NCLEX Practice Questions On Integumentary System Disorders

1. The evening nurse reviews the nursing documentation in the male client's chart and notes that the day nurse has documented that the client has a stage II pressure ulcer in the sacral area. Which of the following would the nurse expect to note on assessment of the client's sacral area?

Intact skin

Full-thickness skin loss

Exposed bone. tendon. or muscle

Partial-thickness skin loss of the dermis

In a stage II pressure ulcer. the skin is not intact. Partial-thickness skin loss of the dermis has occurred. It presents as a shallow open ulcer with a red-pink wound bed. without slough. It may also present as an intact. open or ruptured. serum-filled blister. The skin is intact in stage I. Full-thickness skin loss occurs in stage 3. Exposed bone. tendon. or muscle is present in stage 4.

Explanation

In a stage II pressure ulcer. the skin is not intact. Partial-thickness skin loss of the dermis has occurred. It presents as a shallow open ulcer with a red-pink wound bed. without slough. It may also present as an intact. open or ruptured. serum-filled blister. The skin is intact in stage I. Full-thickness skin loss occurs in stage 3. Exposed bone. tendon. or muscle is present in stage 4.

2. The clinic nurse notes that the physician has documented a diagnosis of herpes zoster (shingles) in the male client's chart. Based on an understanding of the cause of this disorder. the nurse determines that this definitive diagnosis was made following which diagnostic test?

Patch test

Skin biopsy

Culture of the lesion

Woo’s light examination

With the classic presentation of herpes zoster. the clinical examination is diagnostic. A viral culture of the lesion provides the definitive diagnosis. Herpes zoster (shingles) is caused by a reactivation of the varicella-zoster virus. the virus that causes chickenpox. A patch test is a skin test that involves the administration of an allergen to the surface of the skin to identify specific allergies. A biopsy would provide a cytological examination of tissue. In a Wood’s light examination. the skin is viewed under ultraviolet light to identify superficial infections of the skin.

Explanation

With the classic presentation of herpes zoster. the clinical examination is diagnostic. A viral culture of the lesion provides the definitive diagnosis. Herpes zoster (shingles) is caused by a reactivation of the varicella-zoster virus. the virus that causes chickenpox. A patch test is a skin test that involves the administration of an allergen to the surface of the skin to identify specific allergies. A biopsy would provide a cytological examination of tissue. In a Wood’s light examination. the skin is viewed under ultraviolet light to identify superficial infections of the skin.

3. The nurse is assigned to care for a female client with herpes zoster (Shingles). Which of the following characteristics would the nurse expect to note when assessing the lesions of this infection?

Clustered skin vesicles

A generalized body rash

Small blue-white spots with a red base

A fiery red. edematous rash on the cheeks

The primary lesion of herpes zoster is a vesicle. The classic presentation is grouped vesicles on an erythematous base along a dermatome. Because the lesions follow nerve pathways. they do not cross the midline of the body. Options B. C. and D are incorrect descriptions of herpes zoster.

Explanation

The primary lesion of herpes zoster is a vesicle. The classic presentation is grouped vesicles on an erythematous base along a dermatome. Because the lesions follow nerve pathways. they do not cross the midline of the body. Options B. C. and D are incorrect descriptions of herpes zoster.

4. When assessing a lesion diagnosed as malignant melanoma. the nurse in-charge most likely expects to note which of the following?

An irregular shaped lesion

A small papule with a dry. rough scale

A firm. nodular lesion topped with crust

A pearly papule with a central crater and a waxy border

A melanoma is an irregularly shaped pigmented papule or plaque with a red-. white-. or blue-toned color. Basal cell carcinoma appears as a pearly papule with a central crater and rolled waxy border. Squamous cell carcinoma is a firm. nodular lesion topped with a crust or a central area of ulceration. Actinic keratosis. a premalignant lesion. appears as a small macule or papule with a dry. rough. adherent yellow or brown scale.

Explanation

A melanoma is an irregularly shaped pigmented papule or plaque with a red-. white-. or blue-toned color. Basal cell carcinoma appears as a pearly papule with a central crater and rolled waxy border. Squamous cell carcinoma is a firm. nodular lesion topped with a crust or a central area of ulceration. Actinic keratosis. a premalignant lesion. appears as a small macule or papule with a dry. rough. adherent yellow or brown scale.

5. The nurse is reviewing the healthcare record of a male clients scheduled to be seen at the health care clinic. The nurse determines that which of the following individuals is at the greatest risk for development of an integumentary disorder?

An adolescent

An older female

A physical education teacher

An outdoor construction worker

Prolonged exposure to the sun. unusual cold. or other conditions can damage the skin. The outdoor construction worker would fit into a high-risk category for the development of an integumentary disorder. An adolescent may be prone to the development of acne. but this does not occur in all adolescents. Immobility and lack of nutrition would increase the older person’s risk but the older client is not at as high a risk as the outdoor construction worker. The physical education teacher is at low or no risk of developing an integumentary problem.

Explanation

Prolonged exposure to the sun. unusual cold. or other conditions can damage the skin. The outdoor construction worker would fit into a high-risk category for the development of an integumentary disorder. An adolescent may be prone to the development of acne. but this does not occur in all adolescents. Immobility and lack of nutrition would increase the older person’s risk but the older client is not at as high a risk as the outdoor construction worker. The physical education teacher is at low or no risk of developing an integumentary problem.

