[Ex4] - C43 - AP

Question 1

43-1. Fat cells are located in the:

a. epidermis.
b. dermis.
c. hypodermis.
d. fascia beneath the skin.

Answer 1

ANS: C

The hypodermis, also referred to as the subcutaneous layer, is an underlying layer of
connective tissue that contains macrophages, fibroblasts, and fat cells. Fat cells are not found
in the epidermis, the dermis, or the fascia

Question 2

43-2. Of the sweat glands, the _____ glands are most abundant in the axillae and genital areas.

a. eccrine
b. apocrine
c. sebaceous
d. subcutaneous

Answer 2

ANS: B

The apocrine sweat glands are located in the axillae, scalp, face, abdomen, and genital areas.
The eccrine sweat glands are distributed over the body, with the greatest numbers in the palms
of the hands, soles of the feet, and forehead. Neither sebaceous nor subcutaneous glands are
located in the axillae and genital areas.

Question 3

43-3. To promote efficient wound healing, which dressing should be applied to a superficial ulcer?

a. Thick and dry
b. Flat and moist
c. Bulky and dry
d. None

Answer 3

ANS: B

Superficial ulcers should be covered with flat, moisture-retaining dressings. Superficial ulcers
should not be covered with dressings that are dry and thick (bulky). Dressings should not be
avoided.

Question 4

43-4. Individuals of which descent are more prone to developing keloids?

a. Black
b. Northern European
c. Asian
d. Native American

Answer 4

ANS: A

Blacks are at greater risk for the development of keloids. Neither Northern Europeans, Asians,
nor Native Americans are at great risk for the development of keloids.

Question 5

43-5. A wound scar that is sharply elevated, irregularly shaped, and progressively enlarging is a
result of excessive amounts of _____ accumulated during connective tissue repair.

a. elastin
b. collagen
c. keratin
d. calcification

Answer 5

ANS: B

Irregular scar formation is due to excessive fibroblast activity and collagen formation.
Irregular scar formation is not due to excessive elastin, keratin, or calcification.

Question 6

43-6. An increase in _____ is associated with pruritus.

a. substance P
b. norepinephrine
c. dopamine
d. acetylcholine

Answer 6

ANS: D

Acetylcholine, not substance P, is one of the itch mediators. Neither norepinephrine nor
dopamine is considered an itch mediator.

Question 7

43-7. Which cells are involved in initiating immune responses in the skin?

a. Langerhans cells
b. Merkel cells
c. Keratinocytes
d. Melanocyte

Answer 7

ANS: A

The Langerhans cells process the antigen and carry it to T cells. T cells then become
sensitized to the antigen, inducing the release of inflammatory cytokines and the symptoms of
dermatitis. Merkel cells are associated with nerve cells. Keratinocytes are part of the
epidermal layer of the skin and are not involved in immune responses. Melanocytes
synthesize the skin’s pigment.

Question 8

43-8. A 25-year-old paralyzed male develops a dermal pressure ulcer. When assessing the patient’s
skin, which finding is the first indication of this ulcer?

a. Redness
b. Whiteness
c. Indurations
d. Ulceration

Answer 8

ANS: A

The initial sign of a pressure ulcer is redness, not whiteness. Induration and ulceration occur
in later stages.

Question 9

43-9. Pityriasis rosea is caused by a:

a. parasite.
b. virus.
c. bacteria.
d. fungus.

Answer 9

ANS: B

Pityriasis rosea is caused by a virus. Pityriasis rosea is not caused by a parasite, a bacterium,
or a fungus.

Question 10

43-10. A 42-year-old female presents with raised red lesions with a brownish scale. She was
diagnosed with discoid lupus erythematosus. This disorder is related to:

a. infection.
b. trauma.
c. autoimmunity.
d. cancer.

Answer 10

ANS: C

Discoid lupus is related to autoimmunity, not infection, trauma, or cancer.

Question 11

43-11. A 45-year-old male presents with a chronic blister-forming disease of the skin and oral
mucous membranes. The nurse would recognize this condition as:

a. lupus erythematosus.
b. pemphigus.
c. psoriasis.
d. eczema.

Answer 11

ANS: B

Pemphigus is manifested by chronic blister formation. Lupus erythematosus is manifested by
rash and arthritis, not blisters. Psoriasis is manifested by gray-white skin plaques. Eczema is
not manifested by blisters.

