Test Bank for Wound Management Principles and Practices 3rd Edition by Myers

Test Bank for Wound Management Principles and Practices 3rd Edition by Myers/   Chapter 1. Integumentary Anatomy 1. All of the following are functions of the dermis EXCEPT that it: A. houses epidermal appendages. B. assists with vitamin D production. C. provides sensation. D. assists with thermoregulation. 2. Cells that can be found in the dermis are: A. fibroblasts. B. melanocytes. C. Langerhans’ cells. D. Merkel cells. 3. The stratum corneum can be found in the: A. dermis. B. adipose tissue. C. epidermis. D. fascia. 4. A full-thickness wound involves the: A. Epidermis, dermis, and subcutaneous tissue. B. Epidermis. C. Dermis and subcutaneous tissue. D. Subcutaneous tissue. 5. A category/stage II pressure ulcer can also be described as a lesion. A. partial-thickness B. Wagner grade 4 C. superficial thickness D. full-thickness 6. An abrasion most commonly involves _. A. the epidermis B. fascia but not adipose tissue C. the epidermis and dermis D. the epidermis, dermis, and subcutaneous tissue 7. A callus is caused by a buildup of cells within the stratum basale. A. True. B. False. 8. The number of melanocytes determines an individual’s skin color. A. True. B. False. 9. Mast cells produce: A. histamine. B. collagen. C. sebum. D. keratin. 10. Sudoriferous glands are present everywhere EXCEPT in: A. the hands and feet. B. the lips. C. the hands. D. the feet. 11. Which of the following is true regarding hair follicles? A. They are composed of hard keratin. B. They are present everywhere except the palms and soles. C. They assist with infection control. D. They are located in the subcutaneous tissue. 12. When examining a patient’s wound, you notice regularly arranged white fibrous tissue. What do you suspect this structure is? A. Joint capsule B. Muscle C. Tendon D. Bone 13. When examining a patient’s wound, you notice gray black, dry, leathery-appearing irregular fibrous tissue. What do you suspect this structure is? A. Healthy muscle B. Healthy tendon C. Nonviable joint capsule D. Nonviable bone 14. When examining a patient’s pressure ulcer, you are able to identify the patient’s greater trochanter within the wound bed. How would you classify the extent of wound involvement? A. Unable to determine from the information provided B. Superficial C. Partial -thickness D. Full -thickness 15. List five functions of the epidermis. 16. When examining a patient’s wound, you notice regularly arranged red tissue. What do you suspect this structure is? A. Joint capsule B. Tendon C. Bone D. Muscle 17. List three functions of the dermis. 18. A blister occurs: A. at the junction between the dermis and subcutaneous tissue. B. between the papillary and reticular dermis. C. at the junction between the epidermis and dermis. D. between the stratum basale and the stratum corneum. 19. The subcutaneous tissue consists of: A. the epidermis and dermis. B. adipose tissue and fascia. C. keratin and adipose tissue. D. sudoriferous and sebaceous glands. 20. What is the function of the basement membrane? Test Bank Answers Chapter 1 1. B 2. A 3. C 4. A 5. A 6. A 7. B 8. B 9. A 10. B 11. B 12. C 13. C 14. D 15. The correct answer 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 16. D 17. The correct answer should include three of the following possible choices: *Supports and nourishes the epidermis *Houses epidermal appendages *Assists with thermoregulation *Provides sensation 18. C 19. B 20. Correct answers should include the following key points: *Serves as a scaffolding for the epidermis *Serves as a selective filter for substances moving between the epidermis and dermis Chapter 2. Wound Healing 1. skin is electronegative or electro positive?: electronegative 2. what triggers the wound healing cascade?: the local change in polarity, a break in skin continuity lowering electrical resistance, disrupting skin battery. 3. what are the phases of wound healing?: 1. inflammation 2. proliferation, 3. maturation/ regeneration 4. what is the body's first response to injury?: inflammation 5. maturation remodeling phase lasts how long?: 2 years 6. during maturation phase, scar tissue is reorganized according to wolfs law from a haphazard arrange,net to being printed along lines of tissue stress: 7. when wound reoccurs in the same location, what is that commonly due to?: venous insufficiency and neuropathic wounds 8. when 2nd generation wounds heal, its maximal strength is: 64-80% of the original tissue 9. does inflammation occur in dead tissue, or tissue w/out adequate blood flow?: no, inflammation has a vascular and a cellular response, so it cannot occur in dead tissues 10. inflamtion - vascular response: 1. tissue injury causes changes in local circulation ed BV leak transudate into interstitial space causing edema 3. BV constrict to prevent blood loss 4. platelets aggregate to the site of injury, activated platelets become sticky and start adhering to one another and endothelium 5. fibrin and activated platelets form a plug that walls off affected area. 6. platelet plug also close of lymphatic channels, furthering edema. 