PATHO (Quiz #1)
Sweat glands in the axillae Explanation: Sweat glands are in the axillae and the anogenital area, and this is a normal finding. There should be decreased or sparse hair on the inner arms and abdomen. The back should have the thickest dermis. (p.1528)
In assessing a client's integumentary system, what assessment finding does the nurse report as "normal"?
A benzoyl peroxide agent Explanation: Benzoyl peroxide is a topical agent that has both antibacterial and comedolytic properties. It is the topical agent most effective in reducing the Propionibacterium acnes population. Bacterial resistance does not develop to benzoyl peroxide. The irritant effect of the drug also causes vasodilation and increased blood flow, which may hasten resolution of the inflammatory lesions. Although Accutane, low-dose tetracycline, and Retin-A are often used to treat severe acne, these drugs should not be given to those who are pregnant because they can affect the development of the fetus. (p.1550)
A 30-year-old woman, who just found out that she is pregnant, seeks treatment for her severe acne. Which treatment for her skin condition is most appropriate?
Repositioning the patient on a scheduled basis Explanation: Although adequate nutrition is important in both the prevention and treatment of pressure ulcers, the most important intervention is to prevent pressure and ischemia. This can be accomplished by frequently repositioning the client. Prophylactic antibiotics are not commonly used, and dressings are not normally required unless skin breakdown is evident. (p.1571)
A 79-year-old client has been confined to bed after a severe hemorrhagic stroke that has caused hemiplegia. Which of the following measures should his care team prioritize in the prevention of pressure ulcers?
-Focus on replacing fluids that have been lost from the vascular, interstitial, and cellular compartments. -Assess for indications that the child's airway has been compromised by assessing breath sounds and voice quality. -Maintain sterile field when doing dressing changes and debridement. Explanation: Fluid is lost from the vascular, interstitial, and cellular compartments. Because of a loss of vascular volume, major burn victims often present in the emergency department in a form of hypovolemic shock. Manifestations of inhalation injury include hoarseness, drooling and inability to handle secretions, hacking cough, and labored, shallow breathing. Immunologically, the skin is the body's first line of defense. When the skin is no longer intact, the body is open to bacterial infection. The stress of burn injury increases metabolic and nutritional requirements; therefore, nutrition should not be withheld. Pain medication should be titrated to the child's need.
A child has been admitted to the burn unit after pulling a pan of hot water off the stove. Given the fact that there is primarily second- and third-degree burns, the health care worker should prioritize care to focus on which of the following? Select all that apply.
"You should perform aerobic exercise on a regular basis." Explanation: Aerobic exercise is the type of exercise that increases endurance. The other types of exercise do not have the same effect on the body. (p.231)
A client asks what exercise to engage in to increase endurance. What is the nurse's best response?
Contagious and can be transmitted to nonimmune contacts Explanation: Herpes zoster (shingles) is contagious and can be transmitted to nonimmune contacts. Although not as contagious as chickenpox, the reactivated virus can be transmitted to nonimmune contacts. Age or marital status will not affect transmission.
A client calls the clinic and tells the nurse she is concerned because her husband has developed shingles. She asks the nurse if he is contagious. The best response would be that herpes zoster (shingles) is:
A superficial fungal infection Explanation: Diagnosis of superficial fungal infections is primarily done by microscopic examination of skin scrapings for fungal spores, the reproducing bodies of fungi. Potassium hydroxide (KOH) preparations are used to prepare slides of skin scrapings. KOH disintegrates human tissue and leaves behind the threadlike filaments, or hyphae, that grow from the fungal spores, as some types of fungi fluoresce yellow-green when the light is directed onto the affected area. The other options would not be diagnosed with these methods. (p.1543)
A client presents to the urgent care with a skin infection. The health care provider uses a potassium hydroxide (KOH) preparation and the Wood light (UV light) to determine the cause. The client most likely has:
"Have you been under an excessive amount of stress at home or at work?" Explanation: Environmental stimuli may trigger the release of cytokines and growth factors from keratinocytes and other cells, with ensuing immune and inflammatory responses that lead to the full development of psoriatic lesions. Psoriatic lesions can be induced in susceptible individuals by trauma, a process known as the Köbner phenomenon. Precipitating factors for an exacerbation of psoriasis include increased stress, infection, trauma, and the use of certain medications. Types of food ingested, sexual activity, and travel to foreign countries have not been linked to psoriasis. (p.1559)
A client presents with an exacerbation of her psoriasis. The most important question for the nurse to ask the client would be:
"Your body is trying to lower your temperature." Explanation: After exercise, the body dilates blood vessels and shunts blood to the skin to help to decrease the temperature. Skin typically feels hot and sweaty. Evaporation of sweat from the skin surface contributes to loss of heat. As the heat is lost through the skin, the skin typically feels hot. The nurse should calm the client and explain that this is a normal response to exercise. (p.235)
A client who has been exercising says to the nurse, "My skin is so hot!" What is the nurse's best response?
