ATI LPN
Fundamentals of Nursing Skin Integrity and Wound Care NCLEX Questions Questions
Question 1 of 5
The nurse describes several types of burn treatment. Which statement best describes the closed technique?
Correct Answer: C
Rationale: The closed technique involves covering the wound with ointment and gauze saturated with medication.
Question 2 of 5
A nurse is preparing a plan of care for a client with a diagnosis of acute cellulitis of the lower leg. The nurse anticipates which measure will be prescribed to treat this condition?
Correct Answer: A
Rationale: Warm moist compresses promote vasodilation and enhance antibiotic delivery to the infected area in cellulitis.
Question 3 of 5
A nurse is aware that the outer layer of the skin consists of dead cells that contain large amounts of keratin. The physiologic functions of keratin include which of the following?
Correct Answer: C
Rationale: The dead cells of the epidermis contain large amounts of keratin, an insoluble, fibrous protein that forms the outer barrier of the skin. Keratin has the capacity to repel pathogens and prevent excessive fluid loss from the body. It does not contribute directly to antibody production or electrolyte absorption.
Question 4 of 5
A nurse is preparing to perform the physical assessment of a newly admitted patient. During which of the following components of the assessment should the nurse wear gloves?
Correct Answer: B
Rationale: Gloves are worn during skin examination if a rash or lesions are to be palpated. It is not normally necessary to wear gloves to palpate intact skin unless contact with body fluids is foreseeable.
Question 5 of 5
The nurse is caring for a patient who has circumferential full-thickness burns of his forearm? A priority in the plan of care is:
Correct Answer: B
Rationale: Special attention is given to circumferential(completely surrounding a body part) full thickness burns of the extremities. Pressure from bands of eschar or from edema that develops as resuscitation proceeds may impair blood flow to underlying and distal tissue. Therefore, extremities are elevated to reduce edema. Active or passive range-of-motion(ROM) exercises are performed every hour for 5 minutes to increase venous return and to minimize edema. Peripheral pulses are assessed every hour, especially in circumferential burns of the extremities, to confirm adequate circulation. If signs and symptoms of compartment syndrome are present on serial examination, preparation is made for an escharotomy to relieve pressure and to restore circulation.