Dive skin-deep with this Integumentary NCLEX Questions containing 5 items all about the Integumentary System and its disorders and diseases.
16. A client returns to the clinic for follow-up treatment following a skin biopsy of a suspicious lesion performed 1 week ago. The biopsy report indicates that the lesion is a melanoma. The nurse understands that melanoma has which characteristic?
a) Metastasis is rare.
2. It is encapsulated.
3. It is highly metastatic.
4. It is characterized by local invasion.
17. When assessing a lesion diagnosed as malignant melanoma, the nurse most likely expects to note which finding?
1. An irregularly shaped lesion
2. A small papule with a dry, rough scale
3. A firm, nodular lesion topped with crust
4. A pearly papule with a central crater and a waxy border
18. Integumentary NCLEX Questions about a client who is arriving at the emergency department has experienced frostbite to the right hand. Which finding would the nurse note on assessment of the client’s hand?
1. A pink, edematous hand
2. A fiery red skin with edema in the nail beds
3. Black fingertips surrounded by an erythematous rash
4. A white color to the skin, which is insensitive to touch
19. The evening nurse reviews the nursing documentation in a client’s chart and notes that the day nurse has documented that the client has a stage II pressure ulcer in the sacral area. Which finding would the nurse expect to note on assessment of the client’s sacral area?
1. Intact skin
2. Full-thickness skin loss
3. Exposed bone, tendon, or muscle
4. Partial-thickness skin loss of the dermis
20. An adult client was burned in an explosion. The burn initially affected the client’s entire face (anterior half of the head) and the upper half of the anterior torso, and there were circumferential burns to the lower half of both arms. The client’s clothes caught on fire, and the client ran, causing subsequent burn injuries to the posterior surface of the head and the upper half of the posterior torso. Using the rule of nines, what would be the extent of the burn injury?
Integumentary NCLEX Questions
Answers and Rationale
- Rationale: Melanomas are pigmented malignant lesions originating in the melanin-producing cells of the epidermis. This skin cancer is highly metastatic, and a person’s survival depends on early diagnosis and treatment. Options A, B, and D are not characteristics of a melanoma.
- Test-Taking Strategy: Note that options A, B, and D are comparable or alike and indicate a localized lesion rather than one that will spread to other areas of the body. Also, recalling that melanomas are highly metastatic will assist in directing you to the correct option.
-Integumentary NCLEX Questions Rationale: A melanoma is an irregularly shaped pigmented papule or plaque with a red-, white-, or blue-toned color. Actinic keratosis, a premalignant lesion, appears as a small macule or papule with a dry, rough, adherent yellow or brown scale. Squamous cell carcinoma is a firm, nodular lesion topped with a crust or a central area of ulceration. Basal cell carcinoma appears as a pearly papule with a central crater and rolled waxy border.
- Test-Taking Strategy: Note the strategic words most likely. Remembering that irregularly shaped lesions are a cause for concern will assist in directing you to the correct option.
- Rationale: Assessment findings in frostbite include a white or blue color; the skin will be hard, cold, and insensitive to touch. As thawing occurs, flushing of the skin, the development of blisters or blebs, or tissue edema appears. Options A,B, and C are incorrect.
- Test-Taking Strategy: Focus on the subject, assessment findings in frostbite. Noting the words insensitive to touch in the correct option should direct you to this option.
- Rationale: In a stage II pressure ulcer, the skin is not intact. Partial-thickness skin loss of the dermis has occurred. It presents as a shallow open ulcer with a red-pink wound bed, without slough. It may also present as an intact, open or ruptured, serum-filled blister. The skin is intact in stage I. Full-thickness skin loss occurs in stage III. Exposed bone, tendon, or muscle is present in stage IV.
- Integumentary NCLEX Questions Test-Taking Strategy: Focus on the subject, assessment of a pressure ulcer. Focusing on the words stage II and visualizing the appearance of a stage II pressure ulcer will direct you to the correct option.
- Rationale: According to the rule of nines, with the initial burn, the anterior half of the head equals 4.5%, the upper half of the anterior torso equals 9%, and the lower half of both arms equals 9%. The subsequent burn included the posterior half of head, equaling 4.5%, and the upper half of posterior torso, equaling 9%. This totals 36%.
- Test-Taking Strategy: Focus on the subject, the rule of nines. Recalling the percentages associated with the rule of nines and focusing on the burn injury described in the question will direct you to the correct option.
After you reviewed your answers through its rationale, you can also go back to the first page to start from the beginning:
NCLEX Integumentary Questions (1-5)
Or proceed to the next set of questions:
NCLEX Integumentary Questions 21-25