Free NPTE-PT Test Integumentary System and Wounds Questions and Answers — Questions and Answers
Question 1: A physical therapist is assessing a wound on a patient's sacrum. The evaluation reveals full-thickness tissue loss, but the base of the wound is completely obscured by adherent yellow slough and a patch of black eschar. According to the National Pressure Injury Advisory Panel (NPIAP) staging system, what is the correct stage for this pressure injury?
- Stage 3
- Stage 4
- Deep Tissue Injury
- Unstageable (Correct answer)
Correct answer: Unstageable
According to the NPIAP staging system, a pressure injury is classified as Unstageable when the extent of tissue damage cannot be confirmed because it is obscured by slough or eschar. If the slough or eschar were to be removed, the wound would be revealed as either a Stage 3 or Stage 4 pressure injury. Staging cannot be performed until the base of the wound is visible.
Question 2: A patient presents with a shallow ulcer on the medial aspect of the lower leg, superior to the malleolus. The surrounding skin exhibits a brownish discoloration (hemosiderin staining) and significant pitting edema. The wound has irregular borders and is producing a moderate amount of serous drainage. These clinical findings are MOST consistent with which type of ulcer?
- Arterial insufficiency ulcer
- Neuropathic ulcer
- Venous insufficiency ulcer (Correct answer)
- Pressure injury
Correct answer: Venous insufficiency ulcer
The classic presentation of a venous insufficiency ulcer includes a location on the medial lower leg (gaiter area), irregular borders, hemosiderin staining due to chronic fluid leakage, and significant edema. Arterial ulcers are typically located on the toes or lateral malleolus and have a 'punched-out' appearance. Neuropathic ulcers are found on weight-bearing surfaces of the foot, and pressure injuries occur over bony prominences.
Question 3: A physical therapist is selecting a dressing for a wound on a patient's heel that has a large amount of thick, purulent exudate and requires packing. Which of the following dressing categories would be the MOST appropriate primary dressing choice to manage this wound?
- Hydrogel sheet
- Calcium alginate rope (Correct answer)
- Transparent film
- Hydrocolloid wafer
Correct answer: Calcium alginate rope
Calcium alginate dressings are highly absorbent and are ideal for wounds with moderate to heavy exudate. The rope form is specifically designed for packing deep or tunneling wounds. Hydrogels are used to add moisture to dry wounds, while transparent films and hydrocolloids are indicated for wounds with minimal to moderate drainage and are not suitable for packing or heavy exudate.
Question 4: A patient sustained a burn from spilling hot coffee on their forearm. The area is bright red, moist, and has several intact blisters. The patient reports significant pain, and the area blanches with pressure. Based on these findings, how should the physical therapist classify this burn?
- Superficial burn
- Superficial partial-thickness burn (Correct answer)
- Deep partial-thickness burn
- Full-thickness burn
Correct answer: Superficial partial-thickness burn
A superficial partial-thickness burn (second-degree) involves the epidermis and the upper dermis. Its key characteristics include intact blisters, a moist and weeping appearance, significant pain, and blanching with pressure. A superficial burn would be red without blisters. A deep partial-thickness burn is often mottled white or red, may not have blisters, and has less pain due to nerve damage. A full-thickness burn appears leathery or charred and is insensate.
Question 5: A physical therapist is treating a patient with a wound in the proliferative phase of healing. Which of the following clinical findings is MOST characteristic of this specific phase?
- Hemostasis and influx of neutrophils
- Reorganization of collagen fibers and scar maturation
- Formation of granulation tissue and angiogenesis (Correct answer)
- Vasoconstriction and platelet aggregation
Correct answer: Formation of granulation tissue and angiogenesis
The proliferative phase, which follows the inflammatory phase, is characterized by the rebuilding of the wound. Key processes include the formation of granulation tissue (a mix of new collagen, blood vessels, and fibroblasts) and angiogenesis (the development of new blood vessels) to nourish the new tissue. Hemostasis, vasoconstriction, and neutrophil influx occur in the initial hemostasis and inflammatory phases. Collagen reorganization and scar maturation define the final remodeling phase.
Question 6: A physical therapist is managing care for an elderly patient with severe peripheral arterial disease. The patient has a dry, black, non-tender, and firmly adherent eschar covering the entire plantar surface of the heel without any signs of drainage or inflammation. Which of the following interventions is the MOST appropriate?
- Apply a hydrogel to soften the eschar for debridement.
- Initiate sharp debridement to remove the necrotic tissue.
- Protect the heel and leave the stable eschar intact. (Correct answer)
- Use wet-to-dry dressings to facilitate mechanical debridement.
Correct answer: Protect the heel and leave the stable eschar intact.
In a patient with an ischemic limb, a stable (dry, adherent, intact) eschar serves as the body's natural biologic cover and protects the underlying tissue from infection. Debriding this eschar without adequate blood flow to support healing would create an open wound that is highly susceptible to infection and gangrene. The standard of care is to protect the area, offload pressure, and monitor for signs of infection (e.g., drainage, erythema, fluctuance).
Free NPTE-PT Test Integumentary System and Wounds Questions and Answers
A physical therapist is assessing a wound on a patient's sacrum.
The evaluation reveals full-thickness tissue loss, but the base of the wound is completely obscured by adherent yellow slough and a patch of black eschar.
According to the National Pressure Injury Advisory Panel (NPIAP) staging system, what is the correct stage for this pressure injury?