Med Surg Integumentary NCLEX Questions
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Question 1 of 5.
The client with the condition illustrated is prescribed adapalene topical daily to the affected areas. Which information should the nurse exclude when planning client education?
A. The client has acne vulgaris, an inflammatory disease involving the sebaceous glands of the skin characterized by papules or pustules or comedones.
B. Adapalene should be applied once daily in the evening.
C. Exposing the back to the sun after adapalene (Differin) is applied.
D. Only a thin film of adapalene should be applied.
Explanation: The nurse should exclude exposing the back to the sun after adapalene (Differin) is applied. This increases the risk for sunburn. Adapalene should also not be applied to sunburned areas. The client has acne vulgaris. Adapalene should be applied once daily in the evening with a thin film.
Question 2 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?
A. The doctor will graft skin from your back to your leg.'
B. The skin from a donor will be used to cover your burn.'
C. The graft will come from an animal, probably a pig.'
D. I think you should ask your doctor about the graft.'
Explanation: 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 3 of 5.
The client sustained a hot grease burn to the right hand and calls the emergency department for advice. Which information should the nurse provide to the client?
A. Apply an ice pack to the right hand.
B. Place the hand in cool water.
C. Be sure to rupture any blister formation.
D. Go immediately to the doctor's office.
Explanation: Cool water reduces burn progression and pain without tissue damage. Ice causes frostbite, rupturing blisters risks infection, and immediate doctor visits depend on severity.
Question 4 of 5.
The paraplegic client is being admitted to a medical unit from home with a stage IV pressure ulcer over the right ischium. Which assessment tool should be completed on admission to the hospital?
A. Complete the Braden Scale.
B. Monitor the client on a Glasgow Coma Scale.
C. Assess for Babinski's sign.
D. Initiate a Brudzinski flow sheet.
Explanation: The Braden Scale assesses pressure ulcer risk, guiding interventions. Glasgow, Babinski, and Brudzinski are neurological, not relevant to ulcers.
Question 5 of 5.
The nurse writes the problem 'impaired skin integrity' for a client with stage IV pressure ulcers. Which interventions should be included in the plan of care? Select all that apply.
A. Turn the client every three (3) to four (4) hours.
B. Ask the dietitian to consult.
C. Have the client sign a consent for pictures of the wounds.
D. Obtain an order for a low air-loss bed.
E. Elevate the head of the bed at all times.
Explanation: Dietitian consult, wound photos (with consent), and low air-loss bed address stage IV ulcers. Turning every 3–4 hours is too infrequent, and constant head elevation increases coccyx pressure.
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