Which of the following best describes a stage IV pressure ulcer with necrotic tissue?

• A. Red wound with granulation tissue
• B. Purple undermining tissue
• C. Yellow slough
• D. Black, hardened surface

Answer: (D)

Stage IV ulcers involve full-thickness tissue loss with exposed bone, tendon, or muscle. When necrotic tissue is present, it often shows up as eschar—black, dry, and leathery. That hard, dark surface indicates dead tissue that cannot heal in place and typically needs debridement to reveal viable tissue beneath and allow healing to proceed. The other descriptions describe tissue that is healthy (red with granulation) or different forms of nonviable tissue (yellow slough or purple undermining) but do not reflect the characteristic necrosis in a stage IV wound.