The client's mean arterial pressure has increased. Explanation: During aerobic exercise the systolic blood pressure increases due to an increase in cardiac output and increased sympathetic tone. This causes an increase in mean arterial pressure. The systolic pressure usually increases while the diastolic pressure stays relatively stable. The only true statement is that the client's mean arterial pressure has increased. (p.233)
A client who is exercising has a blood pressure of 130/90 at the start of exercise and 150/95 during exercise. What statement is true concerning this assessment?
Small, flat, nonpalpable, discolored lesion Explanation: A macule is a flat, nonpalpable skin color change (color may be brown, white, tan, purple, red)and is less than 1 cm, with a circumscribed border. (p.1536)
A nurse explaining a macule to a patient defines it as being which one of the following?
African American Explanation: A keloid is a hypertrophied scar tissue secondary to excessive collagen formation during healing and are elevated, irregular, and red. There is a greater incidence of this among African Americans. (p.1538)
A nurse is assessing a patient with an irregularly shaped, elevated, firm growth on her right lower ear lobe that developed following an ear piercing. In which of the following races does this excessive formation of collagen occur with greater incidence?
"My schedule includes yoga and a weekly club meeting." Explanation: Chronic fatigue syndrome is a disorder of persistent unrelieved fatigue lasting longer than 6 months. It is managed through pacing activities, emotional support, an exercise program to regain strength, and structured activity to allow resumption of activities of daily living. (p.240-242)
A nurse is evaluating the progress of a patient with chronic fatigue syndrome. Which of the following statement by the patient indicates successful symptom management?
an irregularly shaped lesion
A nurse is performing a skin assessment on a client diagnosed with a malignant melanoma. The nurse would expect to note which characteristic of this type of skin lesion?
Breathlessness begins within 5 minutes Explanation: Normal cardiovascular response to activity includes increased heart rate, increased blood pressure, increased venous return, and vasodilation in active skeletal muscles, coronary arteries, and brain. The respiratory system optimizes the ventilation and perfusion ratio. An abnormal cardiovascular response includes indicators of exercise intolerance such as breathlessness and exertional fatigue. (p.232)
A nurse monitors a 68-year-old patient starting an exercise program. For which of the following manifestations would the nurse stop the activity?
"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." Explanation: The epidermis, which is avascular, is composed of four to five layers of stratified squamous keratinized epithelial cells that are formed in the deepest layer of the epidermis and migrate to the skin surface to replace cells that are lost during normal skin shedding. (p.1527)
A nursing instructor is teaching students about skin structure. The instructor evaluates student knowledge of the epidermis based on which of the following statements?
"It is a hyperkeratotic plaque of skin due to chronic friction." Explanation: A callus is caused by a hyperkeratotic plaque of skin due to chronic friction or rubbing on a single area. It is not caused by infection or lesions. (p.1535)
A patient asks the nurse what caused the callus on his foot. Which of the following is the nurse's best response?
-Pressure -Shearing force -Friction Explanation: Four factors contribute to the development of pressure ulcers: (1) pressure, (2) shearing forces, (3) friction, and (4) moisture. (p.1571)
A patient has a stage three pressure ulcer in the sacral area. What factors can contribute to the development of pressure ulcers? Select all that apply.
