2 MAXE • 152 SRUN
PSU
★
Penn State University
College of Nursing
MAKING LIFE BETTER
EST. 1855
NURS 251 — Examination 2
I N T E G U M E N TA R Y, H E A D , N E C K & S E N S O R Y A SS E SS M E N T
INSTITUTION Penn State University — College of COURSE CODE NURS 251
Nursing
PROGRAM Bachelor of Science in Nursing (BSN) ACADEMIC YEAR
EXAM TITLE Examination 2 — Skin, Hair, Nails, Head, TOTAL QUESTIONS 100 Questions
Neck & Eyes
ACCREDITATION MSCHE — Middle States Commission on FORMAT Multiple Choice — Select the Single Best
Higher Education Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question based on NURS 251 course content.
▸ Questions cover skin assessment (ABCDE, lesions, pressure injuries), nail and hair findings, lymph node assessment, thyroid
evaluation, and eye/ear examination.
▸ Understanding primary vs secondary skin lesions, pressure injury staging, and abnormal integumentary findings is essential.
▸ Correct answers and clinical rationales appear below each question for examination review.
▸ All content aligns with Penn State University BSN curriculum and MSCHE accreditation standards.
SECTION I — INTEGUMENTARY, HEAD, NECK, EYES & EARS Questions 1 –
ASSESSMENT 100
1. What does the ABCDE mnemonic stand for in skin lesion assessment?
A. Asymmetry, Border, Color, Diameter, Evolution
B. Appearance, Bleeding, Crusting, Discharge, Erythema
C. Age, Body site, Contour, Depth, Elevation
D. Acute, Benign, Chronic, Degenerative, Expanding
CORRECT ANSWER A — Asymmetry, Border, Color, Diameter, Evolution
RATIONALE The ABCDE criteria are the standardized screening tool for melanoma: A = Asymmetry (one half unlike the
other), B = Border (irregular, scalloped, or poorly defined), C = Color (varied from one area to another; shades
of brown, black, sometimes white, red, or blue), D = Diameter (>6mm, the size of a pencil eraser), E =
Evolution (changing in size, shape, or color over time). Any lesion meeting these criteria warrants prompt
dermatology referral.
,2. What are the expected variations for skin color?
A. Cyanosis, jaundice, ecchymosis, erythema, pallor
B. Hyperpigmentation and hypopigmentation
C. Petechiae, purpura, and ecchymosis
D. Velvety texture and excessive moisture
CORRECT ANSWER B — Hyperpigmentation and hypopigmentation
RATIONALE Expected variations in skin color include hyperpigmentation (areas of increased melanin, such as freckles,
moles, or pregnancy-related melasma) and hypopigmentation (areas of decreased melanin, such as vitiligo or
post-inflammatory hypopigmentation). These are benign variations from the patient's baseline skin color. In
contrast, cyanosis, jaundice, ecchymosis, erythema, and pallor are unexpected (pathological) findings
indicating underlying disease processes such as hypoxia, liver disease, trauma, inflammation, or anemia.
3. What are the unexpected (pathological) findings of skin color?
A. Hyperpigmentation and hypopigmentation
B. Even and consistent skin tone with genetic background
C. Cyanosis, jaundice, ecchymosis, erythema, pallor
D. Freckles and benign moles
CORRECT ANSWER C — Cyanosis, jaundice, ecchymosis, erythema, pallor
RATIONALE These five findings indicate underlying pathology: Cyanosis = bluish discoloration from deoxygenated
hemoglobin (hypoxia, cardiac disease). Jaundice = yellow discoloration from elevated bilirubin (liver disease,
hemolysis). Ecchymosis = bruising from extravasation of blood (trauma, coagulopathy). Erythema = redness
from increased blood flow (inflammation, infection, sunburn). Pallor = paleness from decreased blood flow or
hemoglobin (anemia, shock, vasoconstriction). Each finding localizes to a different pathophysiological
mechanism and requires further investigation.
4. What is ecchymosis?
A. Small dot-like pinpoint hemorrhages on the skin
B. Redness of the skin from inflammation
C. Bruising — extravasation of blood into the skin
D. Excessive sweating
CORRECT ANSWER C — Bruising — extravasation of blood into the skin
RATIONALE Ecchymosis (commonly called a bruise) is a discoloration of the skin resulting from bleeding underneath,
caused by trauma to small blood vessels. The characteristic color progression (red-purple-blue-green-yellow-
brown) reflects the breakdown of hemoglobin over time. Extensive or spontaneous ecchymosis without
trauma may indicate coagulopathy, thrombocytopenia, anticoagulant therapy, or vasculitis. Ecchymosis
differs from petechiae (pinpoint hemorrhages) and purpura (larger flat areas of hemorrhage) in size and
mechanism.
,5. What is erythema?
