Wound Management Principles and Practices, 4th Edition Test Bank

Type:

Test Bank

Resource:

Wound Management Principles and Practices

Edition:

4th Edition

Author(s):

Betsy A. Myers

Exam Name___________________________________

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

1) Cells that can be found in the dermis are: A) fibroblasts.

C) Merkel cells.

1) B) Langerhans cells.

D) melanocytes.

2) All of the following are functions of the dermis EXCEPT: A) Assists with thermoregulation.

B) Assists with vitamin D production.

C) Provides sensation.

D) Houses epidermal appendages.

2)

3) The stratum corneum can be found in the: A) fascia.

C) epidermis.

3) B) adipose tissue.

D) dermis.

4) A full-thickness wound involves the following tissue layers: A) epidermis, dermis, and subcutaneous tissue.

B) epidermis.

C) dermis and subcutaneous tissue.

D) subcutaneous tissue.

4)

5) A stage 2 pressure injury can also be described as a ________ lesion.

A) superficial thickness B) partial-thickness C) full-thickness D) Wagner grade 4

5)

6) An abrasion most commonly involves: A) the epidermis, dermis, and subcutaneous tissue.

B) the epidermis.

C) the epidermis and dermis.

D) fascia but not adipose tissue.

6)

7) A callus is caused by a build-up of cells within the stratum basale.

A) True.

B) False.

7)

8) The number of melanocytes determines an individual's skin color.

A) True.

B) False.

8)

9) Mast cells produce the following substance: A) keratin.

B) sebum.

9) C) collagen.

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D) histamine.

10) Sudoriferous glands are present everywhere EXCEPT: A) the feet.

B) the lips.

C) the hands.

D) the hands and feet.

10)

11) Which of the following is true regarding hair follicles?

A) They are present everywhere except the palms and soles.

B) They assist with infection control.

C) They are composed of hard collagen.

D) They are located in the subcutaneous tissue.

11)

12) When examining a patient's wound, you notice regularly arranged white fibrous tissue. What do

12)

you suspect this structure is?

A) Bone.

B) Muscle.

C) Joint capsule.

D) Tendon.

13) When examining a patient's wound, you notice gray-black, dry, leathery-appearing, irregular

13)

fibrous tissue. What do you suspect this structure is?

A) Healthy tendon.

B) Nonviable joint capsule.

C) Healthy muscle.

D) Nonviable bone.

14) When examining a patient's pressure injury, you are able to identify the patient's greater

14)

trochanter within the wound bed. How would you classify the extent of wound involvement?

A) Full-thickness.

B) Partial-thickness.

C) Superficial.

D) Unable to determine from the information provided.

15) When examining a patient's wound, you notice regularly arranged red tissue. What do you suspect this structure is?

A) Bone.

B) Tendon.

C) Muscle.

15)

D) Joint capsule.

16) A blister occurs: A) between the stratum basale and the stratum corneum.

B) between the papillary and reticular dermis.

C) at the junction between the dermis and subcutaneous tissue.

D) at the junction between the epidermis and dermis.

16)

17) The subcutaneous tissue consists of: A) keratin and adipose tissue.

C) sudoriferous and sebaceous glands.

17) B) the epidermis and dermis.

D) adipose tissue and fascia.

ESSAY. Write your answer in the space provided or on a separate sheet of paper.

18) List five functions of the epidermis.

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19) List three functions of the dermis.

20) What is the function of the basement membrane?

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Answer Key Testname: UNTITLED2

1) A 2) B 3) C 4) A 5) B 6) B 7) B 8) B 9) D 10) B 11) A 12) D 13) B 14) A 15) C 16) D 17) D 18) Correct answers should include five of the following possible choices:

• Provides a physical and chemical barrier.

• Regulates fluid.

• Provides light touch sensation.

• Assists with thermoregulation.

• Assists with excretion.

• Assists with endogenous vitamin D production.

• Contributes to cosmesis.

19) Correct answers should include three of the following possible choices: • Supports and nourishes the epidermis.

• Houses epidermal appendages.

• Assists with thermoregulation.

• Provides sensation.

20) Correct answers should include the following key points: • Serves as a scaffolding for the epidermis.

• Selective filter for substances moving between the epidermis and dermis.

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Exam Name___________________________________

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

1) The cell responsible for building new granulation tissue is: A) mast cell.

B) angioblast.

C) fibroblast.

2) Cells involved in epithelialization are: A) Merkel cells.

B) keratinocytes.

1) D) keratinocyte.

2)

C) melanocytes.

D) dermoblasts.

3) Cells which can kill bacteria are: A) macrophages and polymorphonuclear neutrophils.

B) macrophages, mast cells, and polymorphonuclear neutrophils.

C) platelets, polymorphonuclear macrophages, and Meissner's cells.

D) keratinocytes, platelets, and macrophages.

3)

4) To assist with managing a wound that is hypogranular: A) apply silicone gel sheeting to the wound bed.

B) lightly fill the wound base with gauze to prevent premature epithelialization.

C) apply silver nitrate to the hypogranular areas.

D) use a more absorptive dressing.

4)

5) Chronic wounds contain: A) high levels of MMPs and high levels of TIMPs. B) low levels of MMPs and low levels of TIMPs. C) high levels of MMPs and low levels of TIMPs. D) low levels of MMPs and high levels of TIMPs.

5)

6) Surgical wound dehiscence is most often due to: A) insufficient collagen tensile strength.

C) infection.

6) B) poor surgical technique.

D) contracture formation.

7) A severely contaminated wound should be allowed to close by: A) stitches but not staples.

B) secondary wound closure.

C) primary wound closure.

D) staples but not stitches.

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7)

8) Which of the following statements regarding integrins is true?

A) Integrins produce vascular endothelial growth factor to assist with angiogenesis.

B) Integrins are a temporary lattice work of vascularized connective tissue that forms during

8)

9) The maximum strength that a scar tissue can attain after the occurrence of remodeling is: A) 80% of original tissue strength.

B) 150% of original tissue strength.

C) 100% of original tissue strength.

D) 50% of original tissue strength.

9)

10) The maturation and remodeling phase of wound healing typically lasts for: A) six months to two years.

B) two to five days.

C) 24-72 hours.

D) two to five months.

10)

the proliferative phase of wound healing.

C) Integrins are cell surface receptors that allow cells to reversibly bind to the extracellular matrix to achieve cell migration.

D) Integrins are specialized fibroblasts that assist with wound contraction.

ESSAY. Write your answer in the space provided or on a separate sheet of paper.

11) Name the three phases of wound healing in the order in which they occur.

12) Name the four main components of the proliferative phase of wound healing.

13) Explain the difference between transudate and exudate.

14) What role does histamine play in the inflammatory process?

15) Name three key cells of the inflammatory phase of wound healing.

16) Using clinical terms, define a scab.

17) Compare and contrast hypogranulation and hypergranulation.

18) Describe the role of matrix metalloproteases (MMPs) in wound healing.

19) Describe three ways chronic wounds are different from acute wounds.

20) Explain why moist, clean wounds heal faster than wounds with nonviable tissue.

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Answer Key Testname: UNTITLED3

1) C 2) B 3) A 4) B 5) C 6) A 7) B 8) C 9) A 10) A 11) Inflammation, Proliferation, Maturation and Remodeling 12) Angiogenesis, granulation tissue formation, wound contraction, epithelialization.

13) Due to the increase in inflammatory cells and mediators, exudate contains more proteins and, therefore, is more

viscous than transudate.

14) Correct answers should include the following key points: • Histamine is released by mast cells during the inflammatory phase of wound healing.

• Histamine causes increased vessel wall permeability and short-term vasodilation.

15) Correct answers should contain three of the four key cells listed: • Platelets.

• Polymorphonuclear neutrophils (PMNs).

• Macrophages.

• Mast cells.

16) Correct answers should include the following information: • A scab is a collection of necrotic cells, fibrin, collagen, and platelets.

17) Both are types of abnormal wound healing. A hypogranular wound appears as a pot hole type wound, whereas a hypergranular wound is when the granulation tissue is excessive and extends above the surface of the surrounding epithelium.

18) MMPs are proteases that degrade the debris formed during the inflammatory phase.

19) The correct answer should contain three of the following key points: • Chronic wounds contain higher levels of MMPs and lower levels of TIMPs than acute wounds.

• Chronic wounds contain senescent cells.

• Chronic wounds have greater numbers of inflammatory cells.

• Chronic wounds do not respond to growth factors.

• Chronic wounds generally have an underlying pathophysiology, such as venous insufficiency.

20) The correct answer should include the following key points: • Epithelial cells cannot migrate over nonviable tissue.

• Increased energy is required to break down debris prior to epithelialization.

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Exam Name___________________________________

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

1) Which of the following general statements about the rate of wound healing is correct?

A) Room temperature wounds heal faster than covered wounds.

B) Partial-thickness wounds heal faster than full-thickness wounds.

C) Time since onset can be used to predict the rate of chronic wound healing.

D) Wounds over boney prominences heal faster than wounds on the face.

1)

2) Which of the following statements is correct?

A) Wounds should heal faster if both the patient and the patient's wound are kept warm.

B) The presence of palpable pulses is an accurate indicator of circulation to a wound.

C) Circulation is controlled by the parasympathetic system.

D) While peripheral vascular disease affects local blood flow to a wound, diabetes does not.

2)

3) Which of the following best completes the statement? Surgical wounds ________.

A) heal at the same rate as traumatic wounds B) heal slower than traumatic wounds C) heal faster than traumatic wounds D) require more energy to breakdown necrotic tissue than traumatic wounds

3)

4) Change in wound surface area can be used to predict wound healing.

A) True.

B) False.

4)

5) The optimum wound temperature to maximize the rate of wound healing is: A) 12°C/54°F. B) 30°C/86°F. C) 37°C/98.6°F.

5) D) 20°C/68°F.

6) Covering a wound with a dressing facilitates wound healing because: A) a dry wound progresses through the phases of inflammation more slowly than a moist

6)

wound.

B) a macerated periwound is less fragile than uninvolved skin.

C) A and B. D) None of the above.

7) Which of the following best completes the statement? Wound infection ________.

A) should be suspected if cardinal signs of inflammation are absent B) is defined by the presence of less than or equal to 100 microorganisms per gram of tissue C) impairs wound healing because bacteria compete with body cells for energy and oxygen D) facilitates wound healing by increasing the body's inflammatory response

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7)

8) Which of the following best completes the statement? Serial debridement ________.

A) slows wound healing by introducing foreign material into the wound bed B) slows wound healing by creating an inflammatory response C) facilitates wound healing by improving local circulation D) facilitates wound healing by removing barriers to healing

8)

9) Wound debridement is vital to wound healing and should be completed despite a patient's pain

9)

complaint.

A) True.

B) False.

10) Which of the following factors can affect patient adherence?

A) The task the patient is being requested to perform.

B) The clinician.

C) The patient's previous experiences.

D) All of the above.

10)

11) Which of the following best completes the statement? Wet-to-dry dressings ________.

A) facilitate wound healing by allowing crust formation, which protects the wound bed from

11)

bacteria

B) impair wound healing by traumatizing healthy granulation tissue C) impair wound healing because they are cytotoxic to living cells D) facilitate wound healing by attracting macrophages 12) Antiseptics should routinely be used: A) as whirlpool additives.

