TEST BANK FOR SAUNDERS COMPREHENSIVE REVIEW FOR THE
NCLEX-RN EXAMINATION, 7TH EDITION, LINDA ANNE SILVESTRI
Adult Health
Test Bank
MULTIPLE CHOICE
1. The nurse reviews the health record of a client with melasma. The nurse would anticipate that this client will
exhibit:
1. Skin that is uniformly dark in color
2. Very pale skin with little pigmentation
3. Patches of skin that have loss of pigmentation
4. Blotchy brown macules across the cheeks and forehead
ANS: 4
Rationale: Melasma is a condition caused by hormonal influences on melanin production and is noted by the
appearance of blotchy brown macules across the cheeks and forehead. “Skin that is uniformly dark in color”
describes vitiligo. “Very pale skin with little pigmentation” and “patches of skin that have loss of pigmentation”
refer to normal variations in skin color.
Test-Taking Strategy: To answer this question correctly, you must be familiar with the various terms used when
discussing skin structures and functions. “Skin that is uniformly dark in color” describes vitiligo. “Very pale skin
with little pigmentation” and “patches of skin that have loss of pigmentation” refer to normal variations in skin
color. Review the description of melasma if you had difficulty with this question.
2. The client with cellulitis of the lower leg has had cultures done on the affected area. The nurse reviewing the
results of the culture report interprets that which of the following organisms is not part of the normal flora of the
skin?
1. Escherichia coli
2. Candida albicans
3. Staphylococcus aureus
4. Staphylococcus epidermidis
ANS: 1
Rationale: E. coli is normally found in the intestines and is a common source of infection of wounds and the
urinary system. C. albicans, S. aureus, and S. epidermis are part of the normal flora of the skin.
, Test-Taking Strategy: To answer this question correctly, you must be familiar with the normal microorganisms
that inhabit the skin. Note that the question asks for the organism that is not part of normal flora. Remember that
E. coli is normally found in the intestines. Review basic skin structures if you had difficulty with this question.
PTS: 1
DIF: Level of Cognitive Ability: Understanding
REF: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: patient-centered collaborative care
(6th ed.). St. Louis: Saunders.
OBJ: Client Needs: Physiological Integrity
TOP: Content Area: Adult Health/Integumentary
MSC: Integrated Process: Nursing Process—Assessment
3. The client complains of chronic pruritus. Which of the following diagnoses would the nurse expect to support
this client’s complaint?
1. Anemia
2. Renal failure
3. Hypothyroidism
4. Diabetes mellitus
ANS: 2
Rationale: Clients with renal failure often have pruritus, or itchy skin. This is because of impaired clearance of
waste products by the kidneys. The client who is markedly anemic is likely to have pale skin. Hypothyroidism
may lead to complaints of dry skin. Clients with diabetes mellitus are at risk for skin infections and skin
breakdown.
Test-Taking Strategy: Focus on the subject, chronic pruritus. Remember that clients with renal failure often
experience this problem. If this question was difficult, review the common causes of pruritus.
PTS: 1
DIF: Level of Cognitive Ability: Understanding
REF: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: patient-centered collaborative care
(6th ed.). St. Louis: Saunders.
OBJ: Client Needs: Physiological Integrity
TOP: Content Area: Adult Health/Integumentary
MSC: Integrated Process: Nursing Process—Assessment
4. A client being seen in an ambulatory clinic for an unrelated complaint has a butterfly rash noted across the nose.
The nurse interprets that this finding is consistent with early manifestations of which of the following disorders?
1. Hyperthyroidism
2. Pernicious anemia
3. Cardiopulmonary disorders
4. Systemic lupus erythematosus (SLE)
ANS: 4
Rationale: An early sign of SLE is the appearance of a butterfly rash across the nose. Hyperthyroidism often
leads to moist skin and increased perspiration. Pernicious anemia is exhibited by pale skin. Severe
cardiopulmonary disorders may lead to clubbing of the fingers.
, Test-Taking Strategy: To answer this question accurately, you must be familiar with the impact of systemic
conditions on the skin. Remember that SLE causes a characteristic butterfly rash. If this question was difficult,
review the disorders identified in the options and the associated skin conditions that occur in each disorder.
PTS: 1
DIF: Level of Cognitive Ability: Understanding
REF: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: patient-centered collaborative care
(6th ed.). St. Louis: Saunders.