Basal cell carcinoma Explanation: Basal cell carcinoma (BCC), which is a neoplasm of the nonkeratinizing cells of the basal layer of the epidermis, is the most common skin cancer in light-skinned people. (p.1576)
A patient has been referred to the dermatology office for an evaluation of a suspected common malignant tumor of the skin. Which is the most common malignant tumor of the skin?
"Keep your room temperature as low as possible." "Avoid glycerin soaps." "Apply moisturizers to legs frequently." Explanation: Dry skin, also called xerosis, may be a natural occurrence, as in the drying of skin associated with aging, or it may be symptomatic of an underlying systemic disease. Moisturizing agents are the cornerstone of treatment for dry skin. These agents exert their effects by repairing the skin barrier, increasing the water content of the skin, reducing transepidermal water loss, and restoring the lipid barrier's ability to attract, hold, and redistribute water. Using room humidifiers and keeping room temperatures as low as possible to prevent water loss from the skin also may be helpful. Glycerine soaps are drying and can exacerbate the symptoms. (p.1540)
A patient has dry skin on both legs and a history of cardiovascular disease. Which of the following interventions should the nurse include in the teaching plan for this patient? Select all that apply.
-Painful -Blistered -Mottled, pink red Explanation: These burns appear as mottled pink, red,or waxy white areas with blisters and edema. The blisters resemble flat, dry tissue paper, rather than the bullous blisters seen with superficial partial-thickness injury. (p.1568)
A patient is being seen in the dermatology clinic for a follow up appointment for a second degree full-thickness burn. What are characteristics of second degree burns? Select all that apply.
"This is an area of atrophy." Explanation: The area of skin that feels like an indentation is most likely lipoatrophy or atrophied skin due to repeated insulin injections. A hypertrophied area would feel like a "lump." A scar is an actual mark left from a healing wound. (p.1538)
A patient shows the nurse an area on his arm where he has repeatedly been giving insulin injections to himself. The nurse feels the area and the skin appears to be thin. The nurse feels a "valley" or indentation in the area. Which of the following would the nurse tell the patient?
51-year-old woman admitted for exacerbation of her multiple sclerosis. Explanation: Neurologic conditions such as multiple sclerosis are particularly associated with chronic fatigue. Infections, wounds, and fistulae will undoubtedly cause fatigue but are less likely to contribute to the long-term presentation associated with chronic fatigue. (p.239)
A physician is providing care for several clients on a hospital-based medical ward. Which client is most likely to experience chronic fatigue?
Benzoyl peroxide Explanation: Benzoyl peroxide is a topical agent that has both antibacterial and comedolytic properties. It is the topical agent most effective in reducing the P. acnes population. The other topical agents do not act as both comedolytic and antibacterial agents. (p.1553)
Acne vulgaris is typically an infection in the adolescent population. What topical agent used in the treatment of acne is both an antibacterial and a comedolytic?
High production of melanin Explanation: Although the number of melanosomes in dark and white skin is the same, black skin produces more melanin, and more quickly, than white skin. Dark-skinned persons do not possess a more superficial distribution of melanocytes or increased levels of tyrosinase. (p.1529)
Dark skin tone is genetically determined and is primarily the result of which of the following?
Cyst Explanation: A cyst is an encapsulated fluid-filled or semisolid mass in the subcutaneous tissue or dermis. (p.1537)
During an examination, a nurse notices a semisolid mass in the subcutaneous tissue on the neck of a patient. When documenting this finding, the nurse would identify this condition using which of the following terms?
False Explanation: Although not as contagious as chickenpox, the reactivated virus can be transmitted to nonimmune contacts. (p.1549)
Herpes zoster (shingles) is not contagious and cannot be transmitted to nonimmune contacts.
The client should subtract his age from 220. Explanation: Maximal heart rate is estimate by age. The client should subtract his age from 220 to estimate his maximal heart rate. (p.237)
How will the nurse teach the client to estimate his maximal heart rate?
Small, raised solid mass with a circumscribed border Explanation: A papule is an elevated, palpable, solid mass with a circumscribed border less than 0.5 cm. (p.1536)
In explaining a papule to a patient, a nurse defines it as being which of the following?
