NSG 121 – GI Questions with Correct Answers 100% Verified by Experts| 2025/2026 Latest
Update
Ischemic lesions of the skin and tissues caused by unrelieved pressure that interferes with
blood and lymph flow pressure ulcers
dead tissue necrosis
A nurse identifies that a client has a pressure ulcer on the sacrum. Which assessment finding
indicates that this is a stage III pressure ulcer?
A. Non-blanchable erythema of intact skin
B. Damage identifies to muscle and bone
C. Skin loss to the dermis
D. Necrosis of subcutaneous tissue D
An 88-year-old client who has limited mobility is admitted to the hospital. Which action by the
nurse prevents injury to the skin normally caused by friction?
A. Avoiding use of a draw sheet when repositioning the client
B. Sprinkling baby powder on the sheets to keep the skin dry
C. Placing the client in the prone position
D. Elevating the head of the bed to a 60-degree angle C
A client with type 1 diabetes mellitus has a blister on the left heel that resulted from improperly
fitting shoes. The nurse should document this ulcer as being which stage?
A. Stage II
B. Stage III
C. Stage IV
,D. Stage I A
The nurse identifies that a client admitted for decreased mental status is at risk for a pressure
ulcer. Which action assists in maintaining skin hygiene to help prevent a pressure ulcer?
A. Applying lotion to moist skin after the bath
B. Massaging bony prominences during the bath
C. Using hot water and mild soap during the bath
D. Monitoring the skin once a week during the bath A
When planning care for a client at risk for developing a pressure ulcer, the nurse addresses the
potential problem of risk for impaired skin integrity. Which nursing intervention assists in
meeting the goals of this diagnosis? (Select all that apply.)
A. Avoiding massaging bony prominences
B. Placing the client in the side-lying position only
C. Keeping the head of the bed elevated more than thirty degrees
D. Inspecting the skin every day
E. Using positioning devices A, D, and E
The nurse is caring for a client with a stage I pressure ulcer to the sacrum. Which product
should the nurse use to help increase blood supply to the skin of this pressure ulcer?
A. Transparent dressing
B. Vacuum-assisted closure
C. Hydrogel dressing
D. Granulex D
,Which action maintains skin hygiene for clients at risk for pressure ulcers? (Select all that
apply.)
A. Avoiding exposure to high humidity
B. Scrubbing the skin to clean it thoroughly when bathing
C. Treating dry skin with moisturizing lotions directly applied to moist skin after bathing
D. Cleaning the skin immediately if exposed to urine or feces
E. Assessing the skin upon admission and then daily using the same screening tool C, D, and
E
Which factor contributes to the formation of pressure ulcers in a client and increases the cells'
need for oxygen?
A. Immobility
B. Diminished sensation
C. Inadequate nutrition
D. Excessive body heat D
Which type of debridement causes the least damage to healthy and healing tissue surrounding
a pressure ulcer?
A. Autolytic
B. Chemical
C. Mechanical
D. Sharp A
Which type of product or dressing for pressure ulcers forms a gel when it comes in contact with
wound exudate?
, A. Alginate dressing
B. Hydrofiber dressing
C. Proteolytic enzymes
D. Hydrocolloid dressing A
Which data should you record when assessing an existing pressure ulcer? (Select all that apply.)
A. Odor of wound bed
B. Color of the wound bed
C. Location in relation to bony prominences
D. Condition of the wound margins
E. Signs of infection B, C, D, and E
The nurse is caring for a client with a pressure ulcer who is at risk for impaired skin integrity.
Which intervention should be included in the nursing plan of care? (Select all that apply.)
A. Cleaning the skin at time of soiling and routinely
B. Inspecting skin at least once a day
C. Increasing amount of time with the head of the bed elevated
D. Avoiding the side-lying position
E. Massaging bony prominences A, B, and D
Mr. Brown is being treated for pressure ulcers. Mr. Brown has dementia and limited mobility,
and he lives with his daughter, spending most of his day sitting in a chair. What should you
suggest to Mr. Brown's daughter to help reduce his risk for pressure ulcers?
