PSU
Penn State University
152 • 2 MAXE
NURS College of Nursing — NURS 251 Exam 2
W E A R E · P E N N S TAT E
251
NURS 251 — Exam 2
I N T E G U M E N TA R Y SYST E M , H E E N T A SS E SS M E N T & P R O F E SS I O N A L N U R S I N G CO N C E PTS
INSTITUTION Penn State University EXAM CODE PSU-NURS251-EX2-2026
PROGRAM NURS 251 — Health Assessment ACADEMIC YEAR
EXAM TITLE NURS 251 Exam 2 — Integumentary & TOTAL QUESTIONS 30 Questions — Comprehensive Review
HEENT
COURSE TITLE Health Assessment FORMAT Multiple Choice — Select the Single Best
Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Questions cover skin function and assessment (including pressure injuries, lesions, Braden Scale), HEENT assessment (head,
eyes/PERRLA, ears, nose/sinuses, mouth, neck), and professional nursing concepts (autonomy, accountability, integrity, caring).
▸ Distinguish carefully between primary and secondary skin lesions, normal vs. abnormal findings in each body system, and the
stages of pressure injuries.
▸ Correct answers and detailed rationales appear below each question for comprehensive review.
▸ All content is derived from Penn State NURS 251 Exam 2 curriculum.
SECTION I — INTEGUMENTARY, HEENT & PROFESSIONAL PRACTICE Questions 1 – 30
1. The skin serves all of the following functions EXCEPT:
A. Protection — first line barrier against infection
B. Regulation of body temperature
C. Production of vitamin D and sensory perception
D. Production of red blood cells — this occurs in bone marrow, not the skin
CORRECT ANSWER D — Red blood cell production (erythropoiesis) occurs in the bone marrow, not the skin. The skin has
seven key functions: protection, prevention of fluid loss, temperature regulation, secretion/excretion,
vitamin D production, sensory perception, and identity.
RATIONALE The integumentary system is the body's largest organ with multiple vital functions: (1) Protection — physical
barrier against pathogens, chemicals, UV radiation; (2) Prevents fluid loss — maintains hydration; (3)
Temperature regulation — sweating, vasodilation/constriction; (4) Secretion/excretion — sebum, sweat; (5)
Vitamin D synthesis — converts cholesterol to vitamin D when exposed to UV light; (6) Sensory perception —
nerve endings detect touch, pressure, temperature, pain; (7) Identity — unique appearance.
, 2. The components of a good skin/nail assessment include examining all of the following EXCEPT:
A. Skin color, temperature, moisture, texture, and integrity (including turgor and lesions)
B. Nail color, shape, consistency, and capillary refill
C. Deep tendon reflexes — these are part of neurological assessment, not integumentary
D. Skin turgor and the presence of edema
CORRECT ANSWER C — Deep tendon reflexes are assessed during the neurological examination, not the integumentary
(skin/nail) assessment.
RATIONALE Comprehensive skin assessment includes: inspection of color, temperature, moisture, texture, integrity
(lesions, wounds, pressure injuries), turgor, edema, and nail assessment (color, shape, consistency, capillary
refill). Equipment needed: good lighting, ruler (to measure lesions), penlight, and gloves. The three-step
integument assessment process: (1) Preparation; (2) Physical Examination; (3) Regional Examination.
3. Which of the following is an EXPECTED finding during a skin assessment?
A. Cyanosis of the lips and nail beds
B. Skin color consistent throughout matching ethnic/racial background, smooth texture, intact integrity, and warm
temperature
C. Tented skin turgor and pitting edema
D. Jaundice (yellowing of the skin and sclera)
CORRECT ANSWER B — Expected findings: consistent skin color matching ethnicity, smooth and uniformly dry texture,
smooth/intact skin integrity, warm and consistent temperature, and turgor that rises easily and
returns rapidly when pinched.
RATIONALE Expected vs. Unexpected findings: Expected variations include hyperpigmentation (freckles, age spots),
hypopigmentation (scars, stretch marks, vitiligo), acne, wrinkles, and decreased turgor in older adults.
UNEXPECTED findings requiring further investigation: cyanosis, ecchymosis (bruising), erythema, jaundice,
pallor, petechiae, rough/dry/flaky skin, diaphoresis, lesions, pressure injuries, hyperthermic/hypothermic
temperature, tented turgor, and edema.
4. Capillary refill assesses:
A. Skin turgor and hydration status
B. Blood flow/perfusion to the nail beds — pressure is applied to blanch the nail, and color should return in less than 2
seconds
C. Respiratory function and oxygenation
D. Neurological sensation in the fingertips
CORRECT ANSWER B — Capillary refill evaluates peripheral perfusion. Normal finding: pink color returns in LESS than 2
seconds after pressure is released. Delayed refill (>2 seconds) indicates decreased circulation.
RATIONALE Capillary refill procedure: (1) Press on the nail bed until it turns white/blanches; (2) Release pressure; (3)
Count seconds until pink color returns. Normal = <2 seconds. Delayed refill indicates poor peripheral
perfusion — possible causes: hypovolemia, hypothermia, peripheral vascular disease, heart failure,
vasoconstriction. This is a quick, non-invasive circulatory assessment.
