CNA Wound Care and Skin Integrity 1 — Questions and Answers

Question 1: What is the PRIMARY cause of pressure injuries (pressure ulcers)?

Exposure to moisture from incontinence
Prolonged pressure that restricts blood flow to skin (Correct answer)
Friction from bed linens
Poor nutritional intake

Correct answer: Prolonged pressure that restricts blood flow to skin

Pressure injuries are caused by sustained pressure that reduces or cuts off blood supply to the skin and underlying tissue, leading to ischemia and tissue death.

Question 2: Which bony prominence is at the HIGHEST risk for pressure injury development?

Kneecap
Sacrum and coccyx (Correct answer)
Shoulder blade
Elbow

Correct answer: Sacrum and coccyx

The sacrum and coccyx (tailbone area) are the most common sites for pressure injuries because they bear substantial weight when a person lies in bed or sits.

Question 3: A Stage 1 pressure injury appears as:

An open wound with visible bone
Non-blanchable redness of intact skin (Correct answer)
A blister filled with fluid
A shallow open crater

Correct answer: Non-blanchable redness of intact skin

A Stage 1 pressure injury is characterized by non-blanchable erythema (redness that does not turn white when pressed) on intact skin, indicating early tissue damage.

Question 4: What does 'blanchable' redness mean?

The skin turns white when pressure is applied, then returns to red (Correct answer)
The skin remains red regardless of pressure
The skin breaks open when touched
The area is infected

Correct answer: The skin turns white when pressure is applied, then returns to red

Blanchable redness temporarily turns white when pressure is applied and returns to red when released, indicating intact capillary blood flow. Non-blanchable redness suggests pressure injury.

Question 5: Which of the following is a risk factor for pressure injury development?

High protein diet
Frequent repositioning
Urinary incontinence (Correct answer)
Regular ambulation

Correct answer: Urinary incontinence

Urinary incontinence exposes the skin to moisture and ammonia, which break down skin integrity and increase the risk of pressure injuries.

Question 6: How often should a bedbound resident be repositioned to prevent pressure injuries?

Every 15 minutes
Every 30 minutes
At least every 2 hours (Correct answer)
Once every 8-hour shift

Correct answer: At least every 2 hours

Current guidelines recommend repositioning bedbound residents at least every 2 hours (or more frequently as determined by care plan) to relieve pressure and restore blood flow.

Question 7: The 30-degree lateral tilt position for pressure injury prevention is preferred over 90-degree because:

It is easier for the CNA to accomplish
It reduces pressure on the trochanter (hip bone) (Correct answer)
It allows the resident to sleep more comfortably
It prevents aspiration

Correct answer: It reduces pressure on the trochanter (hip bone)

A 30-degree lateral tilt distributes body weight over a larger surface area and avoids direct pressure on the trochanter, reducing pressure injury risk compared to a full 90-degree side-lying position.

Question 8: When should the CNA perform skin inspection?

Only when the resident complains of pain
During each repositioning and bathing (Correct answer)
Once per week during scheduled assessments
Only when a wound is already visible

Correct answer: During each repositioning and bathing

Skin should be inspected with each repositioning and during bathing/personal care to detect early signs of breakdown before a full pressure injury develops.

Question 9: A CNA notices redness on a resident's heel that does not turn white when pressed. What should the CNA do?

Apply lotion and recheck in 24 hours without notifying anyone
Report the finding to the nurse immediately and document it (Correct answer)
Massage the area vigorously to increase circulation
Cover with a bandage and monitor

Correct answer: Report the finding to the nurse immediately and document it

Non-blanchable redness is a Stage 1 pressure injury and must be reported to the nurse immediately so that a care plan can be initiated to prevent further deterioration.

Question 10: Why should the CNA AVOID massaging reddened bony prominences?

