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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter60:AssessmentofIntegumentaryFunction  1.

Anurseisawarethattheouterlayeroftheskinconsistsofdeadcellsthatcontainlargeamountsof keratin.Thephysiologicfunctionsofkeratinincludewhichofthefollowing?Selectallthatapply.

A)

Producingantibodies

B)

Absorbingelectrolytes

C)

Maintainingacidbasebalance

D)

Physicallyrepellingpathogens

E)

Preventingfluidloss

Ans:

D,E Feedback: Thedeadcellsoftheepidermiscontainlargeamountsofkeratin,aninsoluble,fibrousproteinthatforms theouterbarrieroftheskin.Keratinhasthecapacitytorepelpathogensandpreventexcessivefluidloss fromthebody.Itdoesnotcontributedirectlytoantibodyproduction,acidbasebalance,orelectrolyte levels.

2.

Whenplanningtheskincareofapatientwithdecreasedmobility,thenurseisawareofthevarying thicknessoftheepidermis.Atwhatlocationistheepidermallayerthickest?

A)

Thescalp

B)

Theelbows

C)

Thepalmsofthehands

D)

Theknees

Ans:

C Feedback: Theepidermisisthethickestoverthepalmsofthehandsandthesolesofthefeet.

3.

Ayoungstudentisbroughttotheschoolnurseafterfallingoffaswing.Thenurseisdocumentingthat thechildhasbruisingonthelateralaspectoftherightarm.Whattermwillthenurseusetodescribe

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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bruisingontheskinindocumentation? A)

Telangiectasias

B)

Ecchymoses

C)

Purpura

D)

Urticaria

Ans:

B Feedback: Telangiectasiasconsistsofredmarksontheskincausedbystretchingofsuperficialbloodvessels. Ecchymosesarebruises,andpurpuraconsistsofpinpointhemorrhagesintotheskin.Urticariaiswheals orhives.

4.

Thenurseinanambulatorycarecenterisadmittinganolderadultpatientwhohasbrightredmoleson theskin.Benignchangesinelderlyskinthatappearasbrightredmolesaretermedwhat?

A)

Cherryangiomas

B)

Solarlentigo

C)

Seborrheickeratoses

D)

Xanthelasma

Ans:

A Feedback: Cherryangiomasappearasbrightredmoles,whilesolarlentigoarecommonlycalledliverspots. Seborrheickeratosesaredescribedascrustybrownstuckonpatches,whilexanthelasmaappearsas yellowish,waxydepositsontheuppereyelids.

5.

Whileassessingadark-skinnedpatientattheclinic,thenursenotesthepresenceofpatchy,milkywhite spots.Thenurseknowsthatthisfindingischaracteristicofwhatdiagnosis?

A)

Cyanosis

B)

Addisonsdisease

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

C)

Polycythemia

D)

Vitiligo

Ans:

D

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Feedback: Withcyanosis,nailbedsaredusky.Withpolycythemia,thenursenotesruddyblueface,oralmucosa, andconjunctiva.Abronzedappearance,orexternaltan,isassociatedwithAddisonsdisease.Vitiligoisa conditioncharacterizedbydestructionofthemelanocytesincircumscribedareasofskinandappearsin lightordarkskinaspatchy,milkywhitespots,oftensymmetricbilaterally. 6.

Whilewaitingtoseethephysician,apatientshowsthenurseskinareasthatareflat,nonpalpable,and havehadachangeofcolor.Thenurserecognizesthatthepatientisdemonstratingwhat?

A)

Macules

B)

Papules

C)

Vesicles

D)

Pustules

Ans:

A Feedback: Amaculeisaflat,nonpalpableskincolorchange,whileapapuleisanelevated,solid,palpablemass.A vesicleisacircumscribed,elevated,palpablemasscontainingserousfluid,whileapustuleisapus-filled vesicle.

7.

AnAfricanAmericanisadmittedtothemedicalunitwithliverdisease.Tocorrectlyassessthispatient forjaundice,onwhatbodyareashouldthenurselookforyellowdiscoloration?

A)

Elbows

B)

Lips

C)

Nailbeds

D)

Sclerae

Ans:

D

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Feedback: Jaundice,ayellowingoftheskin,isdirectlyrelatedtoelevationsinserumbilirubinandisoftenfirst observedinthescleraeandmucousmembranes. 8.