7. activated platelets release chemical mediators 8, after 30 mins of vasoconstriction, blood vessels vasodilator, pushing more fluid into interstitial space, allowing more growth factors and inflammatory cells to reach the injured area. 9. the interstitial space now has exudate - mix of water proteins electrolytes, growth factors, inflammatory mediators 11. what are the chemical mediators that activated platelets release?: 1. cy- tokines 2. growth factors 3. chemotactic agents 12. function of cytokines: cytokines such as interlukin 1, tumor necrosis factor x, are signaling proteins during inflammation 13. function of growth factors: endogenously produced hormone like substance that control cell differentiation, and metabolism. 14. function of chemotactic agents: attract cells necessary for wound repair 15. define transudate: 16. define exudate: 17. what is the function of histamine: short term vasodilation - released by mast cells 18. what is the function of prostaglandin: long term vasodilation - released by injured cells 19. what are the cardinal signs of inflammation?: 1. swelling 2. redness 3. warmth 4. pain 5. decreased function 20. what is a scab?: scab is a collection of necrotic cells, fibrin collagen and platelets - a sort of biological bandaid 21. inflammation cellular response: 1. increased vessel wall leakiness causes decrease in local blood v 2. slowing down flow of circulation WBC - polymorphonuclearcytes traveling within capillaries and arterioles 2. margination occurs - PMNs are pushed to sides of vessel wall 4. PMNs adhere to vessel walls 5. PMNS force their way into interstitial space. diapedesis - migration of PMNs through vessel wall 6. PMS migrate to area of injury 7. PMNS secrete chemotactic agents, interlukin 1, inflammation mediators 22. how are PMNs guided to area of injury?: by a chemical gradient formed by bacterial toxins, dying cells and changes in local PH 23. what are the first cells to reach the site of inure?: PMNs - with in 12-24 hours 24. what id the function of PMNS: 1. secrete chemotactic agents 2. attract more PMNS and inflammatory cells to injured area 3. stimulate fibroblast formation 4. induce vascular growth. 5. secrete enzymes capable of breaking down damaged tissues, and killing bacte- ria 6. phagocytize bacteria a nd debris 7. monocytes arrive, turn into macro phages once in interstitial 25. function of macrophages: 1. secrete nitrous oxide and bacterial enzymes which kill pathogens. 2. phagocytize 3. direct repair proces 5. produce growth factors 26. which are more effective in phagocytizing, macro phages or PMN's?: - PMNs 27. why are macrophages important in wound healing?: they direct repair process, they signal the extent of injury, attracting more inflammatory cells to the area. 28. when does the proliferation phase begin?: 48 hours after injury for healthy individuals 29. what are the four crucial events of the proliferation phase?: 1. angeigen- esis 2. granulation tissue formation 3. wound contraction 4. epithelization 30. what is angiogenesis>: formation of new BV 31. what are angioblasts?: endothelial cells that make up blood v walls adjacent to the zone of injury., bud and grow into effected area. 32. whatr are MPP: MPP are protases produced by -neutrophils - macrophages - keratinocyytes -fibroblasts 33. wants the role of MPP during normal wound healing?: they degrade debris, leaving a defect that must be filled in order for healing to occur. 34. what is granulation tissue?: a temporary lattice work of vascularized ct. 1. fibroblasts migrate to zone of injury and lay down extracellular matrix. 2. 35. what is extra cellular matrix composed of?: it is made of water and proteo- glycans, that fill the spaces between collagen and elastin fibers. 36. what is a function of extracellular matrix?: provide a scaffolding on which fibroblasts and other cells use to migrate across wound bed. 37. what are intergrins?: intergrins are surface cells receptors that reversibly bind to the extracellular matrix that help cells migrate across the wound bed. 38. fibroblasts are guided by chemotactic agents and low oxygenate tension -- as new vessels are formed, stimulus for fibroblasts proliferation decreas- es- granulation tissue is replaced by scar tissue.: 39. what is driving force of wound contraction?: myofibrils 40. describe wound contraction: 1. actin rich myofibrils pull wound margins together, decreasing size of the defect. 