A nurse is discussing pressure ulcer staging with a newly licensed nurse. Which statement should the nurse use to describe a stage 3 pressure ulcer?

Full-thickness tissue loss extending to underlying support structures

A deep crater without visible bone, tendon, or muscle

A shallow, ruptured or intact skin blister without slough

Unbroken skin with un-blancheable erythema

Answer and Explanation

The Correct Answer is B

Choice A rationale

Full-thickness tissue loss extending to underlying support structures such as muscle, tendon, or bone is characteristic of a stage 4 pressure ulcer, not a stage 312.
Choice B rationale
A stage 3 pressure ulcer involves full-thickness skin loss and may appear as a deep crater. There may be damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. This description matches the statement in Choice B, making it the correct answer.
Choice C rationale
A shallow, ruptured or intact skin blister without slough is more indicative of a stage 2 pressure ulcer. In a stage 2 pressure ulcer, there is partial-thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed.
Choice D rationale
Unbroken skin with un-blancheable erythema is characteristic of a stage 1 pressure ulcer, not a stage 3. In a stage 1 pressure ulcer, the skin is not broken, but it has redness that does not lighten (or blanch) when you press on it.

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Correct Answer is B

Explanation

Step 1 is: The prescribed dose is 100 mcg and each tablet contains 50 mcg.
Step 2 is: Divide the prescribed dose by the amount per tablet. So, 100 mcg ÷ 50 mcg/tablet. Step 3 is: The result is 2 tablets.

A. “I will place a bath seat in my shower to use when I bathe.”. B. “I will keep the fluorescent ceiling light on in my room at night.”. C. “I will place an area rug at the entry of my bathroom.”. D. “I will keep my walker at the end of my bed.”. .

Correct Answer is A

Explanation

Choice A rationale
Placing a bath seat in the shower is a good safety measure for a patient with a history of falls. It allows the patient to sit while bathing, reducing the risk of slipping and falling.
Choice B rationale

Keeping the fluorescent ceiling light on in the room at night can actually increase the risk of falls. It can create shadows and glare that can be disorienting, especially for older adults.
Choice C rationale
Placing an area rug at the entry of the bathroom is not recommended. Rugs can easily become tripping hazards, especially if they’re not secured to the floor.
Choice D rationale
Keeping a walker at the end of the bed can be helpful for some patients, but it’s not the best indication that the patient understands home safety instructions. It’s important that the walker is used correctly and that the patient’s home is arranged to accommodate its use.

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A nurse is discussing pressure ulcer staging with a newly licensed nurse. Which statement should the nurse use to describe a stage 3 pressure ulcer?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer levothyroxine 100 mcg orally to a patient with hypothyroidism. The available levothyroxine is in 50 mcg tablets. How many tablets should the nurse administer?

Correct Answer is B

Explanation

A nurse is reinforcing home safety instructions for a patient with a history of falls. Which statement should the nurse identify as an indication that the patient understands the instructions?

Correct Answer is A

Explanation

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