MED SURG: Chapter 22 questions

Age-related changes in the hair and nails include (select all that apply) a. oily scalp. b. scaly scalp. c. thinner nails. d. thicker, brittle nails. e. longitudinal nail ridging.

B,D, and E b. scaly scalp , d. thicker, brittle nails, and e. longitudinal nail ridging.

What is the most common diagnostics test used to determine a causative agent of skin infections? a. Culture b. Tzanck test c. Immunofluorescent studies d. Potassium hydroxide (KOH) slides

a. Culture

The patient is visiting the free clinic to refill her medications. During the generalized assessment, the nurse documents alopecia; an increased heart rate; warm, moist, flushed skin; and thin nails. The patient also states she is anxious and has lost weight lately. Which systemic problem will the nurse most likely suspect and relate to the health care provider? a. Hyperthyroidism b. Systemic lupus erythematosus c. Vitamin B1 (thiamine) deficiency d. Human immunodeficiency virus (HIV) infections

a. Hyperthyroidism

A woman calls the health clinic and describes a rash that she has over the abdomen and chest. She tells the nurse it has raised, fluid filled, small blisters that are distinct. a. Identify the type of primary skin lesion described by this patient. b. What is the distribution terminology for these lesions? c. What additional information does the nurse have to document the critical components of these lesions?

a. Vesicles b. Discrete lesions localized to the chest and abdomen c. Color, size, height, distribution, location, and shape.

Persons with dark skin are most likely to develop a. keloids. b. wrinkles. c. skin rashes. d. skin cancer.

a. keloids.

To assess the skin for temperature and moisture, the MOST appropriate technique for the nurse to use is a. palpation. b. inspection. c. percussion. d. auscultation.

a. palpation.

The nurse assessed the patient's skin lesions as firm, edematous, irregular shaped with a variable diameter. They would be called a. wheals. b. papules. c. pustules. d. plaque.

a. wheals.

An active athletic person calls the clinic and describes her feet as having linear breaks through the skin. What is the best documentation of this problem? a. Scales b. Fissure c. Pustule d. Comedo

b. Fissure

A patient has a plaque lesion on the dorsal forearm. Which type of biopsy is most likely to be used for diagnosis of the lesion? a. Punch biopsy. b. Shave biopsy. c. Incisional biopsy. d. Excisions biopsy.

b. Shave biopsy.

The patient asks the nurse what telangiectasia looks like. Which is the best description for the nurse to give the patient? a. A circumscribed, flat discoloration b. Small, superficial, dilated blood vessels c. Benign tumor or blood and lymph vessels d. Tiny purple spots resulting from tiny hemorrhages

b. Small, superficial, dilated blood vessels

Diagnostic testing is recommended for skin lesions when a. a health history cannot be obtained. b. a more definitive diagnosis is needed. c. percussion reveals an abnormal finding. d. treatment with prescribed medication has failed.

b. a more definitive diagnosis is needed.

A home health nurse is visiting an older obese woman who has recently had hip surgery. She tells the patient's caregiver that the patient has intertrigo. When the caregiver asks what that is, the nurse should tell the caregiver that it is a. thickening of the skin. b. dermatitis in the folds of her skin. c. loss of color in differ areas of her skin. d. a firm plaque caused by fluid in the dermis.

b. dermatitis in the folds of her skin.

The nurse observes that redness remains after palpation of a discolored lesion on the patient's leg. This finding is characteristic of a. varicosities. b. intradermal bleeding. c. dilated blood vessels. d. erythematous lesions.

b. intradermal bleeding.

The primary function of the skin is a. insulation b. protection c. sensation d. absorption

b. protection

When assessing an African American patient, the nurse notes ashen color of the nail beds. What should the nurse do next? a. Palpate for rashes on the legs. b. Assess for jaundice in the sclera of the eye. c. Assess mucous membranes for cyanosis. d. Assess for pallor of the skin on the buttocks.

c. Assess mucous membranes for cyanosis.

When the nurse is assessing the skin of an older adult, which factor is likely to contribute to dry skin? a. Increased bruising. b. Excess perspiration. c. Decreased extracellular fluid. d. Chronic UV light exposure.

c. Decreased extracellular fluid.

On inspection of a patient's dark skin, the nurse notes a blue-gray birthmark on the forehead and eye area. This assessment finding is called a. vitiligo. b. intertrigo. c. Nevus of Ota. d. telangiectasia.

c. Nevus of Ota.

During the physical examination of a patient's skin, the nurse would a. use a flashlight in a poorly lit room. b. note cool, moist skin as a normal finding. c. pinch up a fold of skin to assess turgor. d. perform a lesion-specific examination first and then a general inspection.

c. pinch up a fold of skin to assess turgor.

When assessing the nutritional-metabolic pattern in relation to the skin, the nurse questions the patient regarding a. joint pain. b. the use of moisturizing shampoo. c. recent changes in would healing. d. self-care habits related to daily hygiene.

c. recent changes in would healing.

What is the primary difference between an excoriation and an ulcer? a. Ulcers do not penetrate below the epidermal junction. b. Excoriations involve only thinning of the epidermis and dermis. c. Excoriations will form crusts or scabs, whereas ulcers remain open. d. An excoriation heals without scarring because the dermis is not involved.

d. An excoriation heals without scarring because the dermis is not involved.

Priority Decision: When performing a physical assessment of the skin, what should the nurse do first? a. Palpate the temperature of the skin with the fingertips. b. Assess the degree of turgor by pinching the skin on the forearm. c. Inspect specific lesions before performing a general examination of the skin. d. Ask the patient to undress completely so that all areas of the skin can be inspected.

d. Ask the patient to undress completely so that all areas of the skin can be inspected.

When obtaining important health information about a patient during assessment of the skin, it is most important for the nurse to ask about a. a history of freckles as a child. b. patterns of weight gain and loss. c. communicable childhood illnesses. d. skin problems related to the use of medications.

d. skin problems related to the use of medications.