Health Assessment-Chapter 13-Skin, Hair & Nails

Which statement made by a co-worker indicates a correct understanding of skin structures and functions? 1 "Epidermis is thin, but tough." 2 "Skin is thinner at the palm." 3 "Keratin provides a brown tone to the skin." 4 "The outer layer is mainly made of collagen."

1 "Epidermis is thin, but tough." The epidermis is thin but tough. Its cells are bound tightly together into sheets that form a rugged protective barrier. On the palms and soles skin is thicker (not thinner) because of work and weight bearing. Keratin has no function in skin pigmentation. The epidermis, or the outer layer, is made of tough fibrous protein called keratin. The melanocytes intercalated along the basal cell layer produce the pigment melanin, which gives brown tones to the skin. The basal cell layer of the epidermis is mainly made of keratin; the dermis or inner supportive layer consists mostly of connective tissue, or collagen.

Which statement made by the parent indicates effective learning about ways to prevent diaper rash? 1 "I should change my baby's diapers frequently." 2 "I will use disposable, scented wipes to clean my baby's bottom." 3 "I will soak the diapers in a heavy detergent solution before washing." 4 "I should place a plastic covering over my baby's disposable diapers."

1 "I should change my baby's diapers frequently." Changing the diapers frequently prevents excessive exposure of the newborn's skin to moisture and prevents diaper rash. Diaper dermatitis (rash) is an inflammatory disease caused by skin irritation from ammonia, heat, moisture, and occlusive diapers or coverings. Disposable wipes contain perfumes that may be harmful for the skin. Therefore the parent should avoid using disposable, scented wipes for cleaning the newborn's buttocks. Heavy detergents may result in allergic reactions. Therefore it is not appropriate to use heavy detergents before washing the diapers. Occlusive diapers and coverings can lead to diaper rash by trapping moisture close to the baby's skin and should not be used.

Which condition would cause a light-skinned patient's skin tone to be whitish-pink in color? 1 Albinism 2 Hyperemia 3 Polycythemia 4 Addison disease

1 Albinism Albinism would cause a whitish-pink color in a light-skinned patient. Albinism is an inherited disorder characterized by the complete absence of melanin, which colors the skin, hair, and eyes. In a light-skinned person, the skin color changes to whitish-pink, whereas in a person with darker skin it appears white or tan and creamy-colored. Hyperemia is the increased blood flow through engorged arterioles. In this condition, the skin color changes to red or bright pink, rather than whitish-pink. Polycythemia is the increased red blood cell count that results in ruddy blue-colored skin. Addison disease is characterized by cortisol deficiency, which stimulates the production of melanin and results in bronzed or tanned skin.

Which term would the nurse document in the chart to describe individual lesions that remain separate from each other? 1 Discrete 2 Confluent 3 Gyrate 4 Zosteriform

1 Discrete Discrete describes distinct, individual lesions that remain separate from each other. Confluent indicates the lesions have run together. Gyrate indicates a twisted, coiled spiral, or snakelike configuration. Zosteriform is a linear arrangement along a unilateral nerve route.

Which information would the nurse include in a teaching session about nail physiology? 1 The pink color is because of vascular epithelial cells. 2 The nail matrix is a white, opaque semilunar area. 3 The nails are hard plates of collagen. 4 The ridges on the nail plates disappear with age.

1 The pink color is because of vascular epithelial cells. The nurse would include the following information: nails take their pink color from the underlying nail bed of the vascular epithelial cells. The lunula (rather than the matrix) is the white, opaque crescent area at the proximal end of the nail. The nails are hard plates of keratin, not collagen. Fine longitudinal ridges on the nail bed become prominent with age.

Which microorganism causes athlete's foot? 1 Tinea pedis 2 Tinea corporis 3 Varicella zoster virus 4 Herpes simplex virus

1 Tinea pedis Athlete's foot is a fungal infection that is caused by tinea pedis, or ringworm of the foot, and is characterized by the presence of small vesicles and fissures between the toes and on the sides of the feet. Tinea corporis, varicella zoster virus, or herpes simplex virus infections do not cause athlete's foot. Tinea corporis is a type of ringworm that affects the body, not the feet. Varicella zoster virus causes chickenpox. Herpes simplex virus causes a cold sore infection, resulting in acute gingivostomatitis.

