Porth (2020) 5th nur 317 Flashcards
Chapter 51
A parent calls the health care provider reporting the child has red sores on the face, especially around the nose and mouth that have pus/fluid inside and when the sores burst, they develop a honey-colored crust. The parent is asking whether to make an appointment. Which contagious skin lesion does the provider think the child has developed?
Poison ivy
Impetigo pustule
Sebaceous cyst
Herpes simplex
Impetigo pustule
Rationale:Impetigo is a form of pustule and is primarily described as red sores on the face, especially around a child’s nose and mouth, and on the hands and feet. The sores burst and form honey-colored crusts. This is the classic description of impetigo. A vesicle is less than 0.5 cm, circumscribed, elevated, and a palpable mass containing serous fluid. It may be cause by herpes simplex, a cold sore. Poison ivy develops after exposure to the plant out-of-doors and is described as circumscribed, elevated, palpable masses containing serous fluids. Poison ivy usually is a red, itchy rash with swelling, bumps and blisters that can spread by contact. A sebaceous cyst is an encapsulated, fluid-filled or semisolid mass in the subcutaneous tissue and is not considered contagious.
A biology class is discussing blood flow directions and the role of arteries and veins. The professor says, “The skin is the only place where there is a direct anastomosis between an artery and a vein.” What is the purpose for this type of blood flow in the skin?
Assist in elimination of toxins from the air
Nutrient delivery
Temperature regulation
Higher need for direct oxygenation
Temperature regulation
Rationale:The skin is richly supplied with arteriovenous anastomoses in which blood flows directly between an artery and a vein, bypassing the capillary circulation. These anastomoses are important for temperature regulation. They can open up, letting blood flow through the skin vessels when there is a need to dissipate body heat, and close off, conserving body heat if the environmental temperature is cold. It has nothing to do with nutrient supply, elimination of toxins, or higher oxygen supply.
Which stratum layer of the epidermis has cells working to lose cytoplasm and DNA while synthesizing keratin?
Granulosum
Corneum
Lucidum
Spinosum
Granulosum
Rationale:The stratum granulosum contain the most differentiated cells in the living skin, with some cells losing cytoplasm and DNA, while others in this layer synthesize keratin. The remaining options do not perform the described functions.
Select the cells of the epidermis that are responsible for providing sensory information.
Melanocyte cells
Keratinocytes
Langerhans cells
Merkel cells
Merkel cells
Rationale:The Merkel cells provide sensory information. Langerhans cells link the epidermis to the immune system, melanocytes provide pigmentation to the skin, and keratinocytes provide a protective function to the skin.
A young child asks, “How does our skin get nourished so it does not die and fall off?” The best response by the nurse would be which statement?
“Microscopically, the end arteries and veins nourish the epidermal layer through the dermal papillae.”
“Lymph vessels flow throughout the body and supply all the nutrients the skin needs.”
“Believe it or not, the hair follicles absorb ingredients from the surrounding tissues.”
“Like the rest of our cells, capillaries, arteries, and veins bring nutrients to the top layer of the skin.”
An adolsescent, who is an athlete, asks the health care provider, “Why do I now have such awful body odor? What has changed in my body?” Which response is the best reply?
“Hormones, like androgens and testosterone change the chemicals in your body making it smell worse when one sweats.”
“This is just a sign that you need to thoroughly wash and dry your skin, especially under your arms and your groin, more carefully.”
“As one develops more muscles and are able to work out longer and harder, more sweat mixes with body secretions making up ‘body odor.’”
“Apocrine sweat glands open through a hair follicle and secrete an oily substance that mixes with bacteria on the skin, producing body odor.”
Apocrine sweat glands open through a hair follicle and secrete an oily substance that mixes with bacteria on the skin, producing body odor.”
Rationale:Apocrine sweat glands open through a hair follicle and secrete an oily substance that mixes with bacteria on the skin, producing body odor. Bathing is not the cause since it is caused by increased sweat during exercise. The exercises produces more sweat, it is not because the muscles have more fully developed. The change in hormones are not the reason for body odor, even though the hormones do change at puberty.
A preschooler asks the parents at bath time, “Why are my nipples red?” Which form of melanin is responsible for the coloring of nipples and lips in humans?
