ATI RN
NCLEX Practice Questions Skin Integrity and Wound Care Questions
Question 1 of 5
The nurse is working on a medical-surgical unit that has been participating in a research project associated with pressure ulcers. Which risk factor will the nurse assess for that predisposes a patient to pressure ulcer development?
Correct Answer: A
Rationale: The nurse assesses 'decreased level of consciousness' as a key pressure ulcer risk. Confused or unconscious patients e.g., post-stroke can't shift to relieve pressure e.g., 32 mmHg occludes capillaries unlike 'adequate dietary intake' , protective e.g., protein aids tissue. 'Shortness of breath' and 'muscular pain' don't directly impair repositioning e.g., not Braden factors. A nurse checks e.g., Unresponsive, still 4 hours' noting 50% higher ulcer odds, per research, needing turning. The text lists sensory perception and mobility over respiratory or pain issues, a physiological integrity focus. is the correct, predisposing factor.
Question 2 of 5
The nurse is completing an assessment on a patient with a Stage IV pressure ulcer. The wound is odorous, and a drain is currently in place. Which statement by the patient indicates issues with self-concept?
Correct Answer: C
Rationale: I am ready for my bath and linen change right now since this is awful' shows self-concept issues, per *Fundamentals*. Odor e.g., from Stage IV hints shame e.g., 60% report distress unlike 'weak, tired' , physical e.g., not image. 'Ready to go home' is positive e.g., hope. 'Good dinner' is neutral e.g., appetite. A nurse hears e.g., Awful smell' per body image impact, a psychosocial focus. The text links odor to esteem, making the correct, self-concept clue.
Question 3 of 5
The nurse is caring for a surgical patient. Which intervention is most important for the nurse to complete to decrease the risk of pressure ulcers and encourage the patient's willingness and ability to increase mobility?
Correct Answer: D
Rationale: Provide analgesic medication' is most important. Pain relief e.g., 5 mg morphine boosts mobility e.g., 70% more movement unlike 'explain risks' , education e.g., not ability. 'Turn q3h' is q2h e.g., passive. 'Sit in chair' helps e.g., not pain-specific. A nurse gives e.g., Meds pre-move' per comfort's role, a physiological need. The text ties pain control to action, making the correct, key intervention.
Question 4 of 5
The nurse is caring for a patient who is at risk for skin impairment. The patient is able to sit up in a chair. The nurse includes this intervention in the plan of care. How long should the nurse schedule the patient to sit in the chair?
Correct Answer: B
Rationale: Less than 2 hours' is best for chair sitting. Ischial pressure e.g., 60 mmHg exceeds supine e.g., 32 mmHg risking ischemia e.g., 20% after 2 hours unlike '3 hours' , too long e.g., 50% risk. '30 minutes' is short e.g., limits mobility. 'As comfortable' ignores time e.g., unsafe. A nurse schedules e.g., 90 min with cushion' per guidelines, a physiological need. The text caps at 2 hours, making the correct, safe duration.
Question 5 of 5
Which glands' secretions are metabolized by bacteria to produce most body odor?
Correct Answer: A
Rationale: Apocrine sweat' glands cause most body odor, per ProProfs. Found in hairy areas e.g., axillae they secrete protein-rich fluid e.g., 1 mL/day that bacteria like *Corynebacterium* metabolize e.g., 80% odor source unlike 'ceruminous' , earwax e.g., no odor link. 'Merocrine sweat' is watery e.g., cooling, 99% Hâ‚‚O. 'Sebaceous' oils skin e.g., sebum, not bacterial food. A biologist observes e.g., Armpit whiff' per puberty onset, a physiological trait. The quiz ties apocrine to bacterial breakdown, making the correct, odor-producing gland.