Chapter 9 Skin, Hair, and Nails

Question 1

The skin repairs surface wounds by
a. exaggerating cell replacement.
b. excreting lactic acid.
c. producing vitamins.
d. providing a mechanical barrier.

Answer 1

ANS: A
The skin’s tissue cells have a rapid rate of turnover and constant renewal, thereby enabling the
skin to repair damaged surfaces.

Question 2

The adipose tissue in the hypodermis serves to
a. provide sensory input.
b. generate heat and insulate.
c. create tensile strength.
d. secrete collagen.

Answer 2

ANS: B
The hypodermis layer consists of adipose tissue that serves to generate heat and provide
insulation, shock absorption, and a reserve of calories.

Question 3

The secretory activity of the sebaceous glands is stimulated by
a. body heat.
b. ambient temperature.
c. sex hormones.
d. dietary protein.

Answer 3

ANS: C
The sebaceous glands, when stimulated by the sex hormones, produce a lipid-rich substance
that keeps the skin moist.

Question 4

Mrs. Tuber is a 36-year-old patient who comes into the health center with complaints that her
fingernails are not growing. Which structure is the site of new nail growth?
a. Cuticle
b. Perionychium
c. Matrix
d. Nail bed

Answer 4

ANS: C
The white crescent-shaped area beyond the proximal nail fold is called the matrix, which is
the site of new nail growth

Question 5

Mrs. Leonard brings her newborn infant into the pediatrician’s office for a first well-baby
visit. As the healthcare provider, you teach her that newborns are more vulnerable to
hypothermia because of
a. the presence of coarse terminal hair.
b. desquamation of the stratum corneum.
c. their covering of vernix caseosa.
d. a poorly developed subcutaneous fat layer.

Answer 5

ANS: D
Newborns have a poorly developed subcutaneous fat layer and therefore have a reduced
ability to generate heat.

Question 6

Mrs. Mulligan brings her 16-year-old son into the office for a sports physical examination. As
the healthcare provider, you explain that normal hormone-related changes of adolescence
include
a. increased oil production.
b. slowed hair growth.
c. depleted apocrine glands.
d. decreased sebaceous gland activity.

Answer 6

ANS: A
During adolescence, the sebaceous glands increase sebum production, which causes the skin to have an oily appearance and predisposes the individual to acne.

Question 7

Expected hair distribution changes in older adults include
a. increased terminal hair follicles on the scalp.
b. more prominent axillary and pubic hair production.
c. increased terminal hair follicles to the tragus of men’s ears.
d. more prominent peripheral extremity hair production.

Answer 7

ANS: C
The transition from a vellus to terminal hair pattern occurs in older men at the nares and
tragus.

Question 8

Brittle nails are typical findings in
a. adolescents.
b. infants.
c. pregnant women.
d. older adults.

Answer 8

ANS: D
Older adults typically have decreased peripheral circulation to the nails, causing the nails to
develop longitudinal ridges that are more brittle and susceptible to splitting into layers.

Question 9

Mrs. Franklin is a 68-year-old patient who presents to the office with a complaint that her nails do not seem to be growing. As the healthcare provider, you explain to her that the nails
of older adults grow slowly because of
a. decreased circulation.
b. dietary deficiencies.
c. fungal infections.
d. low hormone levels.

Answer 9

ANS: A
Decreased circulation to the nails of older adults causes nail growth retardation.

Question 10

As part of your health promotion education for a new patient, you explain that the risk factors
for skin cancer include
a. an olive complexion.
b. repeated trauma or irritation to skin.
c. history of allergic reactions to sunscreen.
d. dark eyes and hair.

Answer 10

ANS: B
Fair-skinned persons with light eyes with repeated trauma or skin irritation have higher risk
factors for skin cancer development.

Question 11

The type and brand of grooming products used are important to the health history of
a. adolescents.
b. everyone.
c. older adults.
d. persons with rashes.

Answer 11

ANS: B
Knowledge of exposure to environmental chemicals is valid health history data for all age
groups, not just adolescents, older adults, or persons with rashes.

Question 12

Mr. Donalds is a 45-year-old roofer. Your inspection to determine color variations of the skin
is best conducted
a. using an episcope.
b. under fluorescent lighting.
c. with illumination provided by daylight.
d. using a Wood’s light.

Answer 12

ANS: C
Daylight provides the best illumination source for determining color variations of the skin.

Question 13

Tangential lighting is best used for inspecting skin
a. color.
b. contour.
c. exudates.
d. symmetry.

Answer 13

ANS: B

Tangential lighting—light shined laterally to the surface—is best for inspecting skin contour.

Question 14

Unusual white areas on the skin may be caused by
a. adrenal disease.
b. polycythemia.
c. vitiligo.
d. Down syndrome.

