VERIFIED ANSWERS 2025/2026
1 of 88
Term
What occurs in a pressure wound stage two?
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, Involves the epidermis and the dermis. The wound bed is viable with a
reddish-pinkish bed without slough, eschar, granulation tissue, or
adipose tissue. It can appear as an intact or ruptured blister.
-Ensure there is a basin in front of the pt in case they vomit
-Measure from the tip of the nose, around the ear, all the way down to the
umbilicus; mark that area with a piece of tape
-Feed down and tell the pt to swallow hard
-X-ray to make sure the placing is correct
Intact skin with persistent, no blanchable redness that can feel warmer or cooler
than the adjacent tissue.
Skin and tissue loss with cartilage, bone, fascia, muscle, ligaments, or tendon
exposed in the wound or easily palpable.
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2 of 88
Term
The pt is c/o to the nurse that they are trying to improve their bowel
incontinence, what should the nurse do to help assist with the pts
issue?
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, Place a bedside commode Place the bed at a 45 degree angle
Start the 24hr urine test on their next
void Keep the room well lit
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3 of 88
Definition
Intact skin is no blanchable with deep red, maroon, or purple
discoloration; open wounds have a dark wound bed or blood blister.
Pain and temperature changes can be detected earlier than color
changes. Occurs most frequently over the heels, ankles, ischial
tuberosities, and sacral area.
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What occurs in a pressure What occurs in a pressure wound
wound stage two? stage four?
What occurs when the What is the correct way to use
pressure wound is at the a cane?
deep tissue?
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, 4 of 88
Term
What is libel/defamation of character?
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Making a rude
comment/gossiping about a pt Discussing a pt's treatment plan
or coworker with colleagues
Sharing a pt's medical history Providing false information about a
with family pt's condition
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5 of 88
Definition
-Must wear a mask, gloves, and gown. It spreads by direct contact
between person to person; must separate pts if a pt has it.
-A pt is most at risk if they have a weakened immune system, had
gotten a surgery, and had been at the hospital for an extended amount
of time.
-Six include the skin being red, swollen, and drainage/abscess coming
from the area. This is very resistant to ax.
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