Chapter 13 Skin, Hair, and Nails

         155 Chapter13:Skin,Hair,andNails MULTIPLECHOICE 1.Thenurseeducatorispreparinganeducationmoduleforthenursingstaffontheepidermallayerofskin. Whichofthesestatementswouldbeincludedinthemodule?Theepidermisis: a. Highlyvascular. b. Thickandtough. c. Thinandnonstratified. d. Replacedevery4weeks. ANS:D Theepidermisisthinyettough,replacedevery4weeks,avascular,andstratifiedintoseveralzones. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:General 2.Thenurseeducatorispreparinganeducationmoduleforthenursingstaffonthedermislayerofskin.Which ofthesestatementswouldbeincludedinthemodule?Thedermis: a. Containsmostlyfatcells. b. Consistsmostlyofkeratin. c. Isreplacedevery4weeks. d. Containssensoryreceptors. ANS:D Thedermisconsistsmostlyofcollagen,hasresilientelastictissuethatallowstheskintostretch,andcontains nerves,sensoryreceptors,bloodvessels,andlymphaticvessels.Itisnotreplacedevery4weeks. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:General 3.Thenurseisexaminingapatientwhotellsthenurse,Isuresweatalot,especiallyonmyfaceandfeetbutit doesnthaveanodor.Thenurseknowsthatthisconditioncouldberelatedto: a. Eccrineglands. b. Apocrineglands.       c. Disorderofthestratumcorneum. d. Disorderofthestratumgerminativum.    156 ANS:A Theeccrineglandsarecoiledtubulesthatdirectlyopenontotheskinsurfaceandproduceadilutesaline solutioncalledsweat.Apocrineglandsareprimarilylocatedintheaxillae,anogenitalarea,nipples,andnaval areaandmixwithbacterialfloratoproducethecharacteristicmuskybodyodor.Thepatientsstatementisnot relatedtodisordersofthestratumcorneumorthestratumgerminativum. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 4.Anewborninfantisintheclinicforawell-babycheckup.Thenurseobservestheinfantforthepossibilityof fluidlossbecauseofwhichofthesefactors? a. Subcutaneousfatdepositsarehighinthenewborn. b. Sebaceousglandsareoverproductiveinthenewborn. c. Thenewbornsskinismorepermeablethanthatoftheadult. d. Theamountofvernixcaseosadramaticallyrisesinthenewborn. ANS:C Thenewbornsskinisthin,smooth,andelasticandisrelativelymorepermeablethanthatoftheadult; consequently,theinfantisatgreaterriskforfluidloss.Thesubcutaneouslayerintheinfantisinefficient,not thick,andthesebaceousglandsarepresentbutdecreaseinsizeandproduction.Vernixcaseosaisnotproduced afterbirth. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:HealthPromotionandMaintenance 5.Thenurseisbathingan80-year-oldmanandnoticesthathisskiniswrinkled,thin,lax,anddry.Thisfinding wouldberelatedtowhichfactorintheolderadult? a. Increasedvascularityoftheskin b. Increasednumbersofsweatandsebaceousglands c. Anincreaseinelastinandadecreaseinsubcutaneousfat d. Anincreasedlossofelastinandadecreaseinsubcutaneousfat ANS:D          157 Anaccumulationoffactorsplacetheagingpersonatriskforskindiseaseandbreakdown:thethinningofthe skin,adecreaseinvascularityandnutrients,thelossofprotectivecushioningofthesubcutaneouslayer,a lifetimeofenvironmentaltraumatoskin,thesocialchangesofaging,aincreasinglysedentarylifestyle,andthe chanceofimmobility. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:HealthPromotionandMaintenance 6.Duringtheagingprocess,thehaircanlookgrayorwhiteandbegintofeelthinandfine.Thenurseknows thatthisoccursbecauseofadecreaseinthenumberoffunctioning: a. Metrocytes. b. Fungacytes. c. Phagocytes. d. Melanocytes. ANS:D Intheaginghairmatrix,thenumberoffunctioningmelanocytesdecreases;asaresult,thehairlooksgrayor whiteandfeelsthinandfine.Theotheroptionsarenotcorrect. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:HealthPromotionandMaintenance 7.Duringanexamination,thenursefindsthatapatienthasexcessivedrynessoftheskin.Thebesttermto describethisconditionis: a. Xerosis. b. Pruritus. c. Alopecia. d. Seborrhea. ANS:A Xerosisisthetermusedtodescribeskinthatisexcessivelydry.Pruritusreferstoitching,alopeciareferstohair loss,andseborrheareferstooilyskin. DIF:CognitiveLevel:Remembering(Knowledge) MSC:ClientNeeds:HealthPromotionandMaintenance 8.A22-year-oldwomancomestotheclinicbecauseofseveresunburnandstates,Iwasoutinthesunforjusta coupleofminutes.Thenursebeginsamedicationreviewwithher,payingspecialattentiontowhich medicationclass?        a. Nonsteroidalantiinflammatorydrugsforpain b. Tetracyclinesforacne c. Protonpumpinhibitorsforheartburn d. Thyroidreplacementhormoneforhypothyroidism   158 ANS:B Drugsthatmayincreasesunlightsensitivityandgiveaburnresponseincludesulfonamides,thiazidediuretics, oralhypoglycemicagents,andtetracycline. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:HealthPromotionandMaintenance 9.AwomanisleavingonatriptoHawaiiandhascomeinforacheckup.Duringtheexaminationthenurse learnsthatshehasdiabetesandtakesoralhypoglycemicagents.Thepatientneedstobeconcernedabout whichpossibleeffectofhermedications? a. Increasedpossibilityofbruising b. Skinsensitivityasaresultofexposuretosaltwater c. Lackofavailabilityofglucose-monitoringsupplies d. Importanceofsunscreenandavoidingdirectsunlight ANS:D Drugsthatmayincreasesunlightsensitivityandgiveaburnresponseincludesulfonamides,thiazidediuretics, oralhypoglycemicagents,andtetracycline. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential 10.A13-year-oldgirlisinterestedinobtaininginformationaboutthecauseofheracne.Thenurseshould sharewithherthatacne: a. Iscontagious. b. Hasnoknowncause. c. Iscausedbyincreasedsebumproduction. d. Hasbeenfoundtoberelatedtopoorhygiene.          159 ANS:C Approximately90%ofmalesand80%offemaleswilldevelopacne;causesareincreasedsebumproduction andepithelialcellsthatdonotdesquamatenormally. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:HealthPromotionandMaintenance 11.A75-year-oldwomanwhohasahistoryofdiabetesandperipheralvasculardiseasehasbeentryingto removeacornonthebottomofherfootwithapairofscissors.Thenursewillencouragehertostoptryingto removethecornwithscissorsbecause: a. Thewomancouldbeatincreasedriskforinfectionandlesionsbecauseofherchronicdisease. b. Withherdiabetes,shehasincreasedcirculationtoherfoot,anditcouldcauseseverebleeding. c. Sheis75yearsoldandisunabletosee;consequently,sheplacesherselfatgreaterriskforselfinjurywiththescissors. d. Withherperipheralvasculardisease,herrangeofmotionislimitedandshemaynotbeableto reachthecornsafely. ANS:A Apersonalhistoryofdiabetesandperipheralvasculardiseaseincreasesapersonsriskforskinlesionsinthe feetorankles.Thepatientneedstoseekaprofessionalforassistancewithcornremoval. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential 12.Thenursekeepsinmindthatathoroughskinassessmentisextremelyimportantbecausetheskinholds informationaboutapersons: a. Supportsystems. b. Circulatorystatus. c. Socioeconomicstatus. d. Psychologicalwellness. ANS:B Theskinholdsinformationaboutthebodyscirculation,nutritionalstatus,andsignsofsystemicdiseases,as wellastopicaldataontheintegumentarysystemitself. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare          160 13.Apatientcomesinforaphysicalexaminationandcomplainsoffreezingtodeathwhilewaitingforher examination.Thenursenotesthatherskinispaleandcoolandattributesthisfindingto: a. Venouspooling. b. Peripheralvasodilation. c. Peripheralvasoconstriction. d. Decreasedarterialperfusion. ANS:C Achillyorair-conditionedenvironmentcausesvasoconstriction,whichresultsinfalsepallorandcoolness. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:BasicCareandComfort 14.Apatientcomestotheclinicandtellsthenursethathehasbeenconfinedtohisreclinerchairfor approximately3dayswithhisfeetdownandheasksthenursetoevaluatehisfeet.Duringtheassessment,the nursemightexpecttofind: a. Pallor b. Coolness c. Distendedveins d. Prolongedcapillaryfillingtime ANS:C Keepingthefeetinadependentpositioncausesvenouspooling,resultinginredness,warmth,anddistended veins.Prolongedelevationwouldcausepallorandcoolness.Immobilizationorprolongedinactivitywould causeprolongedcapillaryfillingtime. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 15.Apatientisespeciallyworriedaboutanareaofskinonherfeetthathasturnedwhite.Thehealthcare providerhastoldherthatherconditionisvitiligo.Thenurseexplainstoherthatvitiligois: a. Causedbyanexcessofmelaninpigment b. Causedbyanexcessofapocrineglandsinherfeet c. Causedbythecompleteabsenceofmelaninpigment  d.         161 Relatedtoimpetigoandcanbetreatedwithanointment ANS:C Vitiligoisthecompleteabsenceofmelaninpigmentinpatchyareasofwhiteorlightskinontheface,neck, hands,feet,bodyfolds,andaroundorificesotherwise,thedepigmentedskinisnormal. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 16.Apatienttellsthenursethathehasnoticedthatoneofhismoleshasstartedtoburnandbleed.When assessinghisskin,thenursepaysspecialattentiontothedangersignsforpigmentedlesionsandisconcerned withwhichadditionalfinding? a. Colorvariation b. Borderregularity c. Symmetryoflesions d. Diameteroflessthan6mm ANS:A Abnormalcharacteristicsofpigmentedlesion d in the mnemonic ABCD:    asymmetry  of  pigmentedlesion,borderirregularity,colorvariation,anddiametergreaterthan6mm.  DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:HealthPromotionandMaintenance 17.Apatientcomestotheclinicandstatesthathehasnoticedthathisskinisredderthannormal.Thenurse understandsthatthisconditionisduetohyperemiaandknowsthatitcanbecausedby: a. Decreasedamountsofbilirubinintheblood b. Excessbloodintheunderlyingbloodvessels c. Decreasedperfusiontothesurroundingtissues d. Excessbloodinthedilatedsuperficialcapillaries ANS:D Erythemaisanintenserednessoftheskincausedbyexcessblood(hyperemia)inthedilatedsuperficial capillaries. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation          162 18.Duringaskinassessment,thenursenoticesthataMexican-Americanpatienthasskinthatisyellowishbrown;however,theskinonthehardandsoftpalateispinkandthepatientssclerasarenotyellow.Fromthis finding,thenursecouldprobablyruleout: a. Pallor b. Jaundice c. Cyanosis d. Irondeficiency ANS:B Jaundiceisexhibitedbyayellowcolor,whichindicatesrisinglevelsofbilirubinintheblood.Jaundiceisfirst noticedinthejunctionofthehardandsoftpalateinthemouthandinthescleras. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 19.Ablackpatientisintheintensivecareunitbecauseofimpendingshockafteranaccident.Thenurse expectstofindwhatcharacteristicsinthispatientsskin? a. Ruddyblue. b. Generalizedpallor. c. Ashen,gray,ordull. d. Patchyareasofpallor. ANS:C Pallorattributabletoshock,withdecreasedperfusionandvasoconstriction,inblack-skinnedpeoplewillcause theskintoappearashen,gray,ordull. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 20.Anolderadultwomanisbroughttotheemergencydepartmentafterbeingfoundlyingonthekitchenfloor for2days;sheisextremelydehydrated.Whatwouldthenurseexpecttoseeduringtheexamination? a. Smoothmucousmembranesandlips b. Drymucousmembranesandcrackedlips c. Palemucousmembranes  d.         163 Whitepatchesonthemucousmembranes ANS:B Withdehydration,mucousmembranesappeardryandthelipslookparchedandcracked.Theotherresponses arenotfoundindehydration. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 21.A42-year-oldwomancomplainsthatshehasnoticedseveralsmall,slightlyraised,brightreddotsonher chest.Onexamination,thenurseexpectsthatthespotsareprobably: a. Anasarca. b. Scleroderma. c. Senileangiomas. d. Latentmyeloma. ANS:C Cherry(senile)angiomasaresmall,smooth,slightlyraisedbrightreddotsthatcommonlyappearonthetrunk ofadultsover30yearsold. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 22.A65-year-oldmanwithemphysemaandbronchitishascometotheclinicforafollow-upappointment.On assessment,thenursemightexpecttoseewhichfinding? a. Anasarca b. Scleroderma c. Pedalerythema d. Clubbingofthenails ANS:D Clubbingofthenailsoccurswithcongenitalcyanoticheartdiseaseandneoplasticandpulmonarydiseases.The otherresponsesareassessmentfindingsnotassociatedwithpulmonarydiseases. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 23.AnewborninfanthasDownsyndrome.Duringtheskinassessment,thenursenoticesatransientmottling          164 inthetrunkandextremitiesinresponsetothecooltemperatureintheexaminationroom.Theinfantsmother alsonoticesthemottlingandaskswhatitis.Thenurseknowsthatthismottlingiscalled: a. Cafaulait. b. Carotenemia. c. Acrocyanosis. d. Cutismarmorata. ANS:D PersistentorpronouncedcutismarmorataoccurswithinfantsbornwithDownsyndromeorthoseborn prematurelyandisatransientmottlinginthetrunkandextremitiesinresponsetocoolroomtemperatures.A cafaulaitspotisalargeroundorovalpatchoflight-brownpigmentation.Carotenemiaproducesayelloworangecolorinlight-skinnedpersons.Acrocyanosisisabluishcoloraroundthelips,handsandfingernails,and feetandtoenails. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 24.A35-year-oldpregnantwomancomestotheclinicforamonthlyappointment.Duringtheassessment,the nursenoticesthatshehasabrownpatchofhyperpigmentationonherface.Thenursecontinuestheskin assessmentawarethatanotherfindingmaybe: a. Keratoses. b. Xerosis. c. Chloasma. d. Acrochordons. ANS:C Inpregnancy,skinchangescanincludestriae,lineanigra(abrownish-blacklinedownthemidline),chloasma (brownpatchesofhyperpigmentation),andvascularspiders.Keratosesareraised,thickenedareasof pigmentationthatlookcrusted,scaly,andwarty.Xerosisisdryskin.Acrochordons,orskintags,occurmore oftenintheagingadult. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 25.Amanhascomeintotheclinicforaskinassessmentbecauseheisworriedhemighthaveskincancer. Duringtheskinassessmentthenursenoticesseveralareasofpigmentationthatlookgreasy,dark,andstuckon hisskin.Whichisthebestprediction? a. Senilelentigines,whichdonotbecomecancerous          165 b. Actinickeratoses,whichareprecursorstobasalcellcarcinoma c. Acrochordons,whichareprecursorstosquamouscellcarcinoma d. Seborrheickeratoses,whichdonotbecomecancerous ANS:D Seborrheickeratosesappearlikedark,greasy,stuck-onlesionsthatprimarilydeveloponthetrunk.These lesionsdonotbecomecancerous.Senilelentiginesarecommonlycalledliverspotsandarenotprecancerous. Actinic(senileorsolar)keratosesarelesionsthatarered-tanscalyplaquesthatincreaseovertheyearsto becomeraisedandroughened.Theymayhaveasilvery-whitescaleadherenttotheplaque.Theyoccuronsunexposedsurfacesandaredirectlyrelatedtosunexposure.Theyarepremalignantandmaydevelopinto squamouscellcarcinoma.Acrochordonsareskintagsandarenotprecancerous. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 26.A70-year-oldwomanwholovestogardenhassmall,flat,brownmaculesoverherarmsandhands.She asks,Whatcausestheseliverspots?Thenursetellsher,Theyare: a. Signsofdecreasedhematocritrelatedtoanemia. b. Duetothedestructionofmelanin m exposure   to the  sun.  c. Clustersofmelanocytesthatappearafterextensivesunexposure. d. Areasofhyperpigmentationrelatedtodecreasedperfusionandvasoconstriction.    ANS:C Liverspots,orsenilelentigines,areclustersofmelanocytesthatappearontheforearmsanddorsaofthehands afterextensivesunexposure.Theotherresponsesarenotcorrect. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 27.Thenursenoticesthatapatienthasasolid,elevated,circumscribedlesionthatislessthan1cmin diameter.Whendocumentingthisfinding,thenursereportsthisasa: a. Bulla. b. Wheal. c. Nodule. d. Papule.          166 ANS:D Apapuleissomethingonecanfeel,issolid,elevated,circumscribed,lessthan1cmindiameter,andisdueto superficialthickeningintheepidermis.Abullaislargerthan1cm,superficial,andthinwalled.Awhealis superficial,raised,transient,erythematous,andirregularinshapeattributabletoedema.Anoduleissolid, elevated,hardorsoft,andlargerthan1cm. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 28.Thenursejustnotedfromthemedicalrecordthatthepatienthasalesionthatisconfluentinnature.On examination,thenurseexpectstofind: a. Lesionsthatruntogether. b. Annularlesionsthathavegrowntogether. c. Lesionsarrangedinalinealonganerveroute. d. Lesionsthataregroupedorclusteredtogether. ANS:A Confluentlesions(aswithurticaria[hives])runtogether.Groupedlesionsareclusteredtogether.Annular lesionsarecircularinnature.Zosteriformlesionsarearrangedalonganerveroute. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 29.Apatienthashadaterribleitchforseveralmonthsthathehasbeencontinuouslyscratching.On examination,thenursemightexpecttofind: a. Akeloid. b. Afissure. c. Keratosis. d. Lichenification. ANS:D Lichenificationresultsfromprolonged,intensescratchingthateventuallythickenstheskinandproduces tightlypackedsetsofpapules.Akeloidisahypertrophicscar.Afissureisalinearcrackwithabruptedges, whichextendsintothedermis;itcanbedryormoist.Keratosesarelesionsthatareraised,thickenedareasof pigmentationthatappearcrusted,scaly,andwarty. DIF:CognitiveLevel:Understanding(Comprehension)          167 MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 30.Aphysicianhasdiagnosedapatientwithpurpura.Afterleavingtheroom,anursingstudentasksthenurse whatthephysiciansawthatledtothatdiagnosis.Thenurseshouldsay,Thephysicianisreferringtothe: a. Bluedilationofbloodvesselsinastar-shapedlinearpatternonthelegs. b. Fieryred,star-shapedmarkingonthecheekthathasasolidcircularcenter. c. Confluentandextensivepatchofpetechiaeandecchymosesonthefeet. d. Tinyareasofhemorrhagethatarelessthan2mm,round,discrete,anddarkredincolor. ANS:C Purpuraisaconfluentandextensivepatchofpetechiaeandecchymosesandaflatmacularhemorrhage observedingeneralizeddisorderssuchasthrombocytopeniaandscurvy.Thebluedilationofbloodvesselsina star-shapedlinearpatternonthelegsdescribesavenouslake.Thefieryred,star-shapedmarkingonthecheek thathasasolidcircularcenterdescribesaspiderorstarangioma.Thetinyareasofhemorrhagethatareless than2mm,round,discrete,anddarkredincolordescribespetechiae. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 31.Amotherhasnoticedthatherson,whohasbeentoanewbabysitter,hassomeblistersandscabsonhis faceandbuttocks.Onexamination,thenursenoticesmoist,thin-roofedvesicleswithathinerythematousbase andsuspects: a. Eczema. b. Impetigo. c. Herpeszoster. d. Diaperdermatitis. ANS:B Impetigoismoist,thin-roofedvesicleswithathinerythematousbaseandisacontagiousbacterialinfectionof theskinandmostcommonininfantsandchildren.Eczemaischaracterizedbyerythematouspapulesand vesicleswithweeping,oozing,andcrusts.Herpeszoster(i.e.,chickenpoxorvaricella)ischaracterizedby small,tightvesiclesthatareshinywithanerythematousbase.Diaperdermatitisischaracterizedbyred,moist maculopapularpatcheswithpoorlydefinedborders. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 32.Thenursenoticesthataschool-agedchildhasbluish-white,red-basedspotsinhermouththatareelevated approximately1to3mm.Whatothersignswouldthenurseexpecttofindinthispatient?          