Shadow Health Integumentary System -
Lupe Sosa | Complete Focused Exam,
Contact Dermatitis, Subjective &
1. During the focused interview with Lupe Sosa, which subjective finding most
strongly suggests an allergic contact dermatitis rather than irritant contact
dermatitis?
A. Burning and stinging sensation occurring within minutes of exposure
B. Pruritic, erythematous papules appearing 24 to 72 hours after exposure
C. Sharp demarcation of erythema limited to the area of direct contact
D. Immediate pain and vesiculation confined to the site of exposure
Answer: B. Pruritic, erythematous papules appearing 24 to 72 hours after exposure
Rationale: Allergic contact dermatitis is a delayed type IV hypersensitivity reaction that
typically presents with pruritus and papulovesicular lesions 24-72 hours after allergen
exposure. Irritant contact dermatitis causes immediate burning or stinging with sharp
demarcation, so options A, C, and D describe irritant rather than allergic pathophysiology.
2. While inspecting Lupe Sosa's forearms, the nurse documents multiple small,
fluid-filled, tense lesions less than 1 cm in diameter. Which primary skin lesion term is
most accurate?
A. Bullae
B. Pustules
C. Vesicles
D. Nodules
Answer: C. Vesicles
Rationale: Vesicles are circumscribed, elevated, fluid-filled lesions less than 1 cm in
diameter, which matches the described finding. Bullae are fluid-filled lesions greater than 1
cm, pustules contain purulent exudate, and nodules are solid, elevated lesions extending
into the dermis.
Page 1 of 71
,3. Lupe Sosa reports intense itching that disrupts sleep. Which nursing diagnosis
should be prioritized in her plan of care?
A. Impaired Skin Integrity related to altered epidermal barrier
B. Disturbed Sleep Pattern related to pruritus
C. Risk for Infection related to excoriation
D. Acute Pain related to inflammatory response
Answer: B. Disturbed Sleep Pattern related to pruritus
Rationale: The patient's chief complaint of pruritus disrupting sleep directly supports
Disturbed Sleep Pattern as the priority problem. While Impaired Skin Integrity and Risk for
Infection are relevant, the most immediate patient-centered concern is the sleep disruption
caused by itching.
4. Which question would best elicit the aggravating factors of Lupe Sosa's contact
dermatitis during the focused interview?
A. "Does anyone in your family have a history of eczema or psoriasis?"
B. "What soaps, lotions, or detergents have you used on the affected areas?"
C. "Have you noticed any fever or swollen lymph nodes recently?"
D. "How has this rash affected your ability to work or perform daily activities?"
Answer: B. "What soaps, lotions, or detergents have you used on the affected areas?"
Rationale: Aggravating factors include substances or exposures that worsen the condition,
so asking about soaps, lotions, and detergents directly identifies potential irritants or
allergens. Family history, systemic symptoms, and functional impact address other
subjective domains but not aggravating factors.
Page 2 of 71
,5. The nurse palpates Lupe Sosa's skin lesions. Which finding would be documented as
'induration'?
A. The lesion blanches with pressure and refills slowly
B. The lesion is thickened and hardened on palpation
C. The lesion is freely movable over underlying tissue
D. The lesion exudes serous fluid when compressed
Answer: B. The lesion is thickened and hardened on palpation
Rationale: Induration refers to a hardened, thickened area of skin often resulting from
edema or cellular infiltration, which is detected by palpation. Blanching, mobility, and
exudation describe other characteristics such as vascularity, attachment, and moisture.
6. Which statement by Lupe Sosa would the nurse document as an alleviating factor in
the subjective data?
A. "The rash started after I began using a new laundry detergent."
B. "The itching is worse at night when I am trying to sleep."
C. "Applying cool compresses seems to reduce the itching and redness."
D. "I have a history of seasonal allergies and asthma."
Answer: C. "Applying cool compresses seems to reduce the itching and redness."
Rationale: Alleviating factors are interventions or conditions that improve symptoms; cool
compresses reducing itching and redness fits this category. The new detergent is a
precipitating factor, nighttime worsening is an aggravating factor, and allergy history is
past medical history.
Page 3 of 71
, 7. When documenting the objective skin assessment, which descriptor best
characterizes a lesion that is flat, nonpalpable, and circumscribed, measuring 0.5 cm?
A. Macule
B. Papule
C. Plaque
D. Wheal
Answer: A. Macule
Rationale: A macule is a flat, nonpalpable, circumscribed lesion less than 1 cm in diameter,
often identified by color change alone. Papules are elevated and palpable, plaques are
elevated and larger than 1 cm, and wheals are transient, edematous elevations.
8. The nurse is preparing to document the focused integumentary assessment in
Shadow Health. Which element is essential for meeting documentation standards?
A. Including the patient's subjective complaints verbatim in the objective section
B. Documenting only abnormal findings to save time
C. Recording both normal and abnormal findings using precise anatomical and
descriptive terminology
D. Summarizing the assessment in general terms without specific measurements
Answer: C. Recording both normal and abnormal findings using precise anatomical
and descriptive terminology
Rationale: Accredited documentation standards require complete, accurate recording of
both normal and abnormal findings using precise anatomical and descriptive terminology.
Verbatim subjective data belong in the subjective section, omitting normal findings is
incomplete, and vague summaries lack clinical utility.
