EAQ- Integumentary Flashcards by Sasha K.

Which nursing intervention assists in decreasing the potential occurrence of pressure ulcers when providing care for a client with quadriplegia?

Avoid massaging the client’s legs.

Frequently reposition the client on a scheduled basis.

Increase the fiber content in the client’s food.

Encourage the client to participate in weight-bearing exercises.

Frequently reposition the client on a scheduled basis.

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Which description describes a coalesced type of skin lesion configuration?

Lesions are well defined with sharp borders.

Lesions merge together and appear confluent.

Lesions are ringlike around flat centers of skin.

Lesions have wavy borders that resemble a snake.

Lesions merge together and appear confluent.

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Which description is associated with fissures?

Deep erosions that extend beneath the epidermis

Thinning of the skin surface with a loss of skin markings

Linear cracks in the epidermis that extend into the dermis

Thickened areas of epidermis with accentuated skin markings

Linear cracks in the epidermis that extend into the dermis

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Which characteristic does the nurse associate with a punch biopsy?

It is usually indicated for superficial or raised lesions.

It is more uncomfortable than other biopsies while healing.

It is performed using a circular cutting instrument 2 to 6 mm in diameter.

It removes only the portion of the skin that rises above the surrounding tissue.

It is performed using a circular cutting instrument 2 to 6 mm in diameter.

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Which form is a source of the dermal regeneration template graft?

Porcine skin

Cadaveric skin

Glycosaminoglycan bonded to silicone membrane

Porcine collagen bonded to silicone membrane

Glycosaminoglycan bonded to silicone membrane

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Which type of biopsy is required for removal of entire lesions on the skin?

Punch biopsy

Shave biopsy

Incisional biopsy

Excisional biopsy

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Which test is used in the diagnosis of systemic lupus erythematosus?

Patch test

Photo patch test

Direct immunofluorescence test

Indirect immunofluorescence test

Direct immunofluorescence test

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Which disorder is a cause of systemic altered inflammatory response in impaired wound healing?

Uremia

Cirrhosis

Leukemia

Hypovolemia

Leukemia

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Which term would the nurse use to describe the exudate characteristic of a serosanguineous wound?

Greenish-blue pus

Creamy yellow exudate

Blood-tinged amber fluid

Beige pus with a fishy odor

Blood-tinged amber fluid

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Which infection is caused by a fungus?

Furuncle

Folliculitis

Herpes zoster

Dermatophytosis

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Which skin infection would cause facial paralysis?

Candidiasis

Herpes zoster

Herpes simplex

Dermatophytosis

Herpes zoster

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Which fungal infection does the client refer to as jock itch?

Tinea pedis

Tinea cruris

Tinea corporis

Tinea unguium

Tinea cruris

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Which feature is associated with the “maturation phase” of normal wound healing?

The scar is firm and inelastic on palpation.

Fibrin strands form a scaffold or framework.

White blood cells migrate into the wound.

Epithelial cells are grown over the granulation tissue bed

The scar is firm and inelastic on palpation.

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Which key feature is associated with a stage 2 pressure ulcer?

Presence of nonintact skin

Development of sinus tracts

Damage to the subcutaneous tissues

Appearance of a reddened area over a bony prominence

Presence of nonintact skin

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Which item can cause scald injuries?

Grease

Hot liquids or steam

Alkali in oven cleaners

Open flame in house fires

Hot liquids or steam

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Which secondary skin lesion may include athlete’s foot as an example?

Scar

Scale

Ulcer

Fissure

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Which disease is caused by the virus that causes chickenpox?

Athlete’s foot

Herpes zoster

German measles

Infectious hepatitis

Herpes zoster

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Which component of skin maintains optimal barrier function?

Keratin

Melanin

Collagen

Adipose tissue

Keratin

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Which clinical finding occurs due to thinning of the subcutaneous layer?

