LATEST UPDATE 2025/2026
What are the layers of the skin? - Answers epidermis and dermis
What is the layer of fat under the skin called? - Answers adipose tissue (hypodermis)
What are the functions of the skin? - Answers protection, thermoregulation, sensing
environment
What is the largest organ of the body? - Answers skin
What the the weight percentage of the skin? - Answers 15%
What are the age-related changes of the skin? - Answers Decreased elasticity
Decreased collagen
Thinning
Slow wound healing
Decreased subcutaneous padding
True or false: as nurses we own the skin - Answers true
A nurse is _________ of ___________ the skin - Answers in charge, protecting
What are the two things a nurse should look for when assessing the skin of an admitted patient?
- Answers Look extra to verify any pre-admitted hospital infections/wounds
Identify patients that are at risk for skin integrity
What is the key to prevention of a pressure ulcer? - Answers make sure you do not keep
pressure on one area for too long
What are other precautions that should be taken to maintain the skin integrity of a patient? -
Answers Patient is well-hydrated
Patient is well-nourished
True or false: there is only one type of tape for patients. Therefore, finding the right kind of tape
is not a concern. - Answers false
True or false: it is important to know what medication your patient is on - Answers true
What are the three factors that contribute to pressure injuries? - Answers Intensity
Duration
,Tissue tolerance
How does intensity affect blood flow? - Answers Too much pressure can disrupt the capillary
bed leading to tissue ischemia
What does intensity determine? - Answers extent of interruption of blood supply
The more intense the pressure, the greater what? - Answers ischemia
The greater ischemia the greater what? - Answers tissue damage
Where does intensity increase? - Answers over bony prominences
How can the degree of poor tissue perfusion be estimated? - Answers color changes in the
epidermis
Shows erythema or redness, indicates vasodilation - Answers hyperemia
What causes hyperemia? - Answers Pressure is released and a rush of blood flow to the area
trying to counteract the ischemia
an attempt to overcome ischemic spell - Answers blanching ischemia
What should a nurse see when they press their finger on a patients palm to test for blanching? -
Answers Flesh color-white-flesh color
there is damage to the tissue, does not have a vascular flow and there is also capillary damage -
Answers non-blanching erythema
After a test for non-blanching, what should a nurse see? - Answers red-red (after pressing the
skin stays red)
True or false: skin that is damaged could be lighter or darker than other areas of normal skin -
Answers true
What does hot to the touch skin indicate? - Answers inflammation and a new injury
What will the touch feel like to an older injury of the skin? - Answers cool
True or false: a nurse should palpate the the skin after assessing it - Answers true
What will new skin feel like? - Answers firm
What will taunt skin be like? - Answers stretchy
What does old skin act like? - Answers boggy (spongyness)
What is bogginess? - Answers hanging out
, More than ____ many hours can lead to significant tissue perfusion - Answers 2
What causes this duration to lessen? - Answers poor nutrition and health
Does being on a ventilator affect the duration time too? - Answers yes
Duration is ______ - Answers key
What are some factors that decrease tissue tolerance? - Answers Malnourishment
Poor hydration
Older age
Stage of life (infant, premature babies, newborns)
Poor hygiene
Immobility
Medical condition
What are some medical conditions that could decrease tissue tolerance? - Answers decreased
blood flow
slow wound healing
CDS
Peripheral vascular disease
spinal cord injuries
A nurses finds out that a patient stepped on a nail two day before coming to the doctor. The
nurse assessed the area of the skin and during palpation the patient did not flench when she
touched the tender wound. What does the patient have? - Answers altered sensation
A patient with altered sensation is at risk for what? - Answers ulcer development (diabetes are
at the greatest risk for this)
inability to independently change position - Answers Impaired mobility
inability to effectively communicate what you need - Answers Change in LOC
What are all of the at risk factors for ulcer development? - Answers Altered sensation
Impaired mobility
Change in LOC