ATI RN
NCLEX Questions on Skin Integrity and Wound Care Questions
Question 1 of 5
Because of the way the influenza virus is transmitted from person to person, nurses who are working with clients with influenza should implement
Correct Answer: A
Rationale: The correct answer is A: droplet precautions. Influenza virus is primarily transmitted through respiratory droplets when an infected person coughs or sneezes. Droplet precautions involve wearing a mask and eye protection to prevent the spread of droplets. Isolation precautions (B) are used for infections spread by contact with the patient or their environment. Airborne precautions (C) are for infections transmitted through small particles that remain suspended in the air. Contact precautions (D) are for infections spread by direct or indirect contact with the patient or their environment. Droplet precautions are the most appropriate for influenza due to its mode of transmission through respiratory droplets.
Question 2 of 5
The nurse is providing discharge teaching to a client recovering from pneumonia. Which client statement indicates that additional teaching is needed?
Correct Answer: C
Rationale: Rationale: C is correct because the pneumococcal vaccine is not given every fall; it's typically recommended once or in some cases, a booster after a certain period. A is incorrect as alternative vaccines are available for those allergic to eggs. B is a good practice as the influenza vaccine should be received annually. D is incorrect because the pneumococcal vaccine primarily protects against pneumococcal disease, not all bacterial pneumonia.
Question 3 of 5
A 1-month-old infant is admitted to the hospital with a temperature of 102°F. What is the rationale for a complete septic workup?
Correct Answer: B
Rationale: The correct answer is B: Immature immune system. A 1-month-old infant has an underdeveloped immune system, making them more susceptible to infections. A temperature of 102°F suggests a potential serious infection like sepsis. A complete septic workup is necessary to identify the source of infection and initiate appropriate treatment promptly. Choices A, C, and D are incorrect because the absence of sweat glands, inadequate red blood cells, and poor lung elasticity do not directly relate to the need for a septic workup in this scenario.
Question 4 of 5
An adolescent client is brought to the emergency department (ED) with fatigue, weight loss, a dry cough, and night sweats. The family just recently immigrated to the United States. Based on this data, which potential risk should the nurse include when planning care for this client?
Correct Answer: A
Rationale: The correct answer is A: Pneumothorax. Given the symptoms of fatigue, weight loss, dry cough, and night sweats in an adolescent who recently immigrated, the nurse should consider tuberculosis (TB) as a potential risk. TB can lead to pneumothorax due to lung cavitation and can present with the symptoms described. Atelectasis, renal failure, and reduced peristalsis are less likely in this scenario and do not align with the client's presenting symptoms and recent immigration history.
Question 5 of 5
The most common type of upper urinary tract infection that results from bacteria ascending to the kidney from the lower respiratory tract is
Correct Answer: C
Rationale: The correct answer is C: pyelonephritis. This is because pyelonephritis is a type of upper urinary tract infection that occurs when bacteria ascends from the lower urinary tract to the kidney, often through the ureters. Urethritis (choice A) is an infection of the urethra, not the kidney. Prostatitis (choice B) is an infection of the prostate gland, not the kidney. Cystitis (choice D) is a lower urinary tract infection involving the bladder, not the kidney. Therefore, pyelonephritis is the most appropriate choice in this scenario.