Integ E2 Questions

How do sensory deficits contribute to delayed wound healing? A) By preventing harmful stimuli recognition B) By increasing pain sensitivity C) By improving circulation D) By accelerating healing

A) By preventing harmful stimuli recognition

Why is inappropriate wound care a major factor delaying healing? A) Causes chronic inflammation and infection B) Always improves healing C) Has no effect D) Speeds healing

A) Causes chronic inflammation and infection

Which diseases impair microcirculation and delay wound healing? A) Diabetes mellitus B) Peripheral vascular disease C) Both A and B D) Neither

A) Diabetes mellitus and B) Peripheral vascular disease

Why do surgical wounds generally heal faster than traumatic wounds? A) Less tissue damage B) More blood supply C) Higher infection rates D) Larger wound size

A) Less tissue damage

How does time since onset influence chronic wound prognosis? A) Older wounds generally have worse prognosis B) All wounds heal the same over time C) Time is irrelevant D) Older wounds always heal faster

A) Older wounds generally have worse prognosis

How can patient anxiety be managed to improve wound circulation? A) Provide explanations and distraction B) Ignore anxiety C) Increase pain medication D) Rush treatment

A) Provide explanations and distraction

Why does palpable pulses NOT guarantee adequate wound circulation? A) Pulses only reflect macrocirculation B) Pulses reflect microcirculation C) Pulses guarantee healing D) Pulses indicate infection

A) Pulses only reflect macrocirculation

Why might severe wounds sometimes be painless? A) Sensory loss (neuropathic ulcers) B) High inflammation C) Infection D) Small size

A) Sensory loss (neuropathic ulcers)

What mechanical factor can delay wound closure by increasing tension? A) Swelling B) Proper suturing C) Moisture D) Reduced edema

A) Swelling

Which of the following could cause failure to meet wound healing goals despite good treatment? A. Systemic infection B. Use of topical ointments C. Leg elevation D. Low ambient temperature

A. Systemic infection

Which of the following best describes the financial burden of nonadherence annually in the U.S.? A) $30 million B) $300 billion C) $100 million D) $3 billion

B) $300 billion

How is infection defined in wounds? A) Any presence of bacteria B) >10^5 microbes per gram tissue C) Colonization without symptoms D) No microbes present

B) >10^5 microbes per gram tissue

What defines an acute wound? A) A wound from chronic disease B) A wound caused by surgery or trauma in healthy individuals C) A wound with prolonged healing D) A wound infected with microbes

B) A wound caused by surgery or trauma in healthy individuals

What is the key distinction between adherence and compliance? A) Compliance reflects mutual agreement B) Adherence involves patient autonomy, while compliance implies passive obedience C) Adherence means strict rule following D) Compliance is more empowering for patients

B) Adherence involves patient autonomy, while compliance implies passive obedience

Which of the following is a nonmodifiable systemic factor affecting wound healing? A) Nutrition B) Age C) Physical activity D) Smoking

B) Age

Patient belief in the effectiveness of a treatment impacts adherence because: A) It replaces clinician advice B) Beliefs may override evidence unless addressed C) Beliefs don't matter if instructions are clear D) It leads to overcompliance

B) Beliefs may override evidence unless addressed

How does sympathetic nervous system activation affect wound circulation? A) Causes vasodilation B) Causes vasoconstriction C) No effect D) Increases blood flow

B) Causes vasoconstriction

What is the significance of epidermal appendages in wound healing? A) They prevent infection B) Cells migrate from them aiding re-epithelialization C) They slow healing D) They have no role

B) Cells migrate from them aiding re-epithelialization

Why should PTs monitor medication effects in wound healing? A) Some medications promote infection B) Certain drugs impair immune response and tissue repair C) All medications improve wound tensile strength D) Medications have no impact on healing

B) Certain drugs impair immune response and tissue repair

Which trigger can cause peripheral vasoconstriction during wound care? A) Warmth B) Cold C) Relaxation D) Massage

B) Cold

What systemic factor increases risk for skin breakdown due to poor mobility and positioning? A) Age B) Comorbidities causing activity limitation C) Nutritional deficiency D) Steroid use

