Deck 18: Pressure Ulcers

Question 1

If friction is the only factor present, the injury to the skin is confined to the epidermis and upper dermal layers of the skin.

Answer 1

True

Question 2

Serum albumin levels are frequently used to assess nutritional status, even though they are a poor indicator of protein status as multiple factors decrease albumin levels when protein intake is adequate.

Answer 2

True

Question 3

Pressure ulcers are usually much worse than they appear on the surface; therefore, staging should be to the maximum anatomical depth after necrotic tissue debridement is performed.

Answer 3

True

Question 4

What medical condition should be suspected and evaluated if bone is exposed or the ulcer has failed to heal?

A) Cellulitis
B) Fasciitis
C) Dermatitis
D) Osteomyelitis

Question 5

Which of the following is an emerging assessment technique that helps the clinician visualize, measure, and document the unseen parities and disparities of metabolic activity, perfusion, and inflammation?

A) Pressure map
B) Microclimate control
C) Electrical stimulation
D) Infrared scanning and imaging

Question 6

Depending on the physical health of the individual, pressure ulcers can develop within what time from of the insult?

A) 1-24 hours
B) 24-48 hours
C) 48-72 hours
D) 72-96 hours

Question 7

What extrinsic factor for pressure ulcer development alters the resiliency of the epidermis to external forces by weakening the lipid layer of the stratum corneum?

A) Pressure
B) Shear
C) Friction
D) Moisture

Question 8

Errors in medical care that are clearly identifiable, preventable, and have serious consequences for patients are referred to as which of the following?

A) Reportable events
B) Sentinel events
C) Never events
D) Adverse events

Question 9

Nonblanchable redness of the skin is characteristic of a pressure ulcer in what stage?

A) Stage I
B) Stage II
C) Stage III
D) Stage IV

Question 10

What type of pressure ulcer debridement method is appropriate for noninfected ulcers only?

A) Sharp debridement
B) Autolytic debridement
C) Autolytic debridement
D) Mechanical debridement

Question 11

In 2016, the National Pressure Ulcer Advisory Panel (NPUAP) proposed that the term "pressure injury" replace the term "pressure ulcer" to better capture injuries with both intact and nonintact skin.

Question 12

Offloading is the ability of a support surface to distribute load over the contact areas of the human body to reduce overall pressure and avoid areas of focal pressure.

Question 13

Serum albumin and prealbumin results may be elevated even when protein intake is adequate if the patient is suffering from severe inflammation, infection, acute stress, dehydration, and surgery-related cortisone excess.

Question 14

Moisture, normally caused by which of the following, is an extrinsic factor for pressure ulcer development?

A) Bathing
B) Perspiration
C) Incontinence
D) Topical treatments

Question 15

If which of the following is the only factor present, the injury to the skin is confined to the epidermis and upper dermal layers of the skin?

A) Shear
B) Friction
C) Moisture
D) Infection

Question 16

Subset scores of which of the following or less in any one category on the Braden Scale places one in a high-risk category even if the patient has an overall score greater than 16?

A) 2
B) 3
C) 4
D) 5

Question 17

When pressure ulcers are present on which area, sitting should be limited to three times a day in periods of 60 minutes or less?

A) Trochanter
B) Calcaneus
C) Ischial tuberosity
D) Sacrum/coccyx

Question 18

The depth of ulcers of what stage can vary by anatomical location as wounds on the bridge of the nose, ear, occiput, and malleolus do not have subcutaneous tissue and can be shallow?

A) Stage I
B) Stage II
C) Stage III
D) Stage IV

Question 19

Wet-to-dry dressings, hydrotherapy, and irrigation are all classified as what method of pressure ulcer debridement?

A) Autolytic debridement
B) Sharp debridement
C) Enzymatic debridement
D) Mechanical debridement

Question 20

Stable eschar on what body part serves as "the body's natural biological cover" and should not be removed?

A) Heel
B) Elbow
C) Ankle
D) Coccyx