ATI LPN
Skin Integrity and Wound Care Questions Questions
Question 1 of 5
A hospital is struggling to improve patient satisfaction/HCAPS scores... The best approach is to
Correct Answer: C
Rationale: Engagement seeks solutions. Suggesting alternatives to your supervisor , per the test, opens dialogue for better strategies (e.g., workflow fixes), addressing burnout collaboratively. Silence avoids change. Complaints delegate. CEO talks bypass command. This balances voice and action, making it the correct approach.
Question 2 of 5
The nurse is preparing to provide wound care to a client with a stage 1 pressure injury. Which dressing would the nurse expect to be prescribed in the treatment of this wound?
Correct Answer: B
Rationale: Stage 1 injuries are intact. Transparent dressing , per Braden Scale care, protects non-open skin (red, no breakdown) while allowing monitoring. Hydrogel adds moisture for open wounds. Antimicrobial targets infection, unneeded here. Alginate suits heavy drainage. Transparency preserves integrity and prevents progression, making it the expected choice.
Question 3 of 5
A client is admitted with a burn injury that involves the epidermis and part of the dermis. The nurse knows that this type of burn is classified as:
Correct Answer: B
Rationale: A burn involving the epidermis and part of the dermis is classified as a partial-thickness burn, making choice B the correct answer. This type of burn typically presents with blisters, significant pain due to exposed nerve endings, and redness as blood vessels in the dermis are affected. It may heal spontaneously within two to three weeks with proper care or require skin grafting if deeper layers are involved. Superficial burns only affect the epidermis, causing mild pain and erythema without blisters, and heal quickly within days without scarring. Full-thickness burns extend through the epidermis, dermis, and into underlying tissues like fat or muscle, resulting in a charred appearance, no pain due to nerve destruction, and the need for surgical intervention. Deep partial-thickness burns involve most of the dermis, presenting with white or red skin and severe pain, often requiring grafting due to slower healing. The distinction lies in the depth of tissue involvement, and partial-thickness best matches the description provided.
Question 4 of 5
A client with a burn wound on the chest has a silver sulfadiazine (Silvadene) cream applied to the wound. Which adverse reaction should the nurse monitor for in this client?
Correct Answer: D
Rationale: as the nurse should monitor for both hypersensitivity or allergic reaction and leukopenia or decreased white blood cell count when using silver sulfadiazine (Silvadene) on a burn wound. This topical antimicrobial can cause allergic reactions like rash, itching, or swelling, which may escalate to severe symptoms like difficulty breathing, requiring immediate attention. It can also lead to leukopenia, a drop in white blood cells, increasing infection risk, necessitating regular blood count monitoring. Hyperglycemia isn't a typical adverse reaction to Silvadene; it may occur in burn patients due to stress or infection, not the cream itself. Since both A and B are valid concerns supported by the need for baseline and periodic complete blood counts choice D encompasses the full scope of critical monitoring, ensuring comprehensive care for potential complications.
Question 5 of 5
A client with diabetes mellitus has a diabetic foot ulcer on the left heel. The nurse is preparing to apply a hydrocolloid dressing to the wound. What is an advantage of using this type of dressing?
Correct Answer: D
Rationale: as hydrocolloid dressings stimulate autolytic debridement of necrotic tissue, a key advantage for a diabetic foot ulcer. These dressings are occlusive, forming a gel-like layer over the wound that traps moisture and enzymes, naturally breaking down dead tissue without mechanical intervention. This process is gentle, reducing trauma to surrounding healthy tissue, which is crucial for diabetic patients prone to slow healing. While providing a moist environment is true, it's not unique to hydrocolloids other dressings like hydrogels also do this making it less specific. Absorbing large amounts of exudate is incorrect, as hydrocolloids handle only minimal to moderate drainage, unlike alginates, and can leak if overwhelmed. Allowing frequent inspection is false; hydrocolloids are opaque and typically left in place for days, not designed for regular viewing. Autolytic debridement stands out as the distinct benefit, supporting healing in chronic wounds like diabetic ulcers by clearing necrotic debris efficiently.