Nokea
A nurse is aware that the outer layer of the skin consists of dead cells that contain large amounts of keratin. The physiologic functions of keratin include which of the following? Select all that apply.
- A. Producing antibodies
- B. Absorbing electrolytes
- C. Maintaining acidbase balance
- D. Physically repelling pathogens
- E. Preventing fluid loss
Correct Answer: D,E
Rationale: The dead cells of the epidermis contain large amounts of keratin, an insoluble, fibrous protein that forms the outer barrier of the skin. Keratin has the capacity to repel pathogens and prevent excessive fluid loss from the body. It does not contribute directly to antibody production, acidbase balance, or electrolyte levels.
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A patients health assessment has resulted in a diagnosis of alopecia areata. What nursing diagnosis should the nurse most likely associate with this health problem?
- A. Chronic Pain
- B. Impaired Skin Integrity
- C. Impaired Tissue Integrity
- D. Disturbed Body Image
Correct Answer: D
Rationale: Alopecia areata, causing patchy hair loss, often leads to disturbed body image due to its cosmetic impact. It does not cause pain or impair skin/tissue integrity.
The nurse is performing an initial assessment of a patient who has a raised, pruritic rash. The patient denies taking any prescription medication and denies any allergies. What would be an appropriate question to ask this patient at this time?
- A. Is anyone in your family allergic to anything?
- B. How long have you had this abrasion?
- C. Do you take any over-the-counter drugs or herbal preparations?
- D. What do you do for a living?
Correct Answer: C
Rationale: Asking about over-the-counter drugs or herbal preparations can identify potential causes of a rash. Family allergy history, occupation, or mislabeling the rash as an abrasion are less immediately relevant.
A patient presents at the dermatology clinic with suspected herpes simplex. The nurse knows to prepare what diagnostic test for this condition?
- A. Skin biopsy
- B. Patch test
- C. Tzanck smear
- D. Examination with a Woods light
Correct Answer: C
Rationale: The Tzanck smear examines cells from blistering conditions like herpes simplex. Biopsies diagnose malignancies, patch tests identify allergens, and Woods light assesses pigmentation.
The outer layer of the epidermis provides the most effective barrier to penetration of the skin by environmental factors. Which of the following is an example of penetration by an environmental factor?
- A. An insect bite
- B. Dehydration
- C. Sunburn
- D. Excessive perspiration
Correct Answer: A
Rationale: An insect bite represents penetration of the skin by an environmental factor, breaching the stratum corneum. Dehydration, sunburn, and perspiration are not examples of penetration.
A patient with human immunodeficiency virus (HIV) has sought care because of the recent development of new skin lesions. The nurse should interpret these lesions as most likely suggestive of what?
- A. A reduction in the patients CD4 count
- B. A reduction in the patients viral load
- C. An adverse effect of antiretroviral therapy
- D. Virus-induced changes in allergy status
Correct Answer: A
Rationale: Skin lesions in HIV often indicate a declining CD4 count, reflecting immune deterioration. Viral load typically increases, not decreases, and antiretrovirals or allergy changes are less likely causes.