Integ Exam #2 Flashcards

Question

Which type of support surface is most appropriate for a patient with a stage III or IV pressure ulcer who is bedridden? * A. Standard Foam Mattress * B. Low Air Loss Mattress * C. Air-Fluidized Bed * D. Alternating Pressure Mattress

Answer 1

* **Correct: C. Air-Fluidized Bed** Air-fluidized beds provide advanced pressure relief and are indicated for stage III or IV pressure ulcers. * Incorrect: A. Standard Foam Mattress These mattresses do not provide sufficient pressure relief for advanced ulcers. * Incorrect: B. Low Air Loss Mattress While effective, these are typically used for less severe cases. * Incorrect: D. Alternating Pressure Mattress Alternating pressure mattresses are appropriate but less effective than air-fluidized beds for advanced cases.

Answer 2

* **Correct: A. Air-Fluidized Beds** These beds reduce shear while providing excellent immersion and envelopment. * Incorrect: B. Alternating Pressure Mattresses These redistribute pressure but do not significantly minimize shear forces. * Incorrect: C. Low Air Loss Mattresses Low air loss mattresses focus on heat and moisture control rather than shear reduction. * Incorrect: D. Foam Mattresses Foam mattresses may reduce pressure but are less effective at shear reduction.

Answer 3

* **Correct: B. 30-Degree Tilted** Side-Lying This position offloads pressure from the sacrum and coccyx, reducing risk of pressure injury. * Incorrect: A. Semi-Recumbent This position increases pressure on the sacrum and coccyx. * Incorrect: C. 90-Degree Side-Lying This position increases pressure on the greater trochanter. * Incorrect: D. Supine Supine positioning places direct pressure on the sacrum and coccyx.

Answer 4

* **Correct: B. Every 1–2 hours** Immobile patients should be repositioned every 1–2 hours to prevent pressure ulcers. * Incorrect: A. Every 30 minutes While more frequent repositioning is beneficial, it is not standard practice. * Incorrect: C. Every 4 hours This frequency may increase the risk of pressure injuries. * Incorrect: D. Every 6 hours This is too infrequent to effectively prevent ulcers.

Answer 5

* **Correct: B. To redistribute pressure and conform to body contours** Viscoelastic foam molds to the body, redistributing pressure. * Incorrect: A. To prevent heat loss Foam mattresses are not designed for heat management. * Incorrect: C. To reduce shear forces Foam does not significantly reduce shear forces. * Incorrect: D. To enhance moisture evaporation Foam does not actively manage moisture.

Answer 6

* **Correct: B. Low Air Loss** Mattress Low air loss mattresses are indicated for patients with stage II ulcers that have not improved with standard care. * Incorrect: A. Air-Fluidized Mattress These are typically reserved for advanced stage III or IV ulcers. * Incorrect: C. Alternating Pressure Mattress Alternating pressure mattresses are often a step before low air loss mattresses. * Incorrect: D. Viscoelastic Foam Mattress Foam mattresses are for prevention and less severe cases.

Answer 7

* **Correct: B. Cyclic redistribution of pressure** Alternating pressure mattresses cyclically inflate and deflate to redistribute pressure across different body areas. * Incorrect: A. Continuous air circulation This is a feature of low air loss mattresses, not alternating pressure systems. * Incorrect: C. Reduced moisture at the wound site Moisture management is not the primary function of alternating pressure. * Incorrect: D. Enhanced immersion and envelopment This is more typical of air-fluidized beds.

Answer 8

* **Correct: C. Forward lean** Leaning forward effectively offloads the ischial tuberosities. * Incorrect: A. Reclining backward Reclining may redistribute pressure but does not specifically offload the ischial tuberosities. * Incorrect: B. Side-lean Side-lean redistributes pressure to one side but not from the ischial tuberosities. * Incorrect: D. Push-up pressure relief This offloads the buttocks entirely, not specifically the ischial tuberosities.

Answer 9

* **Correct: A. To offload the greater trochanter** The 30-degree tilted side-lying position reduces pressure on the greater trochanter. * Incorrect: B. To reduce moisture accumulation This position does not directly address moisture control. * Incorrect: C. To minimize shear forces Shear reduction is not the primary goal of this position. * Incorrect: D. To facilitate pulmonary drainage Pulmonary drainage is not the intended outcome.

Answer 10

* **Correct: B. Fluid-Filled Bladders** Fluid-filled bladders evenly distribute pressure across the surface area. * Incorrect: A. Low Air Loss Mattress These manage heat and moisture but do not use fluid-filled bladders. * Incorrect: C. Air-Fluidized Mattress These create a fluid-like medium using air, not fluid bladders. * Incorrect: D. Alternating Pressure Mattress These rely on cyclic inflation and deflation, not fluid-filled components.

Answer 11

* **Correct: A. Air-Fluidized Mattress** Air-fluidized beds are contraindicated for patients with active bleeding due to their effect on moisture evaporation and potential for bleeding exacerbation. * Incorrect: B. Alternating Pressure Mattress These are not contraindicated for active bleeding. * Incorrect: C. Low Air Loss Mattress Low air loss mattresses are suitable for patients with active bleeding. * Incorrect: D. Foam Mattress Foam mattresses are not contraindicated.

Answer 12

* Correct: A. Every 15–30 minutes Wheelchair users should perform pressure relief techniques every 15–30 minutes to prevent pressure injuries. * Incorrect: B. Every 1–2 hours This frequency is recommended for bed-bound patients, not wheelchair users. * Incorrect: C. Every 4 hours This is too infrequent to prevent pressure injuries. * Incorrect: D. Every 6 hours This is insufficient to prevent pressure injuries.

Answer 13

* **Correct: C. Heel ulcer** Elevating and offloading the heels is critical for managing and preventing further damage to heel ulcers. * Incorrect: A. Trochanteric ulcer Trochanteric ulcers require offloading from the greater trochanter, not the heels. * Incorrect: B. Sacral ulcer Sacral ulcers require offloading from the sacrum. * Incorrect: D. Coccygeal ulcer Coccygeal ulcers also require offloading but not from the heels.

Answer 14

* Correct: B. They retain body heat and can warm over time Gel overlays absorb body heat, initially feeling cool but warming over time, which can cause discomfort. * Incorrect: A. They are costly to manufacture Cost is not a primary disadvantage. * Incorrect: C. They lack pressure redistribution capabilities Gel overlays do provide pressure redistribution. * Incorrect: D. They are ineffective for multiple pressure ulcers Gel overlays can be effective for multiple ulcers.

Answer 15

* Correct: C. Positioning one lung higher than the other Lateral rotation beds assist in pulmonary therapy by positioning one lung higher to prevent pneumonia. * Incorrect: A. Pressure redistribution While they redistribute pressure, this is not specific to pulmonary therapy. * Incorrect: B. Cyclic inflation and deflation This is a feature of alternating pressure beds, not lateral rotation beds. * Incorrect: D. Managing heat and moisture This is not the primary function of lateral rotation beds.

Answer 16

* Correct: B. Regulate vessel diameter The tunica media, composed of smooth muscle, modulates vessel diameter to regulate blood flow. * Incorrect: A. Protect vessel walls from trauma This is the function of the tunica externa. * Incorrect: C. Facilitate oxygen exchange Oxygen exchange occurs at the capillaries. * Incorrect: D. Provide structural support Structural support is the role of the tunica externa.

Answer 17

* Correct: B. Arteriosclerosis Arteriosclerosis leads to thickening and hardening of the arterial walls, decreasing perfusion and causing ulcers. * Incorrect: A. Diabetes mellitus Diabetes contributes to arterial insufficiency but is not the most common direct cause. * Incorrect: C. Thromboangiitis obliterans This is a rare condition associated with arterial ulcers. * Incorrect: D. Trauma Trauma may precipitate arterial ulcers but is not the primary cause.

Answer 18

* Correct: B. Activity-induced discomfort relieved by rest Intermittent claudication is ischemic pain triggered by activity and relieved within minutes of rest. * Incorrect: A. Pain at rest caused by ischemia This describes ischemic rest pain, not claudication. * Incorrect: C. Burning pain exacerbated by elevation This also describes ischemic rest pain. * Incorrect: D. Pain caused by venous insufficiency Claudication is specific to arterial insufficiency, not venous issues.

Answer 19

* Correct: B. Anterior leg and lateral malleolus Arterial ulcers are typically found in the lower extremities, particularly the anterior leg and lateral malleolus. * Incorrect: A. Medial malleolus This is a common location for venous ulcers. * Incorrect: C. Popliteal fossa Arterial ulcers are rarely found in this area. * Incorrect: D. Thigh Arterial ulcers are uncommon in the thigh.

Answer 20

* Correct: B. Dependent rubor and elevational pallor These signs indicate impaired arterial perfusion and are hallmark symptoms of arterial insufficiency. * Incorrect: A. Swelling and edema These are more indicative of venous insufficiency. * Incorrect: C. Varicose veins These are associated with venous insufficiency. * Incorrect: D. Warm skin temperature Cool skin temperature is a characteristic of arterial insufficiency.

Answer 21

* Correct: B. Well-defined, dry, and "punched out" wounds Arterial ulcers often have smooth edges and are associated with dry necrosis. * Incorrect: A. Irregular, shallow wounds with heavy exudate These are features of venous ulcers. * Incorrect: C. Circular, moist wounds with granulation tissue Moist wounds are more indicative of pressure or mixed ulcers. * Incorrect: D. Large, weeping wounds above the knee Arterial ulcers are usually located below the knee.

Answer 22

* Correct: C. Determine the severity of arterial insufficiency ABI compares upper and lower extremity pressures to evaluate arterial perfusion. * Incorrect: A. Assess oxygenation of tissues Oxygenation is measured with tcpO2, not ABI. * Incorrect: B. Diagnose venous insufficiency ABI assesses arterial insufficiency, not venous issues. * Incorrect: D. Identify neuropathic involvement ABI is unrelated to neuropathic assessment.

Answer 23

* Correct: A. Hydrogel with a secondary dressing Hydrogel provides moisture to the wound bed, softening necrotic tissue for autolytic debridement. * Incorrect: B. Foam dressing Foam dressings are not typically used for dry necrotic wounds. * Incorrect: C. Alginate Alginate is better suited for wounds with heavy exudate. * Incorrect: D. Hydrocolloid Hydrocolloids are not ideal for arterial ulcers with dry necrosis.

Answer 24

* Correct: B. ABI < 0.5 Debridement is contraindicated when perfusion is insufficient to support healing (ABI < 0.5). * Incorrect: A. Presence of slough Slough may require debridement if perfusion is adequate. * Incorrect: C. Toe pressure >50 mmHg This indicates sufficient perfusion for debridement. * Incorrect: D. Moderate exudate Exudate level does not contraindicate debridement.

Answer 25

* Correct: B. Maintain warmth and avoid compression Maintaining warmth supports circulation, while compression is contraindicated for impaired perfusion. * Incorrect: A. Apply compression therapy Compression is contraindicated in arterial insufficiency. * Incorrect: C. Aggressively debride necrotic tissue Debridement is contraindicated with impaired perfusion. * Incorrect: D. Use foam dressings for heavy exudate Foam dressings are not ideal for dry wounds.

Answer 26

* Correct: A. Smoking Smoking significantly contributes to arterial insufficiency by causing vasoconstriction, increasing clot formation, and reducing oxygen availability. * Incorrect: B. Advanced age While age is a risk factor, smoking has a stronger association with progression. * Incorrect: C. Trauma Trauma is often a precipitating factor but not the primary contributor to progression. * Incorrect: D. Hypertension Hypertension contributes but less significantly than smoking.

Answer 27

* **Correct: B. Evaluate arterial flow in the lower extremities** The Rubor of Dependency test evaluates arterial blood flow by observing color changes with leg elevation and dependency. * Incorrect: A. Assess venous reflux This test does not evaluate venous function. * Incorrect: C. Determine capillary refill time Capillary refill is assessed separately using nail bed pressure. * Incorrect: D. Measure oxygenation in tissues Tissue oxygenation is measured with tcpO2, not this test.

Answer 28

* **Correct: D. ABI < 0.5** An ABI value below 0.5 indicates severe arterial insufficiency, often associated with rest pain or tissue loss. * Incorrect: A. ABI ≥ 1.3 This suggests calcified, non-compressible vessels, common in diabetes or CKD. * Incorrect: B. ABI 0.95–1.0 This range is considered normal. * Incorrect: C. ABI 0.5–0.8 This range indicates moderate arterial disease.

Answer 29

* **Correct: B. Hyperbaric Oxygen Therapy** HBO improves oxygenation and promotes healing in well-perfused arterial ulcers. * Incorrect: A. Negative Pressure Wound Therapy NPWT is contraindicated for poorly perfused wounds. * Incorrect: C. Low-Intensity Laser Therapy While helpful, HBO is more directly beneficial for arterial ulcers. * Incorrect: D. Electrical Stimulation Electrical stimulation is useful but secondary to HBO in arterial ulcers.

Answer 30

* **Correct: C. Demonstrates arterial insufficiency with reactive hyperemia** Dependent rubor is a classic sign of arterial insufficiency and indicates poor perfusion. * Incorrect: A. Indicates venous congestion Venous congestion does not cause dependent rubor. * Incorrect: B. Suggests collateral circulation is intact Dependent rubor suggests inadequate arterial perfusion, not sufficient collateral circulation. * Incorrect: D. Confirms the presence of neuropathy Neuropathy does not typically cause dependent rubor.

Answer 31

* **Correct: B. To evaluate oxygen diffusion across the skin** TcpO2 measures oxygen diffusion to assess tissue perfusion. * Incorrect: A. To assess venous insufficiency TcpO2 is used for arterial, not venous, evaluation. * Incorrect: C. To measure ankle pressure Ankle pressures are measured using ABI, not tcpO2. * Incorrect: D. To determine the risk of neuropathy TcpO2 does not assess neuropathy risk.

Answer 32

* **Correct: B. Revascularization** Revascularization is essential to restore blood flow and relieve ischemic rest pain. * Incorrect: A. Aggressive debridement Debridement is contraindicated without adequate perfusion. * Incorrect: C. Compression therapy Compression is contraindicated in arterial insufficiency. * Incorrect: D. Autolytic debridement Autolytic debridement is not effective without adequate perfusion.

Answer 33

* **Correct: A. Hydrocolloid** Hydrocolloids are occlusive and not recommended for dry necrotic arterial ulcers. * Incorrect: B. Non-adherent foam Foam dressings are suitable for protecting dry necrotic areas. * Incorrect: C. Hydrogel Hydrogel is appropriate for moistening dry necrotic tissue. * Incorrect: D. Alginate Alginate is inappropriate for dry wounds but is not contraindicated.

Answer 34

* **Correct: C. Smoking** Smoking exacerbates arterial insufficiency by increasing clot formation, vasoconstriction, and reducing oxygen delivery. * Incorrect: A. Hyperlipidemia While significant, hyperlipidemia contributes less directly than smoking. * Incorrect: B. Impaired wound healing Impaired healing is a consequence, not a primary contributor. * Incorrect: D. Poor glycemic control Glycemic control impacts arterial health but less than smoking.

Answer 35

* **Correct: C. Revascularization** consultation Immediate revascularization is required for severe arterial insufficiency. * Incorrect: A. Compression therapy Compression is contraindicated with ABI < 0.5. * Incorrect: B. Surgical debridement Debridement is unsafe without adequate perfusion. * Incorrect: D. Apply hydrogel dressing Hydrogel does not address perfusion issues.

Answer 36

* **Correct: B. Peripheral neuropathy** Peripheral neuropathy leads to loss of sensation, making patients unaware of injuries and pressure, which can lead to ulceration. * Incorrect: A. Venous insufficiency Venous insufficiency causes different types of ulcers. * Incorrect: C. Arterial insufficiency Arterial insufficiency is not the primary cause of neuropathic ulcers. * Incorrect: D. Pressure injuries Pressure injuries can contribute but are secondary to neuropathy.

Answer 37

* **Correct: A. Poor glycemic control** Hyperglycemia impairs immune function, collagen synthesis, and angiogenesis, delaying wound healing. * Incorrect: B. Advanced age While age is a factor, poor glycemic control is more significant in diabetes. * Incorrect: C. Inadequate protein intake Protein deficiency affects healing but is not the primary issue in diabetes. * Incorrect: D. Lack of exercise Exercise affects overall health but is less directly linked to delayed wound healing.

Answer 38

* **Correct: B. Well-defined margins with surrounding callus** Neuropathic ulcers typically have well-defined margins and callus around the wound due to repetitive trauma and pressure. * Incorrect: A. Irregular edges with heavy exudate These are characteristics of venous ulcers. * Incorrect: C. Painful wound with erythematous base Neuropathic ulcers are often painless due to sensory loss. * Incorrect: D. Punched-out appearance with dry necrosis This describes arterial ulcers.

Answer 39

* **Correct: C. Plantar aspect of the foot** Neuropathic ulcers commonly occur on weight-bearing areas like the plantar surface. * Incorrect: A. Dorsum of the foot This location is less typical for neuropathic ulcers. * Incorrect: B. Medial malleolus This is a common site for venous ulcers. * Incorrect: D. Popliteal fossa Neuropathic ulcers do not typically occur in this area.

Answer 40

* Correct: C. Identify loss of protective sensation The monofilament test assesses sensory function to identify areas of diminished sensation. * Incorrect: A. Assess motor neuropathy Motor neuropathy involves muscle weakness, not sensory loss. * Incorrect: B. Evaluate arterial blood flow The monofilament test does not assess circulation. * Incorrect: D. Determine autonomic dysfunction The test does not evaluate autonomic functions.

Answer 41

* Correct: A. Total contact cast Total contact casting evenly redistributes pressure, protecting the ulcer and promoting healing. * Incorrect: B. Diabetic shoes Diabetic shoes are effective for prevention but not the gold standard for treatment. * Incorrect: C. Gel heel cushion Heel cushions reduce pressure locally but are not comprehensive solutions. * Incorrect: D. Knee scooter Knee scooters are used for mobility, not pressure off-loading.

Answer 42

* Correct: C. Autonomic neuropathy Autonomic neuropathy affects involuntary functions, such as sweat production and blood flow, contributing to diabetic wound pathology. * Incorrect: A. Sensory neuropathy Sensory neuropathy involves loss of protective sensation, not autonomic function. * Incorrect: B. Motor neuropathy Motor neuropathy causes muscle weakness, not autonomic dysfunction. * Incorrect: D. Mixed neuropathy While mixed neuropathy may involve autonomic dysfunction, the specific cause here is autonomic neuropathy.

Answer 43

* Correct: C. Increased risk of neuropathic ulcers Elevated plantar pressure exacerbates tissue damage, leading to ulcer formation in patients with sensory loss. * Incorrect: A. Increased risk of arterial insufficiency ulcers Arterial ulcers are not caused by plantar pressure. * Incorrect: B. Decreased callus formation Plantar pressure increases callus formation. * Incorrect: D. Improved blood flow to the toes Elevated pressure does not improve circulation.

Answer 44

* Correct: B. Presence of infection or osteomyelitis Total contact casting is contraindicated when infection or osteomyelitis is present, as it can exacerbate the condition. * Incorrect: A. Plantar ulcers with moderate exudate Total contact casting can still be used for exudative ulcers with appropriate dressings. * Incorrect: C. Neuropathic ulcers in non-weight-bearing areas Off-loading is not required for non-weight-bearing areas. * Incorrect: D. Patients with normal sensation Total contact casting is primarily for those with sensory loss.

Answer 45

* Correct: C. Daily Diabetic patients should inspect their feet daily to identify early signs of injury or ulceration. * Incorrect: A. Weekly Weekly inspections may miss early signs of injury. * Incorrect: B. Biweekly This frequency is insufficient for high-risk patients. * Incorrect: D. Monthly Monthly inspections are not frequent enough for prevention.

Answer 46

* Correct: B. Reduces sweat production, causing dry and cracked skin Autonomic neuropathy reduces sweat production, leading to dry skin and fissures that increase ulcer risk. * Incorrect: A. Increases tissue oxygenation Autonomic dysfunction reduces perfusion rather than improving oxygenation. * Incorrect: C. Enhances vascular dilation It impairs vascular regulation, not dilation. * Incorrect: D. Strengthens plantar muscles Motor neuropathy affects muscles, not autonomic neuropathy.

Answer 47

* Correct: B. Start broad-spectrum antibiotics Antibiotics address infection, which must be managed before other interventions like debridement or casting. * Incorrect: A. Apply an alginate dressing Dressings alone do not manage infections. * Incorrect: C. Perform surgical debridement Debridement can spread infection if not controlled first. * Incorrect: D. Initiate total contact casting Casting is contraindicated in the presence of infection.

Answer 48

* Correct: B. 10-gram monofilament test The monofilament test is the gold standard for identifying loss of protective sensation. * Incorrect: A. Tuning fork test The tuning fork evaluates vibratory sensation, not protective sensation. * Incorrect: C. Ankle-brachial index (ABI) ABI assesses arterial perfusion, not sensation. * Incorrect: D. Transcutaneous oxygen pressure (tcpO2) TcpO2 measures tissue oxygenation, not sensory function.

Answer 49

* Correct: B. Muscle atrophy and foot deformities Motor neuropathy causes intrinsic muscle weakness, leading to deformities like claw toes. * Incorrect: A. Loss of sensation This is a feature of sensory neuropathy, not motor neuropathy. * Incorrect: C. Increased sweat production Autonomic neuropathy reduces, not increases, sweat production. * Incorrect: D. Elevated plantar pressures This results from foot deformities caused by motor neuropathy but is not a direct characteristic.

Answer 50

* Correct: B. Off-load pressure and immobilize the foot The CROW device redistributes pressure and immobilizes the foot to facilitate healing. * Incorrect: A. Enhance vascular flow to the foot It does not improve vascular flow. * Incorrect: C. Improve ankle joint mobility The CROW is designed for immobilization, not mobility. * Incorrect: D. Reduce sweat production in autonomic neuropathy It does not address autonomic dysfunction.

Answer 51

* Correct: B. Daily foot inspections and protective footwear Regular inspections and appropriate footwear prevent injury and reduce recurrence risk. * Incorrect: A. Total contact casting Casting is effective for treatment but not prevention. * Incorrect: C. Routine whirlpool therapy Whirlpool therapy is not indicated for prevention. * Incorrect: D. Application of hydrogel dressings Dressings are for wound management, not prevention.

Answer 52

* Correct: A. Custom-molded orthotics Orthotics redistribute plantar pressure, reducing the risk of ulceration. * Incorrect: B. Heel cushions Cushions only address localized pressure and are not sufficient alone. * Incorrect: C. Increased walking activity Excessive activity may increase plantar pressures and injury risk. * Incorrect: D. Surgical intervention Surgery is reserved for severe cases or deformities.

Answer 53

* Correct: B. Increased exudate and erythema These signs indicate inflammation and possible infection in a diabetic ulcer. * Incorrect: A. Presence of granulation tissue Granulation tissue is a sign of healing, not infection. * Incorrect: C. Dry wound bed A dry wound bed does not necessarily indicate infection. * Incorrect: D. Reduced wound size Reduction in size is a sign of healing.

Answer 54

* Correct: A. Charcot restraint orthotic walker (CROW) The CROW is an alternative off-loading device for patients unable to tolerate casting. * Incorrect: B. Diabetic shoes with custom inserts These are preventive measures, not substitutes for casting. * Incorrect: C. Gel heel cushion Cushions provide localized relief but are insufficient for significant off-loading. * Incorrect: D. Ankle-foot orthosis (AFO) AFOs are used for support but do not redistribute pressure.

Answer 55

* Correct: B. 0.8–1.0 ABI values in this range indicate sufficient arterial perfusion for safe compression. * Incorrect: A. 0.9–1.2 While normal, this range may not include all diabetic patients. * Incorrect: C. 0.5–0.7 This range indicates moderate arterial insufficiency, making compression risky. * Incorrect: D. <0.5 ABI below 0.5 is contraindicated for compression therapy.

Answer 56

* Correct: B. Prevent backflow of blood Venous valves ensure unidirectional flow of blood toward the heart. * Incorrect: A. Propel blood forward using muscle contraction Propulsion is achieved by the muscle pump, not valves. * Incorrect: C. Facilitate oxygen exchange Oxygen exchange occurs in capillaries, not veins. * Incorrect: D. Regulate venous blood pressure Pressure regulation involves multiple factors, not solely valves.

Answer 57

* Correct: A. Prolonged standing Standing for extended periods increases venous pressure and contributes to valve dysfunction. * Incorrect: B. Low blood pressure Low blood pressure does not cause venous insufficiency. * Incorrect: C. Sedentary lifestyle While relevant, it is less directly linked than prolonged standing. * Incorrect: D. Low BMI High BMI is a more significant risk factor.

Answer 58

* Correct: B. Dependent edema Dependent edema is a hallmark of venous insufficiency, caused by increased venous pressure and fluid leakage. * Incorrect: A. Intermittent claudication This is associated with arterial insufficiency. * Incorrect: C. Cool, pale skin These symptoms suggest arterial disease. * Incorrect: D. Thickened toenails Thickened toenails are not a primary sign of venous insufficiency.

Answer 59

* Correct: B. Assess valve competency The Trendelenburg test evaluates venous valve function and retrograde blood flow. * Incorrect: A. Evaluate arterial perfusion This is unrelated to the Trendelenburg test. * Incorrect: C. Measure capillary refill time Capillary refill is assessed using different methods. * Incorrect: D. Determine risk of neuropathy Neuropathy is unrelated to venous insufficiency.

Answer 60

* Correct: B. Venous reflux or insufficiency Rapid venous filling indicates valve incompetence and venous reflux. * Incorrect: A. Normal venous return Normal filling time is 5–15 seconds. * Incorrect: C. Delayed arterial perfusion Delayed filling (>20 seconds) suggests arterial disease. * Incorrect: D. Elevated capillary pressure Capillary pressure is not directly measured in this test.

Answer 61

* Correct: A. Medial malleolus Venous ulcers frequently develop near the medial malleolus due to high venous pressure. * Incorrect: B. Plantar surface of the foot This is common for neuropathic ulcers. * Incorrect: C. Dorsum of the foot This location is associated with arterial ulcers. * Incorrect: D. Anterior leg This is less typical for venous ulcers.

Answer 62

* Correct: B. Shallow, irregular, with moderate exudate Venous ulcers typically appear shallow, irregularly shaped, and moderately exudative. * Incorrect: A. Punched-out, dry, with black eschar This describes arterial ulcers. * Incorrect: C. Well-defined, calloused edges These are characteristics of neuropathic ulcers. * Incorrect: D. Circular, deep, with minimal drainage This describes pressure ulcers.

Answer 63

* Correct: B. Reduce venous hypertension Lowering venous pressure promotes healing and reduces ulcer recurrence. * Incorrect: A. Promote arterial perfusion This is relevant for arterial ulcers, not venous. * Incorrect: C. Enhance sensory perception Sensory deficits are not a primary concern in venous ulcers. * Incorrect: D. Decrease oxygen demand This is unrelated to venous ulcer management.

Answer 64

* Correct: A. Short-stretch bandages These provide graduated compression, reducing venous hypertension and promoting healing. * Incorrect: B. Low air loss mattress This is for pressure management, not compression. * Incorrect: C. Total contact cast This is used for off-loading neuropathic ulcers. * Incorrect: D. Hydrocolloid dressing This addresses moisture but does not provide compression.

Answer 65

* Correct: A. ABI <0.8 Compression is contraindicated when ABI indicates moderate or severe arterial insufficiency. * Incorrect: B. Swelling and edema Compression is indicated for edema management. * Incorrect: C. Presence of exudate Compression can help manage venous ulcers with exudate. * Incorrect: D. Irregular wound edges Compression therapy is not contraindicated for irregular wounds.

Answer 66

* Correct: C. Classify severity of venous disorders CEAP (Clinical, Etiological, Anatomical, Pathophysiological) categorizes venous disease for standardized assessment. * Incorrect: A. Evaluate arterial insufficiency CEAP is not used for arterial disorders. * Incorrect: B. Determine risk of neuropathy Neuropathy is unrelated to CEAP. * Incorrect: D. Identify underlying infection CEAP does not assess infection.

Answer 67

* Correct: C. Reflects chronic venous hypertension Hemosiderin staining occurs due to chronic leakage of red blood cells and venous pressure. * Incorrect: A. Indicates arterial insufficiency Hemosiderin staining is unrelated to arterial conditions. * Incorrect: B. Suggests reduced tissue oxygenation Oxygenation issues are more common in arterial insufficiency. * Incorrect: D. Confirms neuropathy Hemosiderin staining is not related to neuropathy.

Answer 68

* Correct: A. Increased venous pressure Chronic venous hypertension leads to tissue damage and ulcer formation. * Incorrect: B. Loss of protective sensation This is a key factor in neuropathic ulcers. * Incorrect: C. Arterial ischemia Ischemia contributes to arterial ulcers, not venous ulcers. * Incorrect: D. Muscle atrophy Muscle atrophy is not a primary factor in venous ulcer development.

Answer 69

* Correct: B. Propel blood toward the heart The calf muscle pump assists in venous return by contracting and pushing blood toward the heart. * Incorrect: A. Prevent venous reflux Valves, not muscles, prevent reflux. * Incorrect: C. Enhance capillary oxygen exchange Oxygen exchange occurs in capillaries, not veins. * Incorrect: D. Maintain valve integrity Valve integrity is not directly affected by the muscle pump.

Answer 70

* Correct: B. Alginate dressing Alginates absorb large amounts of exudate, making them suitable for heavily draining venous ulcers. * Incorrect: A. Hydrocolloid dressing Hydrocolloids are not ideal for heavily exudative wounds. * Incorrect: C. Foam dressing Foam dressings absorb moderate exudate but may not be sufficient for heavy drainage. * Incorrect: D. Transparent film Films are unsuitable for exudative wounds.

Answer 71

* Correct: B. Lipodermatosclerosis This condition involves skin thickening and inflammation due to chronic venous hypertension. * Incorrect: A. Erythema Erythema is nonspecific and not unique to venous disease. * Incorrect: C. Cyanosis Cyanosis is more indicative of arterial or systemic issues. * Incorrect: D. Pallor Pallor is associated with arterial insufficiency, not venous disease.

Answer 72

* Correct: B. Multi-layer bandaging Multi-layer bandages deliver sustained, graduated compression for venous insufficiency management. * Incorrect: A. Elastic stockings Stockings provide compression but not as effectively as multi-layer systems. * Incorrect: C. Tubular bandages Tubular bandages offer light compression. * Incorrect: D. Unna boot Unna boots are effective but less adjustable than multi-layer systems.

Answer 73

* Correct: B. Visualize venous valve function and flow Duplex ultrasound provides real-time imaging to assess valve competency and venous flow. * Incorrect: A. Assess arterial perfusion Duplex ultrasound is not primarily used for arterial evaluation. * Incorrect: C. Measure tissue oxygenation TcpO2 evaluates oxygenation, not duplex ultrasound. * Incorrect: D. Determine ABI ABI measures arterial pressure, not venous flow.

Answer 74

* Correct: A. Compression therapy Compression promotes venous return and lymphatic drainage, reducing edema and enhancing healing. * Incorrect: B. Negative pressure wound therapy NPWT does not directly enhance venous return or lymphatic drainage. * Incorrect: C. Hyperbaric oxygen therapy HBO is for oxygenation, not venous return. * Incorrect: D. Electrical stimulation Electrical stimulation is not a primary treatment for venous insufficiency.

Answer 75

* Correct: A. Daily, during waking hours Compression garments should be worn daily to manage venous pressure and prevent ulcer recurrence. * Incorrect: B. Every other day Intermittent use is ineffective for venous insufficiency. * Incorrect: C. Only when swelling is present Consistent use is required regardless of swelling. * Incorrect: D. During sleep only Compression is typically avoided during sleep.

Answer 76

* Correct: A. Endovenous ablation Endovenous ablation uses thermal energy to close incompetent superficial veins. * Incorrect: B. Vein stripping This is a more invasive procedure than ablation. * Incorrect: C. Sclerotherapy Sclerotherapy involves chemical closure, not thermal energy. * Incorrect: D. Subfascial endoscopic perforator surgery (SEPS) SEPS targets perforator veins, not superficial veins.

Answer 77

* Correct: A. Active infection Unna boots are contraindicated in the presence of infection due to the risk of exacerbation. * Incorrect: B. Edema Unna boots are effective for edema management. * Incorrect: C. ABI >1.0 Normal ABI is not a contraindication. * Incorrect: D. Hemosiderin staining Staining does not contraindicate Unna boot use.

Answer 78

* Correct: B. Treat incompetent perforator veins SEPS targets perforator veins to reduce venous reflux and improve circulation. * Incorrect: A. Remove superficial varicose veins SEPS is not designed for superficial vein treatment. * Incorrect: C. Increase venous pressure The goal is to reduce venous pressure, not increase it. * Incorrect: D. Improve oxygen diffusion to tissues SEPS does not directly affect oxygen diffusion.

Answer 79

* Correct: A. Reduce venous hypertension Managing venous hypertension is critical to healing and preventing venous ulcer recurrence. * Incorrect: B. Enhance arterial flow Arterial flow is not the focus of venous management. * Incorrect: C. Increase oxygen delivery Oxygen delivery is not directly addressed in venous ulcer management. * Incorrect: D. Prevent neuropathic changes Neuropathy is not the primary concern in venous insufficiency.

Answer 80

* Correct: B. Promote venous return and reduce edema Compression therapy enhances venous return, reduces venous hypertension, and decreases edema. * Incorrect: A. Increase arterial blood flow Compression primarily targets the venous system, not arterial flow. * Incorrect: C. Decrease oxygen demand in tissues Compression does not directly affect oxygen demand. * Incorrect: D. Prevent skin breakdown Prevention of skin breakdown is a secondary benefit.

Answer 81

* Correct: B. Short-stretch bandages Short-stretch bandages provide high working pressure during movement, making them ideal for active patients. * Incorrect: A. Long-stretch bandages Long-stretch bandages provide more resting pressure, suitable for less active patients. * Incorrect: C. Elastic stockings These are used for maintenance, not primary therapy. * Incorrect: D. Unna’s Boot This is effective but less adjustable for activity levels.

Answer 82

* Correct: C. 0.8 ABI ≥0.8 indicates sufficient arterial perfusion for safe compression therapy. * Incorrect: A. 0.5 ABI <0.8 suggests significant arterial insufficiency and risks ischemia with compression. * Incorrect: B. 0.6 This value indicates borderline safety, requiring caution. * Incorrect: D. 1.0 ABI of 1.0 is normal but not a minimum requirement.

Answer 83

* Correct: B. Cellulitis Active cellulitis is a contraindication as compression can exacerbate infection. * Incorrect: A. Mild edema Compression is indicated for edema management. * Incorrect: C. Lymphedema Compression is a cornerstone of lymphedema treatment. * Incorrect: D. Venous ulcers Compression is essential for venous ulcer management.

Answer 84

* Correct: C. Improves venous return during movement Higher stiffness creates greater pressure differences, improving venous return during activity. * Incorrect: A. Increases resting pressure Stiff bandages have lower resting pressure. * Incorrect: B. Reduces working pressure Higher stiffness increases working pressure. * Incorrect: D. Enhances skin hydration Compression does not directly affect hydration.

Answer 85

* Correct: A. Multi-layer bandage system Multi-layer bandages create a strong pressure gradient, optimizing venous return. * Incorrect: B. Elastic stockings Stockings provide a consistent gradient but are less adjustable than multi-layer systems. * Incorrect: C. Intermittent pneumatic compression This provides intermittent rather than static gradient pressure. * Incorrect: D. Long-stretch bandages These lack the strong gradient of multi-layer systems.

Answer 86

* Correct: C. Treat venous ulcers Unna’s Boot provides consistent compression and supports healing in venous ulcers. * Incorrect: A. Prevent arterial insufficiency Compression does not address arterial insufficiency. * Incorrect: B. Maintain skin hydration While the zinc oxide in Unna’s Boot can support skin integrity, hydration is not its main purpose. * Incorrect: D. Reduce muscle fatigue Unna’s Boot is unrelated to muscle fatigue management.

Answer 87

* Correct: B. Elastic stockings Elastic stockings are commonly used for maintenance therapy in chronic venous insufficiency. * Incorrect: A. Compression wraps Wraps are more appropriate for acute or short-term management. * Incorrect: C. Pneumatic compression device These are used for specific conditions, not general maintenance. * Incorrect: D. Gel heel cushions Cushions do not provide therapeutic compression.

Answer 88

* Correct: C. 30–40 mmHg This range provides effective therapeutic compression for venous insufficiency. * Incorrect: A. 10–20 mmHg This range is insufficient for venous insufficiency. * Incorrect: B. 20–30 mmHg This range is used for mild conditions, not venous insufficiency. * Incorrect: D. 40–50 mmHg This range may be excessive for many patients.

Answer 89

* Correct: B. Intermittent pneumatic compression pump These pumps enhance venous return by sequentially compressing different sections. * Incorrect: A. Multi-layer bandage Bandages provide static compression, not sequential. * Incorrect: C. Short-stretch bandage These create high working pressure during movement but are not sequential. * Incorrect: D. Toe wraps These address localized compression but do not provide sequential compression.

Answer 90

* Correct: B. 20–30 mmHg This range is appropriate for managing mild lymphedema. * Incorrect: A. 15–20 mmHg This range is typically used for prevention or minor swelling. * Incorrect: C. 30–40 mmHg This range is for moderate to severe conditions. * Incorrect: D. 40–50 mmHg This range is generally too high for mild lymphedema.

Answer 91

* Correct: C. Compliance with wearing schedules Consistent use is essential for the effectiveness of compression therapy. * Incorrect: A. BMI BMI may affect selection but is not critical for success. * Incorrect: B. Skin hydration While important for comfort, hydration is secondary to compliance. * Incorrect: D. Age Age is not a direct determinant of success.

Answer 92

* Correct: B. Multi-layer bandage system Multi-layer systems provide effective compression and manage exudate with absorbent layers. * Incorrect: A. Elastic stockings Stockings are better suited for maintenance therapy. * Incorrect: C. Pneumatic compression pump Pumps are not first-line therapy for active ulcers. * Incorrect: D. Long-stretch bandage These lack sufficient working pressure for venous ulcers.

Answer 93

* Correct: B. Provide high working pressure during activity Short-stretch bandages increase pressure during muscle contraction, enhancing venous return. * Incorrect: A. Maintain consistent pressure at rest They provide low resting pressure. * Incorrect: C. Reduce arterial perfusion Compression does not aim to reduce arterial perfusion. * Incorrect: D. Prevent muscle fatigue Muscle fatigue is not directly addressed by compression.

Answer 94

* Correct: B. Toe wraps Toe wraps effectively target localized swelling in the toes or forefoot. * Incorrect: A. Elastic stockings Stockings provide general compression but may not address localized edema. * Incorrect: C. Pneumatic compression pump Pumps are not ideal for small, localized areas. * Incorrect: D. Multi-layer bandage system Multi-layer systems address larger areas, not localized edema.

Answer 95

* Correct: B. Enhances lymphatic drainage IPC stimulates lymphatic flow, reducing fluid accumulation in lymphedema. * Incorrect: A. Reduces venous hypertension IPC can reduce venous pressure, but its primary mechanism in lymphedema is lymphatic drainage. * Incorrect: C. Increases arterial perfusion IPC does not directly affect arterial flow. * Incorrect: D. Prevents muscle atrophy Muscle atrophy is unrelated to IPC use.

Answer 96

* Correct: B. DVT or thrombophlebitis IPC is contraindicated in active DVT or thrombophlebitis due to the risk of embolism. * Incorrect: A. Peripheral edema IPC is commonly used to manage edema. * Incorrect: C. Post-surgical swelling IPC is often beneficial in post-surgical edema management. * Incorrect: D. Chronic venous insufficiency IPC is an effective adjunct in managing venous insufficiency.

Answer 97

* Correct: C. 30–40 mmHg This range is effective for managing moderate lymphedema. * Incorrect: A. 10–20 mmHg This range is insufficient for moderate lymphedema. * Incorrect: B. 20–30 mmHg This range is used for mild lymphedema. * Incorrect: D. 40–50 mmHg This range may be excessive for moderate cases.

Answer 98

* Correct: B. Create a distal-to-proximal pressure gradient Graduated compression improves venous return by increasing pressure distally and decreasing proximally. * Incorrect: A. Equalize pressure throughout the limb Compression is not equal across the limb. * Incorrect: C. Increase muscle contraction Compression indirectly supports muscle function but does not increase contraction. * Incorrect: D. Prevent arterial ischemia Compression does not address arterial issues.

Answer 99

* Correct: C. Cotton and non-elastic fibers Short-stretch bandages use materials that provide low stretch and high stiffness. * Incorrect: A. Zinc oxide Zinc oxide is used in Unna boots, not short-stretch bandages. * Incorrect: B. Elastic fibers Elastic fibers are characteristic of long-stretch bandages. * Incorrect: D. Silicone gel Silicone gel is used in scar management, not bandages.

Answer 100

* Correct: B. Dynamic compression adjusts pressure with movement Dynamic compression, such as IPC, changes pressure during use, unlike static compression. * Incorrect: A. Static compression uses pumps Static compression does not involve pumps. * Incorrect: C. Static compression requires patient activity Static compression works regardless of activity level. * Incorrect: D. Dynamic compression is contraindicated for venous ulcers Dynamic compression is not contraindicated.

Answer 101

* Correct: C. 6 months Compression stockings typically lose elasticity after 6 months and should be replaced. * Incorrect: A. 1 month One month is too short for typical stocking use. * Incorrect: B. 3 months Stockings usually last longer than 3 months. * Incorrect: D. 12 months Elasticity is often insufficient after 12 months.

Answer 102

* Correct: B. Intermittent pneumatic compression IPC effectively reduces acute post-surgical edema. * Incorrect: A. Elastic stockings Stockings are for maintenance, not acute edema. * Incorrect: C. Hydrocolloid dressings These address wound moisture, not edema. * Incorrect: D. Short-stretch bandages Bandages are less effective for acute swelling compared to IPC.

Answer 103

* Correct: C. Skin integrity and tolerance Elderly patients often have fragile skin, requiring careful selection of compression materials. * Incorrect: A. High working pressure High working pressure may not be well-tolerated by elderly patients. * Incorrect: B. Low resting pressure This is less critical than skin integrity. * Incorrect: D. High compression gradients Compression gradients should be adjusted based on patient needs, not age alone.

Answer 104

* Correct: B. Remove interstitial fluid and transport immune cells The lymphatic system manages fluid balance and immune responses. * Incorrect: A. Transport oxygen to tissues Oxygen transport is handled by the circulatory system. * Incorrect: C. Regulate blood pressure This is a function of the cardiovascular system. * Incorrect: D. Maintain muscle tone Muscle tone is unrelated to the lymphatic system.

Answer 105

* Correct: B. Filariasis Filariasis, a parasitic infection, is the leading cause of secondary lymphedema globally. * Incorrect: A. Malignancy Cancer is a leading cause in developed countries but not worldwide. * Incorrect: C. Obesity Obesity contributes to secondary lymphedema but is not the primary global cause. * Incorrect: D. Trauma Trauma is a potential cause but less common than filariasis.

Answer 106

* Correct: B. Cisterna chyli The cisterna chyli collects lymph from the lower body and drains into the thoracic duct. * Incorrect: A. Thoracic duct The thoracic duct transports lymph to the venous system but does not collect from the lower body. * Incorrect: C. Axillary nodes These nodes manage lymph from the upper extremities and chest. * Incorrect: D. Right lymphatic duct This duct drains lymph from the right upper body, not the lower body.

Answer 107

* Correct: B. Lymphedema Advanced lymphedema causes non-pitting edema and fibrosis due to chronic lymph stasis. * Incorrect: A. Venous insufficiency Venous edema is typically pitting, not non-pitting. * Incorrect: C. Lipedema Lipedema involves fat deposition and is not characterized by fibrosis. * Incorrect: D. Arterial insufficiency Arterial insufficiency leads to ischemic symptoms, not lymphedema.

Answer 108

* Correct: B. Congenital or hereditary origin Primary lymphedema is caused by congenital or hereditary lymphatic abnormalities. * Incorrect: A. Sudden onset after infection This is more indicative of secondary lymphedema. * Incorrect: C. Symmetric bilateral swelling Lymphedema is often asymmetric. * Incorrect: D. Associated with venous ulcers Venous ulcers are not a hallmark of primary lymphedema.

Answer 109

* Correct: B. History of cancer treatment with lymph node dissection Lymph node dissection disrupts lymphatic pathways, increasing lymphedema risk. * Incorrect: A. Family history of edema This is more relevant to primary lymphedema. * Incorrect: C. Low BMI Obesity, not low BMI, is a risk factor. * Incorrect: D. Regular physical activity Physical activity is protective, not a risk factor.

Answer 110

* Correct: B. Bioimpedance spectroscopy This test evaluates tissue fluid composition to identify lymphatic insufficiency. * Incorrect: A. Stemmer’s sign This is a clinical test for skin thickening. * Incorrect: C. Fluoroscopy Fluoroscopy visualizes lymphatic anatomy but does not assess protein concentration. * Incorrect: D. Lymphoscintigraphy This imaging test assesses lymphatic flow, not fluid protein levels.

Answer 111

* Correct: C. Confirms lymphedema A positive Stemmer’s sign, indicated by inability to pinch the skin, is a reliable diagnostic sign of lymphedema. * Incorrect: A. Indicates arterial insufficiency Arterial insufficiency does not cause skin thickening. * Incorrect: B. Suggests venous stasis Venous stasis edema does not typically present with Stemmer’s sign. * Incorrect: D. Diagnoses neuropathy Neuropathy is unrelated to Stemmer’s sign.

Answer 112

* Correct: B. Stage 1 In Stage 1 lymphedema, swelling is reversible with elevation and does not involve fibrosis. * Incorrect: A. Stage 0 Stage 0 involves latent lymphedema with no visible swelling. * Incorrect: C. Stage 2 Stage 2 involves irreversible swelling and fibrosis. * Incorrect: D. Stage 3 Stage 3 is the most advanced, with severe fibrosis and deformity.

Answer 113

* Correct: B. Increase lymphatic flow and reduce fluid buildup MLD uses gentle techniques to stimulate lymphatic drainage and reduce edema. * Incorrect: A. Break down fibrotic tissue MLD does not directly address fibrosis. * Incorrect: C. Promote angiogenesis MLD focuses on lymphatic, not vascular, flow. * Incorrect: D. Improve muscle strength MLD does not target muscle function.

Answer 114

* Correct: B. Active infection MLD is contraindicated in active infections to avoid spreading pathogens. * Incorrect: A. Mild edema MLD is effective for reducing mild edema. * Incorrect: C. Fibrosis MLD is not contraindicated for fibrosis. * Incorrect: D. Venous insufficiency MLD can complement venous insufficiency management.

Answer 115

* Correct: C. Class III (30–40 mmHg) This level provides adequate pressure for moderate lymphedema management. * Incorrect: A. Class I (15–20 mmHg) This is insufficient for moderate cases. * Incorrect: B. Class II (20–30 mmHg) This is appropriate for mild cases. * Incorrect: D. Class IV (>40 mmHg) This is used for severe or refractory cases.

Answer 116

* Correct: D. Gentle, rhythmic movements Gentle exercises stimulate lymphatic flow and reduce fluid accumulation without increasing strain. * Incorrect: A. Isometric exercises Isometric exercises do not promote lymphatic flow effectively. * Incorrect: B. Resistance training Resistance training can be used cautiously but is less beneficial than gentle movements. * Incorrect: C. Aerobic exercise Aerobic exercise benefits overall health but is less targeted for lymphedema.

Answer 117

* Correct: B. Promote lymphatic return and prevent fluid reaccumulation Compression reduces edema by promoting lymphatic drainage and preventing fluid accumulation. * Incorrect: A. Increase arterial blood flow Compression targets the lymphatic system, not arterial flow. * Incorrect: C. Improve skin elasticity Skin elasticity is not directly improved by compression. * Incorrect: D. Reduce muscle fatigue Compression does not address muscle fatigue.

Answer 118

* Correct: C. Stage 2 Stage 2 lymphedema involves irreversible swelling and the onset of fibrosis. * Incorrect: A. Stage 0 This stage involves latent lymphedema with no visible symptoms. * Incorrect: B. Stage 1 Swelling is still reversible in Stage 1. * Incorrect: D. Stage 3 Stage 3 is the most advanced, with severe fibrosis and deformity.

Answer 119

* Correct: B. Suggests another cause of swelling A negative Stemmer’s sign suggests that swelling may not be due to lymphedema. * Incorrect: A. Confirms early-stage lymphedema A positive, not negative, Stemmer’s sign supports lymphedema diagnosis. * Incorrect: C. Indicates venous insufficiency Venous insufficiency does not correlate directly with Stemmer’s sign. * Incorrect: D. Confirms primary lymphedema A positive Stemmer’s sign is indicative, not negative.

Answer 120

* Correct: B. Secondary lymphedema Obesity is a common risk factor for secondary lymphedema due to mechanical compression and inflammation. * Incorrect: A. Congenital lymphedema This occurs due to genetic abnormalities, unrelated to obesity. * Incorrect: C. Primary lymphedema tarda This develops later in life but is not specifically linked to obesity. * Incorrect: D. Idiopathic lymphedema Idiopathic cases have no identifiable cause.

Answer 121

* Correct: B. Reduced gravity effects aiding lymphatic flow Water immersion supports lymphatic flow by reducing gravitational forces and providing gentle compression. * Incorrect: A. Increased resistance for muscle strengthening Resistance training is not the primary benefit for lymphedema. * Incorrect: C. Improved cardiovascular endurance Cardiovascular benefits are secondary. * Incorrect: D. Enhanced joint mobility Joint mobility is not specific to lymphedema.

Answer 122

* Correct: B. Manual lymphatic drainage (MLD) MLD is contraindicated in cardiac edema as it may exacerbate fluid overload. * Incorrect: A. Effleurage Effleurage does not specifically target the lymphatic system. * Incorrect: C. Petrissage Petrissage focuses on muscle manipulation, not lymphatics. * Incorrect: D. Trigger point therapy This is unrelated to lymphatic drainage.

Answer 123

* Correct: C. Deliver graduated compression for lymphatic flow Multilayer bandages provide a pressure gradient to promote lymphatic drainage. * Incorrect: A. Provide uniform compression Compression is graduated, not uniform. * Incorrect: B. Maintain low resting pressure Resting pressure varies based on the bandage system. * Incorrect: D. Improve arterial circulation The focus is on lymphatic flow, not arterial circulation.

Answer 124

* Correct: C. 12–16 hours Compression garments should be worn during waking hours to manage lymphedema effectively. * Incorrect: A. 6 hours This is insufficient for therapeutic outcomes. * Incorrect: B. 8 hours Eight hours may not provide optimal results. * Incorrect: D. 20–24 hours Continuous wear, including sleep, is typically unnecessary.

Answer 125

* Correct: B. Lipedema spares the hands and feet Lipedema affects the lower body but spares the extremities, unlike lymphedema. * Incorrect: A. Lymphedema involves symmetrical swelling Lymphedema is often asymmetrical. * Incorrect: C. Lymphedema is triggered by trauma This can apply to secondary lymphedema but is not diagnostic. * Incorrect: D. Lipedema leads to fibrosis Fibrosis is more characteristic of advanced lymphedema.

Answer 126

* Correct: C. Lymphoscintigraphy Lymphoscintigraphy provides detailed imaging of lymphatic flow and blockages. * Incorrect: A. X-ray X-rays do not visualize the lymphatic system. * Incorrect: B. MRI MRI may show tissue edema but lacks specificity for lymphatics. * Incorrect: D. Ultrasound Ultrasound evaluates fluid accumulation but not lymphatic pathways.

Answer 127

* Correct: C. Feeling of heaviness in the limb Heaviness and tightness are early symptoms of lymphedema. * Incorrect: A. Painful swelling Lymphedema is typically painless in early stages. * Incorrect: B. Skin fibrosis Fibrosis occurs in advanced stages. * Incorrect: D. Visible discoloration Discoloration is not an early symptom.

Answer 128

* Correct: A. Open flames Open flames are the leading cause of thermal burns. * Incorrect: B. Chemicals Chemical burns are less common than thermal burns. * Incorrect: C. Electricity Electrical burns are rare and specific to occupational or accidental exposure. * Incorrect: D. Radiation Radiation burns are uncommon in general populations.

Answer 129

* Correct: B. Superficial partial-thickness This type of burn affects the epidermis and dermis, resulting in blisters. * Incorrect: A. Superficial Superficial burns only involve the epidermis. * Incorrect: C. Deep partial-thickness These burns damage deeper dermal layers and may not form blisters. * Incorrect: D. Full-thickness Full-thickness burns extend through the dermis into subcutaneous tissue.

Answer 130

* Correct: B. Rule of Nines The Rule of Nines is a quick method to estimate burn size in adults. * Incorrect: A. Lund-Browder chart This is more detailed and used primarily for children. * Incorrect: C. Palmar method The Palmar method estimates small burns using the patient’s palm size. * Incorrect: D. Parkland formula This is used for fluid resuscitation, not burn size estimation.

Answer 131

* Correct: C. Zone of hyperemia The zone of hyperemia typically recovers due to adequate blood supply. * Incorrect: A. Zone of coagulation This zone is irreversibly damaged. * Incorrect: B. Zone of stasis This zone is at risk of further damage without intervention. * Incorrect: D. Zone of necrosis Necrosis is not a term used in burn zones.

Answer 132

* Correct: B. Entry and exit wounds Electrical burns typically present with distinct entry and exit points. * Incorrect: A. Blister formation Blisters are more characteristic of superficial partial-thickness burns. * Incorrect: C. Charring of skin Charring may occur but is not specific to electrical burns. * Incorrect: D. Radiation effects Radiation effects are unrelated to electrical burns.

Answer 133

* Correct: D. Epidermis, dermis, and deeper structures Full-thickness burns extend through the skin into underlying tissues. * Incorrect: A. Epidermis only This describes superficial burns. * Incorrect: B. Epidermis and dermis Partial-thickness burns involve these layers. * Incorrect: C. Dermis and subcutaneous tissue This description is incomplete for full-thickness burns.

Answer 134

* Correct: B. Calculate fluid resuscitation needs The Parkland formula calculates the volume of fluids needed for initial resuscitation. * Incorrect: A. Estimate burn size Burn size is estimated using methods like the Rule of Nines. * Incorrect: C. Assess infection risk The formula does not evaluate infection. * Incorrect: D. Determine grafting requirements Grafting decisions are based on wound depth and size.

Answer 135

* Correct: C. Silver sulfadiazine This agent is widely used for its antimicrobial properties in burn care. * Incorrect: A. Bacitracin Bacitracin is effective for minor wounds but not first-line for burns. * Incorrect: B. Mupirocin Mupirocin targets specific infections, not general burn care. * Incorrect: D. Hydrocortisone This is an anti-inflammatory, not an antimicrobial.

Answer 136

* Correct: B. Restricted blood flow and compartment syndrome Circumferential burns can constrict blood flow, leading to compartment syndrome. * Incorrect: A. Increased infection risk This is a complication of all burns, not specific to circumferential burns. * Incorrect: C. Reduced immune response Immune effects are systemic, not specific to circumferential burns. * Incorrect: D. Delayed healing time Delayed healing is a general burn concern.

Answer 137

* Correct: B. Escharotomy Escharotomy relieves pressure and restores chest expansion. * Incorrect: A. Skin grafting Grafting is a later-stage intervention. * Incorrect: C. Wound debridement Debridement removes necrotic tissue but does not relieve pressure. * Incorrect: D. Negative pressure wound therapy This is not used for acute restriction relief.

Answer 138

* Correct: D. Full-thickness burns Grafting is often required for full-thickness burns due to the loss of all skin layers. * Incorrect: A. Superficial burns These heal without intervention. * Incorrect: B. Partial-thickness burns Partial-thickness burns typically heal with conservative care. * Incorrect: C. Deep partial-thickness burns These may require grafting but not always.

Answer 139

* Correct: C. Minimize hypertrophic scarring Pressure garments help remodel collagen and reduce scarring. * Incorrect: A. Reduce pain Pain management involves other modalities. * Incorrect: B. Prevent contractures ROM exercises and splints address contractures. * Incorrect: D. Promote moisture retention Pressure garments do not impact moisture.

Answer 140

* Correct: B. 7–21 days Superficial partial-thickness burns heal within this time frame. * Incorrect: A. 2–5 days This time frame is too short for superficial partial-thickness burns. * Incorrect: C. 3–4 weeks This applies to deeper burns. * Incorrect: D. More than 4 weeks This is typical of chronic wounds, not superficial partial-thickness burns.

Answer 141

* Correct: B. Ongoing tissue destruction Chemical burns continue to damage tissue until the chemical is neutralized. * Incorrect: A. Heat damage Heat is unrelated to chemical burns. * **Incorrect:

Answer 142

* Correct: C. Lund-Browder chart This method accounts for differences in body proportions in children. * Incorrect: A. Rule of Nines This is less accurate in children due to their body proportion differences. * Incorrect: B. Palmar method This is used for small, localized burns. * Incorrect: D. Parkland formula This calculates fluid resuscitation needs, not burn size.

Answer 143

* Correct: B. Irrigate with copious amounts of water Immediate irrigation dilutes and removes the chemical, minimizing tissue damage. * Incorrect: A. Apply a topical antibiotic This is not the first step in chemical burn management. * Incorrect: C. Cover the burn with a sterile dressing This follows irrigation. * Incorrect: D. Neutralize the chemical with an antidote Neutralization is rarely recommended due to risks.

Answer 144

* Correct: C. Full-thickness Full-thickness burns destroy nerve endings, resulting in white, leathery, insensate skin. * Incorrect: A. Superficial partial-thickness These burns retain sensation and are pink with blisters. * Incorrect: B. Deep partial-thickness These burns may be red or white and still have some sensation. * Incorrect: D. Subdermal Subdermal burns involve underlying structures like muscle or bone.

Answer 145

* Correct: C. Urine output Monitoring urine output ensures sufficient perfusion and fluid balance. * Incorrect: A. Blood pressure Blood pressure can be misleading in early burn shock. * Incorrect: B. Heart rate Tachycardia may persist despite adequate resuscitation. * Incorrect: D. Skin turgor This is a less specific indicator of fluid status.

Answer 146

* Correct: C. Autograft Autografts use the patient’s skin and are ideal for permanent coverage. * Incorrect: A. Allograft Allografts are temporary grafts from human donors. * Incorrect: B. Xenograft Xenografts are temporary grafts from animal sources. * Incorrect: D. Synthetic graft Synthetic grafts are man-made materials for temporary use.

Answer 147

* Correct: C. Relieve pressure and restore circulation Escharotomy is performed to relieve pressure from circumferential burns and prevent ischemia. * Incorrect: A. Remove necrotic tissue Debridement addresses necrotic tissue, not escharotomy. * Incorrect: B. Prevent infection While beneficial, this is not the primary goal of escharotomy. * Incorrect: D. Prepare for skin grafting Escharotomy is not directly related to graft preparation.

Answer 148

* Correct: C. Full-thickness circumferential burns These burns can restrict circulation, necessitating escharotomy. * Incorrect: A. Superficial burns These do not penetrate deeply enough to cause pressure complications. * Incorrect: B. Partial-thickness burns These are less likely to require escharotomy. * Incorrect: D. Electrical burns These may require escharotomy but not as commonly as circumferential full-thickness burns.

Answer 149

* Correct: C. Hypermetabolism Severe burns trigger a hypermetabolic state to support healing and energy needs. * Incorrect: A. Hypervolemia Hypovolemia is common due to fluid loss. * Incorrect: B. Hypometabolism The opposite, hypermetabolism, occurs. * Incorrect: D. Hyperthermia Hyperthermia is not a direct systemic effect of burns.

Answer 150

* Correct: C. Range of motion exercises Regular ROM exercises prevent joint contractures in burn patients. * Incorrect: A. Immobilization Prolonged immobilization increases the risk of contractures. * Incorrect: B. Pressure garments Pressure garments minimize scarring but do not prevent contractures. * Incorrect: D. Topical antibiotics These address infection but do not impact contracture prevention.

Answer 151

* Correct: B. Respiratory distress Inhalation injuries can cause airway edema and respiratory distress. * Incorrect: A. Pneumothorax This is unrelated to inhalation injuries. * Incorrect: C. Pleural effusion Pleural effusion is not commonly associated with burns. * Incorrect: D. Pulmonary fibrosis Fibrosis is a chronic, not acute, condition.

Answer 152

* Correct: B. Pressure garment use Pressure garments help remodel collagen and minimize hypertrophic scarring. * Incorrect: A. Daily wound debridement Debridement prevents infection but does not directly reduce scarring. * Incorrect: C. Skin grafting Grafting covers wounds but does not prevent hypertrophic scarring. * Incorrect: D. ROM exercises ROM prevents contractures but does not directly reduce scarring.

Answer 153

* Correct: B. Dry, red skin without blisters Superficial burns cause redness and dry skin without blistering. * Incorrect: A. Blister formation This occurs in superficial partial-thickness burns. * Incorrect: C. Leathery, white appearance This is characteristic of full-thickness burns. * Incorrect: D. Absence of pain Pain is present in superficial burns.

Answer 154

* Correct: B. Using occlusive dressings Occlusive dressings retain moisture and prevent wound desiccation. * Incorrect: A. Applying antimicrobial creams These prevent infection but do not retain moisture. * Incorrect: C. Frequent dressing changes Frequent changes can increase desiccation. * Incorrect: D. Administering systemic antibiotics These address systemic infection but do not impact wound moisture.

Answer 155

* Correct: B. Separation of epidermis from dermis Skin tears occur when the epidermis separates from the dermis, often due to friction or shear forces. * Incorrect: A. Complete loss of skin layers This describes full-thickness wounds. * Incorrect: C. Deep wound extending to muscle This is not characteristic of a skin tear. * Incorrect: D. Irregular wound with necrotic tissue Necrosis is not typical of skin tears.

Answer 156

* Correct: B. Payne-Martin This system categorizes skin tears based on the extent of tissue damage. * Incorrect: A. CEAP CEAP is used for venous disorders. * Incorrect: C. Wagner Wagner classification is for diabetic foot ulcers. * Incorrect: D. Braden Scale Braden assesses pressure ulcer risk, not skin tears.

Answer 157

* Correct: B. Prevent infection through debridement and cleaning Animal bites are prone to infection and require thorough cleaning and debridement. * Incorrect: A. Immediate closure with sutures Immediate closure is often avoided due to infection risk. * Incorrect: C. Use occlusive dressings Occlusive dressings may trap bacteria. * Incorrect: D. Apply compression therapy Compression is not appropriate for bite wounds.

Answer 158

* Correct: B. Brown Recluse Brown Recluse bites can cause necrotic wounds and systemic effects such as fever and malaise. * Incorrect: A. Black Widow Black Widow bites cause neurological symptoms, not necrosis. * Incorrect: C. Tarantula Tarantula bites are typically not medically significant. * Incorrect: D. Hobo Spider Hobo Spider bites are controversial in causing necrosis.

Answer 159

* Correct: B. Rapid rewarming in warm water Warm water immersion restores blood flow and minimizes tissue damage. * Incorrect: A. Debridement of necrotic tissue This is not the first-line treatment. * Incorrect: C. Applying topical antibiotics Antibiotics are secondary to rewarming. * Incorrect: D. Immersion in ice water Ice water worsens frostbite damage.

Answer 160

* Correct: B. Separation of surgical wound edges Dehiscence occurs when surgical wound edges separate before healing is complete. * Incorrect: A. Erythema and swelling These are signs of inflammation, not dehiscence. * Incorrect: C. Presence of exudate Exudate may accompany dehiscence but is not its hallmark. * Incorrect: D. Formation of granulation tissue Granulation tissue is a sign of healing, not dehiscence.

Answer 161

* Correct: B. Covering large wounds with poor vascular supply Flaps are used to provide vascularized tissue to large or poorly healing wounds. * Incorrect: A. Addressing minor skin tears Skin tears do not typically require flaps. * Incorrect: C. Treating superficial abrasions Abrasions heal without flaps. * Incorrect: D. Preventing hypertrophic scars Scar prevention is not the primary purpose of flaps.

Answer 162

* Correct: B. Prepare the limb for prosthetic fitting Shaping ensures optimal prosthetic fit and function. * Incorrect: A. Promote rapid healing Shaping indirectly aids healing but is not its primary goal. * Incorrect: C. Prevent infection Infection prevention involves other interventions. * Incorrect: D. Reduce phantom limb pain Shaping does not address phantom limb pain directly.

Answer 163

* Correct: D. Dirty or infected These wounds are associated with active infection or necrotic tissue, posing the highest infection risk. * Incorrect: A. Clean Clean wounds have minimal infection risk. * Incorrect: B. Clean-contaminated These carry moderate infection risk. * Incorrect: C. Contaminated Contaminated wounds have a higher risk but not as much as dirty wounds.

Answer 164

* Correct: B. Drainage and debridement Abscesses require drainage to remove pus and prevent further infection. * Incorrect: A. Systemic antibiotics Antibiotics are supportive but do not address the abscess directly. * Incorrect: C. Application of topical antiseptics Antiseptics are insufficient for deep abscesses. * Incorrect: D. Compression therapy Compression is not used for abscess management.

Answer 165

* Correct: A. Puncture wound Deep puncture wounds can introduce bacteria into fascia, increasing the risk of necrotizing fasciitis. * Incorrect: B. Abrasion Abrasions are superficial and less likely to lead to this condition. * Incorrect: C. Skin tear Skin tears are unlikely to develop necrotizing fasciitis. * Incorrect: D. Superficial burn These rarely progress to necrotizing fasciitis.

Answer 166

* Correct: B. Promote wound healing by reducing edema and enhancing perfusion NPWT creates a vacuum that enhances healing by improving blood flow and reducing fluid buildup. * Incorrect: A. Provide high-pressure irrigation NPWT does not irrigate wounds. * Incorrect: C. Prevent scar tissue formation While helpful for healing, it does not prevent scarring. * Incorrect: D. Improve nerve regeneration NPWT does not directly impact nerves.

Answer 167

* Correct: B. High infection risk Human bites carry a significant infection risk due to oral bacteria. * Incorrect: A. Delayed healing Healing can be delayed, but infection risk is the primary concern. * Incorrect: C. Severe tissue necrosis Necrosis is less common than infection. * Incorrect: D. Excessive scarring Scarring is not the primary concern with human bites.

Answer 168

* Correct: C. Surgical debridement Surgical debridement is essential for removing necrotic tissue to prevent infection and promote healing. * Incorrect: A. Topical antibiotics While antibiotics may help prevent infection, they do not remove necrotic tissue. * Incorrect: B. Autolytic debridement Autolytic debridement is slower and less effective for extensive necrosis. * Incorrect: D. Compression therapy Compression does not address necrotic tissue.

Answer 169

* Correct: A. Apply pressure and elevate the wound Direct pressure and elevation help control bleeding effectively. * Incorrect: B. Use compression therapy Compression is for edema management, not acute bleeding. * Incorrect: C. Irrigate with saline Irrigation is secondary to stopping the bleeding. * Incorrect: D. Apply a tourniquet immediately Tourniquets are a last resort.

Answer 170

* Correct: B. Remove debris and reduce bacterial load Irrigation cleanses the wound and decreases the risk of infection. * Incorrect: A. Hydrate dry tissue This is not the primary purpose of irrigation. * Incorrect: C. Prevent granulation tissue formation Granulation tissue is desirable in wound healing. * Incorrect: D. Increase vascular perfusion Irrigation does not affect perfusion.

Answer 171

* Correct: B. Contaminated traumatic wound Contaminated wounds have a high infection risk, warranting prophylactic antibiotics. * Incorrect: A. Clean surgical wound These wounds have a low infection risk. * Incorrect: C. Closed laceration Closed wounds generally do not require antibiotics. * Incorrect: D. Superficial abrasion Abrasions rarely require antibiotics.

Answer 172

* Correct: B. Administer a tetanus booster Tetanus prophylaxis is critical for puncture wounds with potential contamination. * Incorrect: A. Apply a pressure dressing Pressure dressings are unnecessary for puncture wounds. * Incorrect: C. Perform immediate suturing Puncture wounds are typically left open to prevent infection. * Incorrect: D. Apply negative pressure therapy NPWT is not appropriate for puncture wounds.

Answer 173

* Correct: B. Suggests underlying infection or tissue loss Tunneling may indicate hidden damage or infection, requiring thorough assessment. * Incorrect: A. Indicates granulation tissue formation Tunneling does not correlate with granulation tissue. * Incorrect: C. Improves wound healing time Tunneling complicates wound healing. * Incorrect: D. Reduces the need for debridement Tunneling often necessitates additional debridement.

Answer 174

* Correct: B. Sharp debridement Debridement physically disrupts biofilm and improves wound healing. * Incorrect: A. Frequent dressing changes Dressing changes alone do not remove biofilm. * Incorrect: C. Application of silver dressings Antimicrobial dressings help prevent biofilm formation but do not eliminate established biofilm. * Incorrect: D. Use of systemic antibiotics Antibiotics have limited effectiveness against biofilm.

Answer 175

* Correct: C. Rotational flap Rotational flaps provide coverage and vascular supply for pressure ulcer reconstruction. * Incorrect: A. Pedicle flap Pedicle flaps are less commonly used for pressure ulcers. * Incorrect: B. Free flap Free flaps are more complex and used for extensive defects. * Incorrect: D. Z-plasty Z-plasty is for scar revision, not pressure ulcers.

Answer 176

* Correct: B. Ensure moist wound healing with hydrogel or NPWT Moisture promotes healing and protects exposed bone. * Incorrect: A. Apply a dry gauze dressing Dry dressings may delay healing and increase infection risk. * Incorrect: C. Use compression bandages Compression is not appropriate for exposed bone wounds. * Incorrect: D. Avoid debridement Debridement may still be necessary to remove necrotic tissue.

Answer 177

* Correct: C. Enzymatic debridement Enzymatic agents break down necrotic tissue selectively. * Incorrect: A. Sharp debridement This uses surgical tools, not chemicals. * Incorrect: B. Autolytic debridement Autolysis relies on the body’s natural enzymes. * Incorrect: D. Mechanical debridement Mechanical methods include wet-to-dry dressings or irrigation.

Answer 178

* Correct: B. Remove necrotic tissue Wet-to-dry dressings mechanically debride necrotic tissue when removed. * Incorrect: A. Promote granulation tissue growth These dressings are not designed to support granulation tissue. * Incorrect: C. Increase wound hydration They often dry out wounds rather than hydrate them. * Incorrect: D. Reduce bacterial load They are not primarily antimicrobial.

Answer 179

* Correct: B. Control the bleeding Bleeding control takes precedence to stabilize the patient. * Incorrect: A. Clean the wound Cleaning follows bleeding control. * Incorrect: C. Apply a sterile dressing Dressings are secondary to hemostasis. * Incorrect: D. Assess for infection Infection assessment occurs after bleeding is managed.

Answer 180

* Correct: C. Avulsion Avulsion wounds occur when high-energy forces tear tissue away from underlying structures. * Incorrect: A. Abrasion Abrasions are caused by friction. * Incorrect: B. Laceration Lacerations result from sharp objects. * Incorrect: D. Puncture wound Puncture wounds are caused by narrow, pointed objects.

Answer 181

* Correct: A. Maintain moisture and promote autolytic debridement Occlusive dressings support moist wound healing and autolysis. * Incorrect: B. Provide compression to reduce edema Compression dressings are not occlusive. * Incorrect: C. Deliver topical antibiotics Occlusive dressings do not deliver medications directly. * Incorrect: D. Absorb heavy exudate They are less effective for highly exudative wounds.