Question 1

A toddler patient has a small, slightly raised bright red area on the trunk. The child's mother reports that the lesion has been present since birth and has become a little larger. What type of lesion does the nurse suspect?

Accepted Answer

Cherry hemangioma is a benign tumor consisting of a mass of small blood vessels and can vary in size. These are typically small, slightly raised lesions that are bright red in color appearing on the face, neck, and trunk of the body. These lesions increase in size with age. Vascular nevi is a type of angioma that involves the capillaries within the skin producing an irregular macular patch that can vary from light red to dark red to purple in color. Purpura is a flat, reddish purple, nonblanchable discoloration in the skin greater than 0.5 cm in diameter. Ecchymosis is a reddish purple, nonblanchable spot of variable size.

Question 2

During a health fair, which recommendation is appropriate as a primary prevention measure to reduce the risk for skin cancer?

Accepted Answer

Wearing protective clothing while in the sun provides primary prevention for skin cancer. Avoiding tanning and sunning are part of primary prevention. Performing self-examination of skin monthly is secondary prevention. Sunscreen also needs to be used on overcast days.

Question 3

A nurse notices several reddish purple, nonblanchable spots of different sizes on the arms and legs of a patient with a low platelet count. How does the nurse distinguish ecchymosis from purpura?

Accepted Answer

Ecchymosis is variable in size and a purpura is greater than 0.5 cm in diameter. This is an accurate statement. Ecchymosis does not blanch and purpura does blanch. Both of these lesions are nonblanchable. Ecchymosis has raised lesions and purpura has flat lesions. Both of these lesions are flat. Ecchymosis is irregularly shaped and purpura is round. There is no specified shape for either type of lesion.

Question 4

A patient complains of itching on her feet. On inspection the nurse observes weeping vesicles and skin that is softened and broken down between the toes. What explanation does the nurse give the patient about the cause of this skin disorder?

Accepted Answer

This is a description of tinea pedia, which is caused by a number of dermophyte fungal infections. Bacterial infections such as cellulitis cause redness, warmth, and tenderness, rather than itching. Allergic reactions such as contact dermatitis cause itching, but they appear as localized erythema, and may also form edema, wheals, scales, or vesicles. Viral infection such as herpes form grouped vesicles that are painful, rather than itching.

Question 5

A patient is visiting an urgent care center after being hit in the back with a baseball. Upon examination, the nurse notes a flat, nonblanchable spot 2.25 cm wide that is reddish-purple in color. How does the nurse document this lesion?

Accepted Answer

Ecchymosis is reddish-purple in color, nonblanchable, and is caused by trauma (being hit with a baseball) to the blood vessel which results in bleeding underneath the skin. The size of the ecchymotic area varies depending on the level of trauma. An angioma is characterized by a small central red area with radiating spider-like legs that blanches with pressure. The lesion of this patient does not blanch. Purpura is flat, reddish purple, nonblanchable, and greater than 0.5 cm in size. It is caused by infection or a bleeding disorder, not trauma. Petechiae are tiny, flat, reddish-purple, nonblanchable spots in the skin less than 0.5 cm in diameter and appear as tiny red spots that are pinpoint to pinhead in size.

Question 6

A nurse is performing an admission physical examination on a patient who has been bedridden for a month. The nurse notices a pressure ulcer on the patient's left trochanter area that involves partial-thickness skin loss with damage to the subcutaneous tissue. The nurse reports this ulcer at what stage?

Accepted Answer

Stage II ulcers have partial-thickness skin loss of dermis. It appears as a shiny or dry shallow open ulcer with pink wound bed without slough or bruising. Stage I ulcers have persistent redness, but the epidermis is intact. Stage III ulcers have full-thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend to, but not through, underlying fascia. Stage IV ulcers have full-thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be within the wound bed.

Question 7

Which questions are appropriate to ask a patient when performing a symptom analysis for a rash? (Select all that apply.)

Accepted Answer

Options A, C-F are questions asked in a symptom analysis that includes the following variables: onset of symptoms, location and duration of symptoms, characteristics, severity of symptoms, related symptoms, alleviating factors, aggravating factors, and attempts at self-treatment. Option B relates to the patient's history.

Question 8

A patient expresses concern that a new lesion may be melanoma. Which finding suggests a malignant melanoma?

Accepted Answer

Irregular border or poorly defined border is an indication of a malignancy. Blanching is not assessed in malignant skin lesions. Diameter of a malignant skin lesion is usually greater than 6 mm. Melanoma is a variety of colors.

Question 9

What findings does the nurse expect when assessing skin, hair, and nails of a healthy male adult? (Select all that apply.)

Accepted Answer

Scalp is bald; freckles are noted on face, back, arms and legs; and skin turgor is elastic. These are expected findings for a healthy adult male. Transverse depression across the nails describes Beau lines. It results from a stressor that temporarily impairs nail formation. An elevated, firm, circumscribed area less than 1 cm wide on the fingers describes a papule, such as a wart. Purpura and ecchymosis on arms and legs are indications of bleeding.

Question 10

A nurse notes that a 2-year-old child has multiple bruises over his body at different stages of healing. What is the most appropriate action for the nurse at this time?

Accepted Answer

Further investigation is needed to rule out abuse. The important clue is bruises in different stages in healing. Injuries to the skin are generally recognized in three forms: bruises, bites, and burns. Remind parents that toddlers are clumsy and may fall, causing bruising. The important clue is bruises in different stages of healing. A coagulation disorder can be ruled out by a laboratory test for platelets. Recommend further observation at future visits. Action must be taken during this visit if abuse is suspected.

Quiz 9: Skin, Hair, and Nails