Chapter 12: Support Surfaces and Special Beds Nursing School Test Banks

MULTIPLE CHOICE

1. The patient is admitted to the unit with a stage III pressure ulcer. When the different types of support surfaces are compared, which would be most therapeutic for this patient?

a.

Foam mattress

b.

Gel overlay

c.

Air-fluidized bed

d.

Air mattress

ANS: C

Air-fluidized beds are recommended for use for patients with stage III and stage IV pressure ulcers. Foam support surfaces are recommended to reduce the risk of the patient developing pressure ulcers. Gel overlay support surfaces are recommended for patients who are wheel chair dependent, as well as those who are at risk for developing pressure ulcers. Nonpowered air-filled mattress are recommended for patients who are able to reposition themselves.

DIF: Cognitive Level: Analysis REF: Text reference: p. 275

OBJ: Identify the different types of support surfaces and specialty beds used for pressure redistribution. TOP: Pressure Ulcers

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. What is the most important factor in preventing and treating pressure ulcers?

a.

Proper use of foam or air mattresses

b.

Proper utilization of an air-fluidized bed

c.

Frequent repositioning of the patient

d.

Proper use of a low-air-loss bed

ANS: C

Frequent repositioning, which temporarily relieves pressure, is the backbone of preventive protocols. It is the nurses responsibility to use appropriate turning schedules for patients in bed or on a chair. No bed or mattress totally eliminates the need for competent nursing care.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 274

OBJ: Explain why preventive nursing care is still essential when support surfaces and specialty beds are used. TOP: Repositioning

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

3. What is the primary purpose for the use of a support surface?

a.

To reduce pressure

b.

To promote patient comfort

c.

To increase circulation

d.

To facilitate patient movement

ANS: A

Support surfaces aid in reducing pressure on the patients skin. Promoting patient comfort may happen, but it is not the primary purpose of the support mattress. A support mattress does not increase patient circulation, nor does it facilitate patient movement.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 274

OBJ: Describe guidelines to follow when placing patients on support surfaces and specialty beds.

TOP: Patient Assessment KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

4. When working with a patient who is being placed on an air mattress/overlay, the nurse should:

a.

apply the preinflated overlay over the standard mattress.

b.

bring any plastic strips or flaps around the corners of the bed mattress.

c.

administer an analgesic after the patient is moved onto the mattress.

d.

keep clamps or pins attached to the sheets to keep them in place over the mattress.

ANS: B

When preparing an air mattress/overlay, bring any plastic strips or flaps around the corners of the bed mattress. This secures the air mattress in place. Apply a deflated mattress flat over the surface of the bed mattress. The decision to administer analgesic would be based on the patients condition rather than on the procedure. Pins and other sharps should not be used, to avoid puncturing an air mattress.

DIF: Cognitive Level: Application REF: Text reference: p. 281

OBJ: Describe guidelines to follow when placing patients on support surfaces and specialty beds.

TOP: Air Mattress/Overlay KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

5. The patient requires a support surface to help prevent pressure ulcers. He has a large open wound on his leg that is dressed daily. The nurse must choose which support surface would be most appropriate. What does the nurse realize when comparing the different types of support surfaces?

a.

Water mattresses are better for patients with open wounds.

b.

Air surface beds cannot be used if the patient needs CPR.

c.

Water mattresses make it hard to regulate patient body temperature.

d.

Air mattresses reduce shear and friction.

ANS: D

Water mattresses are no longer used regularly because they harbor organisms in the water; leaks in the mattress are risky for patients with open wounds; and the structural integrity of the building does not always support the weight of the mattress. Air mattress reduce shear and friction and so are a good choice for this patient. Air surface beds are equipped with a cardiopulmonary resuscitation (CPR) switch to instantly lower the head section from an elevated position and to deflate the mattress to provide a firm surface for chest compressions. Follow the manufacturers directions regarding the temperature of the water. Proper water temperature prevents loss of body heat as the patient lies on the mattress.

