Deck 53: Integumentary System Function,Assessment,and Therapeutic Measures

Question 1

The nurse notes a thickening and hardening of the skin from continued irritation on an individual who is wheelchair-bound.What term should the nurse use to describe this finding?

A) Crust
B) Papule
C) Excoriation
D) Lichenification

Answer 1

Lichenification

Question 2

The nurse notes small (less than 0.5 cm),raised areas that contain serous fluid on a patient's arm.What term should the nurse use to document this finding?

A) Cyst
B) Papule
C) Macule
D) Vesicle

Answer 2

Vesicle

Question 3

While inspecting the skin of a patient's arm the nurse notes lesions that are clustered together.How should the nurse document this finding?

A) Linear
B) Discrete
C) Grouped
D) Confluent

Answer 3

Grouped

Question 4

The nurse is reviewing the functions and purpose of the skin with a group of high school students.From what source should the nurse explain that the epidermis receives its nourishment?

A) Dermis
B) Melanocytes
C) Epithelial cells
D) Epidermal capillaries

Question 5

While collecting data on a patient,the nurse observes that the patient's facial skin is yellowish.What other area should the nurse assess to confirm presence of jaundice?

A) Sclera
B) Nail beds
C) Conjunctivae
D) Mucous membranes

Question 6

A patient is experiencing a fever.What structure should the nurse expect to provide an effective cooling mechanism for the body?

A) Capillaries
B) Eccrine glands
C) Adipose tissue
D) Ceruminous glands

Question 7

The nurse is caring for a patient in a wound clinic who is treated with plastic wrap dressings.Which findings indicate complications related to prolonged application of the dressings? (Select all that apply.)

A) Cyanosis
B) Folliculitis
C) Maceration
D) Skin atrophy
E) Lichenification
F) Hyperpigmentation

Question 8

During report,the nurse is told that a patient "has moderate jaundice." Which assessment finding should the nurse expect to see?

A) Flushing in the face
B) Pale mucous membranes
C) Yellow discoloration of the skin
D) Bluish tinge to the fingers and toes

Question 9

A patient with cancer is experiencing hair loss from chemotherapy treatments.Which term should the nurse use to document this finding?

A) Alopecia
B) Allopathy
C) Ecchymosis
D) Keratopenia

Question 10

The nurse is applying a medicated plastic wrap dressing to a patient's leg.What intervention should the nurse include in the plan of care to prevent development of complications?

A) Apply the dressing twice a day.
B) Apply the dressing four times daily.
C) Remove the dressing for 12 hours a day.
D) Remove the dressing for 24 hours every other day.

Question 11

The nurse is assisting a patient who has a suspected diagnosis of tinea capitis (ringworm).For which diagnostic test should the nurse prepare the patient?

A) Patch test
B) Scratch test
C) Skin biopsy
D) Wood's light examination

Question 12

The nurse is documenting findings from collecting data with a patient.What term should the nurse use to document transverse depressions in the nails?

A) Paronychia
B) Beau's lines
C) Koilonychias
D) Splinter hemorrhages

Question 13

The nurse notices small purplish dots on the abdomen of a patient.Which statement should the nurse use to document the finding?

A) "Diffuse erythema of the abdomen."
B) "Purpura scattered across abdomen."
C) "Scattered ecchymoses noted on abdomen."
D) "Multiple petechiae noted across the abdomen."

Question 14

The nurse is applying wet dressings as ordered to a patient who has a crusted skin lesion.Which assessment finding should cause the nurse the most concern?

A) Edema formation
B) Dry, macerated skin
C) Increased lesion oozing
D) Excessive skin oiliness

Question 15

After a health interview the nurse is concerned that a patient might develop vitamin D deficiency.What information did the nurse use to come to this conclusion?

A) Spends 1 hour each day outside in the sun
B) Uses emollient lotion on skin after bathing
C) Spends no time at all out of doors in the sun
D) Restricts the intake of caffeinated beverages

Question 16

After completing data collection the nurse determines that an older patient is experiencing the death of melanocytes.What observation did the nurse use to make this determination?

A) Dry skin
B) Wrinkled skin
C) Thin and gray hair
D) Thin and fragile skin

Question 17

The nurse is noting the texture of a patient's skin and hair.Which secretion should the nurse identify that prevents drying of skin and hair?

A) Sweat
B) Sebum
C) Melanin
D) Cerumen

Question 18

The nurse is preparing wet dressings for a patient who has a weeping skin lesion.What is the maximum length of time the wet dressings should be used?

A) 24 hours
B) 36 hours
C) 48 hours
D) 72 hours

Question 19

The nurse is reviewing the function and repair of the skin with a patient recovering from burns.Which proteins should the nurse explain as being found in the dermis? (Select all that apply.)

A) Sebum
B) Elastin
C) Keratin
D) Collagen
E) Cerumen
F) Adipose tissue

Question 20

While changing the dressing on a burned arm the patient complains of feeling cold and having extreme pain.However,the patient asks the nurse to not apply so much pressure when wrapping gauze around the limb.What should these findings indicate to the nurse?

A) All nerves in the limb are damaged
B) Free nerve endings in the arm are injured
C) Encapsulated nerve endings in the arm are intact
D) Encapsulated nerve endings in the arm are injured

Question 21

The nurse notes that an older patient is malnourished and has minimal subcutaneous tissue.Which functions of the subcutaneous tissue of the skin should the nurse consider as being potentially altered in this patient? (Select all that apply.)

A) Store energy
B) Cushion bones
C) Support hair growth
D) Provide nourishment to tissues
E) Provide insulation from the cold
F) Destroy pathogens that passed through broken skin

Question 22

A patient has lost all hair over the head,face,and neck from a house fire.What should the nurse do to help the patient since the protective function of the hair has been lost? (Select all that apply.)

A) Increase fluids
B) Protect the eyes
C) Filter the room air
D) Ensure for warmth
E) Provide pain medication

Question 23

A patient with second-degree burns is concerned about skin repair.What should the nurse include when explaining the functions of the epidermal layers of the skin? (Select all that apply.)

A) Contain sensory receptors
B) Provide a barrier against pathogens
C) Prevent loss of water and dehydration
D) Present foreign antigens to helper T cells
E) Prevent entry of excess water into the body

Question 24

The nurse is caring for a dark-skinned African American patient.Which sites should the nurse use evaluate for the presence or absence of cyanosis? (Select all that apply.)

A) Sclera
B) Nail beds
C) Hard palate
D) Soles of the feet
E) Inner aspect of the arm

Question 25

The nurse is assisting in the presentation of the skin for a group of senior citizens in the community center.Which normal changes associated with aging should the nurse include? (Select all that apply.)

A) Fibroblasts in dermis die.
B) Subcutaneous fat increases.
C) Epidermal cell division slows.
D) Hair follicles become inactive.
E) Sweat glands become more active.
F) Sebaceous gland becomes more active.

Question 26

The nurse is reviewing the structure and function of the skin with a patient recovering from multiple abrasions.Which should the nurse explain as being classified as sudoriferous glands? (Select all that apply.)

A) Melanocytes
B) Eccrine glands
C) Apocrine glands
D) Sebaceous glands
E) Ceruminous glands