Wound Certification
Improved Exam With
Questions and Answers
2025/2026
what are 6 risk factor components of Braden Scale for pressure ulcer? -
Correct Answers-sensory perception, moisture, mobility, activity, nutrition,
and shear/friction
What is the name of the organization that developed the pressure ulcer
staging? - Correct Answers-NPUAP (national pressure ulcer advisory panel)
pathological effect of excessive pressure on soft tissue can be attributed by
3 factors? what are they? - Correct Answers-tissue tolerance, duration of
pressure, and intensity of pressure
what are the extrinsic factors that impact pressure ulcers? - Correct Answers-
increase in moisture, friction and shearing
how does friction play a role in shearing which eventually leads to pressure
ulcer? - Correct Answers-friction alone causes only superfical abrasion, but
with gravity it plays a synergistic effect leading to shearing. When gravity
pushes down on the body and resistance (friction) between the patient and
surface is exerted, shearing occurs. because skin does not freely move,
primary effect of shearing occurs at the deeper fascial level.
what are the intrisinc factors of pressur ulcers? - Correct Answers-nutritional
debilitation, advanced age, low BP, stress, smoking, elevated body
temperature
Aging skin undergoes what elements affecting risk for pressure ulcer? -
Correct Answers-dermoepidermal junction flattens, less nutrient exchange
occurs, less resistance to shearing, changes in sensory perception, loss of
dermal thickness, increased vascular fragility; ability of soft tisuse to
distribute mechanical load w/out comprosing blood flow is impaired
What does nonblanching erythema indicate in the skin r/t PU? - Correct
Answers-when pressure is applied to the erythematic area skin becomes
white (blanched), but once relieved, erythema returns -indicating blood flow;
,however in nonblanching erythema, skin does not blanche-indicating
impaired blood flow-suggesting tissue destructon
why does sitting in a chair pose more of a risk in skin break down than lying?
- Correct Answers-deep tissue injury or PU is likely to occur sooner sitting
down because tissue offloading over boney prominences is higher
Describe what you will see in deep tissue injury? - Correct Answers-purple or
maroon localized area of discolored intact skin skinor blood filled blister; may
be preceded by painful, firm, mushy, or boggy; skin may be warmer to cooler
in adjacent tissue. In dark skin, thin blister or eschar over a dark wound bed
may bee seen
Describe stage I pressure ulcer? - Correct Answers-Intact skin with
nonblanchable redness of localized area. Will not see blanching in dark skin,
but changes in skin tissue consistency (firm vs boggy when palpated),
sensation (pain), and warmer or cooler temperature may differ from
surrounding area
Describe stage II pressure ulcer? - Correct Answers-partial-thickness wound
where epidermis and tip of dermis is lost with red-pink wound bed w/out
slough. may also present as intact or open/ruptured serum -filled blister
Describe stage III pressure ulcer? - Correct Answers-full-thickness wound
where both epidermis and dermis is lost and subcutaneous tissue may be
visible, but deeper structures such as muscle, bone, and tendon are not
exposed; slough my be present but it doesn't obscure depth and tunneling
and undermining may be present
Describe stage IV pressure ulcer? - Correct Answers-full-thickness wound
with exposed bone,tendon, and muscle; slough or eschar may be seen in
some parts of the wound bed. you will often see tunneling and undermining.
Osteomyelitis may be dxed at this stage, since bone is palpable
Describe unstageble ulcers? - Correct Answers-full-thickness wound where
base of the ulcer is covered by slough and/or eschar, obscuring depth
When should eschars not be removed? - Correct Answers-when it's stable
with dry, adherent, and intact w/out erythema on the heel; this serves as the
body's natural cover and should not be removed.
Therapeutic function of pressure distribution is accomplised by what 2
factors? - Correct Answers-immersion and envelopement
, Define immersion? - Correct Answers-depth of penetration or skining into
surgace allowing pressure to be spread out over surrounding area rather
than directly over boney prominence
Define envelopement? - Correct Answers-is the ability of support surface to
conform to irregularities without causing substantial increase in pressure
what is bottoming out? - Correct Answers-this occurs when depth of
penetration or sinking is excessive, allowing increased pressure to
concentrate over boney prominences
what factors contribute to bottoming out? - Correct Answers-weight,
disproportion of weight and size such as amputation, tendency to keep HOB
>30 degrees, inappropriate support surface settings
When should you consider reactive support surface with features and
components such as low air loss, alternating pressure, viscous or air fluids? -
Correct Answers-for patients who cannot effectively position off their wound,
have PUs in multiple turning surfaces, or have PUs that fail to improve
despite optimal comprehensive management
When should active support surface be considered? - Correct Answers-when
effective positioning is determined by an MD to be medically contraindicated
What is the difference between an active and reactive support surfaces/ -
Correct Answers-active support surface is a powered mattress or overlay that
changes it's load- distribution with or without applied load; pressure is
redistributed across the body by inflating and deflating the cells of
alternating zones. conversely a reactive support surface moves or changes
load-distribution properties only in response to applied load, such as the
patient's body.