B) as surgical scrubs.

C) for wound irrigation.

D) for pressure injuries but not venous insufficiency ulcers.

ESSAY. Write your answer in the space provided or on a separate sheet of paper.

13) Describe three wound characteristics that affect wound healing.

14) Describe three local factors that affect wound healing.

15) Describe three characteristics of senescent cells found in chronic wounds.

16) Describe three systemic factors that can affect wound healing.

17) Describe five age-related changes that may affect wound healing.

18) Contrast the terms adherence and compliance.

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12)

19) Describe how smoking affects wound healing.

20) Explain why the following statement is inaccurate: Lack of sensation is beneficial for patients with open

wounds because it decreases the pain commonly associated with debridement and decreases the need for prescription pain medications.

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Answer Key Testname: UNTITLED4

1) B 2) A 3) C 4) A 5) C 6) A 7) C 8) D 9) B 10) D 11) B 12) B 13) Correct answers should include three of the following:

• Mechanism of onset.

• Time since onset.

• Wound location.

• Wound dimensions.

• Temperature.

• Wound hydration.

• Infection.

• Necrotic tissue or foreign debris.

14) Correct answers should include the following: • Circulation, sensation, and mechanical stress.

15) Correct answers should include three of the following: Cells within chronic wounds • Proliferate at a slower rate.

• Synthesize fewer proteins.

• Do not respond to growth factors or chemical mediators.

• Migrate at a slower pace.

16) Correct answers should include three of the following: • Advanced age.

• Inadequate nutrition.

• Comorbidities.

• Medications, such as steroids and chemotherapy.

• Lifestyle choices.

17) Correct answers should include five of the following key changes: • Impaired macrophage and fibroblast function.

• Decreased collagen synthesis and strength.

• Epidermal and dermal atrophy.

• Decreased vascular responsiveness.

• Decreased inflammatory response.

• Decreased pain perception.

• Decreased sweat and oil gland function leading to dry skin.

• Increased number of co-morbidities.

18) Compliance infers a one-way interaction between patient and clinician in which the patient follows the clinician's instructions because the clinician told him/her to do so. Adherence implies the patient is free to choose to follow or not follow the clinician's recommendations.

4

Answer Key Testname: UNTITLED4

19) The correct answer should include at least two of the following points:

• Smoking causes vasoconstriction.

• Smoking increases platelet aggregation and clot formation.

• Smoking decreases tissue oxygenation.

20) While this information may be correct, lack of sensation is a risk factor for delayed wound healing and for wound formation because the patient is unable to sense trauma and change potentially harmful behaviors as a result.

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Exam Name___________________________________

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

1) Your patient can feel the 6.10 monofilament but not the 4.17 or the 5.07 monofilament. How do

1)

you interpret these findings?

A) The patient has protective sensation but does not have normal light touch sensation.

B) The patient does not have protective sensation.

C) The patient has normal sensation.

D) The patient is not being accurate, because he/she can feel 10 grams of force but not 75 grams.

2) Which of the following statements regarding wound-related pain is correct?

A) Patients with venous insufficiency wounds have less pain when they elevate their involved

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leg than when they are in a dependent position.

B) Patients with arterial insufficiency wounds have less pain when they elevate their involved leg than when they are in a dependent position.

C) Patients with wounds due to diabetes have less pain when they elevate their involved leg

than when they are in a dependent position.

D) All of the above are correct.

3) The appropriate method for measuring the size of a patient's great toe wound is: A) direct wound measurement.

B) wound tracing.

C) total body surface area.

D) A and B.

3)

4) When measuring the size of a wound from a tracing, you should: A) measure the longest length of the tracing and the widest width perpendicular to that length.

B) assign equal value to the number of full and partially full squares within the tracing grid.

C) count the number of full squares within the tracing grid and disregard the partially filled

4)

5) Photographic wound measurement is: A) the gold standard for wound measurement.

B) a nice adjunct for wound measurement.

C) required for reimbursement under Medicare guidelines.

D) A and C.

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squares.

D) measure the longest length of the tracing and the widest horizontal width.

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6) Which of the following best completes the statement? Undermining ________.

A) is an indicator that the wound is in the maturation and remodeling phase of wound healing B) occurs when the tissue under the wound edges becomes eroded C) is also called tunneling D) all of the above

6)

7) Necrotic tissue that is yellow or tan in color and stringy or mucinous in consistency is called: A) slough.

B) eschar.

C) tendon.

D) It is not possible to tell based on this description.

7)

8) Which of the following types of wound drainage would be considered normal?

A) Drainage that is thin in consistency and pale yellow in color.

B) Drainage that is minimal in amount, has a thin consistency, and a green-blue hue.

C) Drainage that is thick in consistency and white in color.

D) None of the above. It is not normal for wounds to drain.

8)

9) Periwound erythema can be: A) a sign of infection.

C) consistent with a full-thickness wound.

9) B) a normal sign of inflammation.

D) A and B.

10) When assessing for periwound edema, your thumb leaves an impression about 2-4 mm in depth

10)

that rebounds in less than 15 seconds. How would you describe your results?

A) The patient has a wound infection.

B) The patient has 2+ pitting edema.

C) The patient's periwound is indurated.

D) The patient has 4+ pitting edema.

11) When palpating your patient's tibialis posterior artery pulse, you feel it is normal. What grade would you assign it?

A) 3/5.

B) 2+.

C) 1+.

12) Normal capillary refill is: A) 3 seconds.

C) 4+.

11)

D) 5/5.

12)

B) greater than 60 mm Hg. D) determined with monofilaments.

13) Which of the following wounds heal by regeneration?

A) Partial-thickness wounds.

B) Superficial thickness wounds.

C) Full-thickness wounds.

D) A and B.

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13)

14) A pressure injury should be classified using: A) the staging system and/or extent of tissue involved.

B) the Wagner system or extent of tissue involved.

C) degree and extent of tissue involved.

D) the Wagner system but not extent of tissue involved.

14)

15) Which of the following statements regarding wound healing prognoses is true?

A) Wounds that have not closed after 4 weeks of care should be managed surgically.

B) If a 60% decrease in wound surface area is not seen in the first two weeks of interventions,

15)

the plan of care should be reassessed.

C) Full-thickness wounds will heal faster than partial-thickness wounds.

D) None of the above is true.

16) Wound-related goals should be: A) generic, time independent, and measurable.

B) generic, time dependent, and measurable.

C) specific, time independent, and measurable.

D) specific, time dependent, and measurable.

16)

ESSAY. Write your answer in the space provided or on a separate sheet of paper.

17) Name three specific allergies you should ask about during your examination of a patient with an open wound.

18) Explain why you should include a screening of the gastrointestinal system in your examination of patients with open wounds.

19) The National Pressure Ulcer Advisory Panel recommends assessment of the urogenital system in all patients with or at risk for pressure ulcers. Explain how you would screen this system.

20) List four wound characteristics that you would assess in your examination of a patient with an open wound.

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Answer Key Testname: UNTITLED5

1) B 2) A 3) D 4) A 5) B 6) B 7) A 8) A 9) D 10) B 11) B 12) A 13) D 14) A 15) D 16) D 17) Latex, sulfa, and adhesives.

18) Screening of the gastrointestinal system is important because inadequate nutrition delays wound healing and

increases the risk of infection.

19) You should ask the patient or caregiver about urinary frequency, difficulty or pain when urinating, and continence.

20) The correct answer should include four of the following wound characteristics: • Wound size.

• The presence of tunneling or undermining.

• Wound bed.

• Wound edges.

• Wound drainage.

• Wound odor.

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Exam Name___________________________________

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

1) Which of the following are contraindications for sharp debridement?

A) Eschar.

B) Uninfected heel ulcers with normal ankle-brachial indices (ABIs).

C) Areas that cannot be adequately visualized.

D) Slough.

1)

2) Which of the following is NOT a purpose for debridement?

A) Shorten the inflammatory phase of wound healing.

B) Decrease wound odor.

C) Decrease the effectiveness of topical antimicrobials.

D) Decrease bacterial concentration within a wound.

2)

3) Using the red-yellow-black system of wound bed description, the treatment goals for a red

3)

wound include all of the following EXCEPT: A) protecting the wound bed.

B) maintaining a warm, moist wound environment.

C) protecting the periwound.

D) debriding the erythematous periwound region.

4) Which of the following statements regarding blisters and calluses is true?

A) Calluses require debridement but blisters should not be debrided.

B) Blisters require debridement but calluses should not be debrided.

C) It is beyond the scope of practice for physical therapists to debride calluses but not blisters.

D) Blisters and calluses should be debrided.

4)

5) Which of the following is NOT a form of mechanical debridement?

A) Whirlpool.

B) Enzymatic debridement.

C) Wound scrubbing.

D) Wet-to-dry dressings.

5)

6) Sharp debridement requires sterile technique the use of sterile instruments, sterile supplies, and

6)

sterile gloves.

A) True.

B) False.

7) Order the following types of debridement from most expedient to slowest.

A) Sharp, autolytic, enzymatic.

B) Sharp, enzymatic, autolytic.

C) Enzymatic, autolytic, sharp.

D) Enzymatic, sharp, autolytic.

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7)

8) Traditional gauze dressings have a higher rate of wound infection than covering a wound with a

8)

9) Which of the following best completes the statement? Wet-to-dry dressings ________.

A) could be used on wounds which are 100% slough covered B) are also known as moisture-retentive dressings C) are the standard of care for patients with open wounds D) A and C

9)

10) Surgical debridement is indicated for all of the following EXCEPT: A) in the presence of osteomyelitis.

B) wounds with extensive undermining and necrosis.

C) when another form of debridement will suffice.

D) wounds with ascending cellulitis.

10)

11) Biologic debridement may assist with wound debridement because: A) maggots protect granulation tissue.

B) the bacteria within the wound digest the maggots leading to bacterial cell wall collapse.

C) larvae produce enzymes that degrade necrotic tissue without harming living tissue.

D) A and B.

11)

12) You choose to use enzymatic debridement to debride your patient's wound. You are not sure if the

12)

13) All of the following substances can be used for enzymatic debridement EXCEPT: A) collagenase.

B) fibrinolysin.

C) proteolytics.

D) lipase.

13)

14) Serial instrumental debridement: A) occurs at the demarcation between viable and nonviable tissue.

B) must be followed by dry dressings for the first 8-24 hours after the procedure.

C) may require the use of hemostatic agents, such as Gelfoam or silver nitrate.

D) occurs over a series of visits.

14)

moisture-retentive dressing and leaving it in place for three to five days.

A) True.

B) False.

enzyme is working. How long should you wait before modifying your treatment plan?

A) Six days.

B) Four weeks.

C) Two weeks.

D) Two days.

ESSAY. Write your answer in the space provided or on a separate sheet of paper.

15) State two contraindications to autolytic debridement.

16) Define nonselective debridement.

17) Give three examples of selective debridement.

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18) Define autolytic debridement.

19) State two precautions or contraindications to enzymatic debridement.

20) State two drawbacks to wound cleansing.