Decreased tone and elasticity

Decreased sensory perception

Increased risk for hypothermia

Increased susceptibility to dry skin

Increased risk for hypothermia

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Which clinical manifestation is characterized by eczematous eruption with well-defined geometric margins?

Medication eruption

Atopic dermatitis

Contact dermatitis

Nonspecific eczematous dermatitis

Contact dermatitis

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Which condition is an example of a bacterial infection?

Impetigo

Candidiasis

Plantar warts

Verruca vulgaris

Impetigo

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Which causative organism colonization signifies purulent exudates of greenish-blue pus with a fruity odor?

Proteus

Bacteroides

Pseudomonas

Staphylococcus

Pseudomonas

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Which mechanism of action would a nurse recall when using wet-to-damp saline-moistened gauze for wound debridement?

Promoting the dilution of viscous exudate

Removing the necrotic tissue mechanically

Causing a breakdown of the denatured protein of the eschar

Promoting the spontaneous separation of necrotic tissue

Removing the necrotic tissue mechanically

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Which clinical manifestation is associated with cellulitis?

Lymphadenopathy

Occasional papules

Vesicles that evolve into pustules

Isolated erythematous pustules

Lymphadenopathy

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Which type of allergic skin condition is associated with immunological irregularity, asthma, and allergic rhinitis? Urticaria Psoriasis Acne vulgaris Atopic dermatitis

Atopic dermatitis

Which benign condition of the client’s skin is associated with the grouping of normal cells derived from melanocytelike precursor cells? Nevi Psoriasis Acne vulgaris Plantar warts

Nevi

Which type of laser is used in the treatment of vascular and other pigmented lesions? Argon Gold vapors Neodymium Carbon dioxide

Argon

Which dermatological problem is treated by using intralesional corticosteroids? Psoriasis Cellulitis Erysipelas Carbuncles

Psoriasis

Which surgery is used to treat excessive wrinkling or sagging of facial skin? Rhinoplasty Rhytidectomy Dermabrasion Blepharoplasty

Rhytidectomy

Which action would the nurse take when a client who had a total hip replacement states that the plan is to go swimming at the community pool the day after discharge? Tell the client to take a friend along for safety. Encourage participation in this activity because it provides excellent range-of-motion exercise. Explain that the incision should not be immersed in water until it has healed. Let the client know that swimming can substitute for the prescribed physical therapy.

Explain that the incision should not be immersed in water until it has healed.

Which benign condition shows silver scaly plaques on the skin? Nevi Psoriasis Urticaria Acne vulgaris

Psoriasis

Which information would the nurse include in a community education session on decreasing the risk for musculoskeletal injuries? Select all that apply. One, some, or all responses may be correct. Use of seatbelts Obeying speed limits Wearing safety equipment Avoiding impaired vehicle use Refraining from distracted driving

All of the above

Which intervention would the nurse include in the plan of care for a client admitted with herpes zoster? Select all that apply. One, some, or all responses may be correct. Acyclovir Silvadene Gabapentin Wet compresses Contact isolation

All of the above

Which physical assessment finding would the nurse expect in a client admitted with a suspected malignant melanoma on the arm? Large area of petechiae Red birthmark that has recently become lighter in color Brown or black mole with red, white, or blue areas Patchy loss of skin pigmentation

Brown or black mole with red, white, or blue areas

Which type of skin lesion would be suspected when the nurse notices a minute, nonpalpable change in the skin color of a client? Wheal Papule Vesicle Macule

Macule

Which skin color alteration may be observed in a client diagnosed with methemoglobinemia? Red Blue White Yellow-orange

Blue

Which is a serious side effect of x-rays? Vesicles Papules Desquamation Plaque-like lesions

Desquamation

Which clinical manifestation is associated with hypernatremia in burns? Fatigue Seizures Paresthesias Cardiac dysrhythmias

Seizures

Which skin damage is caused by chronic exposure to ultraviolet rays? Select all that apply. One, some, or all responses may be correct. Dryness Photoaging Vascular lesions Wrinkling of skin Benign neoplasm

