ATI LPN
Integumentary System Multiple Choice Questions and Answers Questions
Question 1 of 5
Which of the following manifestations indicates a systemic reaction associated with an inflammatory response?
Correct Answer: C
Rationale: The correct answer is C: Tachypnea (RR 26). Tachypnea, an increased respiratory rate, is a systemic manifestation of an inflammatory response due to the body's attempt to deliver more oxygen to tissues during inflammation. Erythema (choice A) is localized redness, pain (choice B) is a common symptom of inflammation at the site, and edema (choice D) is localized swelling, not a systemic response. Tachypnea is a systemic sign that reflects the body's overall response to inflammation.
Question 2 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 C: "Do-not-resuscitate orders may be rescinded if the client wishes" is also accurate as patients have the right to change their preferences regarding resuscitative measures.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 3 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 4 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.
Question 5 of 5
A nurse assesses clients on a medical-surgical unit. Which client should the nurse evaluate for a wound infection?
Correct Answer: C
Rationale: The correct answer is C because a white blood cell count of 23,000/mm³ indicates a potential infection. Elevated WBC count is a common sign of infection as the body responds to pathogens. The other choices are incorrect because: A: Blood cultures pending do not necessarily indicate a wound infection. B: Thin, serous wound drainage is normal in some cases and does not always indicate infection. D: Decrease in wound size is a positive sign of healing, not infection. In summary, the client with an elevated WBC count should be evaluated for a wound infection due to the potential indication of an inflammatory response.