Answer 14

ANS: C
The absence of melanin produces unpigmented white areas known as vitiligo.

Question 15

Which cultural group has the lowest incidence of nevi?
a. Native Americans
b. African Americans
c. Mexican Americans
d. Asians

Answer 15

ANS: B
Nevi are more common in persons who burn, rather than tan; therefore, African Americans
have the lowest rates of nevi.

Question 16

You are inspecting the lower extremities of a patient and have noted pale, shiny skin of the
lower extremities. This may reflect
a. systemic disease.
b. a history of vigorous exercise.
c. peptic ulcer disease.
d. mental retardation.

Answer 16

ANS: A
Pale, shiny skin of the lower extremities may reflect peripheral changes that occur with
systemic disorders, such as diabetes mellitus and cardiovascular disease.

Question 17

A 29-year-old white woman appears jaundiced. Liver disease as a cause has been excluded.
What history questions should the nurse ask?
a. Whether she had unprotected sex
b. Whether she has a history of diabetes mellitus
c. Whether she had unusual bleeding problems
d. Whether she eats a lot of yellow and orange vegetables

Answer 17

ANS: D
In the absence of liver disease, another cause of jaundice is increased carotene pigmentation.
Diets high in carrots, sweet potatoes, and squash are high in carotene and can make the skin
appear to be jaundiced. Whether she had unprotected sex, a history of diabetes mellitus, or
unusual bleeding problems would not be relevant when assessing the jaundiced skin.

Question 18

Mrs. Bower is a 39-year-old patient who has come to the office for a routine physical
examination. As a healthcare provider, you know that the skin temperature is best assessed with the
a. dorsal surface of the examiner’s hand.
b. palmar surface of the examiner’s hand.
c. ulnar surface of the examiner’s hand.
d. pads of the examiner’s fingers.

Answer 18

ANS: A
The dorsal surface of the hand is best for estimating temperature variations.

Question 19

You are examining a pregnant patient and have noted a vascular lesion. When you blanch over
the vascular lesion, the site blanches and refills evenly from the center outward. The nurse
documents this lesion as a
a. telangiectasia.
b. spider angioma.
c. petechiae.
d. purpura.

Answer 19

ANS: B
Spider angiomas are dilated arterioles. A network of dilated capillaries radiate from the center
arteriole, outward like a spider’s legs. Spider angiomas are often associated with high estrogen
levels, as occur in pregnancy. Blanching over the center is followed by a rapid return of
redness from the center outward. Telangiectasias refill erratically. Petechiae and purpura do
not blanch.

Question 20

Small, minute bruises are called
a. ecchymoses.
b. petechiae.
c. spider veins.
d. telangiectasias.

Answer 20

ANS: B
Petechiae are smaller than 0.5 cm in diameter. Ecchymoses are larger than 0.5 cm in diameter.
Spider veins and telangiectasias are vascular lesions.

Question 21

A flat, nonpalpable lesion is described as a macule if the diameter is
a. larger than 1 cm.
b. smaller than 1 cm.
c. 3 cm exactly.
d. too irregular to measure.

Answer 21

ANS: B
A macule, by definition, is a flat, circumscribed area smaller than 1 cm in diameter and is
measurable. An example of a macular rash is measles.

Question 22

Mrs. Britton is a 34-year-old patient who presents to the office with complaints of skin rashes.
You have noted a 4.3-cm, rough, elevated area of psoriasis. This is an example of a
a. plaque.
b. patch.
c. macule.
d. papule.

Answer 22

ANS: A
A plaque, by definition, is an elevated, firm, rough lesion with a flat top surface larger than 1
cm in diameter, as seen in someone with, for example, psoriasis.

Question 23

Skin turgor checks are performed to determine the
a. temperature of the skin.
b. hydration status.
c. actual age.
d. extent of an ecchymosis.

Answer 23

ANS: B
Skin will remain tented if the patient is dehydrated or will not tent if edema is present

Question 24

You have just completed a skin assessment on Mr. Baker. During your assessment, you have
transilluminated a skin lesion. During the physical examination, you know that skin lesions
are transilluminated to distinguish
a. vascular from nonvascular lesions.
b. furuncles from folliculitis lesions.
c. fluid-filled lesions from solid cysts or masses.
d. herpes zoster from varicella.

Answer 24

ANS: C’

Transillumination is used to determine the presence of fluid in cysts and masses. Fluid-filled
lesions will transilluminate with a red glow, and solid masses will not transilluminate.

Question 25

Fluorescing lesions are best distinguished using a(n)
a. incandescent lamp.
b. magnifying glass.
c. transilluminator.
d. Wood’s lamp.

Answer 25

ANS: D
Fluorescing lesions (e.g., some tinea lesions) show a characteristic yellow-green color under a
Wood’s lamp.

