A patient refuses to remove a specific spiritual garment for ...

[Chelseaamend]

A patient refuses to remove a specific spiritual garment for daily bathing. The most appropriate action for the nurse to take includes:
 
  A. removing the article anyway.
  B. respecting the patient's wishes.
  C. asking the patient to remove the article just during hospitalization.
  D. telling the patient that other patients of the same faith have allowed the item to be removed.

Question 2

Dottie is a 67-year-old patient who was admitted to the hospital when a community health nurse discovered that her family was having difficulty caring for her at home. She has a pressure ulcer on her sacrum. The wound is open with exposed bone.
 
  The nurse admitting her should document this as what stage of a pressure ulcer? A. Stage I
  B. Stage II
  C. Stage III
  D. Stage IV

[Loise Hard]

Answer to Question 1

B
It is important that the patient perceive that caregivers accept certain religious practices or rituals. Asking patients what they expect of their caregivers is a beneficial way to establish a nurse-patient relationship.

Answer to Question 2

D
Stage I: Intact skin with nonblanchable redness of a localized area, usually over a bony prominence
Stage II: Partial-thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed, without slough; may also present as an intact or open/ruptured serum-filled blister
Stage III: Full-thickness tissue loss; subcutaneous fat may be visible, but bone, tendon, or muscle is not exposed; slough may be present but does not obscure the depth of tissue loss; may include undermining and tunneling
Stage IV: Full-thickness tissue loss with exposed bone, tendon, or muscle