Anurseisdoingashiftassessmentonagroupofpatientsafterfirsttakingreport.Anelderlypatientis havingherseconddoseofIVantibioticsforadiagnosisofpneumonia.Thenursenoticesanewrashon thepatientschest.Thenurseshouldaskwhatpriorityquestionregardingthepresenceofareddened rash?

A)

Istherashworseataparticulartimeorseason?

B)

Areyouallergictoanyfoodsormedication?

C)

Areyouhavinganylossofsensationinthatarea?

D)

Isyourrashpainful?

Ans:

B Feedback: Thenurseshouldsuspectanallergicreactiontotheantibiotictherapy.Allergiescanbeasignificant threattothepatientsimmediatehealth,thusquestionsaddressingthispossibilitywouldbeprioritized overthoseaddressingsensation.Askingaboutpreviousrashesisimportant,butthisshouldlikelybe framedinthecontextofanallergyassessment.

9.

Agerontologicnurseisteachingagroupofnursingstudentsaboutintegumentarychangesthatoccurin olderadults.Howshouldthesestudentsbestintegratethesechangesintocareplanning?

A)

Byavoidingtheuseofmoisturizinglotionsonolderadultsskin

B)

Byprotectingolderadultsagainstshearinginjuries

C)

Byavoidingtheuseoficepackstotreatmusclepain

D)

Byprotectingolderadultsagainstexcessivesweataccumulation

Ans:

B Feedback: Cellularchangesassociatedwithagingincludethinningatthejunctionofthedermisandepidermis, whichcreatesariskforshearinginjuries.Moisturizinglotionscanbesafelyusedtoaddressthe increaseddrynessofolderadultsskin.Icepackscanbeused,providedskinisassessedregularlyandthe patientpossessesnormalsensation.Olderadultsperspiremuchlessthanyoungeradults,thussweat

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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accumulationisrarelyanissue. 10. ApatientisdiagnosedwithatrialfibrillationandthephysicianordersCoumadin(warfarin).Forwhat skinlesionshouldthenursemonitorthispatient? A)

Ulcer

B)

Ecchymosis

C)

Scar

D)

Erosion

Ans:

B Feedback: Ecchymosisreferstoaroundorirregularmacularlesion,whichislargerthanpetechiae.Thisoccurs secondarytobloodextravasation.Itisimportanttowatchforecchymosisinapatientreceivinganytype ofanticoagulant.Anulcerisanopenlesionerodedintothepatientsflesh.Ascarisanareaontheskin causedbythehealingofaninjury.Erosionislossofsuperficialepidermisthatdoesnotextendtothe dermisadepressed,moistarea.

11. Anewpatienthascometothedermatologyclinictobeassessedforareddenedrashonhisabdomen. Whatdiagnostictestwouldmostlikelybeorderedtoidentifythecausativeallergen? A)

Skinscrapings

B)

Skinbiopsy

C)

Patchtesting

D)

Tzancksmear

Ans:

C Feedback: Patchtestingisperformedtoidentifysubstancestowhichthepatienthasdevelopedanallergy.Skin scrapingsaredoneforsuspectedfungallesions.Askinbiopsyiscompletedtoruleoutmalignancyand toestablishanexactdiagnosisofskinlesions.ATzancksmearisusedtoexaminecellsfromblistering skinconditions,suchasherpeszoster.

12. Apatientwithasuspectedmalignantmelanomaisreferredtothedermatologyclinic.Thenurseknows tofacilitatewhatdiagnostictesttoruleoutaskinmalignancy?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Tzancksmear

B)

Skinbiopsy

C)

Patchtesting

D)

Skinscrapings

Ans:

B

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Feedback: Askinbiopsyisdonetoruleoutmalignanciesofskinlesions.ATzancksmearisusedtoexaminecells fromblisteringskinconditions,suchasherpeszoster.Patchtestingisperformedtoidentifysubstances towhichthepatienthasdevelopedanallergy.Skinscrapingsaredoneforsuspectedfungalinfections. Anurseisexplainingtheimportanceofsunlightontheskintoawomanwithdecreasedmobilitywho 13. rarelyleavesherhouse.Thenursewouldemphasizethatultravioletlighthelpstosynthesizewhat vitamin? A)

E

B)

D

C)

A

D)

C

Ans:

B Feedback: SkinexposedtoultravioletlightcanconvertsubstancesnecessaryforsynthesizingvitaminD (cholecalciferol).VitaminDisessentialforpreventingrickets,aconditionthatcausesbonedeformities andresultsfromadeficiencyofvitaminD,calcium,andphosphorus.