Keratinocytes
Eumelanin
Pheomelanin
Desmosomes
Pheomelanin
Rationale:Pheomelanin, the yellow to red pigment, is found in all humans. It is particularly concentrated in the lips, nipples, glans penis, and vagina. Eumelanin is abundant in humans. Exposure to the sun’s rays increases the production of eumelanin, causing tanning to occur. A desmosome, also known as a macula adherens, is a cell structure specialized for cell-to-cell adhesion. Keratinocytes produce keratin, a complex protein that forms the surface of the skin and is also the structural protein of the hair and nails. Keratinocytes are now known to be active secretory cells that play an important role in the immunobiology of the skin by communicating and regulating cells of the immune response and secreting cytokines and inflammatory mediators.
An instructor is explaining the pilosebaceous unit when one student stated, “If I have fats and wax on my skin, then I need to scrub harder.” Which function(s)/purpose(s) of sebum will the teacher explain to the students? Select all that apply.
Prevents drying and breaking of hair follicles
Promotes good bumps formation
Lubricates the hair and skin
Prevents evaporation of moisture in cold weather to conserve body heat
Lubricates the hair and skin, Prevents evaporation of moisture in cold weather to conserve body heat
Rationale:The pilosebaceous unit secretes a mixture of lipids, including triglycerides, cholesterol, and wax called sebum. Sebum lubricates the hair and skin. It also prevents undue evaporation of moisture from the skin during cold weather and helps to conserve body heat. Usually washing hair with hot water and drying with hair dryers cause dry hair to crack and break. The arrector pili muscle, located deep to the sebaceous gland, provides a thermoregulatory function by contracting the skin to cause goose bumps.
A client from a nursing facility arrives with fever of unknown origin. On assessment, the nurse notes a wound on the coccyx documented as: Full thickness tissue loss with exposed bone, tendon, or muscle. Which skin lesion description is most appropriate to report to the health care provider?
Rupture of a cyst
Extensive damage with tissue loss due to a pressure injury
Dermal fissure with cracking into the skin
Erosion of superficial epidermis
Extensive damage with tissue loss due to a pressure injury
Rationale:Full thickness tissue loss with exposed bone, tendon, or muscle is a stage 4 pressure injury. There is skin loss extending past the epidermis, necrotic tissue loss, and possible bleeding and scarring of surrounding tissue. This is due to pressure injuries from lack of turning and repositioning. Fissures are linear cracks in the skin that may extend to the dermis and can be caused by fungal infections. Erosion of superficial epidermis usually do not extend to the dermis. This can be caused by moist areas. Cysts are encapsulated fluid-filled masses in the subcutaneous tissue or dermis.
A physiology educator asks the students, “So what layers keep the epidermis and dermis adhere to each other, rather than freely floating in various directions at the same time?” Which student answer(s) correctly identify the zones between the dermis and epidermis responsible for this interface? Select all that apply.
Lamina fibroreticularis
Lamina dens
Collagen
Hemidesosomes
Lamina lucida
Lamina fibroreticularis, Lamina dens, Lamina lucida
Rationale:Lamina lucida, lamina fibroreticularis, and lamina densa are the three distinct zones or layers of the basement membrane, all of which contribute to the adhesions of the two skin layers. Hemidesosomes are like half desmosomes in both structure and function. They lie immediately at the basal plasma membrane. They are involved in relaying signals between the skin layers. Collagen is the most abundant protein in the body. It is the major component of connective tissues that make up several body parts, including tendons, ligaments, skin and muscles. Collagen has many important functions, including providing the skin with structure and strengthening ones bones.
Which characteristic differentiates apocrine sweat glands from eccrine sweat glands?
Apocrine glands are primarily thermoregulatory.
Apocrine glands are more numerous and widely distributed than eccrine glands.
Apocrine secretions help maintain skin pH.
Apocrine secretions contain oils.
Apocrine secretions contain oils.
Rationale:The major difference between apocrine glands and the eccrine glands is that apocrine glands secrete an oily substance. Apocrine glands are less widely distributed than eccrine glands, and they do not contribute as significantly to thermoregulation. Neither is a major contributor to skin pH.
A nurse educator is instructing students on the importance of a skin assessment to help identify underlying systemic disease. Which assessments are correctly correlated to the identified disease? Select all that apply.
