the mouth Rationale Patients with petechiae have pinpoint, discrete deposits of blood visible through the skin or mucous membrane. In patients with dark skin, petechiae are not clearly seen on the skin but may be evident in the buccal mucosa of the mouth or conjunctiva of the eye. Therefore the nurse suspects that patient 2 has petechiae. A keloid (Patient 1) is a thickened, hypertrophied scar beyond the wound margin. Predisposition to keloids is more common in African Americans; keloids are not indications of petechiae. Patients with erythema are characterized by a reddish skin tone with increased skin temperature and inflammation (Patient 3). In patients with dark skin, the redness is not seen. Instead a deeper-brown or purple skin tone is seen, accompanied by increased skin temperature and inflammation. Patients with cyanosis have a grayish blue tone in their nail beds, earlobes, and lips. Patients with dark skin exhibit an ashen or gray color in the conjunctiva of the eye, mucous membrane, and nail beds (Patient 4). p. 401

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. A. Patient's sclera B. Patient's nail beds C. Soles of the patient's feet D. Palms of the patient's hands E. Conjunctiva of the patient's eyes

B. Patient's nail beds E. Conjunctiva of the patient's eyes Rationale 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. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation. 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? A. Purpura B. Petechiae C. Hematoma D. Ecchymosis

B. Petechiae Rationale 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. 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. A. Thicker hair B. Scaly scalp C. Thinner nails D. Longitudinal ridging on nails E. Prolonged blood return when nails are blanched

B. Scaly scalp D. Longitudinal ridging on nails E. Prolonged blood return when nails are blanched Rationale 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. 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? A. To identify an allergen B. To identify a fungal infection C. To identify a viral infection D. To identify a bacterial infection

B. To identify a fungal infection Rationale 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. 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? A. Keloid B. Vitiligo C. Intertrigo D. Hypopigmentation

B. Vitiligo Rationale 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. p. 403

A nurse is dressing the wound of a patient whose fingers were injured in an accident. One of the fingernails is missing. The patient asks the nurse about when the fingernail will grow back. What is the most appropriate answer? A. Within 3 months B. Within 6 months C. Within 12 months D. Within 15 months

B. Within 6 months Rationale In healthy individuals, a lost fingernail usually regenerates in three to six months. Therefore, the most appropriate answer given by the nurse would be within six months. p. 396

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? A. A patch test B. A shave biopsy C. A potassium hydroxide (KOH) microscopic test D. The Tzanck test (Wright's and Giemsa's stain)

C. A potassium hydroxide (KOH) microscopic test Rationale 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. 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? A. Face B. Palms C. Buttocks D. Nail beds

C. Buttocks Rationale 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. pp. 402-403

Which laboratory test would be most important to check in the patient presenting with purpura? A. Urinalysis B. Serum electrolytes C. Coagulation studies D. White blood cell count

C. Coagulation studies Rationale 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. 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? A. Is your sleep being disturbed by any skin condition? B. Is there any specific food that also causes a skin allergy? C. Do you have any chafing or a rash in areas where skin overlaps? D. Are there any skin changes during exercise or other activities?

C. Do you have any chafing or a rash in areas where skin overlaps? Rationale 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. Test-Taking Tip: Become familiar with reading questions on a computer screen. Familiarity reduces anxiety and decreases errors. 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? A. Injury to the sole B. Diminished blood supply to the feet C. Excessive pressure due to weight bearing D. Infection of the feet causing lesions in the soles

C. Excessive pressure due to weight bearing Rationale 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. 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? A. Decreased activity of apocrine and sebaceous glands, decreased density of hair, and increased keratin in nails B. Decreased extracellular water, surface lipids, and sebaceous gland activity, decreased scalp oil, and decreased circulation C. Muscle laxity, degeneration of elastic fibers, collagen stiffening, decreased melanin, and decreased peripheral blood supply D. Increased capillary fragility and permeability, cumulative androgen effect and decreasing estrogen levels, and decreased circulation

C. Muscle laxity, degeneration of elastic fibers, collagen stiffening, decreased melanin, and decreased peripheral blood supply Rationale 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. p. 397

To obtain information about temperature, turgor, moisture, and texture, which assessment technique should the nurse use? A. Inspection of skin color B. Examination for vascularity C. Palpation of skin with the hand D. Percussion of the skin on the back

C. Palpation of skin with the hand Rationale 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. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Example: If you are being asked to identify a diet that is specific to a certain condition, your knowledge about that condition would help you choose the correct response (e.g., cholecystectomy = low-fat, high-protein, low-calorie diet). p. 401

The nurse is assessing the integumentary manifestations of four elderly patients. Which elderly patient does the nurse suspect has diminished blood supply? A. Patient 1: Decreased rate of wound healing B. Patient 2: Increased wrinkling, sagging abdomen C. Patient 3: Cool skin with decreased rosy appearance D. Patient 4: Dry skin with minimal or no precipitation, uneven skin color

C. Patient 3: Cool skin with decreased rosy appearance Rationale Decreased blood supply to the skin decreases the rosy appearance of the skin and mucous membrane. Further, the skin is cool to the touch, and the patient has diminished awareness of pain, touch, temperature, and peripheral vibration. Therefore the nurse suspects that patient 3 has a low blood supply. Decreased rate of wound healing is caused by decreased proliferative capacity. Increased wrinkling, sagging of the abdomen and breasts, and tenting are caused by decreased subcutaneous fat, muscle laxity, degeneration of elastic fibers, and collagen stiffening. Dry skin with minimal or no perspiration and uneven skin color is caused by decreased activity of the apocrine and sebaceous glands. Therefore the nurse does not suspect that patients 1, 2, or 4 have low blood supply. p. 397

