S N O I T N E VR E T N I • Y T I L I B O M M I
Nursing Fundamentals
NURS School of Nursing — Immobility & Quality Review
P R E S S U R E I N J U R I E S · M O B I L I T Y CO M P L I C AT I O N S · Q U A L I T Y I M P R O V E M E N T
MOBILITY
Nursing Fundamentals — Immobility & Quality Care
P R E SS U R E I N J U R I E S , SYST E M -S P E C I F I C I M M O B I L I TY CO M P L I C AT I O N S & E V I D E N C E - B A S E D
INTERVENTIONS
INSTITUTION School of Nursing COURSE CODE NURS-FUND-IMMOBILITY
PROGRAM Nursing — ADN / BSN Pathway ACADEMIC YEAR
EXAM TITLE Immobility Complications & Quality Care TOTAL QUESTIONS 60+ Comprehensive Questions
COURSE TITLE Nursing Fundamentals FORMAT Multiple Choice / Definition / Select All
That Apply
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless otherwise indicated.
▸ Questions cover pressure injury staging, system-specific immobility complications (musculoskeletal, cardiovascular, respiratory,
GI, GU, psychological), evidence-based interventions, and quality improvement concepts.
▸ Verified answers with detailed rationales are provided for comprehensive exam preparation.
▸ Pay close attention to the differences between pressure injury stages and the specific nursing interventions for each immobility
complication.
PRESSURE INJURIES, IMMOBILITY INTERVENTIONS & QUALITY CARE Questions 1 – 60+
1. What happens to skin and tissue under prolonged pressure, and which areas are most susceptible?
A. Skin thickens and becomes more resistant; the palms and soles are most susceptible.
B. Prolonged pressure compresses skin/tissue, restricting blood and lymph flow; bony prominences (occiput, scapulae,
elbows, sacrum, ischium, heels) are most susceptible.
C. Pressure stimulates circulation; all areas are equally at risk.
D. Only patients with diabetes develop pressure injuries.
CORRECT ANSWER B — Pressure compresses tissue, restricting blood/lymph flow; bony prominences are most
susceptible
RATIONALE Pressure injury pathophysiology: External pressure exceeding capillary closing pressure (approximately 32
mmHg) compresses soft tissue between a bony prominence and an external surface. This occludes blood
flow, causing tissue ischemia. If pressure is unrelieved for >2 hours, irreversible tissue damage begins.
Lymphatic flow is also compromised, impairing waste removal. The most susceptible areas are bony
prominences with minimal subcutaneous tissue: occiput (back of head), scapulae (shoulder blades), elbows,
sacrum/coccyx (highest risk), ischial tuberosities (sitting), greater trochanters (side-lying), and heels.
Additional risk factors: moisture (incontinence, perspiration, wound drainage), friction/shear forces,
malnutrition (especially low protein/albumin), and impaired sensation (neuropathy, spinal cord injury).
, 2. Match the pressure injury stage to its description: Damage with skin intact.
A. Stage 1 — persistent redness/discoloration, temperature difference, firmness; intact skin.
B. Stage 2 — open blister, shallow pink/red wound bed.
C. Stage 3 — full-thickness with visible adipose tissue.
D. Stage 4 — exposed muscle, ligaments, or bone.
CORRECT ANSWER A — Stage 1: intact skin with non-blanchable redness, temperature change, and firmness
RATIONALE Stage 1 pressure injury: INTACT skin with non-blanchable erythema (does not turn white when pressed). In
darker skin tones, may appear as persistent red, blue, or purple discoloration different from surrounding skin.
The area may be warmer or cooler than adjacent tissue, and may feel firmer or softer. This is a REVERSIBLE
stage if pressure is relieved. Key nursing actions: offload pressure completely, protect from moisture, reassess
frequently. Note: blanchable redness (reactive hyperemia) is NOT a pressure injury — it indicates intact
circulation responding to pressure.
3. Match the pressure injury stage to its description: Damage into the skin layer.
A. Stage 1 — intact skin with discoloration.
B. Stage 2 — partial-thickness loss; lighter skin tone, open or intact blister, shallow pink/red wound bed without slough
or bruising.
