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Quiz Session - Attempts With Random Questions

NAWCO WCC Exam Questions

Page 10 of 35

181.

Donor sites, venous ulcers, and surgical wounds are examples of which type of wound?

  • Full-thickness skin loss wound

  • Superficial wound

  • Partial-thickness skin loss wound

  • Subcutaneous tissue wound

Correct answer: Full-thickness skin loss wound

There are four categories of wounds categorized by the depth of tissue damage: superficial, partial-thickness, full-thickness, and subcutaneous. Full-thickness skin loss wounds penetrate through the epidermis and dermis into subcutaneous fat and deeper tissues. Examples of such wounds include donor sites, venous ulcers, and surgical wounds.

Healing of full-thickness skin loss wounds involves the formation of granulation tissue and contraction.

182.

What is the most common type of skin graft? 

  • Split-thickness skin graft 

  • Full-thickness skin graft 

  • Cultured epidermal autograft 

  • Extracellular matrix scaffold

Correct answer: Split-thickness skin graft 

A split-thickness skin graft, the most common type, includes the entire epidermis and part of the dermis. The depth (which is at or below 12/1,000 inch) allows the donor site to heal as a superficial partial-thickness wound does, and also will allow for reharvesting if necessary. 

A full-thickness skin graft includes all elements of the skin; when this type of graft is taken, the deficit left requires coverage with another graft. Because of this, full-thickness skin grafts are generally only used to cover small areas.

A cultured epidermal autograft is grown from a patient's own epidermis in culture and eventually transferred to the patient. 

Extracellular matrix scaffolds (dermal replacements) are synthetic skin coverings, or temporary skin substitutes, and are used to promote rapid dermis production with minimal scar tissue formation. They are a type of CTP (cellular- and/or tissue-based product). 

183.

A patient with diabetic neuropathy reports no pain during the application of a debriding agent, which typically causes mild to moderate discomfort in other patients undergoing the same procedure. What does this suggest about this patient’s treatment tolerance?

  • The patient’s neuropathy may be masking pain associated with the treatment

  • The treatment is effective and should be continued 

  • The debriding agent is not strong enough and should be replaced with a more potent agent

  • The patient is likely minimizing their pain level 

Correct answer: The patient’s neuropathy may be masking pain associated with the treatment

Diabetic neuropathy can cause a loss of sensation, which might prevent the patient from feeling the pain that a debriding agent would typically cause. This indicates a need to carefully monitor the treatment's effects, as the patient may not be able to report discomfort or pain accurately. Assuming the treatment is effective or needs to be stronger without considering the neuropathy could lead to inappropriate management decisions.

184.

Why is it important to update risk assessment tools during the course of wound treatment?

  • To assess changes in the patient's condition that could affect healing

  • To comply with healthcare regulations

  • To monitor for potential infection

  • To prepare for potential litigation

Correct answer: To assess changes in the patient's condition that could affect healing

Risk assessment tools are utilized in wound care to monitor various risk factors and patient conditions that can influence wound healing processes. These tools help healthcare professionals identify any new risks or changes in the patient’s health status, such as mobility, nutritional deficiencies, or systemic conditions like diabetes. Updating these tools ensures that the care plan remains aligned with the patient's current needs and can be adjusted appropriately to address any new or worsening issues. This proactive approach helps in managing factors that directly impact healing, making it the primary reason for keeping risk assessment tools current.

While compliance with healthcare regulations is important, it is not the primary clinical reason for updating risk assessment tools. Compliance ensures that legal and operational standards are met, but the clinical justification for using these tools is to enhance patient care by adapting to their current medical needs. Monitoring for infection is a specific aspect of wound management, but risk assessment tools are generally broader, assessing various aspects of the patient's health that affect healing. Thus, while monitoring for infection is crucial, it is only one component of what risk assessment tools are updated for, making this option too narrow to be the best answer. Preparing for potential litigation is a defensive practice that focuses more on legal protection than on improving patient care. While it's necessary to document care processes to defend against possible legal challenges, the primary purpose of updating risk assessment tools should be to enhance patient outcomes through tailored, informed clinical decisions.

185.

Which of the following scenarios best demonstrates the application of evidence-based protocols in wound care?