a. Pink,papularrashonthefaceandneck b. Pruriticvesiclesoverhertrunkandneck c. Hyperpigmentationonthechest,abdomen,andbackofthearms d. Red-purple,maculopapular,blotchyrashbehindtheearsandontheface 168 ANS:D Withmeasles(rubeola),theexaminerassessesared-purple,blotchyrashonthethirdorfourthdayofillness thatappearsfirstbehindtheears,spreadsovertheface,andthenovertheneck,trunk,arms,andlegs.Therash appearscopperyanddoesnotblanch.Thebluish-white,red-basedspotsinthemouthareknownasKoplik spots. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 33.Thenurseisassessingtheskinofapatientwhohasacquiredimmunodeficiencysyndrome(AIDS)and noticesmultiplepatchlikelesionsonthetempleandbeardareathatarefaintpinkincolor.Thenurse recognizestheselesionsas: a. Measles(rubeola). b. Kaposissarcoma. c. Angiomas. d. Herpeszoster. ANS:B Kaposissarcomaisavasculartumorthat,intheearlystages,appearsasmultiple,patchlike,faintpinklesions overthepatientstempleandbeardareas.Measlesischaracterizedbyared-purplemaculopapularblotchyrash thatappearsonthethirdorfourthdayofillness.Therashisfirstobservedbehindtheears,spreadsoverthe face,andthenspreadsovertheneck,trunk,arms,andlegs.Cherry(senile)angiomasaresmall(1to5mm), smooth,slightlyraisedbrightreddotsthatcommonlyappearonthetrunkinalladultsover30yearsold. Herpeszostercausesvesiclesupto1cminsizethatareelevatedwithacavitycontainingclearfluid. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 34.A45-year-oldfarmercomesinforaskinevaluationandcomplainsofhairlossonhishead.Hishairseems tobebreakingoffinpatches,andhenoticessomescalingonhishead.Thenursebeginstheexamination suspecting: a. Tineacapitis. b. Folliculitis.    c. Toxicalopecia. d. Seborrheicdermatitis.       169 ANS:A Tineacapitisisroundedpatchyhairlossonthescalp,leavingbroken-offhairs,pustules,andscalesontheskin, andiscausedbyafungalinfection.LesionsarefluorescentunderaWoodlightandareusuallyobservedin childrenandfarmers;tineacapitisishighlycontagious. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 35.Amotherbringsherchildintotheclinicforanexaminationofthescalpandhair.Shestatesthatthechild hasdevelopedirregularlyshapedpatcheswithbroken-off,stublikehairinsomeplaces;sheisworriedthatthis conditioncouldbesomeformofprematurebaldness.Thenursetellsherthatitis: a. Folliculitisthatcanbetreatedwithanantibiotic. b. Traumaticalopeciathatcanbetreatedwithantifungalmedications. c. Tineacapitisthatishighlycontagiousandneedsimmediateattention. d. Trichotillomania;herchildprobaabsentmindedly her hair.      twirling    ANS:D Trichotillomania,self-inducedhairloss,isusuallyduetohabit.Itformsirregularlyshapedpatcheswith broken-off,stublikehairsofvaryinglengths.Apersonisnevercompletelybald.Itoccursasachild absentmindedlyrubsortwirlstheareawhilefallingasleep,reading,orwatchingtelevision. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 36.Thenursehasdiscovereddecreasedskinturgorinapatientandknowsthatthisfindingisexpectedin whichcondition? a. Severeobesity b. Childhoodgrowthspurts c. Severedehydration d. Connectivetissuedisorderssuchasscleroderma ANS:C          170 Decreasedskinturgorisassociatedwithseveredehydrationorextremeweightloss. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 37.Whileperforminganassessmentofa65-year-oldmanwithahistoryofhypertensionandcoronaryartery disease,thenursenoticesthepresenceofbilateralpittingedemainthelowerlegs.Theskinispuffyandtight butnormalincolor.Noincreasedrednessortendernessisobservedoverhislowerlegs,andtheperipheral pulsesareequalandstrong.Inthissituation,thenursesuspectsthatthelikelycauseoftheedemaiswhich condition? a. Heartfailure b. Venousthrombosis c. Localinflammation d. Blockageoflymphaticdrainage ANS:A Bilateraledemaoredemathatisgeneralizedovertheentirebodyiscausedbyacentralproblemsuchasheart failureorkidneyfailure.Unilateraledemausuallyhasalocalorperipheralcause. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 38.A40-year-oldwomanreportsachangeinmolesize,accompaniedbycolorchanges,itching,burning,and bleedingoverthepastmonth.Shehasadarkcomplexionandhasnofamilyhistoryofskincancer,butshehas hadmanyblisteringsunburnsinthepast.Thenursewould: a. Tellthepatienttowatchthelesionandreportbackin2months. b. Referthepatientbecauseofthesuggestionofmelanomaonthebasisofhersymptoms. c. Askadditionalquestionsregardingenvironmentalirritantsthatmayhavecausedthiscondition. d. Tellthepatientthatthesesignssuggestacompoundnevus,whichisverycommoninyoungto middle-agedadults. ANS:B TheABCDdangersignsofmelanomaareasymmetry,borderirregularity,colorvariation,anddiameter.In addition,individualsmayreportachangeinsize,thedevelopmentofitching,burning,andbleeding,oranewpigmentedlesion.Anyoneofthesesignsraisesthesuggestionofmelanomaandwarrantsimmediatereferral. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation          171 39.Thenurseisassessingforclubbingofthefingernailsandexpectstofind: a. Nailbasesthatarefirmandslightlytender. b. Curvednailswithaconvexprofileandridgesacrossthenails. c. Nailbasesthatfeelspongywithanangleofthenailbaseof150degrees. d. Nailbaseswithanangleof180degreesorgreaterandnailbasesthatfeelspongy. ANS:D Thenormalnailisfirmatitsbaseandhasanangleof160degrees.Inclubbing,theanglestraightensto180 degreesorgreaterandthenailbasefeelsspongy. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 40.Thenurseisassessingapatientwhohasliverdiseaseforjaundice.Whichoftheseassessmentfindingsis indicativeoftruejaundice? a. Yellowpatchesintheoutersclera b. Yellowcolorofthesclerathatext s c. Skinthatappearsyellowwhenexaminedunderlowlight d. Yellowdepositsonthepalmsandsolesofthefeetwherejaundicefirstappears     ANS:B Theyellowscleraofjaundiceextendsuptotheedgeoftheiris.Callusesonthepalmsandsolesofthefeet oftenappearyellowbutarenotclassifiedasjaundice.Scleraljaundiceshouldnotbeconfusedwiththenormal yellowsubconjunctivalfattydepositsthatarecommonintheouterscleraofdark-skinnedpersons. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 41.Thenurseisassessingforinflammationinadark-skinnedperson.Whichtechniqueisthebest? a. Assessingtheskinforcyanosisandswelling b. Assessingtheoralmucosaforgeneralizederythema c. Palpatingtheskinforedemaandincreasedwarmth d. Palpatingfortendernessandlocalareasofecchymosis          172 ANS:C Becauseinflammationcannotbeseenindark-skinnedpersons,palpatingtheskinforincreasedwarmth,for tautortightlypulledsurfacesthatmaybeindicativeofedema,andforahardeningofdeeptissuesorblood vesselsisoftennecessary. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 42.Afewdaysafterasummerhikingtrip,a25-year-oldmancomestotheclinicwitharash.Onexamination, thenursenotesthattherashisred,macular,withabullseyepatternacrosshismidriffandbehindhisknees. Thenursesuspects: a. Rubeola. b. Lymedisease. c. Allergytomosquitobites. d. RockyMountainspottedfever. ANS:B Lymediseaseoccursinpeoplewhospendtiay through September.     The first  disease state     exhibitsthedistinctivebullseyeandaredmacularorpapularrashthatradiatesfromthesiteofthetickbite withsomecentralclearing.Therashspreads5cmorlarger,andisusuallyintheaxilla,midriff,inguinal,or behindtheknee,withregionallymphadenopathy. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 43.A52-year-oldwomanhasapapuleonhernosethathasrounded,pearlybordersandacentralredulcer.She saidshefirstnoticeditseveralmonthsagoandthatithasslowlygrownlarger.Thenursesuspectswhich condition? a. Acne b. Basalcellcarcinoma c. Melanoma d. Squamouscellcarcinoma ANS:B Basalcellcarcinomausuallystartsasaskin-coloredpapulethatdevelopsrounded,pearlyborderswitha centralredulcer.Itisthemostcommonformofskincancerandgrowsslowly.Thisdescriptiondoesnotfit acnelesions.          