Which assessment finding would the nurse expect to observe in an infant who has milia? 1 White papules on the cheeks, forehead, nose, and chin 2 Bluish discoloration of the hands and feet 3 Cream cheese-like substance covering parts of the skin 4 Purple macular patch covering the sacrum

1 White papules on the cheeks, forehead, nose, and chin The obstruction of sebaceous glands causes white papules on the cheeks, forehead, nose, and chin. They are called "milia," and they disappear within a week. Acrocyanosis is a bluish discoloration of the hands and feet and disappears within a few hours. Vernix caseosa is a moist, white, cream cheese substance that covers parts of the skin in all newborns. Mongolian spots are blue-black-to-purple macular areas on the sacrum or buttocks that resemble bruises.

Which skin diseases would the nurse be familiar with when assessing dark-skinned patients? Select all that apply. 1 Keloids 2 Melasma 3 Pruritus 4 Xerosis 5 Pseudofolliculitis

1 Keloids 2 Melasma 5 Pseudofolliculitis Several skin conditions are commonly seen in dark-skinned people: keloids, melasma, and pseudofolliculitis. A keloid is a scar that is formed at the site of a wound and that grows beyond its normal boundaries. Dark-skinned people have dense bundles of collagen right below the epidermis that may affect the production of keloids. Melasma, also called "mask of pregnancy," is a blotchy tan to dark brown discoloration of the face. Pseudofolliculitis, also known as "razor bumps," is caused by shaving too closely with an electric or a straight razor. Pruritus is the most common skin symptom, not specific to one culture. Pruritus is skin itching. It is a pathologic condition that may be caused by dry skin, aging, drug reactions, allergy, obstructive jaundice, uremia, and lice. Xerosis is dryness of the skin, which is a common symptom of aging in all types of people.

Which are functions of the skin? Select all that apply. 1 Regulates body temperature 2 Regulates blood glucose level 3 Assists in acid-base balance 4 Prevents invasion of microorganisms 5 Assists in the production of vitamin D

1 Regulates body temperature 4 Prevents invasion of microorganisms 5 Assists in the production of vitamin D Functions of the skin include the following: regulates body temperature, prevents invasion of microorganisms, and assists in the production of vitamin D. Skin helps in thermoregulation by adjusting heat through the sweat glands and subcutaneous insulation. The skin acts as a mechanical barrier that protects the body against peripheral invasions of microorganisms. Ultraviolet rays of the sun fall on the skin, and the sunlight transforms cholesterol into vitamin D. The hormones insulin and glucagon regulate blood glucose. The acid-base balance is regulated inside the body, and the skin does not participate in this process.

Which response would the nurse make to a parent whose infant has one large, round, light brown patch on the arm? 1 "This is a Mongolian spot." 2 "That is a café au lait spot." 3 "A spot like this is called a bruise." 4 "Your child may have neurofibromatosis."

2 "That is a café au lait spot." A large round or oval patch of light brown pigmentation present at birth is known as a café au lait spot. The name means "coffee with milk" because of its color. It is a normal finding in infants. The Mongolian spot is a common variation of hyperpigmentation in African-American, Asian, American Indian, and Latino newborns. It is a blue-black to purple macular area generally seen at the sacrum or buttocks. Bruising is a soft-tissue injury that follows a rapid, traumatic, or breech birth. Six or more café au lait spots, each more than 1.5 cm in diameter, are diagnostic of neurofibromatosis, an inherited neurocutaneous disease. In this case, the child has only one café au lait spot, so it is not neurofibromatosis.

Which finding would the nurse expect to observe when assessing dark-skinned patients? 1 Pallor with decreased perfusion and shock 2 Cherry-red nail beds with carbon monoxide poisoning 3 Ruddy blue in feet with polycythemia 4 Bright pink skin with hyperemia

2 Cherry-red nail beds with carbon monoxide poisoning A dark-skinned patient will have cherry-red color in nail beds with carbon monoxide poisoning. Pallor occurs in light-skinned patients who have decreased perfusion and shock, whereas dark-skinned patients would have yellow-brown, dull or ashen gray skin color in decreased perfusion and shock. Light-skinned patients have ruddy blue coloring in the feet with polycythemia, whereas dark-skinned patients have redness in lips with polycythemia. Hyperemia causes a purplish tinge in dark-skinned patients that is difficult to see, so nurses must palpate for increased warmth and inflammation in dark-skinned patients, but light-skinned patients will have bright pink skin in hyperemia.