Photoaging Wrinkling of skin

Which physical changes may cause longitudinal nail ridges? Decreased rate of growth Decreased cell division Decreased blood flow Decreased vitamin D production

Decreased blood flow

Which color would the nurse anticipate when assessing a client’s skin tears? Red Gray Black Yellow

Red

Which intervention would be included in the plan of care for the prevention of a pressure injury? Positioning a client directly on the trochanter Keeping the client’s skin directly off plastic surfaces Keeping the head of the bed elevated above 30 degrees Placing a rubber ring or donut under the client’s sacral area

Keeping the client’s skin directly off plastic surfaces

Which condition would a nurse suspect when a client reports crumbly, discolored, and thickened toenails? Allergy Insect bite Fungal infection Bacterial infection

Fungal infection

Which changes with a client’s hair would be responsible for developing white hair at the age of 23? Decreased oils Decreased density Decreased estrogen levels Decreased melanocytes

Decreased melanocytes

Which gastrointestinal (GI) change may be found in the client with burn injuries? Abdominal distention Increased peristalsis Activation of GI motility Increased blood flow to the GI area

Abdominal distention The client with burn injuries may have abdominal distention due to loss of peristalsis

Which finding could be described as visibly dilated, superficial, and cutaneous small blood vessels found on the face and thighs? Tenting Angioma Varicosity Telangiectasia

Telangiectasia

Which description is associated with a hematoma? The occurrence of redness in patches of variable size and shape The thickening of the skin with accentuated normal skin markings The visible swelling due to extravasation of blood of sufficient size The pinpoint, discrete deposits of blood in the extravascular tissues

The visible swelling due to extravasation of blood of sufficient size

Which direction will the nurse include in the teaching plan for a client with lower extremity arterial disease (LEAD)? Trimming toenails so that they are short and rounded Checking bathwater temperature by putting the toes in first Using alcohol to rub hands, feet, legs, and arms at least two times a day Seeking professional treatment for any minor injuries to the extremities

Seeking professional treatment for any minor injuries to the extremities

Which percentage of total body surface area (TBSA) would the nurse calculate for a burn victim who has waxy white areas interspersed with pink and red areas on the anterior trunk and all of both arms? 20 25 30 36

36 Using the rule of nines, the percentage of total body surface area burned is 9% for each arm (18% total for both arms) and 18% for the anterior trunk; thus the total body surface area burned is 36%. The choices 20%, 25%, and 30% are too low.

Which teaching point would the nurse include when teaching a client about how to care for the skin around a colostomy stoma? "Wash with soap and water." "Rinse the area with peroxide." "Apply a thick coat of an emollient." "Rub vigorously to remove hardened feces."

"Wash with soap and water."

Which response by the nurse is therapeutic when a male client with ascites is to have a paracentesis and has signed the consent but, while the nurse is caring for him, he says that he has changed his mind and no longer wants the procedure? "Why did you sign the consent?" "Tell me why you want to refuse the procedure." "You are obviously afraid about something concerning the procedure." "Although the procedure is very important, I understand why you changed your mind."

"Tell me why you want to refuse the procedure."

Which infection is suspected by the primary health care provider when a client reports facial lesions that are surrounded by redness and cause itching with lesions that are found to be thick with a honey-colored crust and surrounded by erythema? Shingles Impetigo Folliculitis Verruca vulgaris

Impetigo

Which fungal infection is commonly referred to as athlete’s foot? Tinea pedis Tinea cruris Tinea corporis Tinea unguium

Tinea pedis

Which type of skin lesion has a wavy border? Annular Circinate Coalesced Serpiginous

Serpiginous

Which assessment finding is associated with chronic eczema? Localized edema Rough, thick skin Decreased skin turgor Increased skin temperature

