ATI LPN
Skin Integrity and Wound Care NCLEX Questions Questions
Question 1 of 5
The nurse identifies which type of wounds heal by tertiary intention?
Correct Answer: D
Rationale: Tertiary intention involves delayed closure after being left open, unlike primary (immediate closure) or secondary (healing from the bottom up) intention.
Question 2 of 5
The nurse understands which rationale to be appropriate for drying a wound after irrigation?
Correct Answer: C
Rationale: Drying prevents moisture-related skin breakdown, not infection or dressing adhesion.
Question 3 of 5
The nurse caring for an unconscious patient who was involved in an automobile accident 2 weeks ago will give priority to which element when planning care to decrease the development of a decubitus ulcer?
Correct Answer: B
Rationale: Pressure is the cornerstone of decubitus ulcer formation, per the flashcards, as sustained force occludes capillaries (15-32 mm Hg), causing tissue ischemia in unconscious patients unable to reposition. Care planning focuses on offloading via turning schedules or specialty beds. Resistance isn't a recognized element here. Weight influences pressure distribution but isn't the root cause. Stress affects general health, not skin integrity directly. Pressure's intensity and duration are modifiable, evidence-based targets nurses prioritize to prevent ulcers, especially in prolonged immobility, making this the correct element.
Question 4 of 5
The nurse is caring for a patient who is experiencing a full-thickness wound repair. Which type of tissue will the nurse expect to observe when the wound is healing?
Correct Answer: C
Rationale: Full-thickness repair produces granulation tissue red, vascular, moist indicating healing progress, per the flashcards. Eschar is necrotic, requiring removal. Slough is dead tissue, impeding repair. Purulent drainage signals infection. Nurses monitor granulation in the proliferative phase, guiding moist dressing use, making this the correct tissue expected.
Question 5 of 5
Which laboratory data will be important for the nurse to monitor when a patient develops a pressure ulcer?
Correct Answer: C
Rationale: Prealbumin , per the flashcards, reflects nutritional status for healing, dropping (<20 mg/dL) in malnutrition a pressure ulcer risk. Vitamin E isn't key. Potassium and sodium are electrolytes, not healing-specific. Nurses track prealbumin over albumin for recent intake, making this the correct data.