  • A wound care specialist develops a protocol based on a comprehensive literature review, including systematic reviews and meta-analyses

  • A team of wound care specialists utilizes a protocol derived from traditional practices known to be effective

  • A new protocol is implemented based on anecdotal evidence from wound care device manufacturers

  • A wound care clinic opts for a protocol that prioritizes the preferences of its patients to ensure satisfaction

Correct answer: A wound care specialist develops a protocol based on a comprehensive literature review, including systematic reviews and meta-analyses

A comprehensive literature review that includes systematic reviews and meta-analyses is indicative of an evidence-based approach. These types of reviews synthesize a vast amount of research and provide a high level of evidence. While traditional practices, manufacturer suggestions, anecdotal evidence, and patient preferences may contribute to the decision-making process, none of them should be the sole basis for a wound care protocol.

186.

A nurse practicing wound care is temporarily relocating to another state due to a family emergency and plans to continue working there. Which step should the wound care nurse take first to ensure compliance with state laws?

  • Verify the state licensing requirements and obtain proper credentials

  • Report the emergency relocation to the current state’s board of nursing

  • Contact their current employer to arrange interstate transfer

  • Start practicing wound care immediately and submit the licensing paperwork once the move is finalized 

Correct answer: Verify the state licensing requirements and obtain proper credentials

Each state has its own licensing requirements, so it's critical for nurses to understand and fulfill these before practicing. This ensures compliance with local laws and avoids penalties for unauthorized practice. State regulations might differ significantly, including variations in the scope of practice. The nurse must understand these requirements and obtain the appropriate credentials before practicing in the new state.

Reporting the relocation to the current state's board of nursing has no bearing on obtaining proper credentials in the new state. The current state's board has no jurisdiction over licensing in other states. The priority is to meet the requirements of the new state. While an employer can assist with guidance, it's ultimately the nurse's responsibility to ensure they are properly licensed in the new state. The employer might not be familiar with all state requirements or able to handle the licensure process directly. Licensing is under the purview of the state board of nursing or relevant regulatory body, not the employer. Practicing without proper credentials in a new state can lead to legal penalties, as it constitutes unauthorized practice. A delay in paperwork submission is not a valid excuse for noncompliance with licensing requirements. Licensing ensures that healthcare professionals meet the necessary standards to provide safe patient care.

187.

Wounds that are left open and allowed to heal by scar formation demonstrate which method of healing?

  • Secondary intention 

  • Primary intention 

  • Tertiary intention 

  • Delayed primary intention 

Correct answer: Secondary intention 

Secondary-intention wounds are left open after surgery. Their healing involves scar tissue replacement during the proliferative phase; that is, the tissue defect must fill with new collagen tissue. These wounds heal more slowly than primary-intention wounds (approximated surgical incisions) because of the volume of connective tissue required to fill the defect. 

Tertiary intention and delayed primary-intention wound healing are synonymous terms, in which a dirty wound is left open to allow cleansing and then closed by the surgeon. 

188.

Which of the following metabolic conditions significantly increases the risk of Lower Extremity Arterial Disease (LEAD)?

  • Diabetes mellitus

  • Hyperthyroidism 

  • Electrolyte imbalances 

  • Anemia 

Correct answer: Diabetes mellitus

Diabetes Mellitus (DM), particularly type 2, is one of the strongest independent predictors of LEAD and significantly increases the risk of LEAD due to the increased likelihood of arterial wall damage, atherosclerosis, and associated complications. Chronic hyperglycemia can damage the blood vessels, leading to poor circulation and an increased risk of LEAD. 

Hyperthyroidism, electrolyte imbalances, and anemia do not directly relate to the risk factors for LEAD.

189.

An elderly patient with Incontinence-Associated Dermatitis (IAD) develops a secondary skin breakdown. Which management strategy is most appropriate to address this patient's skin breakdown?

  • Application of moisture-barrier creams

  • Daily cleaning with soap and water to prevent infection 

  • Implementing a drying agent

  • Regular application of talcum powder

Correct answer: Application of moisture-barrier creams

Moisture-barrier creams (emollient compounds such as lanolin and mineral oil petroleum) effectively prevent further skin breakdown by forming a protective layer over the skin. This helps to manage moisture and reduce irritation from incontinence, which is crucial in treating and preventing IAD. Frequent use of soap and water can exacerbate skin irritation and dryness, further damaging sensitive skin. A drying agent may be too harsh for already compromised skin, potentially worsening the condition. Regular application of talcum powder is not recommended as it can build up and facilitate bacterial or fungal growth, worsening skin integrity.

190.

