1
Explain the structures and function for epidermis, dermis, and subcutaneous tissue
Epidermis: five layers, melanin, keratin
Dermis: capillaries and pain/touch receptors/ blood vessels, sweat glands, collagen
Subcutaneous (hypodermis): has a lot of fat in it, provides insulation and protection
elevated, fluid-filled, thin wall
called bullae if >1cm
vesicle
A nurse assesses a client with a suspected pressure ulcer on the sacrum. The area is intact, non-blanchable, and red. How should the nurse document this finding?
A. Stage 1 pressure ulcer
B. Stage 2 pressure ulcer
C. Unstageable ulcer
D. Suspected deep tissue injury
Answer: A. Stage 1 pressure ulcer
Rationale: A Stage 1 pressure ulcer is characterized by intact skin with non-blanchable redness over a localized area, typically over a bony prominence. The skin may be painful, firm, soft, warmer or cooler compared to adjacent tissue.
6. Which teaching point is most important for a client diagnosed with psoriasis?
A. "You can stop medication once symptoms subside."
B. "Psoriasis is a contagious skin condition."
C. "Avoid triggers like stress and cold weather."
D. "Use antibiotics daily to manage flares."
Answer: C. "Avoid triggers like stress and cold weather."
Rationale: Psoriasis is a chronic autoimmune condition. Triggers like stress, seasonal changes, and certain medications can worsen symptoms. It is not contagious, and antibiotics are not a standard treatment.
A lesion is described as a small, flat, nonpalpable change in skin color. Which lesion best fits this description?
A. Macule
B. Nodule
C. Plaque
D. Papule
Answer: A. Macule
Rationale: A macule is a flat lesion with a color change, such as a freckle or petechiae. It is nonpalpable and less than 1 cm.
Primary vs Secondary lesions
Primary: caused directly by disease, present at onset of disease
ex. vesciles r/t chicken pox, nodules r/t RA
Secondary: result from changes over time caused by disease progression, manipulation or treatment
ex. crusted, excoriated or infection lesion caused by scratching the vesicle, scars, keloids
what are some common lesions in the older adult
lentigines (liver spots), angiomas, telangiectasia, photoaging
A client presents with a painful, red, swollen area on the lower leg. The skin is warm, tender to the touch, and has poorly defined borders. The client has a fever and swollen lymph nodes. What condition does the nurse suspect?
A. Tinea corporis
B. Herpes zoster
C. Cellulitis
D. Psoriasis
Answer: C. Cellulitis
Rationale: Cellulitis is a bacterial skin infection involving the dermis and subcutaneous tissue. It is characterized by redness, swelling, warmth, and pain with systemic signs such as fever and lymphadenopathy.
1. An 82-year-old client has irregular, round, flat lesions with a "stuck-on" appearance on the trunk. Which lesion is the nurse most likely observing?
A. Actinic keratosis
B. Seborrheic keratosis
C. Basal cell carcinoma
D. Squamous cell carcinoma
Answer: B. Seborrheic keratosis
Rationale: Seborrheic keratoses are benign, waxy, wart-like lesions with a "stuck-on" appearance, common in older adults. They are often pigmented and located on the face or trunk.
A nurse assesses an older adult with dry, flaking skin and complains of itching. What is the most appropriate nursing intervention?
A. Apply isopropyl alcohol
B. Encourage hot baths
C. Recommend oatmeal baths and moisturizers
D. Use hydrogen peroxide on affected areas
Answer: C. Recommend oatmeal baths and moisturizers
Rationale: Xerosis (dry skin) in older adults can cause itching and flaking. Tepid oatmeal baths and emollients help restore moisture and reduce irritation.
flat, nonpalpable change in color
port-wine stains, freckles, petechiae, vitligo
macule
what is xerosis and what is the management
common in older adults due to decrease lubrication and reduced moisture retention
s/sx - pruritus, flaking of skin surface, secondary lesions and lichenification
Management - humidification, tepid water, plain soap, oatmeal baths, clothing, hydration
3. Which finding in a mole would most concern the nurse as a possible malignant melanoma?
A. Symmetry
B. Smooth border
C. Uniform brown color
D. Diameter greater than 6 mm
Answer: D. Diameter greater than 6 mm
Rationale: A diameter greater than 6 mm is part of the ABCDE criteria for melanoma: Asymmetry, Border irregularity, Color variation, Diameter >6 mm, and Evolution (changes over time). This finding warrants further evaluation.
2. A nurse is evaluating a lesion described as elevated, pus-filled, and less than 1 cm in diameter. What type of primary lesion is this?
A. Vesicle
B. Pustule
C. Papule
D. Cyst
Answer: B. Pustule
Rationale: A pustule is a small, elevated lesion filled with pus. It is commonly seen in acne and bacterial infections.
A client with a suspicious skin lesion asks why a biopsy is needed. What is the best nurse response?
A. “It will treat the lesion immediately.”
B. “A biopsy will confirm whether the lesion is cancerous.”
C. “It prevents further lesions from forming.”
D. “A biopsy removes all affected skin.”
Answer: B. “A biopsy will confirm whether the lesion is cancerous.”
Rationale: A biopsy is a diagnostic procedure that helps determine whether a lesion is benign or malignant. It is the gold standard for diagnosing skin cancer.
small, elevated, solid mass <0.5cm
moles, warts, psoriasis <0.5cm mass
papule
what is keratoses
tan, waxy can appear greasy - commonly on face or trunk
benign overgrowth and thickening of epithelium
may be removed for biopsy
removal by curettage for cosmetic reasons or to eliminate irritation
4. A nurse is educating a client on preventing pressure ulcers. Which of the following statements indicates a need for further teaching?
A. “I will turn every 2 hours.”
B. “I should keep my skin clean and dry.”
C. “If I get a sore, I’ll use hydrogen peroxide to clean it.”
D. “I will use pillows to reduce pressure on bony areas.”
Answer: C. “If I get a sore, I’ll use hydrogen peroxide to clean it.”
Rationale: Hydrogen peroxide can damage healthy tissue and delay wound healing. Normal saline or prescribed wound cleansers should be used instead. The other statements show correct understanding of pressure ulcer prevention.
3. Which of the following client statements indicates understanding of melanoma prevention?
A. “I will check my moles once a year.”
B. “I use sunscreen only when I go to the beach.”
C. “I examine my skin monthly using a mirror for hard-to-see areas.”
D. “If a mole is itchy, it’s probably healing.”
Answer: C. “I examine my skin monthly using a mirror for hard-to-see areas.”
Rationale: Monthly skin self-examinations using the ABCDE method are key to early melanoma detection. Sunscreen should be used regularly, and changes in moles should always be reported.
Which is a characteristic feature of malignant melanoma?
A. Smooth borders and symmetry
B. Uniform brown pigmentation
C. Asymmetry, color variation, and diameter >6 mm
D. Painless, pearly nodule
Answer: C. Asymmetry, color variation, and diameter >6 mm
Rationale: Malignant melanoma often meets the ABCDE criteria: Asymmetry, Border irregularity, Color variation, Diameter >6 mm, and Evolution (change over time).
raised, flat lesion - group of papules
groupes of papules that form lesions >0.5cm
plaque
what med can be used for psoriasis
calcipotriene (Dovonez)
safe and effective ST and LT
inhibits proliferation in epidermis
Answer: C. “If I get a sore, I’ll use hydrogen peroxide to clean it.”
Rationale: Hydrogen peroxide can damage healthy tissue and delay wound healing. Normal saline or prescribed wound cleansers should be used instead. The other statements show correct understanding of pressure ulcer prevention.
Answer: B. Herpes zoster
Rationale: Herpes zoster (shingles) causes unilateral vesicular eruptions along a dermatome, often accompanied by pain and itching. It is a reactivation of the varicella-zoster virus
An older adult has a rough, scaly, erythematous macule on the face that has not resolved. Which condition does the nurse suspect?
A. Lentigo maligna
B. Seborrheic keratosis
C. Actinic keratosis
D. Psoriasis
Answer: C. Actinic keratosis
Rationale: Actinic keratosis is a premalignant lesion caused by sun exposure. It appears as a rough, scaly patch on sun-exposed skin and may progress to squamous cell carcinoma.
A nurse is teaching a group of older adults about aging skin. Which of the following age-related changes should be included?
A. Increased thickness of the epidermis
B. Increased sebaceous gland activity
C. Decreased elastin and subcutaneous fat
D. Hyperpigmentation of all skin
Answer: C. Decreased elastin and subcutaneous fat
Rationale: Aging leads to thinning of the skin, loss of elasticity due to decreased elastin, and a thinner subcutaneous fat layer, all of which increase the risk for skin tears and bruising.