ATI LPN
NCLEX Questions Skin Integrity and Wound Care Questions
Question 1 of 5
Which measure would be appropriate when caring for a postoperative patient with a bulb suction wound drain?
Correct Answer: C
Rationale: Bulb suction (e.g., Jackson-Pratt) removes fluid. Compressing the bulb restores suction, per surgical care, preventing fluid buildup. Assessing patency and measuring drainage are key but ongoing. Rinsing with sterile water risks contamination not standard. Compression maintains function, an LPN duty, making it the correct and most immediate action.
Question 2 of 5
You administer ketorolac 30 mg IM. The gate control theory indicates the next action to assist in pain control would be to:
Correct Answer: D
Rationale: Gate control theory posits non-pain stimuli block pain signals. Encouraging distraction e.g., music enhances ketorolac's effect, per pain management. Recapping is safety, not pain-related. Massaging may worsen IM irritation. Checking later assesses, doesn't aid. Distraction leverages theory, an LPN adjunct, making it the correct next action.
Question 3 of 5
A patient with chronic pain asks, 'What is a TENS unit?' The best nursing response is:
Correct Answer: B
Rationale: TENS (transcutaneous electrical nerve stimulation) uses skin electrodes to disrupt pain signals, per gate control theory.'Small electrical stimulus' accurately describes it, per nursing texts. Epidural is invasive, not TENS. Finger pressure is acupressure. Support misleads. Clear explanation aids use, an LPN response, making it the correct answer.
Question 4 of 5
Which priority element will the nurse consider when planning care to decrease the development of a decubitus ulcer for an unconscious patient?
Correct Answer: B
Rationale: Pressure is the primary cause of decubitus ulcers, as it disrupts capillary flow when exceeding 15-32 mm Hg, leading to ischemia, per the text. For an unconscious patient, sustained pressure from immobility is the critical factor nurses address through repositioning and support surfaces. Resistance isn't a defined element here. Weight contributes indirectly via pressure distribution but isn't the root cause. Stress affects overall health, not ulcer formation directly. Pressure's intensity, duration, and tissue tolerance are measurable and actionable, making it the priority element in care planning to prevent skin breakdown in vulnerable patients.
Question 5 of 5
Which patient will the nurse see first?
Correct Answer: C
Rationale: Prioritization follows ABCs and acuity. A patient with appendicitis using a heating pad is urgent heat risks rupture, per the text, threatening peritonitis. A Stage IV ulcer is serious but stable. A Braden score of 18 indicates low risk (cutoff 18). An approximated incision is normal healing. The appendicitis patient's immediate danger trumps chronic or stable conditions, making this the correct first priority for nurse intervention.