NORCET Nursing Foundation – Wound & Pressure Injury

Test 01 • 50 MCQs • 50 Marks • 30 Minutes

Conceptual + Clinical + Case-Based + Scenario-Based Questions

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Q1. Which statement best defines a wound?

A. A disruption in the normal continuity of tissue B. A normal physiological process C. A decrease in body temperature D. A temporary increase in appetite

Answer: A. A disruption in the normal continuity of tissue
A wound is an injury or disruption of the normal structure and function of tissue.

Q2. Which type of wound usually has clean edges and minimal tissue loss?

A. Incision B. Abrasion C. Laceration D. Avulsion

Answer: A. Incision
An incision is a wound produced by a sharp object and generally has relatively clean, well-defined edges.

Q3. Which phase of wound healing occurs immediately after injury and involves hemostasis?

A. Hemostatic phase B. Remodeling phase C. Maturation phase only D. Proliferative phase

Answer: A. Hemostatic phase
Hemostasis begins immediately after injury. Vasoconstriction and clot formation help control bleeding.

Q4. Which cell is primarily responsible for producing antibodies?

A. Plasma cell B. Platelet C. Fibroblast D. Erythrocyte

Answer: A. Plasma cell
Plasma cells are differentiated B lymphocytes that produce antibodies. They are not the primary cells responsible for tissue repair.

Q5. Which phase of wound healing is characterized by formation of granulation tissue?

A. Proliferative phase B. Hemostatic phase C. Initial clotting phase only D. Injury phase

Answer: A. Proliferative phase
The proliferative phase includes fibroblast activity, collagen deposition, angiogenesis and formation of granulation tissue.

Q6. Which substance is an important structural protein in wound healing?

A. Collagen B. Hemoglobin C. Bilirubin D. Insulin

Answer: A. Collagen
Collagen provides structural strength to healing tissue and is produced largely by fibroblasts.

Q7. Which phase of wound healing involves collagen remodeling and increasing tensile strength?

A. Remodeling/maturation phase B. Hemostatic phase C. Inflammatory phase only D. Exudative phase

Answer: A. Remodeling/maturation phase
During remodeling, collagen is reorganized and the wound gradually gains tensile strength.

Q8. Which nutrient is particularly important for collagen synthesis and wound healing?

A. Vitamin C B. Vitamin D only C. Sodium only D. Fluoride

Answer: A. Vitamin C
Vitamin C is essential for collagen synthesis and normal wound healing.

Q9. Which nutrient is especially important for tissue repair and wound healing?

A. Protein B. Alcohol C. Excess caffeine D. Trans fat only

Answer: A. Protein
Adequate protein provides amino acids needed for collagen production, tissue repair and immune function.

Q10. Which factor can delay wound healing?

A. Poor nutritional status B. Adequate oxygenation C. Good circulation D. Adequate protein intake

Answer: A. Poor nutritional status
Malnutrition, especially inadequate protein and micronutrients, can impair tissue repair and immune function.

Q11. Which factor is strongly associated with impaired wound healing?

A. Poor tissue perfusion B. Adequate oxygen delivery C. Normal nutrition D. Appropriate wound care

Answer: A. Poor tissue perfusion
Adequate blood flow is necessary for oxygen and nutrient delivery. Poor perfusion can significantly delay healing.

Q12. Which finding is most suggestive of wound infection?

A. Increasing redness, warmth, pain and purulent drainage B. Decreasing pain and clean wound edges C. Healthy granulation tissue D. Minimal serous drainage immediately after surgery

Answer: A. Increasing redness, warmth, pain and purulent drainage
Increasing local inflammation, pain, warmth and purulent drainage may indicate wound infection and require assessment.

Q13. Which wound drainage is typically thin and clear or pale yellow?

A. Serous B. Purulent C. Feculent D. Thick sanguineous

Answer: A. Serous
Serous drainage is usually clear to pale yellow and watery. Its significance depends on the clinical context and amount.

Q14. Purulent wound drainage is usually described as:

A. Thick, cloudy or yellow-green drainage that may have an odor B. Completely clear fluid C. Normal sweat D. Pure blood

Answer: A. Thick, cloudy or yellow-green drainage that may have an odor
Purulent drainage commonly contains inflammatory cells, bacteria and cellular debris and may indicate infection.

Q15. What is a pressure injury?

A. Localized injury to skin and/or underlying tissue caused by pressure or pressure combined with shear B. A viral skin infection only C. A burn caused only by heat D. A normal aging change

Answer: A. Localized injury to skin and/or underlying tissue caused by pressure or pressure combined with shear
Pressure injuries commonly occur over bony prominences and are associated with pressure and/or shear.

