A person has a pressure ulcer on their coccyx, and the top layer of the skin is lost and looks like a blister. What pressure ulcer stage is this?
Stage 1
Stage 4
Stage 3
Stage 2
The Correct Answer is D
Choice A reason: Stage 1 pressure ulcers present with intact skin showing non-blanchable redness, typically over bony prominences, due to localized ischemia from sustained pressure. No skin loss or blistering occurs, as the epidermis remains intact, indicating early tissue stress without ulceration. This does not match the described blister and skin loss, making it incorrect.
Choice B reason: Stage 4 pressure ulcers involve full-thickness tissue loss, exposing underlying structures like muscle, bone, or tendons. Severe necrosis and deep tissue damage occur due to prolonged pressure, disrupting blood supply extensively. The described superficial skin loss with a blister does not involve such deep structures, ruling out Stage 4.
Choice C reason: Stage 3 pressure ulcers feature full-thickness skin loss, extending into subcutaneous tissue but not to muscle or bone. They may show undermining or tunneling due to tissue necrosis. The described blister with top-layer skin loss suggests partial-thickness damage, not deep enough for Stage 3, making this choice incorrect.
Choice D reason: Stage 2 pressure ulcers involve partial-thickness skin loss, affecting the epidermis and possibly dermis, often appearing as a shallow ulcer or fluid-filled blister. The blister and loss of the top skin layer described indicate damage beyond redness but not full-thickness, aligning perfectly with Stage 2 characteristics, making this the correct choice.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Hemoglobin does not store oxygen in the lungs; it binds oxygen in the alveoli and releases it in tissues. Oxygen storage is minimal, and myoglobin in muscles serves this role, making this choice incorrect for hemoglobin’s primary function in gas exchange.
Choice B reason: Hemoglobin does not prevent carbon dioxide from entering the bloodstream. It binds carbon dioxide in tissues and transports it to the lungs for exhalation, facilitating gas exchange, not blocking it, making this choice incorrect for hemoglobin’s role.
Choice C reason: Hemoglobin binds oxygen in the lungs, forming oxyhemoglobin, and transports it via red blood cells to body tissues, where it releases oxygen for cellular metabolism. This is its primary role in gas exchange, making this the correct choice.
Choice D reason: Hemoglobin does not produce oxygen; oxygen is inhaled from the environment. Hemoglobin’s role is to transport oxygen, not synthesize it, making this choice incorrect as it misrepresents the physiological function of hemoglobin in gas exchange.
Correct Answer is D
Explanation
Choice A reason: Chronic asthma involves persistent symptoms managed over time, not an acute, life-threatening event. Status asthmaticus is an acute, severe exacerbation unresponsive to standard treatments, requiring urgent intervention, making this choice incorrect for describing status asthmaticus.
Choice B reason: An asthma attack triggered by exercise is exercise-induced bronchospasm, not status asthmaticus. Status asthmaticus is a severe, prolonged attack resistant to therapy, not defined by a specific trigger like exercise, making this choice incorrect.
Choice C reason: A mild asthma attack resolving with bronchodilators responds to standard therapy, unlike status asthmaticus, which is a severe, life-threatening attack unresponsive to bronchodilators and corticosteroids, requiring intensive care, making this choice incorrect for the condition.
Choice D reason: Status asthmaticus is a severe, prolonged asthma attack that does not respond to standard treatments like bronchodilators and corticosteroids. It causes critical airway obstruction and hypoxia, requiring aggressive medical intervention, accurately describing the condition and making this the correct choice.
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