It is outside the CNA's scope of practice
Massage can further damage fragile capillaries and worsen tissue injury (Correct answer)
It makes the resident uncomfortable
It spreads infection to surrounding tissue

Correct answer: Massage can further damage fragile capillaries and worsen tissue injury

Massaging reddened bony prominences was once thought to increase circulation, but current evidence shows it damages fragile capillaries in already-compromised tissue and should be avoided.

Question 11: Which type of wound dressing helps maintain a moist wound environment?

Dry gauze changed every hour
Hydrocolloid or foam dressing (Correct answer)
Open air exposure without any dressing
Dry absorbent pad

Correct answer: Hydrocolloid or foam dressing

Moist wound healing is the standard of care. Hydrocolloid, foam, and hydrogel dressings maintain a moist environment that promotes cell migration and faster healing.

Question 12: Signs of wound infection include:

Pink edges, minimal exudate, no odor
Increased redness, warmth, swelling, purulent drainage, and odor (Correct answer)
Gradual closure with granulation tissue
Decreased pain over time

Correct answer: Increased redness, warmth, swelling, purulent drainage, and odor

Classic signs of wound infection are redness, warmth, swelling, pain, purulent (pus-like) drainage, and malodor. These must be reported to the nurse immediately.

Question 13: When the CNA observes a wound during peri-care, they should:

Change the wound dressing independently
Document observations and report to the nurse (Correct answer)
Apply antibiotic cream from the supply cart
Leave the wound uncovered for air drying

Correct answer: Document observations and report to the nurse

CNAs do not independently change wound dressings or apply medications. They should observe, document findings accurately, and report changes to the nurse.

Question 14: What is the purpose of a heel protector boot for a bedbound resident?

To keep the feet warm
To elevate the heel off the mattress surface and prevent pressure injury (Correct answer)
To improve circulation to the foot
To prevent foot drop

Correct answer: To elevate the heel off the mattress surface and prevent pressure injury

Heel protector boots (or floated heels using pillows) completely offload pressure from the heel, which is one of the most common sites for pressure injuries in bedbound patients.

Question 15: Moisture-associated skin damage (MASD) is BEST prevented by:

Applying powder to wet skin
Keeping skin clean and dry, using moisture barriers (Correct answer)
Increasing the frequency of bathing with soap
Leaving soiled linens in place until the next scheduled change

Correct answer: Keeping skin clean and dry, using moisture barriers

MASD is prevented by promptly cleansing skin after incontinence, thoroughly drying it, and applying barrier creams or ointments to protect against continued moisture exposure.

Question 16: When repositioning a resident to prevent skin shear, the CNA should:

Drag the resident across the sheet
Use a draw sheet or slide board to lift rather than drag (Correct answer)
Tilt the head of the bed to maximum elevation
Ask the resident to push with their feet

Correct answer: Use a draw sheet or slide board to lift rather than drag

Shear injury occurs when the skin moves in one direction while underlying tissue moves in another. Using lift sheets, transfer belts, or slide boards prevents dragging and reduces shear.

Question 17: Which nutritional deficiency most directly impairs wound healing?

Vitamin C and protein deficiency (Correct answer)
Calcium deficiency
Iron deficiency only
Excessive vitamin D

Correct answer: Vitamin C and protein deficiency

Protein is essential for tissue synthesis and repair, and Vitamin C is required for collagen formation. Deficiencies in either significantly impair wound healing.

Question 18: A resident has a Stage 2 pressure injury. What does this look like?

Intact skin with non-blanchable redness
Partial-thickness skin loss, possibly a shallow open ulcer or blister (Correct answer)
Full-thickness loss with visible fat
Full-thickness loss with visible bone

Correct answer: Partial-thickness skin loss, possibly a shallow open ulcer or blister

Stage 2 involves partial-thickness loss of dermis, presenting as a shallow open ulcer with a pink-red wound bed, or an intact or ruptured blister.