A. "Reposition Mr. Brown in the chair every 3 hours."
Update
Ischemic lesions of the skin and tissues caused by unrelieved pressure that interferes with
blood and lymph flow pressure ulcers
dead tissue necrosis
A nurse identifies that a client has a pressure ulcer on the sacrum. Which assessment finding
indicates that this is a stage III pressure ulcer?
A. Non-blanchable erythema of intact skin
B. Damage identifies to muscle and bone
C. Skin loss to the dermis
D. Necrosis of subcutaneous tissue D
An 88-year-old client who has limited mobility is admitted to the hospital. Which action by the
nurse prevents injury to the skin normally caused by friction?
A. Avoiding use of a draw sheet when repositioning the client
B. Sprinkling baby powder on the sheets to keep the skin dry
C. Placing the client in the prone position
D. Elevating the head of the bed to a 60-degree angle C
A client with type 1 diabetes mellitus has a blister on the left heel that resulted from improperly
fitting shoes. The nurse should document this ulcer as being which stage?
A. Stage II
B. Stage III
C. Stage IV
,D. Stage I A
The nurse identifies that a client admitted for decreased mental status is at risk for a pressure
ulcer. Which action assists in maintaining skin hygiene to help prevent a pressure ulcer?
A. Applying lotion to moist skin after the bath
B. Massaging bony prominences during the bath
C. Using hot water and mild soap during the bath
D. Monitoring the skin once a week during the bath A
When planning care for a client at risk for developing a pressure ulcer, the nurse addresses the
potential problem of risk for impaired skin integrity. Which nursing intervention assists in
meeting the goals of this diagnosis? (Select all that apply.)
A. Avoiding massaging bony prominences
B. Placing the client in the side-lying position only
C. Keeping the head of the bed elevated more than thirty degrees
D. Inspecting the skin every day
E. Using positioning devices A, D, and E
The nurse is caring for a client with a stage I pressure ulcer to the sacrum. Which product
should the nurse use to help increase blood supply to the skin of this pressure ulcer?
A. Transparent dressing
B. Vacuum-assisted closure
C. Hydrogel dressing
D. Granulex D
,Which action maintains skin hygiene for clients at risk for pressure ulcers? (Select all that
apply.)
A. Avoiding exposure to high humidity
B. Scrubbing the skin to clean it thoroughly when bathing
C. Treating dry skin with moisturizing lotions directly applied to moist skin after bathing
D. Cleaning the skin immediately if exposed to urine or feces
E. Assessing the skin upon admission and then daily using the same screening tool C, D, and
E
Which factor contributes to the formation of pressure ulcers in a client and increases the cells'
need for oxygen?
A. Immobility
B. Diminished sensation
C. Inadequate nutrition
D. Excessive body heat D
Which type of debridement causes the least damage to healthy and healing tissue surrounding
a pressure ulcer?
A. Autolytic
B. Chemical
C. Mechanical
D. Sharp A
Which type of product or dressing for pressure ulcers forms a gel when it comes in contact with
wound exudate?
, A. Alginate dressing
B. Hydrofiber dressing
C. Proteolytic enzymes
D. Hydrocolloid dressing A
Which data should you record when assessing an existing pressure ulcer? (Select all that apply.)
A. Odor of wound bed
B. Color of the wound bed
C. Location in relation to bony prominences
D. Condition of the wound margins
E. Signs of infection B, C, D, and E
The nurse is caring for a client with a pressure ulcer who is at risk for impaired skin integrity.
Which intervention should be included in the nursing plan of care? (Select all that apply.)
A. Cleaning the skin at time of soiling and routinely
B. Inspecting skin at least once a day
C. Increasing amount of time with the head of the bed elevated
D. Avoiding the side-lying position
E. Massaging bony prominences A, B, and D
Mr. Brown is being treated for pressure ulcers. Mr. Brown has dementia and limited mobility,
and he lives with his daughter, spending most of his day sitting in a chair. What should you
suggest to Mr. Brown's daughter to help reduce his risk for pressure ulcers?
A. "Reposition Mr. Brown in the chair every 3 hours."
