ATI RN
NCLEX Questions on Skin Integrity and Wound Care Questions
Question 1 of 5
A patient with an enlarging, irregular mole that is 7 mm in diameter is scheduled for outpatient treatment. The nurse should plan to prepare the patient for which procedure?
Correct Answer: D
Rationale: The correct answer is D: Surgical excision. This is the most appropriate procedure for removing a suspicious mole that is irregular, enlarging, and potentially malignant. Surgical excision allows for the complete removal of the mole along with a margin of healthy tissue to ensure that all abnormal cells are eliminated. Curettage (A) involves scraping the skin surface and may not be sufficient for complete removal. Cryosurgery (B) freezes and destroys tissue but may not be adequate for excising a potentially malignant lesion. Punch biopsy (C) is used for sampling a small portion of the mole for diagnostic purposes, not for complete removal.
Question 2 of 5
Which medication information will the nurse identify as a potential risk to a patient’s musculoskeletal system?
Correct Answer: C
Rationale: The correct answer is C because oral corticosteroids, used to treat severe asthma, can lead to musculoskeletal issues like osteoporosis and muscle weakness. Corticosteroids can decrease bone density and increase the risk of fractures. A: Taking multivitamins and calcium supplements promotes bone health. B: Hormone replacement therapy does not directly impact the musculoskeletal system. D: NSAIDs are not typically associated with musculoskeletal risks unless used in high doses for prolonged periods.
Question 3 of 5
Which action can the nurse delegate to unlicensed assistive personnel (UAP) who are working in the orthopedic clinic?
Correct Answer: B
Rationale: The correct answer is B. UAP can safely obtain a blood sample for uric acid from a patient with gout as it is a non-invasive task that does not require specialized nursing knowledge. The rationale includes: 1. UAP training often includes basic phlebotomy skills. 2. Blood sample collection is a routine task that can be delegated. 3. Uric acid testing is a common diagnostic procedure for gout. Other choices require higher-level nursing assessment and intervention skills, which UAP are not trained or qualified to perform. A: Assessing muscle strength requires nursing judgment. C: Performing straight-leg-raise testing involves potential risk of injury. D: Checking for knee crepitation before surgery requires specific knowledge and expertise.
Question 4 of 5
A patient has a long-arm plaster cast applied for fracture immobilization. Until the cast has completely dried, the nurse should
Correct Answer: B
Rationale: The correct answer is B: avoid handling the cast using fingertips. This is because handling the cast while it is still wet can deform or break it, leading to improper immobilization. It is crucial to allow the cast to dry completely to ensure proper support and healing of the fracture. Keeping the arm in a dependent position (choice A) is not necessary for the drying process. Placing gauze around the cast edge (choice C) may interfere with the drying process and cause uneven drying. Covering the cast with a blanket (choice D) may trap moisture and prolong the drying time, leading to potential complications.
Question 5 of 5
After the health care provider recommends amputation for a patient who has nonhealing ischemic foot ulcers, the patient tells the nurse that he would rather die than have an amputation. Which response by the nurse is best?
Correct Answer: C
Rationale: The correct answer is C because it demonstrates active listening and allows the nurse to assess the patient's understanding and concerns about the treatment options. By asking the patient to share what they know, the nurse can address any misconceptions, provide additional information, and involve the patient in decision-making. Choice A is incorrect because it dismisses the patient's feelings and does not address the patient's concerns. Choice B is incorrect because it assumes the patient will be open to using a foot prosthesis without exploring the patient's preferences further. Choice D is incorrect because it does not address the patient's need for information and support in making an informed decision about their treatment options.