ATI RN
NCLEX Practice Questions Skin Integrity and Wound Care Questions
Question 1 of 5
The nurse correctly explains to a young mother that bottle-feeding an infant in the upright position may help to prevent which infectious health problem?
Correct Answer: D
Rationale: The correct answer is D: Otitis media. Bottle-feeding in an upright position helps prevent fluid from entering the middle ear, reducing the risk of otitis media. This infection occurs when bacteria from the nose and throat travel through the Eustachian tube to the middle ear. By keeping the infant upright during feeding, gravity helps prevent this bacterial migration. Choices A, B, and C are incorrect as bottle-feeding in an upright position does not directly impact choking, aspiration, or sinus infections.
Question 2 of 5
The nurse is providing teaching on preventing sepsis. Which should the nurse include as a major risk factor for the development of this health problem?
Correct Answer: C
Rationale: The correct answer is C: Undiagnosed urinary tract infection. UTI is a major risk factor for sepsis as it can lead to bacterial infection spreading to the bloodstream. This can result in systemic inflammation and organ dysfunction, which are characteristic of sepsis. Pneumococcal bacteria (choice A) and leukocytosis (choice B) are not risk factors but rather potential indicators of infection. Elevated temperature (choice D) may indicate infection, but it is not a specific risk factor for sepsis like an untreated UTI.
Question 3 of 5
The nurse is preparing to assess an older adult client admitted with tuberculosis. Which assessment finding does the nurse anticipate?
Correct Answer: C
Rationale: The correct answer is C: Cough. In tuberculosis, a persistent cough is a common symptom due to infection of the lungs. This is caused by the Mycobacterium tuberculosis bacteria affecting the respiratory system. Night sweats (A) are also common in tuberculosis but are not specific to this condition. Swollen lymph nodes (B) typically occur in other infections such as bacterial or viral illnesses. Hemoptysis (D), which is coughing up blood, is a severe symptom seen in advanced stages of tuberculosis but not an early assessment finding.
Question 4 of 5
The nurse in an urgent care center assesses a 40-year-old adult client who presents with a fever of 101.2°F and complaints of painful urination. What should the nurse ask to elicit further data that indicate cystitis?
Correct Answer: D
Rationale: The correct answer is D: "What color is your urine?" This question is essential to assess for cystitis because changes in urine color (such as cloudy or bloody urine) are common symptoms of this condition. Fever and painful urination are also typical symptoms of cystitis, so asking about urine color helps confirm the diagnosis. Choice A is incorrect because menopause symptoms are not relevant to the client's current presentation. Choice B is less pertinent as the duration of fever and presence of chills, while important, may not directly point to cystitis. Choice C is also less relevant as upper abdominal pain or cramping are not specific symptoms of cystitis.
Question 5 of 5
The nurse caring for a client at risk for tuberculosis (TB) should include which symptoms of the disease when educating the client? Select all that apply.
Correct Answer: A
Rationale: Step 1: Fatigue is a common symptom of tuberculosis due to the body's immune response to the infection. Step 2: Low-grade morning fever is not specific to TB and can be seen in various other infections. Step 3: A productive cough that later turns dry is more characteristic of other respiratory conditions, not necessarily TB. Step 4: Weight loss is a common symptom of TB due to the body's increased metabolic demands fighting the infection. Summary: Fatigue is directly related to the body's response to TB infection, making it a key symptom to educate the client about. Other choices are less specific to TB and may be seen in various other conditions.