Presence of actinic keratoses Explanation: Other risk factors include a family history of malignant melanoma, presence of marked freckling on the upper back, history of three or more blistering sunburns before 20 years of age, and presence of actinic keratoses. The other answers are incorrect. (p.1575)
Malignant melanomas are metastatic tumors of the skin. In the past decades, the incidence of malignant melanoma has grown. This is related to more exposure to UV light, such as tanning salons. What are risk factors for developing malignant melanoma?
A sebaceous gland Explanation: Most hair follicles are associated with sebaceous glands, and these structures combine to form the pilosebaceous unit. Langerhans cells are not paired with hair follicles, and apocrine, not eccrine glands, are often associated with a hair follicle. Nerve endings are widely distributed throughout the skin, but these are not paired with hair follicles. (p.1533)
Most of the body's hair follicles are paired with which of the following?
Scaling papules Explanation: Papulosquamous dermatoses are a group of skin disorders characterized by scaling papules and plaques. Nodular ulcerative type is a frequently occurring type of basal cell carcinoma. Squamous cell carcinoma is a red-scaling, keratotic, slightly elevated lesion that later grows outward, with large ulcerations and crusts with raised, erythematous borders. Varicella (chickenpox) is caused by the varicella-zoster virus; characteristic skin lesion occurs in three stages: macule, vesicle, and granular scab. (p.1559)
Papulosquamous dermatoses, such as psoriasis, are a group of skin disorders characterized by:
Anaerobic metabolism, coupled with vasoconstrictor response, can cause an increased afterload on the heart. Explanation: Persons with congestive heart failure (CHF) typically experience symptoms of breathlessness, exertional fatigue, and exercise intolerance, resulting in atrophy of skeletal muscles. When these individuals engage in exercise, there is a shift toward using fast-twitch muscle fibers. This causes an early dependence on anaerobic metabolism and excessive intramuscular acidification that lead to increased fatigability. The increased reliance on anaerobic metabolism and subsequent vasoconstrictor response can also lead to an increase in afterload work for an already compromised left ventricle. (p.234)
People with congestive heart failure need to be on a closely monitored exercise regimen. What is the reason for this?
Sebum Explanation: This mixture is called sebum; it lubricates hair and skin. Sweat comes from sweat glands. Chalasia is an abnormal relaxation of the cardiac sphincter of the stomach. Cerumen is found in the ear. (p.1533)
Sebaceous glands excrete a mixture that lubricates the hair and skin. What is this mixture called?
Merkel cells Explanation: The Merkel cells provide sensory information. Langerhans cells link the epidermis to the immune system, melanocytes provide pigmentation to the skin, and keratinocytes provide a protective function to the skin. (p.1532)
Select the cells of the epidermis that are responsible for providing sensory information.
Tinea capitis Explanation: Tinea capitis, the most common type of fungal infection in children, is an infection of the scalp and hair shaft. Children between the ages of 3 and 14 years are primarily affected. Tinea corporis (ringworm of the body) is commonly found on the trunk, back, or buttocks. Tinea pedis (athlete's foot) is the most common fungal dermatosis, primarily affecting the spaces between the toes, the soles, or the sides of the feet. Candidiasis (moniliasis) is a fungal infection that thrives in moist environments. (p.1544)
Select the fungal infection that involves the scalp and hair shaft, which is most common in children.
Staphylococcus aureus Explanation: Staphylococcus aureus is the microorganism that causes bullous impetigo. Group A beta-hemolytic Streptococcus is the common organism in superficial bacterial infection of impetigo. Tinea capitis is a fungal infection involving the scalp and head. Propionibacterium acnes is the organism responsible for acne. (pg.1546)
Select the microorganism that causes bullous impetigo.
Skin color may influence the appearance of the skin disorder. Explanation: No two skin disorders look exactly alike, nor are they necessarily caused by the same agents. The appearance of many skin disorders may be further influenced by excessive itching, infection, or the effects of self-treatment. Skin color also may influence the appearance.
Select the statement that best describes skin disorders.