3

Answer Key Testname: UNTITLED6

1) C 2) C 3) D 4) D 5) B 6) B 7) B 8) A 9) A 10) C 11) C 12) C 13) D 14) D 15) Autolytic debridement is contraindicated in infected wounds and when there is an urgent need for sharp/surgical debridement (gangrene).

16) Nonselective debridement is the removal of nonspecific areas of devitalized tissue.

17) The correct answer should contain three of the following selective forms of debridement: • Surgical debridement.

• Sharp debridement.

• Enzymatic debridement.

• Autolytic debridement.

18) Autolytic debridement is the use of a moist, warm wound environment to allow endogenous enzymes to digest necrotic material.

19) The correct answer should include two of the following key points: • Contraindicated with exposed deep tissues, such as tendon, ligament, bone, capsule.

• Contraindicated if sharp debridement is required.

• Precaution or not recommended for facial burns.

• Precaution or not recommended for wounds free of necrotic tissue.

• Precaution or not recommended for use in combination with autolytic debridement.

• The enzyme collagenase should not be used in combination with dressings, topical agents, or solutions containing silver, iodine, acetic acid, or hydrogen peroxide.

20) The correct answer should include two of the following key points: • Wound cleansers contain cytotoxic agents.

• Wound cleansers are a form of nonselective debridement.

• Wound cleansers are not effective debriding anything other than loosely adherent necrotic tissue and debris.

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Exam Name___________________________________

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

1) Order the following in order of increasing wound bioburden.

A) Contamination, colonization, infection.

B) Infection, contamination, colonization.

C) Contamination, infection, colonization.

D) Colonization, contamination, infection.

1)

2) All of the following increase the risk of infection EXCEPT: A) presence of granulation tissue.

B) ischemia.

C) malnutrition.

D) steroid use.

2)

3) Which of the following is a potential sign of infection?

A) A decline in wound status.

B) Periwound erythema that is proportional to the size and extent of the wound.

C) Lower extremity edema in a patient with congestive heart failure and a pressure injury.

D) All of the above.

3)

4) Which of the following statements about biofilms is true?

A) MRSA, or methicillin-resistant Staphylococcus aureus, is a form of biofilm.

B) Biofilms are likely to develop resistant organisms.

C) Because biofilms respond predictably to antibiotics, they are considered to be beneficial.

D) Biofilms are free-living organisms that reside within body tissues.

4)

5) Which of the following is considered the gold standard for identifying a wound infection?

A) Fluid aspiration.

B) Blood test.

C) Swab culture.

D) Tissue biopsy.

5)

6) Which of the following best completes the statement? Anaerobic bacteria ________.

A) can only survive in an oxygen-rich environment B) are a form of fungi C) are frequently found in wounds that tunnel D) A and B

6)

7) Which of the following organisms would be killed by an antifungal agent?

A) Candida.

B) Streptococcus aureus.

C) Staphylococcus aureus.

D) B and C.

7)

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8) Community-acquired MRSA, methicillin-resistant Staphylococcus aureus, is becoming more

8)

common in all of the following populations EXCEPT: A) individuals who travel frequently to third world countries.

B) athletes in contact sports.

C) military personnel.

D) A and B. 9) Which of the following statements regarding silver is correct?

A) Silver-containing roll-gauzes are effective in combating wound infections even when not

9)

used as the contact layer.

B) Slow-releasing silver agents maintain their antimicrobial properties for up to seven days.

C) Silver dressings cost about the same as traditional dressings.

D) Because resistance to silver is common, its use in wound care is limited.

10) Which of the following best completes the statement? Antiseptic agents ________.

A) are approved by the Food and Drug Administration, FDA, for use on full-thickness

10)

pressure injuries B) can be used to reduce bacterial concentrations on intact skin

C) should be used as the first line of defense to combat wound infections D) include agents such as triple antibiotic and polysporin powder 11) All of the following are examples of topical antimicrobials EXCEPT: A) bacitracin.

B) first-aid cream.

C) gentamicin.

D) silver sulfadiazine cream.

11)

12) Which of the following best completes the statement? Antibiotics ________.

A) should be prescribed routinely to prevent wound infections B) can be ordered by physical therapists but not by physical therapist assistants C) can be administered orally or intravenously D) have minimal and infrequent side effects

12)

13) Debridement can be used to prevent and to treat a wound infection.

A) True.

B) False.

13)

14) Which of the following are effective in preventing wound infections?

A) Keeping wounds covered with dressings.

B) Standard precautions.

C) Hand washing.

D) All of the above.

14)

2

15) Which of the following situations would require the use of sterile technique?

A) Debridement of a partial-thickness burn that measures 4 cm × 5 cm.

B) Bandaging a patient with a large abdominal wound with gauze packing.

C) Performance of a dressing change by a family member in a home care setting.

D) All of the above.

ESSAY. Write your answer in the space provided or on a separate sheet of paper.

16) Describe two ways increasing wound bioburden impedes wound healing.

17) Define an abscess.

18) What is the difference between a bactericidal agent and a bacteriostatic agent?

19) What is meant by the terms resistance and sensitivity?

20) Describe why a whirlpool can be disinfected but not sterilized.

3

15)

Answer Key Testname: UNTITLED7

1) A 2) A 3) A 4) B 5) D 6) C 7) A 8) A 9) B 10) B 11) B 12) C 13) A 14) D 15) B 16) The correct answer should contain two of the following key points:

• Microbes compete with host cells for oxygen and nutrition.

• Bacterial exotoxins are cytotoxic to host cells.

• Bacterial endotoxins activate host inflammatory processes.

• Increasing bioburden can lead to infection, which will delay or impede wound healing.

17) An abscess is a localized collection of pus composed of devitalized tissue, microbes, and white blood cells.

18) A bactericidal agent kills bacteria while a bacteriostatic agent merely inhibits bacterial replication while present.

19) These terms describe whether a certain strain of bacteria can be killed by a specific antimicrobial (sensitive to it) or if the antimicrobial will be ineffective (resistant).

20) The correct answer should define sterilization (a special process that destroys all microbes in an area using chemicals, dry heat, or steam) and disinfection (a process of cleaning a surface with a topical antimicrobial).

4

Exam Name___________________________________

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

1) Order the following dressings from least absorptive to most absorptive.

A) Hydrogel, alginate, semipermeable foam.

B) Hydrocolloid, semipermeable film, alginate.

C) Semipermeable film, semipermeable foam, alginate.

D) Alginate, hydrogel, semipermeable film.

1)

2) All of the following statements are true about maceration EXCEPT: A) Macerated skin is more permeable than regular skin.

B) Macerated skin is more friable than intact skin.

C) Incontinence or excessive perspiration may result in maceration.

D) Maceration does not increase the risk of infection.

2)

3) An occlusive dressing is: A) impermeable to water, vapor, and bacteria.

B) impermeable to urine and bacteria but not to vapor.

C) permeable to urine, vapor, and bacteria.

D) impermeable to bacteria but not to water or vapor.

3)

4) Which of the following best completes the sentence? A secondary dressing ________.

A) is required to maintain a sterile wound bed B) is also called the contact layer C) can provide increased absorption and cushioning D) assists with wound debridement

4)

5) Which of the following best completes the sentence? Moisture-retentive dressings ________.

A) should be changed daily unless an infection is present B) must be occlusive C) are associated with a lower rate of infection than gauze dressings D) all of the above

5)

6) Which of the following dressings is associated with the formation of granulomas?

A) Hydrocolloids.

B) Alginates.

C) Gauze.

D) Composite dressings.

6)

1

7) A telfa dressing would be most appropriate for the following wounds: A) a wound with periwound maceration.

B) an abdominal wound with significant drainage.

C) a full-thickness pressure ulcer with significant necrotic tissue.

D) a surgical incision that has been closed with staples.

7)

8) All of the following are true of impregnated gauzes EXCEPT: A) Bismuth-impregnated gauzes are cytotoxic to inflammatory cells.

B) Hydrogel-impregnated gauzes are contraindicated for use on wounds with exposed

8)

tendons.

C) Iodine-impregnated gauzes are cytotoxic.

D) Bismuth-impregnated gauzes have antimicrobial properties.

9) Which of the following is true regarding hydrogel dressings?

A) Hydrogel dressings should be used with caution on patients with fragile skin because of

9)

their adhesive qualities.

B) Hydrogel dressings not only donate moisture to a wound but can also absorb some wound drainage.

C) Hydrogel dressings are available in sheet and amorphous form.

D) B and C. 10) Which of the following best completes the sentence? Semipermeable foam dressings ________.

A) are ideal for use in high friction areas B) are indicated for use on dry or eschar-covered wounds C) provide thermal insulation D) allow for easy wound bed visualization while in place

10)

11) Hydrocolloid dressings are: A) nonadhesive.

C) associated with hypogranulation.

11) B) permeable to stool and urine.

D) impermeable to water and bacteria.

12) Alginate dressings may be appropriate in each of the following situations EXCEPT: A) in wounds with tunnels.

B) over exposed tendons.

C) in infected wounds.

D) in heavily draining wounds.

12)

13) Which of the following best completes the sentence? Silver dressings ________.

A) are proven to prevent wound infection B) may have limited value because they are available as primary, but not as secondary, wound

13)

dressings C) cost about the same as other moisture-retentive dressings, such as hydrocolloids

D) should not be used in combination with saline

2

14) The key function of a charcoal dressing is: A) to promote autolytic debridement.

C) to prevent tendon desiccation.

14) B) to control wound odor.

D) to absorb wound drainage.

15) Which of the following best completes the sentence? Skin sealants ________.

A) absorb a moderate amount of wound drainage B) protect the periwound from maceration and adhesives C) should be used on uninfected superficial or partial-thickness lacerations that are less than

15)

24 hours old

D) prevent anhydrous skin by minimizing fluid loss through the epidermis 16) Which of the following are examples of growth factors?

A) Becaplermin gel.

B) Colony stimulating factors.

C) Porcine small intestinal submucosa.

D) All of the above.

16)

17) A wound that is draining and necrotic requires: A) antibiotics.

B) a dressing that can stay in place for several days, such as a semipermeable film.

C) debridement and absorption of exudate.

D) debridement and protection of the wound bed.

17)

ESSAY. Write your answer in the space provided or on a separate sheet of paper.

18) Provide four benefits to moist wound healing.

19) List four functions of wound dressings.

20) Describe five factors you should consider when choosing a dressing for a patient with an open wound.

3

Answer Key Testname: UNTITLED8

1) C 2) D 3) A 4) C 5) C 6) C 7) D 8) B 9) D 10) C 11) D 12) B 13) D 14) B 15) B 16) D 17) C 18) The correct answer should include four of the following key points:

• Moist wound healing facilitates all three phases of wound healing.

• Moist wound healing prevents crust formation and thus eliminates the energy required to break down this barrier.

• Moist wound healing facilitates autolytic debridement by trapping endogenous enzymes.

• Moist wound healing preserves endogenous growth factors.

• Moist wound healing reduces patient pain complaint.

• Moist wound healing enhances cell proliferation, migration and collagen synthesis.

19) The correct answer should include four of the following key points: • Create a moist wound environment.

• Provide thermal insulation.

• Provide a barrier to microbes to prevent infection.

• Control edema.

• Eliminate dead space within a wound bed.

• Assist with wound debridement.

20) The correct answer should include five of the following key points: • Amount of wound drainage.

