ATI RN
NCLEX Questions Skin Integrity and Wound Care Questions
Question 1 of 5
The nurse is assessing a client who presents with purulent drainage and crusting of the eye. The nurse should recognize that these findings are most consistent with which type of infection?
Correct Answer: C
Rationale: The correct answer is C: Bacterial conjunctivitis. Purulent drainage and crusting of the eye are indicative of a bacterial infection. Bacterial conjunctivitis typically presents with these symptoms due to the bacterial presence causing inflammation and discharge. Viral conjunctivitis (A) may have watery discharge, while allergic conjunctivitis (B) is characterized by itching and clear discharge. Fungal conjunctivitis (D) is rare and usually presents with a slow onset and may involve a white patch on the eye.
Question 2 of 5
A toddler with otitis media is prescribed amoxicillin clavulanate 250 mg/5 mL three times daily by mouth for 10 days. What should the nurse teach the mother about this medication?
Correct Answer: B
Rationale: The correct answer is B: Give the antibiotic for the full 10 days as prescribed. The rationale is as follows: 1. Amoxicillin clavulanate is used to treat otitis media, and completing the full course is crucial to ensure the infection is completely eradicated. 2. Stopping the antibiotic prematurely can lead to antibiotic resistance and treatment failure. 3. Using a household teaspoon (Choice C) is inaccurate and can result in incorrect dosing. 4. Administering a loading dose (Choice D) is not necessary for this medication.
Question 3 of 5
Which intervention should the nurse carry out to manage fever in a client with pneumonia? Select all that apply.
Correct Answer: B
Rationale: The correct answer is B: Administer antipyretic medications. Antipyretics help reduce fever by acting on the hypothalamus to lower the body's temperature set point. This intervention is effective and commonly used in managing fever in pneumonia. Choice A is incorrect as increasing room temperature can worsen the fever. Choice C is incorrect because fluid restriction can lead to dehydration, which is harmful during fever. Choice D is incorrect as using ice packs and tepid baths can cause temperature fluctuations, which are not ideal for fever management.
Question 4 of 5
A nurse is caring for a client with septicemia. What assessment by the nurse best addresses the potential for ineffective peripheral perfusion?
Correct Answer: D
Rationale: The correct answer is D: Monitor for cyanosis. In septicemia, inadequate peripheral perfusion can lead to cyanosis due to decreased oxygen delivery. Cyanosis is a late sign of compromised perfusion. Assessing heart rate (choice A) may indicate changes in cardiac function but does not directly assess peripheral perfusion. Monitoring temperature (choice B) can reveal fever, which is common in septicemia, but does not directly assess perfusion. Checking pupil reactions (choice C) is important but does not specifically address peripheral perfusion. Therefore, monitoring for cyanosis is the most direct way to assess for ineffective peripheral perfusion in a client with septicemia.
Question 5 of 5
The nurse in an inner city clinic is providing a health screening for a homeless client with a history of drug abuse. The client has a chronic nonproductive cough. For which should the nurse expect to screen this client?
Correct Answer: D
Rationale: The correct answer is D: Tuberculosis. Given the client's history of drug abuse and chronic nonproductive cough, the nurse should screen for TB due to its high prevalence among homeless individuals and its association with respiratory symptoms. TB can easily spread in crowded environments like homeless shelters. Herpes zoster (A) is a viral infection causing a painful rash, not typically associated with a chronic cough. Sickle cell disease (B) is a genetic blood disorder, unrelated to the client's symptoms. Sick sinus syndrome (C) is a cardiac condition characterized by abnormal heart rhythms, not typically presenting with a chronic cough. In summary, TB is the most likely condition to screen for based on the client's history and symptoms.