Nurse Practitioners in Primary
Care I
Wilkes University
NSG554/NSG 554 Exam 2
Questions & Answers Plus
Detailed Rationales
Latest 2026 | PDF
THIS EXAM CONTAINS:
✓100% Pass
✓Multiple Choice ( A-D)
✓Detailed Rationales For Each Question
✓Correct Answers For Each Question
✓100 Qs & Answers
,SECTION 1: Dermatology – Skin Assessment and Lesion
Identification (Questions 1-15)
Question 1
A primary care provider is performing a skin assessment on a 55-
year-old patient. Which of the following findings is most
concerning for melanoma?
A. A 6 mm brown macule with uniform color on the forearm
B. A 10 mm asymmetric lesion with irregular borders and
multiple colors on the back
C. A 4 mm pink papule with well-defined borders on the cheek
D. A 3 mm flesh-colored dome-shaped papule on the neck
Answer: B. A 10 mm asymmetric lesion with irregular
borders and multiple colors on the back
Rationale: Melanoma is characterized by the ABCDE criteria:
Asymmetry, Border irregularity, Color variation (multiple colors),
Diameter > 6 mm, and Evolution/changing over time. A lesion
that is asymmetric, has irregular borders, and contains multiple
colors is highly suspicious for melanoma. Uniformly colored
macules, well-defined pink papules, and flesh-colored dome-
shaped papules are more consistent with benign lesions such as
seborrheic keratosis, intradermal nevi, or dermatofibromas.
Question 2
A 62-year-old farmer presents with a scaly, erythematous plaque
on his right cheek that has been present for 6 months. He reports
,the lesion bleeds occasionally when scratched. What is the most
likely diagnosis?
A. Actinic keratosis
B. Squamous cell carcinoma
C. Basal cell carcinoma
D. Seborrheic keratosis
Answer: B. Squamous cell carcinoma
Rationale: Squamous cell carcinoma (SCC) often presents as a
scaly, erythematous plaque or nodule that may bleed, crust, or
ulcerate. It typically occurs on sun-exposed areas in patients with
chronic sun exposure. Actinic keratosis is a precursor lesion that
is usually smaller, less indurated, and does not typically bleed.
Basal cell carcinoma often presents as a pearly, telangiectatic
nodule with a rolled border. Seborrheic keratosis is a benign,
waxy, stuck-on appearing lesion.
Question 3
A 70-year-old patient presents with a slowly growing, pearly pink
nodule on the nose with visible telangiectasias and a central
ulceration. What is the most likely diagnosis?
A. Squamous cell carcinoma
B. Basal cell carcinoma
C. Melanoma
D. Actinic keratosis
Answer: B. Basal cell carcinoma
, Rationale: Basal cell carcinoma (BCC) is the most common skin
cancer and typically presents as a pearly, translucent, or pink
nodule with telangiectasias and a rolled border. Central
ulceration (rodent ulcer) is a classic feature. BCC is most common
on sun-exposed areas of the head and neck. It grows slowly and
rarely metastasizes but can cause significant local tissue
destruction.
Question 4
A 45-year-old patient presents with a new 8 mm lesion on the
lower leg that is dark brown to black with irregular borders and
areas of regression (white, scar-like areas). What is the most
appropriate next step?
A. Reassure the patient and schedule routine follow-up in 6
months
B. Perform a shave biopsy
C. Perform an excisional biopsy with 1-2 mm margins
D. Prescribe topical 5-fluorouracil
Answer: C. Perform an excisional biopsy with 1-2 mm
margins
Rationale: This lesion has features suspicious for melanoma
(irregular borders, color variation, areas of regression). The
standard of care for suspicious pigmented lesions is excisional
biopsy with 1-2 mm margins to allow for complete histologic
evaluation and accurate Breslow depth measurement. Shave
biopsy is contraindicated for suspected melanoma as it can
transect the lesion and prevent accurate staging. Observation or
topical therapy is not appropriate for suspicious lesions.
