Test Bank for Wound Management: Principles and Practices, 4th Edition

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Test Bank
for
Wound Management:
Principles and Practice
4 th Edition
Betsy A. Myers, DHS, MPT, OCS, CLT, CWS
Assistant Professor of Physical Therapy,
University of Tennessee at Chattanooga
Chattanooga, TN
and
Staff Physical Therapist,
Saint Francis Health System
Tulsa, OK

iii
TABLE OF CONTENTS
Introduction 1
Chapter 1 Integumentary Anatomy 2
Chapter 2 Wound Healing 6
Chapter 3 Factors Affecting Wound Healing 9
Chapter 4 Examination of Patients with Open Wounds 12
Chapter 5 Debridement 20
Chapter 6 Management of Infection 28
Chapter 7 Dressing Selection and Bandaging 36
Chapter 8 Biophysical Agents 43
Chapter 9 Nutrition and Interdisciplinary Care 51
Chapter 10 Arterial Insufficiency Ulcers 54
Chapter 11 Venous Insufficiency Ulcers 58
Chapter 12 Pressure Injuries 68
Chapter 13 Neuropathic Ulcers 74
Chapter 14 Burns 80
Chapter 15 Lymphedema 86
Chapter 16 Miscellaneous Wounds 92
Chapter 17 Basic Dermatology 96

2
Chapter 1
Integumentary Anatomy
MULTIPLE CHOICE. Choose the one alternative that best completes
the statement or answers the question.
1. All of the following are functions of the dermis EXCEPT:
A. Provides sensation.
B. Houses epidermal appendages.
C. Assists with thermoregulation.
D. Assists with vitamin D production.
2. Cells that can be found in the dermis are:
A. Merkel cells.
B. fibroblasts.
C. Langerhans' cells.
D. melanocytes.
3. The stratum corneum can be found in the:
A. dermis.
B. fascia.
C. epidermis.
D. adipose tissue.
4. A full-thickness wound involves the following tissue layers:
A. Epidermis.
B. Dermis and subcutaneous tissue.
C. Subcutaneous tissue.
D. Epidermis, dermis, and subcutaneous tissue.
5. A stage 2 pressure injury can also be described as a ______ lesion.
A. Wagner grade 4.
B. partial-thickness.
C. superficial thickness.
D. full-thickness.
6. An abrasion most commonly involves ______ .
A. the epidermis, dermis, and subcutaneous tissue.
B. fascia but not adipose tissue.
C. the epidermis.
D. the epidermis and dermis.

3
7. A callus is caused by a build-up 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 the following substances:
A. collagen.
B. keratin.
C. histamine.
D. sebum.
10. Sudoriferous glands are present everywhere EXCEPT:
A. the lips.
B. the hands and feet.
C. the feet.
D. the hands.
11. Which of the following is true regarding hair follicles?
A. They assist with infection control.
B. They are located in the subcutaneous tissue.
C. They are present everywhere except the palms and soles.
D. They are composed of hard collagen.
12. When examining a patient's wound, you notice regularly arranged white fibrous tissue.
What do you suspect this structure is?
A. Muscle.
B. Bone.
C. Joint capsule.
D. Tendon.
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 tendon.
B. Healthy muscle.
C. Nonviable joint capsule.
D. Nonviable bone.
14. When examining a patient's pressure injury, you are able to identify the patient's greater
trochanter within the wound bed. How would you classify the extent of wound
involvement?
A. Superficial.
B. Partial-thickness.

