ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 1 of 43
A nurse is assigned most of the patients with pressure ulcers. The nurse leaves the pressure ulcer open to air and does not apply a dressing. To which patient did the nurse provide care?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 2 of 43
Based on the information in the accompanying figure obtained for a patient in the emergency room, which action will the nurse take first?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 3 of 43
Which of the following parameters is not considered part of a routine skin assessment?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 4 of 43
A nurse is caring for a client with septicemia. What assessment by the nurse best addresses the potential for ineffective peripheral perfusion?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 5 of 43
Which information will the nurse teach seniors at a community recreation center about ways to prevent fractures?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 6 of 43
Which layer of the skin provides protection against bacteria, as well as chemical and mechanical injuries?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 7 of 43
The most common source for bacteria that cause a urinary tract infection is
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 8 of 43
The nurse is assessing a client who presents with purulent drainage and crusting of the eye. The nurse should recognize that these findings are most consistent with which type of infection?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 9 of 43
What initial action should the nurse take when Aaron expresses frustration?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 10 of 43
The infecting organism that causes tuberculosis is
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 11 of 43
A nurse is assessing a patient's wound. Which nursing observation will indicate the wound healed by secondary intention?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 12 of 43
Which goal will the nurse include in Aaron's plan of care?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 13 of 43
On which region of the body would the nurse most expect to observe erysipelas?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 14 of 43
A home health nurse has a caseload of several postoperative patients. Which one would be most likely to require a longer period of care?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 15 of 43
The day after a having a right below-the-knee amputation, a patient complains of pain in the missing right foot. Which action is most important for the nurse to take?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 16 of 43
Most of the body heat is produced by
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 17 of 43
The nurse finds that a patient can flex the arms when no resistance is applied but is unable to flex when the nurse applies light resistance. The nurse should document the patient's muscle strength as level
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 18 of 43
A patient arrived at the emergency department after tripping over a rug and falling at home. Which finding is most important for the nurse to communicate to the health care provider?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 19 of 43
Which client should the nurse anticipate will have the greatest psychosocial needs?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 20 of 43
Which nursing action included in the care of a patient after laminectomy can the nurse delegate to experienced unlicensed assistive personnel (UAP)?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 21 of 43
A patient who has severe refractory psoriasis on the face, neck, and extremities is socially withdrawn because of the appearance of the lesions. Which action should the nurse take first?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 22 of 43
The nurse is assessing a group of older adults. Which client is at greatest risk for skin breakdown? A person who has:
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 23 of 43
A patient in the dermatology clinic has a thin, scaly erythematous plaque on the right cheek. Which action should the nurse take?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 24 of 43
When performing a skin assessment, the nurse notes angiomas on the chest of an older patient. Which action should the nurse take next?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 25 of 43
The nurse in an inner city clinic is providing a health screening for a homeless client with a history of drug abuse. The client has a chronic nonproductive cough. For which should the nurse expect to screen this client?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 26 of 43
Which statement by the patient indicates a good understanding of the nurse's teaching about a new short-arm synthetic cast?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 27 of 43
Which intervention should the nurse carry out to manage fever in a client with pneumonia? Select all that apply.
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 28 of 43
Which oral antiviral drug that is commonly prescribed for influenza A and B works by preventing the release of newly formed virus?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 29 of 43
The nurse is caring for a patient on the medical-surgical unit with a wound that has a drain and a dressing that needs changing. Which action should the nurse take first?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 30 of 43
The nurse collects the following assessment data: right heel with reddened area that does not blanch. Which nursing diagnosis will the nurse assign to this patient?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 31 of 43
Which nursing observation will indicate the patient is at risk for pressure ulcer formation?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 32 of 43
The nurse will determine more teaching is needed if a patient with discomfort from a bunion says, "I will
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 33 of 43
A client is exhibiting manifestations of superficial dermatophytosis of the skin with skin scaling and nail disintegration. Based on these findings, the nurse can anticipate that the client will be prescribed: Select all that apply.
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 34 of 43
Dry, itchy plaques on her elbows and knees have prompted a 23-year-old woman to seek care. The clinician has subsequently diagnosed the client with psoriasis, a disorder that results from:
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 35 of 43
A patient undergoes left above-the-knee amputation with an immediate prosthetic fitting. When the patient arrives on the orthopedic unit after surgery, the nurse should
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 36 of 43
Which information will the nurse include when teaching an older patient about skin care?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 37 of 43
The patient's wound has thick creamy yellow drainage present on the dressing. How will the nurse document this finding?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 38 of 43
A nurse is assessing wound drainage during the immediate postoperative period for a patient who has had a breast removed. In addition to assessing the dressing, where would the nurse also check for drainage?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 39 of 43
A toddler with otitis media is prescribed amoxicillin clavulanate 250 mg/5 mL three times daily by mouth for 10 days. What should the nurse teach the mother about this medication?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 40 of 43
Which of the following is a recommended guideline nurses follow when using an electric heating pad on a patient?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 41 of 43
The nurse is caring for a client who is being discharged following abdominal surgery with an incision. Which instruction is most important for the nurse to teach this client regarding wound healing?
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 42 of 43
Dysplastic nevi are precursors of malignant melanoma that are:
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ATI RN · NCLEX Questions Skin Integrity and Wound Care
Question 43 of 43
The patient has a large left hip decubitus ulcer with tunneling but no involvement of bone, tendon, or muscle. Which pressure injury stage will be recorded in the patient's chart?
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