Ch 08 Skin, Hair, and Nails PDF

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Ch 08 Multiple Choice Identify the choice that best completes the statement or answers the question. ____ a. b. c. d. e.

1.

The skin repairs epidermal wounds by exaggerating cell replacement. excreting lactic acid. producing vitamins. providing a mechanical barrier. increasing the vascularity of the epidermis.

____ a. b. c. d. e.

2.

The adipose tissue in the hypodermis serves to provide sensory input. generate heat and insulate. create tensile strength. restrict water loss. secrete collagen.

____ a.

3.

Sweat glands, hair, and nails are all formed from basement membranes under cellular strata. closely packed squamous cells. invaginations of epidermis into dermis. papillae that penetrate the epidermis. evaginations of the hypodermis.

____ a. b. c. d. e.

4.

The secretory activity of the sebaceous glands is stimulated by body heat. ambient temperature. sex hormones. dietary protein. emotional stimuli.

____ a. b. c. d. e.

5.

Which structure is the site of new nail growth? Cuticle Paronychium Eponychium Nail bed Matrix

____ a. b.

6.

Newborns are more vulnerable to hypothermia because of the presence of coarse terminal hair. desquamation of the stratum corneum.

b. c. d. e.

their covering of vernix caseosa. a poorly developed subcutaneous fat layer. excessive secretion of eccrine sweat glands.

c. d. e.

7.

Normal hormone-related changes of adolescence include increased oil production. the development of fine silky lanugo hair. depletion of apocrine glands. decreased sebaceous gland activity. slowed hair growth.

8.

Expected hair distribution changes in the older adults include increased terminal hair follicles to the scalp. more prominent axillary and pubic hair production. increased terminal hair follicles to the tragus of men’s ears. more prominent peripheral extremity hair production. women possibly developing less coarse facial hair.

____ a. b. c. d. e.

9.

Brittle nails are typical findings in adolescents. infants. pregnant women. older adults. children.

____ a. b. c. d. e.

10.

The nails of older adults grow slowly because of decreased circulation. dietary deficiencies. fungal infections. low hormone levels. high estrogen levels.

____ a. b.

11.

Risk factors for skin cancer include an olive complexion. repeated trauma or irritation to the skin. a history of allergic reactions to sunscreen. dark eyes and hair.

____ a. b. c. d. e. ____ a. b. c. d. e.

c. d.

pigmented bands in the nails.

e.

Which of the following, if reported, belongs in the family history of a patient with a skin rash? a. Father has chronic asthma. b. Sister repeatedly uses a tanning booth. c. Mother trims patient’s nails too short. d. Sister had measles as a child. e. Grandparent had chemical burn. ____

12.

____ 13. 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. e. children. ____

14.

Inspection to determine color variations of the skin is best

conducted: using an episcope. under fluorescent lighting. with illumination provided by daylight. using a Wood’s lamp. using a pen light.

a. b. c. d. e. ____ a. b. c. d. e.

15.

Tangential lighting is best used for inspecting skin color. turgor. exudates. symmetry. contour.

____ a. b. c. d. e.

16.

Unusual white areas on the skin may be caused by: adrenal disease. polycythemia. vitiligo. Down syndrome. lentigo.

____ a. b. c. d. e.

17.

Pigmentary demarcation lines are a precursor of skin cancer more common on people with fair skin commonly seen on the face a normal variation may decrease during pregnancy

____ a. b. c. d. e.

18.

Which cultural group has the lowest incidence of nevi? Native Americans African Americans Mexican Americans Asians Eastern Europeans

____ a. b. c. d. e.

19.

Pale, shiny skin of the lower extremities may reflect excessive steroids. a history of vigorous exercise. peptic ulcer disease. vasculitis. systemic disease.

____ 20. A 29-year-old white woman appears jaundiced. A cause of liver disease has been excluded. What history questions should the nurse ask? a. Whether she had unprotected sex b. If she has a history of diabetes mellitus c. Whether she has unusual bleeding problems d. If she eats a lot of yellow and orange vegetables e. If she has a family history of peripheral vascular disease

The nurse blanches over a vascular lesion on a pregnant patient. The site blanches and refills evenly from the center outward. The nurse documents this lesion as a. telangiectasia. b. a spider angioma. c. petechiae. d. purpura. e. ecchymosis.

