NCLEX-PN
Med Surg Integumentary NCLEX Questions Questions
Extract:
Question 1 of 5
Which information provided by the nurse will best prepare the client for the caloric test?
Correct Answer: A
Rationale: The caloric test involves instilling water to assess vestibular function.
Question 2 of 5
Which immediate nursing interventions are appropriate for this client? Select all that apply.
Correct Answer: B,C,D,E,F
Rationale: Ice packs can worsen tissue damage; other interventions address fluid loss, infection, pain, and oxygenation.
Question 3 of 5
The client is scheduled to have a xenograft to a left lower-leg burn. The client asks the nurse, 'What is a xenograft?' Which statement by the nurse would be the best response?
Correct Answer: C
Rationale: A xenograft uses animal skin (e.g., porcine) for temporary burn coverage. Autografts use the patient’s skin, allografts use donor human skin, and deferring to the doctor avoids education.
Question 4 of 5
The nurse is caring for the client at increased risk for developing pressure ulcers. Which measure should the nurse take to limit shearing forces?
Correct Answer: D
Rationale: Keeping the HOB higher than 30 degrees increases the shearing forces to the shoulders, sacrum, and heels. Padding and air mattresses reduce tissue pressure but not shearing forces. Using a lift sheet helps reduce friction but not shearing forces.
Question 5 of 5
The nurse in the long-term care facility must delegate a nursing task to an unlicensed assistive personnel. Which nursing task would be most appropriate to delegate?
Correct Answer: A
Rationale: Combing nits is a non-invasive task within UAP scope. Massaging, scraping, and applying medication require nursing judgment.