Q16. Which patient is at increased risk for pressure injury?

A. An immobile patient with poor nutrition and impaired sensation B. A fully mobile patient with adequate nutrition C. A patient who changes position independently D. A patient with normal sensation and mobility

Answer: A. An immobile patient with poor nutrition and impaired sensation
Immobility, poor nutrition, impaired sensation and moisture are important risk factors for pressure injury.

Q17. Which site is a common location for pressure injury in a supine patient?

A. Sacrum B. Palm C. Abdomen D. Forearm

Answer: A. Sacrum
The sacrum is a prominent pressure-injury site in patients who spend prolonged periods in the supine position.

Q18. Which site is particularly vulnerable to pressure injury in a patient lying in a lateral position?

A. Greater trochanter B. Abdomen C. Palm D. Forehead only

Answer: A. Greater trochanter
The greater trochanter is a bony prominence that may experience pressure in the lateral position.

Q19. A Stage 1 pressure injury is characterized by:

A. Non-blanchable erythema of intact skin B. Full-thickness skin loss with exposed bone C. Exposed muscle D. Full-thickness tissue loss with slough obscuring the wound

Answer: A. Non-blanchable erythema of intact skin
Stage 1 pressure injury presents as non-blanchable erythema of intact skin. In darker skin tones, color changes may be less obvious.

Q20. Which finding is consistent with a Stage 2 pressure injury?

A. Partial-thickness skin loss with exposed dermis B. Exposed bone C. Full-thickness skin loss with visible adipose D. Exposed tendon

Answer: A. Partial-thickness skin loss with exposed dermis
Stage 2 involves partial-thickness skin loss with exposed dermis. Adipose, granulation tissue, slough and eschar are not visible in a Stage 2 injury.

Q21. Which finding is characteristic of a Stage 3 pressure injury?

A. Full-thickness skin loss with visible adipose tissue B. Intact skin with non-blanchable erythema C. Only superficial epidermal damage D. Exposed bone as the defining feature

Answer: A. Full-thickness skin loss with visible adipose tissue
Stage 3 involves full-thickness skin loss. Adipose may be visible, and granulation tissue or epibole may be present.

Q22. Which finding is characteristic of a Stage 4 pressure injury?

A. Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, cartilage or bone B. Intact skin only C. Partial-thickness skin loss only D. Simple abrasion

Answer: A. Full-thickness skin and tissue loss with exposed or directly palpable deeper structures
Stage 4 is the most severe category and includes full-thickness tissue loss with exposed or directly palpable fascia, muscle, tendon, cartilage or bone.

Q23. What does "unstageable pressure injury" mean?

A. Full-thickness skin and tissue loss in which the extent of tissue damage cannot be confirmed because slough or eschar obscures it B. Stage 1 injury C. A completely healed wound D. A superficial abrasion

Answer: A. Full-thickness skin and tissue loss obscured by slough or eschar
When the wound base is obscured by slough or eschar, the true depth cannot be confirmed, so it is classified as unstageable until the extent can be determined.

Q24. What is a key feature of a deep tissue pressure injury?

A. Persistent non-blanchable deep red, maroon or purple discoloration or a blood-filled blister B. Only a superficial scratch C. Completely normal skin D. A clean surgical incision

Answer: A. Persistent non-blanchable deep red, maroon or purple discoloration or a blood-filled blister
Deep tissue pressure injury can present with persistent non-blanchable discoloration or a blood-filled blister and may indicate underlying tissue damage.

Q25. Which scale is commonly used to assess risk for pressure injury?

A. Braden Scale B. Glasgow Coma Scale only C. Apgar Score D. Silverman-Andersen Score

Answer: A. Braden Scale
The Braden Scale evaluates factors such as sensory perception, moisture, activity, mobility, nutrition and friction/shear.

Q26. Which Braden Scale category assesses the patient's ability to change and control body position?

A. Mobility B. Nutrition C. Moisture D. Sensory perception

Answer: A. Mobility
Mobility refers to the ability to change and control body position independently.

Q27. Which Braden Scale category considers exposure of the skin to urine, stool or other moisture?

A. Moisture B. Activity C. Nutrition D. Friction

Answer: A. Moisture
Moisture assesses how often the patient's skin is exposed to moisture, which can increase skin vulnerability.

Q28. Which intervention is most effective for preventing pressure injury in an immobile patient?