DIF: Cognitive Level: Analysis REF: Text reference: p. 275

OBJ: Describe guidelines to follow when placing patients on support surfaces and specialty beds.

TOP: Comparison of Support Surfaces KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

6. The patient is admitted with a large stage IV pressure ulcer on his coccyx. After comparing the benefits of the following support surfaces, the nurse would choose which of the following as most appropriate for this patient?

a.

Water mattress

b.

Gel overlay

c.

Foam overlay

d.

Air-fluidized bed

ANS: D

If a patient has large stage III or stage IV pressure ulcers on multiple turning surfaces, a low-air-loss bed or air-fluidized bed may be indicated. The use of water mattresses has been reduced considerably because they harbor organisms in the water, and leaks in the mattress are risky for patients with open wounds. Gel overlays are used for moderate- to high-risk patients, not for patients who have stage IV ulcers. They are useful for patients who are wheelchair dependent. Foam overlays are used for moderate- to high-risk patients, not for those with stage IV ulcers.

DIF: Cognitive Level: Analysis REF: Text reference: p. 275

OBJ: Describe correct placement of a patient on an air-fluidized bed, an air-suspension bed, a bariatric bed, a Rotokinetic bed, or a support surface mattress. TOP: Air-Fluidized Beds

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

7. An air-suspension bed is contraindicated for the patient with:

a.

burns.

b.

traction.

c.

osteoporosis.

d.

respiratory insufficiency.

ANS: B

Changes in pressure and position from an air-suspension bed are contraindicated for patients with an unstable spine or traction who must remain in alignment. An air-suspension bed is not contraindicated for patients with burns, osteoporosis, and respiratory insufficiency.

DIF: Cognitive Level: Application REF: Text reference: p. 276

OBJ: Describe correct placement of a patient on an air-fluidized bed, an air-suspension bed, a bariatric bed, a Rotokinetic bed, or a support surface mattress. TOP: Air-Suspension Beds

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

8. Of the following problems that may occur with the use of an air-fluidized bed, which is of greatest concern to the nurse?

a.

Nausea

b.

Anxiety

c.

Slight disorientation

d.

Insensible fluid loss

ANS: D

Diaphoresis often goes undetected, and thus insensible fluid loss is not always evident until a patient develops fluid and electrolyte imbalances. This individual often is already compromised in relation to hydration, fluids, and electrolytes; therefore, the nurse needs to carefully monitor the patients fluid balance status. Some nausea, disorientation, and anxiety can occur, but they are not as critical as insensible fluid loss.

DIF: Cognitive Level: Evaluation REF: Text reference: p. 275

OBJ: Describe correct placement of a patient on an air-fluidized bed, an air-suspension bed, a bariatric bed, a Rotokinetic bed, or a support surface mattress. TOP: Air-Fluidized Beds

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

9. The nurse is caring for a patient who is in an air-fluidized bed. She places the patient in semi-Fowlers position using foam wedges, even though she realizes that:

a.

patients gain the greatest benefit from the prone position in an air-fluidized bed.

b.

for resuscitation, she may have to increase the air pressure of the bed to do CPR.

c.

she may have to increase the air pressure of the bed to turn the patient.

d.

the foam wedges may decrease the effects of the bed.

ANS: D

Although the use of foam wedges as needed is recommended (e.g., elevating the head of the patient for position changes), areas supported by the foam wedges do not benefit from pressure relief of the beds surface. Do not position a patient in a prone (face-down) position on an air-fluidized bed. Suffocation may occur. In emergencies when resuscitation is required, press the CPR switch and unplug the unit to defluidize the bed immediately. To turn patients, position bedpans, or perform other therapies, stop fluidization. Once the procedure is complete, set to continuous fluidization. Stopping fluidization provides firm, molded support that facilitates turning and handling of the patient. Continuous fluidization provides permanent fluid support.