• Condition of wound bed (granular or necrotic).

• Presence of wound infection.

• Skin condition (Can the patient's skin tolerate adhesives?)

• Frequency of dressing changes.

• Availability of wound dressings.

• Cost of dressing.

• Wound location.

4

Exam Name___________________________________

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

1) Which of the following best completes the sentence? Wound irrigation ________.

A) should occur at a pressure of 40-50 psi B) should use saline but not tap water C) can be delivered with pressurized saline canisters D) is contraindicated in a wound with exposed tendons

1)

2) Which of the following best completes the sentence? Whirlpools ________.

A) are a form of selective debridement B) should be reserved for heavily draining wounds C) increase limb volume D) increase bacterial load

2)

3) Which of the following best completes the sentence? Pulsed lavage with suction ________.

A) is contraindicated in tunneling or undermining wounds B) increases limb volume C) promotes granulation tissue formation D) B and C

3)

4) Which of the following best completes the sentence? Electrical stimulation ________.

A) is recommended for acute, necrotic wounds to facilitate debridement B) has a vasoconstrictive effect C) is believed to increase cell proliferation and collagen synthesis D) increases limb volume

4)

5) Ultrasound may be used during the maturation and remodeling phase of wound healing in order

5)

to:

A) combat infection.

C) attract mast cells and macrophages.

B) increase scar mobility.

D) promote granulation tissue formation.

6) Which of the following best completes the sentence? Negative pressure wound therapy ________.

A) is only reimbursable by Medicare if used on chronic wounds B) assists with exudate removal C) uses pressures of 10-15 psi to be effective D) all of the above

1

6)

7) Systemic, or chamber, hyperbaric oxygen therapy: A) is less effective than topical hyperbaric oxygen.

B) promotes debridement of necrotic wounds.

C) is a low cost alternative to electrical stimulation.

D) should be chosen based on the results of a transcutaneous oxygen test.

7)

8) Which of the following modalities has sufficient research demonstrating its efficacy as a first

8)

choice for wound management?

A) Hyperbaric oxygen.

B) Monochromatic infrared energy.

D) Laser.

C) Pulsed lavage with suction.

9) This modality involves the use of helium-neon, gallium-aluminum-arsenide, or

9)

gallium-arsenide to simulate wound healing.

A) Negative pressure wound therapy.

B) Low-intensity laser therapy.

C) MIRE. D) Noncontact normothermic wound therapy.

10) Which of the following ultrasound parameters could be acceptable as an adjunct for scar

10)

management?

A) Continuous, 0.25 W/cm2 .

C) Pulsed, 1.0 MHz.

B) Pulsed, 3.0 MHz. D) Continuous, 1.2 W/cm2.

11) All of the following statements regarding low intensity ultrasound with saline mist are true

11)

EXCEPT: A) This modality may assist with debridement and removal of biofilms.

B) This modality is purported to increase angiogenesis and collagen production.

C) Personal protective equipment required includes gloves, shoe covers, hair cover, and mask with face shield.

D) The ultrasound is delivered at a frequency of 1.0 MHz. 12) Which of the following parameters for electrical stimulation as an adjunct to wound healing are

12)

correct?

A) Intensity of 75-200 Volts, frequency of 80-125 Hz.

B) If infection is suspected, anodal stimulation should be used, at least initially.

C) Intensity of 75-200 Watts, frequency of 1.0 MHz. D) Can be performed topically, in a chamber, or under water.

13) Given the present body of knowledge, which of the following conditions is most likely to benefit from ultraviolet light therapy?

A) Psoriasis and dermatitis.

B) Surgical wounds.

D) None of the above.

C) Wounds due to venous insufficiency.

2

13)

14) All of the following regarding pulsatile lavage are true EXCEPT: A) Pulsatile lavage is no longer safe for use on patients with open wounds, as it was linked to

14)

several severe infections and at least one death.

B) When performing pulsatile lavage, personal protective equipment required includes gloves, shoe covers, hair cover, and mask with face shield.

C) The irrigant solution used with pulsatile lavage should be warmed to 102°F-106°F.

D) Pulsatile lavage can be used on wounds due to trauma, surgery, venous insufficiency, and pressure.

15) Galvanotaxis describes: A) the stimulation of cells to move along an electrical gradient.

B) the current of injury within a wounded area.

C) the way that electrical stimulation debrides nonviable tissue.

D) the way laser therapy enhances granulation tissue formation.

15)

16) All of the following are benefits of whirlpool therapy for patients with open wounds EXCEPT: A) The use of chemical additives is recommended to decrease infection and the risk of

16)

cross-contamination.

B) Irrigation after whirlpool therapy removes four times as many bacteria as whirlpool alone.

C) Whirlpool therapy can soften eschar.

D) Whirlpool therapy can assist with range of motion exercises.

ESSAY. Write your answer in the space provided or on a separate sheet of paper.

17) List three precautions or contraindications to the use of electrical stimulation as an adjunct for wound healing.

18) List three precautions or contraindications to the use of negative pressure wound therapy as an adjunct for wound healing.

19) Describe three advantages of pulsed lavage over whirlpool therapy.

20) Describe three problems with the literature on the use of modalities to enhance wound healing.

3

Answer Key Testname: UNTITLED9

1) C 2) C 3) C 4) C 5) B 6) B 7) D 8) C 9) B 10) D 11) D 12) A 13) A 14) A 15) A 16) A 17) Correct answers should include three of the following key points:

• Contraindicated for use with untreated osteomyelitis.

• Should not be used in combination with topical agents containing heavy metal ions.

• Use caution when applying to patients with sensory neuropathy.

18) Correct answers should include three of the following key points: • Wounds with significant amounts of necrotic tissue.

• Body cavity wounds.

• Untreated osteomyelitis.

• Wounds with exposed blood vessels.

• Use caution with patients on anticoagulants.

19) The correct answer should include three of the following key points: • Pulsed lavage does not require dependent positioning.

• Pulsed lavage is portable and can be used in a home care setting.

• There is a lower risk of cross contamination with pulsed lavage.

• Pulsed lavage can be used to treat individual wounds or parts of wounds rather than an entire extremity.

• Pulsed lavage may be considered less painful than whirlpool.

20) There are many correct answers. Some key points discussed in the chapter include: • Modality parameters are not held constant in different studies and can be a confounding factor.

• Many studies fail to adequately describe wound etiology and characteristics.

• Studies performed on animals do not always have the same results in humans.

• Many studies are performed on acute wounds and the effect on chronic wounds is unknown.

• Many studies are performed on a limited number of patients, giving them low power.

4

Exam Name___________________________________

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

1) A positive nitrogen balance is: A) when more nitrogen is ingested than is excreted.

B) undesirable.

C) suggestive of a vitamin deficiency.

D) a key indicator of normal hydration.

1)

2) How much water per day should healthy individuals without open wounds consume?

A) 30-35 mL/kg of body weight.

B) 600-800 mL per day.

C) Six to eight glasses per day.

D) Two ounces per cm of height.

2)

3) What is the clinical definition of dehydration?

A) When an individual takes in less fluid than he/she urinates.

B) A 10-pound decrease in body weight over less than two weeks.

C) A 10-kg decrease in body weight over a two-week period of time.

D) A 1% decrease in body weight due to fluid loss.

3)

4) All of the following statements about protein are correct EXCEPT: A) Protein deficiency leads to decreased collagen synthesis.

B) A significant amount of protein can be lost through wound drainage.

C) Protein excess causes edema.

D) Protein is required for tissue regeneration and repair.

4)

5) Which of the following best completes the statement? Carbohydrates ________.

A) provide energy for tissue repair and regeneration B) are the building blocks of proteins C) intake should be restricted in patients with open wounds D) are valuable antioxidants

5)

6) Patients with open wounds who are taking corticosteroids long term may benefit from

6)

supplementation with which of the following vitamins?

A) Vitamin B2.

B) Vitamin A. C) Vitamin D.

D) Vitamin C.

7) Patients taking anticoagulants should NOT initiate supplementation with which of the following vitamins?

A) Vitamin C.

B) Vitamin K.

C) Vitamin B1.

1

D) Vitamin A.

7)

8) This vitamin may decrease the inflammatory phase of wound healing and enhance immune function: A) Vitamin E.

B) Vitamin A.

C) Vitamin C.

8)

D) Vitamin K.

9) Which of the following describes clinically significant weight loss?

A) A 20-pound decrease in body weight in one month.

B) A 0.5% decrease in body weight in one week.

C) A 9% decrease in body weight in six months.

D) A 10% decrease in body weight in one month.

9)

10) Your patient has a body mass index of 32. How should you interpret this?

A) The patient is underweight.

B) The patient has a normal weight.

C) The patient is obese.

D) The patient is overweight.

10)

11) Orthostatic hypotension may be a clinical manifestation of: A) dehydration.

B) protein deficiency.

C) vitamin K deficiency.

D) zinc deficiency.

11)

12) What is a normal blood glucose level?

A) >1800 cells/mm3 .

C) 16-40 mg/dL.

12) B) 70-110 mg/dL. D) 3.5-5.5 g/dL.

13) What laboratory test is the best clinical measure for protein deficiency and response to protein supplementation?

A) BUN.

B) Albumin.

C) Creatinine.

13)

D) Prealbumin.

14) What does a total lymphocyte count, TLC, value indicate?

A) TLC is a marker for HIV. B) TLC is an indicator of dehydration.

C) TLC is an indicator of immune function.

D) TLC is a marker for AIDS.

14)

15) Which of the following patients would benefit from total parental nutrition?

A) A patient whose gut is not functioning.

B) A patient at risk for malnutrition.

C) A patient who requires assistance with feeding.

D) A patient who requires encouragement to eat.

15)

ESSAY. Write your answer in the space provided or on a separate sheet of paper.

16) Describe three ways in which fat is vital to wound healing and overall patient health.

17) Describe five physical signs of malnutrition.

18) Define and give the formula for determining the body mass index.

2

19) Describe three components of a nutritional screen in a physical therapy setting.

20) List three keys to a successful interdisciplinary approach to patient care.

3

Answer Key Testname: UNTITLED10

1) A 2) A 3) D 4) C 5) A 6) B 7) B 8) A 9) D 10) C 11) A 12) B 13) D 14) C 15) A 16) The correct answer should include three of the following key points.

• Fat provides energy for cellular processes.

• Fat carries fat-soluble vitamins.

• Fat provides thermal insulation.

• Fat, in the form of free fatty acids, is a vital component of cell membranes.

17) The correct answer should include five of the following key points: • Emaciation.

• Poor dentition.

• Petechiae.

• Transparent skin.

• Pallor.

• Dull or thinning hair.

• Pale eyes.

• Redness or swelling of the mouth or mouth sores.

• Swollen gums that bleed easily.

18) The body mass index is calculated by dividing the patient's weight in kilograms by his/her height in meters squared.

The measure is used to determine if a patient is underweight, normal weight, overweight, or obese.

19) The correct answer should include the following key points: • Assessment for the physical signs of malnutrition.

• Calculation of the patient's BMI, or body mass index.

• Determining recent change in the patient's weight (over the past one week to 6 months).

20) Discipline-specific education, refining procedures, and team training.

4

Exam Name___________________________________

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

1) What percentage of all lower extremity ulcers are believed to be due to arterial insufficiency?