B) Comorbidities causing activity limitation

What is the main goal of PT in chronic wound management? A) Speeding up normal healing B) Eliminating factors delaying healing C) Only dressing wounds D) Avoiding intervention

B) Eliminating factors delaying healing

Which factor should PTs prioritize to reduce wound healing complications? A) Ignoring lifestyle factors B) Encouraging smoking cessation and healthy lifestyle modifications C) Focusing only on pharmacologic treatments D) Disregarding nutrition

B) Encouraging smoking cessation and healthy lifestyle modifications

Which factor does NOT delay wound healing locally? A) Mechanical stress B) Good circulation C) Sensory loss D) Periwound edema

B) Good circulation

What is the PT's role in addressing nonadherence? A) Only educate B) Identify barriers and co-create realistic solutions C) Ignore patient concerns D) Delegate responsibility

B) Identify barriers and co-create realistic solutions

How does malnutrition specifically impair wound healing? A) Increases collagen synthesis B) Impairs inflammation, immune response, and tissue proliferation C) Enhances angiogenesis D) Promotes fibroblast activity

B) Impairs inflammation, immune response, and tissue proliferation

What effect does necrotic tissue have on wound healing? A) Speeds epithelial migration B) Inhibits epithelial migration and promotes infection C) Has no effect D) Prevents infection

B) Inhibits epithelial migration and promotes infection

Which of the following is true about polypharmacy in older adults regarding wound healing? A) It always improves healing B) It can cumulatively suppress immune and repair processes C) It has no clinical relevance D) It enhances vascular responsiveness

B) It can cumulatively suppress immune and repair processes

Why is microcirculation important in wound healing? A) It controls pain perception B) It delivers oxygen and nutrients directly to the wound bed C) It regulates immune cell production D) It prevents wound infection

B) It delivers oxygen and nutrients directly to the wound bed

Why is interdisciplinary consistency important for patient adherence? A) It allows conflicting recommendations B) It simplifies communication and builds trust C) It limits patient autonomy D) It avoids re-assessment

B) It simplifies communication and builds trust

What is a risk when wounds are excessively moist? A) Faster healing B) Maceration and skin breakdown C) No risk D) Reduced oxygen delivery

B) Maceration and skin breakdown

What does presence of colonization in a wound mean? A) Infection B) Microbes present without infection C) No microbes D) Healing wound

B) Microbes present without infection

What is essential for oxygen and nutrient delivery to the wound bed? A) Macrocirculation B) Microcirculation C) Large arteries D) Venous drainage

B) Microcirculation

What should PTs emphasize to support systemic wound healing? A) Only local wound dressings B) Oxygenation, mobility, nutrition, medication awareness, and patient education C) Avoid collaboration with medical teams D) Ignore comorbidities

B) Oxygenation, mobility, nutrition, medication awareness, and patient education

What is a key clinical approach to improve circulation during wound care? A) Keeping patient cold B) Patient comfort and warmth C) Ignoring patient pain D) Using cold packs

B) Patient comfort and warmth

Which of the following medications may improve local circulation in wound healing? A) Steroids B) Pentoxifylline C) NSAIDs D) Chemotherapy agents

B) Pentoxifylline

Which of the following is a subtle clinical sign of impaired vascular responsiveness in aging? A) Rapid wound closure B) Prolonged inflammation and repair phases C) Increased inflammatory cell migration D) Enhanced dermal thickness

B) Prolonged inflammation and repair phases

Why might serial (maintenance) debridement be beneficial in chronic wounds? A) Increases wound size B) Removes necrotic tissue and reduces bioburden C) Causes infection D) Delays healing

B) Removes necrotic tissue and reduces bioburden

How does periwound edema affect wound healing? A) Improves blood flow B) Restricts blood flow C) Has no effect D) Enhances epithelial migration

B) Restricts blood flow

What cellular characteristic is typical of chronic wounds? A) Increased proliferation B) Senescent cells with reduced function C) High responsiveness to growth factors D) Rapid epithelialization