DIF: Cognitive Level: Application REF: Text reference: p. 286

OBJ: Describe correct placement of a patient on an air-fluidized bed, an air-suspension bed, a bariatric bed, a Rotokinetic bed, or a support surface mattress. TOP: Use of Foam Wedges

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

10. A patient is on bed rest after sustaining injuries in a car accident. Which nursing action helps prevent complications of immobility?

a.

Decreasing fluid intake to ease dependent edema

b.

Turning the patient every 2 hours and providing a low-air-loss mattress

c.

Raising the head of the bed to maximize the patients lung inflation

d.

Bathing and feeding the patient to decrease energy expenditure

ANS: B

To avoid pressure ulcers in an immobilized patient, the nurse must assess the skin thoroughly and use such preventive measures as regular turning, a low-air-loss mattress, and a trapeze (if the patients condition allows). The nurse should increase, not decrease, the patients fluid intake to help prevent renal calculi, which may result from immobility. To prevent atelectasis, another complication of immobility, having the patient cough, deep-breathe, and use an incentive spirometer would be more effective than raising the head of the bed. Instead of bathing and feeding the patient, the nurse should promote independent self-care activities whenever possible to prepare the patient for a return to the previous health status.

DIF: Cognitive Level: Analysis REF: Text reference: p. 274|Text reference: p. 277

OBJ: Explain why preventive nursing care is still essential when support surfaces and specialty beds are used. TOP: Use of a Low-Air-Loss Mattress

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

11. After comparing the following support surfaces, the nurse realizes that an extremely obese patient should benefit from the use of a(n):

a.

bariatric bed.

b.

foam mattress.

c.

water mattress.

d.

air-fluidized bed.

ANS: A

A valuable resource in the care of the morbidly obese patient (a person who weighs more than 100 lb above ideal weight) is the bariatric bed, which provides a safe, adaptable surface. The foam or water mattress and the air-fluidized bed are not designed specifically for the obese patient.

DIF: Cognitive Level: Analysis REF: Text reference: p. 275|Text reference: p. 287

OBJ: Describe correct placement of a patient on an air-fluidized bed, an air-suspension bed, a bariatric bed, a Rotokinetic bed, or a support surface mattress. TOP: Bariatric Bed

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

12. Which of the following is a limitation of the bariatric bed?

a.

Lack of an in-bed scale

b.

The narrowness of the bed

c.

Lack of pressure reduction

d.

Increased liability to the institution

ANS: C

A limitation of this bed is the lack of pressure reduction or relief in the mattress. The at-risk obese patient needs to have some type of pressure redistribution mattress placed on the bariatric bed. The bariatric bed possesses an in-bed scale that provides the nurse with a means of obtaining accurate weights and thus improves health care and patient dignity. The bed is slightly wider than a standard hospital bed, yet it is within the guidelines for standard door width, allowing movement into and out of a room without difficulty. A full- or double-wide bariatric bed can accommodate a patient up to 1000 lb. However, when using a full- or double-wide bariatric bed, you must assemble it in the patients room and must not use it for transfers, because this bed is too large to fit through standard hospital doorways. Because the bariatric bed is capable of supporting weights up to 850 pounds, it provides a stable, balanced surface that limits hospital liability should the standard bed frame collapse or the electric motor burn out.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 287

OBJ: Describe correct placement of a patient on an air-fluidized bed, an air-suspension bed, a bariatric bed, a Rotokinetic bed, or a support surface mattress. TOP: Bariatric Bed

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

13. After comparing the benefits of the following support surfaces, the nurse realizes that a patient with multiple trauma and/or spinal cord injury is expected to be placed on a(n):

a.

Rotokinetic bed.

b.

bariatric bed.

c.

flotation mattress.

d.

air-fluidized mattress.

ANS: A

The Rotokinetic bed provides skeletal alignment and constant rotation and is used for patients with multiple trauma and spinal cord injury. Use of the bariatric bed is contraindicated in patients with spinal cord injury. Flotation mattresses and air-fluidized mattresses are contraindicated for patients with an unstable spine.

