Chapter 13: Skin, Hair, and Nails
Jarvis: Physical Examination and Health Assessment, 8th Edition
MULTIPLE CHOICE
1. The nurse educator is preparing an education module on skin, hair, and nails for the nursing
staff. Which of these statements about the epidermal layer of the skin should be included in
the module?
a.
Highly vascular
b.
Thick and tough
c.
Thin and nonstratified
d.
Replaced every 4 weeks
2. The nurse educator is preparing an education module on skin, hair, and nails for the nursing
staff. Which of these statements about the dermal layer of the skin should be included in the
module?
a.
Contains mostly fat cells
b.
Consists mostly of keratin
c.
Is replaced every 4 weeks
d.
Contains sensory receptors
3. The nurse is examining a patient who tells the nurse, “I sure sweat a lot, especially on my face
and feet but it doesn’t have an odor.” The nurse knows that this is likely r/t a disorder with
what part of the body?
a.
Eccrine glands
b.
Apocrine glands
c.
Disorder of the stratum corneum
d.
Disorder of the stratum germinativum
4. A newborn infant is in the clinic for a well-baby checkup. The nurse observes the infant for
the possibility of fluid loss because of which of these factors?
a.
Subcutaneous fat deposits are high in the newborn.
b.
Sebaceous glands are overproductive in the newborn.
c.
The newborn’s skin is more permeable than that of the adult.
d.
The amount of vernix caseosa dramatically rises in the newborn.
5. The nurse is bathing an 80-year-old man and notices that his skin is wrinkled, thin, lax, and
dry. This finding would be r/t which factor in the older adult?
a.
Increased vascularity of the skin
b.
Increased numbers of sweat and sebaceous glands
c.
An increase in elastin and a decrease in subcutaneous fat
d.
An increased loss of elastin and a decrease in subcutaneous fat
6. During the aging process, the hair can look gray or white and begin to feel thin and fine. What
should the nurse understand causes this?
a.
Increased adipose tissue
b.
Increase in the vascularity of the scalp
c.
Decrease in the number of functioning phagocytes
d.
Decrease in the number of functioning melanocytes
7. During an examination, the nurse finds that a patient has excessive dryness of the skin. How
should the nurse document this finding?
a.
Xerosis
b.
Pruritus
c.
Alopecia
d.
Seborrhea
8. A 22-year-old woman comes to the clinic because of severe sunburn and states, “I was out in
the sun for just a couple of minutes.” The nurse begins a medication review with her, paying
special attention to which medication class?
a.
Tetracyclines for acne
b.
Proton pump inhibitors for heartburn
c.
Nonsteroidal anti-inflammatory drugs for pain
d.
Thyroid replacement hormone for hypothyroidism
9. A woman is leaving on a trip to Hawaii and has come in for a checkup. During the
examination the nurse learns that she has diabetes and is prescribed oral hypoglycemic agents.
What should the nurse include in this patient’s teaching?
a.
Increased possibility of bruising
b.
Importance of sunscreen and avoiding direct sunlight
c.
Lack of availability of glucose-monitoring equipment
d.
Skin sensitivity as a result of exposure to salt water
10. A 13-year-old girl is interested in obtaining information about the cause of her acne. What
should the nurse include in the information about acne?
a.
It is contagious.
b.
It has no known cause.
c.
It is caused by increased sebum production.
d.
It has been found to be r/t poor hygiene.
11. 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. Why is it important
that the nurse encourage her to stop trying to remove the corn with scissors?
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.
12. The nurse keeps in mind that a thorough skin assessment is extremely important. What can the
skin provide important information about?
a.
Support systems
b.
Circulatory status
c.
Socioeconomic status
d.
Psychological wellness
13. A patient comes in for a physical examination in late July and states that she was “freezing to
death” while waiting for her examination. The nurse notes that her skin is pale and cool. What
should the nurse understand is the likely cause?
a.
Venous pooling
b.
Peripheral vasodilation
c.
Peripheral vasoconstriction
d.
Decreased arterial perfusion
14. A patient comes to the clinic and tells the nurse that he has been confined to his recliner chair
for approximately 3 days with his feet down and he asks the nurse to evaluate his feet. What
should the nurse expect to find during the assessment?
a.
Pallor
b.
Coolness
c.
Distended veins
d.
Prolonged capillary filling time
15. A patient is especially worried about an area of skin on her feet that has turned white. The
health care provider has told her that her condition is vitiligo. What should the nurse include
in the teaching of vitiligo?
a.
It is associated with an excess of melanin pigment.
b.
It is a result of excess apocrine glands in her feet.
c.
