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52 Health Assessment Jarvis Ch
13: Skin, Hair, & Nails Test
Questions
A mother brings her child in to the clinic for an examination of the scalp and hair. She states that the child has developed some places where there are irregularly shaped patches with broken-off, stub-like hair and she is worried that this could be some form of premature baldness. The nurse tells her that it is:
a.
Folliculitis that can be treated with an antibiotic.
b.
Traumatic alopecia that can be treated with antifungal medications.
c.
Tinea capitis that is highly contagious and needs immediate attention.
d.
Trichotillomania; her child probably has a habit of absentmindedly twirling her hair - ✔ ✔ ANS: trichotillomania and that her child probably has a habit of twirling her hair absentmindedly.
Trichotillomania, self-induced hair loss, is usually due to habit. It forms irregularly-shaped patches with broken-off, stub-like hairs of varying
lengths. A person is never completely bald. It occurs as a child rubs or twirls the area absently while falling asleep, reading, or watching television. See Table 12-12, Abnormal Conditions of Hair, for descriptions of the other terms.
The nurse has discovered decreased skin turgor in a patient and knows that this is an expected finding in which of these conditions?
a.
Severe obesity
b.
Childhood growth spurts
c.
Severe dehydration
d.
Connective tissue disorders such as scleroderma - ✔ ✔ ANS: Severe dehydration
Decreased skin turgor is associated with severe dehydration or extreme weight loss.
While performing an assessment of a 65-year-old man with a history of hypertension and coronary artery disease, the nurse notices the presence of pitting edema in the lower legs bilaterally. The skin is puffy and tight but of normal color. There is no increased redness or tenderness over his lower legs, and the peripheral pulses are equal and
Refer the patient because of the suggestion of melanoma on the basis of her symptoms.
c.
Ask additional questions regarding environmental irritants that may have caused this condition.
d.
Tell the patient that these signs suggest a compound nevus, which is very common in young to middle-aged adults. - ✔ ✔ ANS: refer the patient because of the suspicion of melanoma on the basis of her symptoms.
The ABCD danger signs of melanoma are asymmetry, border irregularity, color variation, and diameter. In addition, individuals may report a change in size, development of itching, burning, bleeding, or a new-pigmented lesion. Any of these signs raise suspicion of malignant melanoma and warrant immediate referral.
The nurse is assessing for clubbing of the fingernails and would expect to find:
a.
Nail bases that are firm and slightly tender.
b.
Curved nails with a convex profile and ridges across the nails.
c.
Nail bases that feel spongy with an angle of the nail base of 150 degrees.
d.
Nail bases with an angle of 180 degrees or greater and nail bases that feel spongy. - ✔ ✔ ANS: an angle of the nail base of 180 degrees or greater with a nail base that feels spongy.
The normal nail is firm at its base and has an angle of 160 degrees. In clubbing, the angle straightens to 180 degrees or greater and the nail base feels spongy.
The nurse is assessing a patient who has liver disease for jaundice. Which of these assessment findings is indicative of true jaundice?
a.
Yellow patches in the outer sclera
b.
Yellow color of the sclera that extends up to the iris
c.
Skin that appears yellow when examined under low light
d.
Yellow deposits on the palms and soles of the feet where jaundice first appears - ✔ ✔ ANS: Yellow color of the sclera that extends up to the iris
A few days after a summer hiking trip, a 25-year-old man comes to the clinic with a rash. On examination, the nurse notes that the rash is red, macular, with a bull's eye pattern across his midriff and behind his knees. The nurse suspects:
a.
Rubeola.
b.
Lyme disease.
c.
Allergy to mosquito bites.
d.
Rocky Mountain spotted fever. - ✔ ✔ ANS: Lyme disease.
Lyme disease occurs in people who spend time outdoors in May through September. The first state has the distinctive bull's eye, a red macular or papular rash that radiates from the site of the tick bite with some central clearing, 5 cm or larger, usually in the axilla, midriff, inguina, or behind the knee, with regional lymphadenopathy.
A 52-year-old woman has a papule on her nose that has rounded, pearly borders and a central red ulcer. She said she first noticed it several months ago and that it has slowly grown larger. The nurse suspects which condition?
a.
Acne
b.
Basal cell carcinoma
c.
Melanoma
d.
Squamous cell carcinoma - ✔ ✔ ANS: Basal cell carcinoma
Basal cell carcinoma usually starts as a skin-colored papule that develops rounded, pearly borders with a central red ulcer. It is the most common form of skin cancer, and it grows slowly. This description does not fit acne lesions. See Table 12-11 for descriptions of malignant melanoma and squamous cell carcinoma.
A 22-year-old woman comes to the clinic because of a severe sunburn and states, "I was just out in the sun for a couple of minutes." The nurse begins a medication review with her, paying special attention to which medication class?
a. Nonsteroidal antiinflammatory drugs for pain
b. Tetracyclines for acne
c. Proton pump inhibitors for heartburn
d. Thyroid replacement hormone for hypothyroidism - ✔ ✔ Tetracyclines for acne
d. Has been found to be related to poor hygiene. - ✔ ✔ has no known cause.
About 70% of teens will have acne, and, although the cause is unknown, it is not caused by poor diet, oily complexion, a contagion, or poor hygiene.
A 75-year-old woman who has a history of diabetes and peripheral vascular disease has been trying to remove a corn on the bottom of her foot with a pair of scissors. The nurse will encourage her to stop trying to remove the corn with scissors because:
a. The woman could be at increased risk for infection and lesions because of her chronic disease.
b. With her diabetes, she has increased circulation to her foot, and it could cause severe bleeding.
c. She is 75 years old and is unable to see; consequently, she places herself at greater risk for self-injury with the scissors.
d. With her peripheral vascular disease, her range of motion is limited and she may not be able to reach the corn safely. - ✔ ✔ the woman could be at increased risk for infection and lesions because of her chronic disease.
A personal history of diabetes and peripheral vascular disease increases a person's risk for skin lesions in the feet or ankles. The patient needs to see a professional for assistance with corn removal.
The nurse keeps in mind that a thorough skin assessment is very important because the skin holds information about a person's:
a. Support systems.
b. Circulatory status.
c. Socioeconomic status.
d. Psychological wellness. - ✔ ✔ circulatory status.
The skin holds information about the body's circulation, nutritional status, and signs of systemic diseases as well as topical data on the integument itself.
A patient comes in for a physical, and she complains of "freezing to death" while waiting for her examination. The nurse notes that her skin is pale and cool and attributes this finding to:
a. Venous pooling.
b. Peripheral vasodilation.
c. Peripheral vasoconstriction.
d. Decreased arterial perfusion. - ✔ ✔ peripheral vasoconstriction.
A chilly or air-conditioned environment causes vasoconstriction, which results in false pallor and coolness. See Table 12-1.
A patient comes to the clinic and tells the nurse that he has been confined to his recliner chair for about 3 days with his feet down and he
A patient tells the nurse that he has noticed that one of his moles has started to burn and bleed. When assessing his skin, the nurse would pay special attention to the danger signs for pigmented lesions and would be concerned with which additional finding?
a. Color variation
b. Border regularity
c. Symmetry of lesions
d. Diameter of less than 6 mm - ✔ ✔ Color variation
Abnormal characteristics of pigmented lesions are summarized in the mnemonic ABCD: asymmetry of pigmented lesion, border irregularity, color variation, and diameter greater than 6 mm.
A patient comes to the clinic and states that he has noticed that his skin is redder than normal. The nurse understands that this condition is due to hyperemia and knows that it can be caused by:
a. Decreased amounts of bilirubin in the blood
b. Excess blood in the underlying blood vessels
c. Decreased perfusion to the surrounding tissues
d. Excess blood in the dilated superficial capillaries - ✔ ✔ excess blood in the dilated superficial capillaries.
Erythema is an intense redness of the skin caused by excess blood (hyperemia) in the dilated superficial capillaries.
During a skin assessment, the nurse notices that a Mexican-American patient has skin that is yellowish-brown; however, the skin on the hard and soft palate is pink and the patient's scleras are not yellow. From this finding, the nurse could probably rule out:
a. Pallor
b. Jaundice
c. Cyanosis
d. Iron deficiency - ✔ ✔ jaundice.
Jaundice is exhibited by a yellow color, which indicates rising amounts of bilirubin in the blood. It is first noticed in the junction of the hard and soft palate in the mouth and in the scleras.
