NUR 550 ACTUAL FINALS QUESTIONS AND
ANSWERS SET A+
✔✔Past Medical History- Skin
Subjective - ✔✔Any previous dermatologic illnesses.
Ask about infectious diseases with associated skin changes like chicken pox, measles,
impetigo, pityriasis rosea, and others.
Identify chronic skin problems such as acne vulgaris or rosacea, psoriasis, and eczema.
Ask about prior diagnosis of skin cancer.
• Previous history of skin disease • Any change in pigmentation • Any dryness or
oiliness • Tattoos • Hair Texture
• Hair loss • Changes in nail shape or color; biting nails • Do you work with chemicals or
specific substances? • How do you care for your skin, hair, and nails
✔✔Cardinal techniques of examination - ✔✔Inspection: Visual observance of details
Palpation: Tactile Pressure from finger pads
Percussion: if right handed, use of the plexor finger of the right hand (usually the third
finger) to deliver a rapid tap or blow against the pleximeter finger (middle finger of left
hand) laid against the surface of the chest or abdomen.
Produces audible sound and palpable vibrations
Provider uses their sense of touch and hearing
Auscultation: use of diaphragm or bell of the stethoscope to detect characteristics of
heart, lung, bowel sounds and bruits in arteries
✔✔History Taking-Skin - ✔✔Symptom Analysis including
onset, progression, trigger, aggravating or alleviating factors;
How has it changed since first appearance; and all associated symptoms-itching,
malaise, and so on.
Ask about dryness, pruritis, sores, rashes, lumps, unusual odor or perspiration,
changes in moles or warts, lesions that do not heal, or areas of chronic irritation.
,Any changes in skin coloration or texture
✔✔Subjective Assessment - ✔✔• Inquire about any common or concerning symptoms: •
Any noted changes in your skin, hair or nails? • Any rashes, sores, lumps, or itching? •
Any growths that you are concerned about? Any new growths or moles? Do you have
any moles that have changed in size, shape, or color?
✔✔Personal and Social History - ✔✔Skin care habits • Cleansing routine, soaps, oils,
lotions • Cosmetics, home remedies, sun screens • Recent changes in skin care habits •
Exposure to sunlight or tanning beds • Skin self-examination • Nail care habits •
Exposure to environmental or occupational hazards • Recent psychological or physical
stress • Use of alcohol, tobacco, or recreational drugs
Previous history of skin diseases or problems
Allergies to food, plants, animals, drugs
Familial predisposition Allergies, hay fever, psoriasis, eczema, acne
Rash or lesions OTC, anxiety, self-esteem, sexually transmitted, tickborne
Change in color Warning signs -ABCDE, itching, burning, bleeding
Excessive bruising, Falls, medication, abuse
✔✔Objective Assessment - ✔✔• Equipment Needed: • Gloves • Good lighting • Ruler
• Inspect and Palpate the skin • Note the color of the skin throughout the examination •
Palpate for temperature, moisture, texture, edema, and turgor • Closely inspect any
lesions
✔✔Skin Assessment Objective Data - ✔✔• Color & pigmentation
• Normal: pink or appropriate for race & even pigmentation
• Change in pigmentation • Vitiligo
• Widespread skin color changes • Pallor • Cyanosis • Erythema • Jaundice
✔✔Skin Assessment - ✔✔• Temperature - use back of hands to assess • Moisture •
Turgor • Lesions • describe
Example: Color : cyanosis = decreased oxygenation
Jaundice of eye sclera and skin = Liver disease
✔✔Assessing Skin Lesions - ✔✔• Location and Distribution • Type of Skin Lesion •
Color • Patterns and shapes
Characteristics • Exudates • Color • Odor • Amount • Consistency
• Configuration (arrangement) • Annular (rings) • Grouped/Clustere d • Linear • Arciform
(bowshaped) • Dermatomal
,✔✔Primary Skin Lesions - ✔✔Flat Non -palpable
+Macule - small spot
+Patch - larger than macule
Elevated Solid Palpable
Papule -up to 0.5 cm Plaque -larger than 0.5 cm, usually coalescence of papules
Nodule - larger than 0.5 cm, deeper and firmer than papule
Tumor - a large nodule
Wheal - irregular, localized skin edema
Elevated fluid filled
Vesicle - up to 0.5 cm filled with serous fluid
