ATI LPN
Skin Integrity Practice Questions Questions
Question 1 of 5
A client who had cardiac surgery 24 hours ago has had a urine output averaging 20 mL hour for 2 hours. The client received a single bolus of 500 mL of intravenous fluid. Urine output for the subsequent hour was 25 mL. Daily laboratory results indicate that the blood urea nitrogen level is 45 mg/dL and the serum creatinine level is 2.2 mg/dL. On the basis of these findings, the nurse would anticipate that the client is at risk for which problem?
Correct Answer: B
Rationale: Low urine output and elevated BUN/creatinine post-surgery suggest acute kidney injury.
Question 2 of 5
A patient with severe eczema is starting a coal tar derivative treatment. What should the nurse include in the teaching plan for the patient relative to this treatment?
Correct Answer: B
Rationale: Persons using coal tar derivatives should avoid exposure to sunlight for 72 hours after use. The product stains clothes and bathroom fixtures.
Question 3 of 5
The nurse making the initial assessment of a burned patient in the emergency room observes that the entire right arm (anterior and posterior), right anterior leg, chest, and abdomen are covered with reddened skin and blisters. Using the Rule of Nines, the nurse estimates the percentage of burn to be
Correct Answer: C
Rationale: Anterior and posterior arm are 9%, anterior leg = 9%, chest = 9%, abdomen = 9%. Total 36%.
Question 4 of 5
The nurse is caring for a patient with a stage III pressure ulcer. Which assessment findings are consistent with this stage of ulcer?
Correct Answer: A
Rationale: A stage III pressure ulcer presents as a crater-like ulcer and underlying subcutaneous tissue is involved in the destructive process. Skin that does not blanch with pressure or is mottled are findings consistent with a stage I pressure ulcer. Excoriation around the lesion is consistent with scratching or another abrasive force.
Question 5 of 5
A nurse assesses the carbon monoxide level of a client following a burn injury and notes that the level is 8%. Based on this level, which finding would the nurse expect to note during the assessment of the client?
Correct Answer: A
Rationale: A carbon monoxide level of 8% is mild (<10%) and may cause tachycardia as the body compensates for reduced oxygen-carrying capacity.