B) Senescent cells with reduced function

What sensory deficit increases wound risk by preventing damage recognition? A) Enhanced sensation B) Sensory deficits C) Increased pain D) None

B) Sensory deficits

What type of mechanical stress involves tissue layers sliding against each other? A) Pressure B) Shear C) Friction D) Compression

B) Shear

Which lifestyle factor has the greatest negative effect on tissue oxygenation? A) Physical inactivity B) Smoking C) Alcohol abuse D) Poor nutrition

B) Smoking

Why is nonverbal pain assessment important in wound care? A) All patients verbalize pain B) Some patients cannot verbalize discomfort C) Pain does not affect circulation D) Pain is irrelevant

B) Some patients cannot verbalize discomfort

What effect do corticosteroids have on wound healing? A) Stimulate angiogenesis B) Suppress inflammation and reduce collagen synthesis C) Promote epithelialization D) Increase wound tensile strength

B) Suppress inflammation and reduce collagen synthesis

What does a nonhealing wound often indicate? A) Normal healing B) Systemic disease like diabetes or cancer C) Recent trauma D) Overhydration

B) Systemic disease like diabetes or cancer

Which patients require daily skin inspection due to lack of sensation? A) Diabetics with neuropathy B) T10 spinal cord injury patients C) Healthy individuals D) Stroke patients

B) T10 spinal cord injury patients

What is a critical PT clinical approach to detecting infection in elderly or immunocompromised patients? A) Wait for classic signs of infection before acting B) Use clinical reasoning beyond classic signs to detect early infection C) Rely solely on patient pain report D) Focus only on wound size

B) Use clinical reasoning beyond classic signs to detect early infection

What is a key strategy to re-educate patients about adherence when nonadherence is suspected? A) Ignore the issue B) Use objective evidence C) Blame the patient D) Discharge the patient

B) Use objective evidence

What is a key strategy to minimize mechanical stress on wounds? A) Allow friction B) Use pressure relief and gentle handling C) Increase tension on edges D) Ignore wound care

B) Use pressure relief and gentle handling

Which of these is NOT a category of factors delaying wound healing? A) Patient adherence B) Wound hydration C) Wound characteristics D) Systemic factors

B) Wound hydration

How does wound location affect healing? A) No effect B) Wounds over bony prominences heal slower C) Wounds on face heal slower D) All wounds heal the same

B) Wounds over bony prominences heal slower

What is the clinical implication of slow progress in complex chronic wounds? A. PTs should consider discharge B. Celebrate small gains to enhance adherence C. Repeat the same treatments more frequently D. Suggest surgical intervention

B. Celebrate small gains to enhance adherence

What patient factor is often underestimated but critical for wound care adherence? A. Social media use B. Cognitive function C. Personality traits D. BMI

B. Cognitive function

What are chronic wounds characterized by? A. Fast healing with debridement B. Delayed or arrested healing process C. Excessive pain but fast closure D. Large size with minimal impact

B. Delayed or arrested healing process

What subtle sign may suggest missed venous pathology in wound care? A. Fever B. Edema and skin discoloration near wound C. Elevated WBC D. Pruritus

B. Edema and skin discoloration near wound

Which clinical failure can delay wound healing despite patient adherence? A. Overuse of topical ointments B. Failure to recognize venous pathology C. Using saline for irrigation D. Delayed debridement

B. Failure to recognize venous pathology

Which of the following is a recommended wound environment to optimize healing? A. Cold and dry B. Moist and warm C. Wet and acidic D. Open to air

B. Moist and warm

What is the best clinician response to outdated wound care practices by colleagues? A. Report them to hospital administration B. Provide evidence-based education through discussion C. Ignore them unless harmful D. Only discuss during staff meetings

B. Provide evidence-based education through discussion

Which wound management technique is now discouraged except in specific cases? A. NPWT B. Whirlpool therapy C. Sharp debridement D. Moist dressings

B. Whirlpool therapy

What is the estimated adherence rate for elderly patients taking prescribed medications? A) 90% B) 75% C) 60% D) 40%