A black patient is in the intensive care unit because of impending shock after an accident. The nurse would expect to find what characteristics in this patient's skin?
a. Ruddy blue.
b. Generalized pallor.
c. Ashen, gray, or dull.
d. Patchy areas of pallor. - ✔ ✔ Ashen, gray, or dull
Pallor due to shock (decreased perfusion and vasoconstriction) in black- skinned people will cause the skin to appear ashen, gray, or dull. See Table 12-2.
A 65-year-old man with emphysema and bronchitis has come to the clinic for a follow-up appointment. On assessment, the nurse might expect to see which assessment finding?
a. Anasarca
b. Scleroderma
c. Pedal erythema
d. Clubbing of the nails - ✔ ✔ Clubbing of the nails
Clubbing of the nails occurs with congenital cyanotic heart disease, neoplastic, and pulmonary diseases. The other responses are assessment findings not associated with pulmonary diseases.
A newborn infant has Down syndrome. During the skin assessment, the nurse notices a transient mottling in the trunk and extremities in response to the cooler examination room temperature. The infant's mother also notices the mottling and asks what it is. The nurse knows that this mottling is called:
a. Caf au lait.
b. Carotenemia.
c. Acrocyanosis.
d. Cutis marmorata. - ✔ ✔ cutis marmorata.
Persistent or pronounced cutis marmorata occurs with Down syndrome or prematurity and is a transient mottling in the trunk and extremities
in response to cooler room temperatures. A café au lait spot is a large round or oval patch of light-brown pigmentation. Carotenemia produces a yellow-orange color in light-skinned persons. Acrocyanosis is a bluish color around the lips, hands and fingernails, and feet and toenails.
A 35-year-old pregnant woman comes to the clinic for a monthly appointment. During the assessment, the nurse notices that she has a brown patch of hyperpigmentation on her face. The nurse continues the skin assessment aware that another finding may be:
a. Keratoses.
b. Xerosis.
c. Chloasma.
d. Acrochordons. - ✔ ✔ Cholasma
In pregnancy, skin changes can include striae, linea nigra (a brownish black line down the midline), chloasma (brown patches of hyperpigmentation), and vascular spiders. Keratoses are raised, thickened areas of pigmentation that look crusted, scaly, and warty. Xerosis is dry skin. Acrochordons, or "skin tags" occur more often in the aging adult.
A man has come in to the clinic for a skin assessment because he is afraid he might have skin cancer. During the skin assessment the nurse notices several areas of pigmentation that look greasy, dark, and "stuck on" his skin. Which is the best prediction? He probably has:
d. Areas of hyperpigmentation related to decreased perfusion and vasoconstriction. - ✔ ✔ clusters of melanocytes that appear after extensive sun exposure."
Liver spots, or senile lentigines, are clusters of melanocytes that appear on the forearms and dorsa of the hands after extensive sun exposure. The other responses are not correct.
The nurse notices that a patient has a solid, elevated, circumscribed lesion that is less than 1 cm in diameter. When documenting this finding, the nurse would report this as a:
a.
Bulla.
b.
Wheal.
c.
Nodule.
d.
Papule. - ✔ ✔ ANS: papule.
A papule is something one can feel, is solid, elevated, circumscribed, less than 1 cm in diameter, and is due to superficial thickening in the epidermis. A bulla is larger than 1 cm, superficial, and thin walled. A wheal is superficial, raised, transient, erythematous, and irregular in
shape due to edema. A nodule is solid, elevated, hard or soft, and larger than 1 cm.
The nurse just noted from a patient's medical record that the patient has a lesion that is confluent in nature. On examination, the nurse would expect to find:
a.
Lesions that run together.
b.
Annular lesions that have grown together.
c.
Lesions arranged in a line along a nerve route.
d.
Lesions that are grouped or clustered together. - ✔ ✔ ANS: lesions that run together.
A father brings in his 2-month-old infant to the clinic because the infant has had diarrhea for the last 24 hours. He says that his baby has not been able to keep any formula down and that the diarrhea has been at least every 2 hours. The nurse suspects dehydration. The nurse should test skin mobility and turgor in this infant over the:
a.
Sternum.
b.