A. Regular repositioning and pressure redistribution B. Keeping the patient in one position C. Massaging reddened bony prominences D. Restricting fluids without indication

Answer: A. Regular repositioning and pressure redistribution
Regular repositioning, pressure redistribution surfaces, skin care and nutritional support are central components of prevention.

Q29. Which action should the nurse avoid when caring for a reddened bony prominence?

A. Vigorous massage of the reddened area B. Relieving pressure C. Assessing the skin D. Repositioning the patient

Answer: A. Vigorous massage of the reddened area
Massaging an area of suspected pressure injury can cause additional tissue damage and should be avoided.

Q30. Which device can help redistribute pressure in a high-risk patient?

A. Pressure-redistributing mattress or support surface B. Hard board placed directly under the patient C. Tight restraints D. Heating pad over the sacrum

Answer: A. Pressure-redistributing mattress or support surface
Appropriate support surfaces can redistribute pressure and reduce the risk of tissue injury.

Q31. Which position is generally useful for reducing pressure on the sacrum?

A. Appropriate lateral positioning with pressure redistribution B. Prolonged supine position C. Sitting continuously without pressure relief D. Trendelenburg continuously

Answer: A. Appropriate lateral positioning with pressure redistribution
Lateral positioning can relieve direct pressure on the sacrum when performed correctly and individualized to the patient's condition.

Q32. Why should a patient be lifted rather than dragged across the bed?

A. To reduce friction and shear B. To increase skin moisture C. To increase pressure D. To reduce oxygenation

Answer: A. To reduce friction and shear
Dragging can cause friction and shear, damaging skin and underlying tissue. Use appropriate lifting or repositioning techniques.

Q33. Which intervention is appropriate for preventing moisture-associated skin damage?

A. Keep the skin clean and dry and use appropriate moisture-barrier products B. Leave urine on the skin C. Scrub the skin aggressively D. Apply alcohol repeatedly

Answer: A. Keep the skin clean and dry and use appropriate moisture-barrier products
Prompt cleansing, gentle drying and barrier protection help reduce moisture-associated skin damage.

Q34. A patient with a pressure injury has poor oral intake. Which intervention is most appropriate?

A. Assess nutritional status and collaborate on adequate protein and calorie intake B. Restrict protein C. Stop all fluids D. Ignore nutritional status

Answer: A. Assess nutritional status and collaborate on adequate protein and calorie intake
Adequate energy and protein are essential for tissue repair. Nutritional assessment and individualized support are important.

Q35. Which finding indicates healthy granulation tissue?

A. Moist, beefy-red tissue that may bleed slightly with gentle contact B. Black necrotic tissue only C. Thick purulent drainage D. Dry leathery eschar only

Answer: A. Moist, beefy-red tissue
Healthy granulation tissue is usually moist and red or beefy-red because of its rich vascular supply.

Q36. What is slough?

A. Devitalized tissue that may appear yellow, tan, gray or white B. Healthy granulation tissue C. New epithelial tissue only D. Normal intact epidermis

Answer: A. Devitalized tissue that may appear yellow, tan, gray or white
Slough consists of nonviable tissue and can obscure the wound bed.

Q37. What is eschar?

A. Thick, dry or leathery devitalized tissue that may appear black or brown B. Healthy pink epithelium C. Normal granulation tissue D. Serous fluid

Answer: A. Thick, dry or leathery devitalized tissue
Eschar is devitalized tissue that can be dry, thick and dark. Its management depends on wound type, location and clinical circumstances.

Q38. A wound is documented as 5 cm long × 3 cm wide × 2 cm deep. What is the calculated wound volume if approximated as a rectangular space?

A. 10 cm³ B. 20 cm³ C. 30 cm³ D. 60 cm³

Answer: C. 30 cm³
Volume = Length × Width × Depth = 5 × 3 × 2 = 30 cm³. Actual wound volume may require more appropriate clinical measurement methods.

Q39. Which information should be included when documenting a wound assessment?

A. Location, length, width, depth, wound bed, drainage and surrounding skin B. Only the patient's name C. Only the dressing color D. Nothing unless the wound is infected

Answer: A. Location, length, width, depth, wound bed, drainage and surrounding skin
Complete wound documentation allows accurate monitoring of healing and detection of deterioration.

Q40. A patient has a Stage 1 pressure injury on the sacrum. What is the priority nursing intervention?

A. Immediately relieve pressure from the affected area B. Massage the area vigorously C. Keep the patient supine continuously D. Apply a heating pad

Answer: A. Immediately relieve pressure from the affected area
The priority in a Stage 1 pressure injury is pressure redistribution/offloading, along with skin assessment and preventive care.