A) 60%.

B) 25%.

C) 5-10%.

D) 80%.

1)

2) Which of the following answers correctly orders the possible progression of symptoms in patients

2)

with progressive arterial insufficiency?

A) Intermittent claudication, rest pain, gangrene.

B) Rest pain, intermittent claudication, gangrene.

C) Gangrene, intermittent claudication, rest pain.

D) Intermittent claudication, gangrene, rest pain.

3) Which of the following statements is correct?

A) High levels of LDLs seem to promote cholesterol deposition.

B) Arterial stenosis decreases resistance to blood flow.

C) Arteriosclerosis is a form of atherosclerosis.

D) Atherosclerosis, if left unchecked, can lead to thinning of the basement membrane.

3)

4) Your patient complains of left calf pain after walking for 10 minutes. You believe the patient may

4)

have an obstruction of the: A) iliofemoral artery.

B) posterior tibial artery.

D) infrapopliteal artery.

C) dorsalis pedis artery.

5) Which of the following statements regarding smoking is true?

A) Smoking slows the atherosclerotic process.

B) Smoking increases wound oxygen tension.

C) Smoking causes vasodilation.

D) Smoking increases the rate of clot formation.

5)

6) Although arterial insufficiency ulcers can occur spontaneously, most are the result of trauma on

6)

an already compromised limb.

A) True.

B) False.

7) Which of the following findings is considered evidence of peripheral arterial disease?

A) Delayed capillary refill.

B) Absence of the dorsalis pedis pulse.

C) Absence of the posterior tibial artery pulse.

D) Absence of the both the dorsalis pedis and posterior tibial artery pulses.

1

7)

8) You are working with a patient with a lower leg wound. The patient's ABI is 0.9. How would you

8)

interpret this?

A) The patient's ABI is normal.

B) The patient likely has diabetes mellitus that is artificially elevating his ABI. C) The patient should have a trial of physical therapy and, if no improvements are found,

should be referred for a surgical consult.

D) The patient should have a vascular consult.

9) What is the minimal decrease in ABI value to indicate a clinically significant progression of peripheral arterial disease?

A) A decrease of 0.01.

9)

B) A decrease of 0.15.

D) A decrease of 1.0.

C) A decrease of 50% or more.

10) Segmental pressure measurements may be superior to an ABI test to identify arterial insufficiency: A) in patients with an ulcer proximal to the ankle.

B) in patients with concomitant venous insufficiency.

C) in patients with diabetes.

D) in patients with toe ulcerations.

10)

11) Which of the following is typical of arterial insufficiency ulcers?

A) Arterial insufficiency ulcers tend to have copious wound drainage.

B) Arterial insufficiency ulcers tend to be irregular or jagged in shape.

C) Arterial insufficiency ulcers tend to have a fibrous or glossy coating over the wound bed.

D) Arterial insufficiency ulcers tend to be located on the distal foot.

11)

12) Why might your patient with an arterial insufficiency ulcer have lower extremity edema?

A) Congestive heart failure.

B) Concomitant venous insufficiency.

C) Prolonged pressure.

D) Both A and B.

12)

13) Which of the following patients should be referred to a vascular surgeon?

13)

1) A patient with an ABI of 1.1.

2) A patient with an ABI of 0.3.

3) A patient with an ABI of 0.8 who has a 20% decrease in wound size in the past two weeks.

4) A patient with an ABI of 0.8 who has a 20% increase in wound size in the past two weeks.

5) A patient with a 0.05 drop with repeat ABI testing.

A) 2 and 4.

B) 1 and 3.

C) 1, 2, 3, 4, and 5.

D) 1, 4, and 5.

14) Tissue oxygen levels greater than ________ are thought to be sufficient for wound healing.

A) 20% B) 50 mm Hg C) 30 mm Hg D) 0.7 mL/kg

2

14)

15) Which of the following statements is correct regarding toe pressures?

A) Values greater than 30 mm Hg are consistent with wound healing.

B) They are a good indicator of macrovascular disease.

C) They have low reliability.

D) Values greater than 0.7 are consistent with wound healing.

15)

16) Which of the following dressings would be most appropriate for a patient with a typical arterial

16)

insufficiency ulcer?

A) An impregnated gauze and gauze pad, secured with an Ace bandage.

B) An alginate, covered by a gauze pad and secured with a gauze roll.

C) A charcoal dressing secured with a gauze roll.

D) An amorphous hydrogel, covered with a gauze pad and secured with a gauze roll.

17) Temporary footwear for patients with arterial insufficiency ulcers should: A) be one size smaller than the patient typically wears, to achieve a snug fit.

B) have pressure relief over the first metatarsal head.

C) have a high toe box.

D) have pronation control.

ESSAY. Write your answer in the space provided or on a separate sheet of paper.

18) List five risk factors that can contribute to arterial insufficiency ulceration.

19) List two wound care precautions for patients with arterial insufficiency ulcers.

20) Describe five benefits of aerobic exercise for patients with arterial insufficiency.

3

17)

Answer Key Testname: UNTITLED11

1) C 2) A 3) A 4) D 5) D 6) A 7) D 8) A 9) B 10) A 11) D 12) D 13) A 14) C 15) A 16) D 17) C 18) The correct answer should include five of the following key points:

• Hyperlipidemia.

• Elevated cholesterol.

• Smoking.

• Diabetes.

• Hypertension.

• Trauma.

• Advanced age.

19) The correct answer should include two of the following key points: • Avoid compression and compression dressings.

• Avoid sharp debridement of dry, eschar-covered, uninfected ulcers in patients with low ABIs. • Gangrene must be surgically debrided.

20) The correct answer should include five of the following key points: Aerobic exercise can assist with: • Increasing symptom-free walking distance.

• Increasing maximum walking distance.

• Weight loss.

• Improving blood sugar control.

• Raising HDL levels.

• Formation of collateral vessels.

4

Exam Name___________________________________

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

1) Venous insufficiency ulcers: A) are the most common type of leg ulcer but rarely recur.

B) are the least common type of leg ulcer but frequently recur.

C) are the least common type of leg ulcer but rarely recur.

D) are the most common type of leg ulcer and frequently recur.

1)

2) Which of the following is true about venous insufficiency ulcers?

A) Lack of appropriate antibiotic coverage is the most common reason for venous insufficiency

2)

ulcer recurrence.

B) Venous insufficiency ulcers are more common in individuals under the age of 65 because these individuals stand more frequently.

C) Venous insufficiency ulcers commonly recur without surgery.

D) Failure to use compression is the most common reason for venous insufficiency ulcer recurrence.

3) The greater and lesser saphenous veins are: A) perforating veins.

C) deep veins.

3) B) fibrin veins.

D) superficial veins.

4) Compared to arteries, veins: A) have bidirectional valves.

B) rely on gravity for venous return.

C) are a low pressure system.

D) have greater muscle content in their walls.

4)

5) Venous insufficiency ulcers are ultimately caused by: A) insufficient numbers of veins.

B) venous hypertension.

C) a hyperactive calf muscle pump.

D) white blood cells.

5)

6) All of the following types of vein dysfunctions can lead to venous insufficiency ulcers EXCEPT: A) atherosclerosis.

B) venous distention.

C) scarring due to a previous blood clot.

D) valve degeneration leading to inability to fully close.

6)

1

7) When should you perform a Homan's test on a patient?

A) If you suspect a venous insufficiency ulcer.

B) If you suspect concomitant arterial insufficiency.

C) If you suspect a deep vein thrombosis.

D) You should not perform this test because it is inaccurate.

7)

8) You should perform an ABI: A) if you want to use compression to manage a patient's wound.

B) to rule out arterial insufficiency.

C) if you suspect a deep vein thrombosis.

D) A and B.

8)

9) Why would you perform a Trendelenburg test?

A) To differentiate between deep/perforating and superficial vein incompetence.

B) To rule out orthostatic hypertension.

C) To identify a deep vein thrombosis.

D) A and B.

9)

10) All of the following are characteristics of a venous insufficiency ulcer EXCEPT: A) irregular shape.

B) dry wound bed.

C) mild to moderate pain.

D) fibrous or glossy coating.

10)

11) Patients with chronic venous insufficiency often have inflammation of the skin associated with

11)

itching and redness also known as: A) cellulitis.

B) dermatitis.

D) pruritus.

C) lipodermatosclerosis.

12) Which of the following is a predictor for expedient chronic venous insufficiency ulcer healing?

A) Concomitant arterial insufficiency.

B) No deep vein involvement.

C) Ulcer present for longer than three months.

D) High body mass index.

12)

13) It is common for patients with chronic venous insufficiency to have allergic reactions or

13)

sensitization.

A) True.

B) False.

14) Given the following dressing choices, which would be the most appropriate for a typical patient with a venous insufficiency ulcer?

A) Oasis.

B) Telfa.

D) Semipermeable foam.

C) Semipermeable film.

2

14)

15) Which of the following is a contraindication to the use of compression therapy for patients with venous insufficiency?

A) An ABI > 0.7.

15)

B) History of a deep vein thrombosis.

D) Pain that is relieved with elevation.

C) Acute infection.

16) When using compression therapy for venous insufficiency ulcer management, the patient should

16)

be instructed to: A) dangle his/her legs frequently to promote blood flow.

B) walk regularly.

C) avoid performing heel or toe raises.

D) all of the above.

17) What level of compression is appropriate for a knee high garment on a patient with moderate venous insufficiency who has no arterial disease?

A) 20-30 mm Hg.

B) 16-20 mm Hg. D) 40-50 mm Hg.

C) 30-40 mm Hg.

ESSAY. Write your answer in the space provided or on a separate sheet of paper.

18) Describe how the respiratory pump works.

19) Define hemosiderin deposition and explain why it is seen in patients with venous insufficiency ulcers.

20) List four types of compression therapy for patients with venous insufficiency ulcers.

3

17)

Answer Key Testname: UNTITLED12

1) D 2) D 3) D 4) C 5) B 6) A 7) D 8) D 9) A 10) B 11) B 12) B 13) A 14) D 15) C 16) B 17) C 18) The correct answer should include the following key points:

• The movement of the diaphragm creates pressure changes within the thorax and abdomen. This produces a pressure gradient that draws venous fluid back toward the heart.

19) The correct answer should include the following key points: • Hemosiderin deposition is a discoloration or darkening of the skin as a result of the breakdown of red blood cells that have been forced into the interstitial space by venous hypertension.

20) The correct answer should include four of the following options: • Paste bandage.

• Short-stretch bandage.

• Multilayer bandage.

• Removable semi-rigid orthotic, such as CircAid. • Tubular bandage.

• Off-the-shelf or custom compression garment.

4

Exam Name___________________________________

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

1) Which of the following are risk factors for pressure injuries?

A) Increased age, cardiovascular disease, and diabetes.

B) Shear, impaired mobility, and excessive moisture.

C) Shear, cardiovascular disease, and decreased range of motion.

D) Malnutrition, decreased range of motion, and maceration.

1)

2) You are examining your patient's skin and notice an area of blanchable erythema over the

2)

posterior heel. This is called: A) a stage II pressure injury.

B) a stage I pressure injury.

D) reactive hyperemia.

C) granulation tissue formation.

