Tissue Integrity ATI Questions & Correct
Answers/ Graded A+
A nurse is providing teaching to a client who is in a wheelchair about measures to avoid skin
breakdown. Which of the following instructions by the nurse is related to preventing skin
breakdown?
🗸🗸: You should shift your weight off your buttocks at intervals throughout the day
A wound, ostomy and continence nurse (WOCN) is providing an in service to a group of nurses about
documentation of pressure injuries. Which of the following statements by one of the group
members indicates an understanding of the teaching?
🗸🗸: Pressure injury documentation includes location, stage, measurements and condition of the
wound bed and any drainage present
A nurse is caring for a client who has sustained a gunshot wound to the abdomen and is 6 hr
postoperative. The nurse notices protrusion of the client's organs from the incision site and call for
help. Which of the following actions should the nurse take?
🗸🗸: Cover the client's wound with a sterile saline dressing
A nurse is teaching assistive personnel (AP) about the skin of older adults. Which of the following
statements by the AP indicates an understanding of the teaching?
1
, 🗸🗸: The skin of older adults is thinner and has less subcutaneous padding over bony prominences
A nurse is preparing to obtain a wound culture from a client who has a suspected wound infection.
Which of the following actions should the nurse take?
🗸🗸: Clean the wound with 0.9% sodium chloride
A nurse is assisting with the care of a client following abdominal surgery. The nurse removes the
client's surgical dressing and notes a separation of the wound edges. The nurse should identify that
the client is experiencing which of the following complications?
🗸🗸: Dehiscence
A nurse is providing teaching to a client about staple removal. Which of the following statements
should the nurse include in the teaching?
🗸🗸: Your staples will be removed in about 2 weeks
A nurse is caring for a group of clients. Which of the following clients should the nurse identify as
having the highest risk for developing alterations in tissue integrity?
🗸🗸: A client who is incontinent and taking a prescribed diuretic
A nurse is caring for a client who has dime-sized stage 1 pressures injury located on the sacrum.
Which of the following dressing types should the nurse use?
2
Answers/ Graded A+
A nurse is providing teaching to a client who is in a wheelchair about measures to avoid skin
breakdown. Which of the following instructions by the nurse is related to preventing skin
breakdown?
🗸🗸: You should shift your weight off your buttocks at intervals throughout the day
A wound, ostomy and continence nurse (WOCN) is providing an in service to a group of nurses about
documentation of pressure injuries. Which of the following statements by one of the group
members indicates an understanding of the teaching?
🗸🗸: Pressure injury documentation includes location, stage, measurements and condition of the
wound bed and any drainage present
A nurse is caring for a client who has sustained a gunshot wound to the abdomen and is 6 hr
postoperative. The nurse notices protrusion of the client's organs from the incision site and call for
help. Which of the following actions should the nurse take?
🗸🗸: Cover the client's wound with a sterile saline dressing
A nurse is teaching assistive personnel (AP) about the skin of older adults. Which of the following
statements by the AP indicates an understanding of the teaching?
1
, 🗸🗸: The skin of older adults is thinner and has less subcutaneous padding over bony prominences
A nurse is preparing to obtain a wound culture from a client who has a suspected wound infection.
Which of the following actions should the nurse take?
🗸🗸: Clean the wound with 0.9% sodium chloride
A nurse is assisting with the care of a client following abdominal surgery. The nurse removes the
client's surgical dressing and notes a separation of the wound edges. The nurse should identify that
the client is experiencing which of the following complications?
🗸🗸: Dehiscence
A nurse is providing teaching to a client about staple removal. Which of the following statements
should the nurse include in the teaching?
🗸🗸: Your staples will be removed in about 2 weeks
A nurse is caring for a group of clients. Which of the following clients should the nurse identify as
having the highest risk for developing alterations in tissue integrity?
🗸🗸: A client who is incontinent and taking a prescribed diuretic
A nurse is caring for a client who has dime-sized stage 1 pressures injury located on the sacrum.
Which of the following dressing types should the nurse use?
2
