chapter 45
A patient asks the nurse what caused the callus on his foot. Which of the following is the nurse's best response?
"It is a hyperkeratotic plaque of skin due to chronic friction."
A nursing instructor is teaching students about skin structure. The instructor evaluates student knowledge of the epidermis based on which of the following statements?
"Keratinized epithelial cells formed in The deepest layer of the epidermis migrate to the skin surface to replace cells that are lost during normal skin shedding."
A client states they have "pruritus." Which question is most appropriate for the nurse to ask?
"Where do you feel itching?"
An elderly client asks the nurse why her skin is so dry. Which response is best for the nurse to give to this client? Select all that apply.
- Changes occur in the sebaceous gland. -A decrease in skin capillaries occurs. - Flattening of the dermal rete ridges occurs.
An 81-year-old woman has noted a gradual decrease in the moisture of her skin over many years. Which phenomena associated with the aging process are known to contribute to her xerosis? Select all that apply.
- Changing composition of sebaceous gland secretions - Flattening of the dermal rete ridges -Decreased moisture secretions from sweat glands - Decrease in skin capillaries
The nurse is assessing a client with darker skin. The nurse is aware that: Select all that apply.
- It will be difficult to assess skin pallor. -Erythema will be difficult to observe. -Verbal histories are important in skin assessment.
Which statements are true regarding the skin disorder referred to as a "corn"? Select all that apply.
- They are well circumscribed. -They can be either hard or soft. - Their location determines whether they are painful. -Their medical name is helomas.
A nurse is preparing for a certification course in wound care and needs to be able to identify various lesions that may be identified when assessing the skin. Which of the definitions below are correctly identified with their skin lesion? Select all that apply.
- Vesicle: A circumscribed, elevated, palpable mass containing serous fluid, <0.5 cm -Nodule: Solid, elevated, hard or soft, larger than 0.5 cm circumscribed
A client with chronic renal disease has severe pruritus. Which interventions should the nurse include in the teaching plan for the client? Select all that apply.
-Keep fingernails trimmed -Moisturize the skin frequently -Take a cool shower before bed
Which immune cells are found in the dermis? Select all that apply.
-Macrophages -T cells - Mast cells -Fibroblasts
Which term is correctly linked with its definition?
A corn is a keratinous thickening of skin.
A man's primary care physician has characterized his skin lesion as being a temporary eruption but has cautioned him against repeated rubbing or scratching to avoid lichenization. What is the most likely categorization of the man's skin lesion?
A rash
The nurse assesses a rash on the client's skin. What statement concerning this is true?
A rash is a temporary eruption of the skin.
Which of the following structures would likely be present in a hair follicle in a man's groin but not in a follicle on his face?
Aprocrine gland
Which statement concerning blood flow to the skin is true?
Arteriovenous anastomoses in the skin regulate temperature.
The nurse has completed an assessment of a client and noted a hyperkeratotic plaque of skin that resulted from chronic pressure or friction. The nurse would document this as:
Callus
An industrial labourer uses his hands every day when he lifts and transfers heavy materials. Which integumentary adaptation to his work is normal?
Calluses
The nurse is recommending to a patient ways to relieve the itching sensation of his uncontrollable pruritis. Which of the following should the nurse recommend?
Cool shower
The nurse is caring for a patient with pruritis. The nurse anticipates orders for which of the following interventions?
Corticosteroids
While working in an allergy clinic, the nurse notices that many patients come in with all types of skin reactions. The nurse working in this area knows that which cells play a role in the development of allergic skin condition?
Langerhans cells
A 42-year-old female client complains of extreme xerosis and states nothing seems to work for her skin. The most appropriate treatment would be to apply:
Emollients or occlusives are the most effective treatment
A fair-skinned red-haired patient comes to the clinic for a routine physical and receives education about regularly applying sunscreen to prevent skin cancer. Which risk factors makes fair-haired clients more susceptible to skin cancer?
Enhanced photoreactivity of pheomelanin
Which layer of the skin contains cells responsible for skin color, tanning, and protection from the sun's ultraviolet radiation?
Epidermis
After falling off his bicycle, an 8-year-old boy has a large abrasion on his posterior thigh that has removed the epidermis in the region but left the dermis largely intact. Which of the following changes in integumentary system would be expected in the area of his wound?
Fewer Merkel and Langerhans cells in the region
The nurse notes a blister on a patient's skin. Which of the following best defines this area?
Fluid-filled papule
Which stratum layer of the epidermis has cells working to lose cytoplasm and DNA while synthesizing keratin?
Granulosum
A 40-year-old male client has a congenital syndrome that affects the function of the Langerhans cells of his epidermis. The man's care provider would expect which of the following manifestations of his condition?
Increased susceptibility to infection
A patient presents with pruritus of the lower extremities. Which of the following is the priority nursing assessment?
Inspection for presence of dry skin
A client has dry skin, and scratching the dry regions causes some skin flakes to become dislodged. Which cell type makes up the dry skin?
