Chapter 13: Support Surfaces and Special Beds

Perry et al.: Clinical Nursing Skills & Techniques, 9th Edition

MULTIPLE CHOICE

1. The patient is admitted to the unit with a stage 3 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 3 and stage 4 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
wheelchair dependent, as well as those who are at risk for developing pressure ulcers.
Nonpowered air-filled mattress is recommended for patients who are able to reposition
themselves.

DIF: Cognitive Level: Analysis REF: Text reference: p. 324

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 nurse’s 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. 324

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 patient’s 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. 323

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
patient’s 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. 330

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 reduces shear
and friction and so is 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 manufacturer’s 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. 326-327

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 4 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 3 or stage 4 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 4 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 4 ulcers.

DIF: Cognitive Level: Analysis REF: Text reference: p. 324

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. 324

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 patient’s 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. 333

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-Fowler’s 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 bed’s 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. 335

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 patient’s 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 patient’s condition allows). The nurse should increase, not decrease, the
patient’s 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. 327

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 pounds 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. 326|Text reference: p. 333
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 pounds. However, when using a
full- or double-wide bariatric bed, you must assemble it in the patient’s 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. 334

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. 334

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 light-headedness.
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 light-headedness 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. 324|Text reference: p. 334
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,
and shear) and intrinsic (e.g., malnutrition, loss of sensation, impaired mobility, aging skin,
impaired mental status, infection, incontinence, and low arteriolar pressure). Turning every
2 hours is a measure to prevent ulcer formation, not a factor that contributes to it.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 322

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 patient’s nutritional status.
c. assessment of the patient’s mobility status.
d. assessment of the patient’s 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 patient’s nutritional, fluid, mobility, and continence
status.

DIF: Cognitive Level: Application REF: Text reference: p. 325

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 patient’s fluid and electrolyte status
 b. The patient’s 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. 327|Text reference: p. 333
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. 322

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. 322

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. 323

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. 327

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 patient’s 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 patient’s weight on air-filled cushions.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 332

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 pounds; 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. 337

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 pounds.

ANS:
bariatric bed

A full or double-wide bariatric bed can accommodate a patient up to 1000 pounds. However,
when using a full or double-wide bariatric bed, you must assemble it in the patient’s 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. 333

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 low-air-loss 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. 324

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. 334
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

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. 334

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