C. Stage 3 — visible adipose tissue.
D. Deep tissue injury — purple/maroon discolored intact skin.
CORRECT ANSWER B — Stage 2: partial-thickness skin loss with exposed dermis; blister (intact or ruptured); pink/red
moist wound bed
RATIONALE Stage 2 pressure injury: Partial-thickness loss of skin with exposed dermis. The wound bed is viable, pink or
red, and moist. May present as an intact or ruptured serum-filled blister. Adipose (fat) and deeper tissues are
NOT visible. No slough (yellow/tan dead tissue) or eschar (black necrotic tissue). No bruising (bruising
indicates deep tissue injury, not Stage 2). Granulation tissue, slough, and eschar are NOT present in Stage 2.
Treatment: moist wound healing environment, offload pressure, protect from moisture and shear. These
wounds can heal relatively quickly with proper care.
4. What are the psychological effects of decreased mobility?
A. Improved self-esteem from rest.
B. Increased dependence on others, loss of privacy, inability to participate in work/hobbies, negatively impacting self-
concept, self-esteem, leading to frustration, anxiety, depression, and social isolation.
C. No psychological effects — only physical effects occur.
D. Euphoria from reduced activity demands.
CORRECT ANSWER B — Dependence, loss of privacy, inability to work/engage in hobbies → decreased self-
concept/esteem → frustration, anxiety, depression, social isolation
RATIONALE Immobility profoundly affects psychological well-being. Loss of independence creates dependence on others
for basic ADLs, threatening dignity and privacy. Inability to work threatens financial security and professional
identity. Abandonment of hobbies and social activities leads to isolation and loss of meaning/purpose. These
losses negatively impact self-concept and self-esteem, triggering frustration, anxiety, and depression. Social
isolation compounds these effects — reduced interaction with family, friends, and community removes
critical emotional support systems. Nursing interventions: encourage participation in self-care to the fullest
extent possible, facilitate communication (phone, video calls, visitors), provide meaningful activities within
physical limitations, screen for depression, and involve mental health professionals when indicated.
Nursing Fundamentals
NURS School of Nursing — Immobility & Quality Review
P R E S S U R E I N J U R I E S · M O B I L I T Y CO M P L I C AT I O N S · Q U A L I T Y I M P R O V E M E N T
MOBILITY
Nursing Fundamentals — Immobility & Quality Care
P R E SS U R E I N J U R I E S , SYST E M -S P E C I F I C I M M O B I L I TY CO M P L I C AT I O N S & E V I D E N C E - B A S E D
INTERVENTIONS
INSTITUTION School of Nursing COURSE CODE NURS-FUND-IMMOBILITY
PROGRAM Nursing — ADN / BSN Pathway ACADEMIC YEAR
EXAM TITLE Immobility Complications & Quality Care TOTAL QUESTIONS 60+ Comprehensive Questions
COURSE TITLE Nursing Fundamentals FORMAT Multiple Choice / Definition / Select All
That Apply
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless otherwise indicated.
▸ Questions cover pressure injury staging, system-specific immobility complications (musculoskeletal, cardiovascular, respiratory,
GI, GU, psychological), evidence-based interventions, and quality improvement concepts.
▸ Verified answers with detailed rationales are provided for comprehensive exam preparation.
▸ Pay close attention to the differences between pressure injury stages and the specific nursing interventions for each immobility
complication.
PRESSURE INJURIES, IMMOBILITY INTERVENTIONS & QUALITY CARE Questions 1 – 60+
1. What happens to skin and tissue under prolonged pressure, and which areas are most susceptible?
A. Skin thickens and becomes more resistant; the palms and soles are most susceptible.
B. Prolonged pressure compresses skin/tissue, restricting blood and lymph flow; bony prominences (occiput, scapulae,
elbows, sacrum, ischium, heels) are most susceptible.
