Chapter 12: Skin, Hair, and Nails

Question 1

Because in humans hair is no longer needed for protection from cold or trauma, it is called:

a. vellus.
b. vagus.
c. vestigial.
d. vestibule.

Answer 1

c.

Question 2

The nurse educator is preparing an education module on the epidermal layer of skin for the nursing staff. Which of the following would be included in the module?

a. The epidermis is very vascular.
b. The epidermis is thick and tough.
c. The epidermis is thin and nonstratified.
d. The epidermis is replaced every 4 weeks.

Answer 2

d.

Question 3

The nurse educator is preparing an education module on the dermis layer of skin for the nursing staff. Which of the following would be included in the module?

a. The dermis contains mostly fat cells.
b. The dermis consists mostly of keratin.
c. The dermis is replaced every 4 weeks.
d. The dermis contains sensory receptors.

Answer 3

d.

Question 4

The nurse is discussing epidermal appendages with a patient. Which of the following would be included in the discussion?

a. Skin
b. Arms
c. Sweat glands
d. Parotid glands

Answer 4

c.

Question 5

During the examination, the patient tells the nurse, “I sure sweat a lot, especially on my face and feet, but it doesn’t have an odour.” The nurse knows that this could be related to:

a. the eccrine glands.
b. the apocrine glands.
c. a disorder of the stratum corneum.
d. a disorder of the stratum germinativum.

Answer 5

a.

Question 6

A newborn infant has been brought to the clinic for a well-baby check. For which of the following reasons of fluid loss does the nurse observe the infant ?

a. Subcutaneous fat deposits are high in the newborn
b. Sebaceous glands are overproductive in the newborn
c. The newborn’s skin is more permeable than that of the adult
d. The amount of vernix caseosa rises dramatically in the newborn

Answer 6

c.

Question 7

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:

a. increased vascularity of the skin in the older adult.
b. increased numbers of sweat and sebaceous glands in the older adult.
c. an increase in elastin and a decrease in subcutaneous fat in the older adult.
d. an increased loss of elastin and a decrease in subcutaneous fat in the older adult.

Answer 7

d.

Question 8

During the aging process, the hair can look grey or white and become thin and fine. The nurse knows that this is because of a decrease in the number of functioning:

a. metrocytes.
b. fungacytes.
c. phagocytes.
d. melanocytes.

Answer 8

d.

Question 9

An Inuit person from the Yukon who is visiting Toronto has come to the clinic during the hottest part of the day in July. It so happens that the clinic’s air conditioning is not functioning, so the temperature inside the clinic is very high. Which of the following statements about sweating tendencies in the Inuit is true?

a. They sweat profusely all over the body because they are not used to hot temperatures.
b. They do not sweat because their diet is so high in roughage that their apocrine glands are less efficient in hot climates.
c. They will sweat more on their faces because this is an adaptation that has been made over time for survival in their environment.
d. They have an overabundance of eccrine sweat glands, so the nurse might expect them to have body odour because of the bacterial flora reacting with the apocrine sweat.

Answer 9

c.

Question 10

The nurse is caring for a child of African descent who has been diagnosed with marasmus. The nurse would expect to find:

a. the hair to be less kinky and to be a copper-red colour.
b. the head to be larger than normal and the eyes to be wide set.
c. the skin on the hands and feet to be scaly and tender.
d. the lymph nodes in the groin to be enlarged and tender.

Answer 10

a.

Question 11

During physical examination, the nurse finds that the patient has excess dryness of the skin. The best term to describe this condition is:

a. xerosis.
b. pruritus.
c. scoliosis.
d. seborritus.

Answer 11

a.

Question 12

A 22-year-old-woman comes to the clinic because of severe sunburn and says, “I was just out in the sun for a couple of minutes.” The nurse begins a medication review with her, paying special attention to medication she is taking for:

a. pain.
b. acne.
c. heartburn.
d. hyperthyroidism.

Answer 12

b.

