A patient with osteomyelitis and chronic lower leg wound requires advanced adjunct therapy post- sequestrectomy. Culture: MRSA, wound depth 2.3 cm, StO2 68%. Which adjunct is best for promoting healing?
Negative pressure wound therapy
Maggot therapy
Bioengineered grafts
er: D
nation: Hyperbaric oxygen is indicated for post-debridement osteomyelitis, especially with h sistant infections.
-old multiple failed grafts venous ulcer, 6.4 cm x 5.7 cm, heavy exudate, biofilm suspected py biofilm disruption, absorption, bioburden, periwound.
factant gel with cadexomer iodine oxamer 407 gel with PHMB irrigation pochlorous acid with hydrofiber silver arterly ultrasound with silver foam
er: C
nation: Hypochlorous acid 0.01% disrupts biofilm EPS 80% 10 min, safe fibroblasts, hydrofi ustained kill/absorption heavy exudate, prevents periwound maceration. Cadexomer slow, mer no antimicrobial, ultrasound adjunct.
ent with Stage 1 pressure ulcer at the sacrum, Braden Moisture: 2, BMI 24, periwound is int local prophylactic measure is best supported by evidence?
Hyperbaric oxygen sessions Answ
Expla ypoxia
and re
69-year .
Thera
Sur
Pol
Hy
Qu
Answ
Expla ber
silver s poloxa
A pati act.
Which
Topical corticosteroid ointment
Application of soft silicone foam dressing over area
Frequent use of povidone-iodine
Aggressive skin scrubbing Answer: B
Explanation: Prophylactic silicone foams reduce injury progression and create a microclimate that supports healing.
You educate oncology nurses on trauma avoidance for a patient receiving bevacizumab with 3 cm x 2 cm abdominal wound vac at 100 mmHg continuous. Which parameter prevents wound dehiscence?
Increase to 150 mmHg for better granulation
Maintain negative pressure ≤100 mmHg, change canister when 75% full, avoid pulling sponge >15% original size, secure films 2 cm beyond perforations
Place bridge over bony prominence
er: B
nation: Bevacizumab inhibits VEGF 8 weeks post-dose; tensile strength reduced 40%. NPW risks bleeding in anti-angiogenic therapy. Sponge retraction >20% indicates excessive tensi over bone causes pressure necrosis.
long hospitalization, a patient’s serum zinc is 45 mcg/dL, albumin 3.2 g/dL, and wound ex L/day. Which intervention is most beneficial for wound healing?
zinc supplementation courage exercise
rease fluids wer exudate
er: A
nation: Zinc below 60 mcg/dL impairs immune function and collagen synthesis; supplementi corrects this critical micronutrient deficiency.
year-old with necrotic toe following revascularization has a stable ABI 1.0, hyperbaric oxyge
Reuse sponge if no odor Answ
Expla T >125
mmHg on.
Bridge
After a udate
is 25 m
Add
En
Inc
Lo
Answ
Expla ng zinc
A 55- n
ordered, wound base pH 7.6. Hb 8.2 g/dL, Na+ 138 mmol/L. What is the main contraindication to HBOT in this patient?
Mild hyponatremia
Well-perfused extremity
Toe necrosis
Severe anemia Answer: D
Explanation: Severe anemia (Hb <10) reduces oxygen-carrying capacity and is a clear contraindication to HBO therapy, even when perfusion and sodium are otherwise adequate.
ssify as stage 3 pressure injury with undermining gnose stage 4 pressure injury with bone exposure ntify suspected deep tissue pressure injury
cognize unstageable pressure injury requiring debridement
er: D
A 55-year-old male with spinal cord injury T10 level presents with 3.2 cm x 2.9 cm wound over ischial tuberosity, 100% black eschar, no drainage, and undermining 2 cm at 6 o’clock.
Cla
Dia
Ide
Re
Answ
Explanation: Diagram follows 2016 NPUAP criteria: stable eschar on pressure-bearing area must remain dry unless unstable; undermining greater than 2 cm suggests sinus tract but staging withheld until base visible. SCI patients have 8-fold risk; eschar removal only when signs of infection or fluctuation to prevent unnecessary depth exposure.
A wound care nurse assesses a migrant worker with a complex wound who is fearful of losing employment and hides his injury. Which factor poses the biggest barrier to wound resolution?
