Which factor contributes to the formation of a pressure injury when a patient’s body slides downward to the foot of the bed?
Shearing force.
Acceleration.
Momentum.
Applied force.
The Correct Answer is A
Choice A rationale:
Shearing force is the primary factor that contributes to the formation of pressure injuries when a patient's body slides downward. It occurs when two surfaces move in opposite directions, causing stress and strain on the tissues between them.
Compression of Tissues: When the patient's body slides downward, the skin and underlying tissues are compressed between the bony prominences (such as the sacrum or heels) and the surface of the bed. This compression restricts blood flow to the area, depriving the tissues of oxygen and nutrients.
Tissue Stretching and Tearing: As the body slides, the skin and underlying tissues are also stretched and pulled in opposite directions. This shearing force disrupts the normal alignment of cells and tissues, leading to microscopic tears and damage.
Impaired Blood Flow: Shearing force further compromises blood flow by stretching and compressing blood vessels. This reduces the delivery of oxygen and nutrients to the tissues, while also hindering the removal of waste products.
Tissue Damage and Necrosis: The combination of compression, stretching, and impaired blood flow leads to cell death and tissue necrosis. This is the hallmark of pressure injuries, which can range from superficial blisters to deep ulcers that extend into muscle and bone.
Factors that Increase Shearing Force: Certain factors can increase the risk of shearing force and pressure injury development, including:
Increased moisture (from sweat or incontinence) Decreased mobility
Poor skin integrity
Malnutrition
Friction from bedsheets
In conclusion, shearing force is the main factor that contributes to pressure injury formation when a patient's body slides downward. It disrupts blood flow, damages tissues, and can lead to significant wounds.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Ineffective breathing pattern related to incisional pain and anesthesia is the priority nursing diagnosis for a patient with shallow respirations following abdominal surgery because it addresses the most immediate and life-threatening concern: impaired gas exchange.
Correct Answer is A
Explanation
Step 1: Convert the prescribed dose to milligrams. 400 mcg = 0.4 mg (since 1 mg = 1000 mcg)
Step 2: Compare the prescribed dose to the pill strength. The prescribed dose is 0.4 mg.
The pill strength is 0.4 mg.
Step 3: Determine the number of pills needed.
Since the prescribed dose and pill strength are equal, only one pill is needed to administer the correct dose.
Rationale for Choice A:
Correct: One pill of 0.4 mg will provide the exact dose of 400 mcg that has been prescribed.
Direct match: The pill strength matches the prescribed dose, eliminating the need for any calculations or adjustments.
Therapeutic equivalence: Administering one pill ensures that the patient receives the intended amount of medication to achieve the desired therapeutic effect.
Adherence to prescription: Conforms to the healthcare provider's instructions, promoting accurate and safe medication administration.
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