ATI LPN
Skin Integrity and Wound Care NCLEX Questions Questions
Question 1 of 5
On arrival from PACU, the patient complains of severe thirst, is restless, tachypneic, and tachycardic. You would likely suspect:
Correct Answer: A
Rationale: Thirst, restlessness, tachypnea, and tachycardia signal hypovolemia fluid loss (e.g., bleeding) post-op, per shock assessment. Cardiogenic shock includes cold, clammy skin, not thirst. Anesthesia response fades, not intensifies. Overdose slows respirations. Hypovolemia fits, needing fluid checks, an LPN alert, making it the correct suspicion.
Question 2 of 5
When administering an ordered antimicrobial for an infection, you should check the laboratory results for:
Correct Answer: B
Rationale: Antimicrobials target specific pathogens. Culture and sensitivity identify the bug and effective drug, per pharmacology, guiding therapy. WBC shows infection but not treatment. CRP indicates inflammation, not specificity. Kidney/liver function monitors safety, not efficacy. C&S ensures right antibiotic, an LPN check, making it the correct lab result.
Question 3 of 5
In determining the patient's perception of pain, which question would be useful?
Correct Answer: C
Rationale: Pain perception is subjective.'How would you describe your pain?' captures quality (e.g., sharp), per PQRST assessment, guiding care. Location and history inform but don't define perception. Activity is context, not feeling. Description shapes treatment, an LPN tool, making it the correct question.
Question 4 of 5
Before you administer an opioid analgesic, the most important nursing action is to:
Correct Answer: D
Rationale: Opioids risk respiratory depression. Assessing respirations ensures safety rate <12/min signals danger, per pharmacology. BP is secondary. Comfort measures delay meds. Constipation is later. Breathing is the priority, an LPN check, making it the correct action.
Question 5 of 5
Which nursing observation will indicate the patient is at risk for pressure ulcer formation?
Correct Answer: A
Rationale: Fecal incontinence increases pressure ulcer risk by exposing skin to moisture, bacteria, and enzymes, causing maceration and breakdown, per nursing principles. Eating two-thirds of breakfast suggests some nutrition, not a risk indicator. A red rash on the shin is concerning but not a high-risk pressure area like the sacrum or heels. Normal capillary refill indicates good circulation, not risk. Moisture from incontinence softens skin, amplifying pressure effects, making this the key observation nurses note for early intervention, aligning with risk assessment tools like Braden.