NMC OSCE Wound Care & Tissue Viability 2 — Questions and Answers
Question 1: A patient has a dry, necrotic wound with hard eschar. Which dressing type would best facilitate autolytic debridement?
- Alginate dressing
- Hydrogel dressing (Correct answer)
- Foam dressing
- Antimicrobial dressing
Correct answer: Hydrogel dressing
Hydrogel dressings donate moisture to dry, necrotic wounds, rehydrating eschar and enabling the body's own enzymes to break down devitalised tissue through autolytic debridement.
Question 2: Which pressure ulcer risk assessment tool is most widely used and recommended in UK clinical practice?
- Norton Scale
- Braden Scale
- Waterlow Score (Correct answer)
- Jackson/Cubbin Scale
Correct answer: Waterlow Score
The Waterlow Score was developed specifically for UK NHS settings and is the most widely used and recommended pressure ulcer risk assessment tool in UK clinical practice.
Question 3: A patient presents with a venous leg ulcer. In which anatomical location is a venous leg ulcer MOST commonly found?
- Over the lateral malleolus
- On the dorsum of the foot
- In the gaiter area around the medial malleolus (Correct answer)
- On the pretibial shin area
Correct answer: In the gaiter area around the medial malleolus
Venous leg ulcers characteristically develop in the gaiter area, particularly around and above the medial malleolus, due to venous hypertension and pooling in this region.
Question 4: Before applying compression bandaging to a patient with a leg ulcer, which investigation is ESSENTIAL to rule out arterial insufficiency?
- D-dimer blood test
- Ankle Brachial Pressure Index (ABPI) (Correct answer)
- Venous duplex ultrasound
- Full blood count
Correct answer: Ankle Brachial Pressure Index (ABPI)
ABPI must be measured before applying compression bandaging to confirm adequate arterial blood supply, as compression is contraindicated in significant arterial disease.
Question 5: According to NICE guidelines, when should a wound swab be taken for microbiological analysis?
- Routinely at every dressing change
- When clinical signs of infection are present (Correct answer)
- When the wound has been present for more than 2 weeks
- Whenever slough is visible in the wound bed
Correct answer: When clinical signs of infection are present
Wound swabs should only be taken when clinical signs of infection are present (erythema, warmth, increased pain, purulent exudate), as all wounds carry bacteria and routine swabbing is not recommended.
Question 6: A patient is lying in a supine position. Which anatomical site is at GREATEST risk of pressure ulcer development?
- Elbows
- Sacrum (Correct answer)
- Knees
- Shoulder blades
Correct answer: Sacrum
The sacrum is the most common site for pressure ulcer development in supine patients, due to the high interface pressure over this prominent bony area combined with shear forces.
Question 7: What is the minimum acceptable ABPI score required before full compression bandaging can be safely applied to a leg ulcer patient?
- 0.5
- 0.6
- 0.8 (Correct answer)
- 1.0
Correct answer: 0.8
An ABPI of 0.8 or above is generally required to safely apply full compression therapy, as lower scores indicate arterial insufficiency that could be worsened by compression.
NMC OSCE Wound Care & Tissue Viability 2
A patient has a dry, necrotic wound with hard eschar.
Which dressing type would best facilitate autolytic debridement?