2025 Wilson Clinical Reasoning Questions for
Nurse 1145 Final Exam : Expert Review and
Preparation Guide
1. A patient has edema and redness of the skin surrounding the nail on his right
index finger. Which data elected from his history best explains this condition?
A. He has a family history of liver disease.
B. There has been a scabies outbreak among his family members.
C. He has a new full-time position as a dishwasher at a local restaurant.
D. He had several warts removed from his hand two years ago.
Correct answer: C. He has a new full-time position as a dishwasher at a local
restaurant.
Rationale: Working as a dishwasher involves frequent exposure to water and cleaning
agents, which can irritate the skin and cause inflammation around the nails, possibly
leading to conditions like paronychia (infection of the nail fold), which could explain the
edema and redness.
2. When examining a 16-year-old male patient, the nurse notes multiple pustules
and comedones on the face. The nurse recognizes that increased activity of which
cells or glands produced these manifestations?
A. Epidermal cells
B. Eccrine glands
C. Apocrine glands
D. Sebaceous glands
Correct answer: D. Sebaceous glands
Rationale: Sebaceous glands are responsible for producing sebum, an oily substance
that, when overproduced or blocked, can result in acne, characterized by pustules (pus-
filled lesions) and comedones (blackheads and whiteheads), especially common
during adolescence.
3. A patient with darkly pigmented skin has been admitted to the hospital with
hepatitis. What is the best way for the nurse to assess for jaundice in this patient?
,A. Inspect the color of the sclera.
B. Inspect genitalia for color.
C. Blanch the fingernails.
D. Jaundice cannot be assessed in patients with darkly pigmented skin.
Correct answer: A. Inspect the color of the sclera.
Rationale: Jaundice is best assessed in the sclera (white part of the eyes), which tends
to turn yellow with elevated bilirubin levels, even in patients with darkly pigmented skin.
This method provides the most reliable indication of jaundice.
4. A patient has multiple solid, red, raised lesions on her legs and groin that she
describes as "itchy insect bites." How does the nurse document these lesions?
1. Wheals
2. Bullae
3. Tumors
4. Plaques
Correct answer: 1. Wheals
Rationale: Wheals are raised, red, itchy lesions often caused by allergic reactions, such
as insect bites. They are transient, meaning they typically resolve within hours, and are
described as hives or welts.
5. The nurse observes multiple red circular lesions with central clearing that are
scattered all over the abdomen and thorax. How does the nurse document the
shape and pattern of these lesions?
1. Gyrate and linear
2. Annular and generalized
3. Iris and discrete
4. Oval and clustered
Correct answer: 2. Annular and generalized
Rationale: Annular lesions are circular or ring-shaped with central clearing, which is
consistent with the description provided. "Generalized" refers to the widespread
distribution across the abdomen and thorax.
,6. Which disorder is an example of a vascular lesion?
1. Dermatofibroma
2. Vitiligo
3. Sebaceous cyst
4. Port wine stain
Correct answer: 4. Port wine stain
Rationale: A port wine stain is a vascular lesion caused by abnormal blood vessel
formation, typically appearing as a red or purple discoloration of the skin.
7. A 60-year-old male patient states that he has a sore above his lip that has not
healed and is getting bigger. The nurse observes a red scaly patch with an ulcerated
center and sharp margins. These findings are commonly associated with which
malignancy?
1. Kaposi's sarcoma
2. Malignant melanoma
3. Basal cell carcinoma
4. Squamous cell carcinoma
Correct answer: 4. Squamous cell carcinoma
Rationale: Squamous cell carcinoma often presents as a red, scaly patch with an
ulcerated center, typically with sharp margins. This type of skin cancer is commonly
found on sun-exposed areas such as the lips.
8. A 48-year-old woman asks the nurse how to best protect herself from excessive
sun exposure while at the beach. Which response would be most appropriate?
1. "Limit your time in the sun to 5 minutes every hour."
2. "Wear a wet suit that covers your arms and legs."
3. "Apply a waterproof sunscreen (SPF 15 or higher) to exposed skin surfaces;
reapply at least every 2 hours."
4. "Apply sunscreen with a minimum SPF 50 to all skin surfaces before leaving for
the beach; this will provide all-day coverage."
, Correct answer: 3. "Apply a waterproof sunscreen (SPF 15 or higher) to exposed
skin surfaces; reapply at least every 2 hours."
Rationale: The most effective way to protect skin from sun exposure is to apply
sunscreen with SPF 15 or higher to exposed areas and to reapply it regularly, especially
after swimming or sweating. SPF 50 may be excessive unless there are specific high-risk
factors.
9. Which patient's description of pain is consistent with injury to a bone?
1. "Deep, dull, and boring"
2. "Cramping even when not moving"
3. "Intermittent, sharp, and radiating"
4. "Numbness and tingling with movement"
Correct answer: 1. "Deep, dull, and boring"
Rationale: Bone pain is often described as deep, dull, and boring. This type of pain is
typically constant and may be aggravated by movement or pressure on the bone.
10. How does the nurse determine if a patient's musculoskeletal examination is
normal?
1. By reading the examination findings documented in the patient's chart
2. By comparing findings from other patients in the same age group
3. By reading descriptions in health assessment books
4. By comparing the patient's left side with the right side
Correct answer: 4. By comparing the patient's left side with the right side
Rationale: To assess normal musculoskeletal findings, the nurse should compare the
left and right sides of the body for symmetry, movement, and strength. This helps detect
any abnormalities or deviations from the expected pattern.
11. While testing a patient's bicep muscle strength, the nurse applies resistance
and asks the patient to perform which motion?