3) You are working as a physical therapist in acute care. While reviewing your patient's chart, you

3)

notice her Braden score is 16. How do you interpret this?

A) The patient is malnourished and should have a referral to a nutritionist.

B) The patient should be on a specialized support surface, such as an air-fluidized mattress.

C) The patient is not at risk for pressure injuries.

D) The patient is at mild risk for pressure injuries.

4) You are working as a physical therapist in a skilled nursing facility. While reviewing the patient's

4)

5) Which of the following instructions regarding pressure injury prevention is correct?

A) Patients should be positioned in bed with the head of bed elevated 45 degrees or more.

B) Donut-type devices, such as ring cushions, should not be used.

C) Diapers should be used on incontinent patients on days when staffing is low.

D) When assisting patients with bed mobility, nursing staff should be instructed to slide

5)

6) A pressure injury that presents as a shallow crater or blister should be described as a ________

6)

chart, you notice that his Braden score changed from 19 to 13. You should conclude that the patient was initially not at risk for pressure injuries but now he is.

A) True.

B) False.

patients rather than drag them.

pressure injury.

A) stage 1

B) stage 2

C) stage 3

1

D) stage 4

7) A stage 3 pressure injury would be classified as impaired integumentary integrity associated with: A) superficial skin involvement.

B) full-thickness skin involvement.

C) partial-thickness skin involvement.

D) skin involvement extending into fascia, muscle, or bone.

7)

8) A pressure injury covered with eschar should be classified as a stage 3 pressure injury.

A) True.

B) False.

8)

9) Pressure injuries are most commonly seen in these locations: A) ulnar styloid process, scapulae, iliac crest.

B) ischium, posterior heel, lateral malleolus.

C) posterior calf, sacrum, and occiput.

D) greater trochanter, anterior thigh, medial malleolus.

9)

10) Which of the following is NOT a recommended pressure injury assessment instrument?

A) Pressure ulcer scale for healing (PUSH).

B) Sessing Scale.

C) Pressure sore status tool (PSST).

D) Gosnell scale.

10)

11) If cared for properly, stage 1 pressure injuries generally heal within: A) one to three months.

B) one to three weeks.

C) 8 to 13 weeks.

D) two days.

11)

12) When assessing your patient's sacral pressure injury, you are able to probe to bone but cannot

12)

13) Your patient presents with a stage 3 pressure injury over his right greater trochanter without

13)

visualize the bone. This patient is at risk for osteomyelitis.

A) True.

B) False.

evidence of infection. Which of the following dressings would be most appropriate?

A) A hydrocolloid.

B) A semipermeable film.

C) A four-layer bandage.

D) A gauze pad taped in place.

14) Charcoal-containing wound dressings may be beneficial for patients with pressure injuries because: A) charcoal dressings stay in place better than other dressings.

B) charcoal dressings can assist in odor control.

C) unlike other synthetic dressings, charcoal dressings do not contain cytotoxic agents.

D) unlike other synthetic dressings, charcoal dressings can be used in combination with a moisture barrier.

2

14)

15) Reactive support surfaces should be used for patients: A) who can attain a variety of positions without bearing weight on an existing pressure injury.

B) who have a spinal cord injury.

C) who have a pressure injury that has improved while on a pressure-reducing device.

D) who are independent with bed mobility.

15)

16) What adjunctive modality should be considered if a pressure injury is not improving as expected

16)

after 30 days of standard care?

A) Ultrasound.

B) Electrical stimulation.

D) Low-intensity laser therapy.

C) Pulsed lavage with suction.

17) Antibiotics should be initiated for patients who: A) have sacral wounds due to stool contamination.

B) have stage 2 or 4 pressure injuries.

C) have periwound erythema.

D) have advancing cellulitis.

17)

18) Ideally, pressure injuries with osteomyelitis should be managed with: A) surgical excision of the infected bone and antibiotics.

B) antibiotics and a topical antimicrobial.

C) a topical antimicrobial.

D) a pressure-relieving mattress.

18)

19) Which of the following methods of debridement would be most appropriate for your patient with

19)

a full-thickness eschar-covered pressure injury with signs of infection?

A) Agonist debridement.

B) Enzymatic debridement.

C) Sharp debridement.

D) Mechanical debridement.

20) Undermining and tunneling may be found in these types of pressure injuries: A) stages 4 and 5.

B) stages 2 and 3.

C) stages 1 and 2.

D) stages 3 and 4.

3

20)

Answer Key Testname: UNTITLED13

1) B 2) D 3) D 4) A 5) B 6) B 7) B 8) B 9) B 10) D 11) B 12) A 13) A 14) B 15) A 16) B 17) D 18) A 19) C 20) D

4

Exam Name___________________________________

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

1) Which of the following statements regarding diabetes is FALSE? A) About half of patients with a diabetic foot ulcer who have an amputation will eventually

1)

have a contralateral amputation.

B) Native Americans and Hispanic/Latino Americans are more likely to develop diabetes than non-Hispanic Whites.

C) Type II diabetes is the most common form of diabetes in the United States.

D) The most frequent cause of type I diabetes is a sedentary lifestyle and suboptimal diet.

2) Which of the following are risk factors that can contribute to neuropathic ulceration and delayed

2)

wound healing?

A) Sensory neuropathy, mechanical stress, and euglycemia.

B) Motor neuropathy, impaired immune response, and foot deformities.

C) Peripheral vascular disease, wearing shoes with a high toe box, and poor glycemic control.

D) Use of a total contact cast, a low ABI, and autonomic neuropathy.

3) You perform an ABI on a patient with a neuropathic ulcer and calculate the value as 1.5. How

3)

should you interpret these results?

A) The patient has combined arterial and venous insufficiency.

B) The patient likely has arterial calcification which is artificially inflating the ABI value.

C) You performed the test incorrectly.

D) The patient likely has moderate arterial insufficiency.

4) Protective sensation is defined as the ability to perceive the ________ monofilament but not the ________ monofilament.

A) 5.07/4.17

B) 4.17/5.07

C) 5.07/6.10

4)

D) 4.17/6.10

5) If the diagnosis for your patient is Wagner grade 2 neuropathic ulceration, what depth of tissue is

5)

involved?

A) Partial-thickness.

B) Superficial thickness.

C) Full-thickness.

D) The patient has no open wound but is at risk for ulceration.

6) Which of the following are typical characteristics of a neuropathic ulceration?

A) Plantar foot location, callused rim, and hemosiderin deposition.

B) Callus rim, foot deformities, and minimal drainage.

C) Distal toe location, cracked skin, and low ABI. D) Plantar foot location, hemosiderin deposition, and normal ABI.

1

6)

7) According to the Diabetes Control and Complications Trial and the United Kingdom Prospective

7)

8) For patients with type II diabetes, a 10 to 15 pound weight loss can:

8)

Diabetes study: A) Patients with sustained hyperglycemia are at increased risk of long-term complications of diabetes, such as vascular disease and nephropathy.

B) Patients who improve their blood sugar control can reverse some of the complications of diabetes, such as neuropathy and retinopathy.

C) Patients with sustained hypoglycemia are at increased risk of infection because they have an impaired immune response and are more likely to have gastroparesis.

D) A and B.

1) improve insulin sensitivity 2) improve glycemic control 3) improve serum lipid levels 4) improve blood pressure A) 1 and 2.

B) 2 and 4.

C) 1 and 3.

D) 1, 2, 3, and 4.

9) Your patient with diabetes presents with dry, cracked skin. What is the most likely cause of this?

A) Old age.

B) Autonomic neuropathy.

C) Decreased vision due to retinopathy.

D) Sensory neuropathy.

9)

10) Your patient with diabetes presents with a rocker-bottom foot. This is most likely due to: A) the combination of chronic hypertension and progressive arterial disease.

B) club foot deformity due to poor diabetes control.

C) fractures and/or dislocations causing a Charcot deformity.

D) all of the above.

10)

11) A localized decrease in plantar foot skin temperature is a hallmark of future ulceration or a

11)

current deep space infection.

A) True.

B) False.

12) One of the most important physical therapy interventions for patients with neuropathic ulcerations is: A) maintaining a moist wound environment.

B) offloading.

C) controlling scar formation.

D) compression.

2

12)

13) Total contact casts are appropriate for the following neuropathic ulcers:

13)

1) Wagner grade 1 2) Wagner grade 2 3) Wagner grade 3 4) Wagner grade 4 5) Wagner grade 5 A) 1 and 2.

B) 4 and 5.

C) 3, 4, and 5.

D) All of the above can be treated with a total contact cast as long as there is no infection present.

14) Which of the following may assist with the management of neuropathic pain and paresthesias?

A) Lidocaine.

B) Pentoxifylline.

C) Cilostazol.

D) Capsaicin.

14)

15) Patients with neuropathic ulcerations that contain exposed bone would most benefit from: A) topical antimicrobials.

B) radiological testing for osteomyelitis.

C) an arteriogram.

D) amputation.

15)

16) Physical therapists cannot debride callus around a neuropathic ulceration because it is viable

16)

tissue.

A) True.

B) False.

17) High plantar foot pressures increase the risk of neuropathic ulceration. Plantar foot pressures: A) are typically greater in the midfoot than the rearfoot.

B) can be reduced by providing full contact insoles.

C) are reduced in patients with limited foot mobility.

D) all of the above.

17)

18) Increased blood flow to the bones of the foot in patients with diabetes predisposes them to

18)

fracture due to osteopenia. What causes this increased blood flow?

A) Motor neuropathy.

B) Autonomic neuropathy.

C) Sensory neuropathy.

D) B and C.

ESSAY. Write your answer in the space provided or on a separate sheet of paper.

19) State two precautions when working with patients with neuropathic ulcers.

20) Aside from a total contact cast, describe three other methods to reduce plantar pressures in patients with neuropathic ulcers.

3

Answer Key Testname: UNTITLED14

1) D 2) B 3) B 4) A 5) C 6) B 7) D 8) D 9) B 10) C 11) B 12) B 13) A 14) D 15) B 16) B 17) B 18) B 19) The correct answer should contain two of the following key points:

• Because this patient population may not show the classic signs of infection, beware of silent infections.

• Beware of sensory neuropathy and educate patients in proper foot care guidelines.

• Monitor for signs of hypoglycemia.

20) The correct answer should include three of the following key points: • Limit weight bearing by prescribing an assistive device.

• Instruct the patient in a step-to gait pattern.

• Use a padded ankle-foot orthosis.

• Use a walking shoe with an insole to distribute pressure.

• Use permanent insoles or orthotics.

4

Exam Name___________________________________

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

1) Child abuse is thought to be responsible for ________ of all pediatric burns.

A) 0%-2% B) 2%-5% C) 10%-30% 2) The severity of a thermal burn is dependent upon: A) voltage.

C) contact time.

1) D) 50%-60% 2)

B) chemical concentration.

D) B and C.

3) Most electrical burns are the result of: A) low voltage current.

B) high voltage current.

C) lightning strikes.

D) accidents resulting from a combination of water and electricity.

3)

4) When examining your patient's burn injuries, you notice the involved area is void of blisters, has a

4)

mottled appearance, and is dry and leathery. How would you classify this patient's burn?

A) Deep partial-thickness.

B) Stage 3.

C) Superficial partial-thickness.