Callus Explanation: A callus is a plaque of skin caused by chronic pressure or friction. Blisters are circumscribed elevations of the skin caused by fluid under or within the epidermis. Corns (helomas) are small, well-circumscribed, conical, keratinous thickenings of the skin and usually appear on the toes from rubbing or using ill-fitting shoes. Rashes are temporary eruptions of the skin, such as those associated with childhood diseases, heat, diaper irritation, or drug-induced reactions. (p.1535)
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:
Mongolian spots Explanation: Mongolian spots are caused by selective pigmentation. They usually occur on the buttocks or sacral area and are seen commonly in Asian and black persons. Hemangiomas are small, red lesions; nevi are moles. Rosacea is a chronic skin disorder causing papules and pustules.
The nurse is assessing an Asian client who presents with pigmented birthmarks on the buttocks and sacral area. The nurse would document this assessment as:
Increased use of oxygen for energy Explanation: Aerobic or endurance exercise increases the body's ability to improve the use of oxygen for energy during prolonged strenuous exercise. (p.231)
The nurse teaches that what is an expected outcome of aerobic exercise?
Slow-twitch muscle fibers Explanation: Skeletal muscle consists of two distinct types of muscle fibers based on differences in their size, speed, contractile properties, endurance, and metabolic characteristics: red (dark) slow-twitch (type I) and white (light) fast-twitch (type II) muscle fibers. Periods of sustained inactivity, such as prolonged immobility or bed rest, primarily affect slow-twitch fibers, which quickly decondition. (p.234)
There are two types of muscle fibers in skeletal muscle. Which type of muscle fiber is affected most by prolonged immobility or bed rest?
The client's heart and lung capacity Explanation: The principal factor that determines how long and effectively a person will be able to exercise is the capacity of the heart, lungs and circulation to deliver oxygen to the working muscles. (p.232)
What does the nurse teach is the principal factor that determines how long the client can exercise?
Psoriasis vulgaris Explanation: In psoriasis vulgaris, the primary lesions are sharply demarcated, thick, red plaques with a silvery scale that vary in size and shape. The other answers are incorrect. (p.1559)
What disease has primary lesions that have a silvery scale over thick red plaques?
"Exercise for 20 minutes or more 3 to 5 days a week." Explanation: Clients should exercise at 55 to 65 percent of their maximum heart rate 3 to 5 days a week, or 20 minutes or more of activity at 70 to 85 percent maximum heart rate for 3 or more days a week. (p.231)
What is the best advice for the nurse to give a client who is starting an exercise program?
Immobility will lead to deconditioning of muscles. Explanation: Immobility and periods of prolonged inactivity leads to deconditioning, primarily of the slow twitch muscle fibers. (p.234)
What should the nurse teach a client who is on bed rest ?
Exercise can increase blood vessel growth and help to decrease symptoms. Explanation: Adaptation to exercise induces angiogenesis with an increased growth of vessels to support blood flow to the exercising muscle. Exercise may help to decrease pain in clients with peripheral vascular disease. (p.233)
What should the nurse teach the client with peripheral vascular disease and intermittent claudication about exercise ?
Activity influences the distribution of type I and type II muscle fiber. Explanation: All skeletal muscle consists of two distinct types of muscle fibers, type I and II. The fibers are influenced by heredity and activity, which influences the distribution of the fibers. (p.234)
What statement accurately explains types of muscle fibers?
"You will walk or run on a moving belt." Explanation: During ergometry testing on a treadmill, the person walks or runs on a moving belt while the speed and the incline of the treadmill are altered. (p.237)
What will the nurse teach the client to expect during ergometry treadmill testing?
Sebaceous glands Explanation: Most hair follicles are associated with sebaceous glands, and these structures combine to form the pilosebaceous unit. The nails are hardened keratinized plates. Eccrine sweat glands transport sweat to the outer skin surface to regulate body temperature. The subcutaneous tissue layer consists primarily of fat and connective tissues that lend support to the vascular and neural structures supplying the outer layers of the skin. (p.1533)
When asked to name the parts of the pilosebaceous unit of the skin, which student has the correct answer?