Question 26

Women with terminal hair growth in a male distribution pattern should receive further
evaluation for a(n)
a. circulation condition.
b. endocrine disorder.
c. inflammatory state.
d. nutritional deficit.

Answer 26

ANS: B
Hirsutism in women (growth of terminal hair in a male distribution) can be a clinical sign of
an endocrine disorder. Hair loss can be associated with poor circulation, inflammation, or
nutritional deficits.

Question 27

Which nail change found on examination would be most alarming?
a. Dark bands seen on all fingernails of a dark-skinned person
b. Yellow discoloration of the great toe of an older adult
c. Single dark band in a white adult
d. Pits in both index fingernails of an adult

Answer 27

ANS: C
Dark bands in a dark-skinned person are normal; yellow in the toe of an older adult can
represent a nail disease or a chronic respiratory condition; and pits are related to psoriasis. A
single dark band in a white adult indicates a more serious condition—melanoma.

Question 28

Transient mottling of the patient’s skin in a cool room is a common finding in
a. menopausal women.
b. newborn infants.
c. pregnant women.
d. sedentary adults.

Answer 28

ANS: B
Cutis marmorata, a mottled appearance, is part of the newborn’s response to changes in
temperature.

Question 29

A single transverse line seen in the palm of a small child may imply
a. Down syndrome.
b. Turner syndrome.
c. systemic sclerosis.
d. profound dehydration.

Answer 29

ANS: A
The simian line, a single transverse crease, is seen on the palm of children with Down
syndrome.

Question 30

Cafe au lait patches are numbered with each assessment of infants and young children because
a. the numbers are expected to increase each year.
b. coalescent lesions are a more serious finding.
c. the presence of six or more patches suggests neurofibromatosis.
d. decreasing numbers are expected with growth.

Answer 30

ANS: C
The presence of six or more patches with diameters larger than 1 cm in children younger than
5 years of age suggests neurofibromatosis. Fewer than five patches is usually considered
harmless. The numbers of cafe au lait patches are not expected to increase each year.
Coalescent lesions are not a more serious finding. Decreasing numbers are not expected with
growth.

Question 31

A Dennie-Morgan fold is probably caused by
a. birth trauma.
b. high fever.
c. excess adipose tissue.
d. chronic rubbing.

Answer 31

ANS: D
Persons with chronic atopic or allergic conditions tend to rub the eyes sufficiently to cause an
extra crease or pleat of skin below the eye, called the Dennie-Morgan fold.

Question 32

Linea nigra is commonly found on the abdomens of
a. infants and children.
b. adolescents.
c. pregnant patients.
d. older adults.

Answer 32

ANS: C
Pregnant patients commonly develop pigmentation of the abdomen from the symphysis pubis
to the top of the fundus in the midline.

Question 33

Cherry angiomas are a common finding in
a. adults older than 30 years.
b. newborns.
c. pregnant women.
d. sunbathers.

Answer 33

ANS: A

Cherry angiomas occur in almost everyone older than 30 years and increase numerically with
age.

Question 34

Pigmented, raised, warty lesions over the face and trunk should be assessed by an experienced
practitioner who can distinguish
a. cutaneous tags from lentigines.
b. furuncles from folliculitis.
c. sebaceous hyperplasia from eczema.
d. seborrheic keratoses from actinic keratoses.

Answer 34

ANS: D
Actinic keratoses have malignant potential, and seborrheic keratoses do not. Because they can
look similar, an experienced practitioner should make the determination.

Question 35

Age spots are also called
a. seborrheic keratoses.
b. solar lentigines.
c. cutaneous horns.
d. acrochordon.

Answer 35

ANS: B
Solar lentigines are irregular, round, gray-brown lesions with a rough surface that occur in
sun-exposed areas and are referred to as age spots.

Question 36

The most common inflammatory skin condition is
a. cutis marmorata.
b. eczematous dermatitis.
c. intradermal nevus.
d. pityriasis rosea.

Answer 36

ANS: B
The most common inflammatory skin disorder is eczematous dermatitis.

Question 37

Which is a noncandidal fungal infection?
a. Pityriasis rosea
b. Psoriasis
c. Tinea corporis
d. Rosacea

Answer 37

ANS: C
Tinea corporis is the only listed fungal infection (noncandidal); the others are not fungal in
origin

Question 38

The characteristic that best differentiates psoriasis from other skin abnormalities is the
a. color of the scales.
b. formation of tiny papules.
c. general distribution over the body.
d. recurrence.

Answer 38

ANS: A

Unlike other skin conditions, silvery papules and plaques characterize psoriasis.

Question 39

Painful vesicles are associated with
a. psoriasis.
b. pityriasis rosea.
c. paronychia.
d. herpes zoster.

