ATI LPN
NCLEX Practice Questions Skin Integrity and Wound Care Questions
Question 1 of 5
One measure to promote early patient ambulation and a return to independence in activities of daily living is to:
Correct Answer: B
Rationale: Early ambulation restores independence. A bedside commode eases toileting, encouraging movement post-op, per mobility protocols. Opening cartons helps eating, not ambulation. Games distract, not mobilize. Bathing in a chair is later-stage. Commode use reduces fall risk while promoting activity, an LPN task, making it the correct measure.
Question 2 of 5
You note a change in mental status in an older adult patient, with flushed, warm, dry skin, full pulse, and low urine output. The priority action is:
Correct Answer: C
Rationale: Altered mental status, warm/dry skin, and oliguria suggest sepsis. Taking vital signs first confirms severity (e.g., fever, tachycardia), per ABCs, guiding urgency. Notifying or drawing blood follows data. History delays. Vitals provide objective evidence, an LPN priority, making it the correct first action.
Question 3 of 5
An appropriate short-term outcome for a patient with acute pain after surgery would be:
Correct Answer: D
Rationale: Short-term outcomes are specific, measurable. Pain adequately controlled with PCA targets relief within hours, per SMART goals. PCA use is action, not outcome. Nurse assessment is process. Healing is long-term. Controlled pain reflects efficacy, an LPN aim, making it the correct outcome.
Question 4 of 5
Which risk factor will the nurse assess for that predisposes a patient to pressure ulcer development?
Correct Answer: A
Rationale: Pressure ulcers result from prolonged pressure impairing blood flow to tissues. A decreased level of consciousness is a key risk factor, per *Fundamentals of Nursing*, because confused or unconscious patients can't reposition themselves to relieve pressure or communicate discomfort. This aligns with the Braden Scale's sensory perception category, where impaired awareness heightens vulnerability. Adequate dietary intake supports healing, not risk. Shortness of breath affects oxygenation but isn't a direct pressure ulcer cause. Muscular pain may limit mobility but isn't primary. Decreased consciousness directly correlates with immobility and unawareness, making it the correct answer nurses assess first in med-surg settings.
Question 5 of 5
Which type of healing will the nurse consider when planning care for a patient with a Stage IV pressure ulcer?
Correct Answer: B
Rationale: Stage IV pressure ulcers, with exposed bone or muscle, heal by full-thickness repair (Choice B), per the text, involving hemostasis, inflammatory, proliferative, and maturation phases due to deep tissue loss. Partial-thickness repair suits shallow wounds. Primary intention is for clean, closed incisions. Tertiary intention delays closure. Full-thickness healing addresses scar formation in severe ulcers, guiding nurses to plan debridement and grafting, making this the correct healing type for care planning.