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A Client Has a Pressure Injury on the Medial Malleolus

Question 19

Multiple Choice

A client has a pressure injury on the medial malleolus. The client's skin is intact with purple discoloration and a blood-filled blister. When documenting this finding, which terminology is appropriate for the nurse to use?


A) Partial-thickness loss of dermis
B) Nonblanchable erythema
C) Suspected deep tissue injury
D) Full-thickness tissue loss

Correct Answer:

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