Question 12

43-12. If a patient has carbuncles, the infection will be located in the:

a. hair follicles.
b. papillary layer of the dermis.
c. reticular layer of the dermis.
d. subcutaneous tissue.

Answer 12

ANS: A

Carbuncles are a collection of infected hair follicles and usually occur on the back of the neck,
the upper back, and the lateral thighs. Carbuncles are not associated with the papillary or
reticular layers of the dermis or the subcutaneous tissue.

Question 13

43-13. A 50-year-old male recently underwent a liver transplant and is taking immunosuppressive
drugs. He now has painful vesicular eruptions on the face and trunk. He reports that he had
chickenpox as a child. Which of the following is the most likely diagnosis based on his
chicken pox history?

a. Erysipelas
b. Poliomyelitis
c. Warts
d. Herpes zoster

Answer 13

ANS: D

Herpes zoster causes shingles, a disorder similar to chicken pox. Erysipelas is caused by strep.
Poliomyelitis is not manifested by painful vesicles. Warts are not painful.

Question 14

43-14. A 20-year-old female presents with vaginal itch and thin-walled pustular lesions and is
diagnosed with candidiasis. This condition is caused by a:

a. yeast-like fungus.
b. virus.
c. bacterium.
d. parasite.

Answer 14

ANS: A

Candidiasis is caused by a yeast-like fungus, not a virus, a bacterium, or a parasite.

Question 15

43-15. For a patient with candidiasis, which factor will exacerbate the condition?

a. Poor hygiene
b. Older age
c. Systemic antibiotics
d. Anemia

Answer 15

ANS: C

Candidiasis is exacerbated by the use of systemic antibiotics because the antibiotics eliminate
normal flora. Candidiasis is not exacerbated by poor hygiene, advanced age, or anemia.

Question 16

43-16. When assessing a patient diagnosed with localized scleroderma, which changes in the skin
will be observed?

a. Cyanosis
b. Hyperpigmented
c. Necrosis
d. Thickening

Answer 16

ANS: D

Localized scleroderma is manifested by thickening, not cyanosis, of the skin. Localized
scleroderma is not manifested by necrosis or hyperpigmentation.

Question 17

43-17. A 52-year-old female diagnosed with systemic scleroderma is at risk for which complication?

a. Cutaneous vasculitis
b. Raynaud phenomenon
c. Cellulitis
d. Infection

Answer 17

ANS: B

Scleroderma can trigger Raynaud phenomenon. Scleroderma is not associated with vasculitis,
cellulitis, or infection.

Question 18

43-18. A 13-year-old female is concerned about several pigmented skin lesions on her body. Her
primary care provider tells her that these lesions must be monitored because of their ability to
transform into malignant melanoma. These lesions are referred to as:

a. macules.
b. nevi.
c. plaques.
d. keloids.

Answer 18

ANS: B

Nevi may undergo transition to malignant melanoma. Neither macules, plaques, nor keloids
undergo transition to malignant melanoma.

Question 19

43-19. A patient wants to know which malignant skin lesion is the most serious. The correct response
is:

a. basal cell carcinoma.
b. squamous cell carcinoma.
c. Kaposi sarcoma (KS).
d. malignant melanoma.

Answer 19

ANS: D

Malignant melanoma is the most serious skin cancer. None of the remaining options poses
such a significant health risk.

Question 20

43-20. A 40 year old is diagnosed with skin cancer. It is explained that the most important risk factor
for skin cancer is:

a. amount of direct sun exposure at a young age.
b. amount of sun exposure over age 50.
c. lifetime amount of sun exposure.
d. living in equatorial regions where the sun is most intense.

Answer 20

ANS: A

Protection from the sun, particularly during the childhood years of life, significantly reduces
the risk of skin cancer in later years.

Question 21

43-21. A 27-year-old male lung transplant patient developed Kaposi sarcoma (KS). The nurse knows
that the cause of this patient’s KS is most likely related to the fact that the patient:

a. is malnourished.
b. was exposed to hepatitis B.
c. is immunosuppressed.
d. was diagnosed with cystic fibrosis.

Answer 21

ANS: C

KS is a vascular malignancy associated with immunodeficiency states and occurs among
transplant recipients taking immunosuppressive drugs. KS is not directly related to
malnourishment, exposure to hepatitis B, or being diagnosed with cystic fibrosis.