Bronze skin associated with Addison disease
Jaundice associated with liver disease
Malar rash associated with systemic lupus erythematosus
Cyanosis associated with diabetes mellitus
Dry, silvery flakes associated with biliary obstruction
Bronze skin associated with Addison disease,
Jaundice associated with liver disease,
Malar rash associated with systemic lupus erythematosus
Rationale:The skin may demonstrate outwardly what occurs inside the body. A number of systemic diseases are manifested by skin disorders (e.g., malar rash associated with systemic lupus erythematous, bronze skin with Addison disease, and jaundice with liver disease). Cyanosis is associated with hypoxia, not diabetes.
An older adult client has noticeable dry skin that is rough and scaly. The client is frequently scratching, resulting in cracking and other skin problems. Which intervention(s) would the nurse consider important to discuss with this client? Select all that apply.
Use room humidifiers, especially in bed room
Use occlusive, petroleum-based creams every morning and night
Increase use of glycerine soap for bathing
Apply emollients to the skin surface, applying frquently
Keep room termperature high enough so the client does not need blankets
Use room humidifiers, especially in bed room, Use occlusive, petroleum-based creams every morning and night, Apply emollients to the skin surface, applying frquently
Rationale:Emollients are fatty acid-containing lotions that replinish the oils on the skin surface, but usually do not leave a residue on the skin. They have short duration of action and need to be applied frequently. Using a room humidifier and keeping room termperatures as low as possible to prevent water loss from the skin may be helpful. Glycerine soaps, although popular and visually appealing, are drying and can exacerbate the symptoms. Occlusives are thick, petroleum-based creams that can form a barrier. They prevent water loss from the skin. They are most effective for relieving skin dryness, but because of their greasiness and lack of cosmetic appeal, some people do not wish to use them.
A client with a parathyroid tumor has elevated calcium levels and low vitamin D levels. The provider suggests that the client get 15 to 20 minutes of unprotected sunlight per day, if possible. How will the provider explain why this intervention will help raise vitamin D levels for this client?
“Exposure to UV rays from sunlight exposes the blood, through vasodilation, to break down calcium and allow influx of vitamin D into the vessels.”
“It is something that occurs after exposure to sunlight that researchers are still studying since its a complex process.”
“Researchers are not sure, but they think it has something to do with the evaporation of moisture on the skin surface when exposed to sunlight.”
“A substance called 7-dehydrocholesterol is converted to an inactive form of vitamin D by UV rays from the sun.”
“A substance called 7-dehydrocholesterol is converted to an inactive form of vitamin D by UV rays from the sun.”
Rationale:The skin functions as an endocrine organ, in which a substance called 7-dehydrocholesterol is converted to an inactive form of vitamin D by UV rays from the sun. It has nothing to do with vasodilation and exposing more blood vessels to the sun rays. It also does not affect the amount of calcium in one’s vessels. The rate at which heat is dissipated from the body is determined by constriction or dilation of the arterioles that supply blood to the skin and through evaporation of moisture and sweat from the skin surface.
A grandchild asks the grandparent, “Why is your hair so gray?” Which response by the grandparent gives the physiologic reason for hair turning gray with aging?
“I have a decreased number of melanosome-producing melanocytes.”
“When I was younger, I had a high fever that killed my ‘hair-color’ cells.”
“I have the beautician dye my hair this color.”
“I have fewer red blood cells now so my hair follicles receive less oxygen.”
“I have a decreased number of melanosome-producing melanocytes.”
Rationale:Large melanosomes are found in the hair of darker-skinned people. Aggregated and encapsulated melanosomes are found in people with light skin. Red hair has spherical melanosomes, whereas gray hair is the result of a decreased number of melanosome-producing melanocytes. None of the other answers are physiologically correct.
The nurse planning a sun safety community education class should include the information that the increased melanin produced by dark-colored skin decreases the risk for:
Pruritis
Skin cancer
Lichenification
Acne vulgaris
Skin cancer
Rationale:The increased melanin produced by dark skin decreases the risk for skin cancer, premature wrinkling, and aging of the skin that occurs with sun exposure. Skin color is not a factor when considering the other options.
