Integumentary System Function, Assessment, and Therapeutic Measures

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. 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
____ 2. 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.”
____ 3. 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
____ 4. 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
____ 5. 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
____ 6. 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
____ 7. 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
____ 8. 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
____ 9. 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.
____ 10. 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
____ 11. 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
____ 12. 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
____ 13. 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
____ 14. 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
____ 15. 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
____ 16. 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
____ 17. 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
____ 18. 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
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

____ 19. 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
____ 20. 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
____ 21. 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
____ 22. 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
____ 23. 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
____ 24. 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.
____ 25. 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
____ 26. 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

Chapter 53. Integumentary System Function, Assessment, and Therapeutic Measures
Answer Section

MULTIPLE CHOICE

1. ANS: A
Hair loss is called alopecia. B. Allopathy is a system of medicine. C. Ecchymosis is bruising. D. Keratopenia is not a medical term.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application

2. ANS: D
Petechiae are small reddish purple hemorrhagic spots, smaller than 0.5 mm in diameter. C. Ecchymosis is bruising. A. Erythema is redness. B. Purpura is bleeding into the skin.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application

3. ANS: D
Lichenification is thickened, hardened skin. A. A crust is a scab formed by dried serum. B. A papule is a raised solid lesion. C. Excoriation is a traumatic abrasion.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application

4. ANS: C
Jaundice, a yellow-orange discoloration, may occur as a result of liver disease. D. Cyanosis presents as a gray cast to the skin related to poor oxygenation. A. Erythema is red or purple gray. B. Pallor is paleness.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Analysis

5. ANS: D
A vesicle is a small fluid-filled blister. C. A macule is a flat change in color usually less than 1 cm. B. A papule is a solid raised lesion. A. A cyst is a closed sac or pouch.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application

6. ANS: A
Although skin is affected by jaundice, the best place to inspect for jaundice is in the sclera of the eye. B. C. D. The best places to inspect for cyanosis are the lips, nail beds, conjunctivae, and palms.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application

7. ANS: D
Wet dressings should not be prescribed for more than 72 hours, because the skin may become too dry or macerated. A. B. C. Wet dressing can be applied for up to 48 hours.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

8. ANS: B
Wet dressings should not be prescribed for more than 72 hours, because the skin may become too dry or macerated. A. C. D. Oiliness, edema, and oozing are not common reactions to wet dressings.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

9. ANS: C
Plastic wrap dressings should be used for no more than 12 hours a day. Wet dressings and ointments should be applied only to affected areas, not to healthy intact skin, because this can cause maceration of good skin. A. B. D. These are inappropriate interventions to prevent a complication from the use of a dressing with a plastic wrap.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

10. ANS: A
The epidermis is made of stratified squamous epithelial tissue and is avascular, meaning that it has no capillaries within it. Its nourishment comes from the dermis beneath it. B. Melanocytes are cells in the lower epidermis that produce the protein melanin. C. Epithelial cells are within the epidermis, D. The epidermis does not have its own blood supply.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application | Question to Guide Your Learning: 2

11. ANS: B
Eccrine glands are found throughout the dermis but are most numerous on the face, palms, and soles. They are activated by high temperatures or by exercise and secrete sweat onto the skin surface. The sweat is evaporated by excess body heat, which is a very effective cooling mechanism, although it does have the potential to lead to dehydration if water is not replaced by drinking. C. Subcutaneous adipose tissue cushions some bones and provides some insulation from cold, but its most important function is energy storage. D. Modified sweat glands called ceruminous glands are found in the dermis of the ear canals. Their secretion is called cerumen or earwax. A. Capillaries may dilate to release heat however this is not the most effective cooling mechanism in the body.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

12. ANS: B
Most ducts of sebaceous glands open into hair follicles; a few open directly onto the skin surface. Their secretion is sebum, a lipid substance that inhibits the growth of some bacteria and prevents drying of skin and hair. D. Modified sweat glands called ceruminous glands are found in the dermis of the ear canals. Their secretion is called cerumen or earwax. A. C. Sweat provides cooling, and melanin is a pigment.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

13. ANS: B
Transverse depressions in the nails are called Beau’s lines. D. Splinter hemorrhages are red or brown streaks in the nail bed. A. Paronychia is inflammation at the base of the nail. C. Koilonychias is concave nails.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

14. ANS: D
Wood’s light examination is the use of ultraviolet rays to detect fluorescent materials in the skin and hair present in certain diseases such as tinea capitis (ringworm). A. B. Patch and scratch tests are performed when allergic contact dermatitis is suspected. C. A skin biopsy is indicated for deeper infections to establish an accurate diagnosis or for the evaluation of current treatment. A biopsy is an excision of a small piece of tissue for microscopic assessment.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