Question 13

A woman has come in for a checkup before leaving on a trip to Hawaii. During the examination, the nurse finds out that she is diabetic and is on oral hypoglycemic agents. Which of the following should the woman be concerned about?

a. An increased possibility of bruising
b. Skin sensitivity as a result of exposure to salt water
c. Possible unavailability of glucose monitoring supplies in Hawaii
d. The importance of wearing sunscreen and avoiding direct sunlight

Answer 13

d.

Question 14

A 13-year old girl is interested in obtaining information about the cause of her acne. The nurse would tell her that acne is:

a. contagious.
b. caused by a poor diet.
c. found in about 70% of all teens.
d. has been found to be related to poor hygiene.

Answer 14

c.

Question 15

A 75-year-old woman who has a history of diabetes and peripheral vascular disease reports that she has tried to remove a corn on the bottom of her foot with a pair of scissors. The nurse will urge her to stop doing this because:

a. the woman could be at increased risk for infection and lesions because of her chronic disease.
b. due to 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 well, so she puts herself at greater risk for self-injury with the scissors.
d. due to her peripheral vascular disease, her range of motion is limited and she may not be able to view her corn safely.

Answer 15

a.

Question 16

A thorough skin assessment is very important because the skin holds information about:

a. support systems.
b. circulatory status.
c. socioeconomic status.
d. psychological wellness.

Answer 16

b.

Question 17

A patient comes in for a physical examination and complains that she was “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 17

c.

Question 18

A patient tells the nurse that he was confined to his recliner chair for about 3 days with his feet down and would like the nurse to evaluate his feet. During the assessment, the nurse might expect to find:

a. pallor.
b. coolness.
c. distended veins.
d. decreased capillary filling time.

Answer 18

c.

Question 19

A patient is especially worried about an area of skin on her feet that has turned white. The health care provider has diagnosed her condition as vitiligo. The nurse explains to her that vitiligo is:

a. caused by an excess of the melanin pigment.
b. caused by an excess of apocrine glands in her feet.
c. caused by the complete absence of the melanin pigment.
d. related to impetigo and it can be treated with an ointment.

Answer 19

c.

Question 20

A patient tells the nurse that he has noticed that one of his nevi has started to burn and bleed. When assessing his skin, the nurse would pay special attention to danger signs such as pigmented lesions. Which additional finding would the nurse be concerned about?

a. Colour variation
b. Border regularity
c. Symmetry of lesions
d. Diameter less than 6 mm

Answer 20

a.

Question 21

A patient comes to the clinic and states that he has noticed that his skin appears redder than normal. The nurse understands this condition to be 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 21

d.

Question 22

During assessment, the nurse notices that the skin of a patient of Asian descent is yellowish-brown in colour. The skin on the hard/soft palate is, however, pink in colour. From this finding, the nurse could probably rule out:

a. pallor.
b. jaundice.
c. cyanosis.
d. iron deficiency.

Answer 22

b.

Question 23

A patient of African descent is in the intensive care unit to be monitored for shock after an accident. What skin characteristics would the nurse expect to find in this patient?

a. Ruddy blue
b. Generalized pallor
c. Ashen, grey, or dull
d. Patchy areas of pallor

Answer 23

c.

Question 24

A patient is experiencing tingling sensations in her feet and has also noticed that her tongue has become very red and painful. The nurse suspects that she has:

a. polycythemia.
b. pernicious anemia.
c. micronucleus anemia.
d. iron deficiency anemia.

Answer 24

b.

Question 25

A 32-year-old female patient complains that she has noticed several small, slightly raised, bright red dots on her chest. On examination, the nurse thinks that the spots are probably:

a. anascara.
b. scleroderma.
c. senile angiomas.
d. latent myeloma.

Answer 25

c.

Question 26

A 65-year-old man with emphysema and bronchitis has come to the clinic for a follow-up appointment. On assessment of his skin, the nurse would expect to find the following:

a. anasarca.
b. scleroderma.
c. pedal erythema.
d. clubbing of the nails.