A. Paleness of the skin
B. Yellow discoloration from bilirubin
C. Redness of the skin
D. Bluish discoloration from deoxygenation
CORRECT ANSWER C — Redness of the skin
RATIONALE Erythema is redness of the skin caused by increased blood flow (hyperemia) to the superficial capillaries. It
can be localized (cellulitis, sunburn, allergic reaction) or generalized (fever, viral exanthem, drug reaction).
Erythema is one of the five cardinal signs of inflammation (rubor) along with heat (calor), swelling (tumor),
pain (dolor), and loss of function (functio laesa). The distribution, borders, and associated symptoms of
erythema provide important diagnostic clues.
6. What is pallor?
A. Excessive redness
B. Paleness of the skin
C. Yellow discoloration
D. Bluish discoloration
CORRECT ANSWER B — Paleness of the skin
RATIONALE Pallor is an abnormal paleness or loss of skin color compared to the patient's baseline. It results from
decreased blood flow (vasoconstriction, shock, heart failure) or decreased hemoglobin (anemia). Best
assessed in mucous membranes (conjunctivae, oral mucosa, nail beds) where ethnic skin color variations
have less influence. Generalized pallor suggests systemic disease (anemia, shock); localized pallor (as in
Raynaud's phenomenon) suggests vasospasm or arterial insufficiency of the affected area.
7. What are petechiae?
A. Large bruises covering extensive areas
B. Small dot-like pinpoint hemorrhages on the skin
C. Fluid-filled blisters larger than 1 cm
D. Superficial, raised, transient wheals from edema
CORRECT ANSWER B — Small dot-like pinpoint hemorrhages on the skin
RATIONALE Petechiae are tiny (1–3mm), non-blanching, reddish-purple spots caused by capillary bleeding into the skin.
They do not blanch when pressed (unlike erythema) because the blood is extravasated into tissue, not
contained within dilated vessels. Causes include: thrombocytopenia (low platelets), vasculitis,
meningococcemia, infective endocarditis, and increased intravascular pressure (violent coughing, vomiting).
The presence of petechiae with fever is a medical emergency requiring immediate evaluation for
meningococcal sepsis or other life-threatening infections.
, 8. What are the unexpected findings of skin texture and moisture?
A. Smooth, even texture with normal moisture
B. Hyperpigmentation and hypopigmentation
C. Velvety, roughness, dryness, flakiness, diaphoresis
D. Warm, intact, and elastic skin
CORRECT ANSWER C — Velvety, roughness, dryness, flakiness, diaphoresis
RATIONALE Abnormal skin texture and moisture findings include: Velvety texture (acanthosis nigricans — associated with
insulin resistance and malignancy), Roughness (chronic irritation, eczema, hypothyroidism), Dryness/xerosis
(dehydration, aging, hypothyroidism, atopic dermatitis), Flakiness/scaling (psoriasis, seborrheic dermatitis,
fungal infection), and Diaphoresis/excessive sweating (fever, hyperthyroidism, hypoglycemia, myocardial
infarction, anxiety). These findings provide clues to systemic disease beyond the skin itself.
9. What is diaphoresis?
A. Excessive dryness of the skin
B. Excessive sweating
C. Redness of the skin
D. Flaking and scaling of the skin
CORRECT ANSWER B — Excessive sweating
RATIONALE Diaphoresis is profuse or excessive sweating beyond what is needed for thermoregulation. It is a clinically
significant sign that can indicate: myocardial infarction (particularly with cool, clammy skin), hypoglycemia
(diaphoresis is a key autonomic symptom), hyperthyroidism (heat intolerance with sweating), infection/fever
(diaphoresis during fever defervescence), anxiety/panic, shock, and certain medications (opioids, SSRIs).
Diaphoresis in the setting of chest pain or altered mental status is a medical emergency.
10. How are pressure injuries assessed and classified?
A. By measuring the patient's pain level on a 1–10 scale
B. By assigning them through stages 1–4, plus unstageable and deep tissue injury
C. By culturing the wound for bacterial infection
D. By assessing only the color of the wound bed
CORRECT ANSWER B — By assigning them through stages 1–4, plus unstageable and deep tissue injury
RATIONALE The National Pressure Injury Advisory Panel (NPIAP) staging system classifies pressure injuries by depth of
tissue destruction: Stage 1 — intact skin with non-blanchable erythema. Stage 2 — partial-thickness loss with
exposed dermis (blister, shallow open ulcer). Stage 3 — full-thickness loss with visible subcutaneous fat (no
bone/tendon/muscle exposure). Stage 4 — full-thickness loss with exposed bone, tendon, or muscle.
Unstageable — full-thickness loss obscured by slough or eschar. Deep Tissue Injury — intact or non-intact skin
with persistent non-blanchable deep red/maroon/purple discoloration. Staging cannot be reversed (a Stage 4
does not become a Stage 2 as it heals).