Which skin finding would the nurse observe in a pregnant patient who has linea nigra? 1 Tan irregular patch on the face 2 Dark brown line down the abdominal midline 3 Tiny red chest lesions with radiating branches 4 Silver-to-pink jagged linear lines on the thighs

2 Dark brown line down the abdominal midline The presence of a dark brown line on the abdominal midline indicates the pregnant patient has linea nigra. Melasma, or the "mask of pregnancy," is characterized by the presence of a tan to dark brown patchy discoloration of the face. Vascular spiders are lesions with tiny red centers that branch, appearing on the face, neck, upper chest, and arms. They are caused by an increase in estrogen levels. Striae are linear silver-to-pink stretch marks that appear on the thighs or abdomen or breasts during the second trimester of pregnancy.

Which patient assessment finding alerts the nurse to a keloid formation at the site of a previous surgery? 1 Area of depressed skin 2 Excess scar tissue 3 Thick, dry exudates 4 Tightly packed papules

2 Excess scar tissue The presence of excessive scar tissue beyond the original injury or surgery indicates the patient has a keloid. The presence of depressed skin at the site of the surgery indicates that the patient has an atrophic scar, caused by the loss of tissue. Crusts are the thick, dried exudates left after the bursting of vesicles or pustules. The presence of tightly packed papules at the site of the surgery indicates the patient has lichenification, caused by prolonged or intense scratching.

Which assessment finding would the nurse observe in a patient with hirsutism? 1 Circular lesions with clear centers on the abdomen of a child 2 Excessive hair growth on a female's face and chest 3 Thick, yellow-to-white, greasy scales on an infant's scalp 4 Multiple pustules with visible hair in the center on a male's neck

2 Excessive hair growth on a female's face and chest The presence of excessive hair growth on a female's face and chest indicates hirsutism. This condition is caused by improper functioning of the endocrine glands or a metabolic dysfunction. Tinea corporis (ringworm of the body) form multiple circular lesions with clear centers on the abdomen, chest, and back of arms. Seborrheic dermatitis (cradle cap) presents with thick, yellow-to-white, greasy scales with mild erythema on an infant's scalp. Folliculitis barbae (razor bumps) presents with multiple pustules and "whiteheads," with hair visible at the center of an erythematous base, usually on a man's face and neck.

Which laboratory finding would the nurse expect in a patient who has a yellowish discoloration of the skin and sclera? 1 Increased red blood cell count 2 Increased serum bilirubin level 3 Decreased arterial oxygen level 4 Decreased hematocrit level

2 Increased serum bilirubin level The patient has jaundice, a disorder characterized by impaired liver functioning, causing the serum bilirubin levels to be increased. The presence of a yellowish discoloration of the skin and sclera indicates the patient has jaundice. An increase in the red blood cells may cause polycythemia, which results in erythema, not yellowish discoloration of the skin. A decrease in arterial oxygen levels causes cyanosis, a bluish color to the skin, not a yellowing of the skin. A decrease in hematocrit level indicates anemia, leading to pallor, not jaundice.

Which abnormal hair condition would cause the nurse to ask about cancer and chemotherapy treatments? 1 Tinea capitis 2 Toxic alopecia 3 Tinea versicolor 4 Traction alopecia

2 Toxic alopecia The nurse would ask the patient with toxic alopecia about cancer and chemotherapy treatments. The loss of hair that results from cancer and chemotherapy is known as toxic alopecia. The medications prescribed for cancer may inhibit the growth of hair cells, resulting in asymmetric balding or patchy hair loss. Tinea capitis is a fungal infection that results in patchy hair loss with pustules and scales on the scalp; it does not result from cancer or chemotherapy. Tinea versicolor is scaling, round patches of pink, tan, or white (thus the name), distributed in a short-sleeved turtleneck sweater area that is caused by a superficial fungal infection, not cancer or chemotherapy. Traction alopecia is hair loss caused by trauma from tight braiding or tight ponytails, barrettes, cornrows, or hair weaves.