DIF: Cognitive Level: Analysis REF: Text reference: p. 289

OBJ: Describe correct placement of a patient on an air-fluidized bed, an air-suspension bed, a bariatric bed, a Rotokinetic bed, or a support surface mattress. TOP: Rotokinetic Bed

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

14. When teaching about the use of the Rotokinetic bed, the nurse informs the patient that the:

a.

bed will be stopped in one position most of the time.

b.

amount of rotation will be greater in the beginning.

c.

patient may experience a sensation of falling or lightheadedness.

d.

bed is moved manually all of the time and will rotate head over feet.

ANS: C

Inform the patient that there will be a sensation of lightheadedness or falling. However, reassure the patient that he or she will not fall because the pads will prevent this and are checked by two people to ensure proper placement. It is recommended that the Rotokinetic bed stay in rotation mode for 20 hours a day. The bed rotates constantly when set on rotation mode. The Rotokinetic bed rotates automatically from side to side.

DIF: Cognitive Level: Application REF: Text reference: p. 276|Text reference: p. 289

OBJ: Describe correct placement of a patient on an air-fluidized bed, an air-suspension bed, a bariatric bed, a Rotokinetic bed, or a support surface mattress. TOP: Rotokinetic Bed

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

1. Factors that contribute to pressure ulcer formation include which of the following? (Select all that apply.)

a.

Friction

b.

Shear

c.

Turning every 2 hours

d.

Malnutrition

e.

Impaired mobility

ANS: A, B, D, E

Factors that contribute to pressure ulcer formation are both extrinsic (e.g., moisture, friction, shear) and intrinsic (e.g., malnutrition, loss of sensation, impaired mobility, aging skin, impaired mental status, infection, incontinence, low arteriolar pressure).

DIF: Cognitive Level: Comprehension REF: Text reference: p. 273

OBJ: Explain why preventive nursing care is still essential when support surfaces and specialty beds are used. TOP: Risk Factors for Pressure Ulcers

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. The patient is admitted to the hospital. Part of the patient assessment will include: (Select all that apply.)

a.

Use of an appropriate pressure ulcer risk scale

b.

Assessment of the patients nutritional status

c.

Assessment of the patients mobility status

d.

Assessment of the patients fluid status

ANS: A, B, C, D

A complete patient assessment includes the use of appropriate pressure ulcer risk scales, the presence of shear and friction, and the patients nutritional, fluid, mobility, and continence status.

DIF: Cognitive Level: Application REF: Text reference: p. 274|Text reference: p. 276

OBJ: Describe guidelines to follow when placing patients on support surfaces and specialty beds.

TOP: Patient Assessment KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

3. Air-fluidized beds require the nurse to assess for which of the following? (Select all that apply.)

a.

The patients fluid and electrolyte status

b.

The patients financial status

c.

The structural strength of the room where the bed will be

d.

The room temperature

ANS: A, B, C, D

Air-fluidized beds provide continuous circulation of warm, dry air, which may increase patient risk for dehydration. The bed also may increase room temperature, making it uncomfortable for the patient and possibly leading to overheating of the equipment. Another concern is that the bed is heavy and expensive. Unless the patient has a physician order, third-party payment may not be available.

DIF: Cognitive Level: Application REF: Text reference: p. 275|Text reference: p. 283

OBJ: Describe correct placement of a patient on an air-fluidized bed, an air-suspension bed, a bariatric bed, a Rotokinetic bed, or a support surface mattress. TOP: Air-Fluidized Beds

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

COMPLETION

1. ____________ are defined as localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.

ANS:

Pressure ulcers

The National Pressure Ulcer Advisory Panel defines pressure ulcers as localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 273

OBJ: Explain why preventive nursing care is still essential when support surfaces and specialty beds are used. TOP: Pressure Ulcers

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. The major cause of pressure ulcers is ________________.