D) Full-thickness.

5) Provided the patient has adequate pain control, in what setting are patients with minor burns generally treated?

A) Outpatient.

5)

B) Acute care community hospital.

D) B and C.

C) Specialized burn unit.

6) The zone of stasis is: A) an area of burned tissue that has been damaged beyond repair that will undergo necrosis.

B) an area of burned tissue with cellular injury and compromised perfusion.

C) an area of burned tissue in which venous pooling results in increased edema and stopping

of the healing progression.

D) an area of burned tissue that has sustained only minimal injury and will completely recover.

1

6)

7) You are an acute care physical therapist working in a burn unit. When you look over your

7)

patient's chart, you notice her temperature is 100.6°F/38.1°C. You should conclude: A) The patient has a burn wound infection and you should request a physician consult for antibiotics.

B) The patient's basal metabolic rate is elevated as a result of the burn injury.

C) The patient's burn wound is colonized and you should request an order for a topical

antimicrobial.

D) The patient has a mild respiratory infection and should be monitored closely.

8) Patients with burn wound injuries are at risk for: A) contractures.

C) pressure injuries.

8) B) infection.

D) all of the above.

9) Areas of closed full-thickness burns: A) require compression for at least three years to prevent contracture formation.

B) require compression for at least five years to prevent hypertrophic scarring.

C) require the use of moisturizing lotions because these areas will no longer sweat.

D) A and C.

9)

10) Because their burn wounds involve a greater surface area, adults with burn injuries are more

10)

likely to have contractures than children.

A) True.

B) False.

11) Debridement of burn wounds: A) may require premedication.

C) often requires repeated debridement.

11) B) decreases the risk of infection.

D) all of the above.

12) The prophylactic use of topical antimicrobials on burn wounds: A) is discouraged because it fosters the development of resistant strains of bacteria.

B) is discouraged because of the potential for adverse reactions such as sensitization and

12)

allergic reactions.

C) is encouraged because most burn wounds are infected.

D) is encouraged because this patient population is at a high risk for infection.

13) You are treating a patient with a deep partial-thickness burn wound involving 15% total body

surface area with irrigation, debridement, and hydrogel-impregnated gauze dressings. You notice an increase in erythema, more purulent drainage, and that the previously red granulation tissue is now pale. What is the most logical reason for this occurrence?

A) The zone of coagulation is resolving.

B) You should be less aggressive with your debridement because this is a sign of a hyperactive inflammatory response.

C) The wound is infected.

D) The patient has an allergy to sulfa.

2

13)

14) What dressings can be used to help reduce or prevent scarring of healed, intact, burned skin?

A) A Vaseline-impregnated gauze covered with a gauze pad, secured with elastic netting.

B) Silicone gel sheeting.

C) A semipermeable film.

D) A hydrocolloid.

14)

15) Your patient presents with a full-thickness circumferential ankle burn. What would be the

15)

optimal positioning for this patient?

A) Short sitting with the ankle in neutral dorsiflexion.

B) Supine with a footboard to keep the ankle in neutral dorsiflexion.

C) Supine with a pillow under the patient's knees.

D) Short sitting with the involved extremity propped on a foot rest.

16) Your patient has a circumferential upper extremity burn wound. The patient complains of

16)

increasing pain and paresthesias in the involved extremity. You should first: A) ask the physician for modifications in the patient's pain medications.

B) assess the pulses and capillary in the involved extremity.

C) elevate the extremity.

D) A and B. 17) Debridement of burn wounds takes priority over intravenous fluid administration.

A) True.

B) False.

17)

18) A key benefit of a full-thickness skin graft is: A) these grafts allow for multiple graft harvests from the same location for patients with large

18)

surface area burns.

B) the ability to move the affected area immediately after grafting.

C) the ability to cover a large surface area.

D) improved cosmesis.

ESSAY. Write your answer in the space provided or on a separate sheet of paper.

19) List three methods of determining burn size.

20) Describe three ways patients with burn injuries may exhibit signs of psychological dysfunction?

3

Answer Key Testname: UNTITLED15

1) C 2) C 3) A 4) D 5) A 6) B 7) B 8) D 9) C 10) B 11) D 12) D 13) C 14) B 15) B 16) B 17) B 18) D 19) The correct answer should include three of the following key points:

• Rule of nines to determine the percentage of total body surface area involved.

• Lund-Browder classification to determine the percentage of total body surface area involved.

• Length × width via direct measurement.

• Length × width via measuring a burn tracing.

• The palmar method is NOT recommended.

20) The correct answer should include three of the following key points: • Altered sleep patterns.

• Confusion/delirium.

• Inappropriate behavior.

• Depression.

• Posttraumatic stress disorder.

4

Exam Name___________________________________

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

1) Your patient is going to have a lumpectomy and lymph node biopsy for breast cancer. After surgery, she will have: A) stage 1 lymphedema.

1)

B) pitting edema.

D) A and B.

C) a risk of developing lymphedema.

2) Your patient presents with stage 2 moderate left lower extremity lymphedema and a superficial

2)

partial-thickness wound. Given this preliminary information, which of the following dressings would be most appropriate?

A) A skin sealant, an alginate, and gauze pad secured with a roll gauze.

B) A skin sealant, a hydrocolloid, and a paste bandage.

C) A skin sealant, a semipermeable foam, and a multilayer compression dressing.

D) A skin sealant, an amorphous hydrogel and an ABD pad, secured with elastic netting.

3) Lymph fluid consists of: A) protein, water, and red blood cells.

B) water, protein, and cellular components.

C) plasma, dead cells, and foreign debris.

D) water, red blood cells, and foreign debris.

3)

4) Which of the following statements about lymphedema is correct?

A) Papillomas and frequent skin infections are characteristics of stage 4 lymphedema.

B) Lymphedema is a nonprogressive swelling of an extremity due to an obstruction in the

4)

lymphatic system.

C) Patients with lymphedema should not allow injections or blood pressure measurements in their affected extremity.

D) Lymphedema may affect as many as 25% of patients after breast cancer treatment.

5) Lymph from which of the following body regions empties into the right lymphatic duct?

A) Right upper and lower extremities.

B) Right upper extremity and bilateral lower extremities.

C) Right upper extremity.

D) The head and neck.

1

5)

6) Which of the following is correct regarding lymph flow?

A) Lymph vessels contract symmetrically with the heart beat to move lymph proximally.

B) Sympathetic stimulation can increase lymph angiomotoricity.

C) Exercise diverts lymphatic flow into working muscles.

D) Deep breathing inhibits lymphatic flow.

6)

7) Mechanical insufficiency: A) is exacerbated by elevating the affected limb.

B) occurs when the lymph system is unable to transport a normal lymphatic load.

C) occurs when the lymph system becomes overwhelmed by an increase in lymphatic load.

D) occurs when there is an increase in capillary reabsorption of lymph fluid.

7)

8) Which of the following results in an increase in ultrafiltration?

A) Diuretics.

B) Manual lymph drainage.

C) Compression bandaging.

D) Travel by airplane.

8)

9) A sprained ankle may result in: A) dynamic insufficiency of the lymphatic system.

B) mechanical insufficiency of the lymphatic system.

C) a decrease in capillary pressure.

D) B and C

9)

10) You are working with an infant whose right lower extremity is 50% larger than his left. You

10)

suspect the patient may have: A) secondary lymphedema.

B) lymphedema tarda.

D) congenital lymphedema.

C) lymphedema praecox.

11) You are a physical therapist evaluating a patient with bilateral lower extremity swelling. The

11)

patient reports her swelling began around puberty. She has no history of surgery or radiation. She reports her legs are tender to touch. On examination, while the patient does appear to have swelling in both legs, the dorsa of both feet appear normal. The patient is most likely to have: A) secondary lymphedema.

B) Noonan syndrome.

C) lipedema.

D) primary lymphedema.

12) You are a physical therapist working with a patient four days after a left mastectomy. You notice a localized accumulation of fluid in the patient's left axilla. Which of the following actions is most appropriate?

A) You should wrap the patient's limb in multilayer compression bandages.

B) You should tell the patient to perform 3 sets of 10 repetitions of resisted right shoulder flexion.

C) You should call the patient's surgeon to report the patient has an infection.

D) You should call the patient's surgeon to alert to the presence of a seroma.

2

12)

13) You are a physical therapist working with a patient with diabetes on weight loss. The patient has

13)

a BMI of 35 and is a 10-year survivor of left breast cancer. You should: A) educate the patient to alternate checking her blood sugar in her left and right hand to eliminate the risk of lymphedema.

B) alert the patient that she is no longer at risk for lymphedema given the time post-surgery.

C) educate the patient to avoid having her blood pressure taken in her left upper extremity to

decrease her risk of lymphedema.

D) educate the patient to have her blood pressure taken only in her lower extremity to decrease the risk of lymphedema.

14) A patient is referred to you for left lower extremity lymphedema management. Your examination

14)

reveals a left ABI of 0.8. How does this affect your interventions?

A) The patient should not receive compression therapy.

B) An ABI of 0.8 does not alter lymphedema interventions for this patient.

C) The patient can perform lower extremity exercises but not activities such as 10 minutes of biking or walking on a treadmill.

D) The patient should not perform lower extremity exercises.

ESSAY. Write your answer in the space provided or on a separate sheet of paper.

15) Provide examples of therapeutic exercises that might be appropriate for a patient with lower extremity lymphedema.

16) You are a clinician examining a patient suspected of having lower extremity lymphedema. The patient has a negative Stemmer sign. How does this affect your working diagnosis?

17) List three risk factors for the development of lymphedema.

18) Describe two key features of stage 2 lymphedema.

19) Provide two reasons why patients with lymphedema are at increased risk for infection.

20) Describe the four main components of lymphedema management.

3

Answer Key Testname: UNTITLED16

1) C 2) C 3) B 4) C 5) C 6) B 7) B 8) D 9) A 10) D 11) C 12) D 13) C 14) B 15) The correct answer should include exercises such as: lower extremity AROM, ankle pumps, heel raises, heel slides,

squats, biking, walking, and breathing exercises. Ideally, exercise would be performed while wearing some form of compression to maximize edema reduction.

16) While a positive Stemmer helps rule in lymphedema, a negative Stemmer sign does not preclude the diagnosis of lymphedema. Further examination is warranted.

17) The correct answer should include three of the following: • Lymph node excision, particularly if prone to scar tissue formation.

• Radiation therapy.

• Time post lymph-node removal.

• Air travel without compression.

• Inflammation or increased lymphatic load from trauma.

• Decreased lymphatic return.

18) The correct answer should include two of the following: • Nonpitting edema.

• Edema that does not decrease with elevation.

• The patient will have fibrotic or shiny skin.

• The patient may have frequent skin infections.

19) The correct answer should include two of the following: • Increased limb size requires the patient's white blood cells and macrophages to travel further to get to a break in the skin.

• Increased limb volume increases the diffusion distance that oxygen and nutrients must travel to reach blood cells.

• The high protein content of lymph fluid is a ready source of food for bacteria.

20) The correct answer should include information on proper skin and nail care, compression, therapeutic exercise, and manual lymph drainage.

4

Exam Name___________________________________

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

1) When examining your acute care patient, you notice an open wound on his extensor forearm that

1)

looks to be an epidermal flap with exposed dermis. The wound is bleeding minimally. This wound is likely: A) an abrasion.

