ATI RN
Skin Integrity NCLEX Questions Questions
Question 1 of 5
A patient reports chronic itching of the ankles and continuously scratches the area. Which assessment finding will the nurse expect?
Correct Answer: B
Rationale: The correct answer is B: Thickening of the skin around the ankles. Chronic scratching due to itching can lead to lichenification, which is thickening and hardening of the skin. This is a common skin finding in individuals who continuously scratch the affected area. Hypertrophied scars (choice A) are more likely to occur with trauma or injury, not chronic itching. Yellowish-brown skin (choice C) may indicate underlying conditions like jaundice, not necessarily related to chronic itching. Complete absence of melanin (choice D) is not a typical finding related to chronic itching. Therefore, the correct assessment finding would be thickening of the skin around the ankles due to chronic scratching.
Question 2 of 5
When assessing a new patient at the outpatient clinic, the nurse notes dry, scaly skin; thin hair; and thick, brittle nails. What is the nurse’s most important action?
Correct Answer: C
Rationale: The correct answer is C: Consult with the health care provider about the need for further diagnostic testing. The nurse's most important action is to investigate the underlying cause of the patient's symptoms, as dry, scaly skin; thin hair; and thick, brittle nails can be indicative of various underlying health conditions such as thyroid disorders, nutritional deficiencies, or skin disorders. By consulting with the health care provider for further diagnostic testing, the nurse can determine the root cause of the symptoms and develop an appropriate treatment plan. Choice A is incorrect because while nutrition is important for skin health, the patient's symptoms may be indicative of a more serious underlying health issue that needs to be addressed first. Choice B is incorrect as referring to a podiatrist for nail trimming does not address the underlying cause of the symptoms. Choice D is incorrect as using moisturizing creams may provide temporary relief but does not address the root cause of the issue.
Question 3 of 5
A patient complains of shoulder pain when the nurse moves the patient’s arm behind the back. Which question should the nurse ask?
Correct Answer: B
Rationale: The correct answer is B: Do you have difficulty when you are putting on a shirt? This question is relevant because it specifically addresses the motion that triggers the patient's shoulder pain. It helps to assess the range of motion and identify any limitations or discomfort during activities involving arm movement behind the back. A: Are you able to feed yourself without difficulty? - While this question addresses arm movement, it does not specifically target the motion that triggers the pain. C: Are you able to sleep through the night without waking? - This question does not directly relate to the shoulder pain triggered by arm movement behind the back. D: Do you ever have trouble lowering yourself to the toilet? - This question does not address the specific movement causing the shoulder pain and is not as relevant for assessing the patient's condition.
Question 4 of 5
A patient with severe kyphosis is scheduled for dual-energy x-ray absorptiometry (DXA) testing. The nurse will plan to
Correct Answer: A
Rationale: The correct answer is A: explain the procedure. This is important because in a DXA testing, there is no contrast medium or sedative required, so starting an IV line for contrast medium injection (B) and giving an oral sedative (C) are unnecessary. Screening for allergies to shellfish or iodine products (D) is also irrelevant since these are not used in DXA testing. A thorough explanation of the procedure ensures the patient understands what to expect and can help alleviate any anxiety or concerns they may have.
Question 5 of 5
Which discharge instruction will the emergency department nurse include for a patient with a sprained ankle?
Correct Answer: C
Rationale: The correct answer is C: Use pillows to elevate the ankle above the heart. Elevating the ankle helps reduce swelling by promoting venous return and decreasing fluid accumulation. This position also helps with pain management. Choice A is incorrect as wrapping the ankle too loosely may not provide adequate support. Choice B is incorrect because heat can increase swelling and inflammation. Choice D is incorrect as moving the ankle through the range of motion can worsen the injury.