C) 60%

Which of the following is NOT a common example of patient nonadherence in wound care? A) Missing follow-up appointments B) Discharging self early C) Asking questions about wound care D) Not following home exercise programs

C) Asking questions about wound care

Which of the following is an example of intentional nonadherence? A) Forgetting to take antibiotics B) Not understanding the dressing process C) Avoiding treatment due to cosmetic concerns D) Missing a session due to vision issues

C) Avoiding treatment due to cosmetic concerns

What is the primary energy source for active cells during wound repair? A) Protein B) Fat C) Carbohydrates D) Vitamins

C) Carbohydrates

How does aging impair wound healing? A) Increases macrophage activity B) Enhances collagen synthesis C) Causes epidermal and dermal atrophy D) Improves vascular responsiveness

C) Causes epidermal and dermal atrophy

How does smoking impair wound healing? A) Enhances fibroblast proliferation B) Increases tissue oxygenation C) Causes vasoconstriction and reduces oxygen delivery D) Improves immune function

C) Causes vasoconstriction and reduces oxygen delivery

What task characteristic typically reduces adherence? A) Simplicity B) Integration into lifestyle C) Causing pain or discomfort D) Use of reminders

C) Causing pain or discomfort

Which clinician behavior most improves patient adherence? A) Giving vague directions B) Frequent changing of therapists C) Demonstrating empathy and active listening D) Being authoritarian

C) Demonstrating empathy and active listening

What is the clinical relevance of the concept that adherence is dynamic? A) It requires no monitoring B) Patients are either fully adherent or nonadherent C) Fluctuation in behavior is normal and must be managed supportively D) It means patients always follow instructions

C) Fluctuation in behavior is normal and must be managed supportively

Which of the following best describes a chronic wound? A) Heals within days B) Progresses through predictable phases C) Healing phases prolonged or arrested D) Always infected

C) Healing phases prolonged or arrested

Why is pain perception important in wound care for older adults? A) It increases vascular constriction B) Older adults have increased pain sensitivity C) Impaired pain perception can delay wound detection D) Pain always correlates with wound severity

C) Impaired pain perception can delay wound detection

Which wound size change after treatment suggests poor healing prognosis? A) 30% decrease B) No change C) Increase in size D) 20% decrease

C) Increase in size

In the communication model of adherence, the role of the patient is to: A) Control the therapy plan B) Deliver the instructions C) Interpret the message and act on it D) Provide supplies

C) Interpret the message and act on it

What is the ideal wound moisture environment? A) Very dry B) Excessively wet C) Moist but not macerated D) Always dry

C) Moist but not macerated

Which of the following is NOT a systemic factor delaying wound healing? A) Diabetes B) Smoking C) Moist wound environment D) Poor nutrition

C) Moist wound environment

What is the relationship between wound pain and severity? A) Always correlated B) Never correlated C) Not always correlated D) Pain predicts healing

C) Not always correlated

Why is managing patient pain crucial for wound healing? A) Pain reduces sympathetic tone B) Pain increases vasodilation C) Pain influences sympathetic vasoconstriction D) Pain is unrelated

C) Pain influences sympathetic vasoconstriction

Which of the following correlates positively with patient adherence and wound outcomes? A) Frequent medication changes B) Passive education C) Patient satisfaction and quality of life D) High pain medication use

C) Patient satisfaction and quality of life

Which factor is most strongly linked to adherence behavior? A) Age B) Gender C) Self-efficacy D) Income

C) Self-efficacy

Why might a diabetic patient resist a low-fat, low-sugar diet? A) They always prefer high protein B) They are unaware of their diagnosis C) Social, cultural preferences and habit strength may override motivation D) Diets have no clinical value

C) Social, cultural preferences and habit strength may override motivation

What environmental factor is known to improve adherence rates? A) Living alone B) Unreliable transportation C) Strong social support D) Sedentary lifestyle

C) Strong social support

What role do psychosocial factors play in wound healing? A) No role B) They only affect pain perception C) They can reduce activity and nutrition, indirectly impairing healing D) They improve circulation

