ATI LPN
NCLEX Style Questions on Skin Integrity and Wound Care Questions
Question 1 of 5
The nurse is administering eyedrops to the client. Which guideline should the nurse adhere to when instilling the drops into the eye?
Correct Answer: C
Rationale: The original multiple-answer question is restructured. Holding the lower lid down and instilling drops into the conjunctiva (from option 4) avoids corneal irritation and ensures proper absorption.
Question 2 of 5
The PACU nurse administers Narcan, an opioid antagonist, to a postoperative client. Which client problem should the nurse include to the plan of care based on this medication?
Correct Answer: B
Rationale: Narcan reverses opioid-induced respiratory depression, highlighting the risk for respiratory complications.
Question 3 of 5
Which laboratory value should be monitored by the nurse for the client diagnosed with diabetes insipidus?
Correct Answer: A
Rationale: Diabetes insipidus causes dilute urine and hypernatremia; serum sodium monitoring is key.
Question 4 of 5
A client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. Which finding would the nurse anticipate when auscultating the client's breath sounds?
Correct Answer: B
Rationale: Pulmonary edema from MI causes crackles due to fluid in the alveoli.
Question 5 of 5
A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which finding supports this diagnosis?
Correct Answer: B
Rationale: Because of the profound deficiency of insulin associated with DKA, glucose cannot be used for energy and the body breaks down fat as a secondary source of energy, leading to acidosis and potential coma. While deep, rapid breathing (Kussmaul's respirations) and elevated blood glucose are also signs, the comatose state is a critical indicator of severe untreated DKA.