WOUND CERTIFICATION FINAL PAPER 2026
QUESTIONS AND COMPLETE SOLUTIONS
◉ What is the name of the organization that developed the pressure
ulcer staging? Answer: NPUAP (national pressure ulcer advisory
panel)
◉ pathological effect of excessive pressure on soft tissue can be
attributed by 3 factors? what are they? Answer: tissue tolerance,
duration of pressure, and intensity of pressure
◉ what are the extrinsic factors that impact pressure ulcers?
Answer: increase in moisture, friction and shearing
◉ how does friction play a role in shearing which eventually leads to
pressure ulcer? Answer: 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? Answer:
nutritional debilitation, advanced age, low BP, stress, smoking,
elevated body temperature
,◉ Aging skin undergoes what elements affecting risk for pressure
ulcer? Answer: 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?
Answer: 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? Answer: 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? Answer: 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? Answer: 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? Answer: 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? Answer: 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? Answer: 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? Answer: full-thickness wound where
base of the ulcer is covered by slough and/or eschar, obscuring
depth
, ◉ When should eschars not be removed? Answer: 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? Answer: immersion and envelopement
◉ Define immersion? Answer: depth of penetration or skining into
surgace allowing pressure to be spread out over surrounding area
rather than directly over boney prominence
◉ Define envelopement? Answer: is the ability of support surface to
conform to irregularities without causing substantial increase in
pressure
◉ what is bottoming out? Answer: this occurs when depth of
penetration or sinking is excessive, allowing increased pressure to
concentrate over boney prominences
◉ what factors contribute to bottoming out? Answer: weight,
disproportion of weight and size such as amputation, tendency to
keep HOB >30 degrees, inappropriate support surface settings
QUESTIONS AND COMPLETE SOLUTIONS
◉ What is the name of the organization that developed the pressure
ulcer staging? Answer: NPUAP (national pressure ulcer advisory
panel)
◉ pathological effect of excessive pressure on soft tissue can be
attributed by 3 factors? what are they? Answer: tissue tolerance,
duration of pressure, and intensity of pressure
◉ what are the extrinsic factors that impact pressure ulcers?
Answer: increase in moisture, friction and shearing
◉ how does friction play a role in shearing which eventually leads to
pressure ulcer? Answer: 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? Answer:
nutritional debilitation, advanced age, low BP, stress, smoking,
elevated body temperature
,◉ Aging skin undergoes what elements affecting risk for pressure
ulcer? Answer: 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?
Answer: 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? Answer: 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? Answer: 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? Answer: 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? Answer: 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? Answer: 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? Answer: 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? Answer: full-thickness wound where
base of the ulcer is covered by slough and/or eschar, obscuring
depth
, ◉ When should eschars not be removed? Answer: 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? Answer: immersion and envelopement
◉ Define immersion? Answer: depth of penetration or skining into
surgace allowing pressure to be spread out over surrounding area
rather than directly over boney prominence
◉ Define envelopement? Answer: is the ability of support surface to
conform to irregularities without causing substantial increase in
pressure
◉ what is bottoming out? Answer: this occurs when depth of
penetration or sinking is excessive, allowing increased pressure to
concentrate over boney prominences
◉ what factors contribute to bottoming out? Answer: weight,
disproportion of weight and size such as amputation, tendency to
keep HOB >30 degrees, inappropriate support surface settings
