While performing a bed bath, the nurse notes an area of tissue injury on the client's sacral area. The wound presents as a shallow open ulcer with a red-pink wound bed and partial thickness loss of dermis. What is the correct name of this wound?

Stage II pressure ulcer

Stage IV pressure ulcer

Stage I pressure ulcer

Stage III pressure ulcer

Answer and Explanation

The Correct Answer is A

A stage II pressure ulcer is a wound that presents as a shallow open ulcer with a red-pink wound bed and partial thickness loss of dermis. This type of wound is caused by unrelieved pressure on the skin, resulting in damage to the underlying tissue. In this scenario, the nurse notes an area of tissue injury on the client's sacral area that matches the description of a stage II pressure ulcer. Stage I pressure ulcers are characterized by non-blanchable erythema of intact skin, while stage III and IV pressure ulcers involve full-thickness tissue loss and may expose underlying muscle, bone, or other structures.

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Correct Answer is B

Explanation

Clara Barton was a pioneering nurse who is best known for founding the American Red Cross in 1881. She was a hospital nurse during the American Civil War and later worked to provide aid to soldiers and civilians aﬀected by war and natural disasters. In 1881, she established the American Red Cross to provide humanitarian assistance during times of crisis. The organization continues to provide disaster relief and support to this day.

A. Questioning a medication order that does not appear to meet the client's needs for pain management. B. Practicing nursing in a culturally competent fashion. C. Exhibiting a willingness to try alternate methods of addressing a client's care needs. D. Waiting for the medical team to determine the focus of the client's supportive care. E. Listening with empathy to a client who has recently been diagnosed.

Correct Answer is ["A","C","E"]

Explanation

The manager observed the nurse performing actions that demonstrate critical thinking, including questioning a medication order that does not appear to meet the client's needs for pain management, exhibiting a willingness to try alternate methods of addressing a client's care needs, and listening to empathy to a client who has recently been diagnosed. These actions show that the nurse is able to think critically and make informed decisions based on the needs of the client.

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While performing a bed bath, the nurse notes an area of tissue injury on the client's sacral area. The wound presents as a shallow open ulcer with a red-pink wound bed and partial thickness loss of dermis. What is the correct name of this wound?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which of the following nursing pioneers established the Red Cross in the United States in 1882?

Correct Answer is B

Explanation

The nurse manager has determined that a new staﬀ nurse is demonstrating characteristics of a critical thinker. Which of the following did the manager observe the nurse perform? Select all that apply.

Correct Answer is ["A","C","E"]

Explanation

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