When are active support surfaces appropriate? - Correct Answers-when
manual frequent repositioning is not possible
when are reactive support surfaces appropriate? - Correct Answers-for
pressure ulcer prevention
what is a benefit in low air loss feature and when is it contraindicated? -
Correct Answers-low air loss assists in managing mositure. It is
contraindicated in patients with unstable spine and it puts patients at risk for
entrapment
when is an air fluidized feature integrated in bed systems appropriate? -
Correct Answers-for patients with multiple stage III or Iv pressure ulcers,
burns, myocutaneous skin flap
Improved Exam With
Questions and Answers
2025/2026
what are 6 risk factor components of Braden Scale for pressure ulcer? -
Correct Answers-sensory perception, moisture, mobility, activity, nutrition,
and shear/friction
What is the name of the organization that developed the pressure ulcer
staging? - Correct Answers-NPUAP (national pressure ulcer advisory panel)
pathological effect of excessive pressure on soft tissue can be attributed by
3 factors? what are they? - Correct Answers-tissue tolerance, duration of
pressure, and intensity of pressure
what are the extrinsic factors that impact pressure ulcers? - Correct Answers-
increase in moisture, friction and shearing
how does friction play a role in shearing which eventually leads to pressure
ulcer? - Correct Answers-friction alone causes only superfical abrasion, but
with gravity it plays a synergistic effect leading to shearing. When gravity
pushes down on the body and resistance (friction) between the patient and
surface is exerted, shearing occurs. because skin does not freely move,
primary effect of shearing occurs at the deeper fascial level.
what are the intrisinc factors of pressur ulcers? - Correct Answers-nutritional
debilitation, advanced age, low BP, stress, smoking, elevated body
temperature
Aging skin undergoes what elements affecting risk for pressure ulcer? -
Correct Answers-dermoepidermal junction flattens, less nutrient exchange
occurs, less resistance to shearing, changes in sensory perception, loss of
dermal thickness, increased vascular fragility; ability of soft tisuse to
distribute mechanical load w/out comprosing blood flow is impaired
What does nonblanching erythema indicate in the skin r/t PU? - Correct
Answers-when pressure is applied to the erythematic area skin becomes
white (blanched), but once relieved, erythema returns -indicating blood flow;
,however in nonblanching erythema, skin does not blanche-indicating
impaired blood flow-suggesting tissue destructon
why does sitting in a chair pose more of a risk in skin break down than lying?
- Correct Answers-deep tissue injury or PU is likely to occur sooner sitting
down because tissue offloading over boney prominences is higher
Describe what you will see in deep tissue injury? - Correct Answers-purple or
maroon localized area of discolored intact skin skinor blood filled blister; may
be preceded by painful, firm, mushy, or boggy; skin may be warmer to cooler
in adjacent tissue. In dark skin, thin blister or eschar over a dark wound bed
may bee seen
Describe stage I pressure ulcer? - Correct Answers-Intact skin with
nonblanchable redness of localized area. Will not see blanching in dark skin,
but changes in skin tissue consistency (firm vs boggy when palpated),
sensation (pain), and warmer or cooler temperature may differ from
surrounding area
Describe stage II pressure ulcer? - Correct Answers-partial-thickness wound
where epidermis and tip of dermis is lost with red-pink wound bed w/out
slough. may also present as intact or open/ruptured serum -filled blister
Describe stage III pressure ulcer? - Correct Answers-full-thickness wound
where both epidermis and dermis is lost and subcutaneous tissue may be
visible, but deeper structures such as muscle, bone, and tendon are not
exposed; slough my be present but it doesn't obscure depth and tunneling
and undermining may be present
Describe stage IV pressure ulcer? - Correct Answers-full-thickness wound
with exposed bone,tendon, and muscle; slough or eschar may be seen in
some parts of the wound bed. you will often see tunneling and undermining.
Osteomyelitis may be dxed at this stage, since bone is palpable
Describe unstageble ulcers? - Correct Answers-full-thickness wound where
base of the ulcer is covered by slough and/or eschar, obscuring depth
When should eschars not be removed? - Correct Answers-when it's stable
with dry, adherent, and intact w/out erythema on the heel; this serves as the
body's natural cover and should not be removed.
Therapeutic function of pressure distribution is accomplised by what 2
factors? - Correct Answers-immersion and envelopement
, Define immersion? - Correct Answers-depth of penetration or skining into
surgace allowing pressure to be spread out over surrounding area rather
than directly over boney prominence
Define envelopement? - Correct Answers-is the ability of support surface to
conform to irregularities without causing substantial increase in pressure
what is bottoming out? - Correct Answers-this occurs when depth of
penetration or sinking is excessive, allowing increased pressure to
concentrate over boney prominences
what factors contribute to bottoming out? - Correct Answers-weight,
disproportion of weight and size such as amputation, tendency to keep HOB
>30 degrees, inappropriate support surface settings
When should you consider reactive support surface with features and
components such as low air loss, alternating pressure, viscous or air fluids? -
Correct Answers-for patients who cannot effectively position off their wound,
have PUs in multiple turning surfaces, or have PUs that fail to improve
despite optimal comprehensive management
When should active support surface be considered? - Correct Answers-when
effective positioning is determined by an MD to be medically contraindicated
What is the difference between an active and reactive support surfaces/ -
Correct Answers-active support surface is a powered mattress or overlay that
changes it's load- distribution with or without applied load; pressure is
redistributed across the body by inflating and deflating the cells of
alternating zones. conversely a reactive support surface moves or changes
load-distribution properties only in response to applied load, such as the
patient's body.
When are active support surfaces appropriate? - Correct Answers-when
manual frequent repositioning is not possible
when are reactive support surfaces appropriate? - Correct Answers-for
pressure ulcer prevention
what is a benefit in low air loss feature and when is it contraindicated? -
Correct Answers-low air loss assists in managing mositure. It is
contraindicated in patients with unstable spine and it puts patients at risk for
entrapment
when is an air fluidized feature integrated in bed systems appropriate? -
Correct Answers-for patients with multiple stage III or Iv pressure ulcers,
burns, myocutaneous skin flap
