ATI RN
Fundamentals of Nursing Skin Integrity Questions Questions
Question 1 of 5
Which action should the nurse take before administering gentamicin (Garamycin) to a patient with acute osteomyelitis?
Correct Answer: C
Rationale: The correct action before administering gentamicin for a patient with acute osteomyelitis is to review the patient’s serum creatinine (Choice C). This is crucial because gentamicin is nephrotoxic, and assessing the patient's renal function helps to prevent kidney damage. Checking for serum creatinine levels allows the nurse to determine if the patient's kidneys can safely metabolize and excrete the medication without causing harm. Choice A (Ask the patient about any nausea) is not directly related to the safe administration of gentamicin for osteomyelitis. Choice B (Obtain the patient’s oral temperature) is important for monitoring infection but is not specifically required before administering gentamicin. Choice D (Change the prescribed wet-to-dry dressing) is unrelated to medication administration and wound care.
Question 2 of 5
A teenager with rosacea should be educated that in addition to the “blush appearance” on the face, she should also assess for which of the following additional complications? Select all that apply.
Correct Answer: C
Rationale: The correct answer is C: Edema of the eyelids. This is correct because rosacea can sometimes lead to ocular complications, such as blepharitis, conjunctivitis, and edema of the eyelids. These conditions can affect the eyes of individuals with rosacea. Rationale: - A: Inflamed and tender axillary lymph nodes are not typically associated with rosacea. This is an incorrect choice. - B: While eye problems are a potential complication of rosacea, edema of the eyelids is a more specific and direct complication that should be assessed for. - D: Large abscesses on the upper arms and neck are not commonly associated with rosacea. This choice is incorrect.
Question 3 of 5
A child has been admitted to the burn unit after pulling a pan of hot water off the stove. Given the fact that there is primarily second- and third-degree burns, the health care worker should prioritize care to focus on which of the following? Select all that apply.
Correct Answer: A
Rationale: The correct answer is A: Focus on replacing fluids that have been lost from the vascular, interstitial, and cellular compartments. In burn injuries, there is a significant loss of fluids due to damage to the skin barrier. Prioritizing fluid replacement helps prevent hypovolemic shock and maintains adequate tissue perfusion. This is crucial in managing burn patients to prevent complications like organ failure. Choices B, C, and D are incorrect: B: Assessing for airway compromise is important but not the top priority in this scenario. Fluid resuscitation takes precedence in managing burn injuries. C: Maintaining a sterile field is important for infection prevention but is not the immediate priority over fluid replacement. D: Withholding nutrition is not recommended as burn injuries increase the body's metabolic demands. Providing adequate nutrition supports healing and recovery, so withholding food can be detrimental. In summary, fluid replacement is prioritized in burn injuries to prevent shock and maintain tissue perfusion.
Question 4 of 5
Which of the following changes are normal in the elderly population? Select all that apply.
Correct Answer: A
Rationale: Rationale for choice A being correct: The dermis and epidermis thin as one ages due to decreased collagen and elastin production. This leads to fragile skin, increased risk of injury, and slower wound healing. Summary of why other choices are incorrect: B: Subcutaneous tissue typically decreases with age, leading to less padding. C: Blood vessels tend to become less elastic and more rigid, not thicker. D: Older adults often experience muscle and fat loss, rather than increased padding on the buttocks.
Question 5 of 5
Which assessment finding indicates to the nurse that the patient is at high risk for developing a pressure injury?
Correct Answer: A
Rationale: A 'serum total protein level of 4.6 g/dL' flags high pressure injury risk, per Potter's *Essentials*. Normal is 6-8 g/dL; 4.6 e.g., 30% below causes edema, impairing oxygen delivery (e.g., 10% less to tissues), softening skin for breakdown. 'Braden Scale score of 22' is low risk e.g., 18 or below for elders signals danger, 22 is safe. 'Cetirizine 5 mg daily' is an antihistamine e.g., no skin integrity link. 'Fasting glucose 84 mg/dL' is normal e.g., 70-100, no risk. A nurse assessing e.g., swollen legs links low protein to 50% higher ulcer odds, per nutrition studies, needing dietary boost. is the correct, critical finding.