6. A male client arrives at the emergency room and has experienced frostbites to the right hand. Which of the following would the nurse note on assessment of the client's hand?

A pink. edematous hand

A fiery red skin with edema in the nail beds

Black fingertips surrounded by an erythematous rash

A white color to the skin. which is insensitive to touch

Assessment findings in frostbite include a white or blue color; the skin will be hard. cold. and insensitive to touch. As thawing occurs. flushing of the skin. the development of blisters or blebs. or tissue edema appears. Options A. B. and C are incorrect.

Explanation

Assessment findings in frostbite include a white or blue color; the skin will be hard. cold. and insensitive to touch. As thawing occurs. flushing of the skin. the development of blisters or blebs. or tissue edema appears. Options A. B. and C are incorrect.

7. Nurse Kevin reviews the client's chart and notes that the physician has documented a diagnosis of paronychia. Based on this diagnosis. which of the following would the nurse expect to note during the assessment?

Red shiny skin around the nail bed

White taut skin in the popliteal area

White silvery patches on the elbows

Swelling of the skin near the parotid gland

Paronychia. or infection around the nail. is characterized by red. shiny skin. often associated with painful swelling. These infections frequently result from trauma. picking at the nail. or disorders such as dermatitis. Often. these become secondarily infected with bacteria or fungus. which later involves the nail. Warm soaks three or four times a day may reduce pain and pressure; however. incision and drainage of the inflamed site frequently are required. Options B. C. and D are incorrect.

Explanation

Paronychia. or infection around the nail. is characterized by red. shiny skin. often associated with painful swelling. These infections frequently result from trauma. picking at the nail. or disorders such as dermatitis. Often. these become secondarily infected with bacteria or fungus. which later involves the nail. Warm soaks three or four times a day may reduce pain and pressure; however. incision and drainage of the inflamed site frequently are required. Options B. C. and D are incorrect.

8. A male client schedule for a skin biopsy is concerned and asks the nurse how painful the procedure is. The appropriate response by the nurse is:

“There is no pain associated with this procedure”

“The local anesthetic may cause a burning or stinging sensation”

A preoperative medication will be given so you will be sleeping and will not feel any pain”

“There is some pain. but the physician will prescribe an opioid analgesic following the procedure”

Depending on the size and location of the lesion. a biopsy is usually a quick and almost painless procedure. The most common source of pain is the initial local anesthetic. which can produce a burning or stinging sensation. Preoperative medication is not necessary with this procedure.

Explanation

Depending on the size and location of the lesion. a biopsy is usually a quick and almost painless procedure. The most common source of pain is the initial local anesthetic. which can produce a burning or stinging sensation. Preoperative medication is not necessary with this procedure.

9. The nurse prepares discharge instructions for a male client following cryosurgery for the treatment of a malignant skin lesion. Which of the following should the nurse include in the instruction?

Avoid showering for 7 to 10 days

Apply ice to the site to prevent discomfort

Apply alcohol-soaked dressing twice a day

Clean the site with hydrogen peroxide to prevent infection

Cryosurgery involves the local application of liquid nitrogen to isolated lesions and causes cell death and tissue destruction. The nurse informs the client that swelling and increased tenderness of the treated area can occur when the skin thaws. Tissue freezing is followed by hemorrhagic blister formation in 1 to 2 days. The nurse instructs the client to clean the treatment site with hydrogen peroxide to prevent secondary infection. A topical antibiotic also may be prescribed. Application of a warm. damp washcloth intermittently to the site will provide relief from any discomfort. Alcohol-soaked dressings will cause irritation. The client does not need to avoid showering.

Explanation

Cryosurgery involves the local application of liquid nitrogen to isolated lesions and causes cell death and tissue destruction. The nurse informs the client that swelling and increased tenderness of the treated area can occur when the skin thaws. Tissue freezing is followed by hemorrhagic blister formation in 1 to 2 days. The nurse instructs the client to clean the treatment site with hydrogen peroxide to prevent secondary infection. A topical antibiotic also may be prescribed. Application of a warm. damp washcloth intermittently to the site will provide relief from any discomfort. Alcohol-soaked dressings will cause irritation. The client does not need to avoid showering.

10. Nurse Imee is implementing a teaching plan to a group of adolescents regarding the causes of acne. Which of the following is an appropriate nursing statement regarding the cause of this disorder?

“Acne is caused by oily skin”

“The actual cause is not known”

“Acne is caused by eating chocolate”

“Acne is caused as a result of exposure to heat and humidity”

The actual cause of acne is unknown. Oily skin or the consumption of foods such as chocolate. nuts. or fatty foods are not causes of acne. Exacerbations that coincide with the menstrual cycle result from hormonal activity. Heat. humidity. and excessive perspiration may play a role in exacerbating acne but does not cause it.

Explanation

The actual cause of acne is unknown. Oily skin or the consumption of foods such as chocolate. nuts. or fatty foods are not causes of acne. Exacerbations that coincide with the menstrual cycle result from hormonal activity. Heat. humidity. and excessive perspiration may play a role in exacerbating acne but does not cause it.