Care I
Wilkes University
NSG554/NSG 554 Exam 2
Questions & Answers Plus
Detailed Rationales
Latest 2026 | PDF
THIS EXAM CONTAINS:
✓100% Pass
✓Multiple Choice ( A-D)
✓Detailed Rationales For Each Question
✓Correct Answers For Each Question
✓100 Qs & Answers
,SECTION 1: Dermatology – Skin Assessment and Lesion
Identification (Questions 1-15)
Question 1
A primary care provider is performing a skin assessment on a 55-
year-old patient. Which of the following findings is most
concerning for melanoma?
A. A 6 mm brown macule with uniform color on the forearm
B. A 10 mm asymmetric lesion with irregular borders and
multiple colors on the back
C. A 4 mm pink papule with well-defined borders on the cheek
D. A 3 mm flesh-colored dome-shaped papule on the neck
Answer: B. A 10 mm asymmetric lesion with irregular
borders and multiple colors on the back
Rationale: Melanoma is characterized by the ABCDE criteria:
Asymmetry, Border irregularity, Color variation (multiple colors),
Diameter > 6 mm, and Evolution/changing over time. A lesion
that is asymmetric, has irregular borders, and contains multiple
colors is highly suspicious for melanoma. Uniformly colored
macules, well-defined pink papules, and flesh-colored dome-
shaped papules are more consistent with benign lesions such as
seborrheic keratosis, intradermal nevi, or dermatofibromas.
Question 2
A 62-year-old farmer presents with a scaly, erythematous plaque
on his right cheek that has been present for 6 months. He reports
,the lesion bleeds occasionally when scratched. What is the most
likely diagnosis?
A. Actinic keratosis
B. Squamous cell carcinoma
C. Basal cell carcinoma
D. Seborrheic keratosis
Answer: B. Squamous cell carcinoma
Rationale: Squamous cell carcinoma (SCC) often presents as a
scaly, erythematous plaque or nodule that may bleed, crust, or
ulcerate. It typically occurs on sun-exposed areas in patients with
chronic sun exposure. Actinic keratosis is a precursor lesion that
is usually smaller, less indurated, and does not typically bleed.
Basal cell carcinoma often presents as a pearly, telangiectatic
nodule with a rolled border. Seborrheic keratosis is a benign,
waxy, stuck-on appearing lesion.
Question 3
A 70-year-old patient presents with a slowly growing, pearly pink
nodule on the nose with visible telangiectasias and a central
ulceration. What is the most likely diagnosis?
A. Squamous cell carcinoma
B. Basal cell carcinoma
C. Melanoma
D. Actinic keratosis
Answer: B. Basal cell carcinoma
, Rationale: Basal cell carcinoma (BCC) is the most common skin
cancer and typically presents as a pearly, translucent, or pink
nodule with telangiectasias and a rolled border. Central
ulceration (rodent ulcer) is a classic feature. BCC is most common
on sun-exposed areas of the head and neck. It grows slowly and
rarely metastasizes but can cause significant local tissue
destruction.
Question 4
A 45-year-old patient presents with a new 8 mm lesion on the
lower leg that is dark brown to black with irregular borders and
areas of regression (white, scar-like areas). What is the most
appropriate next step?
A. Reassure the patient and schedule routine follow-up in 6
months
B. Perform a shave biopsy
C. Perform an excisional biopsy with 1-2 mm margins
D. Prescribe topical 5-fluorouracil
Answer: C. Perform an excisional biopsy with 1-2 mm
margins
Rationale: This lesion has features suspicious for melanoma
(irregular borders, color variation, areas of regression). The
standard of care for suspicious pigmented lesions is excisional
biopsy with 1-2 mm margins to allow for complete histologic
evaluation and accurate Breslow depth measurement. Shave
biopsy is contraindicated for suspected melanoma as it can
transect the lesion and prevent accurate staging. Observation or
topical therapy is not appropriate for suspicious lesions.