Question 19: Unstageable pressure injuries are characterized by:

Non-blanchable redness on intact skin
Full-thickness loss covered by slough or eschar that obscures depth (Correct answer)
Partial-thickness blistering
Deep tissue injury with purple discoloration

Correct answer: Full-thickness loss covered by slough or eschar that obscures depth

An unstageable pressure injury has full-thickness skin and tissue loss but the wound bed is covered by slough or eschar, making it impossible to determine the true depth and stage.

Question 20: A resident's skin tears easily during routine care. The BEST approach is to:

Use tape directly on the skin to secure dressings
Handle skin gently, use non-adhesive dressings, and pad protruding areas (Correct answer)
Bathe more frequently to toughen the skin
Avoid touching the fragile areas completely

Correct answer: Handle skin gently, use non-adhesive dressings, and pad protruding areas

Fragile skin requires gentle handling, non-adhesive or silicone-based dressings, and padding of bony areas to prevent skin tears during transfers and repositioning.

Question 21: When documenting a wound, the CNA should include:

Their own opinion of the wound stage and treatment plan
Size, location, drainage color/amount, surrounding skin condition, and odor (Correct answer)
Only the size of the wound
A photograph without written notes

Correct answer: Size, location, drainage color/amount, surrounding skin condition, and odor

Accurate wound documentation includes location, size (length, width, depth if applicable), drainage characteristics (color, amount, odor), and the condition of surrounding skin.

Question 22: What does granulation tissue look like and indicate?

Yellow, slippery tissue indicating necrosis
Red, bumpy, moist tissue indicating healthy wound healing (Correct answer)
Black, hard tissue indicating eschar
White, flat tissue indicating scarring

Correct answer: Red, bumpy, moist tissue indicating healthy wound healing

Granulation tissue is red-pink, moist, and has a granular or bumpy texture. Its presence indicates active wound healing with new capillary and connective tissue formation.

Question 23: Eschar in a wound bed is described as:

New skin growing across the wound
Hard, black/brown necrotic (dead) tissue (Correct answer)
Yellow, soft sloughing tissue
Healthy granulation tissue

Correct answer: Hard, black/brown necrotic (dead) tissue

Eschar is hard, dry, leathery, black or brown tissue composed of dead cells. It must be assessed by the nurse; stable eschar on heels may sometimes be left intact per clinical judgment.

Question 24: Slough in a wound is BEST described as:

Bright red tissue with new blood vessels
Yellow, tan, or grey soft, moist necrotic tissue (Correct answer)
Brown dry eschar
Normal skin pigmentation

Correct answer: Yellow, tan, or grey soft, moist necrotic tissue

Slough is soft, moist, yellow or tan stringy/clumpy tissue composed of dead cells and fibrin. Like eschar, it impairs healing and requires debridement ordered and performed by the nurse or provider.

Question 25: The use of an alternating pressure mattress is intended to:

Improve the resident's sleep quality
Cyclically redistribute pressure to prevent pressure injury (Correct answer)
Elevate the resident's legs
Provide cooling during fever

Correct answer: Cyclically redistribute pressure to prevent pressure injury

Alternating pressure mattresses inflate and deflate air cells in a cycle, constantly changing the pressure distribution under the patient to reduce prolonged pressure on any single area.

Question 26: When a skin tear occurs during personal care, the CNA should:

Apply tape across the wound edges and continue care
Stop, apply gentle pressure if bleeding, and report to the nurse immediately (Correct answer)
Clean with hydrogen peroxide and cover with a regular bandage
Ignore minor tears and document at shift change

Correct answer: Stop, apply gentle pressure if bleeding, and report to the nurse immediately

Skin tears should be gently cleaned, pressure applied if bleeding, and the nurse notified immediately. Hydrogen peroxide is cytotoxic and harmful to wound healing; tape should not be placed on fragile skin.

Question 27: Which position BEST prevents pressure on the sacrum for a bedbound resident?

