NURS 317 Unit 7 Path Chapter 51 Flashcards
Which stratum layer of the epidermis has cells working to lose cytoplasm and DNA while synthesizing keratin?
a) Granulosum
b) Lucidum
c) Corneum
d) Spinosum
a) Granulosum
Rationale:The stratum granulosum contain the most differentiated cells in the living skin, with some cells losing cytoplasm and DNA, while others in this layer synthesize keratin. The remaining options do not perform the described functions.
A nurse educator is instructing students on the importance of a skin assessment to help identify underlying systemic disease. Which assessments are correctly correlated to the identified disease? Select all that apply.
A) Dry, silvery flakes associated with biliary obstruction
B) Jaundice associated with liver disease
C) Malar rash associated with systemic lupus erythematosus
D) Bronze skin associated with Addison disease
E) Cyanosis associated with diabetes mellitus
B) Jaundice associated with liver disease
C) Malar rash associated with systemic lupus erythematosus
D) Bronze skin associated with Addison disease
Rationale:The skin may demonstrate outwardly what occurs inside the body. A number of systemic diseases are manifested by skin disorders (e.g., malar rash associated with systemic lupus erythematous, bronze skin with Addison disease, and jaundice with liver disease). Cyanosis is associated with hypoxia, not diabetes.
An older adult client has noticeable dry skin that is rough and scaly. The client is frequently scratching, resulting in cracking and other skin problems. Which intervention(s) would the nurse consider important to discuss with this client? Select all that apply.
A) Use room humidifiers, especially in bed room
B) Keep room temperature high enough so the client does not need blankets
C) Use occlusive, petroleum-based creams every morning and night
D) Increase use of glycerine soap for bathing
E) Apply emollients to the skin surface, applying frequently
A) Use room humidifiers, especially in bed room
C) Use occlusive, petroleum-based creams every morning and night
E) Apply emollients to the skin surface, applying frequently
Rationale:Emollients are fatty acid-containing lotions that replinish the oils on the skin surface, but usually do not leave a residue on the skin. They have short duration of action and need to be applied frequently. Using a room humidifier and keeping room termperatures as low as possible to prevent water loss from the skin may be helpful. Glycerine soaps, although popular and visually appealing, are drying and can exacerbate the symptoms. Occlusives are thick, petroleum-based creams that can form a barrier. They prevent water loss from the skin. They are most effective for relieving skin dryness, but because of their greasiness and lack of cosmetic appeal, some people do not wish to use them.
A physiology educator asks the students, “So what layers keep the epidermis and dermis adhere to each other, rather than freely floating in various directions at the same time?” Which student answer(s) correctly identify the zones between the dermis and epidermis responsible for this interface? Select all that apply.
A) Collagen
B) Lamina lucida
C) Hemidesosomes
D) Lamina fibroreticularis
E) Lamina dens
B) Lamina lucida
D) Lamina fibroreticularis
E) Lamina dens
Rationale:Lamina lucida, lamina fibroreticularis, and lamina densa are the three distinct zones or layers of the basement membrane, all of which contribute to the adhesions of the two skin layers. Hemidesosomes are like half desmosomes in both structure and function. They lie immediately at the basal plasma membrane. They are involved in relaying signals between the skin layers. Collagen is the most abundant protein in the body. It is the major component of connective tissues that make up several body parts, including tendons, ligaments, skin and muscles. Collagen has many important functions, including providing the skin with structure and strengthening ones bones.
Select the cells of the epidermis that are responsible for providing sensory information.
A) Merkel cells
B) Melanocyte cells
C) Keratinocytes
D) Langerhans cells
A) Merkel cells
Rationale:The Merkel cells provide sensory information. Langerhans cells link the epidermis to the immune system, melanocytes provide pigmentation to the skin, and keratinocytes provide a protective function to the skin.
A client from a nursing facility arrives with fever of unknown origin. On assessment, the nurse notes a wound on the coccyx documented as: Full thickness tissue loss with exposed bone, tendon, or muscle. Which skin lesion description is most appropriate to report to the health care provider?