Page 4 of 71
Lupe Sosa | Complete Focused Exam,
Contact Dermatitis, Subjective &
1. During the focused interview with Lupe Sosa, which subjective finding most
strongly suggests an allergic contact dermatitis rather than irritant contact
dermatitis?
A. Burning and stinging sensation occurring within minutes of exposure
B. Pruritic, erythematous papules appearing 24 to 72 hours after exposure
C. Sharp demarcation of erythema limited to the area of direct contact
D. Immediate pain and vesiculation confined to the site of exposure
Answer: B. Pruritic, erythematous papules appearing 24 to 72 hours after exposure
Rationale: Allergic contact dermatitis is a delayed type IV hypersensitivity reaction that
typically presents with pruritus and papulovesicular lesions 24-72 hours after allergen
exposure. Irritant contact dermatitis causes immediate burning or stinging with sharp
demarcation, so options A, C, and D describe irritant rather than allergic pathophysiology.
2. While inspecting Lupe Sosa's forearms, the nurse documents multiple small,
fluid-filled, tense lesions less than 1 cm in diameter. Which primary skin lesion term is
most accurate?
A. Bullae
B. Pustules
C. Vesicles
D. Nodules
Answer: C. Vesicles
Rationale: Vesicles are circumscribed, elevated, fluid-filled lesions less than 1 cm in
diameter, which matches the described finding. Bullae are fluid-filled lesions greater than 1
cm, pustules contain purulent exudate, and nodules are solid, elevated lesions extending
into the dermis.
Page 1 of 71
,3. Lupe Sosa reports intense itching that disrupts sleep. Which nursing diagnosis
should be prioritized in her plan of care?
A. Impaired Skin Integrity related to altered epidermal barrier
B. Disturbed Sleep Pattern related to pruritus
C. Risk for Infection related to excoriation
D. Acute Pain related to inflammatory response
Answer: B. Disturbed Sleep Pattern related to pruritus
Rationale: The patient's chief complaint of pruritus disrupting sleep directly supports
Disturbed Sleep Pattern as the priority problem. While Impaired Skin Integrity and Risk for
Infection are relevant, the most immediate patient-centered concern is the sleep disruption
caused by itching.
4. Which question would best elicit the aggravating factors of Lupe Sosa's contact
dermatitis during the focused interview?
A. "Does anyone in your family have a history of eczema or psoriasis?"
B. "What soaps, lotions, or detergents have you used on the affected areas?"
C. "Have you noticed any fever or swollen lymph nodes recently?"
D. "How has this rash affected your ability to work or perform daily activities?"
Answer: B. "What soaps, lotions, or detergents have you used on the affected areas?"
Rationale: Aggravating factors include substances or exposures that worsen the condition,
so asking about soaps, lotions, and detergents directly identifies potential irritants or
allergens. Family history, systemic symptoms, and functional impact address other
subjective domains but not aggravating factors.
Page 2 of 71
,5. The nurse palpates Lupe Sosa's skin lesions. Which finding would be documented as
'induration'?
A. The lesion blanches with pressure and refills slowly
B. The lesion is thickened and hardened on palpation
C. The lesion is freely movable over underlying tissue
D. The lesion exudes serous fluid when compressed
Answer: B. The lesion is thickened and hardened on palpation
Rationale: Induration refers to a hardened, thickened area of skin often resulting from
edema or cellular infiltration, which is detected by palpation. Blanching, mobility, and
exudation describe other characteristics such as vascularity, attachment, and moisture.
6. Which statement by Lupe Sosa would the nurse document as an alleviating factor in
the subjective data?
A. "The rash started after I began using a new laundry detergent."
B. "The itching is worse at night when I am trying to sleep."
C. "Applying cool compresses seems to reduce the itching and redness."
D. "I have a history of seasonal allergies and asthma."
Answer: C. "Applying cool compresses seems to reduce the itching and redness."
Rationale: Alleviating factors are interventions or conditions that improve symptoms; cool
compresses reducing itching and redness fits this category. The new detergent is a
precipitating factor, nighttime worsening is an aggravating factor, and allergy history is
past medical history.
Page 3 of 71
, 7. When documenting the objective skin assessment, which descriptor best
characterizes a lesion that is flat, nonpalpable, and circumscribed, measuring 0.5 cm?
A. Macule
B. Papule
C. Plaque
D. Wheal
Answer: A. Macule
Rationale: A macule is a flat, nonpalpable, circumscribed lesion less than 1 cm in diameter,
often identified by color change alone. Papules are elevated and palpable, plaques are
elevated and larger than 1 cm, and wheals are transient, edematous elevations.
8. The nurse is preparing to document the focused integumentary assessment in
Shadow Health. Which element is essential for meeting documentation standards?
A. Including the patient's subjective complaints verbatim in the objective section
B. Documenting only abnormal findings to save time
C. Recording both normal and abnormal findings using precise anatomical and
descriptive terminology
D. Summarizing the assessment in general terms without specific measurements
Answer: C. Recording both normal and abnormal findings using precise anatomical
and descriptive terminology
Rationale: Accredited documentation standards require complete, accurate recording of
both normal and abnormal findings using precise anatomical and descriptive terminology.
Verbatim subjective data belong in the subjective section, omitting normal findings is
incomplete, and vague summaries lack clinical utility.
Page 4 of 71