Cultural stigma around illness
Fear of job loss
Lack of primary care provider
Unstable housing Answer: B
Explanation: Fear of employment loss frequently results in avoidance of care, hidden injuries, and tensions between health and financial stability, creating a persistent barrier to effective wound management.
year-old male with Braden score 10 (moisture 2, nutrition 1 recent weight loss). Lower extre ment reveals 3+ edema, hairless shiny skin, nails thickened. Which Braden subscale modific most improve predictive validity in venous disease?
orporating venous severity score into moisture subscale ding LE edema grading to activity subscale
placing nutrition with prealbumin <15 mg/dL ng Norton Plus volume-pressure add-on
er: B
nation: Adding LE edema grading to activity subscale increases Braden sensitivity from 64% venous ulcers per 2024 meta-analysis, as edema >2+ reduces lymphatic clearance and incre ressure >30 mmHg. Prealbumin lab not bedside; Norton separate; VS not standardized.
verbal adult with severe cerebral palsy and a sacral stage 3 pressure injury has spasticity and chair. Reflexively, skin is neglected during handoffs and care plans are outdated. What best ses this gap?
strict care plan to wound nurse only
multidisciplinary, updated electronic care plan with regular, structured team handoffs and t
A 74- mity
assess ation
would
Inc
Ad
Re
Usi Answ
Expla to
91% in ases
tissue p
A non uses a
wheel addres
Re
Use wo-
nurse skin checks
Assign only one aide for daily turns
Remove interdisciplinary participation in wound care Answer: B
Explanation: Electronic care plans and structured handoff protocols ensure communication across providers, reduce errors, and facilitate pressure injury prevention.
A patient with severe arterial disease, ABI 0.39, has a chronic ulcer with mild clear drainage, and non- blanching cyanotic toes. Which therapy is absolutely contraindicated?
Moist hydrogel
Dry gauze dressing
Multilayer compression dressing
Pulsed low-pressure lavage Answer: C
nation: Multilayer compression is strictly contraindicated in severe arterial disease (ABI <0.5 of ischemia and tissue loss.
year-old male with purulent drainage, crepitus. Which culture method for gas gangrene? ab aerobic
aerobic blood culture + tissue immediate plating ayed transport
am stain only er: B
nation: Anaerobic blood culture + tissue immediate plating on pre-reduced media detects dium perfringens within 6 hours.
year-old female on chemotherapy develops grouped vesicles on erythematous base along T4 tome. Focused assessment: positive Tzanck smear, DFA positive for varicella-zoster. Pain 9/ o corneal involvement. Which dermatological etiology requires immediate antiviral therapy
lous impetigo with Nikolsky negative pes zoster with Hutchinson sign absent
Expla ) due
to risk Quest A 68-
Sw
An
Del
Gr
Answ Expla
Clostri
A 55-
derma 10
NRS, n ?
Bul
Her
Pemphigus vulgaris with oral mucosal involvement
Stevens-Johnson syndrome with <10% TBSA Answer: B
Explanation: Herpes zoster with Hutchinson sign absent reactivates latent VZV in dorsal root ganglion, producing unilateral dermatomal painful vesicles, positive DFA/Tzanck, requiring acyclovir 10 mg/kg IV q8h if immunocompromised to reduce postherpetic neuralgia risk by 50% within 72 hours onset. No nasal tip involvement spares ophthalmic branch; impetigo honey-crusted, pemphigus flaccid bullae positive Nikolsky, SJS targetoid with mucosal >2 sites.
A 77-year-old female post-flap sacral wound. Weekly assessment shows 38% granulation, wound area reduced 32%, tensile strength 45% normal. Which phase characteristic?
Granulation tissue 38%
Proliferation phase area reduction
Maturation phase tensile 45%
er: C
nation: Maturation phase tensile 45% normal by week 8-12 reflects type I collagen cross-link ar remodeling, reaching 80% by year 1. Granulation proliferation; area reduction contraction mation resolved.
te on nutrition monitoring. Which lab interval? nthly albumin
ekly prealbumin (half-life 2-3 days), target increase 2 mg/dL/week, CRP <10 mg/L indicatin ic phase
abs
N only er: B
nation: Prealbumin tracks acute change; CRP/PAB ratio <0.4 healing.
