NU 518 Exam 2 Study Questions 2024/2025 Exam
Questions and Corresponding Solutions with Surety of
100% Pass Mark.
Bates’ Guide to Physical Evaluation and History Taking, 11th Edition
Section 6: The Skin, Hair, and Nails
1. A 35-year-old archaeologist comes to your office (located in Phoenix, Arizona) for a regular skin
check-up. She has just returned from her annual dig site in Greece. She has fair skin and reddish-blonde
hair. She has a family history of melanoma. She has many freckles scattered across her skin. From this
description, which of the following is not a contributing element for melanoma in this client?
A) Age
B) Hair color
C) Actinic lentigines
D) Heavy sun exposure
Solution: A
Section: 06
Page and Header: 165, Health Promotion and Counseling
Explanation: The risk for melanoma is increased in people over the age of 50; our client is 35 years old.
The other solutions represent known contributing elements for melanoma. Especially with a family
history of melanoma, she should be instructed to keep her skin covered when in the sun and use strong
sunscreen on exposed areas.
2. You are speaking to an 8th grade class about health prevention and are preparing to discuss the
ABCDEs of melanoma. Which of the following descriptions correctly defines the ABCDEs?
A) A = actinic; B = basal cell; C = color changes, especially blue; D = diameter >6 mm; E = evolution
B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E =
evolution
C) A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution
D) A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter >6 mm; E
= evolution
Solution: B
Section: 06
Page and Header: 165, Health Promotion and Counseling
Explanation: This is the correct description for the mnemonic.
3. You are beginning the evaluation of the skin on a 25-year-old teacher. You have previously elicited
that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect that
she has hypothyroidism. What is the expected moisture and texture of the skin of a client with
hypothyroidism?
A) Moist and smooth
B) Moist and rough
C) Dry and smooth
D) Dry and rough
,Solution: D
Section: 06
Page and Header: 168, Techniques of Evaluation
Explanation: A client with hypothyroidism is expected to have skin that is dry as well as rough. This is a
good example of how the skin can give clues to systemic diseases.
4. A 28-year-old client comes to the office for evaluation of a rash. At first there was only one large
patch, but then more marks erupted suddenly on the back and torso; the marks itch. On physical
evaluation, you note that the pattern of eruption is like a Christmas tree and that there are a variety of
erythematous papules and macules on the cleavage lines of the back. Based on this description, what is
the most likely conclusion?
A) Pityriasis rosea
B) Tinea versicolor
C) Psoriasis
D) Atopic eczema
Solution: A
Section: 06
Page and Header: 176, Table 6–2
Explanation: This is a classic description of pityriasis rosea. The description of a large single or “herald”
patch preceding the eruption is a good way to distinguish this rash from other conditions.
5. A 19-year-old construction worker presents for evaluation of a rash. He notes that it started on his
back with a multitude of spots and is also on his arms, chest, and neck. It itches a lot. He does sweat
more than before because being outdoors is part of his job. On physical evaluation, you note dark tan
patches with a reddish cast that has sharp borders and fine scales, scattered more prominently around the
upper back, chest, neck, and upper arms as well as under the arms. Based on this description, what is
your most likely conclusion?
A) Pityriasis rosea
B) Tinea versicolor
C) Psoriasis
D) Atopic eczema
Solution: B
Section: 06
Page and Header: 176, Table 6–2
Explanation: This is a typical description of tinea versicolor. The information that the client is sweating
more also helps support this conclusion, because tinea is a fungal infection and is promoted by moisture.
6. A 68-year-old retired farmer comes to your office for evaluation of a skin mark. On the right
temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry
scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs.
Based on this description, what is your most likely conclusion?
A) Actinic keratosis
B) Seborrheic keratosis
C) Basal cell carcinoma
,D) Squamous cell carcinoma
Solution: A
Section: 06
Page and Header: 185, Table 6–9
Explanation: This is a typical description of actinic keratosis. Actinic keratosis may be easier to feel
than to see. If left untreated, approximately 1% of cases can develop into squamous cell carcinoma.