Answer 26

d.

Question 27

A newborn infant is found to have Down syndrome. During skin assessment, the nurse notices a transient mottling on the trunk and extremities in response to the cooler temperature in the examination room. The infant’s mother has also noticed the mottling and wants to know what it is. The nurse knows that this mottling is called:

a. café au lait spots.
b. carotenemia.
c. acrocyanosis.
d. cutis marmorata.

Answer 27

d.

Question 28

A 35-year-old pregnant woman comes to the clinic for her monthly appointment. During 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. keratosis.
b. mitoasma.
c. linea nigra.
d. linea gravida.

Answer 28

c.

Question 29

A man has come in to the clinic because he is afraid he might have skin cancer. During the skin assessment, the nurse notices several areas of pigmentation that look greasy, dark, and “stuck on” on his skin. Which of the following is the best prediction?

a. He probably has senile lentigines, which do not become cancerous.
b. He probably has actinic keratoses, precursors to basal cell carcinoma.
c. He probably has acrochordons, precursors to squamous cell carcinoma.
d. He probably has seborrheic keratoses, which do not become cancerous.

Answer 29

d.

Question 30

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:

a. “They are signs of decreased hematocrit related to anemia.”
b. “They are due to destruction of melanin in your skin due to exposure to the sun.”
c. “They are clusters of melanocytes that appear after prolonged sun exposure.”
d. “They are areas of hyperpigmentation related to decreased perfusion and vasoconstriction.”

Answer 30

c.

Question 31

The nurse notices that the patient has a solid, elevated, circumscribed lesion that is less than 1 cm in diameter. When documenting this finding, the nurse would report this as a:

a. bulla.
b. wheal.
c. nodule.
d. papule.

Answer 31

d.

Question 32

A patient’s medical record describes a lesion that is confluent in nature. On examination, the nurse would expect 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 32

a.

Question 33

A patient has had a “terrible itch” for several months that he has been scratching continuously. On examination, the nurse might expect to find:

a. a keloid.
b. a fissure.
c. keratosis.
d. lichenification.

Answer 33

d.

Question 34

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:

a. “It is the blue dilation of blood vessels in a star-shaped pattern on the legs.”
b. “It is the fiery red, star-shaped marking on the cheek that has a solid circular centre.”
c. “It is the confluent and extensive patch of petechiae and ecchymoses on the feet.”
d. “It is the tiny little areas of hemorrhage that are less than 2 mm, round, discrete, and dark red in colour.”

Answer 34

c.

Question 35

A woman has noticed that her son, who has 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 35

b.

Question 36

The nurse notices that the patient has bluish-white, red-based spots in her mouth that are elevated about 1 mm to 3 mm. What other signs would the nurse expect to find in this patient?

a. A pink, papular rash on the face and neck
b. Pruritic vesicles over her trunk and neck
c. Hyperpigmentation on the chest, abdomen, and the back of the arms
d. A red-purple, maculopapular, blotchy rash behind the ears and on the face

Answer 36

d.

Question 37

The nurse is assessing the skin of a patient who has AIDS and notices widely disseminated, violet-coloured tumours on the skin and mucous membranes. The nurse would conclude that:

a. the patient is in the first stage of AIDS.
b. the patient is in the advanced stage of AIDS.
c. the patient has been exposed to a viral infection.
d. these lesions indicate an advanced stage of herpes zoster.

Answer 37

b.

Question 38

A 45-year-old farmer comes in for skin evaluation and complains of hair loss. He has noticed that the hair on his head seems to be breaking off in patches and that there is some scaling on his scalp. The nurse would begin the examination suspecting:

a. tinea capitis.
b. tinea corporis.
c. toxic alopecia.
d. seborrheic dermatitis.

Answer 38

a.

