ATI LPN
NCLEX Style Questions on Skin Integrity and Wound Care Questions
Question 1 of 5
The nurse is performing an initial assessment of a patient who has a raised, pruritic rash. The patient denies taking any prescription medication and denies any allergies. What would be an appropriate question to ask this patient at this time?
Correct Answer: C
Rationale: If suspicious areas are noted, the patient is questioned about nonprescription or herbal preparations that might be in use.
Question 2 of 5
The nurse is applying wet dressings as ordered to a patient who has a crusted skin lesion. Which assessment finding should cause the nurse the most concern?
Correct Answer: B
Rationale: Wet dressings should not be prescribed for more than 72 hours, because the skin may become too dry or macerated. Oiliness, edema, and oozing are not common reactions to wet dressings.
Question 3 of 5
A nurse is preparing to discharge a patient from the emergency department after receiving treatment for an ankle sprain. While providing discharge education, the nurse should encourage which of the following?
Correct Answer: D
Rationale: Treatment of a sprain consists of resting and elevating the affected part, applying cold, and using a compression bandage. After the acute inflammatory stage (usually 24 to 48 hours after injury), heat may be applied intermittently. Rotation exercises would likely be painful.
Question 4 of 5
A 20 year-old is brought in by ambulance to the emergency department after being involved in a motorcycle accident. The patient has an open fracture of his tibia. The wound is highly contaminated and there is extensive soft-tissue damage. How would this patient's fracture likely be graded?
Correct Answer: C
Rationale: Open fractures are graded according to the following criteria. Grade I is a clean wound less than 1 cm long. Grade II is a larger wound without extensive soft-tissue damage. Grade III is highly contaminated, has extensive soft-tissue damage, and is the most severe. There is no grade IV fracture.
Question 5 of 5
The nurse notes that a patient's fingertips are blue in color. What should this finding indicate to the nurse?
Correct Answer: D
Rationale: Cyanosis (blue discoloration) indicates poor perfusion or inadequate oxygenation of blood.