Elsevier Wound Care Comprehensive
Question Review 2026 | Wound
Assessment and Nursing Care | Q and As
Section 1: Wound Healing Physiology
1. Which phase of wound healing is characterized by vasoconstriction followed by platelet
aggregation and fibrin clot formation?
A. Inflammatory phase
B. Proliferative phase
C. Maturation phase
D. Hemostasis phase
Rationale: Hemostasis is the immediate physiological response to tissue injury, occurring
within seconds to minutes. It involves transient vasoconstriction to limit blood loss, platelet
adhesion and aggregation to form a temporary plug, and activation of the coagulation cascade
resulting in fibrin clot formation. This foundational phase stabilizes the wound bed and initiates
signaling for subsequent inflammatory processes .
2. A wound healing by primary intention is characterized by:
A. Granulation tissue filling the wound from the bottom up
B. Well-approximated edges with minimal tissue loss
C. Extensive scarring and contraction
D. Delayed closure after infection control
Rationale: Primary intention occurs when wound edges are clean, closely approximated,
and held together by sutures, staples, or adhesive strips (e.g., surgical incision). Healing occurs
with minimal granulation tissue and scarring .
3. A patient asks the nurse what the surgeon meant by "the wound will be allowed to heal by
secondary intention." What is the best response by the nurse?
,A. "The wound will be stapled together until it heals."
B. "The wound will be sutured after the current infection is controlled."
C. "The wound will be left open and heal from the edges inward."
D. "The healing will contract the area to close the wound."
Rationale: Secondary intention occurs when a wound is left open and heals from the
bottom up through granulation tissue formation, wound contraction, and epithelialization. This
is common with wounds that have significant tissue loss or infection .
4. Which nutrient is most critical for collagen synthesis during the wound healing process?
A. Vitamin C
B. Vitamin K
C. Sodium
D. Carbohydrates
Rationale: Vitamin C is essential for collagen synthesis, cross-linking, and fibroblast
proliferation, all of which are necessary for tissue repair. Deficiency impairs wound healing and
increases risk of wound dehiscence .
5. Which of the following factors would most likely delay wound healing? (Select All That
Apply)
A. Advanced age
B. Peripheral vascular disease
C. Corticosteroid therapy
D. Adequate protein intake
E. Obesity
Rationale: Advanced age reduces skin elasticity, collagen synthesis, and immune function.
Peripheral vascular disease impairs oxygen and nutrient delivery to the wound. Corticosteroids
suppress the inflammatory response and inhibit fibroblast proliferation. Obesity reduces
vascularity in adipose tissue and increases tension on wounds .
6. During which phase of wound healing does granulation tissue formation and angiogenesis
primarily occur?
,A. Hemostasis phase
B. Inflammatory phase
C. Proliferative phase
D. Maturation phase
Rationale: The proliferative phase (typically days 4–21) is characterized by fibroblast
proliferation, collagen deposition, angiogenesis (new blood vessel formation), and granulation
tissue formation. Epithelialization also begins during this phase .
7. What is the primary purpose of the inflammatory phase of wound healing?
A. To form a permanent scar
B. To clean the wound of debris and bacteria
C. To strengthen the wound edges
D. To form granulation tissue
Rationale: The inflammatory phase (days 1–4) involves hemostasis and inflammation. Its
primary purpose is to clean the wound through phagocytosis of bacteria and debris by
neutrophils and macrophages, and to prepare the wound bed for subsequent healing phases .
8. A nurse notes that a patient's surgical wound has increased serosanguineous drainage
between postoperative days 4 and 5. What does this finding most likely indicate?
A. Normal wound healing
B. Wound infection
C. Impending wound dehiscence
D. Fistula formation
Rationale: An increase in serosanguineous drainage between postoperative days 4 and 5 is
a warning sign of impending evisceration or dehiscence. This finding warrants immediate
notification of the surgeon .
9. Which type of wound healing occurs when a wound is left open initially, then closed
surgically after edema subsides or infection is controlled?
A. Primary intention
B. Secondary intention
, C. Tertiary intention
D. Quaternary intention
Rationale: Tertiary intention (delayed primary closure) occurs when a wound is intentionally
left open for several days to allow edema to subside or infection to resolve, then is surgically
closed .
10. Which patient would be most likely to develop a pressure ulcer from shearing forces?
A. A patient sitting in a chair who slides down
B. A patient who lifts himself up on his elbows
C. A patient who lies on wrinkled sheets
D. A patient who must remain on his back for long periods of time
Rationale: Shearing forces occur when tissue layers slide over one another, such as when a
patient slides down in a chair or bed while the underlying tissues remain stationary against the
surface. This stretches and tears blood vessels, leading to tissue ischemia .
11. Which clinical finding occurs due to thinning of the subcutaneous layer in older adults?
A. Decreased tone and elasticity
B. Decreased sensory perception
C. Increased risk for hypothermia
D. Increased susceptibility to dry skin
Rationale: Thinning of the subcutaneous layer reduces insulation, resulting in increased risk
for hypothermia. Degeneration of elastic fibers in the dermis results in decreased tone and
elasticity. Reduced nerve endings in the dermis lead to decreased sensory perception.
Decreased dermal blood flow results in increased susceptibility to dry skin .
