ATI LPN
Skin Integrity and Wound Care NCLEX Questions Quizlet Questions
Question 1 of 5
The nurse is caring for a patient who is postoperative day one from an abdominal surgery. When the patient complains of a 'popping sensation' and a wetness in the dressing, the nurse immediately suspects which complication?
Correct Answer: C
Rationale: Wound dehiscence is the separation of tissue layers, often with a popping sensation and wetness, an emergency situation.
Question 2 of 5
The nurse is performing a wet/damp to dry dressing change when the patient begins to complain of severe pain. What does the nurse do first?
Correct Answer: C
Rationale: Stopping the procedure addresses immediate pain, allowing further assessment.
Question 3 of 5
Which nursing observation will indicate the patient is at risk for pressure ulcer formation?
Correct Answer: A
Rationale: Fecal incontinence signals risk, per nursing standards, by exposing skin to moisture and enzymes, softening it for breakdown (maceration). The flashcards list this as a key observation, as prolonged contact with stool rich in bacteria amplifies pressure effects on areas like the coccyx. Eating two-thirds of breakfast suggests some nutrition, not a risk factor. Options C and D are missing, but the context implies fecal incontinence's prominence. Nurses note this in risk assessments (e.g., Braden's moisture subscale), prompting interventions like cleansing and barriers, making this the correct observation.
Question 4 of 5
The nurse caring for a patient who has experienced a laparoscopic appendectomy should expect what type of wound healing when planning care for this patient?
Correct Answer: D
Rationale: Laparoscopic incisions, small and clean, heal by primary intention , per the flashcards, with approximated edges minimizing infection and scarring. Partial-thickness is for shallow loss. Secondary intention suits open wounds. Tertiary intention delays closure. Nurses focus on suture care and infection watch, making this the correct healing type.
Question 5 of 5
A nurse is caring for a patient with a wound. Which assessment data will be most relevant with regard to wound healing?
Correct Answer: B
Rationale: Pulse oximetry , per the flashcards, assesses oxygen saturation crucial for wound healing, as hypoxia delays repair. Muscular strength aids mobility, not healing directly. Options C and D are missing. Nurses ensure oxygenation (>90%) supports cellular repair, making this the correct data.