It is caused by the complete absence of melanin pigment in an area.
d.
It is r/t impetigo and can be treated with a prescription ointment.
16. 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 pays special attention to the danger signs for pigmented
lesions and is concerned with which additional finding?
a.
Color variation
b.
Border regularity
c.
Symmetry of lesions
d.
Diameter of less than 6 mm
17. 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 erythema. What is the likely cause?
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
18. 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 white. From these findings, what can the nurse rule out?
a.
Pallor
b.
Jaundice
c.
Cyanosis
d.
Iron deficiency
19. A black patient is in the intensive care unit because of impending shock after an accident. The
nurse expects 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
20. An older adult woman is brought to the emergency department after being found lying on the
kitchen floor for 2 days; she is extremely dehydrated. What would the nurse expect to see
during the examination?
a.
Pale mucous membranes
b.
Smooth mucous membranes and lips
c.
White patches on the mucous membranes
d.
Dry mucous membranes and cracked lips
21. A 42-year-old woman states that she has noticed several small, slightly raised, bright red dots
on her chest. On examination, the nurse confirms the presence of these “dots.” How should
the nurse document these findings?
a.
Anasarca
b.
Scleroderma
c.
Senile angiomas
d.
Latent myeloma
22. 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 finding?
a.
Anasarca
b.
Scleroderma
c.
Pedal erythema
d.
Clubbing of the nails
23. 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 cool temperature in the
examination room. The infant’s mother also notices the mottling and asks what it is. What
should the nurse tell the mother that this mottling is called?
a.
Carotenemia
b.
Acrocyanosis
c.
Café au lait
d.
Cutis marmorata
24. 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. What other finding should the nurse expect?
a.
Xerosis
b.
Chloasma
c.
Keratoses
d.
Acrochordons
25. A man has come in to the clinic for a skin assessment because he is worried 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 description of these?
a.
Senile lentigines, which do not become cancerous
b.
Seborrheic keratoses, which do not become cancerous
c.
Acrochordons, which are precursors to squamous cell carcinoma
d.
Actinic keratoses, which are precursors to basal cell carcinoma
26. A 70-year-old woman who loves to garden has small, flat, brown macules over her arms and
hands. She asks, “What causes these liver spots?” Which is the best response by the nurse?
a.
“They are signs of decreased hematocrit r/t anemia.”
b.
“Those are due to the destruction of melanin in your skin from exposure to the
sun.”
c.
“They are clusters of melanocytes that appear after extensive exposure to
sunlight.”
d.
“Those are areas of hyperpigmentation r/t decreased perfusion and
vasoconstriction.”
27. The nurse notices that a patient has a solid, elevated, circumscribed lesion that is less than 1
cm in diameter. How should the nurse document this finding?
a.
A bulla
b.
A wheal
c.
A nodule
d.
A papule
28. The nurse just noted from the medical record that the patient has a lesion that is confluent in
nature. What should the nurse expect to find upon examination?
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
29. A patient has had a “terrible itch” for several months that he has been continuously scratching.
What might the nurse expect to find upon physical examination?
a.
A keloid
b.
A fissure
c.
Keratosis
d.
Lichenification
30. A physician has diagnosed a patient with purpura. After leaving the room, a nursing student
asks the nurse what the physician saw that led to that diagnosis. What is the best response by
the nurse?
a.
“Blue dilation of blood vessels in a star–shaped linear pattern on the legs.”
b.
“Fiery red, star–shaped marking on the cheek that has a solid circular center.”
c.
“Confluent and extensive patch of petechiae and ecchymoses on the feet.”
d.
“Tiny areas of hemorrhage that are less than 2 mm, round, discrete, and dark red in
color.”
31. A mother has noticed that her son, who has been to a new babysitter, has some blisters and
scabs on his face and buttocks. On examination, the nurse notices moist, thin-roofed vesicles
with a thin erythematous base. What does the nurse suspect?
a.
Eczema
b.
Impetigo
c.
Herpes zoster
d.
Diaper dermatitis
32. The nurse notices that a school-aged child has bluish-white, red-based spots in her mouth that
are elevated approximately 1 to 3 mm. What other signs would the nurse expect to find in this
patient?
a.
Pink, papular rash on the face and neck
b.
Pruritic vesicles over her trunk and neck
c.
Hyperpigmentation on the chest, abdomen, and back of the arms
d.
Red-purple, maculopapular, blotchy rash behind the ears and on the face
33. The nurse is assessing the skin of a patient who has acquired immunodeficiency syndrome
(AIDS) and notices multiple patchlike lesions on the temple and beard area that are faint pink
in color. What does the nurse suspect?
a.
