NCLEX-PN
Integumentary NCLEX Questions Questions
Extract:
Question 1 of 5
Assuming the following solutions are available, which one is best for the school nurse to use at this time?
Correct Answer: C
Rationale: Mammalise (likely a typo for a sterile saline solution) is the safest and most effective for eye irrigation to flush out chemicals without causing further irritation.
Question 2 of 5
The client is admitted to the outpatient surgery center for removal of a malignant melanoma. Which assessment data indicate the lesion is a malignant melanoma?
Correct Answer: A
Rationale: Asymmetry and irregular borders (ABCD criteria) characterize malignant melanoma. Waxy, scaly, or post-injury lesions suggest other conditions.
Question 3 of 5
The nurse is admitting an 88-year-old client diagnosed with a viral skin infection. Which nursing task could the nurse delegate to the unlicensed assistive personnel?
Correct Answer: C
Rationale: Setting up isolation equipment is within UAP scope. Measuring lesions, applying medication, and assessing advance directives require nursing judgment.
Question 4 of 5
When the nurse assesses the client's operative eye after surgery, which finding is most expected?
Correct Answer: B
Rationale: An iridectomy creates a fixed pupil opening to relieve pressure.
Question 5 of 5
When assessing a burn victim's skin the nurse notices the entire right and left upper extremities are red, moist, weeping, and blistered. How should the nurse document the degree and total body surface area (TBSA) burned?
Correct Answer: B
Rationale: Partial-thickness burns damage the dermis and epidermis, often resulting in loss of epidermis and/or blistering. Each entire upper extremity is blistered. Approximately 18% of the TBSA has a partial-thickness burn (9% TBSA per each upper extremity). This is not a first-degree burn—In a first-degree burn the skin may appear red but intact, no weeping, and no blistering. With full-thickness burns there would be loss of tissue and a black or white charred/waxy appearance to the remaining tissues.