CSLB General Building (B) — All Questions

A client tells you that months ago she slammed her finger in a car door, and ever since, the new nail has grown in with a permanent ridge and a twisted shape. Which nail structure was most likely damaged?

• a.The nail bed
• b.The hyponychium
• c.The matrix✓
• d.The free edge

The matrix is the only tissue that produces new nail cells, so an injury there can change the shape of every nail that grows out afterward, sometimes permanently. The nail bed only supports the plate as it slides forward; it does not manufacture new nail. The hyponychium and the free edge are at the fingertip end, far from where new nail is formed.

A client points at the whitish half-moon shape at the base of her thumbnail and asks you what it is. What is the most accurate answer?

• a.It is the lunula, the part of the matrix that can be seen through the nail plate✓
• b.It is air trapped underneath the nail plate
• c.It is a vitamin deficiency showing through the nail
• d.It is the hyponychium showing through from underneath

The lunula is simply the front portion of the matrix that lies close enough to the surface to be visible, which is why it looks whiter than the rest of the nail. It is not trapped air, and it is not a health or vitamin sign; a manicurist may never explain a nail feature as a medical or nutritional condition. The hyponychium sits under the free edge at the fingertip, not at the base of the nail.

A nervous first-time client asks why she cannot feel anything when you file the surface of her nail. What is the correct explanation?

• a.The nail plate is living skin, but the nerves stop at the free edge
• b.The nail plate is fed by the eponychium, which keeps it numb
• c.The nail plate is a thin layer of cartilage with no blood supply
• d.The nail plate is made of hardened, non-living keratin cells, so it contains no nerves✓

The nail plate is a hardened sheet of keratin made of dead cells, so it has no nerves and no blood vessels of its own and filing its surface is not felt. It is not living skin and it is not cartilage. The eponychium is living skin at the base of the nail and has nothing to do with numbing the plate; if a client does feel pain, you are filing too deeply or touching living tissue and must stop.

You remove a client's polish and notice that the natural nail looks pink through the plate. What is responsible for that pink color?

• a.The keratin of the nail plate is naturally pink
• b.The nail bed under the plate is living tissue rich in blood vessels✓
• c.The lunula runs the full length of the nail
• d.Cuticle tissue stains the plate pink over time

The nail bed is the living skin directly under the nail plate; it is full of blood vessels and nerves, and that blood supply is what shows through as pink. The plate itself is colorless dead keratin, so it takes its color from what is underneath. The lunula is only the visible portion of the matrix at the base, and dead cuticle tissue does not tint the nail.

A client asks you to cut all of her cuticle off and points to the band of living skin at the base of the nail plate. What must you do?

• a.Cut it carefully with sharp nippers because the client requested it
• b.Trim only the top layer of that living skin and leave the rest
• c.Explain that this living skin is the eponychium and may not be cut, then gently push it back and remove only loose dead tissue✓
• d.Soak the finger in acetone until the skin dissolves

The band of living skin at the base of the plate is the eponychium, and cutting living tissue is outside a California manicurist's scope of practice no matter what the client asks for. Cutting it, even partially, breaks the seal that keeps bacteria out and invites infection. Only loose dead tissue sitting on the nail plate may be removed, and acetone does not and should not be used to dissolve skin.CA Business & Professions Code §7320

Which tissue is the true cuticle, the only tissue a manicurist may gently remove?

• a.The dead, colorless tissue that clings to the surface of the nail plate✓
• b.The living skin at the base of the nail plate
• c.The skin that seals underneath the free edge
• d.The wall of skin along each side of the nail

The true cuticle is dead, colorless tissue shed onto the surface of the nail plate, and because it is not living it may be softened and gently removed. The living skin at the base is the eponychium, the seal under the free edge is the hyponychium, and the skin along the sides is the nail fold or sidewall; all three are living and may never be cut. Confusing the eponychium with the cuticle is the most common reason technicians cut skin they should not touch.

A client asks you to dig deep underneath the free edge of her nails with a metal tool so they will be really clean. Why should you refuse?

• a.Because the free edge itself contains nerve endings and will bleed
• b.Because you would break the hyponychium, the skin seal under the free edge that keeps bacteria out✓
• c.Because the matrix is located directly under the free edge
• d.Because metal tools may never touch a natural nail plate

The hyponychium is the living skin that seals the space between the free edge and the fingertip, and it is a barrier against bacteria and fungus. Digging under the free edge tears that seal and creates a direct entry point for infection, so clean gently and only at the surface. The free edge is dead keratin with no nerves, the matrix is at the base of the nail rather than the tip, and disinfected metal implements are allowed when used correctly.

What is the function of the nail grooves and the nail folds (sidewalls)?