Penn State University
152 • 2 MAXE
NURS College of Nursing — NURS 251 Exam 2
W E A R E · P E N N S TAT E
251
NURS 251 — Exam 2
I N T E G U M E N TA R Y SYST E M , H E E N T A SS E SS M E N T & P R O F E SS I O N A L N U R S I N G CO N C E PTS
INSTITUTION Penn State University EXAM CODE PSU-NURS251-EX2-2026
PROGRAM NURS 251 — Health Assessment ACADEMIC YEAR
EXAM TITLE NURS 251 Exam 2 — Integumentary & TOTAL QUESTIONS 30 Questions — Comprehensive Review
HEENT
COURSE TITLE Health Assessment FORMAT Multiple Choice — Select the Single Best
Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Questions cover skin function and assessment (including pressure injuries, lesions, Braden Scale), HEENT assessment (head,
eyes/PERRLA, ears, nose/sinuses, mouth, neck), and professional nursing concepts (autonomy, accountability, integrity, caring).
▸ Distinguish carefully between primary and secondary skin lesions, normal vs. abnormal findings in each body system, and the
stages of pressure injuries.
▸ Correct answers and detailed rationales appear below each question for comprehensive review.
▸ All content is derived from Penn State NURS 251 Exam 2 curriculum.
SECTION I — INTEGUMENTARY, HEENT & PROFESSIONAL PRACTICE Questions 1 – 30
1. The skin serves all of the following functions EXCEPT:
A. Protection — first line barrier against infection
B. Regulation of body temperature
C. Production of vitamin D and sensory perception
D. Production of red blood cells — this occurs in bone marrow, not the skin
CORRECT ANSWER D — Red blood cell production (erythropoiesis) occurs in the bone marrow, not the skin. The skin has
seven key functions: protection, prevention of fluid loss, temperature regulation, secretion/excretion,
vitamin D production, sensory perception, and identity.
RATIONALE The integumentary system is the body's largest organ with multiple vital functions: (1) Protection — physical
barrier against pathogens, chemicals, UV radiation; (2) Prevents fluid loss — maintains hydration; (3)
Temperature regulation — sweating, vasodilation/constriction; (4) Secretion/excretion — sebum, sweat; (5)
Vitamin D synthesis — converts cholesterol to vitamin D when exposed to UV light; (6) Sensory perception —
nerve endings detect touch, pressure, temperature, pain; (7) Identity — unique appearance.
, 2. The components of a good skin/nail assessment include examining all of the following EXCEPT:
A. Skin color, temperature, moisture, texture, and integrity (including turgor and lesions)
B. Nail color, shape, consistency, and capillary refill
C. Deep tendon reflexes — these are part of neurological assessment, not integumentary
D. Skin turgor and the presence of edema
CORRECT ANSWER C — Deep tendon reflexes are assessed during the neurological examination, not the integumentary
(skin/nail) assessment.
RATIONALE Comprehensive skin assessment includes: inspection of color, temperature, moisture, texture, integrity
(lesions, wounds, pressure injuries), turgor, edema, and nail assessment (color, shape, consistency, capillary
refill). Equipment needed: good lighting, ruler (to measure lesions), penlight, and gloves. The three-step
integument assessment process: (1) Preparation; (2) Physical Examination; (3) Regional Examination.
3. Which of the following is an EXPECTED finding during a skin assessment?
A. Cyanosis of the lips and nail beds
B. Skin color consistent throughout matching ethnic/racial background, smooth texture, intact integrity, and warm
temperature
C. Tented skin turgor and pitting edema
D. Jaundice (yellowing of the skin and sclera)
CORRECT ANSWER B — Expected findings: consistent skin color matching ethnicity, smooth and uniformly dry texture,
smooth/intact skin integrity, warm and consistent temperature, and turgor that rises easily and
returns rapidly when pinched.
RATIONALE Expected vs. Unexpected findings: Expected variations include hyperpigmentation (freckles, age spots),
hypopigmentation (scars, stretch marks, vitiligo), acne, wrinkles, and decreased turgor in older adults.
UNEXPECTED findings requiring further investigation: cyanosis, ecchymosis (bruising), erythema, jaundice,
pallor, petechiae, rough/dry/flaky skin, diaphoresis, lesions, pressure injuries, hyperthermic/hypothermic
temperature, tented turgor, and edema.
4. Capillary refill assesses:
A. Skin turgor and hydration status
B. Blood flow/perfusion to the nail beds — pressure is applied to blanch the nail, and color should return in less than 2
seconds
C. Respiratory function and oxygenation
D. Neurological sensation in the fingertips
CORRECT ANSWER B — Capillary refill evaluates peripheral perfusion. Normal finding: pink color returns in LESS than 2
seconds after pressure is released. Delayed refill (>2 seconds) indicates decreased circulation.
RATIONALE Capillary refill procedure: (1) Press on the nail bed until it turns white/blanches; (2) Release pressure; (3)
Count seconds until pink color returns. Normal = <2 seconds. Delayed refill indicates poor peripheral
perfusion — possible causes: hypovolemia, hypothermia, peripheral vascular disease, heart failure,
vasoconstriction. This is a quick, non-invasive circulatory assessment.
