, Silvestri: Saunders Comprehensive Review for the NCLEX-RN®
Examination, 5th Edition
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
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
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.
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