173 DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 44.Afatherbringsinhis2-month-oldinfanttotheclinicbecausetheinfanthashaddiarrheaforthelast24 hours.Hesayshisbabyhasnotbeenabletokeepanyformuladownandthatthediarrheahasbeenatleast every2hours.Thenursesuspectsdehydration.Thenurseshouldtestskinmobilityandturgorovertheinfants: a. Sternum. b. Forehead. c. Forearms. d. Abdomen. ANS:D Mobilityandturgoraretestedovertheabdomeninaninfant.Poorturgor,ortenting,indicatesdehydrationor malnutrition.Theothersitesarenotappropriateforcheckingskinturgorinaninfant. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 45.Asemiconsciouswomanisbroughttotheemergencydepartmentaftershewasfoundonthefloorinher kitchen.Herface,nailbeds,lips,andoralmu cherry-red The   color.   nurse suspects   that this    coloringisdueto: a. Polycythemia. b. Carbonmonoxidepoisoning. c. Carotenemia. d. Uremia. ANS:B Abrightcherry-redcoloringintheface,uppertorso,nailbeds,lips,andoralmucosaappearsincasesofcarbon monoxidepoisoning. DIF:CognitiveLevel:Analyzing(Analysis) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 46.Apatienthasbeenadmittedforseverepsoriasis.Thenurseexpectstoseewhatfindinginthepatients fingernails? a. Splinterhemorrhages    b. Paronychia c. Pitting d. Beaulines       174 ANS:C Sharplydefinedpittingandcrumblingofthenails,eachwithdistaldetachmentcharacterizepittingnailsand areassociatedwithpsoriasis. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation MULTIPLERESPONSE 1.Thenurseispreparingforacertificationcourseinskincareandneedstobefamiliarwiththevariouslesions thatmaybeidentifiedonassessmentoftheskin.Whichofthefollowingdefinitionsarecorrect?Selectallthat apply. a. Petechiae:Tinypunctatehemorrhages,1to3mm,roundanddiscrete,darkred,purple,orbrownin color b. Bulla:Elevated,circumscribedlesionfilledwithturbidfluid(pus) c. Papule:Hypertrophicscar d. Vesicle:Knownasafrictionblister e. Nodule:Solid,elevated,andhardorsoftgrowththatislargerthan1cm ANS:A,D,E Apustuleisanelevated,circumscribedlesionfilledwithturbidfluid(pus).Ahypertrophicscarisakeloid.A bullaislargerthan1cmandcontainsclearfluid.Apapuleissolidandelevatedbutmeasureslessthan1cm. DIF:CognitiveLevel:Understanding(Comprehension) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation 2.Apatienthasbeenadmittedtoahospitalafterthestaffinthenursinghomenoticedapressureulcerinhis sacralarea.ThenurseexaminesthepressureulceranddeterminesthatitisastageIIulcer.Whichofthese findingsarecharacteristicofastageIIpressureulcer?Selectallthatapply. a. Intactskinappearsredbutisnotbroken. b. Partialthicknessskinerosionisobservedwithalossofepidermisordermis. c. Ulcerextendsintothesubcutaneoustissue.          d. Localizedrednessinlightskinwillblanchwithfingertippressure. e. Openblisterareashaveared-pinkwoundbed. f. Patchesofescharcoverpartsofthewound. 175 ANS:B,E StageIpressureulcershaveintactskinthatappearsredbutisnotbroken,andlocalizedrednessinintactskin willblanchewithfingertippressure.StageIIpressureulcershavepartialthicknessskinerosionwithalossof epidermisoralsothedermis;openblistershaveared-pinkwoundbed.StageIIIpressureulcersarefull thickness,extendingintothesubcutaneoustissue;subcutaneousfatmaybeseenbutnotmuscle,bone,or tendon.StageIVpressureulcersinvolveallskinlayersandextendintosupportingtissue,exposingmuscle, bone,andtendon.Slough(stringymatterattachedtothewoundbed)oreschar(blackorbrownnecrotictissue) maybepresent. DIF:CognitiveLevel:Applying(Application) MSC:ClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation