Other Systems

Question 1

A physical therapist is treating a patient with a T6 spinal cord injury. During the session, the patient begins to complain of a pounding headache and is found to have profuse sweating above the level of the lesion. While inspecting for potential triggers, the therapist notes a red, painful area on the patient’s great toe. Which of the following is the most likely classification of the integumentary trigger?

A. Wagner Grade 2 ulcer
B. Stage 2 pressure injury
C. Superficially induced Autonomic Dysreflexia
D. Partial-thickness skin tear

Answer 1

C. Superficially induced Autonomic Dysreflexia

Ingrown toenails, burns, pressure ulcers, blisters, and other integumentary trauma can trigger an episode of Autonomic Dysreflexia when occuring below the level of a pt’s SCI

Question 2

A therapist is evaluating a diabetic foot ulcer on the plantar surface of the first metatarsal head. The wound bed is deep, and the therapist can easily visualize and palpate the joint capsule and a nearby tendon, but there is no evidence of bone involvement or abscess. Using the Wagner Ulcer Classification System, how should this wound be graded?

A. Grade 1
B. Grade 2
C. Grade 3
D. Grade 4

Answer 2

B. Grade 2

Grade 2 is defined as a deep ulcer with penetration through the subcutaneous tissue, potentially exposing bone, tendon, ligament, or joint capsule. It is differentiated from Grade 3 by the absence of osteitis, abscess, or osteomyelitis.

Question 3

During a dressing change for a pressure injury over the sacrum, the therapist observes that the wound bed is completely covered by a thick layer of stringy, mucinous white-yellow tissue that is loosely attached in clumps. There is also a foul-smelling, thick green discharge. How should the therapist document the tissue type and the exudate?

A. Slough and Purulent exudate
B. Hyperkeratosis and Seropurulent exudate
C. Eschar and Sanguineous exudate
D. Gangrene and Serosanguineous exudate

Answer 3

A. Slough and Purulent exudate

Slough is described as moist, stringy, or mucinous white/yellow tissue. The thick green consistency and foul odor of the drainage identify it as Purulent exudate, which is an indicator of infection and always abnormal

Question 4

A patient presents with a pressure-related injury on the heel. The skin is intact but displays a persistent, non-blanchable deep purple discoloration. The area feels boggy compared to the surrounding tissue. According to the NPUAP staging system, which of the following is the most accurate classification?

A. Stage 1 Pressure Injury
B. Unstageable Pressure Injury
C. Stage 4 Pressure Injury
D. Deep Tissue Pressure Injury

Answer 4

D. Deep Tissue Pressure Injury

A Deep Tissue Pressure Injury (DTPI) presents as persistent non-blanchable deep red, maroon, or purple discoloration. It is distinguished from Stage 1 because Stage 1 does not include purple or maroon discoloration (which indicates deeper damage)

Question 5

A physical therapist is examining a patient with a history of chronic venous insufficiency. The patient has a wound on the medial malleolus that appears as a shallow abrasion. The epidermis is missing, and the dermis is visible as a pink, moist bed, but no subcutaneous fat is exposed. How should the therapist classify the depth of this wound?

A. Full-thickness wound
B. Subcutaneous wound
C. Partial-thickness wound
D. Superficial wound

Answer 5

C. Partial-thickness wound

A Partial-thickness wound extends through the epidermis and into, but not through, the dermis. Since the dermis is exposed but adipose (subcutaneous fat) is not, it cannot be full-thickness

Question 6

A patient with long-standing Diabetes Mellitus presents for an evaluation of the right foot. The therapist observes a significant hallux valgus deformity and heavy, white-gray callus formation under the second metatarsal head. There are no open lesions or drainage present. According to the Wagner Ulcer Classification System, what is the appropriate grade for this foot?

A. Grade 0
B. Grade 1
C. Grade 2
D. Grade 3

Answer 6

A. Grade 0

Grade 0 is characterized by the absence of an open lesion. However, the presence of “pre-ulcerative lesions,” “healed ulcers,” or “bony deformity” (like the hallux valgus and callus/hyperkeratosis mentioned) confirms this classification

Question 7

A therapist is treating a patient with a Stage 4 pressure injury. During the assessment, the therapist notes that the drainage is thin and watery but has a distinct cloudy, opaque appearance with a tan tint. Which of the following best describes this finding and its clinical significance?

A. Serosanguineous exudate; normal during the proliferative phase.
B. Seropurulent exudate; an abnormal finding indicating impending infection.
C. Purulent exudate; an abnormal finding indicating established infection.
D. Serous exudate; a normal finding during the inflammatory phase

Answer 7

B. Seropurulent exudate; an abnormal finding indicating impending infection.

Seropurulent exudate is described as cloudy or opaque with a yellow or tan color and a thin, watery consistency. It is an early warning sign of infection and is always abnormal

Question 8

A patient with severe peripheral arterial disease (PAD) presents with a dark, shriveled, and cold foot. The tissue has undergone extensive decay due to a complete lack of blood supply, and the surgeon has determined that a midfoot disarticulation is required. Using the Wagner Scale, how should this be classified?

A. Grade 2
B. Grade 3
C. Grade 4
D. Grade 5

Answer 8

D. Grade 5

While Grade 4 involves gangrene of a digit, Grade 5 is specifically defined as gangrene of the foot requiring disarticulation.

Question 9

A physical therapist is evaluating a patient with a T4 spinal cord injury who suddenly develops a pounding headache, flushing, and profuse sweating. Upon inspection, the therapist finds a small, localized area of non-blanchable redness on the patient’s heel. The skin is intact. What is the most likely classification of the integumentary trigger?
A. Deep Tissue Pressure Injury
B. Stage 1 Pressure Injury
C. Stage 2 Pressure Injury
D. Unstageable Pressure Injury

Answer 9

B. Stage 1 Pressure Injury

The patient is experiencing Autonomic Dysreflexia triggered by integumentary trauma. The description of “non-blanchable erythema of intact skin” is the hallmark of a Stage 1 Pressure Injury

Question 10

A patient with long-standing diabetes presents with a deep ulcer on the plantar surface of the foot. The therapist notes the presence of a localized collection of pus and clinical signs of bone infection. Using the Wagner Scale, which grade is most appropriate?
A. Grade 1
B. Grade 2
C. Grade 3
D. Grade 4

Answer 10

C. Grade 3

Grade 3 is specifically defined by the presence of a deep ulcer with osteitis (bone inflammation), abscess, or osteomyelitis (bone infection).

Question 11

During a wound assessment, the therapist observes a thick, leathery, black tissue firmly adhered to the wound bed of a pressure injury on the sacrum. There is no signs of infection. How should this tissue be documented?
A. Slough
B. Hyperkeratosis
C. Eschar
D. Gangrene

Answer 11

C. Eschar

Eschar is characterized as hard or leathery, black/brown, dehydrated tissue that is firmly adhered to the wound bed.

Question 12

A patient presents with a wound resulting from a non-blistering sunburn. The skin is red and painful, but the epidermis remains intact. How is this wound depth categorized, and what is the expected healing process?
A. Superficial; heals through the inflammatory process
B. Partial-thickness; heals by re-epithelialization
C. Full-thickness; heals by secondary intention
D. Subcutaneous; heals by secondary intention

Answer 12

A. Superficial; heals through the inflammatory process

A Superficial wound involves trauma where the epidermis remains intact. These wounds typically heal as part of the normal inflammatory process

Question 13

A therapist is assessing a pressure injury over the ischial tuberosity. The wound involves full-thickness skin loss where adipose tissue is visible, and the edges appear rolled (epibole). However, no muscle, tendon, or bone is exposed. Which stage is this?
A. Stage 2
B. Stage 3
C. Stage 4
D. Unstageable

Answer 13

B. Stage 3

Stage 3 involves full-thickness skin loss where adipose (fat) is visible and epibole is often present, but deeper structures (muscle/bone) are not exposed

Question 14

A diabetic patient presents with a foot deformity (Charcot foot) and a history of multiple healed ulcers on the first metatarsal head. There are currently no open lesions or signs of infection. What is the Wagner Scale grade?
A. Grade 0
B. Grade 1
C. Grade 2
D. Grade 3

Answer 14

A. Grade 0

Grade 0 on the Wagner Scale is used when there is no open lesion, but pre-ulcerative lesions, healed ulcers, or bony deformities are present

Question 15

While performing a dressing change, a therapist notes a thin, watery exudate that has a clear, light color. This is observed during the proliferative phase of healing. How should this be documented?
A. Sanguineous exudate
B. Serosanguineous exudate
C. Seropurulent exudate
D. Serous exudate

Answer 15

D. Serous exudate

This presents with a clear, light color and a thin, watery consistency
- This is considered to be normal in a healthy healing wound and is observed during the inflammatory and proliferative phases of healing

Question 16

A therapist is evaluating a wound on the heel that is covered by 100% stable, dry, adherent eschar. There is no edema or erythema in the surrounding tissue. What is the most appropriate action?
A. Classify as Stage 4 and debride
B. Classify as Unstageable and leave the eschar intact
C. Classify as Deep Tissue Injury and apply a hydrocolloid
D. Classify as Stage 3 and perform sharp debridement

Answer 16

B. Classify as Unstageable and leave the eschar intact

Wounds obscured Full-thickness skin and Tissue loss. Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or escar

• Stable eschar (i.e., dry, adherent, intact without erythema) on the heel or ischemic limb should not be softened or removed

Question 17

A patient has a diabetic ulcer on the great toe. The therapist observes that the entire digit has become dark and shriveled due to an interruption in blood flow. Which term and Wagner Grade best describe this?
A. Slough; Grade 3
B. Hyperkeratosis; Grade 2
C. Gangrene; Grade 4
D. Eschar; Grade 5

Answer 17

C. Gangrene; Grade 4

Gangrene is death and decay of tissue from interrupted blood flow. Wagner Grade 4 specifically denotes gangrene of a digit

Question 18

A therapist observes thin, watery, red-colored drainage from a wound. The therapist recognizes this may be indicative of new blood vessel growth. What is the correct term for this exudate?
A. Purulent
B. Seropurulent
C. Sanguineous
D. Serous

Answer 18

C. Sanguineous

Sanguineous exudate is red with a thin, watery consistency, representing the presence of blood. This may be indicative of new blood vessel growth or the disruption of blood vessels

Question 19

A pressure injury presents with persistent, non-blanchable deep purple discoloration of the skin. The therapist notes the area was preceded by significant pain and temperature changes. Which of the following is the correct classification?
A. Stage 1 Pressure Injury
B. Deep Tissue Pressure Injury
C. Stage 2 Pressure Injury
D. Unstageable Pressure Injury

Answer 19

B. Deep Tissue Pressure Injury

Deep Tissue Pressure Injury (DTPI) is characterized by persistent non-blanchable deep red, maroon, or purple discoloration

Question 20

A wound extends through the epidermis and into the dermis, but not through it. It presents as a moist, pink wound bed. Which wound depth classification and healing type applies?
A. Superficial; inflammatory process
B. Partial-thickness; re-epithelialization
C. Full-thickness; secondary intention
D. Subcutaneous; secondary intention

Answer 20

B. Partial-thickness; re-epithelialization

A partial thickness wound will typically heal by re-epithelialization or epidermal resurfacing depending on the depth

Question 21

A patient with peripheral arterial disease has gangrene involving the majority of the foot, requiring a surgical disarticulation. What Wagner Grade is this?
A. Grade 2
B. Grade 3
C. Grade 4
D. Grade 5

Answer 21

D. Grade 5

Wagner Grade 5 is defined as gangrene of the foot requiring disarticulation

Question 22

A therapist is evaluating a wound that presents with cloudy, opaque, tan-colored drainage. It has a thin, watery consistency. What does this finding indicate?
A. Normal healing
B. Healthy blood vessel growth
C. Impending infection
D. Wound infection

Answer 22

C. Impending infection

Seropurulent exudate (cloudy/opaque/tan) is an early warning sign of impending infection and is always abnormal.

Question 23

A physical therapist assesses a pressure injury and can directly palpate the patient’s tendon and bone at the base of the ulcer. How should this be staged?
A. Stage 2
B. Stage 3
C. Stage 4
D. Unstageable

Answer 23

C. Stage 4

Stage 4 is defined by full-thickness skin and tissue loss with exposed or directly palpable bone, tendon, or muscle.

Question 24

A patient has a deep diabetic ulcer that has penetrated through the subcutaneous tissue, exposing the joint capsule, but there is no evidence of bone infection or abscess. What Wagner Grade is this? A. Grade 1 B. Grade 2 C. Grade 3 D. Grade 4

Answer 24

B. Grade 2 ## Footnote Grade 2 is a deep ulcer penetrating subcutaneous tissue, potentially exposing bone/tendon/capsule, but without the infection markers of Grade 3.

Question 25

A therapist observes white/gray, firm tissue around a chronic wound on the plantar surface of the foot. The tissue is soggy due to high moisture. What is the correct term for this necrotic tissue? A. Slough B. Eschar C. Hyperkeratosis D. Gangrene

Answer 25

C. Hyperkeratosis ## Footnote Hyperkeratosis (also known as a callus) is white/gray and can be firm or soggy depending on moisture

Question 26

A therapist notes thick, viscous, green-colored drainage from a wound that also has a foul odor. How should this be documented? A. Serous exudate B. Sanguineous exudate C. Seropurulent exudate D. Purulent exudate

Answer 26

D. Purulent exudate ## Footnote Purulent exudate is yellow or green, thick and viscous, and generally indicates infection

Question 27

A wound assessment reveals moist, stringy, yellow tissue that is loosely attached in clumps to the wound bed. This tissue is best described as: A. Eschar B. Slough C. Hyperkeratosis D. Gangrene

Answer 27

B. Slough ## Footnote Slough is described as moist, stingy or mucinous, white/yellow tissue that tendsto be loosely attached in clumps to the wound bed

Question 28

A patient presents with a pressure injury that has partial-thickness skin loss. The wound bed is red and moist, and there is a small serum-filled blister present. No adipose or deeper tissues are visible. Which stage is this? A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4

Answer 28

B. Stage 2 ## Footnote Stage 2 involves partial-thickness skin loss with exposed dermis. It can present as a viable, pink/red, moist wound bed or an intact/ruptured serum-filled blister

Question 29

A patient presents with a pressure injury on the sacrum that is covered in moist, stringy yellow slough. The therapist's primary goal is to remove exudate and debris. According to the Red-Yellow-Black system, which of the following is the most appropriate classification and goal? A. Red wound; Protect wound and maintain moist environment B. Yellow wound; Remove exudate and debris C. Black wound; Debride necrotic tissue D. Red wound; Remove exudate and absorb drainage

Answer 29

B. Yellow wound; Remove exudate and debris ## Footnote The Yellow wound description matches moist, yellow slough. The goal for these wounds is to remove exudate and debris and absorb drainage

Question 30

A therapist is treating a heavily draining infected pressure injury. The therapist decides to use a dressing that acts as a hemostat and forms a hydrophilic gel. Which dressing is most appropriate? A. Transparent Film B. Hydrocolloid C. Alginate D. Hydrogel

Answer 30

C. Alginate ## Footnote Alginates are highly absorptive, act as a hemostat, and create a hydrophilic gel through ion interaction. **They are specifically indicated for infected, highly draining wounds**

Question 31

A patient has a chronic wound with large amounts of thick, adherent, necrotic tissue. The patient is also showing early signs of sepsis. Which form of debridement is the most expedient and indicated in this case? A. Autolytic debridement B. Enzymatic debridement C. Sharp debridement D. Wet-to-dry debridement

Answer 31

C. Sharp debridement ## Footnote Sharp debridement is the **most** expedient form of removing necrotic tissue and is specifically **indicated for wounds with large amounts of thick, adherent tissue or in the presence of sepsis**

Question 32

A physical therapist is considering Negative Pressure Wound Therapy (NPWT) for a patient with a dehisced surgical incision. Which of the following would be an absolute contraindication for this modality? A. Heavily draining granular wound B. Malignancy within the wound C. Partial-thickness burn D. Use of anticoagulant medication

Answer 32

B. Malignancy within the wound ## Footnote Contraindications for NPWT include malignancy within the wound, untreated osteomyelitis, and exposed arteries or veins

Question 33

A patient has a superficial abrasion with minimal drainage. The therapist wants a dressing that allows for easy visual inspection of the wound and provides resistance to shearing forces. Which dressing should be selected? A. Foam dressing B. Alginate C. Transparent film D. Gauze

Answer 33

C. Transparent film ## Footnote Film dressings are useful for superficial or partial-thickness wounds with minimal drainage (e.g., scalds, abrasions, lacerations) and transparent films allow for easy visual inspection

Question 34

A therapist is using a debridement method that utilizes the body's own mechanisms to remove nonviable tissue by establishing a moist environment to rehydrate eschar. This is known as: A. Selective Sharp debridement B. Non-selective Mechanical debridement C. Autolytic debridement D. Enzymatic debridement

Answer 34

C. Autolytic debridement ## Footnote Autolytic debridement uses the body's own mechanisms (enzymatic digestion) to remove nonviable tissue by establishing a moist environment

Question 35

A patient with a neuropathic ulcer that extends into the subcutaneous tissue is being considered for growth factor application. What is a requirement for this intervention to be successful? A. The wound must be closed by primary intention B. Presence of significant necrotic eschar C. Adequate circulation to sustain wound healing D. The patient must have a history of neoplasm at the site

Answer 35

C. Adequate circulation to sustain wound healing ## Footnote Growth factors are indicated for neuropathic ulcers extending into subcutaneous tissue only if there is adequate circulation to sustain healing

Question 36

Which of the following is considered a non-selective form of debridement that may traumatize healthy granulation tissue? A. Autolytic debridement B. Wet-to-dry dressings C. Enzymatic debridement D. Sharp debridement

Answer 36

B. Wet-to-dry dressings ## Footnote Wet-to-dry dressings are a form of non-selective (mechanical) debridement. They should be used sparingly because they traumatize viable granulation tissue during removal

Question 37

A therapist chooses a dressing that consists of gel-forming polymers backed by a strong film adhesive. The dressing absorbs exudate by swelling into a gel-like mass. Which dressing is this? A. Foam B. Hydrocolloid C. Hydrogel D. Alginate

Answer 37

B. Hydrocolloid ## Footnote Hydrocolloids consist of gel-forming polymers that absorb exudate by swelling into a gel-like mass. They do not require a secondary dressing

Question 38

A patient with a chronic diabetic wound is referred for Hyperbaric Oxygen therapy. Which of the following is a contraindication for this treatment? A. Osteomyelitis B. Untreated pneumothorax C. Compromised skin graft D. Necrotizing soft tissue infection

Answer 38

B. Untreated pneumothorax ## Footnote Contraindications for Hyperbaric Oxygen include: Teminal illness, untreated pneumothorax, active malignacy, pregnancy, seizure disorder, emphysema, and use of certain chemotherapy agents

Question 39

A wound is described as being 100% covered in black, thick eschar that is firmly adhered. What is the primary goal for this wound? A. Protect the wound B. Absorb drainage C. Debride necrotic tissue D. Maintain a moist environment

Answer 39

C. Debride necrotic tissue ## Footnote According to the Red-Yellow-Black system, a Black wound consists of thick eschar, and the primary goal is to debride necrotic tissue

Question 40

A patient has a very heavily draining wound. The therapist applies an Alginate dressing. What must be done to complete the dressing application? A. Apply a primary adhesive over the alginate B. No further steps; Alginates are self-adhesive C. Apply a secondary dressing D. Apply a moisture barrier ointment

Answer 40

C. Apply a secondary dressing ## Footnote Alginates are highly permeable and non-occlusive; therefore, **they always require a secondary dressing** to stay in place and manage moisture

Question 41

A therapist is treating a patient with an infected wound that has loose debris. Which non-selective debridement method uses pressurized fluid (like pulsatile lavage) to remove tissue? A. Hydrotherapy B. Wound Irrigation C. Wet-to-dry D. Sharp debridement

Answer 41

B. Wound Irrigation ## Footnote Wound irrigation (e.g., pulsatile lavage) uses pressurized fluid to remove necrotic tissue and is desirable for infected wounds or those with loose debris

Question 42

A patient has significant incontinence. Which skin care product is specifically designed to adhere to the skin and repel excess moisture to protect the perineal area? A. Therapeutic moisturizer B. Skin cleanser C. Moisture barrier D. Wound cleanser

Answer 42

C. Moisture barrier ## Footnote (e.g., Ointment) Moisture barriers are designed to adhere to the skin and repel excess moisture from protected areas - They are frequently used to protect surrounding skin from a heavily draining wound or perineal tissues from exposure to incontinence

Question 43

A physical therapist is using High-Voltage Pulsed Current (HVPC) to enhance wound healing. What is the physiological effect of this monophasic direct current? A. Decreases oxygen perfusion B. Increases bacterial activity C. Stimulates angiogenesis D. Decreases tensile strength of the scar

Answer 43

C. Stimulates angiogenesis ## Footnote HVPC stimulates angiogenesis (new blood vessel growth) and epithelial migration, while decreasing bacterial activity and wound pain, and increases oxygen perfusion and tensile srength

Question 44

A wound is 100% pink with healthy granulation tissue. The therapist’s goal is to maintain a moist environment. How is this wound classified? A. Black wound B. Yellow wound C. Red wound D. Granular wound

Answer 44

C. Red wound ## Footnote Red wounds are pink granulation tissue; the goal is protection and maintaining a moist environment

Question 45

A therapist applies a hydrophilic polyurethane base dressing to a partial-thickness wound with moderate exudate. The dressing has a hydrophobic outer layer. What dressing is this? A. Hydrogel B. Alginate C. Foam dressing D. Gauze

Answer 45

C. Foam dressing ## Footnote Foam dressings comprise a hydrophilic polyurethane base and a hydrophobic outer layer

Question 46

Enzymatic debridement is being used on a patient’s pressure injury. When should the therapist discontinue the use of this topical preparation? A. Once the wound begins to drain heavily B. Once devitalized tissue is removed C. After two weeks of application regardless of status D. When granulation tissue first appears

Answer 46

B. Once devitalized tissue is removed ## Footnote Enzymatic debridement should be discontinued once devitalized tissue is removed to avoid damaging healthy adjacent tissue

Question 47

A patient has a very dry wound that needs rehydration to facilitate autolytic debridement. The wound has minimal drainage. Which dressing is the most appropriate choice to add moisture? A. Alginate B. Foam C. Hydrogel D. Gauze

Answer 47

C. Hydrogel ## Footnote Hydrogels are moisture-retentive and consist of varying amounts of water and gel-forming material, making them ideal for dry wounds

Question 48

Which dressing is largely impermeable to bacteria and water but permeable to vapor and oxygen? A. Transparent film B. Alginate C. Gauze D. Hydrofiber

Answer 48

A. Transparent film ## Footnote Transparent films are permeable to vapor and oxygen but impermeable to bacteria and water

Question 49

A therapist is applying an adhesive dressing. Before application, they apply a product that creates a thin plastic film to protect the skin from adhesive-related tissue damage. What is this product? A. Skin cleanser B. Liquid skin protectant C. Moisture barrier D. Therapeutic moisturizer

Answer 49

B. Liquid skin protectant ## Footnote Liquid skin protectants (sealants) create a thin plastic film to protect against adhesive-related damage

Question 50

Which of the following is a disadvantage of using Alginate dressings? A. Cannot be used on infected wounds B. May dehydrate the wound bed C. Cannot be used on wounds with an exposed tendon or bone D. Low absorptive capacity

Answer 50

C. Cannot be used on wounds with an exposed tendon or bone

Question 51

A therapist is performing whirlpool hydrotherapy. Which side effect should they be most concerned about regarding the patient's cardiovascular system? A. Hypertension B. Hypotension C. Bradycardia D. Hypervolemia

Answer 51

B. Hypotension ## Footnote PT must be aware of potential hydrotherapy side effects such as maceration of viable tissue, edema from dependent LE positioning, and systemic effects such as hypotension

Question 52

A patient has a small, non-infected granular wound. The therapist wants an occlusive dressing that does not require a secondary dressing and provides moderate absorption. Which is best? A. Alginate B. Hydrogel sheet C. Hydrocolloid D. Transparent film

Answer 52

C. Hydrocolloid ## Footnote Hydrocolloids provide moderate absorption and do not require a secondary dressing. Also, Provides a moist environment for wound healing, Enables autolytic debridement, Offers protection from microbial contamintation, and Provides a waterproof surface

Question 53

A therapist is evaluating a wound cleanser. They note that many cleansers have a specific potential downside despite being effective at removing foreign material. What is this downside? A. They cause excessive dryness B. They may cause inflammation C. They promote bacterial growth D. They are always highly occlusive

Answer 53

B. They may cause inflammation ## Footnote Wound cleansers are not typically designed to remove necrotic tissue, **but rather associated wound substances such as foreign materials, exudate and dried blood**

Question 54

What is the primary purpose of a secondary dressing? A. To provide direct contact with the wound bed B. To provide debridement of necrotic tissue only C. To secure a primary dressing and provide additional absorption D. To replace the need for a primary dressing

Answer 54

C. To secure a primary dressing and provide additional absorption ## Footnote Secondary dressings are placed directly over the primary dressing to provide additional protection, absorption, occlusion, and/or to secure the primary dressing in place

Question 55

patient is using a topical agent derived from naturally occurring protein factors to increase the growth rate of new tissue. This is known as: A. Enzymatic debridement B. Autolytic debridement C. Growth factors D. Hyperbaric oxygen

Answer 55

C. Growth factors ## Footnote Growth factors are derived from naturally occurring protein factors and facilitate healing by stimulating specific cell activity

Question 56

A therapist decides to use a foam dressing on a patient with a pressure injury. What is an advantage of this dressing? A. Allows for easy visualization of the wound B. Is highly occlusive C. Provides prophylactic protection and cushioning D. Never requires a secondary dressing

Answer 56

C. Provides prophylactic protection and cushioning ## Footnote Other advantages: - Provides a moist enviornment for wound healing - Available in adhesive and non-adhesive forms - Provides prophylactic protection and cushioning - Encourages autolytic debridement - Provides moderate absorption

Question 57

Which of the following describes a fully occlusive substance? A. Gauze pad B. Alginate C. Latex glove D. Transparent film

Answer 57

C. Latex glove ## Footnote Occlusion refers to impermeability; a latex glove is completely impermeable (fully occlusive)

Question 58

A therapist is using Therapeutic Ultrasound on a wound. At what intensity has it been shown to enhance all phases of wound healing? A. High intensity B. Low intensity C. Pulsed only D. Continuous only

Answer 58

B. Low intensity ## Footnote - During Inflammatory and Proliferative phases, fibroblast, endothelial, and white blood cell activity are stimulated by ultrasound - During early stages of repair, it has been shown to enhance the strength and elasticity of scar tissue

Question 59

A patient with a heavily draining wound is using Alginates. The therapist notes the dressing needs to be changed frequently. Why is this a common occurrence? A. Alginates have low absorption B. Alginates are highly occlusive C. Changes are based on the level of exudate D. Alginates promote wound dryness

Answer 59

C. Changes are based on the level of exudate ## Footnote Alginates may require frequent changes based on the level of exudate

Question 60

A therapist chooses a dressing that can be used for wet-to-dry debridement but notes it has a tendency to adhere to the wound bed, traumatizing viable tissue. What dressing is this? A. Gauze B. Hydrocolloid C. Foam D. Transparent film

Answer 60

A. Gauze ## Footnote Gauze has a tendency to adhere to the wound bed and traumatize tissue upon removal. Other Disadvantages: - Highly permeable - Requires frequent dressing changes - Prolonged use decreases cost effectiveness - Increased infected rate compared to occlusive dressings

Question 61

Which debridement method is described as non-selective and specifically involves a whirlpool tank? A. Wound irrigation B. Enzymatic debridement C. Hydrotherapy D. Wet-to-dry

Answer 61

C. Hydrotherapy ## Footnote Hydrotherapy uses a whirlpool tank with agitation for non-selective debridement

Question 62

A therapist wants to use an autolytic debridement method. Which of the following is not a common method used for this? A. Transparent films B. Alginates C. Hydrocolloids D. Sharp debridement

Answer 62

D. Sharp debridement ## Footnote Common methods of **autolytic debridement** include the use of transparent films, hydrocolloids, hydrogels, and alginates - This is non-invasive and pain-free - This can be used with any amount of necrotic tissue, however, requires a longer healing period and is **not commonly performed on infected wounds**

Question 63

A therapist uses a hydrogel as a coupling agent for which modality? A. HVPC B. Ultrasound C. NPWT D. Hyperbaric oxygen

Answer 63

B. Ultrasound ## Footnote Hydrogels can be used as a coupling agent for ultrasound

Question 64

Which dressing is specifically contraindicated for infected wounds? A. Gauze B. Alginate C. Hydrocolloid D. Foam

Answer 64

C. Hydrocolloid ## Footnote Hydrocolloids cannot be used on infected wounds, may traumatize surrounding intact skin upon removal and may tend to roll in areas of excessive friction

Question 65

What is a disadvantage of Negative Pressure Wound Therapy? A. Increases bacterial colonization B. Decreases capillary blood flow C. Treatment can be painful D. Increases interstitial edema

Answer 65

C. Treatment can be painful ## Footnote Disadvantages of NPWT include: - Requires special supplies and training - Treatment can be painful - Not reimbused in acute or long-term care settings

Question 66

A patient is using a water-based moisturizer to replace skin moisture lost to the air. Which product is best for less frequent reapplication? A. Lotion B. Cream C. Moisture barrier D. Skin sealant

Answer 66

B. Cream ## Footnote Creams are thicker than lotions with higher concentrations of oils, making reapplication less frequent

Question 67

A therapist is using a debridement method that removes both viable and nonviable tissue. What is the general term for this? A. Selective debridement B. Autolytic debridement C. Non-selective debridement D. Sharp debridement

Answer 67

C. Non-selective debridement ## Footnote Non-selective debridement is often termed “mechanical debridement” and is most commonly performed via wet-to-dry dressings, wound irrigation, and hydrotherapy (whirlpood)

Question 68

A physical therapist inspects the progress of a partial-thickness wound on a patient's anterior forearm. The therapist notes evidence of resurfacing of the wound with notable changes in the edges of the wound. This observation is MOST consistent with which of the following conditions? A. Maceration B. Granulation C. Epithelialization D. Infection

Answer 68

C. Epithelialization ## Footnote Epithelialization refers to the process of epidermal resurfacing and appears as pink or red skin. This process is a function of keratinocytes, which makes up the layers of the dermis and epidermis as well as the linings of various body organs. (PT365 - 10/15/25)

Question 69

The physical therapist department sponsers a community education program on diabetes mellitus. Which of the following characteristics is NOT typical of Type 1 diabetes? A. Age of onset less than 25 years of age B. Gradual onset C. Controlled through insulin and diet D. Islet cell antibodies present at onset

Answer 69

B. Gradual onset ## Footnote Type 1 diabetes has an abrupt onset and accounts for 5-10 percent of all cases. This type of diabetes requires insulin injections and is more common in children and young adults. Type 2 DM typically occurs in patients over 40 years of age, has a gradual onset, and can usually be controlled with diet, exercise, and oral insulin medication (PT365 - 10/25/2025)

Question 70

A physical therapist performs circumferential measurements on a four-year-old child and notes edema in both lower extremities. Based on the clinical presentation, which diagnosis would be MOST likely? A. Lymphadenitis B. Deep vein thrombosis C. Milroy's Disease D. Wilson's Disease

Answer 70

C. Milroy's Disease ## Footnote Milroy's disese is an inherited type of primary lymphedema that typically presents in infancy. Bilateral LE edema is the most common symptom of this disease, and it may worsen over time (PT365 - 10/08/2025)

Question 71

A physical therapist is performing an evaluation on a 50-year-old patient who is experiencing knee pain following a fall directly onto their right knee two days prior. The patient was able to bear weight on their right knee immediately following the injury and is not experiencing isolated tenderness of the fibular head. During the physical exam, the patient's left knee flexion range of motion is 135°, and their right knee flextion range of motion is 85°. What is the MOST appropriate course of action for the therapist to take? A. Refer the patients for a knee MRI B. Imaging is not required; continue treatment as usual C. Refer the patient for a knee X-ray series D.

Answer 71

C. Refer the patient for a knee X-ray series ## Footnote The Ottawa knee rules are used to determine whether a patient requires a knee X-ray series following a knee injury. A knee X-ray series is required if a patient with knee injury also has any of the following: - Age 55 and older - Isolated patellar tenderness without other bone tenderness - Tenderness of the fibular head - Inability to flex the knee to 90° - Inability to bear weight immediately after injury In this case, the patient is demonstrating an inability to flex their right knee beyond 90° and does not have a prior history of knee conditions, a knee X-ray series is required. (Pocket Prep.)

Question 72

A physical therapist educates a patient status post transfemoral amputation on the importance of frequent skin checks. What is the MOST appropriate resource for the patient to utilize when inspecting the posterior aspect of the residual limb? A. Hand mirror B. Video camera C. Caregiver D. Prosthetist

Answer 72

A. Hand mirror ## Footnote The use of a hand mirror during skin insepection of the residual limb will enable the patient to view the entire limb without being dependent on another person. - A patient should regularly inspect all areas of the residual limb using a mirror to maintain healthy skin. Proper skin care is important for all patients following amputation. (PT365 - 12/29/25)

Question 73

A patient two days following Cesarean delivery complains of incisional pain with coughing and sneezing. What is the MOST appropriate initial physical therapy intervention? A. Brace the incision with a pillow when coughing or sneezing B. Contact the pelvic floor muscles C. Perform friction massage around the incision D. Initiate postural awareness activities

Answer 73

A. Brace the incision with a pillow when coughing or sneezing ## Footnote Post-op pain and discomfort may develop due to adhesions at the site of the incision, poor posture, abdominal weakness, and/or pelvic floor dysfunction. - Bracing an abdominal incision with a pillow during a cough or sneeze supports healing tissue by limiting the abdominal pressure associated with the activity. Instructing the patient in this technique provides an appropriate and immediate method of improving overall comfort. (PT365 - 12/30/25)

Question 74

A physical therapist observes a wound that is noticeably red, slightly shiny, and mildly moist. What is the therapist MOST likely observing? A. Slough B. Granulation tissue C. Nectrotic tissue D. Exposed tendon

Answer 74

B. Granulation tissue ## Footnote This is with the Red-Yellow-Black wound classification system. - Granulation tissue is characterized as pink or red, shiny and moist (PT365 - 1/10/26)

Question 75

A patient presents with a small, round, partial-thickness wound on the lateral malleolus with distinct wound edges. Upon examination, the wound bed is a grey color without evidence of granulation tissue and appears to be dry. The wound is extremely tender to palpation and the patient reports calf pain during walking. These findings are MOST associated with which of the following types of ulcers? A. Venous stasis B. Neuropathic C. Arterial D. Decubitus

Answer 75

C. Arterial ## Footnote Arterial ulcers are the result of arterial insufficiency secondary to inadequate circulation of oxygenated blood (e.g., ischemia), often due to complicating factors such as atherosclerosis. Artial ulcers are often small, round, with distinct wound margins and the wound bed typically lacks granulation tissue due to the lack of blood supply. Pain is often served and arterial ulcers are typically located on the distal limb and foot, especially the toes, the dorsal surface of the foot or the lateral malleolus. (PT365 - 1/13/26)

Question 76

A physical therapist prepares to apply a sterile dressing to a wound after debridement. The therapist begins the process by drying the wound using a towel. The therapist applied medication to the wound using a gauze pad and then applies a series of dressings that are secured using a bandage. The application of which step would NOT warrent the use of sterile technique? A. Bandage B. Dressings C. Medication D. Towel

Answer 76

A. Bandage ## Footnote Application of a bandage does not require sterile technique since the bandage does not come in direct contact with the wound. All other aspects of the scenario require sterile wound technique to proteect the wound and surrounding area, the patient, and the caregiver from contamination (PT365 - 1/15/26)

Question 77

A physical therapist applies a dressing to an area of skin on a patient's heel. The therapist decided to use the dressing as a prophylactic measure to reduce the risk of skin breakdown in an area that was determined to be particularly susceptible. Which of the following dressings would the therapist have MOST likely used? A. Calcium alginate B. Hydrocolloid C. Hydrogel D. Transparent film

Answer 77

D. Transparent film ## Footnote Transparent film dressings consist of thin membranes coated with a layer of acrylic adhesive. Since the film is transparent, it allows for frequent assessment of the wound and offers some level of protection. The films are oxygen permeable, however, are impermeable to microorganisms and moisture. (PT365 - 1/17/25)

Question 78

A physical therapist is treating a patient with an acute ankle sprain. The therapist plans to utilize elastic bandaging to reduce the patient's ankle edema. Which of the following bandages would be the MOST appropriate to use with this patient? A. Short-stretch bandaging to utilize a high working pressure B. Short-stretch bandageing to utilize high resting pressure C. Long-stretch bandageing to utilize a high working pressure D. Long-stretch bandageing to utilize a high resting pressure

Answer 78

D. Long-stretch bandageing to utilize a high resting pressure ## Footnote Long-stretch bandages are often used following an ankle sprain to assist with controlling edema using their high resting pressure. (PT365 - 1/18/25)

Question 79

A physical therapist examins the wound of a patient with diabetes mellitus. The wound is located on the plantar surface of the foot under the head of the first metatarsal and appears non-infected. When asked to flex the great toe, the therapist noticed a tendon gliding in the wound bed. Which of the Wagner Ulcer Grade Classification Scale BEST describes this wound? A. Grade 1 B. Grade 2 C. Grade 3 D. Grade 4

Answer 79

B. Grade 2 ## Footnote A grade 2 ulcer is a deep ulcer with penetration through the subcutaneous tissue, potentially exposing bone, tendon, ligament or joint capsule. The described wound is consistent with a grade 2 neuropathic ulcer. (PT365 - 1/19/25)

Question 80

A physical therapist inspects a burn obtained as a result of iontophoresis. The therapist describes the burn as an alkaline reaction. Which of the following factors would MOST likely cause this type of adverse reaction? A. Sodium hydroxide forming under the cathode B. Hydrochloric acid forming under the cathode C. The size of the cathode being larger than the anode D. An increase in the amount of space between the electrodes

Answer 80

A. Sodium hydroxide forming under the cathode ## Footnote Iontophoresis utilizes a continuous direct current which moves ions through the body's tissues. - A patient may have an alkaline reaction from the iontophoresis treatment as a result of sodium hydroxide forming under the negative electrode (cathode) (PT365 - 1/21/26)

Question 81

A patient is unable to take in an adequate supply of nutrients by mouth. As a result, the patient's physician orders the implementation of tube feeding. What type of tube is MOST commonly used for short-term feeding? A. Endobrachial B. Nasogastric C. Endotracheal D. Tracheostomy

Answer 81

B. Nasogastric ## Footnote A nasogastric tube is a plastic tube inserted through a nostril that extends into the stomach. The device is commonly used for liquid feeding, medication administration or to remove gas from the stomach. A gastric tube is inserted directly into the stomach for long-term feeding (PT365 - 2/1/26)

Question 82

A physical therapist examines a patient post-surgery. The patient has diabetes, however, has no other significant past medical history. Which of the following situation would MOST warrent immediate medical attention? A. Signs of confusion and lethargy B. Systolic BP increase of 20 mmHg during exercise C. Lack of significant clinical findings following the examination D. Discovery of significant past medical history unknown to the physician

Answer 82

A. Signs of confusion and lethargy ## Footnote Confusion and lethargy in a pt with diabetes are signs of hypoglycemia, or low blood glucose. If untreated, hypoglycemia can rapidly progress towards a life-threatening situation - It is important to treat hypoglycemia immediately using glucose tablets or sugar in order to raise blood glucose levels (PT365 - 2/20/26)

Question 83

A physical therapist reviews the medical record of a patient who sustained a spinal cord injury. A note recently entered by the physician indicates that the patient contracted a respiratory infection. Which type of spinal cord injury would be MOST susceptible to this condition? A. Complete C4 Tetraplegia B. Cauda Equina Lesion C. Brown-Sequard's Syndrome D. Posterior Cord Syndrome

Answer 83

A. Complete C4 Tetraplegia ## Footnote A patient with complete C4 tetraplegia will present with a loss of motor and sensory function secondary to damage to the spinal cord. Since the primary muscle of respiration, the Diaphragm (C3-C5), is impaired, the patient will be unable to voluntarily or effectively ventilate - The patient will exhibit limited ability to clear secretions, impaird mobility, and alveolar hypoventilation (PT356 - 2/24/26)

Question 84

A physical therapist reviews the medical record of a patient admitted to the hospital with suspected renal involvement. Which laboratory test would be the MOST useful to assess the patient's present renal function? A. Platelet count B. Hemoglobin C. Blood Urea Nitrogen D. Hematocrit

Answer 84

C. Blood Urea Nitrogen ## Footnote Blood urea nitrogen is a common measure used to assess renal (kidney function) function. The normal blood urea nitrogen level for adults is 10-20 mg/dL - An increased blood urea nitrogen level can be indicative of dehydration, renal failure, or heart failure. A decreased blood urea nitrogen level can be indicative of malnourishment, hepatic failure or pregnancy (PT365 - 3/2/26)

Question 85

A physical therapist works with a patient with hemiparesis who uses a hemiplegic chair for mobility. Which activity would become more challenging for the patient based on this specific type of wheelchair? A. Reaching for objects ouside the base of support B. Standing up form the seat of the chair C. Performing independent pressure relief D. Elevating the legs for edema management

Answer 85

B. Standing up form the seat of the chair ## Footnote A hemiplegic chair incorporates a seat that is approximately two inches lower than a standard chair to enable the user to use the LEs to proper the chair. The patient typically uses one handrim and one or both feet to help propel and steer the wheelchair. One or both front riggings on the wheelchair are removed to provide the feet with necessary space for propulsion. - So since the chair is lower than a standard chair, standing would require significantly more UE and LE strength (PT365 - 3/3/26)

Question 86

A physical therapist treats a patient that is seven months pregnant. The therapist positions the patient in a hooklying position and asks the patient to raise their head from the plinth. Which medical condition is MOST consistent with the described scenario? A. DeQuervain's Disease B. Diastasis Recti C. Thoracic Outlet Syndrome D. Piriformis Syndrome

Answer 86

B. Diastasis Recti ## Footnote Diastasis Recti is a separation of the Rectus Abdominis muscle along the linea alba that can occur during pregnancy. Testing for diastasis recti should be performed on all pregnant women prior to prescribing exercises that require the use of the abdominals. Biomechanical and hormonal changes may cause the separation. Diastasis recti is diagnosed if there is separation greater than the width of two fingers when the women lifts her head and shoulders off the plinth. Focused abdmoninal activities and rotational exercises should be avoided until healing has reduced the separation (PT365 - 3/17/26)

Question 87

A patient with an indwelling Foley Catheter reports new lower abdominal discomfort during gait training. The therapist observes the collection bag positioned at the level of the umbilicus. Which of the following actions would be MOST appropriate for the clinician to perform first? A. Continue gait training and document any additional symptoms B. Lower the drainage bag below the bladder level C. Cease treatment and notify nursing staff about the client's symptoms D. Clamp the catheter tubing before continuing ambulation

Answer 87

B. Lower the drainage bag below the bladder level ## Footnote [(Link for YT vid)](https://www.youtube.com/watch?v=JCA9QePrEJE) The bag must remain below the bladder at all times to prevent retrograde flow, which can cause pain and significantly increase the risk of catheter-assocated UTI. Adjusting the bag height is fully within the PT scope and typically resolves sx's immediately, making it the most appropriate first action.

Question 88

A patient presents with bilateral, symmetrical leg enlargement that is painful to palpation, shows easy bruising, and spares the feet. Stemmer sign is negative. Which of the following conditions is MOST likely present? A. Chronic Venous Insufficiency B. Congestive heart failure C. Lymphedema D. Lipedema

Answer 88

D. Lipedema ## Footnote [(Link for YT vid)](https://www.youtube.com/watch?v=d5Nriv7JgIo) Lipedema is defined by bilateral, symmetrical adipose tisue hypertrophy of the LE's, often extending from the hips to the ankles while sparing the feet, creating a classic "cuffing" appearance. The tissue is painful to palpation, prone to easy bruising due to capillary fragility, and resistant to elevation, compression, and weight loss. Stemmer sign remains negative because the lymphatic system is not primarily impaired in early stages. This constellation of findings - symmetry, pain, bruising, and footing sparing - aligns directly with lipedema and distinguishes it from other causes of LE swelling.