ATI LPN
Skin Integrity Nursing Questions Questions
Question 1 of 5
The nurse is caring for a 26-year-old male patient who was burned 72 hours ago. He has partial-thickness burns to 24% of his body surface area. He begins to excrete large amounts of urine. What should the nurse do?
Correct Answer: C
Rationale: As the blood volume increases, the cardiac output increases to increase renal perfusion. The result includes diuresis. However, a great risk for the patient includes fluid overload because of the rapid movement of fluid back into the intravascular space.
Question 2 of 5
The mother of a 4-year-old child reports concerns about how to completely rid her home of lice. Which response indicates that the mother needs further instruction?
Correct Answer: C
Rationale: For items that cannot be cleaned, such as some stuffed animals, sealing them in plastic bags with the air expelled for 14 days can be effective. Linens should be washed and dried on the hottest cycle. Application of alcohol-based lotion requires reapplication after 1 week. Sharing hats or hairbrushes increases the likelihood of lice transmission.
Question 3 of 5
A client is brought to the emergency room following a burn injury. In assessment the nurse notes that the client's eyebrow and nasal hairs are singed. The nurse would identify this type of burn as:
Correct Answer: A
Rationale: Singed eyebrow and nasal hairs indicate exposure to heat and flames, characteristic of a thermal burn, often with inhalation injury risk.
Question 4 of 5
A nurse performs a skin assessment on an assigned client and notes the presence of lesions that are red-tan scaly plaques. The nurse documents this findings as:
Correct Answer: D
Rationale: Red-tan scaly plaques are characteristic of actinic keratoses, precancerous lesions from sun exposure.
Question 5 of 5
A student nurse is instructed by the registered nurse to monitor a client who has dark skin for cyanosis. The registered nurse determines that the student needs instructions regarding physical assessment techniques for the dark-skinned client if the student states that the best area to assess for cyanosis was in the:
Correct Answer: C
Rationale: In dark-skinned clients, cyanosis is best assessed in the sclera, conjunctiva, or oral mucosa, not nail beds or lips, due to pigmentation.