4
C. Full-thickness.
D. Unable to determine from the information provided.
15. When examining a patient's wound, you notice regularly arranged red tissue. What do
you suspect this structure is?
A. Joint capsule.
B. Bone.
C. Tendon.
D. Muscle.
16. A blister occurs:
A. between the papillary and reticular dermis.
B. at the junction between the epidermis and dermis.
C. at the junction between the dermis and subcutaneous tissue.
D. between the stratum basale and the stratum corneum.
17. The subcutaneous tissue consists of:
A. keratin and adipose tissue.
B. sudoriferous and sebaceous glands.
C. adipose tissue and fascia.
D. the epidermis and dermis.
ESSAY. Write your answer in the space provided or on a separate sheet of paper.
18. List five functions of the epidermis.
19. List three functions of the dermis.
20. What is the function of the basement membrane?
1) B
2) D
3) C
4) D
5) B
6) C
7) B
8) B
9) C
10) A
11) C
12) D
13) C
14) C

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15) D
16) B
17) C
18) Correct answers 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.
19) Correct answers should include three of the following possible choices:
* Supports and nourishes the epidermis.
* Houses epidermal appendages.
* Assists with thermoregulation.
* Provides sensation.
20) Correct answers should include the following key points:
* Serves as a scaffolding for the epidermis.
* Selective filter for substances moving between the epidermis and dermis.

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6
Chapter 2
Wound Healing
CHAPTER O BJECTIVES
1. Describe the vascular response of inflammation.
2. State the cells involved in the inflammatory phase and describe their functions.
3. Describe the proliferative phase of wound healing.
4. State the cells involved in the proliferative phase and describe their functions.
5. Describe the maturation and remodeling phase of wound healing.
6. Differentiate between wound closure by primary, secondary, and delayed primary wound
closure.
7. Compare and contrast absence of inflammation and chronic inflammation.
8. Explain why absence of inflammation and chronic inflammation occur and interventions that
may improve wound healing.
9. Compare and contrast hypogranulation and hypergranulation.
10. Explain why hypogranulation and hypergranulation occur and interventions that may
improve wound healing.
11. Compare and contrast hypertrophic scarring, keloids, contractures, and wound dehiscence.
12. Explain why hypertrophic scarring, keloids, contractures, and wound dehiscence may occur
and interventions that may improve wound healing.
KEY TERMS
Abrasion
Angioblasts
Angiogenesis
Chemotactic agents
Chemotaxis
Closed wound
Collagenases
Contracture
Current of injury
Cytokines
Cytotoxic agents
Dehiscence
Delayed primary closure
Diapedesis
Epibole
Epithelialization
Exudate
Fibroblast
Granulation tissue
Growth factors
Healed wound
Hypergranulation
Hypertrophic scarring
Hypogranular
Inflammation
Integrins
Keloids
Macrophages
Margination
Mast cells
Matrix metalloproteases (MMPs)
Maturation/remodeling
Myofibroblasts
Platelets

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Polymorphonuclear neutrophils (PMNs)
Primary closure
Proliferation
Prostaglandins
Scab
Secondary closure
Tissue inhibitors of matrix metalloproteases
(TIMPs)Transudate
Wound contraction
CHAPTER O UTLINE
I. Introduction
II. Phases of Wound Healing
A. Inflammation
1. Vascular response
2. Cellular response
B. Proliferation
1. Angiogenesis
2. Granulation tissue formation
3. Wound contraction
4. Epithelialization
C. Maturation and remodeling
III. Types of Wound Closure
A. Primary closure
B. Secondary closure
C. Delayed primary closure
IV. Abnormal Wound Healing
A. Absence of inflammation
B. Chronic inflammation
C. Hypogranulation or nonadvancing wound edge
D. Hypergranulation
E. Hypertrophic scarring
F. Keloids
G. Contractures
H. Dehiscence
DISCUSSION POINTS
1. Why is a wound likely to recur in the same location as a previous ulcer?
2. How can inflammation be both beneficial and problematic?
3. Why are inflamed wounds characterized by local redness, heat, swelling, pain, and decreased
function?
4. When looking at an open wound, how might you be able to tell that the wound is primarily in
the proliferative phase of wound healing?