ANS:

unrelieved pressure

The major cause of pressure ulcers is unrelieved pressure. The greater the pressure and the longer the pressure is applied, the greater the likelihood that a pressure ulcer will develop.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 273

OBJ: Explain why preventive nursing care is still essential when support surfaces and specialty beds are used. TOP: Pressure Ulcers

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

3. The nurse understands that an _____________________using foam, air, water, or gel can be placed on top of the mattress to provide pressure relief.

ANS:

overlay

Support surfaces are categorized as mattress (or wheelchair) overlays, mattress replacements, or specialty beds. An overlay rests on top of the hospital mattress and uses foam, air, water, gel, or combinations of these products to provide pressure relief.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 278

OBJ: Compare and contrast mattress overlays and mattress replacements.

TOP: Overlays KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

4. A ______________ serves as an artificial layer of fat to protect bony surfaces.

ANS:

flotation pad

A flotation pad is made of a silicone or polyvinyl chloride gel enclosed in a vinyl-covered square. The pad serves as an artificial layer of fat to protect bony surfaces such as the sacrum and the greater trochanters. These flotation pads are available for the bed or for wheelchair patients.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 278

OBJ: Compare and contrast mattress overlays and mattress replacements.

TOP: Flotation Pads KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

5. _________________ beds are for patients who are immobile or otherwise are confined to the bed; they support a patients weight on air-filled cushions.

ANS:

Air-suspension

Air-suspension beds are for patients who are immobile or otherwise are confined to the bed. The air-suspension bed supports a patients weight on air-filled cushions.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 283

OBJ: Describe correct placement of a patient on an air-fluidized bed, an air-suspension bed, a bariatric bed, a Rotokinetic bed, or a support surface mattress. TOP: Air-Suspension Beds

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

6. The patient will be going home but still requires an air-fluidized bed. Before discharge, it will be necessary for the company that is leasing the bed to inspect the home for accessibility and ________________.

ANS:

structural support

Beds weigh between 1700 and 2100 lb; therefore the company that is leasing the bed needs to inspect the home for accessibility and structural support.

DIF: Cognitive Level: Application REF: Text reference: p. 287

OBJ: Describe correct placement of a patient on an air-fluidized bed, an air-suspension bed, a bariatric bed, a Rotokinetic bed, or a support surface mattress. TOP: Home Care Considerations

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

7. A full or double-wide_____________ can accommodate a patient up to 1000 lb.

ANS:

bariatric bed

A full or double-wide bariatric bed can accommodate a patient up to 1000 lb. However, when using a full or double-wide bariatric bed, you must assemble it in the patients room and must not use it for transfers, because this bed is too large to fit through standard hospital doorways.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 287

OBJ: Describe correct placement of a patient on an air-fluidized bed, an air-suspension bed, a bariatric bed, a Rotokinetic bed, or a support surface mattress. TOP: Bariatric Bed

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

8. Use of the bariatric bed is contraindicated in patients with ___________________.

ANS:

spinal cord injury

Use of this bed is contraindicated in patients with spinal cord injury.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 288

OBJ: Describe correct placement of a patient on an air-fluidized bed, an air-suspension bed, a bariatric bed, a Rotokinetic bed, or a support surface mattress. TOP: Bariatric Bed

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

9. The _______________ bed rotates and improves skeletal alignment with constant side-to-side rotation up to 90 degrees.

ANS:

Rotokinetic

This bed improves skeletal alignment with constant side-to-side rotation up to 90 degrees.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 289

OBJ: Describe correct placement of a patient on an air-fluidized bed, an air-suspension bed, a bariatric bed, a Rotokinetic bed, or a support surface mattress. TOP: Rotokinetic Bed

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

10. It is recommended that the Rotokinetic bed stay in the rotation mode for at least _______ hours a day.

ANS:

20

twenty

It is recommended that the Rotokinetic bed stay in the rotation mode for at least 20 hours a day.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 289

OBJ: Describe correct placement of a patient on an air-fluidized bed, an air-suspension bed, a bariatric bed, a Rotokinetic bed, or a support surface mattress. TOP: Rotokinetic Bed

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

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