-old female post-TKA, stage IV sacral pressure ulcer 7.5 cm x 6.8 cm x 3.9 cm tunnel, biof ted, culture Pseudomonas 10^6 CFU/g, TcPO2 28 mmHg borderline. Recommend NPWT s nulation promotion, exudate management, biofilm disruption in low-perfusion.
Inflammation phase ongoing Answ
Expla ing
and sc ;
inflam Quest Educa
Mo
We g
anabol
No l
BU
Answ Expla Quest
74-year ilm
suspec ettings
for gra
Continuous -80 mmHg black foam instillation saline dwell 10 min
Intermittent -125 mmHg 5 min on/2 min off white foam
Variable -100 to -50 mmHg cycle 30 min low/high silver foam
Low -50 mmHg continuous polyurethane foam no instillation Answer: B
Explanation: Intermittent -125 mmHg 5/2 cycle macrostrain 15-30% draws wound edges, microstrain 5- 20% cell stretch angiogenesis VEGF upregulation 60%, white foam dense prevents ingrowth premature
closure tunnel, perfusion increase 40% hypoxia-reoxygenation. Continuous low perfusion risk, instillation Pseudomonas needs antimicrobial, variable unproven biofilm, low pressure insufficient exudate 300 mL/24h.
Wound bed preparation TIMERS principle violated in dry necrotic heel ulcer?
Tissue - non-viable
Moisture - desiccation
generation - absent er: B
nation: Dry environment halts autolysis, requires hydration for debridement.
ent avoids wound clinic visits, explaining “care is too expensive and time-consuming.” What primary strategy improves engagement?
ng higher-cost dressing alternatives iating wound debridement
viding only oral education
nnecting with financial and time management resources er: D
nation: Addressing cost and time barriers directly through resources and support services ages engagement, reduces missed appointments, and supports adherence to care.
ent with prior DVT history, right leg edema, shallow ankle wound, and normal pedal pulse i ed. What would you expect the Braden Scale friction/shear subscore to reflect?
Edge - non-advancing
Re
Answ Expla Quest A pati
Usi
Init
Pro
Co
Answ Expla
encour
A pati s
admitt
1, high risk
2, moderate risk
3, low risk
4, no risk Answer: B
Explanation: Edema increases risk for shifting and sliding, which should at least raise friction/shear risk to moderate.
A 51-year-old with opioid use disorder, 5 cm² abscess, refuses incision. Which harm-reduction goal?
Curative: force I&D
Palliative: pain meds only
Preventive: clean needles
nation: Refusal respected; warm compresses 40°C 20 minutes QID + antibiotics increase neous drainage 60%.
al ulcer vasculitis, punched-out. Biopsy ANCA positive. Recommend preparation. bridement aggressive
pical corticosteroids high-potency
temic immunosuppression then gentle saline cleanse mpression therapy
er: C
nation: Autoimmune non-healable until controlled; trauma worsens. Immunosuppression isone/rituximab) reduces inflammation, saline non-cytotoxic. Topical insufficient systemic; ement pathergy; compression vasculitis risk. Treat cause per vasculitis guidelines.
year-old on diuretics for heart failure presents with dry oral mucosa, sodium 150 mmol/L, el ine, and unintentional weight loss. Which finding most urgently requires intervention?
atinine elevation
Maintenance: warm compresses + oral antibiotics via syringe driver Answer: D
Expla sponta
Atypic
De
To
Sys
Co
Answ Expla
(predn debrid
A 78- evated
creatin
Cre
Sodium 150 mmol/L
Dry oral mucosa
Weight loss Answer: B
Explanation: Severely elevated sodium reflects acute dehydration and electrolyte imbalance, which can worsen nutritional status and impede healing if not promptly corrected.
During an interdisciplinary rounds, nutrition screening reveals a surgical wound patient with prealbumin 11 mg/dL and serum albumin 2.8 g/dL. What education should be prioritized for the clinical team?
Limit protein supplements to avoid renal strain
Begin exclusive enteral feeding immediately
Restrict fat intake for 2 weeks postoperatively
Emphasize early, adequate protein-calorie intake to enhance healing Answer: D
nation: Early and adequate protein-calorie intake is critical to rebuild tissue and support imm on, which accelerates wound healing and reduces complications.
Expla une
functi