Chapter 39: Structure, Function, and Disorders of the Integument My Nursing Test Banks

Huether and McCance: Understanding Pathophysiology, 5th Edition

Chapter 39: Structure, Function, and Disorders of the Integument

Test Bank

MULTIPLE CHOICE

1. A 12-year-old female notices her hair and skin feel more oily than normal. Her primary care provider explains that during puberty her sebaceous glands enlarge and are stimulated by:

a.

Androgens

b.

Estrogen

c.

Vitamin D

d.

Progesterone

ANS: A

Sebaceous glands secrete sebum, composed primarily of lipids, which oils the skin and hair and prevents drying. Androgens stimulate the growth of sebaceous glands, and their enlargement is an early sign of puberty.

Androgens, not estrogen, are responsible for enlargement of the sebaceous glands.

Androgens, not vitamin D, are responsible for enlargement of the sebaceous glands.

Androgens, not progesterone, are responsible for enlargement of the sebaceous glands.

REF: p. 1040

2. Of the sweat glands, the _____ glands are most abundant in the axillae and genital areas.

a.

Eccrine

b.

Apocrine

c.

Sebaceous

d.

Subcutaneous

ANS: B

The apocrine sweat glands are located in the axillae, scalp, face, abdomen, and genital areas.

The eccrine sweat glands are distributed over the body, with the greatest numbers in the palms of the hands, soles of the feet, and forehead.

Apocrine sweat glands, not the sebaceous glands, are located in the axillae and genital areas.

Apocrine sweat glands, not the subcutaneous glands, are located in the axillae and genital areas.

REF: p. 1040

3. If a patient has carbuncles, the infection will be located in the:

a.

Hair follicles

b.

Papillary layer of the dermis

c.

Reticular layer of the dermis

d.

Subcutaneous tissue

ANS: A

Carbuncles are a collection of infected hair follicles and usually occur on the back of the neck, the upper back, and the lateral thighs.

Carbuncles are a collection of infected hair follicles, not the papillary layer of the dermis.

Carbuncles are a collection of infected hair follicles, not the reticular layer of the dermis.

Carbuncles are a collection of infected hair follicles, not the subcutaneous tissue.

REF: p. 1053

4. Which cells are involved in initiating immune responses in the skin?

a.

Langerhans cells

b.

Merkel cells

c.

Keratinocytes

d.

Melanocytes

ANS: A

The Langerhans cells process the antigen and carry it to T cells. T cells then become sensitized to the antigen, inducing the release of inflammatory cytokines and the symptoms of dermatitis.

Langerhans cells initiate the immune response. Merkel cells are associated with nerve cells.

Keratinocytes are part of the epidermal layer of the skin and are not involved in immune responses.

Melanocytes synthesize the skins pigment.

REF: p. 1048

5. Fat cells are located in the:

a.

Epidermis

b.

Dermis

c.

Hypodermis

d.

Fascia beneath the skin

ANS: C

The hypodermis is an underlying layer of connective tissue that contains macrophages, fibroblasts, and fat cells.

Fat cells are not found in the epidermis but in the hypodermis.

Fat cells are not found in the dermis but in the hypodermis.

Fat cells are not found in the fascia but in the hypodermis.

REF: p. 1038

6. A 25-year-old paralyzed male develops a dermal pressure ulcer. When assessing the patients skin, which finding is the first indication of this ulcer?

a.

Redness

b.

Whiteness

c.

Indurations

d.

Ulceration

ANS: A

The initial sign of a pressure ulcer is redness.

The initial sign of a pressure ulcer is redness, not whiteness.

The initial sign of a pressure ulcer is redness, not an area of induration.

The initial sign of a pressure ulcer is redness, not ulceration.

REF: p. 1049

7. To promote efficient wound healing, which dressing should be applied to a superficial ulcer?

a.

Thick and dry

b.

Flat and moist

c.

Bulky and dry

d.

None

ANS: B

Superficial ulcers should be covered with flat, moisture-retaining dressings.

Superficial ulcers should be covered with flat and moist dressings, not dry and thick.

Superficial ulcers should be covered with flat, not bulky, dressings.

Superficial ulcers should be covered with flat, moisture-retaining dressings. Dressings should not be avoided.

REF: p. 1047

8. Individuals of _____ descent are more prone to developing keloids?

a.

African-American

b.

Northern European

c.

Asian

d.

Native American

ANS: A

African Americans are at greater risk for the development of keloids.

African Americans, not Northern Europeans, are at greater risk for the development of keloids.

African Americans, not Asians, are at greater risk for the development of keloids.

African Americans, not Native Americans, are at greater risk for the development of keloids.