C) They can reduce activity and nutrition, indirectly impairing healing

Which patient population has the lowest estimated adherence rate for foot inspection in diabetes management? A) Those who inspect feet daily B) Patients using insulin C) Those who never inspect foot skin D) Children with type 1 diabetes

C) Those who never inspect foot skin

Which of the following is recommended to improve patient adherence? A) Increase task complexity B) Avoid discussing side effects C) Use specific instructions and simplify tasks D) Provide general advice without follow-up

C) Use specific instructions and simplify tasks

Which vitamin is essential as a cofactor in wound healing? A) Vitamin D B) Vitamin K C) Vitamin C D) Vitamin B12

C) Vitamin C

What is a potential danger of overusing whirlpool therapy in wound care? A. It causes dehydration B. Promotes infection C. Can damage granulation tissue and delay healing D. Reduces immune cell migration

C. Can damage granulation tissue and delay healing

Why are adherence logs and contracts underutilized despite evidence of effectiveness? A. They are not reimbursed by insurance B. Clinicians are unaware of them C. Clinicians cite time constraints and lack of training D. They violate patient privacy laws

C. Clinicians cite time constraints and lack of training

What does the whirlpool overuse example best illustrate in clinical practice? A. Value of documentation B. Importance of billing accuracy C. Critical appraisal of traditional methods D. The need for longer treatment times

C. Critical appraisal of traditional methods

What subtle yet essential concept should PTs keep in mind regarding wound healing timelines? A. All wounds should heal in 2 weeks B. Progress is linear if patient adheres C. Healing timelines vary widely; patience and monitoring are critical D. Healing only occurs with antibiotics

C. Healing timelines vary widely; patience and monitoring are critical

When are systemic antibiotics appropriate in PT wound management? A. Always when wound is present B. For malodor or slough C. If there are signs of systemic infection or cellulitis D. When debridement fails

C. If there are signs of systemic infection or cellulitis

Which modifiable factor most strongly influences wound healing? A. Age B. Ethnicity C. Infection and necrotic tissue D. Skin color

C. Infection and necrotic tissue

Why is "dry wound theory" now considered inappropriate for most wound care? A. It delays bleeding B. It increases cost C. It leads to crusting and slower healing D. It causes excessive exudate

C. It leads to crusting and slower healing

A patient's blood sugar is consistently 160 mg/dL. What impact might this have on wound care outcomes? A. Minimal, unless infection is present B. None; only hypoglycemia matters C. It may impair healing D. It improves immune response

C. It may impair healing

Which of the following best explains why nonadherence should not be viewed solely as patient failure? A. It is often unavoidable in all patient populations B. It indicates need for stronger medications C. It reflects gaps in communication, education, or resources D. It is mainly due to mental illness

C. It reflects gaps in communication, education, or resources

Which of the following most accurately describes why adherence in wound care is uniquely complex in physical therapy? A. Patients are less likely to understand instructions. B. Wound care involves simple but frequent tasks. C. Tasks are often painful, inconvenient, or multi-step. D. Clinicians typically provide minimal supervision.

C. Tasks are often painful, inconvenient, or multi-step.

Which patient behavior may indicate inappropriate wound self-management requiring immediate clinician intervention? A. Wearing loose shoes B. Skipping a dressing change C. Using kerosene-soaked newspaper on ulcers D. Taking vitamins without prescription

C. Using kerosene-soaked newspaper on ulcers

Optimal temperature for wound healing is approximately: A) 12°C B) 20°C C) 30°C D) 37-38°C

D) 37-38°C

What local factors influence wound healing? A) Circulation B) Sensation C) Mechanical stress D) All of the above

D) All of the above

Which comorbidity is known to impair oxygenation and tissue perfusion in wound healing? A) Diabetes mellitus B) COPD C) Peripheral vascular disease D) All of the above

D) All of the above

What is the appropriate PT approach to wound care for a patient undergoing chemotherapy? A) Always avoid PT during chemotherapy B) Proceed with normal wound care without precautions C) Defer all care to oncology team D) Use clinical judgment balancing risk and benefit with interdisciplinary coordination

D) Use clinical judgment balancing risk and benefit with interdisciplinary coordination