A patient is devoid of melanin pigment in patchy areas of the skin on the face, neck, hands, feet, and body folds. Which term would the nurse use to describe this condition? 1 Freckles 2 Vitiligo 3 Moles 4 Birthmarks

2 Vitiligo Vitiligo is an acquired condition characterized by a lack of melanin pigment in patchy areas of the skin on the face, neck, hands, feet, and body folds and around orifices. Dark-skinned people are more susceptible to this condition. Freckles are tiny, flat macules of brown melanin pigment that occur on skin that is frequently exposed to the sun. A mole is a clump of melanocytes that are flat or raised and brown or tan in color. A birthmark is a tan or brown mark that exists from birth.

Which piece of equipment would the nurse obtain to help detect a fungal infection on the patient's scalp? 1 Sterile gloves 2 Wood's light 3 Magnifier 4 Small centimeter ruler

2 Wood's light A Wood's light is used to indicate fungal infections. With the room darkened, shine the Wood's light on the area. If the lesion is a fungal infection, a blue-green fluorescence color appears. Examination gloves (not sterile gloves) are used when contact with bodily secretions is possible, but they are not useful for detecting fungal infections. Although a magnifier will increase the size of the skin lesion for easier inspection, it will not help detect whether it is a fungal infection. A small centimeter ruler is used to measure the wound margins but does not help detect a fungal infection.

The nurse imprints the thumb against the patient's tibia for 3 to 4 seconds and finds that the dent remains for a short time after removing the thumb. How would the nurse chart this finding? 1 Tenting edema greater than 3 seconds 2 Bilateral edema in extremities 3 Pitting edema present in lower leg 4 Anasarca noted in tibial area

3 Pitting edema present in lower leg If the pressure leaves a dent in the skin, "pitting" edema is present. Tenting is used to describe skin turgor, not edema. Bilateral indicates both legs would have edema, and this is not the case based upon the information in the scenario. Anasarca is generalized edema over the whole body, not in one leg.

Which skin structure is altered when a patient reports dryness of the scalp, forehead, face, and chin? 1 Keratin 2 Melanocytes 3 Sebaceous glands 4 Adipose tissue

3 Sebaceous glands Sebaceous glands keep the scalp, forehead, face, and chin lubricated. Sebum secreted from the sebaceous gland oils and lubricates the skin and hair and forms an emulsion with water that retards water loss from the skin. Keratin has no function in preventing skin dryness. The epidermis, or the outer layer, is made of tough fibrous protein called keratin. Melanocytes secrete melanin that controls skin color. Adipose tissues are fat deposits interspersed below the skin; they help in thermoregulation and provide protection.

Which statement would the nurse expect to hear from a patient who has folliculitis barbae? 1 "These cornrows are the only way I wear my hair." 2 "The follicles turned blue with a special light." 3 "My child had head lice a few weeks ago." 4 "I like shaving closely with an electric razor."

4 "I like shaving closely with an electric razor." Folliculitis barbae, also called razor bumps, occurs after shaving when growing-out hairs curl in on themselves and pierce the skin, making a foreign-body inflammatory reaction. Trauma from cornrows or tight braiding leads to traction alopecia, not folliculitis barbae. Tinea capitis, or scalp ringworm, is a fungal infection in which the lesions fluoresce blue-green under a Wood's light. Head lice, also called pediculosis capitis, present with nits (eggs), not folliculitis barbae.

The bedridden patient has a pressure injury in which the bones are visible and there is black necrotic tissue around the edges. Which type of pressure injury would the nurse report the patient has? 1 Non-blanchable erythema 2 Partial-thickness skin loss 3 Full-thickness skin loss 4 Full-thickness skin/tissue loss

4 Full-thickness skin/tissue loss A pressure injury (PI) that involves all skin layers and extends into supporting tissue, exposing bone and showing eschar (black necrotic tissue) indicates a full-thickness skin/tissue loss. A PI characterized by localized redness (that does not blanch) with intact skin is a non-blanchable erythema. A partial-thickness skin loss is characterized by loss of epidermis and exposed dermis. A full-thickness skin loss is associated with damage to the subcutaneous tissues. In this PI, the nurse can visualize subcutaneous fat from the wound, but not the bone.