REF: p. 1047

9. A 23-year-old male received a knife wound in a fight. His scar was sharply elevated, irregularly shaped, and progressively enlarging. This condition is caused by excessive amounts of _____ in the corneum during connective tissue repair.

a.

Elastin

b.

Collagen

c.

Keratin

d.

Calcification

ANS: B

Irregular scar formation is due to excessive fibroblast activity and collagen formation.

Irregular scar formation is due to excessive fibroblast activity and collagen, not elastin, formation.

Irregular scar formation is due to excessive fibroblast activity and collagen, not keratin, formation.

Irregular scar formation is due to excessive fibroblast activity and collagen, not calcification, formation.

REF: p. 1047

10. A 23-year-old male reports a rash and pruritus. An increase in _____ is associated with pruritus?

a.

Substance P

b.

Norepinephrine

c.

Dopamine

d.

Acetylcholine

ANS: D

Acetylcholine is one of the itch mediators.

Acetylcholine, not substance P, is one of the itch mediators.

Acetylcholine, not norepinephrine, is one of the itch mediators.

Acetylcholine, not dopamine, is one of the itch mediators.

REF: p. 1047

11. A 19-year-old female developed a circular, demarcated, and salmon-pink lesion. Two weeks later she developed more lesions over the trunk and upper part of the extremities. The diagnosis is pityriasis rosea, and the nurse knows the disorder is caused by a:

a.

Parasite

b.

Virus

c.

Bacteria

d.

Fungus

ANS: B

Pityriasis rosea is caused by a virus.

Pityriasis rosea is caused by a virus, not a parasite.

Pityriasis rosea is caused by a virus, not bacteria.

Pityriasis rosea is caused by a virus, not a fungus.

REF: p. 1050

12. A 12-year-old female visits her primary care provider to obtain acne medication for recurrent acne vulgaris. This condition is an inflammatory disorder of the:

a.

Apocrine glands

b.

Pilosebaceous follicle

c.

Dermal layer

d.

Eccrine gland

ANS: B

Acne vulgaris is an inflammatory disorder of the pilosebaceous follicle.

Acne vulgaris is an inflammatory disorder of the pilosebaceous follicle, not the apocrine glands.

Acne vulgaris is an inflammatory disorder of the pilosebaceous follicle, not the dermal layer.

Acne vulgaris is an inflammatory disorder of the pilosebaceous follicle, not the eccrine gland.

REF: p. 1051

13. A 42-year-old female presents with raised red lesions with a brownish scale. She was diagnosed with discoid lupus erythematosus. A clinician recalls this disorder is related to:

a.

Infection

b.

Trauma

c.

Autoimmunity

d.

Cancer

ANS: C

Discoid lupus is related to autoimmunity.

Discoid lupus is related to autoimmunity, not infection.

Discoid lupus is related to autoimmunity, not trauma.

Discoid lupus is related to autoimmunity, not cancer.

REF: p. 1051

14. In discoid lupus erythematosus, skin lesions may be accompanied by Raynaud phenomenon, which is manifested by:

a.

Bone deformities

b.

Vasospasm in the extremities

c.

Arterial aneurysms

d.

Venous thrombus

ANS: B

Raynaud phenomenon is manifested by vasospasm in the extremities.

Raynaud phenomenon is manifested by vasospasm, not bone deformities, in the extremities.

Raynaud phenomenon is manifested by vasospasm, not arterial aneurysms, in the extremities.

Raynaud phenomenon is manifested by vasospasm, not venous thrombus, in the extremities.

REF: p. 1056

15. A 45-year-old male presents with a chronic blister-forming disease of the skin and oral mucous membranes. The nurse would recognize this condition as:

a.

Lupus erythematosus

b.

Pemphigus

c.

Psoriasis

d.

Eczema

ANS: B

Pemphigus is manifested by chronic blister formation.

Lupus erythematosus is manifested by rash and arthritis, not blisters.

Psoriasis is manifested by gray-white skin plaques, not blisters.

Eczema is not manifested by blisters.

REF: pp. 1051-1052

16. A 9-year-old male presents with severe erythematous bullous lesions that are believed to be an adverse response to a medication. Which of the following is the most likely diagnosis?

a.

Pemphigus

b.

Acne vulgaris

c.

Lupus erythematosus

d.

Stevens-Johnson syndrome

ANS: D

The most common form of erythema multiforme in children and young adults is Stevens-Johnson syndrome.

Pemphigus is not manifested by erythema.

Acne is not manifested by erythema.

Lupus erythematosus is not manifested by bullae.