• a.They produce the new nail cells at the base of the nail
• b.They seal the nail plate so water cannot pass under it
• c.They deliver the blood supply directly into the nail plate
• d.They form the tracks and folds of skin that hold the nail plate and guide it as it grows forward✓

The nail grooves are the narrow tracks on each side of the nail bed, and the nail folds or sidewalls are the skin that overlaps them; together they hold the plate in place and steer its growth toward the fingertip. New nail cells come only from the matrix, the seal under the free edge is the hyponychium, and the plate itself has no blood supply because it is dead keratin. Filing or cutting into the sidewalls damages living skin and can lead to an ingrown nail.

A client has a dark stain on her natural nail close to the base and asks how long it will take to grow out completely. Based on normal nail growth, what should you tell her?

• a.About 4 to 6 months, because a fingernail grows roughly 1/10 inch (about 2.5 mm) per month✓
• b.About 3 to 4 weeks, since the whole nail is replaced every month
• c.About 2 years, the same as any nail on the body
• d.It will never grow out, because the stain is in the nail bed

A healthy fingernail grows about 1/10 inch, or roughly 2.5 mm, each month, so it takes about four to six months for a completely new plate to replace the old one. A nail is nowhere near replaced in a month, and two years is far longer than even a toenail needs. Telling her the stain is in the nail bed would be guessing at a medical explanation, which a manicurist may not do.

A client lost part of her big toenail after dropping something on her foot and wants to know how long it will take for a completely new toenail to replace it. What is the best answer?

• a.About 4 to 6 weeks
• b.About 4 to 6 months, the same as a fingernail
• c.About 9 to 12 months, because toenails grow more slowly than fingernails✓
• d.Toenails never fully replace themselves once they are lost

Toenails grow noticeably more slowly than fingernails and generally need about nine to twelve months to be completely replaced. Four to six weeks is nowhere near enough time, and four to six months is the timeline for a fingernail, not a toenail. Toenails do regrow as long as the matrix was not permanently destroyed, but growth also slows with age, poor circulation and illness.

A client removes her sandals and you see a thickened, yellow-green toenail that is crumbling at the edge and gives off a foul odor. What must you do?

• a.Buff the nail thin, disinfect extra well, and continue the pedicure
• b.Politely explain that you cannot perform the service and recommend that she see a physician✓
• c.Tell her she has a nail fungus and sell her an antifungal product from the retail shelf
• d.Service the other nine toes and simply skip that one

A thickened, discolored, crumbling nail with an odor shows signs of infection, and California manicurists may not service an infected nail. The correct response is to politely explain that you cannot perform the service and recommend she see a physician, without naming a disease. Buffing or filing it spreads the organism through the dust and around the salon, working around it still exposes the tools, the water and the next client, and naming the condition and selling a treatment is diagnosing and treating, which is outside your scope.California Board of Barbering and Cosmetology Health and Safety Regulations (CCR Title 16)

A regular client sits down and the skin around one fingernail is red, shiny, swollen and painful, with a small amount of pus at the nail fold. What is the correct action?

• a.Press gently to release the pus, then disinfect the area and continue
• b.Work around that finger and complete the other nine nails
• c.Tell her it is paronychia and that she needs an antibiotic
• d.Politely explain that you cannot perform the service and recommend that she see a physician✓

Redness, swelling, pain and pus are classic signs of an active infection, and a manicurist may not service infected skin or nails. You should politely explain that you cannot perform the service and recommend she see a physician. Squeezing pus spreads bacteria and can drive the infection deeper, working around the finger still puts your implements and the next client at risk, and naming the condition and recommending an antibiotic is a medical diagnosis you are not licensed to make.CA Business & Professions Code §7320

During a pedicure consultation you notice that the side of a client's big toe is swollen, warm and oozing fluid where the nail has grown down into the skin. What must you do?

• a.Politely explain that you cannot perform the service and recommend that she see a physician✓
• b.Lift the nail corner with a metal pusher and pack cotton underneath it
• c.Cut a V-shaped notch in the center of the nail so the corner will grow out
• d.Trim the ingrown corner out with nippers and apply antiseptic

Swelling, heat and discharge mean the ingrown toenail is already infected, and servicing infected tissue is prohibited, so you politely decline and recommend a physician or podiatrist. Digging the corner out or packing cotton under the nail means working on living, infected tissue and can push bacteria deeper. Cutting a V-notch does nothing to change how the nail grows, since growth comes only from the matrix, and applying antiseptic to an infection is treatment, which is outside a manicurist's scope.California Board of Barbering and Cosmetology Health and Safety Regulations (CCR Title 16)

A client's foot has itchy, peeling skin between the toes with raw, weeping cracks in it. What is the correct response?

• a.Soak the foot longer in the disinfected spa so the skin softens first
• b.Use a foot file on the peeling skin, then finish the pedicure while wearing gloves
• c.Politely explain that you cannot perform the service and recommend that she see a physician✓
• d.Apply an antifungal cream from your retail shelf and rebook her for next week

Broken, weeping skin is an open door for infection and is also a sign of a contagious condition, so no service may be performed and you politely refer her to a physician. Soaking or filing that skin spreads the organism into the tub, the file and the towels, and gloves protect you but do nothing to protect the client or the next client. Applying an antifungal product is treating a condition, and a manicurist may not treat or diagnose anything.California Board of Barbering and Cosmetology Health and Safety Regulations (CCR Title 16)

A teenage client is worried about small white spots scattered across several of her fingernails. The nail folds and surrounding skin look completely healthy. What should you do?