Select the layer of dermis characterized by a complex meshwork of three-dimensional collagen bundles interconnected with large elastic fibers.
Epidermis
Subcutaneous tissue
Reticular dermis
Papillary dermis
Reticular dermis
Rationale:The reticular dermis is a complex meshwork of three-dimensional collagen bundles interconnected with large elastic fibers and is the thicker area of the dermis, which forms the bulk of the dermal layer. The papillary layer of the dermis is a thin superficial layer that interdigitates directly with the epidermis.
During finals week, a college student notices an increase in the amount of acne on the face. Which physiological principal is responsible for this acne during times of added stress?
During times of stress, the tonofilaments disconnect, thereby breaking the underlying stability for the epidermis.
Langerhans cells are innervated by sympathetic nerve fibers, which may explain why the skin’s immune system is altered under stress.
Merkel cells are neuroendocrine cells that release hormones into the blood in response to neural stimuli.
Adherens junctions provide strong mechanical connections between cells and communicate about the presence of neighboring cells.
Langerhans cells are innervated by sympathetic nerve fibers, which may explain why the skin’s immune system is altered under stress.
Rationale:Langerhans cells are the immunologic cells responsible for recognizing foreign antigens harmful to the body. Langerhans cells are innervated by sympathetic nerve fibers, which may explain why the skin’s immune system is altered under stress. The other statements speak to various cells within the skin structures, but are not the reason why students, during times of stress, develop exacerbations of acne.
A child arrives to the outpatient clinic with a high fever of 103°F (39.5°C). The parents have the child wrapped in many blankets to “keep thim warm, since the child is shivering.” What is the rationale for the health care provider to educate the parents that less blankets will help the child more?
“Since your child is not coughing or throwing up, I think you just need to take him home and give him liquid acetaminophen.”
“Fever dilates vessels and results in sweating, the purpose of the eccrine sweat glands. Too many blankets are counterproductive and will actually help the temperature to go higher.”
“We know you want to keep your child comfortable, but blankets will not help lower your child’s fever.”
“Let’s remove the blankets and place ice packs under your child’s arms instead.”
“Fever dilates vessels and results in sweating, the purpose of the eccrine sweat glands. Too many blankets are counterproductive and will actually help the temperature to go higher.”
Rationale:An example of negative feedback is body temperature regulation. If blood temperature rises too high, this is sensed by specialized neurons in the hypothalamus of the brain. They signal other nerve centers, which in turn send signals to the blood vessels of the skin. As these blood vessels dilate, more blood flows close to the body surface and excess heat radiates from the body. If this is not enough to cool the body back to its set point, the brain activates sweating. Evaporation of sweat from the skin has a strong cooling effect, as we feel when we are sweaty and stand in front of a fan. Shivering may occur. Each muscle tremor in shivering releases heat energy and helps warm the body back toward its 98.6°F (37°C) set point. Removing the blankets and placing ice packs under the child’s arms instead does not teach the parents anything about fever control. Confirming the parents goal of keeping the child comfortable, but stating, “blankets will not help lower your child’s fever” does not address the principle of evaporation of the sweat. Antipyretic drugs, such as aspirin, ibuprofen, and acetaminophen, often are used to alleviate the discomforts of fever and protect vulnerable organs, such as the brain, from extreme elevations in body temperature. However, the differential diagnosis of fever is quite broad and includes both infectious and noninfectious causes. These causes should be investigated rather than just sending the child home.
A child with strep throat is given a prescription for pencillin. After the first dose, the parents call to report the development of a skin rash. Which skin lesion discription leads the provider to discontinue the medication and encourage them to seek help if the child has trouble breathing?
Pus-filled vesicle
Flat, nonpalpable, circumscribed skin color change less than 1-cm diameter
Elevated, irregular mass of varying sizes
Encapsulated, fluid-filled masses
Elevated, irregular mass of varying sizes
Rationale:Elevated, irregular mass of varying sizes can describe urticaria (hives) and may be caused by an allergy to penicillin. Flat, nonpalpable, circumscribed skin color change less than 1-cm diameter is a characteristic of a macule. Pus-filled vesicle describes a pustule and usually associated with acne or impetigo. Encapsulated, fluid-filled masses usually describes a cyst.