Q41. Case Scenario: An unconscious patient has been immobile for 3 days. The nurse notices non-blanchable redness over the sacrum. What is the most appropriate action?

A. Relieve pressure immediately and implement a pressure-injury prevention plan B. Massage the sacrum C. Leave the patient in the same position D. Apply direct heat

Answer: A. Relieve pressure immediately and implement a pressure-injury prevention plan
Non-blanchable erythema on intact skin is consistent with Stage 1 pressure injury. Pressure should be relieved promptly.

Q42. Case Scenario: A bedridden patient has frequent urinary incontinence and moist skin around the sacral area. Which intervention is most important?

A. Prompt cleansing, gentle drying, moisture protection and pressure redistribution B. Keep the skin wet C. Scrub the skin vigorously D. Avoid repositioning

Answer: A. Prompt cleansing, gentle drying, moisture protection and pressure redistribution
Moisture increases skin vulnerability. Incontinence care combined with pressure redistribution helps prevent skin breakdown.

Q43. Case Scenario: A patient has a wound with increasing pain, warmth, swelling and purulent drainage. What should the nurse do?

A. Assess the wound and promptly report suspected infection B. Ignore the findings C. Massage the wound D. Stop all wound assessment

Answer: A. Assess the wound and promptly report suspected infection
Increasing pain, warmth, swelling and purulent drainage are concerning for infection and require prompt clinical assessment.

Q44. Case Scenario: A patient with a pressure injury has poor appetite and significant weight loss. Which team member should the nurse consider involving?

A. Dietitian/nutrition professional B. No one C. Only the hospital security officer D. Only the housekeeping department

Answer: A. Dietitian/nutrition professional
Poor intake and weight loss can impair healing. Nutritional assessment and individualized nutritional support may improve the patient's ability to heal.

Q45. A patient is being repositioned in bed. Which action best reduces shear?

A. Use a lift sheet or appropriate repositioning device B. Drag the patient by the shoulders C. Pull the patient across the sheet D. Keep the patient in one position

Answer: A. Use a lift sheet or appropriate repositioning device
Using appropriate equipment reduces friction and shear and protects both the patient and healthcare worker.

Q46. Which statement about pressure injury prevention is correct?

A. Prevention requires assessment of risk, mobility, skin, moisture, nutrition and pressure redistribution B. Only the dressing matters C. Nutrition has no role D. Repositioning is never required

Answer: A. Prevention requires assessment of multiple risk factors
Pressure injury prevention is multifactorial and includes risk assessment, repositioning, pressure redistribution, skin care, moisture management and nutrition.

Q47. A wound has black eschar completely covering the wound bed. How should the wound be initially categorized regarding depth?

A. Unstageable if it is a pressure injury and the full extent is obscured B. Stage 1 C. Stage 2 D. Healed

Answer: A. Unstageable if it is a pressure injury and the full extent is obscured
When slough or eschar obscures the extent of full-thickness tissue loss, the pressure injury cannot be accurately staged until the depth can be determined.

Q48. Which patient requires especially careful pressure-injury prevention?

A. An elderly, immobile patient with incontinence and poor nutrition B. A young mobile patient with normal nutrition C. A patient who walks independently D. A patient who changes position independently

Answer: A. An elderly, immobile patient with incontinence and poor nutrition
Multiple risk factors—immobility, moisture, age-related vulnerability and malnutrition—substantially increase pressure-injury risk.

Q49. A patient with a pressure injury asks why repositioning is necessary even when there is no pain. What is the best explanation?

A. Pressure can damage tissue even when the patient does not perceive pain B. Repositioning is only for comfort C. Pain is always required before tissue damage occurs D. Repositioning increases pressure injury risk

Answer: A. Pressure can damage tissue even when the patient does not perceive pain
Patients with impaired sensation may not feel pain despite tissue damage. Therefore, regular assessment and pressure redistribution remain essential.

Q50. Case Scenario: A 72-year-old immobile patient with diabetes and poor nutritional intake develops a sacral wound. The wound has full-thickness skin loss with visible adipose tissue, but no exposed fascia, muscle, tendon, cartilage or bone. Which pressure injury stage is most consistent with this description?

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

Answer: C. Stage 3
Stage 3 pressure injury involves full-thickness skin loss with visible adipose tissue. Deeper structures such as fascia, muscle, tendon, cartilage or bone are not exposed or directly palpable in the description.

NORCET Exams Preparation Series - Day 4 ( Wound And Pressure Injury MCQs Practice )