Practice Question
A nurse is assessing a client who has a pressure ulcer. The nurse should recognize which of the following findings is a manifestation of a stage 3 pressure ulcer?
Answer Choices:
Correct Answer:
Necrotic subcutaneous tissue
Rationale:
- A stage 3 pressure injury involves full-thickness skin loss, extending into the subcutaneous tissue but not exposing bone or muscle.
- The presence of necrotic tissue (slough or eschar) is typical in this stage and requires debridement and advanced wound care.
- Recognizing pressure ulcer stages allows for timely intervention, preventing progression to stage 4 or infection.
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This question is from RN Nurs102 Fundamentals Retake which contains 95 questions.
More Questions from This Exam
A nurse instructs a female client about collecting a midstream urine sample. Which of the following client statements indicates an understanding of the procedure?
Answer Choices:
A. I'll use each cleansing wipe twice.
B. I'll urinate a little then stop.
C. I'll clean the inside of the container with a wipe.
D. I'll use the cleansing wipe from front to back.
As part of an annual physical examination, a nurse is preparing a client to undergo a chest x-ray. Which of the following instructions should the nurse give the client prior to the procedure?
Answer Choices:
A. Remove all metal necklaces.
B. Take several shallow breaths during the procedure.
C. Do not eat or drink anything the morning of the test.
D. Expect minor discomfort after the procedure.
A nurse is caring for a client who requests prescription pain medication. Which of the following actions should the nurse perform first?
Answer Choices:
A. Administer the medication.
B. Reposition the client.
C. Review the effects of the pain medication.
D. Determine the location of the pain.
A nurse is preparing to perform hand hygiene. Which of the following actions should the nurse take?
Answer Choices:
A. Hold the hands higher than the elbows.
B. Rub hands and arms to dry.
C. Adjust the water temperature to feel hot.
D. Apply 4 to 5 ml of liquid soap to the hands.
A nurse is caring for an older adult client who is at risk for skin breakdown. Which of the following interventions should the nurse use to help maintain the integrity of the client's skin?
Answer Choices:
A. Apply cornstarch to keep the skin dry
B. Reposition the client every 3 hours
C. Massage bony prominences to promote circulation
D. Provide the client with a diet high in protein
Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: RN ATI Fundamentals of Nursing
- Answer Choices: 4