Bulla - > than 0.5 cm, filed with serous fluid
Pustule -filled with pus
✔✔Signs to alert you for Malignant Melanoma !!! - ✔✔ABCDE
DANGER SIGNS: ABCDE
• Asymmetry
• Border irregularity
• Color variation
• Diameter
• Elevation and Enlargement
✔✔Skin Cancer - ✔✔Change in mole or lesion -Warning signs
• New pigmentations • Pain • Itching • Tenderness • Change in size or bleeding of a
mole
✔✔Inflammatory versus Bacterial Infections - ✔✔• Eczematous Dermatitis • Most
common inflammatory skin disorder: • Irritant contact dermatitis • Allergic contact
dermatitis • Atopic dermatitis
• Psoriasis • Chronic and recurrent disease of keratin synthesis
• Rosacea • Chronic inflammatory skin disorder
• Folliculitis • Inflammation and infection of the hair follicle and surrounding dermis
• Furuncle (boil) • Deep-seated infection of the pilosebaceous unit
• Cellulitis • Diffuse, acute, infection of the skin and subcutaneous tissue
✔✔Other Skin Disorders - ✔✔• Tinea(dermatophytosis) • Group of noncandidal fungal
infections that involve the stratum corneum, nails, or hair
• Acanthosis nigrans • Nonspecific reaction pattern associated with obesity, certain
endocrine syndromes or malignancies, or as an inherited disorder
✔✔Pediatric Considerations - ✔✔• Seborrheic dermatitis • Little known about etiology •
Condition most commonly occurs in infants within the first 3 months of life. • Miliaria
(prickly heat) • Caused by sweat retention from occlusion of sweat ducts during periods
of heat and high humidity • Impetigo • Common, contagious superficial skin infection
, Acne vulgaris Impaction and obstruction of the outflow of sebum Chickenpox (varicella)
Acute, highly communicable disease common in children and young adults Measles
(rubeola) Measles virus infects by invasion of the respiratory epithelium. German
measles (rubella) Mild, febrile, highly communicable viral disease
✔✔Elder Considerations - ✔✔• Stasis dermatitis • Occurs on the lower legs in some
patients with venous insufficiency
• Solar keratosis (actinic keratosis) • Squamous cell carcinoma confined to the
epidermis
• Physical abuse in older adults • Look for bruising, burns, abrasions, or areas of
tenderness • Particularly on hidden areas such as the axillae, inner thighs, soles of the
feet, palms, and abdomen
✔✔Special Considerations pregnant women - ✔✔Striaegravidarum(stretch marks) •
Telangiectasias/hemangiom as • Cutaneous tags • Increased pigmentation • Palmar
erythema • Itching • Altered hair growth
✔✔Hair Assessment - ✔✔• Distribution • Thickness • Texture • Infections • Scalp
Lesions • Normal age related changes
Alopecia & traction alopecia
✔✔Nail Assessment - ✔✔Assess: • Nail bed color (translucent with pink nail bed) •
Texture (smooth, ridging, pitting) • Consistency (firm, spongy) • Nail angle (< 160
degrees-normal) • Surrounding tissues • Note changes with aging:thicker, dull, splitting,
longitudinal bands
✔✔Nails - ✔✔Nails: Clubbing: bulbous swelling of nail base loss of normal angle
between nail and nail fold ? Hypoxia, change in innervation, genetics, or fragments of
platelets
Spooning: nutritional deficiency
Paronychia: superficial infection of nail plate, nail folds red, swollen, and tender Staph
aureus or Streptococcus/ often related to trauma of nail biting, manicuring, frequent
water immersion
✔✔The head Subjective Assessment - ✔✔• Any loss of consciousness? Or change in
consciousness? • Any history of seizures? • Any recent changes in vision such as
double vision? • Any chronic nausea or vomiting especially projectile? • Any frequent or
severe headaches? Where is pain or discomfort? • Any recent head trauma? • Any
chronic analgesic use
✔✔The head Objective Assessment - ✔✔• The Hair- quantity, distribution, texture, and
pattern of loss • Scalp- check for scales, lumps, or lesions • Skull- size and contour;
observe suture line • Face- facial expressions; look for symmetry, masses, or
involuntary movements • Skin- color, pigment, texture, hair distribution
ANSWERS SET A+
✔✔Past Medical History- Skin
Subjective - ✔✔Any previous dermatologic illnesses.