____

21.

____ 22. Small, less than 0.5-cm in diameter, red-purple nonblanchable discolorations of the skin are a. ecchymoses. b. petechiae. c. spider veins. d. telangiectasias. e. purpura. ____

23.

A flat, nonpalpable lesion is described as a macule if the diameter

is a.

greater than 1 cm.

less than 1 cm. greater than 2 cm. too irregular to measure. exactly 5 mm.

b. c. d. e. ____ a. b. c. d. e.

24.

A 4 × 3-cm, rough, elevated area of psoriasis is an example of a plaque. patch. macule. papule. wheal.

____ 25. The nurse inspects an annular lesion. What type of additional lighting source should be used for further assessment? a. Florescent lighting b. Wood’s lamp c. Goose-neck lamp d. Sunlight e. Cobalt blue ____ a. b. c. d. e.

26.

Skin turgor checks are performed to determine the temperature of the skin. hydration status. skin texture. the extent of an ecchymosis. skin moisture.

____ a. b. c.

27.

Skin lesions are transilluminated to determine vascular from nonvascular lesions. furuncles from folliculitis lesions. fluid-filled lesions in solid cysts or masses. herpes zoster from varicella. macules from papules.

28.

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

d. e. ____ a. b. c. d. e.

____ 29. Women with terminal hair growth in a male distribution pattern should receive further evaluation for a(n) a. circulation condition. b. gastrointestinal disorder.

inflammatory state. nutritional deficit. endocrine disorder.

c. d. e.

The nurse assesses the patient’s nails and finds transverse white bands that cover the nail except for a narrow zone at the distal tip. Additional physical examination of this patient should include a. palpation of the liver. b. auscultation for carotid bruits. c. inspection for jaundice. d. fist percussion of the kidney. e. chest percussion. ____

30.

____ 31. The nurse assesses the nail base angle using the Schamroth technique. The normal expected examination finding is nail beds that are _____ at the bases. a. flat b. convex c. concave d. bowed e. elevated ____ a.

32.

Which nail change found on examination would be most alarming? Dark bands seen in all fingernails of a dark-skinned person A yellow discoloration of the great toe of an older adult A single blue nail Pits in both index fingernails of an adult Longitudinal ridges in an older adult

33.

Transient mottling of the patient’s skin in a cool room is a common

b. c. d. e. ____

finding in menopausal women. newborn infants. pregnant women. sedentary adults. older adults.

a. b. c. d. e. ____

34.

A single transverse crease seen on the palm of a small child may

imply a. b. c. d.

Down syndrome. Turner syndrome. systemic sclerosis. profound dehydration.

neurofibromatosis.

e.

Café au lait patches are numbered with each assessment of infants and young children because a. their numbers are expected to increase each year. b. coalescent lesions are a more serious finding. c. the presence of more than six patches suggests neurofibromatosis. d. decreasing numbers are expected with growth. e. a higher number correlates with the development of erythema toxicum. ____

35.

____ a. b. c. d. e.

36.

A Dennie-Morgan fold is probably caused by birth trauma. high fever. excess adipose tissue. kidney disease. chronic rubbing.

____ a. b. c. d. e.

37.

Linea nigra is commonly found on the abdomens of newborns. infants and children. adolescents. pregnant women. older adults.

____ a. b. c. d. e.

38.

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

____ 39. 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. e. herpes zoster from varicella. ____ 40. Which decubitus ulcer stage indicates damage into the subcutaneous tissue?

Stage I Stage II Stage III Stage IV Stage V

a. b. c. d. e.

Age spots are also called

____ a. b. c. d. e.

41.

____ a. b. c. d. e.

42.

The most common inflammatory skin condition is cutis marmorata. eczematous dermatitis. intradermal nevus. pityriasis rosea. psoriasis.

