EXAM 5 CERTIFICATION TEST WITH
ACCURATE ANSWERS
◉ Erikson's Psychosocial Theory Older Adults. Answer: Integrity vs.
Despair
People in late adulthood reflect on their lives and feel either a sense
of satisfaction or a sense of failure. People who feel proud of their
accomplishments feel a sense of integrity, and they can look back on
their lives with few regrets.
◉ Droplet Precautions. Answer: Droplet Precautions:
Use a private room, if available. Door may remain open.
Wear PPE upon entry into the room for all interactions that may
involve contact with the patient and potentially contaminated areas
in the patient's environment.
Transport patient out of room only when necessary and place a
surgical mask on the patient if possible.
Keep visitors 3 ft from the infected person.
◉ Why are masks beneficial with droplet precautions?. Answer:
Masks help prevent the wearer from inhaling large-particle aerosols,
which usually travel short distances (about 3 ft), and small-particle
droplet nuclei, which can remain suspended in the air and travel
,longer distances. Masks also protect the patient from the respiratory
secretions of the health care worker. Masks discourage the wearer
from touching the eyes, nose, and mouth, thus limiting contact of
organisms with mucous membranes.
◉ Cough Etiquette. Answer: Any patients, family members, and
visitors with undiagnosed, transmissible respiratory infections
require education to cover their mouth and nose with a tissue when
coughing and promptly dispose of the tissue. During periods of
increased occurrence of respiratory infections, offer a surgical mask
to coughing patients and other symptomatic people upon entry to
the health care facility or office. Encourage the coughing patient to
maintain more than a 3-ft separation from other people in the health
care facility or office.
◉ Factors Affecting Risk for Infection. Answer: Factors affecting the
risk for infection include: integrity of mucous membranes, pH levels
of the gastrointestinal and genitourinary tracts, immune response,
age, sex, race, heredity, level of fatigue, nutritional status, stress
level, use of invasive or indwelling medical devices and
immunizations (natural or acquired)
◉ Abnormal Wound Drainage. Answer: Purulent drainage is made
up of white blood cells, liquefied dead tissue debris, and both dead
and live bacteria. Purulent drainage is thick, often has a musty or
foul odor, and varies in color (such as dark yellow or green),
depending on the causative organism.
,◉ Pressure Ulcer Stage 1. Answer: A stage 1 pressure injury is a
defined, localized area of intact skin with nonblanchable erythema
(redness). Darkly pigmented skin may not have visible blanching; its
color may differ from the surrounding skin. The area may be painful,
firm, soft, warmer, or cooler as compared to adjacent tissue
◉ Pressure Ulcer Stage 2. Answer: A stage 2 pressure injury involves
partial-thickness loss of dermis and presents as a shallow, open
ulcer or a ruptured/intact serum-filled blister
◉ Pressure Ulcer Stage 3. Answer: A stage 3 pressure injury
presents with full-thickness tissue loss. Subcutaneous fat may be
visible and epibole (rolled wound edges) may occur, but bone,
tendon, or muscle is not exposed. Slough and/or eschar that may be
present do not obscure the depth of tissue loss. Ulcers
◉ Pressure Ulcer Stage 4. Answer: Stage 4 injuries involve full-
thickness tissue loss with exposed or palpable bone, cartilage,
ligament, tendon, fascia, or muscle. Slough or eschar may be present
on some part of the wound bed; epibole, undermining, and/or
tunneling often occur
◉ Wound Infection. Answer: Symptoms of infection include purulent
drainage; increased drainage, pain, redness, and swelling in and
around the wound; increased body temperature; and increased
, white blood cell count. Additional signs and symptoms include
delayed healing and discoloration of granulation tissue in the wound
◉ Braden Scale. Answer: Braden Scale: mental status, continence,
mobility, activity, and nutrition
Using the Braden scale (VHMMN)
Lower to 9 Very high risk-V
10 to 12 High risk-H
13 to 14 Moderate risk-M
15 to 18 Mild risk-M
19 to 23 indicate No risk-N
◉ Heat Application. Answer: The application of heat accelerates the
inflammatory response to promote healing.
The application of local heat dilates peripheral blood vessels,
increases tissue metabolism, reduces blood viscosity and increases
capillary permeability, reduces muscle tension, and helps relieve
pain. Vasodilation increases local blood flow. In turn, the supply of
oxygen and nutrients to the area is increased, and venous congestion
is decreased
Careful on large parts of the body
◉ Dysnpea Positioning. Answer: High Fowler's Position because
accessory muscles can easily be used to promote respirations
ACCURATE ANSWERS
◉ Erikson's Psychosocial Theory Older Adults. Answer: Integrity vs.
