NURS 330 Exam 3 UPDATED ACTUAL Questions and CORRECT
Answers
How is a skin assessment typically performed? It is integrated with other assessments or could be conducted as a stand-alone
focused clinical visit (i.e., concerned about a skin condition).
What elements are included in the inspection phase of a - Inspect for color, texture, moisture, and integrity.
skin assessment? - Color should be appropriate for ethnicity.
What elements are included in the palpation phase of a Palpate for texture, moisture, temperature (use back of hand), mobility (does the
skin assessment? skin move?), and turgor (elasticity).
What health promotion topics are part of the skin Health promotion about skin & nail care and prevention of skin cancer.
assessment?
What are the five main functions of the skin and nails? - Protect the inner body parts & organs.
- Body temp regulation through shivering & sweating.
- Sensory perception of temp, touch, & pain.
- Excrete waste & toxic substances.
- Produce vitamin D.
What are some key points to ask about during the skin - Past history of skin disease.
health history? - Family history of skin cancer.
- Change in pigmentation.
- Change in mole (color, size, shape, sudden appearance of tenderness, bleeding,
or itching - signs that suggest neoplasm).
- Excessive dryness or moisture.
- pruritis.
What is pruritis and what can it occur with? - Pruritis is itching.
- It occurs with dry skin, aging, drug reaction, allergy, uremia, or lice.
- Can cause excoriation.
, What is excoriation? Excoriation is skin breakdown that occurs when the top surface of the skin is
scratched off.
What is important to inquire about regarding excessive - Various stages of healing.
bruising? - Inquire about how the bruise happened.
What are the four stages of a Haematoma/Bruise color - Stage 1: Reddish.
change? - Stage 2: Purple.
- Stage 3: Blueish.
- Stage 4: Yellowish.
What key questions should be asked about a rash or - Location (gives a clue to possible cause).
lesions? - Is the rash raised or flat? Is it tender, warm? Does it crust? Or have an odor?
- Have you had this rash before?
- Exposure to new environmental agents, such as a new pet, food, drug, soap,
shampoo, etc.?
- Is it pruritic (itchy)?
What other health history items are important for the skin - Medication.
assessment? - Change in Nails (e.g., brittleness).
- Environmental or occupational hazards:
- People at risk: farmers, sailors, construction workers.
- use of sunscreen when out in the sun?
What does patient-centered care include in the skin Inquiring about self-care—skin care routine, nails and hair care?
assessment?
Why should a nurse consciously attend to skin - you grow so accustomed to seeing the skin that you are likely to ignore it as you
characteristics during an assessment? assess the organ systems underneath.
- The skin holds information about the body's circulation (cyanosis, discoloration,
blanching), nutritional status (iron deficiencies - bruise easier or pallor), and signs
of systemic diseases ( jaundice).
What three external variables can influence skin color? Emotions, Environment, and Physical state.
What is the first step in assessing skin color? Start by knowing the person's normal skin color.
What is the expected finding for skin color? Color is even and consistent with genetic background.
What is Vitiligo? patches of non-pigmented skin
What are Freckles? Small, flat macules of brown melanin pigment that occur on sun-exposed skin.
What are some other expected variations in skin color? Birthmarks and old scars.
skin color unexpected findings - pallor (white)
- Erythema (red)
- cyanosis (blue)
- jaundice (yellow)
- ecchymosis
Answers
How is a skin assessment typically performed? It is integrated with other assessments or could be conducted as a stand-alone
focused clinical visit (i.e., concerned about a skin condition).
What elements are included in the inspection phase of a - Inspect for color, texture, moisture, and integrity.
skin assessment? - Color should be appropriate for ethnicity.
What elements are included in the palpation phase of a Palpate for texture, moisture, temperature (use back of hand), mobility (does the
skin assessment? skin move?), and turgor (elasticity).
What health promotion topics are part of the skin Health promotion about skin & nail care and prevention of skin cancer.
assessment?
What are the five main functions of the skin and nails? - Protect the inner body parts & organs.
- Body temp regulation through shivering & sweating.
- Sensory perception of temp, touch, & pain.
- Excrete waste & toxic substances.
- Produce vitamin D.
What are some key points to ask about during the skin - Past history of skin disease.
health history? - Family history of skin cancer.
- Change in pigmentation.
- Change in mole (color, size, shape, sudden appearance of tenderness, bleeding,
or itching - signs that suggest neoplasm).
- Excessive dryness or moisture.
- pruritis.
What is pruritis and what can it occur with? - Pruritis is itching.
- It occurs with dry skin, aging, drug reaction, allergy, uremia, or lice.
- Can cause excoriation.
, What is excoriation? Excoriation is skin breakdown that occurs when the top surface of the skin is
scratched off.
What is important to inquire about regarding excessive - Various stages of healing.
bruising? - Inquire about how the bruise happened.
What are the four stages of a Haematoma/Bruise color - Stage 1: Reddish.
change? - Stage 2: Purple.
- Stage 3: Blueish.
- Stage 4: Yellowish.
What key questions should be asked about a rash or - Location (gives a clue to possible cause).
lesions? - Is the rash raised or flat? Is it tender, warm? Does it crust? Or have an odor?
- Have you had this rash before?
- Exposure to new environmental agents, such as a new pet, food, drug, soap,
shampoo, etc.?
- Is it pruritic (itchy)?
What other health history items are important for the skin - Medication.
assessment? - Change in Nails (e.g., brittleness).
- Environmental or occupational hazards:
- People at risk: farmers, sailors, construction workers.
- use of sunscreen when out in the sun?
What does patient-centered care include in the skin Inquiring about self-care—skin care routine, nails and hair care?
assessment?
Why should a nurse consciously attend to skin - you grow so accustomed to seeing the skin that you are likely to ignore it as you
characteristics during an assessment? assess the organ systems underneath.
- The skin holds information about the body's circulation (cyanosis, discoloration,
blanching), nutritional status (iron deficiencies - bruise easier or pallor), and signs
of systemic diseases ( jaundice).
What three external variables can influence skin color? Emotions, Environment, and Physical state.
What is the first step in assessing skin color? Start by knowing the person's normal skin color.
What is the expected finding for skin color? Color is even and consistent with genetic background.
What is Vitiligo? patches of non-pigmented skin
What are Freckles? Small, flat macules of brown melanin pigment that occur on sun-exposed skin.
What are some other expected variations in skin color? Birthmarks and old scars.
skin color unexpected findings - pallor (white)
- Erythema (red)
- cyanosis (blue)
- jaundice (yellow)
- ecchymosis