Answer 39

ANS: D
Herpes zoster (shingles) produces painful itching or burning of the dermatome area.

Question 40

A 17-year-old student complains of a ―rash for 3 days.‖ You note pale, erythematous oval
plaques over the trunk. They have fine scales and are arranged in a fernlike pattern, with
parallel alignment. What is the nurse’s next action?
a. Teach infectious control measures.
b. Inquire about another recent skin lesion.
c. Inspect the palms and the soles.
d. Inform the patient that this will resolve within a week.

Answer 40

ANS: B
The described rash is the typical presentation of pityriasis rosea. The rash is not infectious or contagious, does not involve the palms and soles, and usually lasts for several weeks.
Pityriasis rosea begins with a sudden primary (herald) patch, with generalized eruption to the
trunk and extremities following 1 to 3 weeks later.

Question 41

Which of the following is an ABCDE characteristic of malignant melanoma?
a. Asymmetric borders
b. Borders well demarcated
c. Color of lesion is uniform
d. Diameter less than 6 mm

Answer 41

ANS: A
ABCDE melanoma mnemonic includes asymmetry, borders that are irregular, color that is not
the same all over, diameter larger than 6 mm and growing, and evolution.

Question 42

The most common cutaneous neoplasm is
a. basal cell carcinoma.
b. compound nevus.
c. seborrheic keratosis.
d. senile actinic keratosis.

Answer 42

ANS: A
Basal cell carcinoma is the most common form of skin cancer. It occurs more frequently on
sun-exposed parts of the body.

Question 43

Soft, painless, bluish papules in persons who are HIV-positive are most likely
a. Kaposi sarcoma.
b. malignant melanoma.
c. molluscum contagiosum.
d. pityriasis rosea.

Answer 43

ANS: A
Kaposi sarcoma is the more common malignant skin lesion of HIV-infected persons. The
lesions are soft, painless, bluish purple macules or papules.

Question 44

A 5-year-old child presents with discrete vesicles on an erythematous base that began near her
scalp and are spreading to the trunk. The child has a low-grade fever and feels tired. What is
the nurse’s next action?
a. Teach infectious control measures.
b. Inquire about other patterns of physical abuse.
c. Inspect the buccal mucosa for Koplik spots.
d. Inform the parent that this will resolve within a couple of days.

Answer 44

ANS: A
The description of this child’s complaint is a varicella rash, not physical abuse or rubeola.
Chickenpox is a highly communicable disease and can be prevented by immunization. The
period of communicability lasts from 1 or 2 days before onset of the rash until all the vesicles
have crusted over, which usually takes about 1 week. This is not physical abuse. Inspecting
the buccal mucosa for Koplik spots will not diagnose the problem. This will not resolve
within a couple of days.

Question 45

During history taking, a mother states that her son awoke in the middle of the night
complaining of intense itching to his legs. Today, your inspection reveals a honey-colored
exudate from the vesicular rash on his legs. Which condition is consistent with these findings?
a. Exanthem
b. Impetigo
c. Solar keratoses
d. Trichotillomania

Answer 45

ANS: B
Impetigo causes intense pruritus, regional lymphadenopathy, and honey-colored exudative
crusting as the vesicles or bullae rupture and dry.

Question 46

You are conducting a preschool examination on a 5-year-old child. Which injury would most
likely raise your suspicion that the child is being abused?
a. Recent bruising over both knees
b. A healed laceration under the chin
c. A bruise on the right shin with associated abrasion of tissue
d. Bruises in various stages of resolution over body soft tissues

Answer 46

ANS: D
Toddlers and older children who bruise themselves accidentally do so over bony prominences,
like the knees, chin, and shin. Bruises over soft tissues are more consistent with abuse.

Question 47

Assessment of poor hygiene, healed fractures with deformity, or unexplained trauma in older
adults indicates
a. sexual abuse.
b. physical neglect.
c. psychological abuse.
d. violated rights.

Answer 47

ANS: B
Physical neglect is described as the most common form of elder abuse.

Question 48

The nurse assesses the nail base angle using the Schamroth technique. Which nail bed shape
indicates a normal expected examination finding?
a. Flat
b. Convex
c. Concave
d. Bowed

Answer 48

ANS: C
The normal nail base angle should be 160 degrees, which results in a concave nail base that
produces a diamond-shaped window with the Schamroth technique.

Question 49

Which identify the signs and symptoms of basal cell cancer? (Select all that apply.)
a. Itching
b. Reddish patch
c. Starts from a nevi
d. Various clinical forms—cystic, nodular, pigmented
e. Macule type

Answer 49

ANS: A, B, D
Common signs and symptoms of basal cell carcinoma include a, pink, red, tan, white, black,
or brown shiny nodule, in a variety of clinical forms, which may be crusted and itching.