Health Assessment and Physical

Examination Australian and New

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CHAPTER 8: SKIN, HAIR, AND NAILS

MULTIPLE CHOICE

1. The skin is the largest organ in the body and has all of the following functions except:
a. temperature control.
b. protection.
c. secretion.
d. pain control.

ANS: D PTS: 1 DIF: Moderate TOP: Skin

2. The order of the integumentary system from the outermost layer to the innermost layer is:
a. epidermis, hypodermis, dermis.
b. dermis, subcutaneous tissue, epidermis.
c. epidermis, dermis, subcutaneous tissue.
d. subcutaneous tissue, dermis, epidermis.
ANS: C PTS: 1 DIF: Easy TOP: Skin

3. The palms of the hands and soles of the feet have an extra epidermal layer called the:
a. stratum corneum.
b. stratum lucidum.
c. stratum granulosum.
d. stratum spinosum.
ANS: B PTS: 1 DIF: Easy TOP: Epidermis

4. Which skin diseases are found more commonly in light-skinned than in dark-skinned individuals?
a. keloid formation and acne keloidal folliculitis
b. dermatosis papulosa nigra and seborrheic dermatitis
c. squamous and basal cell carcinoma and actinic keratosis
d. hypopigmented sarcoidosis and granulomatous skin lesions
ANS: C PTS: 1 DIF: Easy TOP: Health history: Race:
light skinned

5. A patient complaining of pruritus should be assessed for associated signs and symptoms including:
a. rash and oedema.
b. coolness and pallor.
c. cyanosis and coolness.
d. ecchymosis and purpura.
ANS: A PTS: 1 DIF: Moderate TOP: Health history: Pruritus

6. When assessing Ms D, who complains of a problem with her fingernails, the nurse should
specifically question her about a history of:
a. eczema, melanoma and herpes zoster.
b. psoriasis, fungal infections and trauma.
c. alopecia, trichotillomania and chemotherapy.
d. vitiligo and lupus erythematosus.
ANS: B PTS: 1 DIF: Difficult TOP: Health History: Medical
history: Nail specific
 7. Which diseases, reported by Mr R during his family health history, are familial in nature?
a. cutaneous moniliasis and paronychia
b. pediculosis pubis and tinea capitis
c. psoriasis, brittle nails and hair loss
d. verruca vulgaris and acne
ANS: C PTS: 1 DIF: Moderate TOP: Family health history

8. Which skin manifestation caused by substance abuse is related to alcohol abuse?

a. yellow discolouration of the fingertips of one hand
b. telangiectasia (spider veins) on the nose, neck and upper chest
c. leathery facial appearance
d. bruises between the toes and under the nails
ANS: B PTS: 1 DIF: Moderate TOP: Drug use

9. Ms S, a 20-year-old college student, worked for the past four summers as a lifeguard at the
community swimming pool. During her assessment, she asks many questions related to the care of
her skin and hair. Because Ms S’s work environment involved daily exposure to sunlight she is at
risk for:
a. contact dermatitis and eczema.
b. rashes, urticaria and angioedema.
c. basal or squamous cell carcinoma and wrinkles.
d. seborrheic keratosis and acne.
ANS: C PTS: 1 DIF: Difficult TOP: Health history:
Work environment

10. Ms S, a 20-year-old college student, worked for the past four summers as a lifeguard at the
community swimming pool. During her assessment, she asks many questions related to the care of
her skin and hair. You ask Ms S a number of questions so that together you can develop a realistic
plan of care for her skin and hair. Which question is the least helpful?
a. Do you wear a hat, visor, long sleeves or pants in the sun?
b. Do you use a hair dryer, heated curlers or curling iron?
c. How frequently do you cut your hair?
d. What strength of sunscreen product do you use?
ANS: C PTS: 1 DIF: Difficult
TOP: Clinical reasoning: Specific health history questions regarding the skin, hair, and nails

11. Ms B relates that she has received a weekly manicure and pedicure in various commercial salons
within and outside of the United States for many years. You caution her that because standards of
sterilising equipment used in salons vary, she has an increased risk of:
a. hepatitis B.
b. Staphylococcus infection.
c. Candidiasis infection.
d. herpes simplex infection.
ANS: A PTS: 1 DIF: Moderate TOP: Health promotion:
manicures and pedicures

12. When performing an assessment of skin, hair and nails, you should enhance your visual inspection
by using a magnifying glass and the best source of light, which is:
a. daylight.
 b. fluorescent light.
c. incandescent light.
d. a flashlight.
ANS: A PTS: 1 DIF: Easy TOP: Approach to skin, hair,
and nails assessment