• a.Refuse the service, because white spots always mean a fungal infection
• b.Tell her the spots mean she is low on calcium and should take a supplement
• c.Scrape the spots off the nail plate with a metal pusher
• d.Explain that white spots (leukonychia) usually come from minor injury to the matrix, then continue the service as normal✓

Leukonychia is a harmless disorder, usually caused by a small bump or injury at the matrix, and because there is no infection you may service the nails normally. It is not a fungal infection, so refusing service is not needed, and the spots grow out on their own. Telling a client she is low on calcium is offering a medical or nutritional opinion you are not licensed to give, and the spots are inside the plate so scraping only thins and damages the nail.

A client has living skin that has grown forward and is stuck tightly to the surface of the nail plate, a condition called pterygium. What is the correct way to handle it?

• a.Cut the attached skin away with nippers so the nail looks longer
• b.Do not cut it; care for the area gently, keep it conditioned with oil, and refer her to a physician if it is severe✓
• c.File it off the nail plate with a coarse abrasive
• d.Leave an acid cuticle remover on it for twenty minutes until the skin releases

Pterygium is living skin, not dead cuticle, so cutting or filing it is cutting living tissue and is outside a manicurist's scope; it also makes the condition worse and can cause bleeding and infection. The correct approach is gentle care with oil and massage, and a referral to a physician if the growth is severe. A strong cuticle remover left on for twenty minutes will irritate and burn the skin without solving anything.CA Business & Professions Code §7320

A client who spent two weeks in the hospital with a high fever now has a deep horizontal groove running across every fingernail at about the same place, and she asks you what disease she has. How should you respond?

• a.Explain that grooves like these can appear after an illness because nail growth slows, that you are not permitted to diagnose, and that her doctor can answer health questions, then service the nails gently✓
• b.Tell her she has a serious internal disease and should stop getting manicures
• c.Diagnose it as a fungal infection and refuse all service
• d.Buff the grooves completely flat so the nails look smooth again

Horizontal grooves across the nails, known as Beau's lines, commonly follow a fever, illness or serious stress that temporarily slowed the matrix, and the nail is not infected, so it may be serviced gently. Nail changes can reflect general health, but a manicurist may never name a disease or make a diagnosis; that is the physician's job. Buffing the grooves flat would thin the plate and weaken it, and calling it a fungal infection is both wrong and a diagnosis you cannot make.CA Business & Professions Code §7320

How many bones are found in the wrist, the palm and the fingers of one hand?

• a.5 carpals in the wrist, 8 metacarpals in the palm and 12 phalanges in the fingers
• b.8 carpals in the wrist, 5 metacarpals in the palm and 14 phalanges in the fingers✓
• c.7 carpals in the wrist, 5 metacarpals in the palm and 26 phalanges in the fingers
• d.8 carpals in the wrist, 14 metacarpals in the palm and 5 phalanges in the fingers

Each hand has 8 carpals in the wrist, 5 metacarpals in the palm and 14 phalanges in the fingers, because the thumb has two phalanges and each of the other four fingers has three. The forearm you massage above the wrist has only two bones, the radius on the thumb side and the ulna on the little-finger side. The other choices simply swap those numbers around; 7 is the number of tarsals in the foot, not carpals in the wrist.

You are massaging a client's lower leg and foot during a pedicure. Which statement about the bones you are working over is correct?

• a.The lower leg has a single bone called the fibula, and the foot has 14 bones in total
• b.The lower leg contains the radius and the ulna, and the foot has 26 bones
• c.The tibia is the small outer bone and the fibula is the large shin bone, and the foot has 19 bones
• d.The tibia is the large inner shin bone and the fibula is the smaller outer bone, and the foot has 26 bones: 7 tarsals, 5 metatarsals and 14 phalanges✓

The lower leg has two bones, the larger tibia along the inner shin and the thinner fibula on the outer side, and each foot has 26 bones made up of 7 tarsals, 5 metatarsals and 14 phalanges. The radius and ulna are forearm bones, not leg bones. The remaining choices either drop a bone from the lower leg or reverse the sizes of the tibia and fibula.

While massaging a client's lower leg you work the muscle that runs down the front of the shin and lifts the foot upward at the ankle. Which muscle is it?

• a.The gastrocnemius
• b.The soleus
• c.The tibialis anterior✓
• d.The peroneus longus

The tibialis anterior lies along the front of the shin and pulls the foot upward, so it is the muscle you feel there. The gastrocnemius and the soleus are the calf muscles at the back of the leg and they point the foot downward, while the peroneus longus turns the foot outward. In the hand, remember that flexors bend the fingers, extensors straighten them, abductors spread them apart and adductors draw them back together.