NCLEX-PN
Integumentary System NCLEX Questions Questions
Extract:
Question 1 of 5
The nurse is preparing to irrigate the student's eye. What steps are appropriate in completing the irrigation? Select all that apply.
Correct Answer: C,E
Rationale: Hand hygiene and gloves prevent infection, and placing the solution in the conjunctival sac ensures effective irrigation without damaging the cornea.
Question 2 of 5
The nurse is planning care for the client with a Stage II pressure ulcer on the ball of the right foot. Which interventions should the nurse include in this client's care? Select all that apply.
Correct Answer: C,D,E
Rationale: The dressing protects the underlying wound and provides a moist environment for healing. The client should be repositioned at least every 2 hours. Positioning devices are utilized to keep the load or pressure off the wound. Daily wound cultures are unnecessary, as all wounds contain bacteria. The wound should be cleansed gently to prevent further tissue trauma.
Question 3 of 5
If a client with a middle ear infection reports the following symptoms, which one suggests that the infection has spread to the inner ear?
Correct Answer: D
Rationale: Postural dizziness suggests inner ear involvement, such as labyrinthitis.
Question 4 of 5
If a client with a middle ear infection reports the following symptoms, the blood pressure and the infection has spread to the inner ear?
Correct Answer: D
Rationale: Postural dizziness suggests inner ear involvement, such as labyrinthitis.
Question 5 of 5
The experienced nurse is observing the new nurse administer medications. Which actions by the new nurse require the experienced nurse to intervene? Select all that apply.
Correct Answer: A,C,E
Rationale: Tretinoin (Retin-
A) should not be applied to open wounds; the experienced nurse should intervene. Actinic keratosis treatment using fluorouracil (Carac) causes the affected area to become worse before getting better; the medication should not be withheld. When taking acitretin (Soriatane), the client should not become pregnant for three years following treatment. Withholding isotretinoin until pregnancy status is known is appropriate. Waiting two hours to apply tacrolimus after lotion is correct.