1. Extension of the arm
2. Flexion of the arm
Nurse 1145 Final Exam : Expert Review and
Preparation Guide
1. A patient has edema and redness of the skin surrounding the nail on his right
index finger. Which data elected from his history best explains this condition?
A. He has a family history of liver disease.
B. There has been a scabies outbreak among his family members.
C. He has a new full-time position as a dishwasher at a local restaurant.
D. He had several warts removed from his hand two years ago.
Correct answer: C. He has a new full-time position as a dishwasher at a local
restaurant.
Rationale: Working as a dishwasher involves frequent exposure to water and cleaning
agents, which can irritate the skin and cause inflammation around the nails, possibly
leading to conditions like paronychia (infection of the nail fold), which could explain the
edema and redness.
2. When examining a 16-year-old male patient, the nurse notes multiple pustules
and comedones on the face. The nurse recognizes that increased activity of which
cells or glands produced these manifestations?
A. Epidermal cells
B. Eccrine glands
C. Apocrine glands
D. Sebaceous glands
Correct answer: D. Sebaceous glands
Rationale: Sebaceous glands are responsible for producing sebum, an oily substance
that, when overproduced or blocked, can result in acne, characterized by pustules (pus-
filled lesions) and comedones (blackheads and whiteheads), especially common
during adolescence.
3. A patient with darkly pigmented skin has been admitted to the hospital with
hepatitis. What is the best way for the nurse to assess for jaundice in this patient?
,A. Inspect the color of the sclera.
B. Inspect genitalia for color.
C. Blanch the fingernails.
D. Jaundice cannot be assessed in patients with darkly pigmented skin.
Correct answer: A. Inspect the color of the sclera.
Rationale: Jaundice is best assessed in the sclera (white part of the eyes), which tends
to turn yellow with elevated bilirubin levels, even in patients with darkly pigmented skin.
This method provides the most reliable indication of jaundice.
4. A patient has multiple solid, red, raised lesions on her legs and groin that she
describes as "itchy insect bites." How does the nurse document these lesions?
1. Wheals
2. Bullae
3. Tumors
4. Plaques
Correct answer: 1. Wheals
Rationale: Wheals are raised, red, itchy lesions often caused by allergic reactions, such
as insect bites. They are transient, meaning they typically resolve within hours, and are
described as hives or welts.
5. The nurse observes multiple red circular lesions with central clearing that are
scattered all over the abdomen and thorax. How does the nurse document the
shape and pattern of these lesions?
1. Gyrate and linear
2. Annular and generalized
3. Iris and discrete
4. Oval and clustered
Correct answer: 2. Annular and generalized
Rationale: Annular lesions are circular or ring-shaped with central clearing, which is
consistent with the description provided. "Generalized" refers to the widespread
distribution across the abdomen and thorax.
,6. Which disorder is an example of a vascular lesion?
1. Dermatofibroma
2. Vitiligo
3. Sebaceous cyst
4. Port wine stain
Correct answer: 4. Port wine stain
Rationale: A port wine stain is a vascular lesion caused by abnormal blood vessel
formation, typically appearing as a red or purple discoloration of the skin.
7. A 60-year-old male patient states that he has a sore above his lip that has not
healed and is getting bigger. The nurse observes a red scaly patch with an ulcerated
center and sharp margins. These findings are commonly associated with which
malignancy?
1. Kaposi's sarcoma
2. Malignant melanoma
3. Basal cell carcinoma
4. Squamous cell carcinoma
Correct answer: 4. Squamous cell carcinoma
Rationale: Squamous cell carcinoma often presents as a red, scaly patch with an
ulcerated center, typically with sharp margins. This type of skin cancer is commonly
found on sun-exposed areas such as the lips.
8. A 48-year-old woman asks the nurse how to best protect herself from excessive
sun exposure while at the beach. Which response would be most appropriate?
1. "Limit your time in the sun to 5 minutes every hour."
2. "Wear a wet suit that covers your arms and legs."
3. "Apply a waterproof sunscreen (SPF 15 or higher) to exposed skin surfaces;
reapply at least every 2 hours."
4. "Apply sunscreen with a minimum SPF 50 to all skin surfaces before leaving for
the beach; this will provide all-day coverage."
, Correct answer: 3. "Apply a waterproof sunscreen (SPF 15 or higher) to exposed
skin surfaces; reapply at least every 2 hours."
Rationale: The most effective way to protect skin from sun exposure is to apply
sunscreen with SPF 15 or higher to exposed areas and to reapply it regularly, especially
after swimming or sweating. SPF 50 may be excessive unless there are specific high-risk
factors.
9. Which patient's description of pain is consistent with injury to a bone?
1. "Deep, dull, and boring"
2. "Cramping even when not moving"
3. "Intermittent, sharp, and radiating"
4. "Numbness and tingling with movement"
Correct answer: 1. "Deep, dull, and boring"
Rationale: Bone pain is often described as deep, dull, and boring. This type of pain is
typically constant and may be aggravated by movement or pressure on the bone.
10. How does the nurse determine if a patient's musculoskeletal examination is
normal?
1. By reading the examination findings documented in the patient's chart
2. By comparing findings from other patients in the same age group
3. By reading descriptions in health assessment books
4. By comparing the patient's left side with the right side
Correct answer: 4. By comparing the patient's left side with the right side
Rationale: To assess normal musculoskeletal findings, the nurse should compare the
left and right sides of the body for symmetry, movement, and strength. This helps detect
any abnormalities or deviations from the expected pattern.
11. While testing a patient's bicep muscle strength, the nurse applies resistance
and asks the patient to perform which motion?
1. Extension of the arm
2. Flexion of the arm
