NPTE-PT Integumentary System and Wounds 5 — Questions and Answers
Question 1: A patient has a full-thickness wound on the sacrum measuring 4 cm × 3 cm × 2 cm deep. The wound is 80% granulation tissue and 20% slough. Which dressing combination is most appropriate?
- Hydrocolloid wafer only
- Alginate rope to fill dead space and a foam secondary dressing (Correct answer)
- Dry gauze packed tightly into the wound cavity
- Transparent film dressing only
Correct answer: Alginate rope to fill dead space and a foam secondary dressing
Deep wounds require a filler dressing (alginate rope) to manage exudate and eliminate dead space, with a secondary foam dressing to absorb drainage.
Question 2: Which of the following is a cardinal sign differentiating infected cellulitis from a deep vein thrombosis (DVT) in a patient with a lower extremity wound?
- Localized warmth and erythema only
- Fever, ascending red streaks (lymphangitis), and purulent wound drainage (Correct answer)
- Pitting edema with a positive Homans' sign
- Calf pain with dorsiflexion and normal skin temperature
Correct answer: Fever, ascending red streaks (lymphangitis), and purulent wound drainage
Lymphangitis (ascending red streaks), fever, and purulent drainage are signs of spreading wound infection/cellulitis rather than DVT.
Question 3: A PT is applying pulsed lavage with suction to a wound. Which situation would be a contraindication to this intervention?
- Wound with moderate exudate and fibrinous slough
- Exposed blood vessels, nerves, or anastomotic sites within the wound (Correct answer)
- Clean granulating wound in the proliferative phase
- Wound on the lower leg of a patient with venous insufficiency
Correct answer: Exposed blood vessels, nerves, or anastomotic sites within the wound
Pulsed lavage is contraindicated over exposed vital structures such as blood vessels, nerves, tendons, or surgical anastomoses due to the risk of damage.
Question 4: Which skin condition is characterized by a chronic autoimmune blistering disorder primarily affecting skin folds and mucous membranes in older adults?
- Psoriasis vulgaris
- Pemphigus vulgaris (Correct answer)
- Contact dermatitis
- Eczema herpeticum
Correct answer: Pemphigus vulgaris
Pemphigus vulgaris is an autoimmune blistering disease affecting mucous membranes and skin in older adults, caused by antibodies against desmogleins.
Question 5: A patient with a diabetic foot ulcer is classified as Wagner Grade 3. What does this indicate?
- Superficial ulcer without penetration to deeper structures
- Deep ulcer penetrating to tendon, capsule, or joint
- Deep ulcer with osteomyelitis or joint sepsis (Correct answer)
- Gangrene limited to the forefoot
Correct answer: Deep ulcer with osteomyelitis or joint sepsis
Wagner Grade 3 indicates a deep ulcer complicated by osteomyelitis, abscess formation, or septic arthritis, requiring aggressive medical management.
Question 6: A PT is evaluating the periwound skin and observes maceration. Which of the following is the most likely cause?
- Wound drying out due to inadequate moisture
- Excessive wound exudate saturating the periwound skin (Correct answer)
- Arterial insufficiency reducing skin perfusion
- Radiation damage to the epidermis
Correct answer: Excessive wound exudate saturating the periwound skin
Maceration is caused by excessive moisture (typically from heavy wound exudate) that softens and breaks down periwound skin, making it white, soft, and friable.
Question 7: Which factor most significantly impairs wound healing in a patient who is malnourished?
- Increased inflammatory cytokine production
- Impaired collagen synthesis due to inadequate protein and vitamin C (Correct answer)
- Excessive platelet aggregation at the wound site
- Accelerated keratinocyte migration across the wound surface
Correct answer: Impaired collagen synthesis due to inadequate protein and vitamin C
Protein deficiency impairs collagen synthesis, and vitamin C deficiency (a cofactor for proline hydroxylation) further weakens collagen crosslinking, delaying healing.
NPTE-PT Integumentary System and Wounds 5
A patient has a full-thickness wound on the sacrum measuring 4 cm × 3 cm × 2 cm deep.
The wound is 80% granulation tissue and 20% slough.
Which dressing combination is most appropriate?