ATI RN
Skin Integrity and Wound Care Questions Questions
Question 1 of 5
The nurse is caring for a client who is receiving IV antibiotics for the treatment of a Staphylococcus aureus infection. Which nursing interventions are appropriate when providing care to this client? Select the one that does not apply
Correct Answer: D
Rationale: The correct answer is D: Assess pain level. In this scenario, the client is receiving IV antibiotics for a Staphylococcus aureus infection, which is not typically associated with significant pain. The priority nursing interventions should focus on monitoring for allergic reactions due to antibiotic administration, assessing renal and liver function to ensure proper medication metabolism and excretion, and encouraging adequate fluid intake to prevent dehydration and support kidney function. Assessing pain level is not directly related to the treatment of Staphylococcus aureus infection with antibiotics and would not be a priority in this case.
Question 2 of 5
The nurse is assessing a college student who presents with red, swollen eyes; photophobia; and yellowish drainage from the conjunctiva. Which question should the nurse ask the client first?
Correct Answer: D
Rationale: The correct question to ask the client first is D: "Have any of your friends experienced these symptoms?" This question helps identify if the symptoms are due to a contagious condition like conjunctivitis, commonly known as pink eye. By inquiring about friends' symptoms, the nurse can assess potential exposure and recommend appropriate precautions. Explanation for other choices: A: Asking about caffeine consumption is unrelated to the client's eye symptoms. B: Inquiring about sand in the eye is not relevant to the symptoms described. C: Asking about HIV exposure is not the priority as the symptoms presented are indicative of a different condition.
Question 3 of 5
The nurse is caring for a client who presents with acute malaise, muscle aches, and fever. Which additional assessment findings should the nurse recognize as consistent with influenza? Select the one that does not apply
Correct Answer: C
Rationale: The correct answer is C: Hypotension. Influenza typically presents with symptoms such as malaise, muscle aches, fever, and a nonproductive cough. Hypotension is not a common symptom of influenza. It is more indicative of other conditions like sepsis or dehydration. Difficulty urinating is not typically associated with influenza either. A lack of recent vaccinations (choice A) can contribute to susceptibility to influenza, and a nonproductive cough (choice B) is a common respiratory symptom seen in influenza cases. Thus, hypotension is the outlier among these assessment findings.
Question 4 of 5
The nurse is caring for a client who refuses treatment for otitis media. The nurse correctly teaches the client that she is at increased risk for developing which condition?
Correct Answer: B
Rationale: The correct answer is B: Meningitis. Otitis media is an infection of the middle ear, and if left untreated, the infection can spread to the meninges, causing meningitis. Meningitis is a serious condition that can lead to inflammation of the brain and spinal cord. This progression from otitis media to meningitis highlights the importance of treating infections promptly to prevent complications. Choices A, C, and D are incorrect as there is no direct causal relationship between otitis media and external otitis, pneumonia, or influenza.
Question 5 of 5
An older adult client is admitted with pneumonia. Which manifestations would the nurse expect to find when assessing this client? Select all that apply.
Correct Answer: A
Rationale: The correct answer is A: Hemoptysis. In pneumonia, hemoptysis (coughing up blood-tinged sputum), is a common symptom due to inflammation and infection in the lungs. It is caused by the destruction of lung tissue and blood vessels. Increased appetite (B) is unlikely as pneumonia typically causes a decreased appetite due to feeling unwell. Cough (C) is a common manifestation of pneumonia, but it is not specific to pneumonia alone. Tachypnea (D) is also a common symptom of pneumonia due to the body's attempt to increase oxygen intake, but it is not as specific as hemoptysis in this context.