Question 1

After falling off his bicycle, an 8-year-old boy has a large abrasion on his posterior thigh that has removed the epidermis in the region but left the dermis largely intact. Which of the following changes in integumentary system would be expected in the area of his wound?

Accepted Answer

Merkel cells and Langerhans cells are components of the epidermis. Bleeding may be minimal since the epidermis is avascular. Subcutaneous tissue is below the dermis and would not be directly exposed, and hair follicle roots exist at a deeper level than the epidermis.

Question 2

Which of the following statements best conveys an aspect of the process of keratinization?

Accepted Answer

The stratum germinativum, or stratum basale, consists of a single layer of basal cells that are attached to the basal lamina. The basal cells, which are columnar, undergo mitosis to produce new keratinocytes that move toward the skin surface to replace cells lost during normal skin shedding. Keratinization does not originate in the dermis or stratum granulosum, and the basal cells of the epidermis do not migrate to the surface.

Question 3

A nurse is teaching a client about the role that skin plays in forming a barrier to environmental agents and microorganisms. The nurse would recognize that which of the following types of cells/junctions are involved in the communication and regulation of the immune response and the secretions of cytokines?

Accepted Answer

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. Gap junctions allow ions and molecules to pass between skin cells, and adherens junctions provide a mechanical connection between cells. Desmosomes are localized patches or plaques that hold two cells tightly together by proteins called cadherins. They are terminal end points on the cell walls of keratinocytes.

Question 4

While studying the skin in a science class, a student asks why all people have a pinkish color to their lips/mucous membranes. The instructor would respond by citing which of the following responses?

Accepted Answer

Pheomelanin, the yellow to red pigment, is found in all humans. It is particularly concentrated in the lips, nipples, glans penis, and vagina. Melanocytes arepigment-synthesizing cells that are scattered in the basal layer and are responsible for skin color (not mucous membranes). Tyrosinase converts the amino acid tyrosine to a precursor of melanin. If one has a lack of tyrosinase, the end result will be albinism. In dark-skinned people, larger melanin-containing melanosomes are produced and transferred individually to the keratinocyte.

Question 5

A 40-year-old male client has a congenital syndrome that affects the function of the Langerhans cells of his epidermis. The man's care provider would expect which of the following manifestations of his condition?

Accepted Answer

Langerhans cells are the immunologic cells responsible for recognizing foreign antigens harmful to the body, and they play an important role in defending the body against foreign antigens. A lack of Langerhans cells would not manifest in increased permeability of the skin, unexpected coloration, or separation between layers.

Question 6

Clinical investigation of a 40-year-old female client with diverse dermatological signs and symptoms has focused on the woman's basement membrane. Which of the following skin functions would a clinician most likely attribute to a region of the integument other than the basement membrane?

Accepted Answer

While the basement membrane plays roles in adhering between skin layers and is a common site of immunoglobulin deposition and blister formation, it is not a major site of afferent nerve endings and consequent sensory transmission.

Question 7

A person with severe lymphedema is asking the nurse where specifically are the lymph vessels located in the skin layers. The nurse would respond,

Accepted Answer

Dermal papillae contain capillaries, end arterioles, and venules that nourish the epidermal layers of the skin. This layer of the dermis is richly vascularized. Lymph vessels and nerve tissue also are found in this layer. The basement membrane is a layer of intercellular and extracellular matrices that serves as an interface between the dermis and the epidermis. Merkel cells are connected to afferent nerve terminals, forming a Merkel disk. They are believed to be neuroendocrine cells. Subcutaneous tissue consists of fat cells and connective tissues that lend support to the vascular and neural structures.

Question 8

Which of the following components of immune function is absent in the dermis?

Accepted Answer

While macrophages, T cells, fibroblasts, and mast cells are all present in the dermis, lymph nodes are not noted to be present in this layer.

Question 9

The skin is richly supplied with arteriovenous anastomoses in which blood flows directly between an artery and a vein, bypassing the capillary circulation. What is the primary significance of these structures?

Accepted Answer

Anastomoses are important for temperature regulation. They can open up, letting blood flow through the skin vessels when there is a need to dissipate body heat, or close off, conserving body heat if the environmental temperature is cold. Although goose bumps are a reaction to cold, they are actually caused by the contraction of the arrector pili muscles.

Question 10

A 51-year-old woman who was born congenitally blind and deaf is able to distinguish individuals by light touch of the individual's face. Which of the following components of the woman's skin innervation likely contributes the most to this ability?

Accepted Answer

Meissner corpuscles are rapidly adapting nerve endings located on the palmar surfaces of the fingers and hands; as such, they would be likely to be involved in fine distinction using the fingers. Ruffini corpuscles are located in the subcutaneous tissue of hairy and glabrous skin, while pacinian corpuscles detect gross pressure and vibration.Nociceptors detect painful stimuli.

Question 11

A frustrated 26-year-old female has sought a referral to a dermatologist in an effort to resolve her sweating and body odor that persists despite good hygiene. Which of the following facts would underlie the explanation that her physician provides about her problem?

Accepted Answer

Body odor is the result of apocrine sweat gland secretions combining with bacteria to produce a characteristic odor. Neither eccrine sweat glands nor sebaceous glands are primarily involved.

Question 12

Which of the following structures would likely be present in a hair follicle in a man's groin but not in a follicle on his face?

