A wound care nurse has been consulted on a patient with multiple pressure wounds. The nurse comes across this heal wound. How should she document the following wound?

Unstageable Ulcer

Stage II Pressure Ulcer

Stage IV Pressure Ulcer

Stage III Pressure Ulcer

Answer and Explanation

The Correct Answer is A

Choice A rationale: An unstageable ulcer is covered with slough or eschar, making it difficult to determine the depth of tissue involvement. The presence of eschar prevents accurate staging of the wound.
Choice B rationale: Stage II pressure ulcers involve partial-thickness skin loss, typically presenting as a shallow open ulcer with a red-pink wound bed.
Choice C rationale: Stage IV pressure ulcers involve full-thickness tissue loss with exposed bone, tendon, or muscle, which is not described in this scenario.
Choice D rationale: Stage III pressure ulcers involve full-thickness tissue loss without exposed bone, tendon, or muscle, but the presence of eschar makes accurate staging challenging.

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Correct Answer is A

Explanation

Choice A rationale: Dark amber, cloudy, and unpleasant-smelling urine may indicate a urinary tract infection.
Choice B rationale: Urinary retention is not typically associated with dark amber, cloudy urine.
Choice C rationale: Cloudy urine may be associated with urinary incontinence but is not typically dark amber with an unpleasant odor.
Choice D rationale: Urinary frequency does not typically cause dark amber, cloudy urine.

A. Carrying an air-filled ball while wading through the water across the width of a pool B. Contracting the gluteal muscles while holding a simple yoga pose C. Walking single file at a rate of 3 miles (5 km)/hour around a racetrack two times D. Sitting in a chair with a low weight on the side and lifting the knee to the seat level of the chair

Correct Answer is B

Explanation

Choice A rationale: Carrying an air-filled ball while wading through the water across the width of a pool is an isotonic exercise.
Choice B rationale: Contracting the gluteal muscles while holding a simple yoga pose is an isometric exercise.
Choice C rationale: Walking at a rate of 3 miles (5 km)/hour around a racetrack is an isotonic exercise.
Choice D rationale: Sitting in a chair with a low weight on the side and lifting the knee to the seat level of the chair is an isotonic exercise.

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A wound care nurse has been consulted on a patient with multiple pressure wounds. The nurse comes across this heal wound. How should she document the following wound?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client and observes that the client's urine is dark amber, cloudy, and has an unpleasant odor. The nurse should recognize that these findings are associated with which of the following?

Correct Answer is A

Explanation

The nurse is leading an exercise class for a group of adults aged 65 years and older. The nurse incorporates isotonic. Isometric, and isokinetic exercises into the class. Which activity is an isometric exercise?

Correct Answer is B

Explanation

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