NPTE Practice Test 7

Scenario: outpatient wound clinic, diabetic foot wound

A 63-year-old man with an 18-year history of type 2 diabetes is referred to an outpatient wound clinic for a wound under the right first metatarsal head that has been present for 6 weeks. He works as a mail carrier and walks about 6 miles per shift.

Medical history: HbA1c 8.4%, hypertension, hyperlipidemia. He quit smoking 10 years ago. Medications: metformin, insulin glargine, lisinopril, atorvastatin.

Examination at the first visit: the 10-g monofilament is not felt at 7 of 10 sites on each foot. Dorsalis pedis and posterior tibial pulses are palpable bilaterally, and the right ankle-brachial index (ABI) is 1.04. The wound is round, with a thick rim of callus. The base is 100% pink-red granulation tissue with no visible tendon, joint capsule or bone, and a probe-to-bone test is negative. There is a small amount of serous drainage, no odor, and no periwound erythema, warmth or induration. Temperature is 98.4°F (36.9°C).

Current plan: weekly visits for callus debridement and a foam dressing, with a removable walking boot. At week 4 he says he takes the boot off during his route because it slows him down.