ATI LPN
Skin Integrity Nursing Questions Questions
Question 1 of 5
A nurse performs a skin assessment on an assigned client and notes the presence of lesions that are red-tan scaly plaques. The nurse documents this findings as:
Correct Answer: D
Rationale: Red-tan scaly plaques are characteristic of actinic keratoses, precancerous lesions from sun exposure.
Question 2 of 5
An African American is admitted to the medical unit with liver disease. To correctly assess this patient for jaundice, on what body area should the nurse look for yellow discoloration?
Correct Answer: D
Rationale: Jaundice, a yellowing of the skin, is directly related to elevations in serum bilirubin and is often first observed in the sclerae and mucous membranes.
Question 3 of 5
A nurse is conducting a health interview and is assessing for integumentary conditions that are known to have a genetic component. What assessment question is most appropriate?
Correct Answer: A
Rationale: Eczema and psoriasis are known to have a genetic component.
Question 4 of 5
A patient with a 60% burn in the acute phase of treatment develops a tense abdomen, decreasing urine output, hypercapnia, and hypoxemia. Based on this assessment, the nurse anticipates interventions to evaluate and treat the patient for:
Correct Answer: C
Rationale: Intraabdominal hypertension(IAH) is a serious complication caused by circumferential torso burn injuries or edema from aggressive fluid resuscitation. Signs and symptoms of IAH include tense abdomen, decreased urine output, and worsening pulmonary function. Acute kidney injury will not result from aggressive fluid resuscitation. Acute respiratory distress syndrome would present with signs of hypoxia and hypercarbia, but not a tense abdomen. Disseminated intravascular disorder may present as a tense abdomen if there is active bleeding, but it would not present with pulmonary symptoms.
Question 5 of 5
The nurse is applying a medicated plastic wrap dressing to a patient's leg. What intervention should the nurse include in the plan of care to prevent development of complications?
Correct Answer: C
Rationale: Plastic wrap dressings should be used for no more than 12 hours a day. Wet dressings and ointments should be applied only to affected areas, not to healthy intact skin, because this can cause maceration of good skin.