14. AnurseisworkingwithapatientwhohasadiagnosisofCushingsyndrome.Whencompletinga physicalassessment,thenurseshouldspecificallyobserveforwhatintegumentarymanifestation? A)

Alopecia

B)

Yellowishskintone

C)

Patchy,bronzepigmentation

D)

Hirsutism

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

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D Feedback: Cushingsyndromecausesexcessivehairgrowth,especiallyinwomen.Alopeciaishairlossfromthe scalpandotherpartsofthebody.Jaundicecausesayellowdiscolorationinlight-skinnedpatients,but thisdoesnotaccompanyCushingsyndrome.PatientsthathaveAddisonsdiseaseexhibitabronze discolorationtotheirskinduetoincreasedmelaninproduction.

15. Theouterlayeroftheepidermisprovidesthemosteffectivebarriertopenetrationoftheskinby environmentalfactors.Whichofthefollowingisanexampleofpenetrationbyanenvironmentalfactor? A)

Aninsectbite

B)

Dehydration

C)

Sunburn

D)

Excessiveperspiration

Ans:

A Feedback: Thestratumcorneum,theouterlayeroftheepidermis,providesthemosteffectivebarriertoboth epidermalwaterlossandpenetrationofenvironmentalfactors,suchaschemicals,microbes,insectbites, andothertrauma.Dehydration,sunburn,andexcessiveperspirationarenotexamplesofpenetrationof anenvironmentalfactor.

16. Anurseinadermatologyclinicisreadingtheelectronichealthrecordofanewpatient.Thenursenotes thatthepatienthasahistoryofaprimaryskinlesion.Whatisanexampleofaprimaryskinlesion? A)

Crust

B)

Keloid

C)

Pustule

D)

Ulcer

Ans:

C Feedback: Apustuleisanexampleofaprimaryskinlesion.Primaryskinlesionsareoriginallesionsarisingfrom previouslynormalskin.Crusts,keloidsandulcersaresecondarylesions.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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17. AnunresponsiveCaucasianpatienthasbeenbroughttotheemergencyroombyEMS.Whileassessing thispatient,thenursenotesthatthepatientsfaceisacherry-redcolor.Whatshouldthenursesuspect? A)

Carbonmonoxidepoisoning

B)

Anemia

C)

Jaundice

D)

Uremia

Ans:

A Feedback: Carbonmonoxidepoisoningcausesabrightcherryredcolorinthefaceanduppertorsoinlight-skinned persons.Indark-skinnedpersons,therewillbeacherryredcolortonailbeds,lips,andoralmucosa. Whenanemiaoccursinlight-skinnedpersons,theskinhasgeneralizedpallor.Anemiaindark-skinned personsmanifestsasayellow-browncoloration.Jaundiceappearsasayellowcolorationofthesclerae. Uremiagivesayellow-orangetingetotheskin.

18. AnurseisprovidinganeducationalpresentationaddressingthetopicofProtectingYourSkin.When discussingtheanatomyoftheskinwiththisgroup,thenurseshouldknowthatwhatcellsareresponsible forproducingthepigmentationoftheskin? A)

IsletsofLangerhans

B)

Squamouscells

C)

Tcells

D)

Melanocytes

Ans:

D Feedback: Melanocytesarethespecialcellsoftheepidermisthatareprimarilyresponsibleforproducingthe pigmentmelanin.IsletsofLangerhansareclustersofcellsinthepancreas.Squamouscellsareflat,scaly epithelialcells.Tcellsfunctionintheimmuneresponse.

19. Awoundcarenurseisreviewingskinanatomywithagroupofmedicalnurses.Whichareaoftheskin wouldthenurseidentifyasprovidingacushionbetweentheskinlayers,muscles,andbones? A)

Dermis

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

Subcutaneoustissue

C)

Epidermis

D)

Stratumcorneum

Ans:

B

1139

Feedback: Thesubcutaneoustissue,orhypodermis,istheinnermostlayeroftheskinthatisresponsiblefor providingacushionbetweentheskinlayers,muscles,andbones.Thedermisisthelargestportionofthe skin,providingstrengthandstructure.Theepidermisistheoutermostlayerofstratifiedepithelialcells andcomposedofkeratinocytes.Thestratumcorneumistheoutermostlayeroftheepidermis,which providesabarriertopreventepidermalwaterloss. 20. Ayoungstudentcomestotheschoolnurseandshowsthenurseamosquitobite.Asthenurseexpects, thebiteiselevatedandhasserousfluidcontainedinthedermis.Howwouldthenurseclassifythis lesion? A)

