A client presents with a ring-shaped lesion with a clear center on the arm. Which condition does the nurse suspect?
Psoriasis
Tinea capitis
Eczema
Tinea corporis
The Correct Answer is D
Rationale:
A. Psoriasis is a chronic autoimmune-mediated skin disorder characterized by hyperproliferation of keratinocytes and inflammation. Clinically, it presents as well-demarcated, erythematous plaques covered with silvery-white scales, often found on extensor surfaces such as the elbows, knees, scalp, and lower back. Psoriatic lesions are typically not ring-shaped, nor do they have a clear center, so psoriasis does not match the client’s description.
B. Tinea capitis is a fungal infection caused primarily by dermatophytes affecting the scalp. It presents with scaling, hair loss, broken hairs, and sometimes pustules or kerion formation. Lesions occur on the scalp and hair-bearing areas, not usually on the arm, and the classic ring-shaped pattern with central clearing seen in tinea corporis is not characteristic of tinea capitis.
C. Eczema (atopic dermatitis) is a chronic inflammatory skin condition associated with impaired skin barrier function and immune dysregulation. It typically presents as pruritic, erythematous, and sometimes oozing patches. The lesions are often irregularly shaped, may be lichenified, and lack the ring-shaped configuration with central clearing. While eczema can affect the arms, the pattern described in the client does not align with classic eczema presentation.
D. Tinea corporis, also known as ringworm of the body, is a superficial fungal infection caused by dermatophytes such as Trichophyton species. The pathophysiology involves fungal invasion of the stratum corneum, which induces an inflammatory response in the surrounding skin. Clinically, tinea corporis presents as annular (ring-shaped) lesions with raised, scaly borders and central clearing, which is highly distinctive. The clear center results from the resolution of fungal activity in the central area while the fungus continues to proliferate at the edges, producing the characteristic ring pattern. Lesions may be single or multiple and can occur on any exposed skin area, including the arms, legs, and trunk. The presence of a ring-shaped lesion with a clear center, as reported by the client, is a classic hallmark of tinea corporis, making this the most likely diagnosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Rationale:
A. Pulmonary fibrosis and scarring is incorrect. Pulmonary fibrosis involves thickening and stiffening of lung tissue, which leads to restrictive lung disease and reduced lung compliance. While it impairs gas exchange, it does not cause the characteristic wheezing seen in asthma, which is primarily due to airway obstruction rather than tissue stiffness.
B. Decreased lung compliance and atelectasis is incorrect. Decreased compliance and alveolar collapse (atelectasis) can impair ventilation and oxygenation, but they are not the primary mechanism for wheezing. Wheezing results from airflow limitation in the bronchi and bronchioles, not alveolar collapse.
C. Alveolar fluid accumulation and edema is incorrect. Pulmonary edema, often seen in heart failure or acute lung injury, causes crackles (rales) and shortness of breath, but it is not the main cause of wheezing in asthma. Wheezing is due to obstruction in small airways, not fluid in alveoli.
D. Airway inflammation and bronchoconstriction is correct. Asthma is characterized by chronic inflammation of the airways, leading to edema, mucus production, and hyperreactivity of bronchial smooth muscle. During an asthma attack, bronchoconstriction narrows the airways, causing turbulent airflow, which produces the high-pitched, musical sound known as wheezing. This pathophysiological process also contributes to symptoms such as shortness of breath, chest tightness, and cough, making it the primary mechanism underlying asthma-related wheezing.
Correct Answer is D
Explanation
Rationale:
A. Veins are incorrect. Veins have thinner walls and less smooth muscle compared with arteries because they operate under lower pressure. Their structure includes valves to prevent backflow, but they do not require thick muscular walls to maintain blood pressure.
B. Venules are incorrect. Venules are small vessels that collect blood from capillaries and transport it to veins. Their walls are very thin, primarily composed of endothelium and a small amount of smooth muscle, insufficient for significant pressure regulation.
C. Capillaries are incorrect. Capillaries consist of a single layer of endothelial cells and a basement membrane to facilitate exchange of gases, nutrients, and waste between blood and tissues. They have no smooth muscle layer.
D. Arteries is correct. Arteries have the thickest walls and the most smooth muscle and elastic tissue of all blood vessels. This structure allows arteries to withstand and regulate high-pressure blood flow from the heart, maintain blood pressure through vasoconstriction and vasodilation, and distribute blood efficiently to organs and tissues. The thick smooth muscle layer is essential for maintaining vascular tone and responding to changes in physiological demand.
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