C. Pressure stimulates circulation; all areas are equally at risk.
D. Only patients with diabetes develop pressure injuries.
CORRECT ANSWER B — Pressure compresses tissue, restricting blood/lymph flow; bony prominences are most
susceptible
RATIONALE Pressure injury pathophysiology: External pressure exceeding capillary closing pressure (approximately 32
mmHg) compresses soft tissue between a bony prominence and an external surface. This occludes blood
flow, causing tissue ischemia. If pressure is unrelieved for >2 hours, irreversible tissue damage begins.
Lymphatic flow is also compromised, impairing waste removal. The most susceptible areas are bony
prominences with minimal subcutaneous tissue: occiput (back of head), scapulae (shoulder blades), elbows,
sacrum/coccyx (highest risk), ischial tuberosities (sitting), greater trochanters (side-lying), and heels.
Additional risk factors: moisture (incontinence, perspiration, wound drainage), friction/shear forces,
malnutrition (especially low protein/albumin), and impaired sensation (neuropathy, spinal cord injury).
, 2. Match the pressure injury stage to its description: Damage with skin intact.
A. Stage 1 — persistent redness/discoloration, temperature difference, firmness; intact skin.
B. Stage 2 — open blister, shallow pink/red wound bed.
C. Stage 3 — full-thickness with visible adipose tissue.
D. Stage 4 — exposed muscle, ligaments, or bone.
CORRECT ANSWER A — Stage 1: intact skin with non-blanchable redness, temperature change, and firmness
RATIONALE Stage 1 pressure injury: INTACT skin with non-blanchable erythema (does not turn white when pressed). In
darker skin tones, may appear as persistent red, blue, or purple discoloration different from surrounding skin.
The area may be warmer or cooler than adjacent tissue, and may feel firmer or softer. This is a REVERSIBLE
stage if pressure is relieved. Key nursing actions: offload pressure completely, protect from moisture, reassess
frequently. Note: blanchable redness (reactive hyperemia) is NOT a pressure injury — it indicates intact
circulation responding to pressure.
3. Match the pressure injury stage to its description: Damage into the skin layer.
A. Stage 1 — intact skin with discoloration.
B. Stage 2 — partial-thickness loss; lighter skin tone, open or intact blister, shallow pink/red wound bed without slough
or bruising.
C. Stage 3 — visible adipose tissue.
D. Deep tissue injury — purple/maroon discolored intact skin.
CORRECT ANSWER B — Stage 2: partial-thickness skin loss with exposed dermis; blister (intact or ruptured); pink/red
moist wound bed
RATIONALE Stage 2 pressure injury: Partial-thickness loss of skin with exposed dermis. The wound bed is viable, pink or
red, and moist. May present as an intact or ruptured serum-filled blister. Adipose (fat) and deeper tissues are
NOT visible. No slough (yellow/tan dead tissue) or eschar (black necrotic tissue). No bruising (bruising
indicates deep tissue injury, not Stage 2). Granulation tissue, slough, and eschar are NOT present in Stage 2.
Treatment: moist wound healing environment, offload pressure, protect from moisture and shear. These
wounds can heal relatively quickly with proper care.
4. What are the psychological effects of decreased mobility?
A. Improved self-esteem from rest.
B. Increased dependence on others, loss of privacy, inability to participate in work/hobbies, negatively impacting self-
concept, self-esteem, leading to frustration, anxiety, depression, and social isolation.
C. No psychological effects — only physical effects occur.
D. Euphoria from reduced activity demands.
CORRECT ANSWER B — Dependence, loss of privacy, inability to work/engage in hobbies → decreased self-
concept/esteem → frustration, anxiety, depression, social isolation
RATIONALE Immobility profoundly affects psychological well-being. Loss of independence creates dependence on others
for basic ADLs, threatening dignity and privacy. Inability to work threatens financial security and professional
identity. Abandonment of hobbies and social activities leads to isolation and loss of meaning/purpose. These
losses negatively impact self-concept and self-esteem, triggering frustration, anxiety, and depression. Social
isolation compounds these effects — reduced interaction with family, friends, and community removes
critical emotional support systems. Nursing interventions: encourage participation in self-care to the fullest
extent possible, facilitate communication (phone, video calls, visitors), provide meaningful activities within
physical limitations, screen for depression, and involve mental health professionals when indicated.
