ATI LPN
Fundamentals Wound Care and Skin Integrity Questions Questions
Question 1 of 5
A nurse is caring for a client brought to the emergency room following a burn injury that occurred in the basement of the home. Which initial finding would indicate the presence of inhalation injury?
Correct Answer: B
Rationale: Singed nasal hairs are a classic initial sign of inhalation injury due to heat exposure to the upper airway.
Question 2 of 5
The nurse in an ambulatory care center is admitting an older adult patient who has bright red moles on the skin. Benign changes in elderly skin that appear as bright red moles are termed what?
Correct Answer: A
Rationale: Cherry angiomas appear as bright red moles, while solar lentigo are commonly called liver spots. Seborrheic keratoses are described as crusty brown stuck-on patches, while xanthelasma appears as yellowish, waxy deposits on the upper eyelids.
Question 3 of 5
An 80-year-old patient is brought to the clinic by her son. The son asks the nurse why his mother has gotten so many spots on her skin. What would be an appropriate response by the nurse?
Correct Answer: A
Rationale: The major changes in the skin of older people include dryness, wrinkling, uneven pigmentation, and various proliferative lesions.
Question 4 of 5
The nurse is caring for patient who has been struck by lightning. Because of the nature of the injury, the nurse assesses the patient for which of the following?
Correct Answer: A
Rationale: Lightning injury frequently causes cardiopulmonary arrest. However, of those patients who survive, 70% will have transient central nervous system deficits. Contractures, infection, and stress ulcer risks are no greater than with other causes of burn injury.
Question 5 of 5
While collecting data on a patient, the nurse observes that the patient's facial skin is yellowish. What other area should the nurse assess to confirm presence of jaundice?
Correct Answer: A
Rationale: Although skin is affected by jaundice, the best place to inspect for jaundice is in the sclera of the eye. The best places to inspect for cyanosis are the lips, nail beds, conjunctivae, and palms.