The nurse is caring for four patients. Which patient does the nurse suspect will have delayed wound healing? A. Patient 1: Anemia B. Patient 2: Liver Disease C. Patient 3: Diabetes Mellitus D. Patient 4: Respiratory Disorder

C. Patient 3: Diabetes Mellitus Rationale Diabetes mellitus (Patient C) is a condition characterized by high blood sugar levels. High blood glucose levels impair tissue interiority and delay wound healing. Anemia (Patient A) causes pallor, or pale color of the skin, not delayed wound healing. It results from reduced amounts of oxyhemoglobin. Liver diseases (Patient B), jaundice for example, cause yellow coloration of the skin, not delayed wound healing. Respiratory disorders (Patient D) cause cyanosis, not delayed wound healing. p. 398

The nurse is reviewing the function of the skin layers. Which of these is the primary function of the epidermis layer of the skin? A. Insulation B. Excretion C. Protection D. Absorption

C. Protection Rationale 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. 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? A. Teach the patient to take the drug with food to minimize the side effects. B. Inform the patient she can continue this medication because the acne has reduced. C. Tell the patient to stop this medication because it would have adverse effects on the fetus. D. Inform the patient that an overdose of Accutane can have serious consequences during pregnancy and tell her to reduce the dose.

C. Tell the patient to stop this medication because it would have adverse effects on the fetus. Rationale 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. p. 400

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? A. The patient has a skin allergy. B. The patient has a malignant skin condition. C. The patient has a fungal infection of the skin. D. The patient has systemic lupus erythematosus (SLE).

C. The patient has a fungal infection of the skin. Rationale 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. p. 405

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? A. 1-2 months B. 3-6 months C. 6-12 months D. 12-24 months

D. 12-24 months Rationale 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. STUDY TIP: Remember that intelligence plays a vital role in your ability to learn. However, being smart involves more than just intelligence. Being practical and applying common sense are also part of the learning experience. p. 396

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? A. Dry, scaly skin B. Supple, moist skin C. Reddening of the skin D. Dark circles under the eyes

D. Dark circles under the eyes Rationale 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. p. 400

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? A. Advise the patient to undergo a diagnostic test for jaundice. B. Advise the patient to decrease the intake of food rich in Vitamin B 12. C. Advise the patient to undergo an immunofluorescent microscopic test. D. Advise the patient to decrease consumption of vegetables rich in carotene.

D. Advise the patient to decrease consumption of vegetables rich in carotene. Rationale 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 B 12 is a water-soluble vitamin responsible for the functioning of the brain and nervous system. Decreasing intake of Vitamin B 12 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. 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? A. Reddish skin tone B. Deeper brown or purple skin tone C. Grayish blue tone noted in nail beds, earlobes, lips, mucous membranes, palms, and soles D. Ashen or gray color noted in the conjunctiva of the eye, mucous membranes, and nail beds

D. Ashen or gray color noted in the conjunctiva of the eye, mucous membranes, and nail beds Rationale 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. STUDY TIP: Focus your study time on the common health problems that nurses most frequently encounter. 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? A. Warm, flushed skin, alopecia, and thin nails B. General hyperpigmentation and loss of body hair C. Pale skin, pale mucous membranes, hair loss, and nail dystrophy D. Cold, dry, pale skin; dry, coarse hair; and brittle, slow growing nails

D. Cold, dry, pale skin; dry, coarse hair; and brittle, slow growing nails Rationale 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. p. 399

To determine the presence of petechiae in a patient with dark skin, the nurse should assess what part of the body? A. Nail B. Face C. Buttocks D. Conjunctiva

D. Conjunctiva Rationale Petechiae are small pinpoint lesions. The nurse should check for these lesions in the conjunctiva of the eye or buccal mucosa in dark-skinned people. Unlike fair-skinned people, these lesions are difficult to see on the nail, face, or buttocks of dark-skinned people. 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? A. Face B. Chest C. Sclera D. Palms of hands

D. Palms of the hands Rationale 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. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. p. 403

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? A. Acne B. Moles C. Comedo D. Pseudofolliculitis

D. Pseudofolliculitis Rationale 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. pp. 403, 405

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? A. Ulcers B. Wheals C. Vesicles D. Pustules

D. Pustules Rationale 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. Test-Taking Tip: After you have eliminated one or more choices, you may discover that two of the options are very similar. This can be very helpful because it may mean that one of these look-alike answers is the best choice and the other is a very good distractor. Test both of these options against the stem. Ask yourself which one completes the incomplete statement grammatically and which one answers the question more fully and completely. The option that best completes or answers the stem is the one you should choose. Here, too, pause for a few seconds, give your brain time to reflect, and recall may occur. 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? A. Vitiligo B. Intertrigo C. Petechiae D. Telangiectasia

D. Telangiectasia Rationale 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. 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? A. The findings are normal. B. Jaundice may be present. C. The patient may have a thyroid disorder. D. The patient may have subcutaneous bleeding.

D. The patient may have subcutaneous bleeding. Rationale 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. 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? A. The outer dead layer of skin cells is not shed. B. The inner layer of skin stops producing new skin cells. C. The rate of removal of outer dead skin is much more than the rate of production of new skin cells. D. The rate of new skin cell production is much more than the rate of removal of outer dead skin cells.

D. The rate of new skin cell production is much more than the rate of removal of outer dead skin cells. Rationale 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. 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? A. Wheals B. Papules C. Pustules D. Vesicles

D. Vesicles Rationale 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). STUDY TIP: Enhance your organizational skills by developing a checklist and creating ways to improve your ability to retain information, such as using index cards with essential data, which are easy to carry and review whenever you have a spare moment. p. 401