Routine use of prophylactic antibiotics for uncomplicated puncture wounds in healthy individuals is discouraged due to the risk of predisposing the patient to a secondary infection. When antibiotics are unnecessarily prescribed to these patients, what is the most common organism seen in these secondary infections?

  • Pseudomonas

  • Staphylococcus

  • Escherichia coli

  • Clostridium difficile

Correct answer: Pseudomonas

Use of prophylactic antibiotics can predispose a healthy individual with an uncomplicated puncture wound to a secondary infection with Pseudomonas. For contaminated puncture wounds, for wounds to the plantar area of the foot, or in patients who are immunocompromised, antibiotics such as Ancef or Kefzol (first-generation cephalosporins) are recommended for prophylaxis treatment.

191.

The Rule of Nines is a method for estimating surface area. This method divides the body into how many areas? 

  • Eleven 

  • Ten

  • Nine

  • Eight

Correct answer: Eleven 

The Rule of Nines allows for a quick estimate of body surface area and is often used in triage situations. This method for estimating surface area divides the body into 11 different areas equal to 9% each, with the final 1% for the genitalia.

192.

An elderly patient with a pressure ulcer on the sacrum spends most of the day in a seated position. Which intervention is most critical for promoting healing of the ulcer?

  • Increased frequency of repositioning 

  • Use of a standard wheelchair cushion

  • Application of topical antibiotics

  • Regular use of an antiseptic wash

Correct answer: Increased frequency of repositioning 

Increasing the frequency of repositioning is essential to alleviate pressure and enhance blood circulation to the affected area, which is vital for healing pressure ulcers, especially in areas like the sacrum. The use of a standard wheelchair cushion provides some relief but may not adequately redistribute pressure compared to specialized cushions or mattresses. The application of topical antibiotics may help manage bacterial load but does not address the primary cause of pressure ulcers. Regular use of an antiseptic wash aids cleaning but does not alleviate the physical pressure causing the ulcer.

193.

Which of the following signs and/or symptoms is most commonly the first indication of lower extremity arterial disease (LEAD)?

  • Lower extremity pain worsened by activity and relieved by rest

  • Rest pain in the lower extremity 

  • Thin, shiny skin 

  • Prolonged venous filling time 

Correct answer: Lower extremity pain worsened by activity and relieved by rest

Pain in the lower extremity is often the first indication of LEAD and worsens as the disease process advances; the patient typically reports pain that is worsened by activity or elevation and relieved by rest and dependency. The location of the pain may suggest the level of occlusion. 

Advanced LEAD is typically evidenced by rest pain. Assessment findings in a patient with chronic tissue ischemia include thin, shiny skin and prolonged venous filling time (>20 seconds). 

194.

Medicare covers three support surfaces for patients with pressure ulcers who meet specific criteria. Which of the following product types is not included in group 1 support surfaces? 

  • Air-fluidized bed systems 

  • Mattresses 

  • Pressure pads 

  • Mattress overlays 

Correct answer: Air-fluidized bed systems 

For all three support surfaces, patients should have a care plan established by their physician or home care nurse; medicare coverage for all three groups continues until the patient's pressure ulcer is healed. A group 1 support surface is generally designed to either replace a standard hospital or home mattress or as an overlay on top of a standard hospital or home mattress. Products in this category include mattresses, pressure pads, and mattress overlays (foam, air, water, or gel).

Air-fluidized bed systems are a group 3 support surface. 

195.

You are working as the wound care nurse in a clinic and overhear a colleague discussing a high-profile patient's wound care treatment details with a nonmedical friend over the phone. What should you do in this situation to ensure HIPAA compliance?

  • Report the incident to the clinic’s HIPAA authority figure 

  • Advise the colleague about the correct treatment options

  • Remind the colleague to speak more quietly when discussing patient information

  • Since it does not directly involve patient care, ignore the situation

Correct answer: Report the incident to the clinic’s HIPAA authority figure 

Discussing patient information with unauthorized individuals, especially in a non-professional setting, is a clear violation of HIPAA (Health Insurance Portability and Accountability Act) regulations, which aim to protect patient privacy and confidentiality. The appropriate response is to report the incident to the HIPAA compliance officer or another relevant authority within the clinic to address the breach and prevent future occurrences. This ensures that the clinic maintains compliance with HIPAA regulations and protects patient confidentiality.

