Nokea
A wound care nurse is reviewing skin anatomy with a group of medical nurses. Which area of the skin would the nurse identify as providing a cushion between the skin layers, muscles, and bones?
- A. Dermis
- B. Subcutaneous tissue
- C. Epidermis
- D. Stratum corneum
Correct Answer: B
Rationale: The subcutaneous tissue (hypodermis) cushions between skin layers, muscles, and bones. The dermis provides strength, the epidermis is the outer layer, and the stratum corneum is the outermost epidermal layer.
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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.
A patient is diagnosed with atrial fibrillation and the physician orders Coumadin (warfarin). For what skin lesion should the nurse monitor this patient?
- A. Ulcer
- B. Ecchymosis
- C. Scar
- D. Erosion
Correct Answer: B
Rationale: Ecchymosis, or bruising, is a risk with anticoagulants like warfarin due to blood extravasation. Ulcers, scars, and erosions are not directly associated with anticoagulant use.
A nurse is explaining the importance of sunlight on the skin to a woman with decreased mobility who rarely leaves her house. The nurse would emphasize that ultraviolet light helps to synthesize what vitamin?
- A. E
- B. D
- C. A
- D. C
Correct Answer: B
Rationale: Ultraviolet light exposure aids in synthesizing vitamin D, essential for preventing rickets and supporting bone health. Vitamins E, A, and C are not synthesized via sunlight.
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.
Assessment of a patients leg reveals the presence of a 1.5-cm circular region of necrotic tissue that is deeper than the epidermis. The nurse should document the presence of what type of skin lesion?
- A. Keloid
- B. Ulcer
- C. Fissure
- D. Erosion
Correct Answer: B
Rationale: An ulcer involves skin loss past the epidermis with necrotic tissue. Keloids are scar tissue, fissures are linear, and erosions are superficial.