Integumentary System

5% of the NPTE · blueprint NPTE-PT content outline effective January 2024 (v1.1)

Short answer

Integumentary carries 8-11 of the 180 scored items. Content covers wound assessment and pressure-injury staging, burn depth classification and the rule of nines, selecting debridement methods, choosing dressings by wound moisture and exudate, oedema and scar management, and the precautions and contraindications that apply to modalities used on compromised skin.

Why it matters on this exam

Small but highly rule-based: staging, classification and dressing-selection questions have defensible single answers, making this a reliable scoring block.

Key concepts

Pressure-injury staging: stage 1 non-blanchable erythema with intact skin; stage 2 partial thickness with exposed dermis; stage 3 full thickness with visible fat; stage 4 exposed bone, tendon or muscle; unstageable when slough or eschar obscures the base; deep-tissue injury as persistent non-blanchable deep red or maroon discolouration.
Burn depth: superficial, superficial partial thickness (blisters, very painful), deep partial thickness, full thickness (insensate, leathery); rule of nines for adults and the modified proportions for children.
Debridement: sharp, enzymatic, autolytic, mechanical — chosen by tissue type, infection risk and urgency; eschar on a stable, dry, non-infected heel is generally left intact.
Dressings: match to moisture — hydrogel to donate, alginate and foam to absorb, transparent film for protection and autolysis.
Scar and oedema: compression, positioning, and the timeline in which scar remains modifiable.

Common mistakes

Staging a wound covered by slough rather than recording it as unstageable.
Using an absorptive dressing on a dry wound bed and stalling healing.

Worked example

A sacral wound shows visible subcutaneous fat, no exposed bone or tendon, with moderate exudate. That is stage 3, and the dressing choice should manage moderate exudate — an alginate or foam rather than a hydrogel.

Original practice questions

Integumentary SystemDifficulty 2/5

A sacral pressure injury shows visible subcutaneous fat without exposed bone, tendon or muscle. How is it staged?

AStage 2, because the wound extends below the epidermis
BStage 3, because full-thickness loss exposes subcutaneous fat
CStage 4, because the wound base is deep and irregular
DUnstageable, because the depth cannot be determined visually

Show answer and rationale

Correct: B. Stage 3 is full-thickness skin loss in which fat is visible but bone, tendon and muscle are not. Stage 4 exposes those deeper structures, and a wound is unstageable only when slough or eschar obscures the base.

A — Stage 2 is partial thickness with exposed dermis and no visible fat.
C — Stage 4 requires exposed bone, tendon or muscle.
D — The base is visible, so the injury can be staged.

Integumentary SystemDifficulty 3/5

Using the rule of nines for an adult, what percentage of total body surface area is burned when the entire anterior trunk and one entire arm are involved?

A22.5 percent, counting the anterior trunk as 18 and half an arm
B18 percent, counting the trunk as 9 and the arm as 9
C27 percent, counting the anterior trunk as 18 and the arm as 9
D36 percent, counting the whole trunk as 27 and the arm as 9

Show answer and rationale

Correct: C. In the adult rule of nines the anterior trunk is 18 percent and an entire upper limb is 9 percent, giving 27 percent.

B — The anterior trunk is 18 percent, not 9.
D — The whole trunk anterior and posterior is 36 percent, not 27.
A — An entire arm is 9 percent, not 4.5.

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Primary references

NPTE-PT Test Content Outline, effective January 2024 (v1.1) — Federation of State Boards of Physical Therapy (FSBPT) · primary · retrieved 2026-09-22, verified 2026-09-22

Last reviewed: 2026-09-22Next review by: 2026-12-21Draft — pending editorial reviewHow we verify facts