A) Dermal fissure with cracking into the skin
B) Rupture of a cyst
C) Erosion of superficial epidermis
D) Extensive damage with tissue loss due to a pressure injury
D) Extensive damage with tissue loss due to a pressure injury
Rationale:Full thickness tissue loss with exposed bone, tendon, or muscle is a stage 4 pressure injury. There is skin loss extending past the epidermis, necrotic tissue loss, and possible bleeding and scarring of surrounding tissue. This is due to pressure injuries from lack of turning and repositioning. Fissures are linear cracks in the skin that may extend to the dermis and can be caused by fungal infections. Erosion of superficial epidermis usually do not extend to the dermis. This can be caused by moist areas. Cysts are encapsulated fluid-filled masses in the subcutaneous tissue or dermis.
A preschooler asks the parents at bath time, “Why are my nipples red?” Which form of melanin is responsible for the coloring of nipples and lips in humans?
A) Pheomelanin
B) Eumelanin
C) Desmosomes
D) Keratinocytes
A) Pheomelanin
Rationale:Pheomelanin, the yellow to red pigment, is found in all humans. It is particularly concentrated in the lips, nipples, glans penis, and vagina. Eumelanin is abundant in humans. Exposure to the sun’s rays increases the production of eumelanin, causing tanning to occur. A desmosome, also known as a macula adherens, is a cell structure specialized for cell-to-cell adhesion. Keratinocytes produce keratin, a complex protein that forms the surface of the skin and is also the structural protein of the hair and nails. Keratinocytes are now known to be active secretory cells that play an important role in the immunobiology of the skin by communicating and regulating cells of the immune response and secreting cytokines and inflammatory mediators.
Which characteristic differentiates apocrine sweat glands from eccrine sweat glands?
A) Apocrine glands are primarily thermoregulatory.
B) Apocrine secretions help maintain skin pH.
C) Apocrine secretions contain oils.
D) Apocrine glands are more numerous and widely distributed than eccrine glands.
C) Apocrine secretions contain oils.
Rationale:The major difference between apocrine glands and the eccrine glands is that apocrine glands secrete an oily substance. Apocrine glands are less widely distributed than eccrine glands, and they do not contribute as significantly to thermoregulation. Neither is a major contributor to skin pH.
A child with strep throat is given a prescription for pencillin. After the first dose, the parents call to report the development of a skin rash. Which skin lesion discription leads the provider to discontinue the medication and encourage them to seek help if the child has trouble breathing?
A) Elevated, irregular mass of varying sizes
B) Flat, nonpalpable, circumscribed skin color change less than 1-cm diameter
C) Encapsulated, fluid-filled masses
D) Pus-filled vesicle
A) Elevated, irregular mass of varying sizes
Rationale:Elevated, irregular mass of varying sizes can describe urticaria (hives) and may be caused by an allergy to penicillin. Flat, nonpalpable, circumscribed skin color change less than 1-cm diameter is a characteristic of a macule. Pus-filled vesicle describes a pustule and usually associated with acne or impetigo. Encapsulated, fluid-filled masses usually describes a cyst.
A client with a parathyroid tumor has elevated calcium levels and low vitamin D levels. The provider suggests that the client get 15 to 20 minutes of unprotected sunlight per day, if possible. How will the provider explain why this intervention will help raise vitamin D levels for this client?
A) “Exposure to UV rays from sunlight exposes the blood, through vasodilation, to break down calcium and allow influx of vitamin D into the vessels.”
B) “It is something that occurs after exposure to sunlight that researchers are still studying since its a complex process.”
C) “Researchers are not sure, but they think it has something to do with the evaporation of moisture on the skin surface when exposed to sunlight.”
D) “A substance called 7-dehydrocholesterol is converted to an inactive form of vitamin D by UV rays from the sun.”
D) “A substance called 7-dehydrocholesterol is converted to an inactive form of vitamin D by UV rays from the sun.”
Rationale:The skin functions as an endocrine organ, in which a substance called 7-dehydrocholesterol is converted to an inactive form of vitamin D by UV rays from the sun. It has nothing to do with vasodilation and exposing more blood vessels to the sun rays. It also does not affect the amount of calcium in one’s vessels. The rate at which heat is dissipated from the body is determined by constriction or dilation of the arterioles that supply blood to the skin and through evaporation of moisture and sweat from the skin surface.
Select the layer of dermis characterized by a complex meshwork of three-dimensional collagen bundles interconnected with large elastic fibers.