____ a. b. c. d. e.

43.

Which of the following is a noncandidal fungal infection? Pityriasis rosea Psoriasis Milia Rosacea Tinea corporis

seborrheic keratoses. senile lentigines. cutaneous horns. acrochordon. cutaneous tags.

____ 44. 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. e. loss of hair. ____ a. b. c. d. e.

45.

Painful vesicles are associated with psoriasis. pityriasis rosea. paronychia. herpes zoster. rosacea.

____ 46. 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.

Inquire about another recent skin lesion. Inspect the palms and the soles. Inform the patient that this will resolve within 1 week. Ask about sexual contacts.

b. c. d. e. ____

47.

Which of the following is an ABCD characteristic of malignant

melanoma? Asymmetric borders Borders well demarcated Color of lesion is uniform Diameter less than 6 mm Severe blistering or sunburns as a child

a. b. c. d. e.

____ a. b. c. d. e.

48.

The most common cutaneous neoplasm is basal cell carcinoma. compound nevus. seborrheic keratosis. senile actinic keratosis. malignant melanoma.

____

49.

Soft, painless, bluish papules in persons who are HIV-positive are

most likely Kaposi sarcoma (KS). malignant melanoma. molluscum contagiosum. pityriasis rosea. herpes zoster.

a. b. c. d. e.

____ 50. A 5-year-old child presents with discrete vesicles on an erythemic base (dew drops on a rose petal appearance) 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. Ask about a family history of rashes. 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. e. Teach infectious control measures.

During history taking, a mother states that her son awoke in the middle of the night complaining of intense itching on his legs. Today your inspection reveals honey-colored exudate from the vesicular rash on his legs. ____

51.

Which condition is consistent with these findings? a. Exanthem b. Impetigo c. Solar keratoses d. Trichotillomania e. Drug eruption You are conducting a preschool examination on a 5-year-old child. Which injury would most likely raise your suspicion that the child was 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 e. A scab on the elbow ____

52.

____ 53. Assessment of poor hygiene, healed fractures with deformity, or unexplained trauma in older adults indicates a. sexual abuse. b. physical neglect. c. psychologic abuse. d. violated rights. e. financial abuse.

Ch 08 Answer Section MULTIPLE CHOICE 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. The epidermis is avascular and depends on the underlying dermis for its nutrition. PTS: 1 REF: p. 115 MSC: Organ System: Skin/Connective 2. ANS: B

TOP: Discipline: Physiology

The hypodermis layer consists of adipose tissue that serves to generate heat and to provide insulation, shock absorption, and a reserve of calories. PTS: 1 REF: p. 115 MSC: Organ System: Skin/Connective 3. ANS: C

TOP: Discipline: Physiology

Skin appendages are formed embryonically when the epidermis invaginates into the dermis.

PTS: 1 REF: p. 115 MSC: Organ System: Skin/Connective 4. ANS: C

TOP: Discipline: Embryology

The sebaceous glands, when stimulated by the sex hormones, become stimulated to produce a lipid-rich substance that keeps the skin moist. PTS: 1 REF: p. 116 MSC: Organ System: Skin/Connective 5. ANS: E

TOP: Discipline: Physiology

The white, crescent-shaped area beyond the proximal nail fold (lunula) is the distal end of the nail matrix, which is the site of new nail growth. PTS: 1 REF: p. 116 MSC: Organ System: Skin/Connective 6. ANS: D

TOP: Discipline: Physiology

Newborns have a poorly developed subcutaneous fat layer and therefore have a reduced ability to generate heat and become insulated from the environment. The eccrine sweat glands do not begin to function until after the first month of life. PTS: 1 REF: p. 116 MSC: Organ System: Skin/Connective 7. ANS: A

TOP: Discipline: Pathophysiology

During adolescence, the sebaceous glands increase sebum production, which causes the skin to have an oily appearance and predisposes the individual to acne. PTS: 1 REF: p. 116 MSC: Organ System: Skin/Connective 8. ANS: C

