A nurse documents a stage 1 pressure ulcer on a patient's lateral malleolus. What assessment findings would indicate that this ulcer has progressed to stage II?
1. The subcutaneous fat layer is exposed.
2. A fluid-filled blister is present.
3. A shallow open ulcer is present.
4. There is an area of boggy purple skin on the bony prominence.
5. There is an area of skin that does not turn white with pressure.
2, 3
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A nurse is performing an admission assessment on a patient new to the unit. What would be the best way to phrase a question about the patient's marital status?
A) "Is your spouse living with you?" B) "Are you living with your spouse?" C) "Do you live alone or with someone?" D) "Are you married, divorced, or widowed?"
The nurse is assessing a pregnant patient. Which clinical manifestation does the nurse anticipate for this patient?
1) Enlarged cervical lymph nodes 2) Palatal petechiae 3) Pharyngitis 4) Nasal stuffiness
The safe use of electrical equipment involves which of the following?
a. Turning on equipment before unplugging it b. Having moist hands c. Using water to put out an electrical fire d. Keeping electrical cords away from heat-ing vents
Which of the following statements about the parasympathetic nervous system is not true?
a. It is active when the person is prepared for fight or flight b. It enhances the motility of the gastrointestinal tract c. It increases digestion and absorption d. It includes the vagus nerve