A) Subcutaneous tissue
B) Epidermis
C) Reticular dermis
D) Papillary dermis
C) Reticular dermis
Rationale:The reticular dermis is a complex meshwork of three-dimensional collagen bundles interconnected with large elastic fibers and is the thicker area of the dermis, which forms the bulk of the dermal layer. The papillary layer of the dermis is a thin superficial layer that interdigitates directly with the epidermis.
A grandchild asks the grandparent, “Why is your hair so gray?” Which response by the grandparent gives the physiologic reason for hair turning gray with aging?
A) “I have fewer red blood cells now so my hair follicles receive less oxygen.”
B) “I have the beautician dye my hair this color.”
C) “I have a decreased number of melanosome-producing melanocytes.”
D) “When I was younger, I had a high fever that killed my ‘hair-color’ cells.”
C) “I have a decreased number of melanosome-producing melanocytes.”
Rationale:Large melanosomes are found in the hair of darker-skinned people. Aggregated and encapsulated melanosomes are found in people with light skin. Red hair has spherical melanosomes, whereas gray hair is the result of a decreased number of melanosome-producing melanocytes. None of the other answers are physiologically correct.
A parent calls the health care provider reporting the child has red sores on the face, especially around the nose and mouth that have pus/fluid inside and when the sores burst, they develop a honey-colored crust. The parent is asking whether to make an appointment. Which contagious skin lesion does the provider think the child has developed?
A) Herpes simplex
B) Poison ivy
C) Impetigo pustule
D) Sebaceous cyst
C) Impetigo pustule
Rationale:Impetigo is a form of pustule and is primarily described as red sores on the face, especially around a child’s nose and mouth, and on the hands and feet. The sores burst and form honey-colored crusts. This is the classic description of impetigo. A vesicle is less than 0.5 cm, circumscribed, elevated, and a palpable mass containing serous fluid. It may be cause by herpes simplex, a cold sore. Poison ivy develops after exposure to the plant out-of-doors and is described as circumscribed, elevated, palpable masses containing serous fluids. Poison ivy usually is a red, itchy rash with swelling, bumps and blisters that can spread by contact. A sebaceous cyst is an encapsulated, fluid-filled or semisolid mass in the subcutaneous tissue and is not considered contagious.
An adolsescent, who is an athlete, asks the health care provider, “Why do I now have such awful body odor? What has changed in my body?” Which response is the best reply?
A) “This is just a sign that you need to thoroughly wash and dry your skin, especially under your arms and your groin, more carefully.”
B) “As one develops more muscles and are able to work out longer and harder, more sweat mixes with body secretions making up ‘body odor.’”
C) “Hormones, like androgens and testosterone change the chemicals in your body making it smell worse when one sweats.”
D) “Apocrine sweat glands open through a hair follicle and secrete an oily substance that mixes with bacteria on the skin, producing body odor.”
D) “Apocrine sweat glands open through a hair follicle and secrete an oily substance that mixes with bacteria on the skin, producing body odor.”
Rationale:Apocrine sweat glands open through a hair follicle and secrete an oily substance that mixes with bacteria on the skin, producing body odor. Bathing is not the cause since it is caused by increased sweat during exercise. The exercises produces more sweat, it is not because the muscles have more fully developed. The change in hormones are not the reason for body odor, even though the hormones do change at puberty.
An instructor is explaining the pilosebaceous unit when one student stated, “If I have fats and wax on my skin, then I need to scrub harder.” Which function(s)/purpose(s) of sebum will the teacher explain to the students? Select all that apply.
A) Promotes good bumps formation
B) Lubricates the hair and skin
C) Prevents drying and breaking of hair follicles
D) Prevents evaporation of moisture in cold weather to conserve body heat
B) Lubricates the hair and skin
D) Prevents evaporation of moisture in cold weather to conserve body heat
Rationale:The pilosebaceous unit secretes a mixture of lipids, including triglycerides, cholesterol, and wax called sebum. Sebum lubricates the hair and skin. It also prevents undue evaporation of moisture from the skin during cold weather and helps to conserve body heat. Usually washing hair with hot water and drying with hair dryers cause dry hair to crack and break. The arrector pili muscle, located deep to the sebaceous gland, provides a thermoregulatory function by contracting the skin to cause goose bumps.
