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NCLEX PN· Integumentary · NCLEX Questions Integumentary System

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Showing all 5 practice questions with expert explanatory rationales.

Question 1 of 5

The wound care nurse documented a client's pressure ulcers on admission as 3.3 cm Ã— 4 cm stage II on the coccyx. Which information would alert the nurse that the client's pressure ulcer is getting worse?

A. The skin is not broken and is 2.5 cm Ã— 3.5 cm with erythema that does not blanch.

B. There is a 3.2-cm Ã— 4.1-cm blister that is red and drains occasionally.

C. The skin covering the coccyx is intact but the client complains of pain in the area.

D. The coccyx wound extends to the subcutaneous layer and there is drainage.

Expert Explanatory Rationale

Correct Answer: The coccyx wound extends to the subcutaneous layer and there is drainage.

Question 2 of 5

An electrician was wearing a glove that had a hole in it when he grabbed a 'hot' wire. His coworkers came to him immediately and called the rescue squad. When the industrial nurse reached him, the electric current had been shut off. What action should the nurse take initially?

A. Dress the entrance and exit wounds

B. Check respirations and pulse rate

C. Remove clothing from the burned area

D. Roll him in a blanket

Expert Explanatory Rationale

Correct Answer: Check respirations and pulse rate

Question 3 of 5

Which other assessment finding is most indicative of an infection in the external ear?

A. Foul-smelling drainage

B. Scarred tympanic membrane

C. Diminished hearing

D. Enlarged lymph nodes

Expert Explanatory Rationale

Correct Answer: Foul-smelling drainage

Question 4 of 5

Which response by the nurse is best in this situation?

A. Gravity helps to reattach the separated retina.

B. I'm very small to be a reasonable, and I'm very

C. I can get you a sedative if it's hard to lie still.

D. The doctor knows what's best for you, and you should listen.

Expert Explanatory Rationale

Correct Answer: Gravity helps to reattach the separated retina.

Question 5 of 5

The nurse is teaching a class on how to prevent Lyme disease. Which intervention should be included in the discussion?

A. Instruct the clients to wear dark clothes when hunting.

B. Use a sunscreen of at least SPF 30 when outside.

C. Avoid dense undergrowth when in a wooded area.

D. Do not use any type of insect repellant when deer hunting.

Expert Explanatory Rationale

Correct Answer: Avoid dense undergrowth when in a wooded area.

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