Ask about infectious diseases with associated skin changes like chicken pox, measles,
impetigo, pityriasis rosea, and others.
Identify chronic skin problems such as acne vulgaris or rosacea, psoriasis, and eczema.
Ask about prior diagnosis of skin cancer.
• Previous history of skin disease • Any change in pigmentation • Any dryness or
oiliness • Tattoos • Hair Texture
• Hair loss • Changes in nail shape or color; biting nails • Do you work with chemicals or
specific substances? • How do you care for your skin, hair, and nails
✔✔Cardinal techniques of examination - ✔✔Inspection: Visual observance of details
Palpation: Tactile Pressure from finger pads
Percussion: if right handed, use of the plexor finger of the right hand (usually the third
finger) to deliver a rapid tap or blow against the pleximeter finger (middle finger of left
hand) laid against the surface of the chest or abdomen.
Produces audible sound and palpable vibrations
Provider uses their sense of touch and hearing
Auscultation: use of diaphragm or bell of the stethoscope to detect characteristics of
heart, lung, bowel sounds and bruits in arteries
✔✔History Taking-Skin - ✔✔Symptom Analysis including
onset, progression, trigger, aggravating or alleviating factors;
How has it changed since first appearance; and all associated symptoms-itching,
malaise, and so on.
Ask about dryness, pruritis, sores, rashes, lumps, unusual odor or perspiration,
changes in moles or warts, lesions that do not heal, or areas of chronic irritation.
,Any changes in skin coloration or texture
✔✔Subjective Assessment - ✔✔• Inquire about any common or concerning symptoms: •
Any noted changes in your skin, hair or nails? • Any rashes, sores, lumps, or itching? •
Any growths that you are concerned about? Any new growths or moles? Do you have
any moles that have changed in size, shape, or color?
✔✔Personal and Social History - ✔✔Skin care habits • Cleansing routine, soaps, oils,
lotions • Cosmetics, home remedies, sun screens • Recent changes in skin care habits •
Exposure to sunlight or tanning beds • Skin self-examination • Nail care habits •
Exposure to environmental or occupational hazards • Recent psychological or physical
stress • Use of alcohol, tobacco, or recreational drugs
Previous history of skin diseases or problems
Allergies to food, plants, animals, drugs
Familial predisposition Allergies, hay fever, psoriasis, eczema, acne
Rash or lesions OTC, anxiety, self-esteem, sexually transmitted, tickborne
Change in color Warning signs -ABCDE, itching, burning, bleeding
Excessive bruising, Falls, medication, abuse
✔✔Objective Assessment - ✔✔• Equipment Needed: • Gloves • Good lighting • Ruler
• Inspect and Palpate the skin • Note the color of the skin throughout the examination •
Palpate for temperature, moisture, texture, edema, and turgor • Closely inspect any
lesions
✔✔Skin Assessment Objective Data - ✔✔• Color & pigmentation
• Normal: pink or appropriate for race & even pigmentation
• Change in pigmentation • Vitiligo
• Widespread skin color changes • Pallor • Cyanosis • Erythema • Jaundice
✔✔Skin Assessment - ✔✔• Temperature - use back of hands to assess • Moisture •
Turgor • Lesions • describe
Example: Color : cyanosis = decreased oxygenation
Jaundice of eye sclera and skin = Liver disease
✔✔Assessing Skin Lesions - ✔✔• Location and Distribution • Type of Skin Lesion •
Color • Patterns and shapes
Characteristics • Exudates • Color • Odor • Amount • Consistency
• Configuration (arrangement) • Annular (rings) • Grouped/Clustere d • Linear • Arciform
(bowshaped) • Dermatomal
,✔✔Primary Skin Lesions - ✔✔Flat Non -palpable
+Macule - small spot
+Patch - larger than macule
Elevated Solid Palpable
Papule -up to 0.5 cm Plaque -larger than 0.5 cm, usually coalescence of papules
Nodule - larger than 0.5 cm, deeper and firmer than papule
Tumor - a large nodule
Wheal - irregular, localized skin edema
Elevated fluid filled
Vesicle - up to 0.5 cm filled with serous fluid
