,Keywords:
Wound care, Pressure injury, Pressure ulcer staging, Braden Scale, Wound assessment, Dressings, Debridement,
Negative pressure wound therapy, Infection control, Wound healing
Answer Format:
Each question is followed by the correct answer and a detailed rationale explaining why it is correct, along with
succinct explanations for why the other options are incorrect. This format reinforces learning and aids in
understanding key concepts.
Compliance Checklist:
Aligns with the latest NPUAP/EPUAP pressure injury staging guidelines
References current CDC and WHO infection control recommendations
Incorporates evidence-based practice from the Wound, Ostomy and Continence Nurses Society (WOCN)
Includes legal and ethical documentation standards for nursing practice
Reflects the 2026-2027 academic year curriculum requirements
Content Area Overview:
Content Area Questions Key Topics Weight
Wound Healing Principles 1-20 Phases of healing, types of healing, factors 13%
affecting healing
Pressure Injury Staging and 21-40 NPUAP staging, differential assessment, 13%
Classification unstageable injuries
Risk Assessment and Prevention 41-60 Braden Scale, repositioning, support 13%
surfaces, skin care
Wound Assessment and 61-80 Measurement, tunneling, undermining, 13%
Documentation exudate, photography
Wound Cleansing and Dressing 81-100 Cleansing solutions, dressing types, 13%
Selection moisture balance
Debridement and Advanced 101-120 Debridement methods, NPWT, skin 13%
Therapies substitutes, growth factors
Infection Control and 121-135 Signs of infection, swab cultures, 10%
Management antimicrobial dressings, systemic antibiotics
Patient Education and Special 136-150 Diabetic foot ulcers, venous stasis, patient 10%
Populations teaching, nutritional support
Page 2
,Q1. A patient with a sacral pressure injury presents with a wound bed that is 80%
covered by thick, yellow, stringy slough. The wound edges are rolled and
non-advancing. Which intervention is most appropriate for initial management?
A. Autolytic debridement with a hydrocolloid dressing
B. Mechanical debridement with wet-to-dry gauze
C. Enzymatic debridement with collagenase after cross-hatching
D. Surgical sharp debridement to viable tissue
Correct Answer: C. Enzymatic debridement with collagenase after cross-hatching
Rationale: Thick slough with rolled edges requires rapid removal to promote healing.
Collagenase is effective for enzymatic debridement of thick slough, especially when
cross-hatched to increase surface area. Autolytic debridement is too slow for this amount
of slough. Mechanical debridement is nonselective and can damage healthy tissue.
Surgical sharp debridement may be indicated, but enzymatic is often preferred when
bleeding risk is high or surgical consult is pending.
Why Wrong:
A - Autolytic debridement is slow and insufficient for thick, extensive slough.
B - Mechanical debridement is nonselective and may traumatize viable tissue.
D - Surgical sharp debridement is invasive and not the first-line when less invasive
options are available.
Reference: NPIAP (2019) Pressure Injury Staging and Debridement Guidelines; Sussman
& Bates-Jensen, Wound Care, 5th Ed.
Q2. Which of the following best explains why a pressure injury in a patient with
spinal cord injury may be classified as Stage 3 or 4 despite intact skin appearance?
A. Deep tissue injury is not visible on the surface initially.
B. The injury is actually a Kennedy terminal ulcer.
C. The skin is thin and transparent in paralyzed areas.
D. Shearing forces cause undermining that is not visible externally.
Correct Answer: A. Deep tissue injury is not visible on the surface initially.
Rationale: In patients with spinal cord injury and impaired sensation, pressure injuries
often originate deep at the bone-muscle interface and progress outward. The overlying
skin may remain intact for days, masking the severity. When the skin eventually breaks, the
injury is already Stage 3 or 4. Deep tissue injury (DTI) is a distinct category but can
evolve into full-thickness ulcers. Undermining may occur but is not the primary reason for
the staging discrepancy.
Why Wrong:
B - Kennedy terminal ulcer is a specific phenomenon near end of life, not typical of
spinal cord injury.
C - Thin skin is not the cause of the deep origin of pressure injury.
