ATI LPN
Integumentary System Multiple Choice Questions and Answers Questions
Question 1 of 5
The Rule of Nines refers to:
Correct Answer: B
Rationale: The Rule of Nines is a method used to estimate the total body surface area affected by burns in adults. It divides the body into regions, each representing 9% or multiples of 9% of the total body surface area. This helps determine the severity of the burn and guide treatment. Choice B is correct as it accurately reflects the application of the Rule of Nines in assessing burn percentage in adults. Choices A, C, and D are incorrect as the Rule of Nines specifically applies to adults and not children, and it does not refer to the depth of a burn but rather the extent of the burn injury.
Question 2 of 5
The home health nurse has identified a series of concerns while providing services to a client. During one of the visits, the nurse becomes concerned about criminal activity in the home. What initial action by the nurse is most appropriate?
Correct Answer: C
Rationale: The most appropriate initial action for the nurse in this scenario is to leave the home. This is the correct answer because the nurse's safety should be the top priority. By leaving the potentially dangerous situation, the nurse can ensure their own well-being and then take appropriate steps to address the concerns. Dialing 911 or advising the client to leave the home could escalate the situation and put the nurse at risk. Contacting the physician may not provide immediate assistance in this urgent situation. In summary, leaving the home allows the nurse to prioritize safety and seek help or resources to address the concerns in a safer environment.
Question 3 of 5
A group of students is attending an in-service about do-not-resuscitate orders. Which of the following statements by one of the students indicate the need for further teaching?
Correct Answer: A
Rationale: The correct answer is A: "Do-not-resuscitate orders are a form of euthanasia and I can just participate in a slow code if not completed." This statement is incorrect because do-not-resuscitate orders are not a form of euthanasia. Euthanasia involves intentionally ending a patient's life, while DNR orders allow for a natural death without resuscitative measures. Additionally, participating in a "slow code" is unethical and not an appropriate response to a DNR order. Choices B and C are correct statements. B: "My nursing license will not be in jeopardy if I follow do-not-resuscitate orders" is true as long as the nurse follows legal and ethical guidelines. C: "Do-not-resuscitate orders may be rescinded if the client wishes" is also accurate as patients have the right to change their preferences regarding resuscitative measures.
Question 4 of 5
When obtaining the health history of a 60-year-old female, the client reports noting small red lesions on her vulva. Based upon your knowledge, which of these diagnoses is most likely correct?
Correct Answer: D
Rationale: The correct diagnosis is D: Vulvar carcinoma. In a 60-year-old female with small red lesions on the vulva, vulvar carcinoma is the most likely cause due to the age group and presentation. Vulvar carcinoma commonly presents as red, white, or pigmented lesions, and its incidence increases with age. Herpes simplex (choice A) typically presents with vesicles and ulcers, not red lesions. Primary syphilis (choice B) presents with a painless chancre, while secondary syphilis (choice C) presents with a rash that typically involves the palms and soles. These choices are less likely based on the client's age, lesion appearance, and clinical findings.
Question 5 of 5
While assessing a client, a nurse detects a bluish tinge to the client's palms, soles, and mucous membranes. Which action should the nurse take next?
Correct Answer: B
Rationale: The correct answer is B: Use pulse oximetry to assess the client's oxygen saturation. The bluish tinge, known as cyanosis, indicates decreased oxygen saturation in the blood. Using pulse oximetry will provide objective data on the client's oxygen levels. This is crucial in determining the severity of hypoxemia and guiding further interventions. Choice A: Asking about medications is not the immediate priority when cyanosis is detected. Medications may be relevant but do not address the urgent need for assessing oxygen saturation. Choice C: Auscultating lung fields is important in assessing respiratory status, but it does not directly address the need to determine the client's oxygen saturation level. Choice D: Palpating pulses can provide information on perfusion, but it does not directly assess the client's oxygenation status, which is the immediate concern when cyanosis is present.