Question 22

43-22. A client is burned through all the dermis with only a few epidermal appendages intact. This
burn is classified as:

a. first degree.
b. superficial partial-thickness.
c. deep partial-thickness.
d. third degree.

Answer 22

ANS: C

Deep partial-thickness burns involve the entire dermis, sparing skin appendages such as hair
follicles and sweat glands. First-degree burns involve only the epidermis. Superficial
partial-thickness burns involve deeper thickness. Third-degree burns involve destruction of
the entire epidermis, dermis, and often underlying subcutaneous tissue.

Question 23

43-23. Which of the following burns is most painful?

a. First degree
b. Second degree
c. Charring
d. Third degree

Answer 23

ANS: B

Second-degree burns leave tactile and pain sensors intact and are the most painful. All of the
other options result in less pain.

Question 24

43-24. A 10-year-old male is playing with matches and gets burned. His burn is waxy white in
appearance. This burn is classified as:

a. first degree.
b. superficial partial-thickness.
c. deep partial-thickness.
d. third degree.

Answer 24

ANS: C

Deep partial-thickness burns involve the entire dermis, sparing skin appendages such as hair
follicles and sweat glands. These wounds look waxy white. First-degree burns are red and
have no blisters. Superficial burns involve fluid-filled blisters. Third-degree burns are dry and
have a leathery appearance.

Question 25

43-25. In burn injury patients, the rule of nines and the Lund and Browder chart are used to estimate:

a. depth of burn injury.
b. possibility of infection.
c. degree of systemic involvement.
d. total body surface area burned.

Answer 25

ANS: D

The rule of nines estimates the total body surface area burned, not the depth of burn injury. It
does not estimate the degree of systemic involvement. The possibility of infection is 100%.

Question 26

43-26. Which process would be expected in the first 24 hours following a serious burn?

a. Increased capillary permeability
b. Diuresis
c. Decreased levels of stress hormones
d. Fluid overload

Answer 26

ANS: A

Increased capillary permeability occurs, leading fluid to shift to interstitial spaces. Blood is
shunted from the kidneys, so decreased urination occurs. Increased levels of stress hormones
are secreted. Hypovolemia, not fluid overload, occurs.

Question 27

43-27. Hypovolemia in the early stages of burn shock is directly related to:

a. decreased cardiac contractility and shunting of blood away from visceral organs.
b. increased capillary permeability and evaporative water loss.
c. hypometabolism and renal water loss.
d. bacterial infection of the wound and resulting bacteremia.

Answer 27

ANS: B

Hypovolemia occurs due to increased capillary permeability. Decreased cardiac contractility
occurs, but this is not the direct cause of hypovolemia. Blood is shunted from the kidneys, so
water loss does not occur. Bacterial infection is a risk, but it is not the cause of hypovolemia.

Question 28

43-28. A 28-year-old male is admitted to the burn unit 2 hours after receiving second- and
third-degree burns over 50% of his body surface in an industrial explosion. Abnormal vital
signs include low blood pressure and tachycardia. Lab results show a high hematocrit due to:

a. sickle cell syndrome.
b. fluid movement out of the vascular space.
c. renal failure.
d. increased vascular protein secondary to increased metabolism.

Answer 28

ANS: B

Fluid and protein movement out of the vascular compartment results in an elevated
hematocrit. Sickle cell syndrome does not result in increased hematocrit. Renal failure can
occur, but this does not result in an increase in the hematocrit. Protein loss leads to decreased
protein, not increased.

Question 29

43-29. A 36-year-old male is experiencing frontotemporal hair recession. He is diagnosed with male
pattern baldness, which is a form of:

a. alopecia.
b. areata.
c. hirsutism.
d. paronychia.

Answer 29

ANS: A

Male-pattern alopecia is an inherited form of irreversible baldness with hair loss in the central
scalp and recession of the frontotemporal hairline. Alopecia areata is an autoimmune
T-cell-mediated chronic inflammatory disease directed against hair follicles that results in hair
loss. Hirsutism is a form of abnormal hair growth in women. Paronychia is an inflammation of
the cuticle.

Question 30

43-30. A 15-year-old female reports abnormal hair growth on her face and body. This condition is
referred to as:

a. alopecia.
b. areata.
c. hirsutism.
d. paronychia.

Answer 30

ANS: C

Abnormal hair growth is referred to as hirsutism. Loss of hair is alopecia. Areata is a specific
form of alopecia. Paronychia is an infection around the nail.