TOP: Discipline: Physiology

The transition from vellus to terminal hair pattern occurs in older men at the nares and the tragus. PTS: 1 REF: p. 117 MSC: Organ System: Skin/Connective 9. ANS: D

TOP: Discipline: Physiology

Older adults typically have decreased peripheral circulation to the nails, causing the nails characteristically to develop longitudinal ridges that are more brittle and susceptible to splitting into layers. PTS: 1 REF: p. 117 MSC: Organ System: Skin/Connective 10. ANS: A

TOP: Discipline: Pathophysiology

Decreased circulation to the nails of older adults causes nail growth retardation. PTS: 1 REF: p. 117 MSC: Organ System: Skin/Connective 11. ANS: B

TOP: Discipline: Physiology

Fair-skinned persons with light-colored eyes and repeated trauma or skin

irritation are at have higher risk factor for skin cancer development. Pigmented bands in the nails are an expected finding in dark-skinned individuals. PTS: 1 REF: p. 117 MSC: Organ System: Skin/Connective 12. ANS: A

TOP: Discipline: Pathophysiology

Asthma and many dermatologic findings have shared atopic (allergic) qualities. PTS: 1 REF: p. 118 MSC: Organ System: Skin/Connective 13. ANS: B

TOP: Discipline: Pathophysiology

Knowledge of exposure to environmental chemicals is valid health history data for all age groups. PTS: 1 REF: p. 119 MSC: Organ System: Skin/Connective 14. ANS: C

TOP: Discipline: Physiology

Daylight provides the best illumination source for determining color variations of the skin. PTS: 1 REF: p. 119 MSC: Organ System: Skin/Connective 15. ANS: E

TOP: Discipline: Physiology

Tangential lighting, light shined laterally to the surface, is best for inspecting skin contours. PTS: 1 REF: p. 120 MSC: Organ System: Skin/Connective 16. ANS: C

TOP: Discipline: Physiology

The absence of melanin produces unpigmented white areas known as vitiligo. PTS: 1 REF: p. 122 MSC: Organ System: Skin/Connective 17. ANS: D

TOP: Discipline: Pathophysiology

Pigmentary demarcation lines are a normal variation. They mark the border between deeply pigmented skin and lighter pigmented skin. They are most commonly seen on the arms, legs, chest, and back and have been reported most often in black and Japanese populations. Accentuation of preexisting lines or appearance of new lines may occur during pregnancy They are not a precursor of skin cancer. PTS: 1 REF: p. 121 MSC: Organ System: Skin/Connective 18. ANS: B

TOP: Discipline: Pathophysiology

Nevi are more common in persons who burn rather than tan; therefore, African Americans have the lowest rates of nevi. PTS: 1 REF: p. 121 MSC: Organ System: Skin/Connective 19. ANS: E

TOP: Discipline: Pathophysiology

Pale, shiny skin of the lower extremities may reflect peripheral changes that occur with systemic disorders, such as diabetes mellitus and cardiovascular disease. PTS: 1 REF: p. 123 MSC: Organ System: Skin/Connective 20. ANS: D

TOP: Discipline: Pathophysiology

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. PTS: 1 REF: p. 123 MSC: Organ System: Skin/Connective 21. ANS: B

TOP: Discipline: Pathophysiology

Spider angiomas are dilated arterioles. A network of dilated capillaries radiates 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. Whereas telangiectases refill erratically, petechiae, purpura, and ecchymoses do not blanch. PTS: 1 REF: p. 123 MSC: Organ System: Skin/Connective 22. ANS: B

TOP: Discipline: Pathophysiology

Petechiae are red-purple, nonblanchable discolorations less than 0.5 cm diameter. They are frequently caused by intravascular defects or infections. PTS: 1 REF: p. 124 MSC: Organ System: Skin/Connective 23. ANS: B

TOP: Discipline: Pathophysiology

A macule by definition is a flat, circumscribed area that is less than 1 cm in diameter. An example of a macular rash is measles. PTS: 1 REF: p. 126 MSC: Organ System: Skin/Connective 24. ANS: A

TOP: Discipline: Pathophysiology

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