13. When inspecting the skin, you should observe each area for the ten key characteristics. These are
colour, moisture, temperature, texture, turgor, oedema,:
a. lesions, vascularity, bleeding and ecchymosis.
b. pigmentation, bruising, bleeding and eruptions.
c. xerosis, ecchymosis, distribution of hair and vascularity.
d. vascularity, pigmentation, xerosis and lesions.
ANS: A PTS: 1 DIF: Easy TOP: Inspection of the
skin

14. The presence of jaundice in a dark-skinned individual appears as a yellow to orange colouration of
the:
a. skin, mucous membranes and palmar and plantar surfaces.
b. fingernails and skin.
c. sclera, hard palate and palmar and plantar surfaces.
d. sclera only.
ANS: C PTS: 1 DIF: Moderate TOP: Inspection of the
skin: Colour

15. Light-skinned patients with chronic renal disease often have a characteristic skin colour associated
with retained urochrome pigments and anemia described as:
a. bright red to ruddy appearance.
b. greyish cast to their skin.
c. orange-yellow colouration.
d. brown cast to their skin.
ANS: B PTS: 1 DIF: Moderate TOP: Inspection of the
skin: Colour

16. A white cast to the skin resulting from a congenital inability to form melanin is known as:
a. vitiligo.
b. pallor.
c. jaundice.
d. albinism.
ANS: D PTS: 1 DIF: Easy TOP: Inspection of the
skin: Colour

17. Small, reddish purple discolourations of the skin, less than 0.5 cm in diameter, are known as:
a. ecchymoses.
b. petechiae.
c. purpura.
d. spider telangiectasia.
ANS: B PTS: 1 DIF: Moderate TOP: Bleeding, ecchymosis,
and vascularity
18. You are most likely to find petechiae during an assessment of a dark-skinned individual when
inspecting the:
a. palmar surfaces.
b. mucous membranes and axillae.
c. sclera of the eyes.
d. tongue.
ANS: B PTS: 1 DIF: Moderate TOP: Bleeding, ecchymosis,
and vascularity

19. Ecchymoses on the face, breasts and buttocks of a 14-year-old girl are most likely to be related to:
a. liver dysfunction.
b. heparin or Coumadin use.
c. trauma from physical abuse.
d. familial blood condition.
ANS: C PTS: 1 DIF: Difficult TOP: Urgent finding: Signs of
abuse

20. A bright red, star-shaped lesion on the face, neck or chest that blanches with pressure is called a:
a. venous star.
b. cherry angioma.
c. hemangioma.
d. spider angioma.
ANS: D PTS: 1 DIF: Moderate TOP: Bleeding, ecchymosis,
and vascularity

21. The terms discrete, linear, annular and zosteriform refer to which characteristic of skin lesions?
a. morphology
b. size
c. grouping or arrangement
d. types of exudate
ANS: C PTS: 1 DIF: Moderate TOP: Lesions

22. A nodule is an example of which type of lesion?

a. nonpalpable
b. palpable
c. secondary
d. tertiary
ANS: B PTS: 1 DIF: Easy TOP: Figure 8.8 Morphology
of primary lesions

23. Mr D shows you an area on his right hand where a loss of epidermal tissue exposes the dermis.
You recognise this lesion as a(n):
a. excoriation.
b. wheal.
c. keloid.
d. scar.
ANS: A PTS: 1 DIF: Difficult TOP: Figure 8.9 Morphology
of secondary lesions
24. Ms K expresses concern about a mole on her right leg that has recently started itching. Which
accompanying finding most likely indicates a developing cancerous lesion?
a. regular and distinct border
b. multiple colourations
c. edema in both feet
d. inflammation of periungual tissue
ANS: B PTS: 1 DIF: Difficult
TOP: Urgent finding: Skin self-assessment

25. The patient shows you several symmetrical white patchy area on his skin. You consider the
possibility that this is caused by
a. vitiligo.
b. skin cancer.
c. systemic lupus erythematosus.
d. albinism.

