Melanocytes give rise to the pigment melanin, which is responsible for skin color. Where can the melanocytes be found?
- A. Dermis
- B. Superficial fascia
- C. Epidermis
- D. Loose connective tissue
Correct Answer: C
Rationale: A layer in the epidermis contains highly specialized cells called melanocytes.
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Which may indicate a malignant melanoma in a nevus on a patient's arm?
- A. Even coloring of the mole
- B. Decrease in size of the mole
- C. Irregular border of the mole
- D. Symmetry of the mole
Correct Answer: C
Rationale: Any change in color, size, or texture and any bleeding or pruritus of a nevus deserves investigation. A malignant melanoma is a cancerous neoplasm in which pigment cells or melanocytes invade the epidermis, dermis, and sometimes the subcutaneous tissue.
A patient, age 27, sustained thermal burns to 18% of her body surface area. After the first 72 hours, the nurse will have to observe for which most common cause of burn-related deaths?
- A. shock.
- B. respiratory arrest.
- C. hemorrhage.
- D. infection.
Correct Answer: D
Rationale: Infection is the most common complication and cause of death after the first 72 hours. Shock, due to hypovolemia is most common during the emergent phase of the burn injury. Respiratory arrest and hemorrhage are not common causes of death.
During primary survey of a patient who sustained a burn injury, the nurse checks for which as an early signs of carbon monoxide poisoning?
- A. Dizziness
- B. Urticaria
- C. Vomiting
- D. Headache
- E. Vertigo
- F. Unsteady gait
Correct Answer: C,D,F
Rationale: Early signs of carbon monoxide poisoning include headache, nausea, vomiting, and unsteady gait. Urticaria is a skin reaction seen in allergic responses. Dizziness and vertigo are not signs of carbon monoxide poisoning.
A patient, age 46, reports to the health care provider's office with urticaria with elevated lesions that are white in the center with a pale red border on hands and arms. He says, 'It itches like crazy.' Which type of lesion would the nurse include in the documentation?
- A. Macules
- B. Plaques
- C. Wheals
- D. Vesicles
Correct Answer: C
Rationale: Urticaria is the term applied to the presence of wheals or hives in an allergic reaction commonly caused by drugs, food, insect bites, inhalants, emotional stress, or exposure to heat or cold. The lesions are elevated with a white center and a pale red border. Macules are small, flat blemishes flush with the skin surface. Plaques are elevated, firm, rough lesions with a flat topped surface. A vesicle is a circumscribed elevation of skin filled with serous fluid.
Which will the nurse examine when assessing a patient for tinea corporis?
- A. Soles of the feet
- B. Scalp
- C. Groin
- D. Abdomen
Correct Answer: D
Rationale: Tinea corporis is known as ringworm of the body. It occurs on parts of the body with little or no hair. Tinea pedis is a fungal infection of the feet. Tinea capitus is a fungal infection of the scalp. Tinea cruris is a fungal infection of the groin area.
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