CRRN Wound Care and Skin Integrity in Rehabilitation 1 — Questions and Answers
Question 1: A patient with paraplegia develops a stage 3 pressure injury over the ischial tuberosity. Which factor is the PRIMARY cause of ischial pressure injuries in wheelchair users?
- Shear force from ambulation
- Sustained pressure exceeding capillary closing pressure during prolonged sitting (Correct answer)
- Moisture from urinary incontinence alone
- Friction from bed linen
Correct answer: Sustained pressure exceeding capillary closing pressure during prolonged sitting
Ischial pressure injuries in wheelchair users result from sustained pressure exceeding capillary closing pressure (~32 mmHg), causing tissue ischemia during prolonged sitting.
Question 2: A CRRN is staging a wound with slough covering 70% of the wound bed. The visible tissue appears to reach subcutaneous fat. Which pressure injury stage is CORRECT?
- Stage 1
- Unstageable (Correct answer)
- Stage 2
- Stage 4
Correct answer: Unstageable
When slough or eschar obscures the wound base and prevents accurate depth assessment, the injury is classified as unstageable until the wound bed is debrided.
Question 3: Which pressure redistribution surface is MOST appropriate for a patient with multiple stage 2 pressure injuries who requires full-time bed rest?
- Standard hospital mattress with a thin foam overlay
- Low-air-loss or alternating pressure mattress system (Correct answer)
- Donut cushion placed under bony prominences
- Sheepskin pad over the existing mattress
Correct answer: Low-air-loss or alternating pressure mattress system
Low-air-loss or alternating pressure mattress systems provide superior pressure redistribution for high-risk patients with existing injuries compared to passive foam surfaces.
Question 4: A patient with diabetes and a neuropathic plantar foot ulcer is in wound rehabilitation. Which offloading device is considered the GOLD STANDARD for plantar foot ulcer healing?
- Therapeutic footwear and custom orthotics
- Total contact cast (TCC) (Correct answer)
- Removable walking boot (RCW) with strict compliance instructions
- Crutches with non-weight-bearing to the affected foot
Correct answer: Total contact cast (TCC)
The total contact cast (TCC) is the gold standard for offloading diabetic neuropathic foot ulcers because it distributes pressure over the entire foot and ensures compliance.
Question 5: A wound care nurse is selecting a dressing for a stage 3 pressure injury with moderate exudate and a clean, granulating base. Which dressing type is MOST appropriate?
- Dry gauze dressing changed every 8 hours
- Alginate or foam dressing to maintain moist wound healing while managing exudate (Correct answer)
- Transparent film dressing to observe the wound
- Iodine-soaked gauze packing
Correct answer: Alginate or foam dressing to maintain moist wound healing while managing exudate
Alginate and foam dressings absorb moderate-to-heavy exudate while maintaining the moist environment proven to optimize wound healing and granulation tissue formation.
Question 6: A rehabilitation patient with spinal cord injury is being taught pressure relief techniques for wheelchair use. Which frequency of pressure relief is RECOMMENDED to prevent ischial pressure injuries?
- Every 4 hours
- Every 15–30 minutes for at least 1–2 minutes (Correct answer)
- Once in the morning and once at night
- Only when the patient feels discomfort
Correct answer: Every 15–30 minutes for at least 1–2 minutes
Pressure relief maneuvers every 15–30 minutes for 1–2 minutes are the standard SCI guideline to restore tissue perfusion and prevent ischial pressure injuries.
CRRN Wound Care and Skin Integrity in Rehabilitation 1
A patient with paraplegia develops a stage 3 pressure injury over the ischial tuberosity.
Which factor is the PRIMARY cause of ischial pressure injuries in wheelchair users?