7. A 58-year-old gardener comes to your office for evaluation of a new mark on her upper chest. The
mark appears to be “stuck on” and is oval, brown, and slightly elevated with a flat surface. It has a
rough, wartlike texture on palpation. Based on this description, what is your most likely conclusion?
A) Actinic keratosis
B) Seborrheic keratosis
C) Basal cell carcinoma
D) Squamous cell carcinoma
Solution: B
Section: 06
Page and Header: 185, Table 6–9
Explanation: This is a typical description for seborrheic keratosis. The “stuck on” appearance and the
rough, wartlike texture are key features for the conclusion. They often produce a greasy scale when
scratched with a fingernail, which further helps to distinguish them from other marks. Frequently, these
benign marks actually meet several of the ABCDEs of melanoma, so it is important to distinguish these
marks to prevent unnecessary biopsy. It is important to consider biopsy whenever there is any doubt,
though.
8. A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after being in the hospital
for 6 weeks. She was treated for sepsis and respiratory failure and had to be on the ventilator for 3
weeks. You are completing your initial assessment and are evaluating her skin condition. On her sacrum
there is full-thickness skin loss that is 5 cm in diameter, with damage to the subcutaneous tissue. The
underlying muscle is not affected. You diagnose this as a pressure ulcer. What is the stage of this ulcer?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
Solution: C
Section: 06
Page and Header: 191, Table 6–13
Explanation: A stage 3 ulcer is a full-thickness skin loss with damage to or necrosis of subcutaneous
tissue that may extend to, but not through, the underlying muscle.
9. An 8-year-old girl comes with her mother for evaluation of hair loss. She denies pulling or twisting
her hair, and her mother has not noted this behavior at all. She does not put her hair in braids. On
physical evaluation, you note a clearly demarcated, round patch of hair loss without visible scaling or
, inflammation. There are no hair shafts visible. Based on this description, what is your most likely
conclusion?
A) Alopecia areata
B) Trichotillomania
C) Tinea capitis
D) Traction alopecia
Solution: A
Section: 06
Page and Header: 192, Table 6–14
Explanation: This is a typical description for alopecia areata. There are no contributing elements for
trichotillomania or for traction alopecia. The physical evaluation is not consistent with tinea capitis
because the skin is intact.
10. A mother brings her 11 month old to you because her mother-in-law and others have told her that
her baby is jaundiced. She is eating and growing well and performing the developmental milestones she
should for her age. On evaluation you indeed notice a yellow tone to her skin from head to toe. Her
sclerae are white. To which area should your next questions be related?
A) Diet
B) Family history of liver diseases
C) Family history of blood diseases
D) Ethnicity of the child
Solution: A
Section: 06
Page and Header: 163, Anatomy and Physiology
Explanation: The lack of jaundice in the sclerae is an important clue. Typically, this is the first place
where one sees jaundice. This evaluation should also be carried out in natural light (sunlight) as
opposed to fluorescent lighting, which can alter perceived colors. Many infants this age have a large
proportion of carrots, tomatoes, and yellow squash, which are rich in carotene. Liver and blood diseases
can cause jaundice, but this should involve the sclerae. The ethnicity of the child should not cause a
perceived change from her usual skin tone.
11. A new mother is concerned that her child occasionally “turns blue.” On further questioning, she
mentions that this is at her hands and feet. She does not remember the child's lips turning blue. She is
otherwise eating and growing well. What would you do now?
A) Reassure her that this is normal
B) Obtain an echocardiogram to check for structural heart disease and consult cardiology
C) Admit the child to the hospital for further observation
D) Question the validity of her story
Solution: A
Section: 06
Page and Header: 163, Anatomy and Physiology
Explanation: This is an example of peripheral cyanosis. This is a very common and benign condition
which typically occurs when the child is slightly cold and his peripheral circulation is adjusting to keep
Questions and Corresponding Solutions with Surety of
100% Pass Mark.
Bates’ Guide to Physical Evaluation and History Taking, 11th Edition
Section 6: The Skin, Hair, and Nails
1. A 35-year-old archaeologist comes to your office (located in Phoenix, Arizona) for a regular skin
check-up. She has just returned from her annual dig site in Greece. She has fair skin and reddish-blonde
hair. She has a family history of melanoma. She has many freckles scattered across her skin. From this
description, which of the following is not a contributing element for melanoma in this client?
A) Age
B) Hair color
C) Actinic lentigines
D) Heavy sun exposure
Solution: A
Section: 06
Page and Header: 165, Health Promotion and Counseling
Explanation: The risk for melanoma is increased in people over the age of 50; our client is 35 years old.
The other solutions represent known contributing elements for melanoma. Especially with a family
history of melanoma, she should be instructed to keep her skin covered when in the sun and use strong
sunscreen on exposed areas.
2. You are speaking to an 8th grade class about health prevention and are preparing to discuss the
ABCDEs of melanoma. Which of the following descriptions correctly defines the ABCDEs?
A) A = actinic; B = basal cell; C = color changes, especially blue; D = diameter >6 mm; E = evolution
B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E =
evolution
C) A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution
D) A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter >6 mm; E
= evolution
Solution: B
Section: 06
Page and Header: 165, Health Promotion and Counseling
Explanation: This is the correct description for the mnemonic.
3. You are beginning the evaluation of the skin on a 25-year-old teacher. You have previously elicited
that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect that
she has hypothyroidism. What is the expected moisture and texture of the skin of a client with
hypothyroidism?
A) Moist and smooth
B) Moist and rough
C) Dry and smooth
D) Dry and rough
,Solution: D
Section: 06
Page and Header: 168, Techniques of Evaluation
Explanation: A client with hypothyroidism is expected to have skin that is dry as well as rough. This is a
good example of how the skin can give clues to systemic diseases.
4. A 28-year-old client comes to the office for evaluation of a rash. At first there was only one large
patch, but then more marks erupted suddenly on the back and torso; the marks itch. On physical
evaluation, you note that the pattern of eruption is like a Christmas tree and that there are a variety of
erythematous papules and macules on the cleavage lines of the back. Based on this description, what is
the most likely conclusion?
A) Pityriasis rosea
B) Tinea versicolor
C) Psoriasis
D) Atopic eczema
Solution: A
Section: 06
Page and Header: 176, Table 6–2
Explanation: This is a classic description of pityriasis rosea. The description of a large single or “herald”
patch preceding the eruption is a good way to distinguish this rash from other conditions.
5. A 19-year-old construction worker presents for evaluation of a rash. He notes that it started on his
back with a multitude of spots and is also on his arms, chest, and neck. It itches a lot. He does sweat
more than before because being outdoors is part of his job. On physical evaluation, you note dark tan
patches with a reddish cast that has sharp borders and fine scales, scattered more prominently around the
upper back, chest, neck, and upper arms as well as under the arms. Based on this description, what is
your most likely conclusion?
A) Pityriasis rosea
B) Tinea versicolor
C) Psoriasis
D) Atopic eczema
Solution: B
Section: 06
Page and Header: 176, Table 6–2
Explanation: This is a typical description of tinea versicolor. The information that the client is sweating
more also helps support this conclusion, because tinea is a fungal infection and is promoted by moisture.
6. A 68-year-old retired farmer comes to your office for evaluation of a skin mark. On the right
temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry
scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs.
Based on this description, what is your most likely conclusion?
A) Actinic keratosis
B) Seborrheic keratosis
C) Basal cell carcinoma
,D) Squamous cell carcinoma
Solution: A
Section: 06
Page and Header: 185, Table 6–9
Explanation: This is a typical description of actinic keratosis. Actinic keratosis may be easier to feel
than to see. If left untreated, approximately 1% of cases can develop into squamous cell carcinoma.
