Health Assessment Assessing Skin, Hair, and Nails Chapter 13 Latest Update 2025-2026 Exam Questions with 100% Verified Correct Answers Guaranteed A+
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 a ventilator for 3 weeks. The nurse is completing an initial assessment and evaluating the client's 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. What is the stage of this pressure ulcer?
- 4
- 3
- 1
- 2 - CORRECT ANSWER: Correct answer: 3
Explanation:
A stage III 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. (less)
Reference:
Weber, J., & Kelley, J. H. (2014). Health Assessment in Nursing, 5th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, Chapter 14: Assessing Skin, Hair, and Nails, p. 264.
A client asks a nurse to look at a raised lesion on the skin that has been present for about 5 years. Which is an "ABCD" characteristic of malignant melanoma?
a) Asymmetrical shape
b) Borders well demarcated 1 / 3
c) Color is uniform
d) Diameter less than 6mm - CORRECT ANSWER: Correct response: Asymmetrical
shape
Explanation:
Malignant melanomas are evaluated according to the mnemonic ABCDE: A for
asymmetrical, B for irregular borders, C for color variations, D for diameter exceeding 1/8 to1/4 inch (3-4mm), and E for elevated. (less)
Reference:
Weber, J., & Kelley, J. H. (2014). Health Assessment in Nursing, 5th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, Chapter 14: Assessing Skin, Hair, and Nails, p. 268.
A client presents to the clinic and reports numerous skin tags in the left axillary area.The client is worried about skin cancer. What can the nurse tell the client about skin tags to alleviate fear of cancer?
a) Skin tags can turn into skin cancer if they are not removed
b) Skin tags are an early precursor to more serious skin cancer conditions
c) Skin tags are common benign skin lesions
d) Skin tags need to be removed as soon as possible or they will keep growing -
CORRECT ANSWER: Correct response: Skin tags are common benign skin lesions
Explanation:
Common benign skin lesions include freckles, birth marks, skin tags, moles, and cherry angiomas. Skin tags will not turn into skin cancer and are not early precursors to other more serious skin cancer conditions. Skin tags do not keep growing if not removed.
Reference:
Weber, J., & Kelley, J. H. (2014). Health Assessment in Nursing, 5th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, Chapter 14: Assessing Skin, Hair, and Nails, p. 258
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A client presents to the health care clinic with reports of new onset of generalized hair loss for the past 2 months. The client denies the use of any new shampoos or other hair care products and claims not to be taking any new medications. The nurse should ask the client questions related to the onset of which disease process?
a) Liver disease
b) Crohn's disease
c) Diabetes mellitus
d) Hypothyroidism - CORRECT ANSWER: Correct response: Hypothyroidism
Explanation:
Generalized hair loss can be a finding in hypothyroidism. None of the other conditions listed is associated with generalized hair loss. Diabetes is a problem with glucose regulation. Crohn's disease is an inflammatory process in the large intestines. Liver disease results in many problems with fluid regulation, metabolism of drugs, and storage of glucose.
A nurse cares for a client of Asian decent and notices that the client sweats very little and produces no body odor. What is an appropriate action by the nurse in regards to this finding?
a) Document the findings in the client's record as normal
b) Ask the client about overuse of antiperspirant products
c) Assess the client for changes in sensation due to vascular problems
d) Monitor the client for additional findings of cystic fibrosis - CORRECT ANSWER:
Explanation:
Asians and Native Americans have fewer sweat glands than Caucasians and therefore produce less sweat and less body odor. Changes in sensation are not caused by alterations in sweat glands but are a circulation issue. Cystic fibrosis is an alteration in the exocrine glands that causes the production of thick mucous, especially in the lungs.Overuse of antiperspirants would be needed for excessive sweating, not decrease in sweating. (less)
Reference:
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