The nurse is assessing a client with a stage 3 pressure ulcer. Which finding is consistent with this type of pressure ulcer?

  1. Eschar is present on at least part of the wound.
  2. Full-thickness skin loss is present with undermining.
  3. Partial-thickness skin loss of the epidermis is present.
  4. The area is red and does not blanch with external pressure.
Number 2 is correct.
Rationale: Eschar on at least part of the wound indicates a stage 4 wound. Partial-thickness skin loss is found in stage 2 wounds. Areas that are red and do not blanch with external pressure are stage 1 wounds.