Question

4. A patient's pressure ulcer is superficial and presents clinically as an abrasion, blister or shallow crate. How would the nurse document this pressure ulcer? a. Stage 1 b. Stage 1 c. Stage III d. Stage IV 5. The nurse is applying a heating pad to a patient experiencing neck pain. Which nursing action is performed correctly? a. The nurse uses a safety pin to attach the pad to the bedding b. The nurse covers the heating pad with a heavy blanket C. The nurse places the heating pad under the patient's neck d. The nurse keeps the pad in place for 20-30 minutes, assessing regularly 6. The nurse is performing pressure ulcer assessment for patient in a hospital setting. Which patient would the nurse consider to be at greatest risk for developing a pressure ulcer? a. A newborn b. A patient with cardiovascular disease C. An older patient with arthritis d. A critical care patient 7. The nurse considers the impact of shearing forces in the development of pressure ulcers in patients. Which patient would be most likely to develop a pressure ulcer from shearing forces? a. A patient sitting in a chair who slides down b. A patient who lifts himself up in this elbows C. A patient who lies on wrinkled sheets d. A patient who must remain on his back for long periods of time

Answer 1

4. A patient's pressure ulcer is superficial and presents clinically as an abrasion, blister or shallow crater.

It is a stage ii pressure sore because there is blister and involvement of very superficial layers.

Answer - b. stage II

5. the nurse is applying a heating pad to a patient experiencing neck pain. then the nurse should cover the heating pad with a heavy blanket to prevent direct burn injury.

Answer - b. the nurse covers the heating pad with a heavy blanket

6. The nurse is performing a pressure ulcer assessment for the patient in a hospital setting, then a critical care patient is considered to be at great risk for developing pressure ulcers because there is almost no movement or very limited movement in a critically ill patent.

Answer - d. A critical care patient

7. The nurse considered the impact of shearing forces in the development of pressure ulcers in patients, then the patient who must remain on his back for a long period of time is most likely to develop a pressure ulcer from shearing forces because of weakening tissue and tissue damage on the back due to lack of oxygen supply.

Answer d. the patient who must remain on his back for a long period of time.