15. ANS: C
Sensory receptors for the cutaneous senses reside in the dermis. Receptors for heat, cold, and pain are free nerve endings; encapsulated nerve endings are specific for touch and pressure. The sensitivity of an area of skin is determined by the density of receptors present. A. B. D. These are incorrect interpretations of the patient’s response and extent of injury to the nerve endings in the burned arm.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

16. ANS: C
One function of the skin is the formation of vitamin D from cholesterol when the skin is exposed to the UV rays of the sun. Having no sun exposure can increase this patient’s risk of developing a vitamin D deficiency. A. Spending time in the sun reduces this patient’s risk of a vitamin D deficiency. B. D. Use of emollients and restricting caffeine will not adversely affect the patient’s vitamin D level.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

17. ANS: C
With aging the hair follicles become inactive and melanocytes die leading to gray and thin hair. A. Dry skin is caused by less active sebaceous glands. B. Wrinkled skin is caused by less active sebaceous glands and deterioration of collagen and elastin fibers. D. Thin and fragile skin is caused by slowing of epidermal cell division.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

18. ANS: C
Grouped lesions are clustered together. A. Linear lesions form a line. B. Discrete lesions are individual, separate, and distinct. D. Confluent lesions merge so that discrete lesions are not visible or palpable.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

MULTIPLE RESPONSE

19. ANS: B, C, D
Continued use of occlusive dressings can cause skin atrophy, folliculitis, maceration, erythema, and systemic absorption of the medication. To prevent some of these complications, the dressing is removed for 12 out of every 24 hours. A. E. F. Properly applied occlusive dressings do not cause cyanosis, lichenification, or hyperpigmentation.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

20. ANS: C, D
Keratinocytes produce the protein keratin. Collagen is the most abundant protein in the body. A. Sebum is a lipid substance. B. Elastin makes the dermis elastic. E. Cerumen is wax. F. Adipose tissue is subcutaneous tissue, not associated with protein.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

21. ANS: B, C, D, E
The stratum corneum is many layers of dead cells; all that remains is their keratin. An unbroken stratum corneum is an effective barrier against pathogens and most chemicals, although even microscopic breaks are sufficient to permit their entry. Keratin is relatively waterproof, so it prevents the loss of water and therefore dehydration, and also prevents the entry of excess water by way of the body surface. Also in the epidermis are Langerhans’ cells, a type of macrophage that presents foreign antigens to helper T cells. This is the first step in the destruction of pathogens that have penetrated the epidermis. A. The sensory receptors are in the dermis.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

22. ANS: B, C, E
Sudoriferous glands are also known as sweat glands. There are two kinds of sudoriferous glands: apocrine and eccrine. Apocrine glands are really modified scent glands and are most numerous in the axillae and genital area; they are activated by stress and emotions. Eccrine glands are found throughout the dermis but are most numerous on the face, palms, and soles. Modified sweat glands called ceruminous glands are found in the dermis of the ear canals. Their secretion is called cerumen or earwax. D. Sebaceous glands secrete a lipid substance. A. Melanocytes produce melanin.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

23. ANS: B, E, F
In the subcutaneous tissue are numerous white blood cells that destroy any pathogens that have entered by way of broken skin. Subcutaneous adipose tissue cushions some bones and provides some insulation from cold, but its most important function is energy storage. D. Excess nutrients are changed to triglyceride and stored as potential energy for times when food intake may decrease. C. Hair follicles are located in the dermis not in the subcutaneous tissue.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Analysis

24. ANS: A, C, D
In normal aging, cell division slows, hair follicles become inactive, and fibroblast in the dermis die. E. F. Sebaceous and sweat glands become less, not more, active. B. Subcutaneous fat decreases, not increases.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

25. ANS: B, D
Cyanosis presents as a gray cast to the skin. The nail beds, palms, and soles may have a bluish cast. A. C. Jaundice can be noted in the oral mucosa (particularly the hard palate) and in the sclera closest to the cornea. E. The inner aspect of the arm is not used to evaluate for cyanosis.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

26. ANS: B, C, D
Human hair keeps dust and sweat out of the eyes. Nostril hair filters air entering the nasal cavities. Hair on the head provides thermal insulation. A. E. Hair does not ensure adequate hydration or reduce pain. Increasing fluids and providing pain medication will not help replace the protective function of the patient’s hair.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application