,1. A patient has a wound that is healing by primary intention. Which of the following best
describes this process?
A) The wound has significant tissue loss, and edges are not approximated
B) The wound is infected and requires debridement before closure
C) The wound edges are approximated, and healing occurs with minimal granulation tissue
D) The wound heals from the bottom up with extensive scarring
Correct Answer: The wound edges are approximated, and healing occurs with minimal
granulation tissue
Rationale: Primary intention healing occurs in clean surgical incisions where wound edges are
brought together (approximated). This results in minimal granulation tissue and scarring.
Secondary intention involves tissue loss, healing from the base upward, and more scarring.
Tertiary intention (delayed primary closure) occurs when a wound is left open and closed later .
2. A nurse is caring for a patient with a Stage 3 pressure injury. Which structures are involved in
this type of wound?
A) Epidermis only
B) Epidermis and dermis, presenting as a blister
C) Full-thickness skin loss with visible subcutaneous fat; muscle and bone not exposed
D) Full-thickness skin loss with exposed muscle, tendon, or bone
Correct Answer: Full-thickness skin loss with visible subcutaneous fat; muscle and bone not
exposed
Rationale: A Stage 3 pressure injury involves full-thickness skin loss extending into subcutaneous
tissue. Subcutaneous fat may be visible, but muscle, tendon, and bone are NOT exposed. Stage
2 involves partial-thickness loss (epidermis/dermis). Stage 4 involves exposed muscle, tendon,
or bone .
,3. A patient's wound is healing, and the nurse observes new tissue that is pink, red, moist, and
granular. This tissue is called:
A) Slough
B) Eschar
C) Granulation tissue
D) Epithelial tissue
Correct Answer: Granulation tissue
Rationale: Granulation tissue is new connective tissue with microscopic blood vessels that
appears pink/red, moist, and granular. It indicates healthy wound healing during the
proliferative phase. Slough is yellow or white devitalized tissue, eschar is black or brown
necrotic tissue, and epithelial tissue is thin and pink, migrating across the wound surface .
4. Which of the following is a primary function of epithelial tissue?
A) Contraction and distention
B) Protection, absorption, and secretion
C) Support and connection of body structures
D) Conduction of electrical impulses
Correct Answer: Protection, absorption, and secretion
Rationale: Epithelial tissue covers body surfaces, lines cavities, and forms glands. Its functions
include protection (skin), absorption (intestinal lining), and secretion (glands). Connective tissue
provides support and connection, muscle tissue enables movement, and nervous tissue
conducts impulses .
, 5. A patient has impaired wound healing due to malnutrition. Which laboratory value is most
indicative of nutritional status affecting wound healing?
A) Hemoglobin
B) White blood cell count
C) Serum albumin
D) Blood glucose
Correct Answer: Serum albumin
Rationale: Albumin, a protein produced by the liver, reflects nutritional status. Low serum
albumin (<3.5 g/dL) indicates protein malnutrition, which impairs wound healing by reducing
collagen synthesis and immune function. Hemoglobin reflects oxygen-carrying capacity, WBC
indicates infection, and glucose reflects metabolic control .
6. Which of the following correctly describes the sequence of events in the inflammatory
response?
A) Vasodilation → increased capillary permeability → leukocyte migration → phagocytosis
B) Vasoconstriction → decreased capillary permeability → leukocyte migration → repair
C) Leukocyte migration → vasodilation → phagocytosis → tissue repair
D) Phagocytosis → vasodilation → increased permeability → leukocyte migration
Correct Answer: Vasodilation → increased capillary permeability → leukocyte migration →
phagocytosis
Rationale: The inflammatory response begins with vasodilation and increased capillary
permeability, allowing fluid and leukocytes to exit the blood. Chemotaxis guides leukocytes to
the injury site, where they perform phagocytosis to remove pathogens and debris. This
sequence is essential for localizing and eliminating the cause of injury .
describes this process?
A) The wound has significant tissue loss, and edges are not approximated
B) The wound is infected and requires debridement before closure
C) The wound edges are approximated, and healing occurs with minimal granulation tissue
D) The wound heals from the bottom up with extensive scarring
Correct Answer: The wound edges are approximated, and healing occurs with minimal
granulation tissue
Rationale: Primary intention healing occurs in clean surgical incisions where wound edges are
brought together (approximated). This results in minimal granulation tissue and scarring.
Secondary intention involves tissue loss, healing from the base upward, and more scarring.
Tertiary intention (delayed primary closure) occurs when a wound is left open and closed later .
2. A nurse is caring for a patient with a Stage 3 pressure injury. Which structures are involved in
this type of wound?
A) Epidermis only
B) Epidermis and dermis, presenting as a blister
C) Full-thickness skin loss with visible subcutaneous fat; muscle and bone not exposed
D) Full-thickness skin loss with exposed muscle, tendon, or bone
Correct Answer: Full-thickness skin loss with visible subcutaneous fat; muscle and bone not
exposed
Rationale: A Stage 3 pressure injury involves full-thickness skin loss extending into subcutaneous
tissue. Subcutaneous fat may be visible, but muscle, tendon, and bone are NOT exposed. Stage
2 involves partial-thickness loss (epidermis/dermis). Stage 4 involves exposed muscle, tendon,
or bone .
,3. A patient's wound is healing, and the nurse observes new tissue that is pink, red, moist, and
granular. This tissue is called:
A) Slough
B) Eschar
C) Granulation tissue
D) Epithelial tissue
Correct Answer: Granulation tissue
Rationale: Granulation tissue is new connective tissue with microscopic blood vessels that
appears pink/red, moist, and granular. It indicates healthy wound healing during the
proliferative phase. Slough is yellow or white devitalized tissue, eschar is black or brown
necrotic tissue, and epithelial tissue is thin and pink, migrating across the wound surface .
4. Which of the following is a primary function of epithelial tissue?
A) Contraction and distention
B) Protection, absorption, and secretion
C) Support and connection of body structures
D) Conduction of electrical impulses
Correct Answer: Protection, absorption, and secretion
Rationale: Epithelial tissue covers body surfaces, lines cavities, and forms glands. Its functions
include protection (skin), absorption (intestinal lining), and secretion (glands). Connective tissue
provides support and connection, muscle tissue enables movement, and nervous tissue
conducts impulses .
, 5. A patient has impaired wound healing due to malnutrition. Which laboratory value is most
indicative of nutritional status affecting wound healing?
A) Hemoglobin
B) White blood cell count
C) Serum albumin
D) Blood glucose
Correct Answer: Serum albumin
Rationale: Albumin, a protein produced by the liver, reflects nutritional status. Low serum
albumin (<3.5 g/dL) indicates protein malnutrition, which impairs wound healing by reducing
collagen synthesis and immune function. Hemoglobin reflects oxygen-carrying capacity, WBC
indicates infection, and glucose reflects metabolic control .
6. Which of the following correctly describes the sequence of events in the inflammatory
response?
A) Vasodilation → increased capillary permeability → leukocyte migration → phagocytosis
B) Vasoconstriction → decreased capillary permeability → leukocyte migration → repair
C) Leukocyte migration → vasodilation → phagocytosis → tissue repair
D) Phagocytosis → vasodilation → increased permeability → leukocyte migration
Correct Answer: Vasodilation → increased capillary permeability → leukocyte migration →
phagocytosis
Rationale: The inflammatory response begins with vasodilation and increased capillary
permeability, allowing fluid and leukocytes to exit the blood. Chemotaxis guides leukocytes to
the injury site, where they perform phagocytosis to remove pathogens and debris. This
sequence is essential for localizing and eliminating the cause of injury .