OBJ: Client Needs: Physiological Integrity
TOP: Content Area: Adult Health/Integumentary
MSC: Integrated Process: Nursing Process—Assessment
5. The nurse notes that the older adult client has a number of bright, ruby-colored, round lesions scattered on the
trunk and thighs. The nurse correctly interprets the finding as alterations in blood vessels of the skin and defines
them as:
1. Purpura
2. Venous star
3. Cherry angioma
4. Spider angioma
ANS: 3
Rationale: A cherry angioma occurs with increasing age and has no clinical significance. It is noted by the
appearance of small, bright, ruby-colored round lesions on the trunk and/or extremities. Purpura results from
hemorrhage into the skin. A venous star results from increased pressure in veins, usually in the lower legs, and
has an irregularly shaped bluish center with radiating branches. Spider angiomas have a bright red center, with
legs that radiate outward. These are commonly seen in those with liver disease or vitamin B deficiency, although
they can occur occasionally without underlying pathology.
Test-Taking Strategy: To answer this question accurately, you must be familiar with the various alterations in
vascularity that can occur in the skin. Note the relationship of the words “ruby” in the question and “cherry” in
the correct option. If you had difficulty with this question, review the various skin alterations identified in each
of the options.
PTS: 1
DIF: Level of Cognitive Ability: Understanding
REF: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: patient-centered collaborative care
(6th ed.). St. Louis: Saunders.
OBJ: Client Needs: Physiological Integrity
TOP: Content Area: Adult Health/Integumentary
MSC: Integrated Process: Nursing Process—Assessment
6. The client has been diagnosed with paronychia. The nurse understands that this is a disorder of the:
1. Nails
2. Hair follicles
3. Pilosebaceous glands
4. Epithelial layer of skin
ANS: 1
, Rationale: Paronychia is a fungal infection that is most often caused by Candida albicans. This results in
inflammation of the nail fold, with separation of the fold from the nail plate. The area is generally tender to touch,
with purulent drainage. Disorders of the hair follicles include folliculitis, furuncles, and carbuncles. Disorders of
the pilosebaceous glands include acne vulgaris and seborrheic dermatitis. There are a variety of disorders
involving the epithelial skin.
Test-Taking Strategy: To answer this question accurately, you must be familiar with a variety of skin disorders
and their causes. Remember that paronychia is a nail disorder. If this question was difficult, review the
characteristics of paronychia.
PTS: 1
DIF: Level of Cognitive Ability: Understanding
REF: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: patient-centered collaborative care
(6th ed.). St. Louis: Saunders.
OBJ: Client Needs: Physiological Integrity
TOP: Content Area: Adult Health/Integumentary
MSC: Integrated Process: Nursing Process—Assessment
7. The client is diagnosed with a full-thickness burn. The nurse understands that which of the following structural
areas of the skin is involved?
1. Epidermis only
2. Epidermis and deeper dermis
3. Epidermis and upper layer of dermis
4. Epidermis, entire dermis, and epithelial portion of subcutaneous fat
ANS: 4
Rationale: A full-thickness burn involves the epidermis, entire dermis, and epithelial portion of subcutaneous fat
layer. “Epidermis only” describes a superficial burn. “Epidermis and deeper dermis” describes a partial-thickness
burn, and “epidermis, entire dermis, and epithelial portion of subcutaneous fat” describes a deep partial-thickness
burn.
Test-Taking Strategy: To answer this question accurately, you must be familiar with the classification of burn
depth and the associated skin structures affected. Noting the words “full-thickness” will direct you to “epidermis,
entire dermis, and epithelial portion of subcutaneous fat.” If this question was difficult, review the types of burn
injuries.
PTS: 1
DIF: Level of Cognitive Ability: Understanding
REF: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: patient-centered collaborative care
(6th ed.). St. Louis: Saunders.
OBJ: Client Needs: Physiological Integrity
TOP: Content Area: Adult Health/Integumentary
MSC: Integrated Process: Nursing Process—Assessment
8. A client who suffered carbon monoxide poisoning from working on an automobile in a closed garage has a
carbon monoxide level of 15%. The nurse would anticipate observing which sign or symptom?
1. Coma
2. Flushing
3. Dizziness
4. Tachycardia
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