ATI RN
NCLEX Questions Skin Integrity and Wound Care Questions
Question 1 of 5
A patient in the dermatology clinic has a thin, scaly erythematous plaque on the right cheek. Which action should the nurse take?
Correct Answer: A
Rationale: The correct answer is A because a thin, scaly erythematous plaque may indicate skin cancer, such as squamous cell carcinoma. A skin biopsy is crucial to confirm the diagnosis and determine the appropriate treatment plan. Choice B is incorrect as corticosteroid cream is not suitable for potential skin cancer. Choice C is incorrect as tretinoin is mainly used for acne and photoaging, not for suspected skin cancer. Choice D is incorrect as antibiotics are not typically indicated for non-infectious skin conditions like squamous cell carcinoma.
Question 2 of 5
A patient who has severe refractory psoriasis on the face, neck, and extremities is socially withdrawn because of the appearance of the lesions. Which action should the nurse take first?
Correct Answer: D
Rationale: The correct answer is D because asking the patient to describe the impact of psoriasis on quality of life is the first step in understanding the patient's perspective and needs. This allows the nurse to assess the severity of the emotional and social impact, which can guide further interventions. Options A, B, and C do not address the root cause of the patient's social withdrawal and may not be as effective in addressing the patient's emotional distress.
Question 3 of 5
The nurse finds that a patient can flex the arms when no resistance is applied but is unable to flex when the nurse applies light resistance. The nurse should document the patient’s muscle strength as level
Correct Answer: C
Rationale: The correct answer is C (2). This patient demonstrates muscle strength that is graded as 2 according to the Medical Research Council (MRC) scale. A score of 2 indicates that the patient can move the joint against gravity but not against resistance. Choices A, B, and D are incorrect because they represent different levels of muscle strength based on the MRC scale. Choice A (0) indicates no muscle contraction, choice B (1) indicates a flicker or trace of contraction, and choice D (3) indicates movement against gravity but not against resistance. Therefore, the best description of the patient's muscle strength in this scenario is level 2.
Question 4 of 5
Which information will the nurse teach seniors at a community recreation center about ways to prevent fractures?
Correct Answer: C
Rationale: The correct answer is C: Buy shoes that provide good support and are comfortable to wear. This is crucial in preventing falls and fractures as proper footwear can improve balance and reduce the risk of slipping. Seniors should choose shoes with non-slip soles, good arch support, and a comfortable fit to prevent falls. Tacking down scatter rugs (A) can also help prevent falls, but focusing on footwear is more directly related to fracture prevention. Expecting most falls to happen outside the home (B) is not a proactive prevention strategy. Getting instruction in range-of-motion exercises (D) is important for overall mobility but does not directly address fracture prevention.
Question 5 of 5
Which statement by the patient indicates a good understanding of the nurse’s teaching about a new short-arm synthetic cast?
Correct Answer: C
Rationale: The correct answer is C because applying an ice pack to the cast over the fracture site helps reduce swelling and pain, promoting healing. This technique is commonly recommended for managing acute injuries. It shows the patient understands the importance of managing swelling in the initial phase of injury recovery. A is incorrect because getting the cast wet can weaken it and lead to skin irritation. B is incorrect as moving fingers and elbow can disrupt the healing process and cause complications. D is incorrect because applying lotion under the cast can create moisture buildup, leading to skin issues and discomfort.