A patient with possible malignant melanoma reports that a mole has recently changed color. Which additional mole change would the nurse monitor for? 1 Perfectly symmetrical 2 Well-defined margins 3 Smaller than 3 millimeters 4 Light bleeding

4 Light bleeding The nurse would monitor for light bleeding. A rapidly changing lesion and development of bleeding in a mole may be an indication of malignant melanoma. In multiple melanoma the mole would be asymmetrical, not symmetrical. The borders are irregular with poorly defined margins (not well-defined margins) in malignant melanoma. The diameter is greater than 6 millimeters, the size of a pencil eraser, in a mole with malignant melanoma.

Which condition would the nurse provide information about to a patient wanting a tattoo? 1 Albinism 2 Acrocyanosis 3 Addison disease 4 Non-TB mycobacterial infections

4 Non-TB mycobacterial infections Although professional tattooing now uses aseptic conditions, non-TB mycobacterial infections still occur. Albinism is caused by a total absence of melanin throughout the integument. Exposure to tattoo needles and equipment does not decrease melanin production and does not cause albinism. Acrocyanosis is caused by hypoxic conditions, not because of tattooing. Addison disease is a hormonal disorder caused by deficiency of cortisol, not by tattooing.

Which patient assessment would the nurse report as a normal skin finding? 1 Slightly yellow 2 Diaphoresis present 3 Tented skin turgor 4 Smooth, firm skin

4 Smooth, firm skin The texture of normal skin is smooth and firm; thus the nurse would report smooth, firm skin as normal. Slightly yellow indicates jaundice, an abnormal finding. Diaphoresis is excessive sweating and is an abnormal finding of the skin. Tented skin turgor indicates dehydration or extreme weight loss, both abnormal findings.

A patient injured 2 days ago while playing soccer has reddish-brown linear streaks on the toenails. Which abnormal nail condition is the patient exhibiting? 1 Scabies 2 Beau line 3 Acute paronychia 4 Splinter hemorrhages

4 Splinter hemorrhages The presence of reddish-brown linear streaks on the nails indicates splinter hemorrhages, which are caused by damage to the nail bed capillaries; splinter hemorrhages are commonly caused by sport injuries or trauma. Scabies is associated with the presence of linear or curved elevated burrows on the fingers and the wrist. It is an infection caused by the scabies mite. Beau line is characterized by the presence of a transverse furrow or groove across the nail that extends to the nail bed and is caused by an acute illness or toxic reaction or trauma. Acute paronychia is caused by a bacterial infection and is associated with the presence of pus, swollen nail folds, and throbbing pain in the nails.

In which area would the nurse assess for cherry angiomas on a patient? 1 Scalp 2 Legs 3 Arms 4 Torso

4 Torso Cherry (senile) angiomas are small, smooth, slightly raised bright red dots that commonly appear on the trunk (torso) of all adults older than 30 years of age. These lesions will increase in number and size with age and are not significant. Cherry angiomas do not appear on the scalp, but tinea capitis, head lice, toxic alopecia, and traction alopecia can all affect the scalp. Chery angiomas are not located on the extremities, but local arterial insufficiency and venous stasis can affect the appearance of lower legs. Senile lentigines appear on the forearms, but not cherry angiomas.

Which term would the nurse use to describe the white cheesy substance on the neonate's body? 1 Lanugo 2 Chloasma 3 Cutis marmorata 4 Vernix caseosa

4 Vernix caseosa Vernix caseosa is a thick, cheesy substance made of sebum and epithelial cells. Lanugo is the fine, downy hair that is present in the newborn for the first few months after birth. Chloasma is an irregular brown patch of hyperpigmentation on the face that occurs with pregnancy or in women taking oral contraceptive pills. Cutis marmorata is a transient mottling, reticulated red or blue pattern, in the trunk and extremities in response to cooler room temperatures.