Despair
People in late adulthood reflect on their lives and feel either a sense
of satisfaction or a sense of failure. People who feel proud of their
accomplishments feel a sense of integrity, and they can look back on
their lives with few regrets.
◉ Droplet Precautions. Answer: Droplet Precautions:
Use a private room, if available. Door may remain open.
Wear PPE upon entry into the room for all interactions that may
involve contact with the patient and potentially contaminated areas
in the patient's environment.
Transport patient out of room only when necessary and place a
surgical mask on the patient if possible.
Keep visitors 3 ft from the infected person.
◉ Why are masks beneficial with droplet precautions?. Answer:
Masks help prevent the wearer from inhaling large-particle aerosols,
which usually travel short distances (about 3 ft), and small-particle
droplet nuclei, which can remain suspended in the air and travel
,longer distances. Masks also protect the patient from the respiratory
secretions of the health care worker. Masks discourage the wearer
from touching the eyes, nose, and mouth, thus limiting contact of
organisms with mucous membranes.
◉ Cough Etiquette. Answer: Any patients, family members, and
visitors with undiagnosed, transmissible respiratory infections
require education to cover their mouth and nose with a tissue when
coughing and promptly dispose of the tissue. During periods of
increased occurrence of respiratory infections, offer a surgical mask
to coughing patients and other symptomatic people upon entry to
the health care facility or office. Encourage the coughing patient to
maintain more than a 3-ft separation from other people in the health
care facility or office.
◉ Factors Affecting Risk for Infection. Answer: Factors affecting the
risk for infection include: integrity of mucous membranes, pH levels
of the gastrointestinal and genitourinary tracts, immune response,
age, sex, race, heredity, level of fatigue, nutritional status, stress
level, use of invasive or indwelling medical devices and
immunizations (natural or acquired)
◉ Abnormal Wound Drainage. Answer: Purulent drainage is made
up of white blood cells, liquefied dead tissue debris, and both dead
and live bacteria. Purulent drainage is thick, often has a musty or
foul odor, and varies in color (such as dark yellow or green),
depending on the causative organism.
,◉ Pressure Ulcer Stage 1. Answer: A stage 1 pressure injury is a
defined, localized area of intact skin with nonblanchable erythema
(redness). Darkly pigmented skin may not have visible blanching; its
color may differ from the surrounding skin. The area may be painful,
firm, soft, warmer, or cooler as compared to adjacent tissue
◉ Pressure Ulcer Stage 2. Answer: A stage 2 pressure injury involves
partial-thickness loss of dermis and presents as a shallow, open
ulcer or a ruptured/intact serum-filled blister
◉ Pressure Ulcer Stage 3. Answer: A stage 3 pressure injury
presents with full-thickness tissue loss. Subcutaneous fat may be
visible and epibole (rolled wound edges) may occur, but bone,
tendon, or muscle is not exposed. Slough and/or eschar that may be
present do not obscure the depth of tissue loss. Ulcers
◉ Pressure Ulcer Stage 4. Answer: Stage 4 injuries involve full-
thickness tissue loss with exposed or palpable bone, cartilage,
ligament, tendon, fascia, or muscle. Slough or eschar may be present
on some part of the wound bed; epibole, undermining, and/or
tunneling often occur
◉ Wound Infection. Answer: Symptoms of infection include purulent
drainage; increased drainage, pain, redness, and swelling in and
around the wound; increased body temperature; and increased
, white blood cell count. Additional signs and symptoms include
delayed healing and discoloration of granulation tissue in the wound
◉ Braden Scale. Answer: Braden Scale: mental status, continence,
mobility, activity, and nutrition
Using the Braden scale (VHMMN)
Lower to 9 Very high risk-V
10 to 12 High risk-H
13 to 14 Moderate risk-M
15 to 18 Mild risk-M
19 to 23 indicate No risk-N
◉ Heat Application. Answer: The application of heat accelerates the
inflammatory response to promote healing.
The application of local heat dilates peripheral blood vessels,
increases tissue metabolism, reduces blood viscosity and increases
capillary permeability, reduces muscle tension, and helps relieve
pain. Vasodilation increases local blood flow. In turn, the supply of
oxygen and nutrients to the area is increased, and venous congestion
is decreased
Careful on large parts of the body
◉ Dysnpea Positioning. Answer: High Fowler's Position because
accessory muscles can easily be used to promote respirations