Angiomas
b.
Herpes zoster
c.
Measles (rubeola)
d.
Kaposi’s sarcoma
34. A 45-year-old farmer comes in for a skin evaluation and complains of hair loss on his head.
His hair seems to be breaking off in patches, and he notices some scaling on his head. What
does the nurse suspect?
a.
Folliculitis
b.
Tinea capitis
c.
Toxic alopecia
d.
Seborrheic dermatitis
35. A mother brings her 10-year-old daughter into the clinic for an examination of the scalp and
hair. She states that the child has developed irregularly shaped patches with broken-off,
stublike hair in some places; she is worried that this condition could be some form of
premature baldness. What is the best response by the nurse?
a.
“This looks like folliculitis which can be treated with an antibiotic.”
b.
“This sounds like traumatic alopecia which can be treated with antifungal
medications.”
c.
“This appears to be tinea capitis which is highly contagious and needs immediate
attention.”
d.
“This appears to be trichotillomania. Does your daughter have a habit of
absentmindedly twirling her hair?”
36. The nurse has discovered decreased skin turgor in a patient and knows that this finding is
expected in which condition?
a.
Severe obesity
b.
Severe dehydration
c.
Childhood growth spurts
d.
Connective tissue disorders such as scleroderma
37. 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 bilateral pitting edema in the lower
legs. The skin is puffy and tight but normal in color. No increased redness or tenderness is
observed over his lower legs, and the peripheral pulses are equal and strong. In this situation,
the nurse suspects that the likely cause of the edema is which condition?
a.
Heart failure
b.
Venous stasis
c.
Local inflammation
d.
Peripheral arterial insufficiency
38. A 40-year-old woman reports a change in mole size, accompanied by color changes, itching,
burning, and bleeding over the past month. She has a dark complexion and has no family
history of skin cancer, but she has had many blistering sunburns in the past. What is the best
response by the nurse?
a.
Tell the patient to watch the lesion and report back in 2 months.
b.
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.
39. The nurse is assessing for clubbing of the fingernails. Which is the best description of
clubbing?
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
40. The nurse is assessing a patient with 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
41. The nurse is assessing for inflammation in a dark-skinned person. Which technique is the
best?
a.
Assessing the skin for cyanosis and swelling
b.
Palpating the skin for edema and increased warmth
c.
Assessing the oral mucosa for generalized erythema
d.
Palpating for tenderness and local areas of ecchymosis
42. 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. What does the nurse suspect?
a.
Eczema
b.
Rubeola
c.
Lyme disease
d.
Medication allergy
43. 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.
Melanoma
c.
Basal cell carcinoma
d.
Squamous cell carcinoma
44. 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 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. Where should the
nurse test for skin mobility and turgor?
a.
Over the sternum
b.
On the forehead
c.
On the forearms
d.
Over the abdomen
45. A semiconscious woman is brought to the emergency department after she was found on the
floor in her kitchen. Her face, nail beds, lips, and oral mucosa are a bright cherry-red color.
What should the nurse suspect is the likely cause of these findings?
a.
Uremia
b.
Carotenemia
c.
Polycythemia
d.
Carbon monoxide poisoning
46. A patient has been admitted for severe psoriasis. The nurse expects to see what finding in the
patient’s fingernails?
a.
Pitting
b.
Paronychia
c.
Beau lines
d.
Splinter hemorrhages
MULTIPLE RESPONSE
1. The nurse is preparing for a certification course on skin care and needs to be familiar with the
various lesions that may be identified on assessment of the skin. Which of the following
definitions are correct? (Select all that apply.)
a.
Papule: Hypertrophic scar.
b.
Vesicle: Known as a friction blister.
c.
Bulla: Elevated, circumscribed lesion filled with turbid fluid (pus).
d.
Nodule: Solid, elevated, and hard or soft growth that is larger than 1 cm.
e.
Petechiae: Tiny punctate hemorrhages, 1 to 3 mm, round and discrete, dark red,
purple, or brown in color.
2. A patient has been admitted to a hospital after the staff in the nursing home noticed a pressure
ulcer in his sacral area. The nurse examines the pressure ulcer and determines that it is a stage
II ulcer. Which of these findings are characteristic of a stage II pressure ulcer? (Select all that
apply.)
a.
Intact skin appears red but is not broken.
b.
Patches of eschar cover parts of the wound.
c.
Ulcer extends into the subcutaneous tissue.
d.
Open blister areas have a red-pink wound bed.
e.
Localized redness in light skin will blanch with fingertip pressure.
f.
Partial thickness skin erosion is observed with a loss of epidermis or dermis.