Rough, thick skin

Which condition would a nurse suspect when a client with a skin infection reports an itching sensation associated with pain at the site of infection and shows erythematous blisters and interdigital scaling and maceration? Tinea pedis Tinea cruris Tinea corporis Tinea unguium

Tinea pedis

Which changes to the client’s skin are caused by the atrophy of eccrine sweat glands? Ecchymosis Dry skin Wrinkles Skin shearing

Dry skin

Which complication is being prevented by the nurse frequently repositioning a client with advanced muscular dystrophy who has respiratory distress? Renal calculi Disorientation Pressure injuries Urinary infection

Pressure injuries

Which statement describes the function of the dermis? Provides cells for wound healing Assists in retention of body heat Acts as mechanical shock absorber Inhibits proliferation of microorganisms

Provides cells for wound healing

Which information would the nurse include in the teaching plan of a client who is receiving combination chemotherapy for stage II Hodgkin disease and is at risk for stomatitis? "Rinse the mouth 3 times a day with lemon juice and water." "Brush the teeth once daily and use dental floss after each meal." "Clean the mouth with a soft toothbrush or a gentle spray." "Gently clean the mouth with commercial mouthwash."

"Clean the mouth with a soft toothbrush or a gentle spray."

Which information will the nurse explain to a burn client receiving the open method for wound treatment? "Bathing will not be permitted." "Dressings will be changed daily." "Personal protective equipment will be worn by staff." "Room temperature will be kept below 72°F [22.2°C]."

"Personal protective equipment will be worn by staff."

Which term would the nurse use to document a 1 cm elevated solid lesion noted on a client’s skin? Papule Nodule Vesicle Pustule

Nodule

Which intervention would the nurse use for a client with full-thickness burns to the chest and anterior right arm? Select all that apply. One, some, or all responses may be correct. Monitoring vital signs Cutting off the clothing Inserting a urinary catheter Removing the client’s jewelry Establishing an intravenous line

All of the above

Which finding would indicate that a client needs to be evaluated by the health care provider for Alzheimer disease (AD)? Forgets home address Has difficulty multitasking Unable to find food in freezer Neglects balancing checkbook

Forgets home address

Which characteristic mental change occurs with delirium and differentiates it from dementia? Daytime sleepiness Rapid-onset confusion Lasts over several years Progressive deterioration

Rapid-onset confusion

Which client statement about self-care measures to prevent dry skin indicates the need for further teaching? "I will decrease intake of caffeine and alcohol." "I will use deodorant soap in place of alkaline soap." "I will wear splints at night to prevent scratching in a deep sleep." " I will adjust my thermostat to remain around 74°F to 78°F (23.3°C–25.5°C)."

"I will use deodorant soap in place of alkaline soap."

Which description of a vesicle would a nurse recall when reading a report for a client that has interacted with poison ivy and has vesicles on the arms and legs? A lesion filled with purulent drainage An erosion into the dermis A solid mass of fibrous tissue A lesion filled with serous fluid

A lesion filled with serous fluid

At which angle will the nurse place the head of the bed to prevent the effects of shearing force when caring for a client who has been in a coma for 2 months and is being maintained on bed rest? 30 degrees 45 degrees 60 degrees 90 degrees

30 degrees

Which recommendations would the nurse include in a client’s discharge instructions regarding a home skincare program for psoriasis? "Shower twice a day with mild soap and warm water." "Soak the affected areas in hot water on a daily basis." "Apply an alcohol free, moisturizing lotion several times a day." "Cover affected areas when in contact with others."

"Apply an alcohol free, moisturizing lotion several times a day."

Which type of lesion does the client with an elevated, solid lesion measuring 4 mm × 4 mm in size have? Papule Vesicle Pustule Macule

Papule

A hospital-acquired infection is also called a/an ___________ infection.

nosocomial

You know that acetaminophen should be effective in reducing Dave's temperature because of its ____________ action. antipyretic anti-inflammatory analgesic antiinfective

antipyretic

EAQ- Integumentary Flashcards

(72 cards)