,NU 518 Exam 3 | Advanced Nursing Assessment (2026)
Q&A | University of South Alabama
1. Which pigment is responsible for the yellow coloration of the skin in a client
with jaundice?
A) Melanin
B) Carotene
C) Bilirubin
D) Hemoglobin
Correct Answer: Bilirubin
Rationale: Jaundice results from increased bilirubin, a yellow-brown pigment
arising from the breakdown of heme in red blood cells. Melanin is a brownish
pigment increased by sunlight, carotene is a yellow pigment found in
subcutaneous fat, and hemoglobin is the oxygen-carrying pigment in red blood
cells.
2. A flat, circumscribed skin lesion measuring 0.5 cm in diameter is best
documented as which type of primary lesion?
A) Macule
B) Papule
C) Vesicle
D) Bulla
Correct Answer: Macule
,Rationale: A macule is a flat, circumscribed lesion smaller than 1 cm. A papule is
raised and smaller than 1 cm, a vesicle is a small fluid-filled lesion, and a bulla is a
larger fluid-filled lesion. Accurate lesion description guides differential diagnosis.
3. Which skin finding is most suggestive of actinic keratosis?
A) A pearly nodule with telangiectasia
B) A rough, scaly patch on sun-exposed skin
C) An irregular, multicolored macule
D) A violaceous plaque on the lower leg
Correct Answer: A rough, scaly patch on sun-exposed skin
Rationale: Actinic keratosis presents as rough, scaly patches on sun-exposed
areas and is considered a precancerous lesion. A pearly nodule suggests basal cell
carcinoma, an irregular multicolored macule suggests melanoma, and a violaceous
plaque suggests other dermatoses.
4. A client’s skin is cool, pale, and mottled with a capillary refill of 4 seconds.
Which underlying process should the nurse suspect?
A) Increased melanin production
B) Decreased peripheral perfusion
C) Excessive carotene intake
D) Bilirubin deposition
Correct Answer: Decreased peripheral perfusion
, Rationale: Cool, pale, mottled skin with prolonged capillary refill suggests
decreased peripheral perfusion from shock, vasoconstriction, or arterial
insufficiency. Melanin, carotene, and bilirubin affect skin color but do not produce
these circulatory findings.
5. Which nail finding is associated with chronic hypoxemia?
A) Koilonychia
B) Clubbing
C) Beau’s lines
D) Splinter hemorrhages
Correct Answer: Clubbing
Rationale: Clubbing—increased curvature and thickening of the nail bed—is
associated with chronic hypoxemia from conditions such as cystic fibrosis or
congenital heart disease. Koilonychia suggests iron deficiency, Beau’s lines
indicate interrupted growth, and splinter hemorrhages suggest endocarditis.
6. A client reports patchy hair loss with scaling and pustules on the scalp. Which
condition should the nurse suspect?
A) Alopecia areata
B) Tinea capitis
C) Telogen effluvium
D) Androgenetic alopecia
Correct Answer: Tinea capitis
Q&A | University of South Alabama
1. Which pigment is responsible for the yellow coloration of the skin in a client
with jaundice?
A) Melanin
B) Carotene
C) Bilirubin
D) Hemoglobin
Correct Answer: Bilirubin
Rationale: Jaundice results from increased bilirubin, a yellow-brown pigment
arising from the breakdown of heme in red blood cells. Melanin is a brownish
pigment increased by sunlight, carotene is a yellow pigment found in
subcutaneous fat, and hemoglobin is the oxygen-carrying pigment in red blood
cells.
2. A flat, circumscribed skin lesion measuring 0.5 cm in diameter is best
documented as which type of primary lesion?
A) Macule
B) Papule
C) Vesicle
D) Bulla
Correct Answer: Macule
,Rationale: A macule is a flat, circumscribed lesion smaller than 1 cm. A papule is
raised and smaller than 1 cm, a vesicle is a small fluid-filled lesion, and a bulla is a
larger fluid-filled lesion. Accurate lesion description guides differential diagnosis.
3. Which skin finding is most suggestive of actinic keratosis?
A) A pearly nodule with telangiectasia
B) A rough, scaly patch on sun-exposed skin
C) An irregular, multicolored macule
D) A violaceous plaque on the lower leg
Correct Answer: A rough, scaly patch on sun-exposed skin
Rationale: Actinic keratosis presents as rough, scaly patches on sun-exposed
areas and is considered a precancerous lesion. A pearly nodule suggests basal cell
carcinoma, an irregular multicolored macule suggests melanoma, and a violaceous
plaque suggests other dermatoses.
4. A client’s skin is cool, pale, and mottled with a capillary refill of 4 seconds.
Which underlying process should the nurse suspect?
A) Increased melanin production
B) Decreased peripheral perfusion
C) Excessive carotene intake
D) Bilirubin deposition
Correct Answer: Decreased peripheral perfusion
, Rationale: Cool, pale, mottled skin with prolonged capillary refill suggests
decreased peripheral perfusion from shock, vasoconstriction, or arterial
insufficiency. Melanin, carotene, and bilirubin affect skin color but do not produce
these circulatory findings.
5. Which nail finding is associated with chronic hypoxemia?
A) Koilonychia
B) Clubbing
C) Beau’s lines
D) Splinter hemorrhages
Correct Answer: Clubbing
Rationale: Clubbing—increased curvature and thickening of the nail bed—is
associated with chronic hypoxemia from conditions such as cystic fibrosis or
congenital heart disease. Koilonychia suggests iron deficiency, Beau’s lines
indicate interrupted growth, and splinter hemorrhages suggest endocarditis.
6. A client reports patchy hair loss with scaling and pustules on the scalp. Which
condition should the nurse suspect?
A) Alopecia areata
B) Tinea capitis
C) Telogen effluvium
D) Androgenetic alopecia
Correct Answer: Tinea capitis