PSU
★
Penn State University
College of Nursing
MAKING LIFE BETTER
EST. 1855
NURS 251 — Examination 2
I N T E G U M E N TA R Y, H E A D , N E C K & S E N S O R Y A SS E SS M E N T
INSTITUTION Penn State University — College of COURSE CODE NURS 251
Nursing
PROGRAM Bachelor of Science in Nursing (BSN) ACADEMIC YEAR
EXAM TITLE Examination 2 — Skin, Hair, Nails, Head, TOTAL QUESTIONS 100 Questions
Neck & Eyes
ACCREDITATION MSCHE — Middle States Commission on FORMAT Multiple Choice — Select the Single Best
Higher Education Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question based on NURS 251 course content.
▸ Questions cover skin assessment (ABCDE, lesions, pressure injuries), nail and hair findings, lymph node assessment, thyroid
evaluation, and eye/ear examination.
▸ Understanding primary vs secondary skin lesions, pressure injury staging, and abnormal integumentary findings is essential.
▸ Correct answers and clinical rationales appear below each question for examination review.
▸ All content aligns with Penn State University BSN curriculum and MSCHE accreditation standards.
SECTION I — INTEGUMENTARY, HEAD, NECK, EYES & EARS Questions 1 –
ASSESSMENT 100
1. What does the ABCDE mnemonic stand for in skin lesion assessment?
A. Asymmetry, Border, Color, Diameter, Evolution
B. Appearance, Bleeding, Crusting, Discharge, Erythema
C. Age, Body site, Contour, Depth, Elevation
D. Acute, Benign, Chronic, Degenerative, Expanding
CORRECT ANSWER A — Asymmetry, Border, Color, Diameter, Evolution
RATIONALE The ABCDE criteria are the standardized screening tool for melanoma: A = Asymmetry (one half unlike the
other), B = Border (irregular, scalloped, or poorly defined), C = Color (varied from one area to another; shades
of brown, black, sometimes white, red, or blue), D = Diameter (>6mm, the size of a pencil eraser), E =
Evolution (changing in size, shape, or color over time). Any lesion meeting these criteria warrants prompt
dermatology referral.
,2. What are the expected variations for skin color?
A. Cyanosis, jaundice, ecchymosis, erythema, pallor
B. Hyperpigmentation and hypopigmentation
C. Petechiae, purpura, and ecchymosis
D. Velvety texture and excessive moisture
CORRECT ANSWER B — Hyperpigmentation and hypopigmentation
RATIONALE Expected variations in skin color include hyperpigmentation (areas of increased melanin, such as freckles,
moles, or pregnancy-related melasma) and hypopigmentation (areas of decreased melanin, such as vitiligo or
post-inflammatory hypopigmentation). These are benign variations from the patient's baseline skin color. In
contrast, cyanosis, jaundice, ecchymosis, erythema, and pallor are unexpected (pathological) findings
indicating underlying disease processes such as hypoxia, liver disease, trauma, inflammation, or anemia.
3. What are the unexpected (pathological) findings of skin color?
A. Hyperpigmentation and hypopigmentation
B. Even and consistent skin tone with genetic background
C. Cyanosis, jaundice, ecchymosis, erythema, pallor
D. Freckles and benign moles
CORRECT ANSWER C — Cyanosis, jaundice, ecchymosis, erythema, pallor
RATIONALE These five findings indicate underlying pathology: Cyanosis = bluish discoloration from deoxygenated
hemoglobin (hypoxia, cardiac disease). Jaundice = yellow discoloration from elevated bilirubin (liver disease,
hemolysis). Ecchymosis = bruising from extravasation of blood (trauma, coagulopathy). Erythema = redness
from increased blood flow (inflammation, infection, sunburn). Pallor = paleness from decreased blood flow or
hemoglobin (anemia, shock, vasoconstriction). Each finding localizes to a different pathophysiological
mechanism and requires further investigation.
4. What is ecchymosis?
A. Small dot-like pinpoint hemorrhages on the skin
B. Redness of the skin from inflammation
C. Bruising — extravasation of blood into the skin
D. Excessive sweating
CORRECT ANSWER C — Bruising — extravasation of blood into the skin
RATIONALE Ecchymosis (commonly called a bruise) is a discoloration of the skin resulting from bleeding underneath,
caused by trauma to small blood vessels. The characteristic color progression (red-purple-blue-green-yellow-
brown) reflects the breakdown of hemoglobin over time. Extensive or spontaneous ecchymosis without
trauma may indicate coagulopathy, thrombocytopenia, anticoagulant therapy, or vasculitis. Ecchymosis
differs from petechiae (pinpoint hemorrhages) and purpura (larger flat areas of hemorrhage) in size and
mechanism.
,5. What is erythema?