Advising the colleague about the correct treatment options is inappropriate because this continues to breach patient confidentiality by discussing the case without regard to privacy. Reminding the colleague to speak more quietly when discussing patient information does not address the fundamental issue of disclosing patient information to unauthorized persons, which is a violation regardless of the volume of the conversation. All healthcare professionals have a duty to protect patient information and to address any violations of privacy and confidentiality they become aware of, regardless of their direct involvement in the care of the patient.

196.

A 49-year-old patient with obesity and a history of hypertension has a diabetic foot ulcer with significant maceration of the surrounding skin. What evidence-based protocol should be followed to reduce the risk of wound infection?

  • Use an absorbent antimicrobial dressing to control drainage

  • Cover the ulcer with a hydrogel dressing to reduce maceration

  • Recommend bedrest and properly fitting shoes to promote wound healing

  • Initiate systemic antibiotics and apply a foam dressing 

Correct answer: Use an absorbent antimicrobial dressing to control drainage

The ulcer's surrounding skin is macerated, indicating that excess exudate is present. An absorbent antimicrobial dressing helps manage exudate levels by drawing excess fluid away from the skin, reducing further maceration and preventing infection. The antimicrobial properties help control bacterial load and bioburden, reducing the risk of infection.

Hydrogel dressings are beneficial for dry wounds needing moisture and would exacerbate maceration rather than alleviate it, increasing the risk of infection. While rest and properly fitting shoes can aid wound healing, recommending these without addressing the underlying issues (exudate management and infection risk) is insufficient. Proper dressing changes and wound care are needed to promote healing. Foam dressings are effective for managing exudate and may be considered appropriate. However, systemic antibiotics are not automatically warranted for diabetic ulcers with maceration unless there are clear signs of infection (e.g., increased erythema, purulence, warmth). Beginning antibiotics without a confirmed infection risks antimicrobial resistance.

197.

Which of the following is the most effective strategy when educating patients and their families about wound care treatment plans?

  • Ensure all instructions are verbally communicated in clear and simple terms

  • Provide written information with ample additional explanations

  • Explain the treatment plan using medical terminology for context 

  • Encourage the patient and their family to look up information online as needed 

Correct answer: Ensure all instructions are verbally communicated in clear and simple terms

Using clear and straightforward verbal communication ensures that the patient and their families understand the treatment plan. This approach simplifies complex medical information, allowing everyone involved to be informed and follow through with care instructions.

Providing written information alone is ineffective because not all patients and family members may have strong literacy skills or be fluent in the language used. Explaining the treatment plan in medical jargon can be confusing to patients and their families, especially if they do not have a medical background. This may discourage them from asking questions and lead to non-adherence due to a lack of understanding. Encouraging patients and families to research online independently might expose them to unreliable or conflicting information. Additionally, many patients might struggle to identify credible online sources or understand the content without guidance.

198.

An adult patient has sustained burns to the back of their left arm, posterior head and neck, anterior trunk, perineum, and front of the right leg.

Using the Rule of Nines, what percentage of their total body surface area (TBSA) has been burned?

  • 37%

  • 45%

  • 28%

  • 54%

Correct answer: 37%

According to the Rule of Nines, to estimate the TBSA of a burn injury, add the following: the back of the left arm (4.5%), anterior trunk (18%), front of the right leg (9%), posterior head and neck (4.5%), and perineum (1%). This equals 37%.

199.

What is the standard treatment for chronic venous insufficiency? 

  • Compression therapy 

  • Pharmacologic management 

  • Exercise 

  • Weight control and dietary modifications 

Correct answer: Compression therapy 

Compression therapy is the standard treatment for chronic venous insufficiency. Because venous insufficiency is associated with increased hydrostatic pressure in veins in the legs, compression therapy is used to reduce that pressure and aid in venous return. Wraps, bandages, garments, or devices can provide compression. 

Other treatment modalities include limb elevation, weight control, exercise, and pharmacologic therapy. They are often used in conjunction with compression therapy. 

200.

What are the initial indicators of a possible fistula? 

  • Fevers and abdominal pain 

  • Passage of GI secretions or urine through an unintentional opening onto the skin 

  • Surgical site infection

  • Dehisced wound 

Correct answer: Fevers and abdominal pain 

Fevers and abdominal pain are the initial indicators of a possible fistula. The passage of GI secretions or urine through an unintentional opening onto the skin heralds the development of a cutaneous fistula. Surgical incisions, associated surgical site infections, and dehisced wounds are common locations of fistula development (not early indicators of a fistula). 

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