12. Which phase of wound healing involves collagen remodeling and scar maturation?
A. Hemostasis phase
B. Inflammatory phase
C. Proliferative phase
D. Maturation phase
Question Review 2026 | Wound
Assessment and Nursing Care | Q and As
Section 1: Wound Healing Physiology
1. Which phase of wound healing is characterized by vasoconstriction followed by platelet
aggregation and fibrin clot formation?
A. Inflammatory phase
B. Proliferative phase
C. Maturation phase
D. Hemostasis phase
Rationale: Hemostasis is the immediate physiological response to tissue injury, occurring
within seconds to minutes. It involves transient vasoconstriction to limit blood loss, platelet
adhesion and aggregation to form a temporary plug, and activation of the coagulation cascade
resulting in fibrin clot formation. This foundational phase stabilizes the wound bed and initiates
signaling for subsequent inflammatory processes .
2. A wound healing by primary intention is characterized by:
A. Granulation tissue filling the wound from the bottom up
B. Well-approximated edges with minimal tissue loss
C. Extensive scarring and contraction
D. Delayed closure after infection control
Rationale: Primary intention occurs when wound edges are clean, closely approximated,
and held together by sutures, staples, or adhesive strips (e.g., surgical incision). Healing occurs
with minimal granulation tissue and scarring .
3. A patient asks the nurse what the surgeon meant by "the wound will be allowed to heal by
secondary intention." What is the best response by the nurse?
,A. "The wound will be stapled together until it heals."
B. "The wound will be sutured after the current infection is controlled."
C. "The wound will be left open and heal from the edges inward."
D. "The healing will contract the area to close the wound."
Rationale: Secondary intention occurs when a wound is left open and heals from the
bottom up through granulation tissue formation, wound contraction, and epithelialization. This
is common with wounds that have significant tissue loss or infection .
4. Which nutrient is most critical for collagen synthesis during the wound healing process?
A. Vitamin C
B. Vitamin K
C. Sodium
D. Carbohydrates
Rationale: Vitamin C is essential for collagen synthesis, cross-linking, and fibroblast
proliferation, all of which are necessary for tissue repair. Deficiency impairs wound healing and
increases risk of wound dehiscence .
5. Which of the following factors would most likely delay wound healing? (Select All That
Apply)
A. Advanced age
B. Peripheral vascular disease
C. Corticosteroid therapy
D. Adequate protein intake
E. Obesity
Rationale: Advanced age reduces skin elasticity, collagen synthesis, and immune function.
Peripheral vascular disease impairs oxygen and nutrient delivery to the wound. Corticosteroids
suppress the inflammatory response and inhibit fibroblast proliferation. Obesity reduces
vascularity in adipose tissue and increases tension on wounds .
6. During which phase of wound healing does granulation tissue formation and angiogenesis
primarily occur?
,A. Hemostasis phase
B. Inflammatory phase
C. Proliferative phase
D. Maturation phase
Rationale: The proliferative phase (typically days 4–21) is characterized by fibroblast
proliferation, collagen deposition, angiogenesis (new blood vessel formation), and granulation
tissue formation. Epithelialization also begins during this phase .
7. What is the primary purpose of the inflammatory phase of wound healing?
A. To form a permanent scar
B. To clean the wound of debris and bacteria
C. To strengthen the wound edges
D. To form granulation tissue
Rationale: The inflammatory phase (days 1–4) involves hemostasis and inflammation. Its
primary purpose is to clean the wound through phagocytosis of bacteria and debris by
neutrophils and macrophages, and to prepare the wound bed for subsequent healing phases .
8. A nurse notes that a patient's surgical wound has increased serosanguineous drainage
between postoperative days 4 and 5. What does this finding most likely indicate?
A. Normal wound healing
B. Wound infection
C. Impending wound dehiscence
D. Fistula formation
Rationale: An increase in serosanguineous drainage between postoperative days 4 and 5 is
a warning sign of impending evisceration or dehiscence. This finding warrants immediate
notification of the surgeon .
9. Which type of wound healing occurs when a wound is left open initially, then closed
surgically after edema subsides or infection is controlled?
A. Primary intention
B. Secondary intention
, C. Tertiary intention
D. Quaternary intention
Rationale: Tertiary intention (delayed primary closure) occurs when a wound is intentionally
left open for several days to allow edema to subside or infection to resolve, then is surgically
closed .
10. Which patient would be most likely to develop a pressure ulcer from shearing forces?
A. A patient sitting in a chair who slides down
B. A patient who lifts himself up on his elbows
C. A patient who lies on wrinkled sheets
D. A patient who must remain on his back for long periods of time
Rationale: Shearing forces occur when tissue layers slide over one another, such as when a
patient slides down in a chair or bed while the underlying tissues remain stationary against the
surface. This stretches and tears blood vessels, leading to tissue ischemia .
11. Which clinical finding occurs due to thinning of the subcutaneous layer in older adults?
A. Decreased tone and elasticity
B. Decreased sensory perception
C. Increased risk for hypothermia
D. Increased susceptibility to dry skin
Rationale: Thinning of the subcutaneous layer reduces insulation, resulting in increased risk
for hypothermia. Degeneration of elastic fibers in the dermis results in decreased tone and
elasticity. Reduced nerve endings in the dermis lead to decreased sensory perception.
Decreased dermal blood flow results in increased susceptibility to dry skin .
12. Which phase of wound healing involves collagen remodeling and scar maturation?
A. Hemostasis phase
B. Inflammatory phase
C. Proliferative phase
D. Maturation phase