Bulla - > than 0.5 cm, filed with serous fluid
Pustule -filled with pus
✔✔Signs to alert you for Malignant Melanoma !!! - ✔✔ABCDE
DANGER SIGNS: ABCDE
• Asymmetry
• Border irregularity
• Color variation
• Diameter
• Elevation and Enlargement
✔✔Skin Cancer - ✔✔Change in mole or lesion -Warning signs
• New pigmentations • Pain • Itching • Tenderness • Change in size or bleeding of a
mole
✔✔Inflammatory versus Bacterial Infections - ✔✔• Eczematous Dermatitis • Most
common inflammatory skin disorder: • Irritant contact dermatitis • Allergic contact
dermatitis • Atopic dermatitis
• Psoriasis • Chronic and recurrent disease of keratin synthesis
• Rosacea • Chronic inflammatory skin disorder
• Folliculitis • Inflammation and infection of the hair follicle and surrounding dermis
• Furuncle (boil) • Deep-seated infection of the pilosebaceous unit
• Cellulitis • Diffuse, acute, infection of the skin and subcutaneous tissue
✔✔Other Skin Disorders - ✔✔• Tinea(dermatophytosis) • Group of noncandidal fungal
infections that involve the stratum corneum, nails, or hair
• Acanthosis nigrans • Nonspecific reaction pattern associated with obesity, certain
endocrine syndromes or malignancies, or as an inherited disorder
✔✔Pediatric Considerations - ✔✔• Seborrheic dermatitis • Little known about etiology •
Condition most commonly occurs in infants within the first 3 months of life. • Miliaria
(prickly heat) • Caused by sweat retention from occlusion of sweat ducts during periods
of heat and high humidity • Impetigo • Common, contagious superficial skin infection
, Acne vulgaris Impaction and obstruction of the outflow of sebum Chickenpox (varicella)
Acute, highly communicable disease common in children and young adults Measles
(rubeola) Measles virus infects by invasion of the respiratory epithelium. German
measles (rubella) Mild, febrile, highly communicable viral disease
✔✔Elder Considerations - ✔✔• Stasis dermatitis • Occurs on the lower legs in some
patients with venous insufficiency
• Solar keratosis (actinic keratosis) • Squamous cell carcinoma confined to the
epidermis
• Physical abuse in older adults • Look for bruising, burns, abrasions, or areas of
tenderness • Particularly on hidden areas such as the axillae, inner thighs, soles of the
feet, palms, and abdomen
✔✔Special Considerations pregnant women - ✔✔Striaegravidarum(stretch marks) •
Telangiectasias/hemangiom as • Cutaneous tags • Increased pigmentation • Palmar
erythema • Itching • Altered hair growth
✔✔Hair Assessment - ✔✔• Distribution • Thickness • Texture • Infections • Scalp
Lesions • Normal age related changes
Alopecia & traction alopecia
✔✔Nail Assessment - ✔✔Assess: • Nail bed color (translucent with pink nail bed) •
Texture (smooth, ridging, pitting) • Consistency (firm, spongy) • Nail angle (< 160
degrees-normal) • Surrounding tissues • Note changes with aging:thicker, dull, splitting,
longitudinal bands
✔✔Nails - ✔✔Nails: Clubbing: bulbous swelling of nail base loss of normal angle
between nail and nail fold ? Hypoxia, change in innervation, genetics, or fragments of
platelets
Spooning: nutritional deficiency
Paronychia: superficial infection of nail plate, nail folds red, swollen, and tender Staph
aureus or Streptococcus/ often related to trauma of nail biting, manicuring, frequent
water immersion
✔✔The head Subjective Assessment - ✔✔• Any loss of consciousness? Or change in
consciousness? • Any history of seizures? • Any recent changes in vision such as
double vision? • Any chronic nausea or vomiting especially projectile? • Any frequent or
severe headaches? Where is pain or discomfort? • Any recent head trauma? • Any
chronic analgesic use
✔✔The head Objective Assessment - ✔✔• The Hair- quantity, distribution, texture, and
pattern of loss • Scalp- check for scales, lumps, or lesions • Skull- size and contour;
observe suture line • Face- facial expressions; look for symmetry, masses, or
involuntary movements • Skin- color, pigment, texture, hair distribution