REF: p. 1052

17. A 50-year-old male recently underwent a liver transplant and is taking immunosuppressive drugs. He now has painful vesicular eruptions on the face and trunk. He reports that he had chickenpox as a child. Which of the following is the most likely diagnosis based on his chicken pox history?

a.

Erysipelas

b.

Poliomyelitis

c.

Warts

d.

Herpes zoster

ANS: D

Herpes zoster causes shingles, a disorder similar to chicken pox.

Erysipelas is caused by strep.

Poliomyelitis is not manifested by painful vesicles.

Warts are not painful.

REF: p. 1054

18. Tinea corporis (ringworm) is a _____ infection of the skin.

a.

Nematode

b.

Fungal

c.

Viral

d.

Bacterial

ANS: B

Tinea corporis is caused by a fungus.

Tinea corporis is caused by a fungus, not a nematode.

Tinea corporis is caused by a fungus, not a virus.

Tinea corporis is caused by a fungus, not bacteria.

REF: p. 1055

19. A 20-year-old female presents with vaginal itch and thin-walled pustular lesions. She is diagnosed with candidiasis. This condition is caused by a:

a.

Yeast

b.

Virus

c.

Bacterium

d.

Fungus

ANS: A

Candidiasis is a yeast.

Candidiasis is a yeast, not a virus.

Candidiasis is a yeast, not a bacterium.

Candidiasis is a yeast, not a fungus.

REF: p. 1055

20. For a patient with candidiasis, which factor will exacerbate the condition?

a.

Poor hygiene

b.

Older age

c.

Systemic antibiotics

d.

Anemia

ANS: C

Candidiasis is exacerbated by the use of systemic antibiotics because the antibiotics eliminate normal flora.

Candidiasis is exacerbated by the use of systemic antibiotics because the antibiotics eliminate normal flora. It is not due to poor hygiene.

Candidiasis is exacerbated by the use of systemic antibiotics because the antibiotics eliminate normal flora. Older age is not a factor.

Candidiasis is exacerbated by the use of systemic antibiotics because the antibiotics eliminate normal flora. Anemia is not a factor.

REF: p. 1055

21. A 10-year-old male is given penicillin for an infection. He has an allergic reaction, during which he develops urticarial lesions. These lesions are mediated by the release of:

a.

Beta-adrenergic agonists

b.

Histamine

c.

Calcium

d.

Cortisol

ANS: B

Urticarial lesions are mediated by the histamine response.

Urticarial lesions are mediated by the histamine response, not beta responses.

Urticarial lesions are mediated by the histamine response, not calcium.

Urticarial lesions are mediated by the histamine response, not cortisol.

REF: p. 1056

22. When assessing a patient with scleroderma, which changes in the skin will be observed?

a.

Thinning

b.

Hyperpigmented

c.

Necrosis

d.

Hardening

ANS: D

Scleroderma is manifested by hardening of the skin.

Scleroderma is manifested by hardening, not thinning, of the skin.

Scleroderma is manifested by hardening, and the skin becomes hypopigmented.

Scleroderma is manifested by hardening, not necrosis, of the skin.

REF: p. 1056

23. A 52-year-old female is diagnosed with scleroderma. Which complication leads to ulcer formation?

a.

Cutaneous vasculitis

b.

Raynaud phenomenon

c.

Cellulitis

d.

Infection

ANS: B

Ulcer formation is due to Raynaud phenomenon.

Ulcer formation is due to Raynaud phenomenon, not vasculitis.

Ulcer formation is due to Raynaud phenomenon, not cellulitis.

Ulcer formation is due to Raynaud phenomenon, not infection.

REF: p. 1056

24. What of the following behavior in the patient with scleroderma would cause the nurse concern?

a.

Wears mittens on cold days

b.

Smokes a few cigarettes a day

c.

Applies lotion daily

d.

Seeks warmer environments

ANS: B

Smoking should be avoided as it promotes vasoconstriction that may worsen Raynaud phenomenon.

Mittens are appropriate.

Lotion may not help, but could help skin remain supple.

Warm environments are better than cold.

REF: p. 1056

25. A 13-year-old female is concerned about several pigmented skin lesions on her body. Her primary care provider tells her that these lesions must be monitored because of their ability to transform into malignant melanoma. These lesions are referred to as:

a.

Macules

b.

Nevi

c.

Plaques

d.

Keloids

ANS: B

Nevi may undergo transition to malignant melanoma.

Nevi, not macules, may undergo transition to malignant melanoma.

Nevi, not plaques, may undergo transition to malignant melanoma.

Nevi, not keloids, may undergo transition to malignant melanoma.

REF: p. 1057

26. A patient wants to know which malignant skin lesion is the most serious. The correct response is:

a.