A. Paleness of the skin
B. Yellow discoloration from bilirubin
C. Redness of the skin
D. Bluish discoloration from deoxygenation
CORRECT ANSWER C — Redness of the skin
RATIONALE Erythema is redness of the skin caused by increased blood flow (hyperemia) to the superficial capillaries. It
can be localized (cellulitis, sunburn, allergic reaction) or generalized (fever, viral exanthem, drug reaction).
Erythema is one of the five cardinal signs of inflammation (rubor) along with heat (calor), swelling (tumor),
pain (dolor), and loss of function (functio laesa). The distribution, borders, and associated symptoms of
erythema provide important diagnostic clues.
6. What is pallor?
A. Excessive redness
B. Paleness of the skin
C. Yellow discoloration
D. Bluish discoloration
CORRECT ANSWER B — Paleness of the skin
RATIONALE Pallor is an abnormal paleness or loss of skin color compared to the patient's baseline. It results from
decreased blood flow (vasoconstriction, shock, heart failure) or decreased hemoglobin (anemia). Best
assessed in mucous membranes (conjunctivae, oral mucosa, nail beds) where ethnic skin color variations
have less influence. Generalized pallor suggests systemic disease (anemia, shock); localized pallor (as in
Raynaud's phenomenon) suggests vasospasm or arterial insufficiency of the affected area.
7. What are petechiae?
A. Large bruises covering extensive areas
B. Small dot-like pinpoint hemorrhages on the skin
C. Fluid-filled blisters larger than 1 cm
D. Superficial, raised, transient wheals from edema
CORRECT ANSWER B — Small dot-like pinpoint hemorrhages on the skin
RATIONALE Petechiae are tiny (1–3mm), non-blanching, reddish-purple spots caused by capillary bleeding into the skin.
They do not blanch when pressed (unlike erythema) because the blood is extravasated into tissue, not
contained within dilated vessels. Causes include: thrombocytopenia (low platelets), vasculitis,
meningococcemia, infective endocarditis, and increased intravascular pressure (violent coughing, vomiting).
The presence of petechiae with fever is a medical emergency requiring immediate evaluation for
meningococcal sepsis or other life-threatening infections.
, 8. What are the unexpected findings of skin texture and moisture?
A. Smooth, even texture with normal moisture
B. Hyperpigmentation and hypopigmentation
C. Velvety, roughness, dryness, flakiness, diaphoresis
D. Warm, intact, and elastic skin
CORRECT ANSWER C — Velvety, roughness, dryness, flakiness, diaphoresis
RATIONALE Abnormal skin texture and moisture findings include: Velvety texture (acanthosis nigricans — associated with
insulin resistance and malignancy), Roughness (chronic irritation, eczema, hypothyroidism), Dryness/xerosis
(dehydration, aging, hypothyroidism, atopic dermatitis), Flakiness/scaling (psoriasis, seborrheic dermatitis,
fungal infection), and Diaphoresis/excessive sweating (fever, hyperthyroidism, hypoglycemia, myocardial
infarction, anxiety). These findings provide clues to systemic disease beyond the skin itself.
9. What is diaphoresis?
A. Excessive dryness of the skin
B. Excessive sweating
C. Redness of the skin
D. Flaking and scaling of the skin
CORRECT ANSWER B — Excessive sweating
RATIONALE Diaphoresis is profuse or excessive sweating beyond what is needed for thermoregulation. It is a clinically
significant sign that can indicate: myocardial infarction (particularly with cool, clammy skin), hypoglycemia
(diaphoresis is a key autonomic symptom), hyperthyroidism (heat intolerance with sweating), infection/fever
(diaphoresis during fever defervescence), anxiety/panic, shock, and certain medications (opioids, SSRIs).
Diaphoresis in the setting of chest pain or altered mental status is a medical emergency.
10. How are pressure injuries assessed and classified?
A. By measuring the patient's pain level on a 1–10 scale
B. By assigning them through stages 1–4, plus unstageable and deep tissue injury
C. By culturing the wound for bacterial infection
D. By assessing only the color of the wound bed
CORRECT ANSWER B — By assigning them through stages 1–4, plus unstageable and deep tissue injury
RATIONALE The National Pressure Injury Advisory Panel (NPIAP) staging system classifies pressure injuries by depth of
tissue destruction: Stage 1 — intact skin with non-blanchable erythema. Stage 2 — partial-thickness loss with
exposed dermis (blister, shallow open ulcer). Stage 3 — full-thickness loss with visible subcutaneous fat (no
bone/tendon/muscle exposure). Stage 4 — full-thickness loss with exposed bone, tendon, or muscle.
Unstageable — full-thickness loss obscured by slough or eschar. Deep Tissue Injury — intact or non-intact skin
with persistent non-blanchable deep red/maroon/purple discoloration. Staging cannot be reversed (a Stage 4
does not become a Stage 2 as it heals).