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5. You have been working with a 6-year-old patient with deeply pigmented skin who sustained
a full-thickness burn covering 75% of his upper extremity. The burn wound is now closed.
What information would you provide to an insurer about the patient’s wound healing and
impairments to justify the patient’s requirement for continued physical therapy?
6. How are chronic wounds different from acute wounds?
TEACHING T IPS
1. Using some of the images of patients with open wounds, have the students determine the
primary phase of wound healing for each wound. Ensure that the students describe particular
characteristics, such as the presence of granular budding or epithelialization.
2. Make a list of all of the cells involved in wound healing. Ask the students to describe their
key functions and what phase(s) these functions occur in.
3. Have students group the various types of abnormal wound healing listed within the chapter
by the phase of inflammation.
4. Have students use the chapter objectives to assess their understanding of the information
provided.
5. Have students define a sampling of the key terms provided. Students may check their
answers either within the chapter or by using the Glossary in Appendix A.

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Chapter 3
Factors Affecting Wound Healing
CHAPTER O BJECTIVES
1. State the difference between an acute and a chronic wound.
2. Describe wound characteristics associated with delayed wound healing.
3. Compare and contrast colonization and infection.
4. Describe local factors associated with delayed wound healing.
5. Describe systemic factors associated with delayed wound healing.
6. Identify potential barriers and methods to facilitate patient adherence.
7. Identify and prevent common inappropriate wound management practices which can delay
wound healing.
KEY TERMS
Acute wound
Adherence
Chronic wound
Colonization
Infection
Macerated
Necrotic tissue
CHAPTER O UTLINE
I. Introduction
II. Wound Characteristics
A. Mechanism of onset
B. Times since onset
C. Wound location
D. Wound dimensions
E. Temperature
F. Wound hydration
G. Infection
H. Necrotic tissue or foreign bodies
I. Changes in chronic wounds
III. Local Factors
A. Circulation
B. Sensation
C. Mechanical stress

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IV. Systemic Factors
A. Age
B. Inadequate nutrition
C. Comorbidities
D. Medication
E. Lifestyle choices
V. Patient Adherence
A. Understanding and Enhancing Adherence
1. Patient characteristics
2. Task characteristics
3. Health care provider characteristics
VI. Inappropriate Wound Management
DISCUSSION POINTS
1. Certain wound characteristics are known to affect the rate of wound healing. List some of
these characteristics and describe what interventions can be used to address these factors to
facilitate wound healing.
2. Now that you know more about normal wound healing and factors that can affect wound
healing, how are chronic wounds different from acute wounds?
3. In what ways are matrix metalloproteases (MMPs) beneficial? In what ways are they
detrimental?
4. Circulation, sensation, and mechanical stress are local factors that affect wound healing. This
chapter provides some ways in which clinicians can assist with improving circulation.
a. How might a physical therapist address loss of sensation as a risk factor for delayed
wound healing?
b. How might a physical therapist address adverse mechanical stresses in a patient who is
nonambulatory?
TEACHING T IPS
1. Many times, in physical therapy, the terms acute and chronic are incorrectly used to denote
arbitrary time frames for a rehabilitation program, such as acute, subacute, and chronic
phases. Help the students clarify the proper use of the terms of acute wounds and chronic
wounds using the definitions provided in the chapter.
2. Provide a scrambled list of factors known to affect wound healing. Have the students group
these factors into the following categories:
a. Wound characteristics
b. Local factors
c. Systemic factors
d. Factors that can be modified with physical therapy interventions

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e. Factors that can be modified with medical interventions
f. Factors that cannot be modified
3. If students are having difficulty understanding what macerated tissue looks like, try having
them put an adhesive bandage (e.g., a Band-Aid) on a finger, then soak the finger in a cup of
water during the lecture portion of the class.
4. Integrate information from students’ previous or current coursework regarding the
psychosocial aspects of disability and impairments with methods to enhance patient
adherence.
5. Have the students use the chapter objectives to assess their understanding of the information
provided.
6. Have the students define a sampling of the key terms provided. Students may check their
answers either within the chapter or by using the Glossary in Appendix A.

