A nurse is assessing a client with a skin condition. Which of the following describes the client’s condition?

Full thickness skin loss with visible bone.

Intact skin with localized erythema.

Partial-thickness skin loss with red tissue.

Full thickness skin loss with visible adipose tissue.

Answer and Explanation

The Correct Answer is D

Choice A rationale

Full thickness skin loss with visible bone is not described in the question. This would be a description of a stage IV pressure ulcer, which involves full thickness tissue loss with exposed bone, tendon, or muscle.

Choice B rationale

Intact skin with localized erythema is not described in the question. This would be a description of a stage I pressure ulcer, which involves intact skin with non-blanchable redness of a localized area usually over a bony prominence.

Choice C rationale

Partial-thickness skin loss with red tissue is not described in the question. This would be a description of a stage II pressure ulcer, which involves partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough.

Choice D rationale

Full thickness skin loss with visible adipose tissue is the condition described in the question. This would be a description of a stage III pressure ulcer, which involves full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscle are not exposed.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is B

Explanation

The pH of gastric secretions is typically low, reflecting the acidic environment of the stomach. A pH reading of 4.0 would be expected if the nasogastric (NG) tube is correctly placed in the stomach.

A. Surgical debridement of the wound B. Increased drainage from the wound C. Documenting the wound status daily D. Increased monitoring of the wound condition

Correct Answer is A

Explanation

Choice A rationale

A black pressure ulcer indicates necrotic tissue, which often requires surgical debridement.

Choice B rationale

Increased drainage from the wound is not typically associated with a black pressure ulcer.

Choice C rationale

While documenting the wound status daily is part of wound care, it is not a specific event anticipated when planning care for a patient with a black pressure ulcer.

Choice D rationale

Increased monitoring of the wound condition is part of wound care, but it is not a specific event anticipated when planning care for a patient with a black pressure ulcer.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse is assessing a client with a skin condition. Which of the following describes the client’s condition?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a patient with a nasogastric (NG) tube and tests the pH of the secretions to verify correct placement of the tube. What pH reading should the nurse expect?

Correct Answer is B

Explanation

The nurse notes that a patient has a black pressure ulcer on the left hip. Which event will the nurse anticipate when planning care for this patient?

Correct Answer is A

Explanation

What should a nurse include in a nutrition class for pregnant teenagers? Choose all that apply.

A nurse is teaching a parent of a-month-old infant about home safety. Which of the following instructions should the nurse include in the teaching?( select all that apply)

A nurse is preparing to administer three liquid medications to a client who has an NG feeding tube with continuous enteral feedings. Which of the following actions should the nurse take?

A nurse is preparing a preoperative patient for a sigmoid colostomy. What information should the nurse include in the discussion?

The same nurse is now preparing to clean the abrasion on the client’s right elbow. The provider has prescribed mechanical debridement for the wound. Exhibits Which of the following is a form of mechanical debridement that the nurse should expect to use?

A nurse is teaching a client who has urinary incontinence about avoiding foods and beverages that can cause bladder irritation.Which of the following foods and beverages is a bladder irritant?