Question 39

A mother brings her child in to the clinic for scalp and hair examination. She says that the child has developed irregularly shaped patches on her head with broken-off, stub-like hair and she is worried that this could be some form of premature baldness. She tells the nurse that the child’s hair is always kept very short. The nurse reassures her by telling her that it is:

a. folliculitis and that it can be treated with an antibiotic.
b. traumatic alopecia that can be treated with antifungal medications.
c. tinea capitis, which is highly contagious and needs immediate treatment.
d. trichotillomania which may be caused by her child habitually twirling her hair in an absentminded way.

Answer 39

d.

Question 40

The nurse has discovered decreased skin turgor in a patient. In which of the following would this be an expected finding?

a. Cases of severe obesity
b. During childhood growth spurts
c. In an individual who is severely dehydrated
d. With conditions of connective tissue disorders, such as scleroderma

Answer 40

c.

Question 41

When performing an assessment of a 65-year-old man with a history of hypertension and coronary artery disease, the nurse notices bilateral pitting edema in the lower legs. The skin is puffy and tight but of normal colour. There is no increased redness or tenderness, and the peripheral pulses are equal and strong. In this situation, which of the following is the most likely cause of the edema?

a. Heart failure
b. Venous thrombosis
c. A local inflammation
d. Blockage of lymphatic drainage

Answer 41

a.

Question 42

A 40-year-old woman reports a change in mole size, accompanied by colour 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 for further changes and report back in 2 months.
b. refer the patient because of the suspicion of melanoma based on her symptoms.
c. ask additional questions about environmental irritants that may have caused this condition.
d. suspect that this is a compound nevus, which is very common in young to middle-aged adults.

Answer 42

b.

Question 43

Which of the following assessment findings is most consistent with clubbing of the fingernails?

a. A nail base that is firm to palpation and slightly tender
b. Curved nails with a convex profile and ridges across the surface
c. A nail base that feels spongy and has an angle of 150 degrees
d. A nail base with an angle of 180 degrees or greater and feels spongy

Answer 43

d.

Question 44

Jaundice is manifested by a yellow skin colour, indicating rising levels of bilirubin in the blood. Which of the following findings is indicative of true jaundice?

a. Yellow patches throughout the sclera
b. Yellow colour of the sclera, with the colour extending 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 is first manifested

Answer 44

b.

Question 45

When assessing inflammation in a dark-skinned person, the nurse may need to:

a. assess the skin for cyanosis and swelling.
b. assess the oral mucosa for generalized erythema.
c. palpate the skin for edema and increased warmth.
d. palpate for tenderness and local areas of ecchymosis.

Answer 45

c.

Question 46

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 and macular, and a bull’s eye pattern is present 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 46

b.

Question 47

The papule on the nose of a 52-year-old woman has rounded, pearly borders and a central red ulcer. She tells the nurse that it has been present for several months and is slowly growing larger. Which of the following conditions does the nurse suspect?

a. Acne
b. Basal cell carcinoma
c. Malignant melanoma
d. Squamous cell carcinoma

Answer 47

b.

Question 48

A father brings his 2-month-old infant to the clinic because the infant has had diarrhea for the last 24 hours. He says that his baby has not been able to keep any formula down and that the diarrhea has been occurring at least every 2 hours. The nurse suspects dehydration. Where should the nurse test skin mobility and turgor in this infant?

a. Over the sternum
b. Over the forehead
c. Over the forearms
d. Over the abdomen

Answer 48

d.

Question 49

A semiconscious woman is brought to the emergency department after being found on the floor in her kitchen. Her face, nail beds, lips, and oral mucosa are a bright cherry-red colour. The nurse suspects that this colouring is due to:

a. polycythemia.
b. carbon monoxide poisoning.
c. carotenemia.
d. uremia.

Answer 49

b.

Question 50

A patient has been admitted for severe iron deficiency anemia. What can the nurse expect to find in the patient’s fingernails?

a. Splinter hemorrhages
b. Paronchyia
c. Koilonychia (spoon nails)
d. Beau’s lines

Answer 50

c.