ATI LPN
Integumentary System Multiple Choice Questions and Answers Questions
Question 1 of 5
The nurse witnessed a vehicle hit a pedestrian. The victim is dazed and tries to get up. A leg appears fractured. Which intervention should the nurse take?
Correct Answer: D
Rationale: The correct answer is D: Stay with the victim and encourage him or her to remain still. This is the correct intervention as it is important to prevent further injury and movement can exacerbate the fracture. By staying with the victim and encouraging stillness, the nurse can help minimize potential harm. A: Trying to reduce the fracture manually is not recommended as it can lead to further damage and should only be done by medical professionals. B: Assisting the victim to get up and walk can worsen the fracture and cause more harm. C: Leaving the victim alone to call an ambulance can leave the victim vulnerable and without immediate assistance.
Question 2 of 5
The client diagnosed with chronic otitis media is scheduled for a mastoidectomy. Which discharge teaching should the nurse discuss with the client?
Correct Answer: D
Rationale: The correct answer is D: Do not allow water to enter the ear for six (6) weeks. This instruction is essential post-mastoidectomy to prevent infection and promote healing. Water exposure can introduce bacteria, leading to complications. Option A is incorrect as the Valsalva maneuver should be avoided to prevent pressure changes in the ear. Option B is incorrect as hearing can improve after mastoidectomy. Option C is incorrect as ophthalmic drops are not indicated for ear care.
Question 3 of 5
The elderly client is complaining of abdominal discomfort. Which scientific rationale should the nurse remember when addressing an elderly client's perception of pain?
Correct Answer: C
Rationale: The correct answer is C because as people age, their reaction to painful stimuli may decrease due to changes in the nervous system. This is important for nurses to consider when assessing and managing pain in elderly clients. Choice A is incorrect as elderly clients may have different pain perceptions compared to other age groups. Choice B is incorrect as not all elderly clients require more pain medication. Choice D is incorrect as the Wong scale is not specifically recommended for elderly clients.
Question 4 of 5
The nurse is admitting a client diagnosed with primary adrenal cortex insufficiency (Addison's disease). Which clinical manifestations should the nurse expect to assess?
Correct Answer: C
Rationale: The correct answer is C: Bronze pigmentation, hypotension, and anorexia. Primary adrenal cortex insufficiency (Addison's disease) is characterized by decreased production of cortisol and aldosterone. Bronze pigmentation is due to increased melanocyte-stimulating hormone. Hypotension is a result of aldosterone deficiency leading to sodium and water loss. Anorexia can occur due to decreased cortisol levels affecting glucose metabolism. A: Moon face, buffalo hump, and hyperglycemia are manifestations of Cushing's syndrome, which is excessive cortisol production. B: Hirsutism, fever, and irritability are not typical manifestations of Addison's disease. D: Tachycardia, bulging eyes, and goiter are signs of hyperthyroidism, not adrenal insufficiency.
Question 5 of 5
The client is one (1) hour postoperative thyroidectomy. Which intervention should the nurse implement?
Correct Answer: A
Rationale: The correct answer is A: Check the posterior neck for bleeding. This intervention is crucial post-thyroidectomy to monitor for any signs of bleeding, which can be life-threatening. Checking for bleeding is a priority as it can lead to airway compromise and requires immediate intervention. Assessing for Chvostek's sign (B) is unrelated to a thyroidectomy and is used to detect hypocalcemia. Monitoring serum calcium level (C) is important but not as immediate as checking for bleeding. Changing the surgical dressing (D) is important for wound care but does not address the critical need to assess for bleeding.