Keratinocytes
A nurse is teaching a client about the role that skin plays in forming a barrier to environmental agents and microorganisms. The nurse would recognize that which of the following types of cells/junctions are involved in the communication and regulation of the immune response and the secretions of cytokines?
Keratinocytes
A nursing instructor is teaching students about skin structure. The instructor evaluates student knowledge of the Langerhans cells based on which of the following statements?
Langerhans cells are the immunologic cells responsible for recognizing foreign antigens harmful to the body.
The health care provider has just completed a skin assessment on a client. The client asks what causes the numerous freckles that she has. The best response is:
Localized collections of eumelanin contribute to the development.
A 51-year-old woman who was born congenitally blind and deaf is able to distinguish individuals by light touch of the individual's face. Which of the following components of the woman's skin innervation likely contributes the most to this ability?
Meissner corpuscles
Which of the following are pigment-synthesizing cells?
Melanocytes
A patient expresses concern to the nurse about and an area of skin on the chest that has recently turned white and was diagnosed as vitiligo. The nurse tells the patient that vitiligo is caused by which of the following?
Melanocytes are destroyed, leading to a complete absence of melanin pigment.
A client has sought care for a serious sunburn that resulted from falling asleep at the beach. What physiologic process was involved in the client's overexposure to ultraviolet radiation?
Melanocytes were unable to sufficiently protect that client
Select the cells of the epidermis that are responsible for providing sensory information.
Merkel cells
A nurse assesses a patient with a 3-cm lipoma in the subcutaneous tissue. Which of the following terms would best describe this lesion?
Nodule
Select the statement that best describes skin disorders.
Skin color may influence the appearance of the skin disorder.
A person with severe lymphedema is asking the nurse where specifically are the lymph vessels located in the skin layers. What would the nurse would respond?
Papillary dermis layer
The nurse is assessing a patient who has a small pinpoint rash. Which of the following is the best cause of this rash?
Pinpoint petechiae
The first-line treatment for dry skin is moisturizing agents. How do these agents work?
Repairing the skin barrier
What is the purpose of Langerhans cells in the epidermis?
Responsible for recognizing antigens
Select the layer of dermis characterized by a complex meshwork of three-dimensional collagen bundles interconnected with large elastic fibers.
Reticular dermis
Sebaceous glands excrete a mixture of lipids that lubricates the hair and skin. What is this mixture called?
Sebum
A nurse explaining a macule to a patient defines it as being which one of the following?
Small, flat, nonpalpable, discolored lesion
In explaining a papule to a patient, a nurse defines it as being which of the following?
Small, raised solid mass with a circumscribed border
A child comes in to show his parents (who are nurses) a blister on his foot from "breaking in" a new pair of shoes. The child wants to "pop the blister" to get all the fluid out of it so it won't hurt so much when he puts on shoes and socks. The parents know that breaking the skin of the blister will put him at risk for which of the following?
Secondary infection
The nurse planning a sun safety community education class should include the information that the increased melanin produced by dark-colored skin decreases the risk for which of the following?
Skin cancer
Pruritis, or the itch sensation, is a by-product of almost all skin disorders. However, we can itch without having a skin disorder. Itch then can be local or central in our bodies. Where is it postulated that a central "itch center" exists?
Somatosensory cortex
A nurse educator is teaching students about the layers of the skin. Which of the following layers are commonly referred to as prickle cells?
Stratum spinosum
In assessing a client's integumentary system, what assessment finding does the nurse report as "normal"?
Sweat glands in the axillae
Among the skin's protective functions is the fact that it serves as an immunologic barrier. What cells are responsible for detecting foreign antigens?
The Langerhans cells
Fingernails and toenails, unlike hair, grow continuously. The nail plate itself is nearly transparent and acts as a window for viewing what?
The amount of oxygen in the blood
What is the source of nutrition for the epidermis?
The dermis
What statement is true concerning the skin?
The skin is the largest organ of the body.
Lichenified skin is defined as being which one of the following?
Thickened skin with exaggerated markings
A patient with albinism has a genetic lack of which of the following enzymes?
Tyrosinase
A client visiting the family medical physician is reporting her skin itching [pruritus]. Given that this is severe enough to causing excessive scratching that has broken the skin, the healthcare provider may want to educate the client to try which intervention?
Utilize topical antihistamines or corticosteroids for cutaneous disorders mediated by histamine.
During a physical assessment, a nurse determines that a patient has excessively dry skin. Which of the following terms would the nurse use to document this condition?
Xerosis
The skin assessment of a black client reveals the presence of white areas on the skin that are flat, nonpalpable, less than 1 cm in diameter, and have a circumscribed border. How does the nurse document the finding?
macule
When trying to explain the advantages of using an emollient over other products to a patient suffering from dry skin, the nurse will emphasize that emollients:
can replenish the oils on the skin surface because they contain fatty acids.
The skin is richly supplied with arteriovenous anastomoses in which blood flows directly between an artery and a vein, bypassing the capillary circulation. This particular vascular structure allows a client to:
regulate body temperature.
