ATI RN
NCLEX Skin Integrity Questions Questions
Question 1 of 5
An appropriate nursing intervention for a patient who has acute low back pain and muscle spasms is to teach the patient to
Correct Answer: C
Rationale: The correct answer is C because keeping the head elevated slightly and flexing the knees when resting in bed helps to reduce pressure on the lower back, promoting relaxation of the muscles and reducing muscle spasms. Elevating the head slightly can also help maintain proper spinal alignment. Choice A is incorrect because keeping both feet flat on the floor when prolonged standing is required may not directly address the low back pain and muscle spasms. Choice B is incorrect because twisting gently from side to side can aggravate the muscle spasms and strain the lower back muscles further. Choice D is incorrect because cold packs can actually help reduce muscle spasms and inflammation, so avoiding their use would not be beneficial for managing acute low back pain and muscle spasms.
Question 2 of 5
A nurse is teaching a patient with contact dermatitis of the arms and legs about ways to decrease pruritus. Which information should the nurse include in the teaching plan(select the one that does not apply)?
Correct Answer: C
Rationale: The correct answer is C. Adding oil to bath water can exacerbate contact dermatitis by further irritating the skin. Oil can create a barrier that traps irritants and moisture, worsening symptoms. The other options are appropriate for managing pruritus in contact dermatitis. A: Cool, wet cloths or compresses can provide relief by soothing and reducing inflammation. B: Cool or tepid baths help to soothe the skin and reduce itching. D: Rubbing dry with a towel after bathing helps prevent skin maceration and further irritation. Adding oil to bath water is contra-indicated in contact dermatitis management.
Question 3 of 5
Atopic dermatitis can be described as: Select all that apply.
Correct Answer: B
Rationale: Atopic dermatitis is characterized by oozing due to the disrupted skin barrier. Vesicle formation is more characteristic of allergic contact dermatitis. Round, erythematous papules that enlarge and coalesce are seen in nummular eczema. Raised wheals with associated itching are typical of urticaria. Oozing is specific to atopic dermatitis due to impaired skin barrier function.
Question 4 of 5
Which of the following actions could result in pressure ulcer formation?
Correct Answer: A
Rationale: The correct answer is A because pulling a stroke client up in bed can create friction and shear forces on the skin, leading to pressure ulcer formation. This action puts pressure on vulnerable areas of the skin, especially if the client is immobile or has limited mobility. Turning a client from side to side every 2 hours (B) is actually a preventive measure to reduce pressure ulcer risk by redistributing pressure. Allowing a client to slide up in a chair at mealtime (C) may not directly contribute to pressure ulcers unless prolonged pressure is exerted. Applying powder to buttocks area when diaphoresis has become a problem (D) can help reduce moisture but is not a direct cause of pressure ulcers.
Question 5 of 5
Which one of the following skin disorders seen in elderly persons is considered a premalignant lesion?
Correct Answer: B
Rationale: The correct answer is B: Actinic keratosis. Actinic keratosis is considered a premalignant lesion because it is caused by prolonged sun exposure and can progress to squamous cell carcinoma if left untreated. It appears as rough, scaly patches on the skin and is commonly seen in elderly individuals with a history of sun damage. Cherry angiomas (A), solar lentigines (C), and telangiectases (D) are not considered premalignant lesions. Cherry angiomas are benign skin growths, solar lentigines are age spots caused by sun exposure, and telangiectases are dilated blood vessels.