CH 13 - Skin, Hair, and Nails

Question 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.

Answer 1

d. Replaced every 4 weeks.

Question 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.

Answer 2

d. Contains sensory receptors.

Question 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.

Answer 3

a. Eccrine glands.

Question 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.

Answer 4

c. The newborns skin is more permeable than that of the adult.

Question 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

Answer 5

d. An increased loss of elastin and a decrease in subcutaneous fat

Question 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.

Answer 6

d. Melanocytes.

Question 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.

Answer 7

a. Xerosis.

Question 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

Answer 8

b. Tetracyclines for acne

Question 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

Answer 9

d. Importance of sunscreen and avoiding direct sunlight

Question 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.

Answer 10

c. Is caused by increased sebum production.

Question 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 self- injury 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.

Answer 11

a. The woman could be at increased risk for infection and lesions because of her chronic disease.

Question 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.

Answer 12

b. Circulatory status.

Question 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.

Answer 13

c. Peripheral vasoconstriction.

Question 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

Answer 14

c. Distended veins

Question 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. Related to impetigo and can be treated with an ointment

Answer 15

c. Caused by the complete absence of melanin pigment

Question 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

Answer 16

a. Color variation

Question 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

Answer 17

d. Excess blood in the dilated superficial capillaries

Question 18

During a skin assessment, the nurse notices that a Mexican-American patient has skin that is yellowish- brown; 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

Answer 18

b. Jaundice

Question 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.

Answer 19

c. Ashen, gray, or dull.

Question 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. White patches on the mucous membranes

Answer 20

b. Dry mucous membranes and cracked lips

Question 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.

Answer 21

c. Senile angiomas.

Question 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

Answer 22

d. Clubbing of the nails

Question 23

newborn infant has Down syndrome. During the skin assessment, the nurse notices a transient mottling 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.

Answer 23

d. Cutis marmorata.

Question 24

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.

Answer 24

c. Chloasma.

Question 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
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

Answer 25

d. Seborrheic keratoses, which do not become cancerous

Question 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 in your skin from exposure to the sun.
c. Clusters of melanocytes that appear after extensive sun exposure.
d. Areas of hyperpigmentation related to decreased perfusion and vasoconstriction.

Answer 26

c. Clusters of melanocytes that appear after extensive sun exposure.

Question 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.

Answer 27

d. Papule.

Question 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.

Answer 28

a. Lesions that run together.

Question 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.

Answer 29

d. Lichenification.

Question 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.

Answer 30

c. Confluent and extensive patch of petechiae and ecchymoses on the feet.

Question 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.

Answer 31

b. Impetigo.

Question 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

Answer 32

d. Red-purple, maculopapular, blotchy rash behind the ears and on the face

Question 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.

Answer 33

b. Kaposis sarcoma.

Question 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.

Answer 34

d. Seborrheic dermatitis.

Question 35

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

Answer 35

c. Severe dehydration

Question 36

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. V enous thrombosis
c. Local inflammation
d. Blockage of lymphatic drainage

Answer 36

a. Heart failure

Question 37

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.

Answer 37

b. Refer the patient because of the suggestion of melanoma on the basis of her symptoms.

Question 38

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.

Answer 38

d. Nail bases with an angle of 180 degrees or greater and nail bases that feel spongy.

Question 39

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 extends up to the iris
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

Answer 39

b. Yellow color of the sclera that extends up to the iris

Question 40

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

Answer 40

c. Palpating the skin for edema and increased warmth

Question 41

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.

Answer 41

b. Lyme disease.

Question 42

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

Answer 42

c. Palpating the skin for edema and increased warmth

Question 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

Answer 43

b. Basal cell carcinoma

Question 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.

Answer 44

d. Abdomen.

Question 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 mucosa are a bright cherry-red color. The nurse suspects that this coloring is due to:

a. Polycythemia.
b. Carbon monoxide poisoning.
c. Carotenemia.
d. Uremia.

Answer 45

b. Carbon monoxide poisoning.

Question 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

Answer 46

c. Pitting

Question 47

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

Answer 47

a. Petechiae: Tiny punctate hemorrhages, 1 to 3 mm, round and discrete, dark red, purple, or brown in color
d. Vesicle: Known as a friction blister
e. Nodule: Solid, elevated, and hard or soft growth that is larger than 1 cm

Question 48

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.

Answer 48

b. Partial thickness skin erosion is observed with a loss of epidermis or dermis.
e. Open blister areas have a red-pink wound bed.