Vesicle

B)

Macule

C)

Nodule

D)

Wheal

Ans:

D Feedback: Awhealisaprimaryskinlesionthatiselevatedandhasfluidcontainedinthedermis.Anexampleofa whealwouldbeaninsectbiteorhives.Vesicles,macules,andnodulesarenotcharacterizedbyelevation andthepresenceofserousfluid.

21. Whileassessinga25-year-oldfemale,thenursenotesthatthepatienthashaironherlowerabdomen. Earlierinthehealthinterview,thepatientstatedthathermensesareirregular.Thenurseshouldsuspect whattypeofhealthproblem? A)

Ametabolicdisorder

B)

Amalignancy

C)

Ahormonalimbalance

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

D)

Aninfectiousprocess

Ans:

C

1140

Feedback: Somewomenwithhigherlevelsoftestosteronehavehairintheareasgenerallythoughtofasmasculine, suchastheface,chest,andlowerabdomen.Thisisoftenanormalgeneticvariation,butifitappears alongwithirregularmensesandweightchanges,itmayindicateahormonalimbalance.This combinationofirregularmensesandhairdistributionisinconsistentwithmetabolicdisorders, malignancy,orinfection. 22. An82-year-oldpatientisbeingtreatedinthehospitalforasacralpressureulcer.Whatage-related changeismostlikelytoaffectthepatientscourseoftreatment? A)

Increasedthicknessofthesubcutaneousskinlayer

B)

Increasedvascularsupplytosuperficialskinlayers

C)

Changesinthecharacterandquantityofbacterialskinflora

D)

Increasedtimerequiredforwoundhealing

Ans:

D Feedback: Woundhealingbecomesslowerwithage,requiringmoretimeforolderadultstorecoverfromsurgical andtraumaticwounds.Therearenochangesinskinflorawithincreasedage.Vascularsupplyandskin thicknessbothdecreasewithage.

23. Anurseispreparingtoperformthephysicalassessmentofanewlyadmittedpatient.Duringwhichof thefollowingcomponentsoftheassessmentshouldthenurseweargloves?Selectallthatapply. A)

Palpationofthepatientsscalp

B)

Palpationofthepatientsupperextremities

C)

Palpationofarashonthepatientstrunk

D)

Palpationofalesiononthepatientsupperback

E)

Palpationofthepatientsfingers

Ans:

C,D

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

1141

Feedback: Glovesarewornduringskinexaminationifarashorlesionsaretobepalpated.Itisnotnormally necessarytowearglovestopalpateapatientsscalp,extremities,orfingersunlesscontactwithbody fluidsisreasonablyforeseeable. 24. Apatientwithanexceptionallylowbodymassindexhasbeenadmittedtotheemergencydepartment withsignsandsymptomsofhypothermia.Thenurseshouldknowthatthispatientssusceptibilitytoheat lossisrelatedtoatrophyofwhatskincomponent? A)

Epidermis

B)

Merkelcells

C)

Dermis

D)

Subcutaneoustissue

Ans:

D Feedback: Thesubcutaneoustissuesandtheamountoffatdepositsareimportantfactorsinbodytemperature regulation.Theepidermisisanoutermostlayerofstratifiedepithelialcells.Merkelcellsarereceptors thattransmitstimulitotheaxonthroughachemicalsynapse.Thedermismakesupthelargestportionof theskin,providingstrengthandstructure.Itiscomposedoftwolayers:papillaryandreticular.

25. Anurseisreviewinggerontologicconsiderationsrelatingtothecareofpatientswithdermatologic problems.Whatvulnerabilityresultsfromtheage-relatedlossofsubcutaneoustissue? A)

Decreasedresistancetoultravioletradiation

B)

Increasedvulnerabilitytoinfection

C)

Diminishedprotectionoftissuesandorgans

D)

Increasedriskofskinmalignancies

Ans:

C Feedback: Lossofthesubcutaneoustissuesubstancesofelastin,collagen,andfatdiminishestheprotectionand cushioningofunderlyingtissuesandorgans,decreasesmuscletone,andresultsinthelossofthe insulatingpro...