ATI RN
Skin Integrity NCLEX Questions Questions
Question 1 of 5
The nurse notes the presence of white lesions that resemble milk curds in the back of a patient’s throat. Which question by the nurse is appropriate at this time?
Correct Answer: A
Rationale: The correct answer is A: Are you taking any medications? This question is appropriate because white lesions resembling milk curds in the throat could indicate oral thrush, a fungal infection common in individuals on certain medications like antibiotics or corticosteroids. Asking about medications can help identify the underlying cause. Summary of other choices: B: Do you have a productive cough? - This question is not directly related to the presence of white lesions in the throat. C: How often do you brush your teeth? - Oral hygiene practices are important, but not likely the cause of white lesions. D: Have you had an oral herpes infection? - Oral herpes typically presents as cold sores, not white lesions resembling milk curds in the throat.
Question 2 of 5
A patient complains of shoulder pain when the nurse moves the patient’s arm behind the back. Which question should the nurse ask?
Correct Answer: B
Rationale: The correct answer is B: Do you have difficulty when you are putting on a shirt? This question is relevant because it specifically addresses the motion that triggers the patient's shoulder pain. It helps to assess the range of motion and identify any limitations or discomfort during activities involving arm movement behind the back. A: Are you able to feed yourself without difficulty? - While this question addresses arm movement, it does not specifically target the motion that triggers the pain. C: Are you able to sleep through the night without waking? - This question does not directly relate to the shoulder pain triggered by arm movement behind the back. D: Do you ever have trouble lowering yourself to the toilet? - This question does not address the specific movement causing the shoulder pain and is not as relevant for assessing the patient's condition.
Question 3 of 5
A patient with severe kyphosis is scheduled for dual-energy x-ray absorptiometry (DXA) testing. The nurse will plan to
Correct Answer: A
Rationale: The correct answer is A: explain the procedure. This is important because in a DXA testing, there is no contrast medium or sedative required, so starting an IV line for contrast medium injection (B) and giving an oral sedative (C) are unnecessary. Screening for allergies to shellfish or iodine products (D) is also irrelevant since these are not used in DXA testing. A thorough explanation of the procedure ensures the patient understands what to expect and can help alleviate any anxiety or concerns they may have.
Question 4 of 5
Which discharge instruction will the emergency department nurse include for a patient with a sprained ankle?
Correct Answer: C
Rationale: The correct answer is C: Use pillows to elevate the ankle above the heart. Elevating the ankle helps reduce swelling by promoting venous return and decreasing fluid accumulation. This position also helps with pain management. Choice A is incorrect as wrapping the ankle too loosely may not provide adequate support. Choice B is incorrect because heat can increase swelling and inflammation. Choice D is incorrect as moving the ankle through the range of motion can worsen the injury.
Question 5 of 5
A patient with a complex pelvic fracture from a motor vehicle crash is on bed rest. Which nursing assessment finding indicates a potential complication of the fracture?
Correct Answer: B
Rationale: The correct answer is B because a distended abdomen and absent bowel sounds can indicate internal bleeding or organ damage, common complications of pelvic fractures. This suggests potential abdominal compartment syndrome or intra-abdominal hemorrhage. Choices A and C are typical symptoms of a pelvic fracture and do not specifically indicate a complication. Choice D may be common due to the impact of the crash but does not directly indicate a complication like internal bleeding.