Passpoint-Integumentary

Question 1 See full question When assessing a client who is incontinent for risk for developing a pressure ulcer, the nurse should note which factor that can most alter tissue tolerance and lead to the development of a pressure ulcer? You Selected:  exposure to moisture Correct response:  exposure to moisture Explanation: Remediation: Question 2 See full question The nurse is assessing a hospitalized older client for the presence of pressure ulcers. The nurse notes that the client has a 1 inch × 1 inch (3 cm x 3 cm) area on the sacrum in which there is skin breakdown as far as the dermis. What should the nurse note on the medical record? You Selected:  stage I pressure ulcer Correct response:  stage II pressure ulcer Explanation: Remediation: Question 3 See full question Which factor is most important for the nurse to consider when determining the angle at which to insert the needle for a subcutaneous injection? You Selected:  length of the needle Correct response:  amount of subcutaneous tissue Explanation: Remediation: Question 4 See full question During the first 48 to 72 hours of fluid resuscitation therapy after a major burn injury, the nurse should monitor hourly which information that will be used to determine the IV infusion rate? You Selected:  urine output Correct response:  urine output Explanation: Remediation: Question 5 See full question A nurse is preparing a discharge teaching plan for a client with atopic dermatitis. Which instruction should the nurse include in her teaching plan? You Selected:  Use a topical skin moisturizer daily. Correct response:  Use a topical skin moisturizer daily. Explanation: Remediation: Question 6 See full question A client with deep partial-thickness and full-thickness burns on the arms receives autografts. Two days later, the nurse finds the client doing arm exercises. The nurse provides additional client teaching because these exercises may: You Selected:  dislodge the autografts. Correct response:  dislodge the autografts. Explanation: Remediation: Question 7 See full question A client has partial-thickness burns on both lower extremities and portions of the trunk. Which I.V. fluid does the nurse plan to administer first?