Inquire through: | Professional | Confidential Support
Chapter 22: Assessment of the Skin, Hair,
and Nails Ignatavicius: Medical-Surgical
Nursing, 10th Edition Verified and Updated
Questions and Answers (100% Correct
Answers)
1. While assessing a client, a nurse detects a bluish tinge to the client's palms, soles,
and mucous membranes. Which action should the nurse take next?
a. Ask the client about current medications he or she is taking.
b. Use pulse oximetry to assess the client's oxygen saturation.
c. Auscultate the client's lung fields for adventitious sounds.
d. Palpate the client's bilateral radial and pedal pulses.
Answer: b. Use pulse oximetry to assess the client's oxygen saturation.
Cyanosis can be present when impaired gas exchange occurs. In a client with dark
skin, cyanosis can be seen because the palms, soles, and mucous membranes have a
bluish tinge. The nurse will assess for systemic oxygenation before continuing with
other assessments.
2. A nurse assesses a client who is admitted with inflamed soft-tissue folds around
the nail plates. Which question should the nurse ask to elicit useful information
about the possible condition?
a. "What do you do for a living?"
b. "Are your nails professionally manicured?"
c. "Do you have diabetes mellitus?"
d. "Have you had a recent fungal infection?"
Answer: a. "What do you do for a living?"
The condition chronic paronychia is common in people with frequent intermittent
exposure to water, such as homemakers, bartenders, and laundry workers. The other
, Inquire through: | Professional | Confidential Support
questions would not provide information specifically related to this assessment
finding.
3. A nurse assesses a client who has multiple areas of ecchymosis on both arms.
Which question should the nurse ask first?
a. "Are you using lotion on your skin?"
b. "Do you have a family history of this?"
c. "Do your arms itch?"
d. "What medications are you taking?"
Answer: d. "What medications are you taking?"
Certain drugs such as aspirin, warfarin, and corticosteroids can lead to easy or
excessive bruising, which can result in ecchymosis. The other options would not
provide information about bruising.
4. After teaching a client who expressed concern about a rash located beneath her
breast, a nurse assesses the client's understanding. Which statement indicates the
client has a good understanding of this condition?
a. "This rash is probably due to fluid overload."
b. "I need to wash this daily with antibacterial soap."
c. "I can use powder to keep this area dry."
d. "I will schedule a mammogram as soon as I can."
Answer: c. "I can use powder to keep this area dry."
Rashes limited to skinfold areas (e.g., on the axillae, beneath the breasts, in the
groin) may reflect problems related to excessive moisture. The client needs to keep
the area dry; one option is to use powder. Good hygiene is important, but the rash
does not need an antibacterial soap. Fluid overload and breast cancer are not related
to rashes in skinfolds.
5. A nurse assesses a client who has two skin lesions on his chest. Each lesion is the
size of a nickel, flat, and darker in color than the client's skin. How should the nurse
document these lesions?
Chapter 22: Assessment of the Skin, Hair,
and Nails Ignatavicius: Medical-Surgical
Nursing, 10th Edition Verified and Updated
Questions and Answers (100% Correct
Answers)
1. While assessing a client, a nurse detects a bluish tinge to the client's palms, soles,
and mucous membranes. Which action should the nurse take next?
a. Ask the client about current medications he or she is taking.
b. Use pulse oximetry to assess the client's oxygen saturation.
c. Auscultate the client's lung fields for adventitious sounds.
d. Palpate the client's bilateral radial and pedal pulses.
Answer: b. Use pulse oximetry to assess the client's oxygen saturation.
Cyanosis can be present when impaired gas exchange occurs. In a client with dark
skin, cyanosis can be seen because the palms, soles, and mucous membranes have a
bluish tinge. The nurse will assess for systemic oxygenation before continuing with
other assessments.
2. A nurse assesses a client who is admitted with inflamed soft-tissue folds around
the nail plates. Which question should the nurse ask to elicit useful information
about the possible condition?
a. "What do you do for a living?"
b. "Are your nails professionally manicured?"
c. "Do you have diabetes mellitus?"
d. "Have you had a recent fungal infection?"
Answer: a. "What do you do for a living?"
The condition chronic paronychia is common in people with frequent intermittent
exposure to water, such as homemakers, bartenders, and laundry workers. The other
, Inquire through: | Professional | Confidential Support
questions would not provide information specifically related to this assessment
finding.
3. A nurse assesses a client who has multiple areas of ecchymosis on both arms.
Which question should the nurse ask first?
a. "Are you using lotion on your skin?"
b. "Do you have a family history of this?"
c. "Do your arms itch?"
d. "What medications are you taking?"
Answer: d. "What medications are you taking?"
Certain drugs such as aspirin, warfarin, and corticosteroids can lead to easy or
excessive bruising, which can result in ecchymosis. The other options would not
provide information about bruising.
4. After teaching a client who expressed concern about a rash located beneath her
breast, a nurse assesses the client's understanding. Which statement indicates the
client has a good understanding of this condition?
a. "This rash is probably due to fluid overload."
b. "I need to wash this daily with antibacterial soap."
c. "I can use powder to keep this area dry."
d. "I will schedule a mammogram as soon as I can."
Answer: c. "I can use powder to keep this area dry."
Rashes limited to skinfold areas (e.g., on the axillae, beneath the breasts, in the
groin) may reflect problems related to excessive moisture. The client needs to keep
the area dry; one option is to use powder. Good hygiene is important, but the rash
does not need an antibacterial soap. Fluid overload and breast cancer are not related
to rashes in skinfolds.
5. A nurse assesses a client who has two skin lesions on his chest. Each lesion is the
size of a nickel, flat, and darker in color than the client's skin. How should the nurse
document these lesions?