Accepted Answer

Apocrine glands are only found in hair follicles in the underarms and groin. All hair follicles contain an arrector pili muscle, sebaceous gland, and blood supply in the form of the hair papilla.

Question 13

While working in an allergy clinic, the nurse notices that many patients come in with all types of skin reactions. The nurse working in this area knows that which cells play a role in the development of allergic skin condition?

Accepted Answer

Langerhans cells, the antigen-presenting cells of the epidermal skin, not only protect against harmful pathogens but also play an important role in the development of allergic skin conditions. Merkel cells play a role in the neuroendocrine cell function such as neurotransmission for autonomic nerves. Spherical melanosomes are found in people with light skin. Red hair has spherical melanosomes. Keratin is a protein that forms the surface of the skin and is also the structural protein of the hair and nails.

Question 14

A man's primary care physician has characterized his skin lesion as being a temporary eruption but has cautioned him against repeated rubbing or scratching as to avoid lichenization. What is the most likely categorization of the man's skin lesion?

Accepted Answer

A rash is a temporary eruption of the skin that can result in excoriation or lichenization if rubbed or scratched excessively. Corns, calluses, and blisters are not noted to share these characteristics.

Question 15

A child comes in to show his parents (who are nurses) a blister on his foot from "breaking in" a new pair of shoes. The child wants to "pop the blister" to get all the fluid out of it, so it would not hurt so much when he puts on shoes/socks. The parents know that breaking the skin of the blister will put him at risk for

Accepted Answer

A blister is a vesicle or fluid-filled papule. They can have a mechanical origin caused by friction from repeated rubbing on a single area of skin. Friction blisters most commonly occur on the palmar and plantar surfaces of the hands and feet where the skin is constantly exposed to mechanical trauma. Breaking the skin of a blister to remove the fluid is inadvisable because of the risk of secondary infection. Fluid volume deficit is highly unlikely with only one blister on the foot. The fluid in the blister is composed of proteins but unlikely to cause a shift in fluids due to only having one blister. The child can continue to be active but usually need a dressing/bandage placed over the blister for comfort.

Question 16

Following exposure to poison oak while camping, a 20-year-old male is experiencing pruritus as a consequence of his immune response to irritants in the plant. What physiological process best accounts for his complaint?

Accepted Answer

It is generally agreed that itch is a sensation that originates in free nerve endings in the skin, is carried by small myelinated type C nerve fibers to the dorsal horn of the spinal cord, and is then transmitted to the somatosensory cortex via the spinothalamic tract. Itching is no longer considered to be a low-level pain response. Ruffini corpuscles and Langerhans cells are not noted to play a role in pruritus.

Question 17

A boy has arrived home after experiencing his first outdoor camping trip with his Boy Scout troupe. Upon arrival at home, he is very uncomfortable and scratching at a rash. It appears that he contacted poison ivy and that it has spread to many areas on his body. The nurse in the clinic will likely prescribe which of the following treatment measures for this child? Select all that apply.

Accepted Answer

Most treatment measures for pruritus are nonspecific. Rubbing using the entire hand helps prevent scratching. Because vasodilation tends to increase itching, cold applications may provide relief. Cool showers before bed may be helpful. Topical corticosteroids may be helpful in some cases. However, systemic antihistamines and corticosteroids may be indicated for people with severe pruritus. Occlusive dressings are thick creams that contain petroleum and can act as a barrier to prevent water loss from the skin. They usually are prescribed for dry skin.

Question 18

An 81-year-old woman has noted a gradual decrease in the moisture of her skin over many years. Which phenomena associated with the aging process are known to contribute to her xerosis? Select all that apply.

Accepted Answer

The effects of aging on skin dryness include a change in the composition of sebaceous gland secretions and a decrease in the secretion of moisture from the sweat glands.Aging is also accompanied by a decrease in skin capillaries and flattening of the dermal rete ridges resulting in less surface area for exchange of fluids between the dermis, epidermis, and skin surface. Separation of the basement membrane is not noted to be a normal accompaniment to aging.

Question 19

When trying to explain the advantages of using an emollient over other products to a patient suffering from dry skin, the nurse will emphasize emollients

Accepted Answer

Emollients are fatty acid-containing lotions that replenish the oils on the skin surface but usually do not leave a residue on the skin. Humectants are the additives in lotions that draw out the water from the deeper skin layers and hold it on the skin surface.However, the water that is drawn to the skin is transepidermal water, not atmospheric water. Thus, continued evaporation from the skin can actually exacerbate dryness.Occlusive are thick creams that contain petroleum to act as a barrier. Lotions or cream additives include steroids or mild anesthetics, such as camphor, menthol, lidocaine, or benzocaine. These agents work by suppressing itching while moisturizing the skin.

Question 20

Which of the following facts accounts for the variation in skin tone that exists between individuals?

Accepted Answer

The amount of melanin in the keratinocytes determines a person's skin color.Dark-skinned and light-skinned people have the same amount of melanocytes. However, in dark-skinned people, larger melanosomes are produced and transferred to the keratinocyte individually. In light-skinned people, a number of smaller melanosomes are packaged together in a membrane and then transferred to the keratinocyte. The way the melanosomes are packaged is responsible for the pigmentation in darker-skinned persons. Darker-skinned people do not have more melanocytes than light-skinned people, but the production and packaging of pigment is different.

Quiz 57: Understanding the Processes and Functions of the Skin