ATI LPN
Fundamentals of Nursing Medication Administration Questions Questions
Question 1 of 4
A nurse is caring for a client who has undergone a skin graft to cover a burn injury on the right arm. Which intervention should the nurse include in the plan of care to promote graft adherence?
Correct Answer: C
Rationale: Immobilizing the right arm with a splint or sling helps to prevent movement and shear forces that can dislodge or damage the graft. The nurse should also avoid applying pressure or friction to the graft site.
Question 2 of 4
A client with venous insufficiency has a venous stasis ulcer on the lower leg. Which instruction should the nurse give to the client to promote wound healing?
Correct Answer: D
Rationale: The client with venous insufficiency has impaired venous return from the lower extremities, which causes edema, inflammation, and skin breakdown. The nurse should instruct the client to apply compression stockings or bandages to improve blood flow and reduce swelling; avoid crossing the legs or wearing tight-fitting clothing that can constrict blood vessels; and keep the leg elevated when sitting or lying down to facilitate venous return.
Question 3 of 4
A client has a stage 3 pressure ulcer on the left trochanter with moderate serosanguineous drainage. The wound is 4 cm in length, 3 cm in width, and 2 cm in depth. The wound bed is 80% granulation tissue and 20% slough. Which type of dressing should the nurse use for this wound?
Correct Answer: C
Rationale: Alginate is a type of dressing that is derived from seaweed and forms a gel-like substance when in contact with wound exudate. It is highly absorbent and can handle moderate to large amounts of drainage. It also provides a moist wound environment and supports autolytic debridement of slough and eschar. It is suitable for wounds with depth, such as stage 3 or 4 pressure ulcers.
Question 4 of 4
A client is scheduled for a skin graft surgery to treat a large wound on the arm. The nurse explains to the client that the graft will be taken from the thigh. What term should the nurse use to describe this type of graft?
Correct Answer: A
Rationale: An autograft is a type of skin graft that uses the client's own skin as the donor site. This is the preferred type of graft, as it has the lowest risk of rejection and infection, and provides the best cosmetic and functional results.