B) a spider bite wound.

C) a skin tear.

D) a pressure injury.

2) You are working on mobility training with a patient who is obese and had a laparotomy the

2)

previous day. How might you protect the patient's surgical incision?

A) Ensure the gait belt encompasses the incision to provide extra support.

B) Use Montgomery straps.

C) If not done in surgery, you should request the use of skin glue to reinforce the sutures.

D) Instruct the patient in shallow breathing pattern to decrease tension across the incision.

3) A sinus tract that connects two epithelial surfaces is called: A) a tunnel.

B) a fistula.

C) a partial-thickness wound.

D) an ileostomy.

3)

4) Patients with puncture wounds: A) should receive a tetanus booster if they have not had one in the last 5 years.

B) should be observed for rabies.

C) should be prescribed prophylactic antibiotics.

D) all of the above.

4)

5) Patients with clenched fist human bite wound injuries: A) are at increased risk of infection because the victim's teeth can penetrate into the patient's

5)

joint or other deep tissues.

B) are at increased risk of infection because the human mouth has more varied microflora than an animal's mouth.

C) should be irrigated with an antimicrobial solution for 20 minutes and then sutured.

D) A and B. 6) Your patient reports the insidious onset of a reddish blister on his thumb that gradually

developed into an open wound. The wound now presents with a central necrotic area surrounded by significant erythema. The most likely cause of this skin presentation is: A) neuropathic ulcer.

B) cellulitis.

C) pyoderma gangrenosum.

D) brown recluse spider bite.

1

6)

7) Which of the following is correct regarding primary closure of lacerations?

A) Staples provide a more cosmetically appealing scar than wounds closed with skin glue.

B) Sutures and staples should be removed no sooner than 21 days.

C) Primary closure should never be performed if there is a delay of more than 2 hours between

7)

8) Spider bite wounds: A) caused by black widow spiders rarely require medical interventions.

B) are diagnosed by wound cultures.

C) benefit from manual therapy to promote circulation.

D) caused by a brown recluse spider generally heal without complications in 3-5 days.

8)

9) Which type of wound may benefit from wound scrubbing?

A) An abrasion.

B) A wound that was surgically debrided.

C) Radiation fibrosis.

D) Pyoderma gangrenosum.

9)

10) The Payne-Martin Classification System is used for: A) describing the extent of infection in surgical wounds.

B) wounds caused by radiation.

C) abrasions.

D) skin tears.

10)

11) Patients with irradiated skin should be encouraged to: A) rub the affected tissue vigorously for 2-3 minutes daily.

B) avoid applying sunscreen to affected areas due to the chance of an allergic reaction.

C) bathe daily or less often.

D) choose adhesive dressings if open wounds occur in irradiated areas.

11)

12) Pyoderma gangrenosum is associated with the following conditions: A) Crohn's disease, osteoarthritis, and rheumatoid arthritis.

B) Lupus, rheumatoid arthritis, and fibromyalgia.

C) Crohn's disease, lupus, and ulcerative colitis.

D) Ulcerative colitis, osteoarthritis, and irritable bowel syndrome.

12)

13) Which of the following describes the components of effective management of pyoderma

13)

the time of injury and the time of attempted closure.

D) Absorbable sutures have low rates of wound dehiscence and do not require follow-up for removal.

gangrenosum?

A) Limited debridement, corticosteroids, and absorptive dressings.

B) Aggressive debridement, corticosteroids, and absorptive dressings.

C) Aggressive debridement, immunosuppressive agents, and absorptive dressings.

D) Limited debridement, immunosuppressive agents, and anabolic steroids.

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14) Your patient presents with a clean partial-thickness abrasion to her extensor forearm from a fall

14)

on carpeting. Which of the following interventions would be most appropriate?

A) Whirlpool, sharp debridement, and a gauze dressing.

B) Irrigation, debridement, electrical stimulation, and a gauze dressing.

C) Irrigation, skin sealant, and a semipermeable film.

D) Pulsed lavage, skin sealant, an alginate, ABD pad, and 6-ply roll gauze.

15) While generally only superficial or partial-thickness, skin tears may bleed significantly in patients who are on blood thinners.

A) True.

15)

B) False.

16) Which of the following adjunctive interventions may be appropriate for a deep wound with dead space?

A) Continuous ultrasound.

16)

B) Pulsed ultrasound.

D) Negative pressure wound therapy.

C) Low level laser therapy.

17) Sutures are more likely to cause an inflammatory response than staples.

A) True.

B) False.

17)

ESSAY. Write your answer in the space provided or on a separate sheet of paper.

18) You are working in an urgent care facility when a patient with a dog bite wound seeks treatment. In addition to examining the patient and the patient's wound, list three pieces of information you should obtain.

19) Describe four characteristics of radiation fibrosis and irradiated tissue.

20) Describe two factors that can be addressed prior to a planned surgery to decrease the risk of wound dehiscence.

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Answer Key Testname: UNTITLED17

1) C 2) B 3) B 4) C 5) D 6) D 7) D 8) D 9) A 10) D 11) C 12) C 13) A 14) C 15) A 16) D 17) A 18) The correct answer should include three of the following key points:

• Is the dog known to the patient?

• Does the dog have a current rabies vaccination?

• Was the dog behaving erratically/abnormally?

• Was the dog provoked?

• Is the dog available for observation and examination?

19) The correct answer should include four of the following key descriptors: • The skin appears discolored, dry, hairless, atrophied, fibrotic, inelastic, and may appear semitranslucent with superficial blood vessels visible.

20) The correct answer should include two of the following key points: • Maximize the patient's nutrition request a dietary consult if the patient is malnourished.

• Optimize the patient's blood sugar control request a dietary consult or reinforce proper nutrition guidelines to the patient.

• Have the patient quit smoking.

• If time allows, have the patient participate in a supervised weight loss program.

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Exam Name___________________________________

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

1) What are two of the most common problems associated with aging skin?

A) Xerosis and psoriasis.

B) Xerosis and pruritus.

C) Pruritus and lentigo.

D) Cellulitis and lentigo.

1)

2) Vesicles, pustules, and bullae are considered primary lesions.

A) True.

B) False.

2)

3) After treating a patient with an ice pack to the right shoulder, you notice pink edematous wheals

3)

4) Most early melanomas are asymmetrical.

A) True.

4)

and the patient complains of pruritus. The most likely reaction the patient is experiencing is: A) eczema.

B) frost bite.

C) urticaria.

D) erysipelas.

B) False.

5) Capillary hemangiomas, port wine stains, and cherry angiomas are disorders of the lymph vessels.

A) True.

5)

B) False.

6) Which of the following clinical characteristics can be used to help differentiate lipomas and

6)

dermatofibromas from metastatic tumors and malignant cysts?

A) Dermatofibromas are only found on the trunk.

B) Metastatic tumors and malignant cysts often have pain, develop rapidly, and may ulcerate.

C) Melanomas have a positive dimple sign.

D) Lipomas are hard and nonmovable beneath the skin.

7) Which form of skin cancer presents primarily on the face, head, and neck?

A) Basal cell carcinoma.

B) Squamous cell carcinoma.

C) Kaposi's sarcoma.

D) Malignant melanoma.

7)

8) Which type of lesion appears red, pink, or tan in color and becomes purple-brown with a green

8)

hemosiderin halo over time?

A) Ecthyma.

B) Pyoderma gangrenosum.

D) Squamous cell carcinoma.

C) Kaposi's sarcoma.

9) Which of the following are common pigmentary disorders?

A) Melasma, ephelides, lentigines.

B) Vitiligo, scleroderma, and eczema.

C) Ephelides, nevi, and albinism.

D) Vitiligo, albinism, and psoriasis.

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9)

10) This describes a condition when the skin appears hard and smooth and often presents with

10)

hypopigmented areas that are immobile or feel "bound down."

A) Vitiligo.

B) Lupus erythematosus.

C) Scleroderma.

D) Psoriasis.

11) A patient is being treated in an outpatient wound center for an infected plantar diabetic foot ulcer.

11)

Treatment includes debridement as needed, silver sulfadiazine, dry dressings, and off-loading with a post-op shoe. On the second day of treatment, the patient reports a rash and severe pruritus around the wound and along the dorsum of the foot. The most likely cause of the patient's symptoms is: A) rapidly progressing wound infection.

B) untreated Charcot foot.

C) cutaneous drug reaction to silver sulfadiazine.

D) maceration due to improperly managed exudate.

12) Which of the following interventions for cellulitis is generally discouraged, as it may exacerbate the condition?

A) Superficial debridement.

12)

B) Moist heat.

D) Dry dressings.

C) Whirlpool.

13) You have been asked to do a home consult on a 91-year-old recently widowed female with a

13)

diagnosis of severe right hip degenerative joint disease. In your examination, you notice crops of erythematous vesicles along her right anterior thigh. The patient reports the areas is painful and severely pruritic. The most likely cause of her skin condition is: A) a burn from a heating pad.

B) impetigo.

C) dermatitis.

D) herpes zoster.

14) When examining a patient's foot, you should assess the interdigital spaces for signs of tinea pedis

14)

and educate the patient regarding appropriate foot care to care for the following: A) fungal infections.

B) xerosis.

C) trench foot.

D) candidiasis.

15) A physical therapist who frequently wears gloves, repeatedly washes his hands, and regularly

15)

utilizes hand sanitizer may develop the following condition: A) tinea manuum.

B) yellow nail syndrome.

C) candidiasis.

D) allergic contact dermatitis.

16) Most biophysical agents are contraindicated for use locally in the presence of cancer or suspected cancer, as the modality may cause mitogenic activity of the cancer cells.

A) True.

B) False.

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16)

17) The elderly are at risk for skin tears. The main anatomic region for this increased risk is: A) flattened epidermal rete pegs and dermal papillae.

B) reduced number of sweat glands.

C) decreased thickness of dermis and hypodermis.

D) decreased vascularity, particularly in the capillary loops of the dermal papillae.

17)

18) The finger and toe nails should be a regular part of the integumentary examination. Which of the

18)

following nail presentations can be a consequence of cardiac, pulmonary, hepatic, or gastrointestinal disease?

A) Clubbing.

B) Dystrophic nail changes.

C) Yellow nail syndrome.

D) Onychomycosis.

19) Which disease is characterized by round, circumscribed, erythematous, dry, scaling plaques of

19)

various sizes that are covered by silvery, white scales?

A) Psoriasis.

B) Discoid lupus erythematosus.

C) Ecthyma.

D) Seborrheic keratosis.

20) A 27-year-old male is being treated in outpatient physical therapy for a herniated L4-L5 disc.

During your examination, you notice a firm nodule (2.0 cm × 1.5 cm) with a purulent core lateral to T5. The patient reports the area is tender and he thinks it started four days ago. The most likely cause of this nodule is: A) squamous cell carcinoma.

B) malignant melanoma.

C) pilonidal cyst.

D) abscess.

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20)

Answer Key Testname: UNTITLED18

1) B 2) A 3) C 4) A 5) B 6) B 7) A 8) C 9) A 10) C 11) C 12) C 13) D 14) A 15) D 16) A 17) A 18) A 19) A 20) D

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