Basal cell carcinoma

b.

Squamous cell carcinoma

c.

Kaposi sarcoma (KS)

d.

Malignant melanoma

ANS: D

Malignant melanoma is the most serious skin cancer.

Malignant melanoma, not basal cell carcinoma, is the most serious skin cancer.

Malignant melanoma, not squamous cell carcinoma, is the most serious skin cancer.

Malignant melanoma, not KS, is the most serious skin cancer.

REF: p. 1058

27. A 40-year-old female is diagnosed with skin cancer. Her primary care provider explains that the most important risk factor for skin cancer is:

a.

Amount of direct sun exposure at a young age

b.

Amount of sun exposure over age 50

c.

Lifetime amount of sun exposure

d.

Living in equatorial regions where the sun is most intense

ANS: A

Protection from the sun, particularly during the childhood years of life, significantly reduces the risk of skin cancer in later years.

Protection from the sun at a young age, not after 50, is the most important way to decrease cancer risk.

Protection from the sun, particularly during the childhood years of life, significantly reduces the risk of skin cancer in later years.

Protection from the sun, particularly during the childhood years of life, not avoiding equatorial regions, significantly reduces the risk of skin cancer in later years.

REF: p. 1058

28. A 27-year-old male lung transplant patient developed KS. He tells the nurse he thought only people with AIDS developed this type of cancer. The nurse knows that the cause of this patients KS is most likely related to the fact that the patient:

a.

Is malnourished

b.

Was exposed to hepatitis B

c.

Is immunosuppressed

d.

Is diabetic

ANS: C

KS is a vascular malignancy associated with immunodeficiency states and occurs among transplant recipients taking immunosuppressive drugs.

KS is not related to malnourishment.

KS is not related to exposure to hepatitis B.

KS is not related to the presence of diabetes.

REF: p. 1060

29. A 29-year-old female is burned through all her dermis with only a few epidermal appendages intact. This burn is classified as:

a.

First degree

b.

Superficial partial-thickness

c.

Deep partial-thickness

d.

Third degree

ANS: C

Deep partial-thickness burns involve the entire dermis, sparing skin appendages such as hair follicles and sweat glands.

First-degree burns involve only the epidermis.

Superficial partial-thickness burns involve deeper thickness.

Third-degree burns involve destruction of the entire epidermis, dermis, and often underlying subcutaneous tissue.

REF: p. 1060

30. Which of the following burns is most painful?

a.

First degree

b.

Superficial partial-thickness

c.

Deep partial-thickness

d.

Third degree

ANS: B

Superficial partial-thickness burns leave tactile and pain sensors intact and are the most painful.

Superficial partial-thickness burns, not first degree, are the most painful.

Superficial partial-thickness burn, not deep thickness, are the most painful.

Third-degree burns are less painful.

REF: p. 1060

31. A 10-year-old male is playing with matches and gets burned. His burn is waxy white in appearance. This burn is classified as:

a.

First degree

b.

Superficial partial-thickness

c.

Deep partial-thickness

d.

Third degree

ANS: C

Deep partial-thickness burns involve the entire dermis, sparing skin appendages such as hair follicles and sweat glands. These wounds look waxy white.

First-degree burns are red and have no blisters.

Superficial burns involve fluid-filled blisters.

Third-degree burns are dry and have a leathery appearance.

REF: p. 1060

32. In burn injury patients, the rule of nines and the Lund and Browder chart are used to estimate:

a.

Depth of burn injury

b.

Possibility of infection

c.

Degree of systemic involvement

d.

Total body surface area burned

ANS: D

The rule of nines estimates the total body surface area burned.

The rule of nines estimates the total body surface area burned, not the depth of burn injury.

The rule of nines estimates the total body surface area burned; the possibility of infection is 100%.

The rule of nines estimates the total body surface area burned. It does not estimate the degree of systemic involvement.

REF: p. 1062

33. A 30-year-old male firefighter is badly burned and is admitted to the emergency department. Which of the following would be expected in the first 24 hours?

a.

Increased capillary permeability

b.

Diuresis

c.

Decreased levels of stress hormones

d.

Fluid overload

ANS: A

Increased capillary permeability occurs, leading fluid to shift to interstitial spaces.

Blood is shunted from the kidneys, so decreased urination occurs.

Increased levels of stress hormones are secreted.

Hypovolemia, not fluid overload, occurs.

REF: p. 1063

34. Hypovolemia in the early stages of burn shock is directly related to:

a.

Decreased cardiac contractility and shunting of blood away from visceral organs

b.

Increased capillary permeability and evaporative water loss

c.

