American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first step in treating an unstageable pressure ulcer?

1. Administering antibiotics

2. Debridement of eschar

3. Applying a moisture-retentive dressing

4. Using a pressure-relieving device

The correct answer is: Debridement of eschar

The first step in treating an unstageable pressure ulcer is debridement of eschar. Unstageable pressure ulcers are characterized by the presence of necrotic tissue, commonly in the form of eschar, which obscures the true depth and stage of the ulcer. Debridement is crucial because it involves the removal of this necrotic tissue, allowing for better assessment and treatment of the wound. Once the eschar is debrided, healthcare providers can then visualize the wound bed, determine the extent of tissue damage, and implement appropriate interventions based on the ulcer's actual stage. Effective debridement can also facilitate healing by promoting granulation tissue formation and preventing infection, which is essential in the management of ulcers. While other options play a role in the overall management of pressure ulcers, debridement is the critical first step to initiate effective treatment and should take priority to ensure proper healing and wound care moving forward. Using pressure-relieving devices, applying moisture-retentive dressings, or administering antibiotics would follow the debridement process depending on the specific conditions of the ulcer and the patient's overall health.