Page 3
, D - Undermining is a feature of full-thickness ulcers but not the reason for intact skin
appearance.
Reference: NPIAP (2019) Staging Consensus; Bryson et al., Spinal Cord Injury Pressure
Injury Pathogenesis.
Q3. A wound care team is implementing a pressure injury prevention bundle for a
group of patients. Which element is considered the primary evidence-based
intervention for reducing pressure injury incidence?
A. Repositioning every 2 hours with skin inspection
B. Use of a low-air-loss mattress for all patients
C. Nutritional supplementation with high-protein formula
D. Application of a barrier cream to at-risk areas
Correct Answer: A. Repositioning every 2 hours with skin inspection
Rationale: Regular repositioning to relieve pressure is the cornerstone of pressure injury
prevention. It is the most directly effective intervention to reduce sustained pressure and is
supported by strong evidence. Support surfaces and nutrition are adjuncts. Barrier creams
protect skin from moisture but do not relieve pressure.
Why Wrong:
B - Low-air-loss mattresses are not needed for all patients; they are for high-risk
individuals.
C - Nutrition is important but not the primary direct pressure-relieving intervention.
D - Barrier creams address moisture-associated skin damage, not pressure.
Reference: NPIAP/EPUAP/PPPIA Prevention and Treatment of Pressure Injuries (2019);
Chou et al., AHRQ (2013).
Q4. A patient has a pressure injury on the heel with a dry, stable eschar. The team is
debating debridement. According to current guidelines, what is the appropriate
action?
A. Debride immediately to assess the depth of the injury
B. Leave the eschar intact and offload the heel
C. Apply a hydrogel dressing to soften the eschar
D. Perform surgical debridement to prevent infection
Correct Answer: B. Leave the eschar intact and offload the heel
Rationale: Dry, stable eschar on the heel is a natural protective cover. Current guidelines
recommend NOT debriding if there is no evidence of infection or instability. Offloading is
essential to prevent further damage. Debridement of stable heel eschar can introduce
infection and delay healing.
Why Wrong:
A - Debriding stable heel eschar is contraindicated unless infection or instability is
Page 4
Wound care, Pressure injury, Pressure ulcer staging, Braden Scale, Wound assessment, Dressings, Debridement,
Negative pressure wound therapy, Infection control, Wound healing
Answer Format:
Each question is followed by the correct answer and a detailed rationale explaining why it is correct, along with
succinct explanations for why the other options are incorrect. This format reinforces learning and aids in
understanding key concepts.
Compliance Checklist:
Aligns with the latest NPUAP/EPUAP pressure injury staging guidelines
References current CDC and WHO infection control recommendations
Incorporates evidence-based practice from the Wound, Ostomy and Continence Nurses Society (WOCN)
Includes legal and ethical documentation standards for nursing practice
Reflects the 2026-2027 academic year curriculum requirements
Content Area Overview:
Content Area Questions Key Topics Weight
Wound Healing Principles 1-20 Phases of healing, types of healing, factors 13%
affecting healing
Pressure Injury Staging and 21-40 NPUAP staging, differential assessment, 13%
Classification unstageable injuries
Risk Assessment and Prevention 41-60 Braden Scale, repositioning, support 13%
surfaces, skin care
Wound Assessment and 61-80 Measurement, tunneling, undermining, 13%
Documentation exudate, photography
Wound Cleansing and Dressing 81-100 Cleansing solutions, dressing types, 13%
Selection moisture balance
Debridement and Advanced 101-120 Debridement methods, NPWT, skin 13%
Therapies substitutes, growth factors
Infection Control and 121-135 Signs of infection, swab cultures, 10%
Management antimicrobial dressings, systemic antibiotics
Patient Education and Special 136-150 Diabetic foot ulcers, venous stasis, patient 10%
Populations teaching, nutritional support
Page 2
,Q1. A patient with a sacral pressure injury presents with a wound bed that is 80%
covered by thick, yellow, stringy slough. The wound edges are rolled and
non-advancing. Which intervention is most appropriate for initial management?
