Wound Treatment Associate (WTA) Practice Exam

Which of the following best describes the edge of a Stage 2 pressure injury?

1. Firm with no undermining

2. Non-blanchable erythema

3. Necrotic with tunneling

4. Granulating with a pink base

The correct answer is: Firm with no undermining

The edge of a Stage 2 pressure injury is best described as firm with no undermining. In this stage, the injury is characterized by partial thickness loss of skin, which involves the epidermis and may involve the dermis. The wound may present as a shallow open ulcer with a red or pink wound bed, but the edges of the injury remain well-defined and firm. Importantly, undermining, which involves the skin edges being lifted from the underlying tissue, is not a characteristic of a Stage 2 injury. In contrast, non-blanchable erythema pertains to Stage 1 pressure injuries, where the skin is intact but shows signs of redness that do not fade when pressure is applied. Necrotic tissue and tunneling are features associated with more advanced stages, such as Stage 3 or Stage 4, where the damage is deeper and involves more extensive tissue loss. Granulating tissue with a pink base suggests healing and is more characteristic of a Stage 3 or 4 pressure injury, where there's significant tissue loss and the wound is in its healing phase. Hence, the description of the edge as firm with no undermining is accurate for Stage 2 pressure injuries.