Supine (flat on back)
High Fowler's position (60–90 degrees)
30-degree lateral tilt or prone position per care plan (Correct answer)
Trendelenburg position

Correct answer: 30-degree lateral tilt or prone position per care plan

Lateral tilting and prone positioning (when appropriate) offload sacral pressure. The supine and high Fowler's positions place maximum pressure on the sacrum/coccyx.

Question 28: Which of the following is an extrinsic risk factor for pressure injuries?

Malnutrition
Advanced age
Friction and shear from movement (Correct answer)
Peripheral vascular disease

Correct answer: Friction and shear from movement

Extrinsic (external) factors such as pressure, friction, shear, and moisture act directly on the skin from the outside. Malnutrition, age, and vascular disease are intrinsic (internal) factors.

Question 29: What is the Braden Scale used for?

Measuring wound size
Assessing a resident's risk for developing pressure injuries (Correct answer)
Staging an existing pressure injury
Measuring pain levels

Correct answer: Assessing a resident's risk for developing pressure injuries

The Braden Scale is a validated risk-assessment tool that evaluates six factors (sensory perception, moisture, activity, mobility, nutrition, friction/shear) to predict pressure injury risk.

Question 30: When applying lotion to a resident's skin during care, the CNA should:

Apply lotion between the toes to keep them moisturized
Apply lotion to dry areas but avoid between toes and open skin (Correct answer)
Rub lotion vigorously into reddened pressure areas
Apply lotion only if ordered by the physician

Correct answer: Apply lotion to dry areas but avoid between toes and open skin

Lotion should be applied to dry skin to maintain moisture but avoided between the toes (excess moisture promotes fungal infection) and over broken or open skin areas.

Question 31: A full-thickness pressure injury that reveals subcutaneous fat but no bone or tendon is classified as:

Stage 1
Stage 2
Stage 3 (Correct answer)
Stage 4

Correct answer: Stage 3

Stage 3 pressure injuries involve full-thickness skin loss with visible subcutaneous fat but no exposed bone, tendon, or muscle. Depth may vary by anatomical location.

Question 32: A pressure injury with exposed bone, tendon, or muscle is classified as:

Unstageable
Stage 4 (Correct answer)
Stage 3
Deep tissue pressure injury

Correct answer: Stage 4

Stage 4 pressure injuries involve full-thickness tissue loss with exposed bone, cartilage, or muscle. They carry a high risk of osteomyelitis (bone infection).

Question 33: What does 'tunneling' in a wound mean?

The wound is healing from the outside in
A channel or passageway that extends from the wound into surrounding tissue (Correct answer)
The wound has multiple layers of dead tissue
The wound is draining excessively

Correct answer: A channel or passageway that extends from the wound into surrounding tissue

Tunneling refers to a channel or passageway extending from the wound surface into surrounding tissue. It must be measured and reported, as it complicates healing and may hide infection.

Question 34: How should the CNA handle a wound during a dressing change (if within scope of practice per facility policy)?

Use clean gloves only and bare hands to hold dressing in place
Use sterile technique with sterile gloves and sterile supplies as required (Correct answer)
Use the same gloves worn during personal care
Apply dressing without gloves for better feel

Correct answer: Use sterile technique with sterile gloves and sterile supplies as required

Wound care typically requires sterile or at minimum clean technique depending on wound type and facility policy, always with appropriate gloves to prevent infection.

Question 35: Which of the following BEST describes the role of the CNA in wound care?

Independently staging, treating, and documenting all wounds
Observing, reporting changes, assisting with dressing changes per nurse direction, and preventing new wounds (Correct answer)
Prescribing appropriate dressing types
Performing wound debridement as needed

Correct answer: Observing, reporting changes, assisting with dressing changes per nurse direction, and preventing new wounds

CNAs observe and report wound changes, assist the nurse with dressing changes, maintain clean and dry skin, and implement repositioning schedules to prevent new pressure injuries.

CNA Wound Care and Skin Integrity 1

What is the PRIMARY cause of pressure injuries (pressure ulcers)?

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