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12
Chapter 4
Examination of Patients with Open Wounds
CHAPTER O BJECTIVES
1. Describe the four aspects of obtaining the history of patients with open wounds.
2. State the key components of the systems review for patients with open wounds.
3. Identify and document wound characteristics.
4. Identify and document periwound and associated skin characteristics.
5. Assess and document circulation.
6. Assess and document sensory integrity.
7. Classify open wounds based on extent of tissue damage.
8. Document goals for patients with open wounds.
KEY T ERMS
Capillary refill
Eschar
Induration
Pitting edema
Semmes–Weinstein monofilaments
Sinus tract
Slough
Tunneling
Undermining
CHAPTER O UTLINE
I. Introduction
II. Examination
A. History
1. Review of systems
2. General demographics
3. Lifestyle and functional status
4. Past and current general medical history
5. Past and current wound history
B. Systems review
1. Cardiovascular/pulmonary system
2. Musculoskeletal system
3. Neuromuscular system
4. Integumentary system
C. Tests and measures
1. Integumentary integrity
a. Wound characteristics

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i. Wound location
ii Wound size
iii Tunneling/undermining
iv Wound bed
v Wound edges
vi Wound drainage
vii Wound odor
b. Periwound and associated skin characteristics
i. Structure and quality
ii. Color
iii Epithelial appendages
iv. Edema
v. Temperature
3. Circulation
4. Sensory integrity
III. Clinical Decision Making
A. Diagnosis
B. Prognosis
C. Interventions
D. Goals and outcomes
DISCUSSION POINTS
1. Obtaining a medical history and performing a systems review are vital parts of the physical
therapy examination. List some medical conditions that can adversely affect wound healing
and describe why healing may be compromised.
2. Why might it be important to assess motor function and range of motion in a patient with an
open wound?
3. What are some of the benefits and limitations of using direct measurement to determine
wound size?
4. When assessing a patient’s wound bed, it is important to estimate what percentage of the
wound bed is granular and what percentage is necrotic. Describe ways you might improve
the reliability of your estimation.
5. When assessing a patient’s open wound, you notice minimal wound drainage. Is this
desirable or problematic? Why?
T EACHING T IPS
1. Many times, students and clinicians are under the mistaken belief that the examination
of patients with open wounds is vastly different from the examination of patients that are
classified within other practice patterns. Have the students note the similarities across
practice patterns in the following portions of a physical therapy examination:

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a. History
b. Systems review
c. Tests and measures
2. Integrate information from student’s previous or current coursework regarding the review
of systems by asking the students to build a list of questions that would address the patient’s
overall feeling of physical and emotional wellbeing as well as the following body systems:
cardiovascular, pulmonary, endocrine, neuromuscular, gastrointestinal, and genitourinary.
3. To ensure carryover of current and previous coursework, have the students describe various
medical conditions that can be associated with abnormal laboratory values listed in
Table 4–2.
4. Have the students use the chapter objectives to assess their understanding of the information
provided.
5. Have the students define a sampling of the key terms provided. Students may check their
answers either within the chapter or by using the Glossary in Appendix A.
6. Have the students create their own template for performing a physical therapy examination
on a patient with an open wound.
7. Use the laboratory handout to increase student comprehension and skill performance.
L ABORATORY ACTIVITIES
SUPPLIES
1. Sponges at least 1-inch thick
2. Student lab handouts
3. Transparencies and grid-marked wound measuring sheets, if possible
4. Fine-tipped marker
5. Skin pen
6. Gloves
7. Alcohol or disinfectant
8. Measuring tapes
9. Monofilaments: 6.10, 5.07, 4.17
MEASURE M OCK W OUNDS ON SPONGES
Use scissors to cut out areas on the top of each sponge of different shapes and depths. Try to
include areas of undermining or tunneling. On some wounds use a red marker to demonstrate
areas of erythema surrounding the wound edges. On some sponges, make multiple wounds. If you
would like to ensure student accuracy, measure the wounds you created or have the students work
in pairs to compare their findings.

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