7. A 58-year-old gardener comes to your office for evaluation of a new mark on her upper chest. The
mark appears to be “stuck on” and is oval, brown, and slightly elevated with a flat surface. It has a
rough, wartlike texture on palpation. Based on this description, what is your most likely conclusion?
A) Actinic keratosis
B) Seborrheic keratosis
C) Basal cell carcinoma
D) Squamous cell carcinoma
Solution: B
Section: 06
Page and Header: 185, Table 6–9
Explanation: This is a typical description for seborrheic keratosis. The “stuck on” appearance and the
rough, wartlike texture are key features for the conclusion. They often produce a greasy scale when
scratched with a fingernail, which further helps to distinguish them from other marks. Frequently, these
benign marks actually meet several of the ABCDEs of melanoma, so it is important to distinguish these
marks to prevent unnecessary biopsy. It is important to consider biopsy whenever there is any doubt,
though.
8. A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after being in the hospital
for 6 weeks. She was treated for sepsis and respiratory failure and had to be on the ventilator for 3
weeks. You are completing your initial assessment and are evaluating her skin condition. On her sacrum
there is full-thickness skin loss that is 5 cm in diameter, with damage to the subcutaneous tissue. The
underlying muscle is not affected. You diagnose this as a pressure ulcer. What is the stage of this ulcer?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
Solution: C
Section: 06
Page and Header: 191, Table 6–13
Explanation: A stage 3 ulcer is a full-thickness skin loss with damage to or necrosis of subcutaneous
tissue that may extend to, but not through, the underlying muscle.
9. An 8-year-old girl comes with her mother for evaluation of hair loss. She denies pulling or twisting
her hair, and her mother has not noted this behavior at all. She does not put her hair in braids. On
physical evaluation, you note a clearly demarcated, round patch of hair loss without visible scaling or
, inflammation. There are no hair shafts visible. Based on this description, what is your most likely
conclusion?
A) Alopecia areata
B) Trichotillomania
C) Tinea capitis
D) Traction alopecia
Solution: A
Section: 06
Page and Header: 192, Table 6–14
Explanation: This is a typical description for alopecia areata. There are no contributing elements for
trichotillomania or for traction alopecia. The physical evaluation is not consistent with tinea capitis
because the skin is intact.
10. A mother brings her 11 month old to you because her mother-in-law and others have told her that
her baby is jaundiced. She is eating and growing well and performing the developmental milestones she
should for her age. On evaluation you indeed notice a yellow tone to her skin from head to toe. Her
sclerae are white. To which area should your next questions be related?
A) Diet
B) Family history of liver diseases
C) Family history of blood diseases
D) Ethnicity of the child
Solution: A
Section: 06
Page and Header: 163, Anatomy and Physiology
Explanation: The lack of jaundice in the sclerae is an important clue. Typically, this is the first place
where one sees jaundice. This evaluation should also be carried out in natural light (sunlight) as
opposed to fluorescent lighting, which can alter perceived colors. Many infants this age have a large
proportion of carrots, tomatoes, and yellow squash, which are rich in carotene. Liver and blood diseases
can cause jaundice, but this should involve the sclerae. The ethnicity of the child should not cause a
perceived change from her usual skin tone.
11. A new mother is concerned that her child occasionally “turns blue.” On further questioning, she
mentions that this is at her hands and feet. She does not remember the child's lips turning blue. She is
otherwise eating and growing well. What would you do now?
A) Reassure her that this is normal
B) Obtain an echocardiogram to check for structural heart disease and consult cardiology
C) Admit the child to the hospital for further observation
D) Question the validity of her story
Solution: A
Section: 06
Page and Header: 163, Anatomy and Physiology
Explanation: This is an example of peripheral cyanosis. This is a very common and benign condition
which typically occurs when the child is slightly cold and his peripheral circulation is adjusting to keep
