A nurse is caring for a client who has a stage IV pressure ulcer. Which of the following is a characteristic of this type of ulcer?
A) Presence of redness accompanied by blistering or a skin tear
B) Presence of a shallow skin crater that extends to the subcutaneous tissue
C) Presence of redness that fails to resume normal color when pressure is relieved
D) Presence of deeply ulcerated tissue exposing muscles and bones
D
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A stage IV pressure ulcer is characterized by deeply ulcerated tissue exposing the muscles and bones. Stage I is characterized by intact but reddened skin that remains red and fails to resume its normal color when pressure is relieved. A stage II pressure ulcer is red and accompanied by blistering or a skin tear. A stage III pressure ulcer has a shallow skin crater that extends to the subcutaneous tissue. It may be accompanied by serous or purulent drainage caused by a wound infection.
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