ATI LPN
Skin Integrity NCLEX Questions Questions
Question 1 of 5
A hospital wishes to implement bar coding in an effort to reduce errors during medication administration. Which of the following would be most helpful during initial design of the new process?
Correct Answer: A
Rationale: Design needs workflow insight. Observing nurses , per the test and Lean principles, reveals real-time barcoding challenges (e.g., scanning barriers), informing process fit. Physician surveys miss administration. Patient focus groups or CNO interviews lack frontline detail. Observation drives usability, making it the correct choice.
Question 2 of 5
A client has a wound with a moderate amount of drainage and is scheduled for a dressing change. Which dressing, if selected by the student nurse, requires further intervention by the nursing instructor?
Correct Answer: D
Rationale: Drainage needs absorption. Semipermeable film , per wound care guidelines, suits minimal exudate, not moderate, risking leakage and infection. Foam and alginate absorb well. Hydrocolloid manages light-to-moderate but seals less effectively here. The instructor intervenes to ensure proper exudate management, critical for healing, making this the dressing needing correction.
Question 3 of 5
The registered nurse (RN) directs the licensed practical nurse (LPN) to assist with the care of a client who has a sacral pressure injury. Which is the most appropriate activity for the RN to delegate to the LPN?
Correct Answer: A
Rationale: LPN scope includes basic care. Positioning , per nursing delegation standards (e.g., NCSBN), suits LPN skills, aiding pressure relief. Initiating protocols or determining plans (Choice D, incomplete) require RN judgment. Meeting (Choice C, incomplete) is vague but likely RN-level. Delegation optimizes care safely, making this the most appropriate activity.
Question 4 of 5
A client has a venous ulcer on the lower leg that is treated with compression therapy. The nurse instructs the client to elevate the leg above the level of the heart whenever possible. What is the rationale for this instruction?
Correct Answer: A
Rationale: Choice A is correct because elevating the leg above the heart reduces edema and venous pressure, which is the primary rationale for this instruction in managing a venous ulcer. Venous ulcers stem from chronic venous insufficiency, causing blood pooling, increased pressure, and swelling in the lower legs. Elevation leverages gravity to enhance venous return to the heart, alleviating these issues and supporting healing. Increasing arterial blood flow and oxygenation is more relevant to arterial ulcers, where elevation might worsen perfusion by countering gravity's aid to arterial flow. Preventing infection and inflammation is critical but not directly tied to elevation; it relies more on wound care practices like cleansing and dressings. Stimulating nerve regeneration and sensation is unrelated to venous ulcers or elevation, as neuropathy isn't a primary concern here. Thus, reducing edema and venous pressure best explains the benefit of elevation in this context.
Question 5 of 5
A nurse is assessing a client with a pressure ulcer on the sacrum. Which finding indicates a potential complication of the wound?
Correct Answer: C
Rationale: Foul-smelling greenish discharge is the correct answer, indicating a potential complication such as infection in the pressure ulcer. This type of discharge, often linked to bacteria like Pseudomonas, combined with a foul odor, suggests microbial overgrowth that can hinder healing and lead to serious outcomes like sepsis if untreated. Prompt reporting and a wound culture are critical to identify the pathogen and tailor treatment. Serous drainage is typically clear and watery, a normal part of healing unless it becomes excessive or purulent. Redness and warmth around the wound are expected signs of inflammation and increased blood flow during early healing stages, not necessarily problematic unless accompanied by worsening symptoms. Granulation tissue is a healthy sign, showing new tissue growth and vascularization, not a complication. The distinct foul-smelling, greenish discharge stands out as an abnormal finding requiring immediate attention, distinguishing it from the other options.