A. Autolytic debridement with a hydrocolloid dressing
B. Mechanical debridement with wet-to-dry gauze
C. Enzymatic debridement with collagenase after cross-hatching
D. Surgical sharp debridement to viable tissue
Correct Answer: C. Enzymatic debridement with collagenase after cross-hatching
Rationale: Thick slough with rolled edges requires rapid removal to promote healing.
Collagenase is effective for enzymatic debridement of thick slough, especially when
cross-hatched to increase surface area. Autolytic debridement is too slow for this amount
of slough. Mechanical debridement is nonselective and can damage healthy tissue.
Surgical sharp debridement may be indicated, but enzymatic is often preferred when
bleeding risk is high or surgical consult is pending.
Why Wrong:
A - Autolytic debridement is slow and insufficient for thick, extensive slough.
B - Mechanical debridement is nonselective and may traumatize viable tissue.
D - Surgical sharp debridement is invasive and not the first-line when less invasive
options are available.
Reference: NPIAP (2019) Pressure Injury Staging and Debridement Guidelines; Sussman
& Bates-Jensen, Wound Care, 5th Ed.
Q2. Which of the following best explains why a pressure injury in a patient with
spinal cord injury may be classified as Stage 3 or 4 despite intact skin appearance?
A. Deep tissue injury is not visible on the surface initially.
B. The injury is actually a Kennedy terminal ulcer.
C. The skin is thin and transparent in paralyzed areas.
D. Shearing forces cause undermining that is not visible externally.
Correct Answer: A. Deep tissue injury is not visible on the surface initially.
Rationale: In patients with spinal cord injury and impaired sensation, pressure injuries
often originate deep at the bone-muscle interface and progress outward. The overlying
skin may remain intact for days, masking the severity. When the skin eventually breaks, the
injury is already Stage 3 or 4. Deep tissue injury (DTI) is a distinct category but can
evolve into full-thickness ulcers. Undermining may occur but is not the primary reason for
the staging discrepancy.
Why Wrong:
B - Kennedy terminal ulcer is a specific phenomenon near end of life, not typical of
spinal cord injury.
C - Thin skin is not the cause of the deep origin of pressure injury.
Page 3
, D - Undermining is a feature of full-thickness ulcers but not the reason for intact skin
appearance.
Reference: NPIAP (2019) Staging Consensus; Bryson et al., Spinal Cord Injury Pressure
Injury Pathogenesis.
Q3. A wound care team is implementing a pressure injury prevention bundle for a
group of patients. Which element is considered the primary evidence-based
intervention for reducing pressure injury incidence?
A. Repositioning every 2 hours with skin inspection
B. Use of a low-air-loss mattress for all patients
C. Nutritional supplementation with high-protein formula
D. Application of a barrier cream to at-risk areas
Correct Answer: A. Repositioning every 2 hours with skin inspection
Rationale: Regular repositioning to relieve pressure is the cornerstone of pressure injury
prevention. It is the most directly effective intervention to reduce sustained pressure and is
supported by strong evidence. Support surfaces and nutrition are adjuncts. Barrier creams
protect skin from moisture but do not relieve pressure.
Why Wrong:
B - Low-air-loss mattresses are not needed for all patients; they are for high-risk
individuals.
C - Nutrition is important but not the primary direct pressure-relieving intervention.
D - Barrier creams address moisture-associated skin damage, not pressure.
Reference: NPIAP/EPUAP/PPPIA Prevention and Treatment of Pressure Injuries (2019);
Chou et al., AHRQ (2013).
Q4. A patient has a pressure injury on the heel with a dry, stable eschar. The team is
debating debridement. According to current guidelines, what is the appropriate
action?
A. Debride immediately to assess the depth of the injury
B. Leave the eschar intact and offload the heel
C. Apply a hydrogel dressing to soften the eschar
D. Perform surgical debridement to prevent infection
Correct Answer: B. Leave the eschar intact and offload the heel
Rationale: Dry, stable eschar on the heel is a natural protective cover. Current guidelines
recommend NOT debriding if there is no evidence of infection or instability. Offloading is
essential to prevent further damage. Debridement of stable heel eschar can introduce
infection and delay healing.
Why Wrong:
A - Debriding stable heel eschar is contraindicated unless infection or instability is
Page 4