ANS: A PTS: 1 DIF: Moderate TOP: Skin

26. Which individual should receive further assessment to determine the cause of the change in hair
distribution?
a. Mr B, 60 years old, has lost all of the hair on his scalp over the past 15 years.
b. Mrs Y, 26 years old, has experienced an increase of facial hair in the past year.
c. Mr K, 55 years old, has developed coarse dark hairs in his ears and nose.
d. Ms W, 11 years old, has recently developed several dark hairs in her axillae and pubic
area.
ANS: B PTS: 1 DIF: Difficult TOP: Inspection of the hair:
Distribution

27. When capillary refill is checked, the amount of time for the nail colour to return after the pressure
is released on the patient’s nail should not exceed:
a. 1–2 seconds.
b. 2–3 seconds.
c. 3–4 seconds.
d. 4–5 seconds.
ANS: B PTS: 1 DIF: Easy TOP: Inspection of the nails:
Colour

28. Clubbing occurs when:

a. purpura or ecchymosis develops under the nail plate.
b. the nail separates from the nail bed.
c. depression ridges develop horizontally down the middle of the nail.
d. the nail base is spongy and the angle is greater than 160°.
ANS: D PTS: 1 DIF: Difficult TOP: Shape and configuration

29. Central cyanosis is secondary to:

a. changes in outside temperature.
b. marked heart and lung disease.
c. nervous anxiety.
d. age-related changes in skin colour.

ANS: B PTS: 1 DIF: Easy TOP: Inspection of the

 Skin: Colour

30. A 5-year-old girl has had a rash on her arms and trunk for the past 48 hours and complains of
pruritus. Three types of lesions are noted: macules, papules, and vesicles. Some of the vesicles
have crusts. Based on your assessment, you conclude the girl has which disorder?
a. varicella
b. scabies
c. psoriasis
d. impetigo
ANS: A PTS: 1 DIF: Difficult TOP: Lesions

31. Which of the following is a priority to include when instructing a patient to perform a skin
assessment?
a. ‘Begin performing skin examinations after age 40.’
b. Look for any changes in moles, especially colour and size.’
c. ‘Evaluate the evenness of skin colour, moisture, and temperature.’
d. ‘Assess the entire body and look for changes in skin or moles.’
ANS: D PTS: 1 DIF: Difficult
TOP: Urgent finding: Skin self-assessment

32. The nurse is caring for a patient with a burn injury. Which of the following assessments would
provide the nurse with the most accurate information about the type of burn?
a. red, dry, painful skin with no blisters
b. red, blistery, painful skin with serous exudate
c. leathery, dry, hard, painless skin
d. leathery, dry, hard, painless skin with exposed and damaged muscle and bone
ANS: C PTS: 1 DIF: Moderate TOP: Clinical reasoning:
Identifying Burns

33. Skin turgor or elasticity is assessed by;

a. palpating an areas of skin with your finger pads.
b. pinching an area of skin and releasing it quickly.
c. pinching a small area of skin between your thumb and forefinger and releasing it slowly.
d. palpating an are of skin with the dorsal aspect of your hand.

ANS: C Pts: 1 DIF: Easy TOP: Skin Turgor

34. The patient presents with a mole on their leg. The most useful neumonic for assessing the mole is
a. PQRST.
b. ABCDE.
c. SAMPLE.
d. HIPA.

ANS: B PTS: 1 DIF: Easy TOP: Skin

35. A patient with the following condition can present with cyanosis but still have a normal
Haemaglobin, Hematocrit, and normal perfusion:
a. jaundice.
b. sickle cell anemia.
c. anemia.
d. polycythaemia.
 ANS: D PTS: 1 DIF: Moderate TOP: Skin

36. Non mucous membrane skin areas are palpated for moisture using which part of the hand.
a. dorsal
b. palmar
c. fingertips
d. ulnar side

ANS: A PTS: 1 DIF: Moderate TOP: Skin

COMPLETION

1. Located in subcutaneous tissue, ____________________ cells trigger the body’s reaction to

allergens.

ANS:
mast
PTS: 1 DIF: Easy TOP: Subcutaneous tissue

2. The fine hair that covers the majority of the body is called ____________________ hair.

ANS:
vellus
PTS: 1 DIF: Easy TOP: Hair

3. A white cast to the skin resulting from a congenital inability to form melanin is known as
____________________.

ANS:
albinism
PTS: 1 DIF: Easy TOP: Inspection of the skin: Colour

4. A stage ____________________ pressure ulcer will show damage to the subcutaneous tissues.

ANS:
three
PTS: 1 DIF: Moderate TOP: Urgent finding: Stages of pressure ulcers

5. The largest organ of the body is the skin, also known as the ____________________ system, or
cutaneous tissue.

ANS:
integumentary
PTS: 1 DIF: Easy TOP: Background

6. Cooling of the skin is called _________________.

ANS: hypothermia
Pts: 1 DIF: Easy TOP: Skin Temperature

7. Skin turgor or skin elasticity is an indication of the skins state of ______________.

ANS: hydration
Pts: 1 DIF: Easy TOP: Skin

8. An accumulation of fluid in the intracellura spaces is called ____________.

ANS: oedema
Pts: 1 DIF: Moderate TOP: Skin Temperature