To lubricate skin and hair Explanation: Sebaceous glands secrete sebum, an oily mixture consisting of lipids, including triglycerides, cholesterol, and wax, that lubricates hair and skin. Keratinocytes of the epidermis produce a fibrous protein called keratin, which is essential to the protective function of skin. Sweat glands produce watery secretions. The dermis supports the epidermis and serves as its primary source of nutrition. (p.1533)
When asking pathophysiology students, "Why do sebaceous glands secrete sebum?" the student with the correct answer would be:
Melanocytes Explanation: In addition to the keratinocytes, the epidermis has melanin pigment-producing melanocytes that protect against ultraviolet radiation and Langerhans cells that link the epidermis to the immune system. Subcutaneous tissue contains fat and binds the dermis to underlying body tissues. The third keratinocyte layer, the stratum granulosum, is composed of flat cells containing protein granules called keratohyalin granules. (p.1529)
When talking to a group of teenagers about ways to protect against skin damage from ultraviolet radiation, the nurse should discuss which of the following tissues/cells?
-The client with an infectious disease -A baby that wears a diaper -A client who is in a hot room and has a fever Explanation: The clients most likely to have a rash of the noted clients are those with an infectious disease, with a fever in a hot room, and the baby with a diaper. Clients with diabetes or a musculoskeletal disease may form a rash; however, they are not the most likely of these choices to have a rash.(p.1536)
Which client is most likely to have a rash? Select all that apply
Pulling a stroke client up in bed Explanation: Factors contributing to the development of pressure ulcers include external pressure that compresses blood vessels and friction and shearing forces that tear and injure blood vessels. Shearing forces are caused by the sliding of one tissue layer over another with stretching and angulation of blood vessels, causing injury and thrombosis. Shear occurs when the skeleton moves, but the skin remains fixed to an external surface, such as occurs with transfer from a stretcher to a bed or pulling a person up in bed. Whether a person is sitting or lying down, the weight of the body is borne by tissues covering the bony prominences. Moisture contributes to pressure ulcer formation by weakening the cell wall of individual skin cells and by changing the protective pH of the skin.
Which of the following actions could result in pressure ulcer formation?
Dark skin color Explanation: Dark-skinned people are rarely affected. Males are twice as likely as females to have squamous cell carcinoma. Age and history are not protective, as the increase in the incidence of squamous cell carcinomas is consistent with increased exposure to ultraviolet radiation. (p.1577)
Which of the following factors is most protective against squamous cell carcinomas?
Anticoagulants and regular repositioning Explanation: DVT is a major complication of bed rest. It can occur due to several factors: venous stasis, hypercoagulability that results from reduced circulating volume, and vessel injury from external pressure. Interventions to prevent DVT include anticoagulant therapy, early mobility or routine position changes, sequential compression stockings, and maintaining adequate hydration. (p.245-247)
Which of the following interventions will the nurse caring for a patient on bed rest implement to prevent deep-vein thrombosis (DVT)?
Weight lifting In isometric exercise, such as weight lifting, sustained muscle contraction is generated against an immovable load with no change in length of the involved muscle group or joint movement. Swimming and brisk walking are examples of aerobic exercise, while stretching is an example of a flexibility exercise.
Which of the following is an example of an isometric exercise?
Proteins are necessary for rebuilding tissues in the body. Proteins are necessary for rebuilding tissues in the body, but they are not used for energy during exercise. Hydration is essential before during and after exercise to replace lost body fluid. Fat intake is not essential, although increased calorie use occurs with regular exercise. (p.235)
Which of the following statements is true considering nutrition and hydration status with exercise?
Dyspnea during activity During activity, dyspnea is not expected. If it occurs the patient should sit and rest. The other cardiovascular responses to exercise are expected : increased respiratory rate, heart rate and blood pressure. (p.238)
Which of the following will the nurse assess in order to determine that a patient has activity intolerance?
A corn is a keratinous thickening of skin. Explanation: A corn is a keratinous thickening of the skin that usually appears on the toes. A blister is a vesicle and a callous is a hyperkeratotic plaque. Pruritis refers to the sensation of itching. (p.1536)
Which term is correctly linked with its definition?