Hypometabolism and renal water loss

d.

Bacterial infection of the wound and resulting bacteremia

ANS: B

Hypovolemia occurs due to increased capillary permeability.

Decreased cardiac contractility occurs, but this is not the direct cause of hypovolemia.

Blood is shunted from the kidneys, so water loss does not occur.

Bacterial infection is a risk, but it is not the cause of hypovolemia.

REF: p. 1063

35. A 28-year-old male is admitted to the burn unit 2 hours after receiving second- and third-degree burns over 50% of his body surface in an industrial explosion. Abnormal vital signs include low blood pressure and tachycardia. Lab results show a high hematocrit due to:

a.

Sickle cell syndrome

b.

Fluid movement out of the vascular space

c.

Renal failure

d.

Increased vascular protein secondary to increased metabolism

ANS: B

Fluid and protein movement out of the vascular compartment results in an elevated hematocrit.

Sickle cell syndrome does not result in increased hematocrit.

Renal failure can occur, but this does not result in an increase in the hematocrit.

Protein loss leads to decreased protein, not increased.

REF: p. 1063

36. A 36-year-old male is experiencing frontotemporal hair recession. He is diagnosed with male pattern baldness, which is a form of:

a.

Alopecia

b.

Areata

c.

Hirsutism

d.

Paronychia

ANS: A

Male-pattern alopecia is an inherited form of irreversible baldness with hair loss in the central scalp and recession of the frontotemporal hairline.

Alopecia areata is an autoimmune T cell-mediated chronic inflammatory disease directed against hair follicles and results in hair loss.

Hirsutism is a form of abnormal hair growth in women.

Paronychia is an inflammation of the cuticle.

REF: p. 1065

37. A 15-year-old female reports abnormal hair growth on her face and body. This condition is referred to as:

a.

Alopecia

b.

Areata

c.

Hirsutism

d.

Paronychia

ANS: C

Abnormal hair growth is referred to as hirsutism.

Loss of hair is alopecia.

Areata is a specific form of alopecia.

Paronychia is an infection around the nail.

REF: p. 1065

38. The patient has burns to both forearms that extend from the fingers to the elbows with no normal tissue present. The nurse has difficulty assessing the patients pulse, and the patient complains of numbness in the fingers. The nurse notifies the primary care provider and expects the primary care provider to:

a.

Increase fluid intake.

b.

Perform an escharotomy.

c.

Order physical therapy.

d.

Perform debridement of some burned tissue.

ANS: B

Escharotomies (tissue decompression by cutting through burned skin) are performed to release pressure and prevent compartment syndrome (the compression of blood vessels, veins, muscle, or abdominal organs resulting in irreversible injury).

The patient needs relief from the compression of the burns; increasing fluid intake will not help.

Physical therapy will not decrease the patients symptoms. An escharotomy should be performed.

Debridement will not release the constricted blood supply. An escharotomy is needed.

REF: p. 1062

MULTIPLE RESPONSE

1. Dermal appendages include which of the following structures? (Select all that apply.)

a.

Sweat glands

b.

Nails

c.

Dermal papilla

d.

Hair

e.

Eccrine glands

ANS: A, B, D, E

The dermal appendages include the nails, hair, sebaceous glands, and the eccrine and apocrine sweat glands.

REF: p. 1038

2. A 70-year-old male nursing home resident developed a dermal pressure ulcer. This condition is most often caused by (select all that apply):

a.

Shearing forces

b.

Friction

c.

Moisture

d.

Unrelieved pressure

e.

High-carbohydrate diet

ANS: A, B, C, D

Pressure ulcers are ischemic ulcers resulting from unrelieved pressure, shearing forces, friction, and moisture. A high-carbohydrate diet is not a factor in development of pressure ulcers.

REF: p. 1040

3. A 30-year-old female has a history of frequent candidiasis. The areas most likely affected include (select all that apply):

a.

Plantar surface of the foot

b.

Eyes

c.

Ears

d.

Mucous membranes

e.

Vagina

ANS: D, E

Candidiasis does not affect the soles of the feet, the eyes, or the ears. It does affect the mucous membranes and the vagina.

REF: p. 1055

4. Which of the following diseases are attributed to mosquito bites? (Select all that apply.)

a.

Malaria

b.

Yellow fever

c.

Dengue fever

d.

Encephalitis

e.

Lyme disease

ANS: A, B, C, D

Mosquitoes are responsible for malaria, yellow fever, dengue fever, filariasis, and encephalitis. Ticks cause Lyme disease.

REF: p. 1057

Mosby items and derived items 2012 Mosby, Inc., an imprint of Elsevier Inc.

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