41. the amount of wound contraction is affected by what?: the amount of wound contraction is affected by 1. shape 2. depth 3. size of wound 42. wound contraction invokes stretching of entire demise w out cellular proliferation.: 1. wound defect is filled with granulation tissue 2. epidermal appendages begin to multiply and migrate across wound bed. 3. keratinocytes elongate, extend pseudopods across extracellular matrix, re repethelializing wound. 43. describe epithelialization: 44. epithelial cells cannot migrate over non viable tissue, kirtanocyts must secrete enzymes to break down debris in their path: epithelialization is slowed by low oxygen tension and thick debris. 45. what is the function of collagneases: breaks down old collagen, while new collagen is being formed. 46. what are the two theories that explain the reorientation of collagen?`: 1. induction theory - scar tissue attempts to mimic the tissue surrounding it. 2. tension theory - hypothesizes that internal and external stresses force collagen fibers to realign 47. what are the types of wound closure: 1. primary closure 2. secondary closure 3. delayed primary closure 48. primary closure -: 1. simplest and fastest type of wound closure wound edges are able to be approximated with little or no granulation tissue formation 3. healing occurs by primary closure when wound edges can be physically approx- imated. 49. secondary closure-: when wind edges cannot be approximated 50. wound healing by secondary closure heal by wound repair: 51. what is wound repair a combination of?: wound repair is a combination of 1. granulation tissue formation 2. wound contraction 3. epithlilization 52. what is the time of wound closure in 2ndary wound contraction deter- mined by?: 1. rate of wound contraction 2. depth of tissue loss 53. what is delayed primary closure?: delayed primary closure is combination of healing by primary and secondary closure 54. describe delayed primary closure.: 1. if wound is contaminated, delayed PC may be used to decrease the chance of infection 2. wound is cleaned and surgically closed 55. delayed primary closure is performed on what types of wounds?: lacera- tions, or surgical wounds once they are believed to be free of debris 56. chronic wounds or abnormal wound healing is due to what?: failure to move through the inflatory process or to do so in an untimely fashion. 57. what type of cells do chronic wounds have?: senescent cells 58. what are senescent cells?: cells that are mitotically active but non responsive 59. in chronic wounds, what leads to extracellular matrix degradation?: the higher levels of MPP and lower levels of tissue inhibitors of metalloprotases (TIMPs) 60. chronic wounds contain greater number of inflammatory cytokines and chronic pound cells that do not respond to growth factors.: 61. what is the goal of inflammatory phase?: to cleanse the wound of debris and set stage for further healing by calling cells necessary to repair injured area. 62. reduced or absent inflammation is seen in which patents.: 1. patents taking high doses of steroids 2. malnourished pt 3. elderly 4. pts with immune system disorders 63. chronic inflammation is often accompanied by: fibrosis 64. inflammation in acute wound healing lasts: 2 weeks 65. chronic inflammation prevents wound from progressing into proliferation phase.: 66. what are the three common causes of chronic inflammation>: 1. foreign body in wound bed. 2. repetitive mechanical trauma 3. use of cytotoxic agents 67. hypo granular wound: - aloud that fails to build enough granulation tissue to fill the wound defect, resulting in a pothole type wound 68. one way a non advancing wound edge is caused?: - its caused by scar tissue formation around wound 69. in which pt is hypo granular tissue seen in?: 1. patients w malnutrition 2. patients w diabetes 70. what is hyper granulation: its when granulation tissue formation continues after wound defect has been filled. 71. which type of dressing leads to hyper granulation?: colloid dressing 72. what are the three ways hyper granulation tissue can be resolved?: 1. pressure over the tissue- causing local ischmia and reversal of the oxygen depen- dent granulation 2. silver nitrate - cauterizes the pathological tissue, silver nitrate stick is rolled over granulation tissue, tissue will turn ashen grey 3. surgically removed 73. what is hypertrophic scarring due to?: overproduction of immature collagen synthesis and lysis 74. appearance of hypertrophic scarring: red, raised fibrous lesions 75. what conditions are hypertrophic scarring most likely to occur in?: 1. prolonged inflammatory phase 2. burns 76. darker skinned individuals have a higher predisposition to hypertrophic scarring.: