ATI LPN
Skin Integrity NCLEX Questions Questions
Question 1 of 5
While bathing a patient, the nurse assesses a red, unblanchable area on the coccyx. Which type of dressing should the nurse apply?
Correct Answer: A
Rationale: A transparent film for a stage I pressure ulcer will protect it from shearing injury and will retain moisture. A hydrocolloid dressing would be appropriate for a larger, more advanced pressure ulcer. There is no discharge in a stage I pressure ulcer, making absorbent and wet-to-dry dressing options inappropriate.
Question 2 of 5
A nurse is reviewing the nursing care plan for a client for whom a stage 4 decubiti ulcer has been documented. Which of the following would the nurse expect to note on assessment of the client?
Correct Answer: D
Rationale: Stage 4 pressure ulcers involve full-thickness tissue loss extending into muscle, bone, or supporting structures.
Question 3 of 5
The client with acquired immunodeficiency syndrome (AIDS) is suspected of having cutaneous Kaposi's sarcoma. The nurse prepares the client for which test that will confirm the presence of this type of sarcoma?
Correct Answer: C
Rationale: A punch biopsy of the lesion confirms Kaposi's sarcoma by histologically identifying spindle cells and vascular structures.
Question 4 of 5
The nurse is preparing to send a culture for a patient who has a possible herpes zoster infection on the chest. Which action is appropriate?
Correct Answer: A
Rationale: For lesions with vesicles or bullae, the lesion should be opened using sterile technique and a specimen obtained from the center of the lesion. Aspiration of bullae would present a risk of injury to the patient. Swabbing the area would be likely to result in obtaining normal skin flora rather than the infectious agent. Anaerobic cultures would be unnecessary for an infection on the skin of the chest and would unnecessarily increase the cost of the culture.
Question 5 of 5
While assessing a 25-year-old female, the nurse notes that the patient has hair on her lower abdomen. Earlier in the health interview, the patient stated that her menses are irregular. The nurse should suspect what type of health problem?
Correct Answer: C
Rationale: Some women with higher levels of testosterone have hair in areas generally thought of as masculine, such as the face, chest, and lower abdomen, which may indicate a hormonal imbalance when paired with irregular menses.