NAWCO WCC Exam Questions

Correct answer: Ask the patient and caregiver if they need any clarifications

By directly asking if they need clarifications, you can gauge their understanding and address any immediate concerns, ensuring effective communication. This approach helps clarify any confusion or misunderstandings in real time, making it easier for the patient and caregiver to follow through with post-operative care. It also allows you to adjust your approach based on the patient's and caregiver's responses, ensuring the information is communicated effectively and in a way that resonates with them.

Continuing with the planned education without checking for understanding risks further confusing the patient and caregiver. Immediate clarification is essential to ensure comprehension, as post-operative care involves critical steps for recovery. Switching to a more technical explanation risks compounding the confusion. More technical explanations might increase misunderstanding and hinder effective communication, particularly if the initial information is already unclear. Ending the session prematurely denies the patient and caregiver critical information necessary for post-operative care. Instead, clarifying and re-explaining concepts ensures they are prepared for the care ahead.

Correct answer: Pain and fever

Cellulitis is an infection involving subcutaneous tissue. It usually has an indistinct border and is characterized by pain, warmth, and edema with a red appearance of the skin. Patients can present with fevers, chills, headaches, muscle aches, and fatigue. 

The other answer choices are common characteristics of stasis dermatitis, a distressing inflammation of the epidermis and dermis on the lower extremities of a patient with lower extremity venous disease (LEVD). 

Correct answer: 3 seconds 

Capillary refill is performed by pressing the soft pad of the finger or toe until it turns white, then releasing pressure and noting the time it takes for color to return. A normal capillary refill time is under 3 seconds. Poor circulation is evidenced by increased or delayed capillary refill times (over 3 seconds) and may indicate lower extremity arterial disease (LEAD). 

Correct answer: Contraction

A scar that is immature is more likely to respond to treatment. To determine maturity, assess color, pliability, height, and texture. After the scar has matured, it may be either hypopigmented or hyperpigmented. Mature scars are generally more pliable than immature scars. 

To assess the pliability of a scar, simply pinch it. A scar that is not pliable will be difficult to pinch between the fingers because of the stiffness of the tissue. A scar that is raised above the plane of the normal adjacent skin demonstrates hypertrophy. As scar tissue is being actively deposited, if it becomes hypertrophied to any degree, the texture of the scar will deviate from that of the normal surrounding skin.  

Correct answer: Vitamin C

Vitamin C, also known as ascorbic acid, plays a critical role in collagen synthesis, a fundamental process in wound healing. It is a necessary cofactor for the enzymes that stabilize and cross-link collagen fibers, leading to strong tissue formation. Vitamin C also supports the immune system and enhances the production of fibroblasts and keratinocytes, which are critical for burn wound healing.

Potassium is important for maintaining electrolyte balance and cellular function but is not directly linked to collagen synthesis or wound healing. It is crucial for nerve function, muscle contraction, and maintenance of normal blood pressure. Vitamin K is vital to the blood clotting process and bone health. While it plays a role in hemostasis (stopping bleeding), it doesn't directly contribute to collagen synthesis or the repair of burn wounds. Sodium is also an electrolyte necessary for maintaining fluid balance, nerve function, and muscle contraction. However, like potassium, it doesn't contribute directly to collagen synthesis or wound healing.

Correct answer: Hypertension with increasing blood pressure 

Vital indications of systemic infection leading to sepsis include: 

• temperature >38 degrees or <35 degrees C
• heart rate >90/min
• respiratory rate >20/min
• temperature changes with chills
• hypotension with falling blood pressure and <90 mm Hg systolic or >40 mm Hg decrease from normal reading
• leukocytes >12,000, <4,000 mm³, or more than 10% immature forms

Two or more of the above criteria must be present to diagnose SIRS (systemic inflammatory response syndrome), sepsis, MODS (multiorgan dysfunction syndrome), or CARS (compensatory antiinflammatory response syndrome). 

Correct answer: Active cellulitis in the affected leg

Active cellulitis is an acute bacterial skin and soft-tissue infection characterized by redness, warmth, swelling, and pain. When compression therapy is applied to a leg with active cellulitis, the increased pressure can exacerbate the infection by impairing circulation to the infected and inflamed tissues. This can lead to further tissue damage, the spread of the infection, and potentially severe systemic effects. Therefore, it is essential to treat the cellulitis before considering the application of compression therapy.

Compression therapy is indicated and beneficial for managing edema, especially in patients with venous leg ulcers. Compression helps to reduce swelling and improve venous return, which is essential for healing venous ulcers. Therefore, moderate edema is not a contraindication but rather a condition for which compression therapy is typically used.

While a history of delayed wound healing can present challenges in wound management, it is not a contraindication for compression therapy. In fact, compression therapy might improve wound healing in patients with venous leg ulcers by increasing blood flow and reducing edema, thereby providing better oxygenation and nutrient delivery to the wound site. Compression therapy aims to address the underlying venous insufficiency that often contributes to delayed wound healing.

The use of anticoagulant medication is not a contraindication for compression therapy. Patients on anticoagulants may be at a higher risk of bleeding, but compression therapy does not significantly increase this risk when appropriately applied. It's essential to monitor for signs of increased bruising or bleeding, but anticoagulant use alone does not preclude the use of compression therapy.

Correct answer: Shear 

Shear is a two-sided force of an outside pressure pulling the subcutaneous tissues in one direction, while the movement of the bony structures beneath the tissues pulls in an opposite direction. 

Shear injures deep tissues, resulting in undermining and tunneling of pressure ulcers, the formation of pockets of fluid, or tissue damage deep under the skin. 

Correct answer: Assess the bandage application for proper pressure and positioning

Increased pain and numbness could indicate that the compression bandages are applied too tightly or are improperly positioned. Assessing and correcting the application can alleviate discomfort and prevent complications, such as nerve compression or restricted blood flow.

While the bandages may require loosening, the priority should be to assess the pressure and position of the bandages. Analgesics can help alleviate discomfort but do not address the underlying cause of the pain and numbness, which in this case is likely due to how the bandages are applied. Merely managing symptoms with pain medication can overlook a potentially correctable mechanical issue with the bandaging technique that could resolve the discomfort. These symptoms can indicate serious problems, such as improper bandage application leading to poor circulation or nerve compression. It is critical to assess and adjust the therapy appropriately rather than assuming such symptoms are normal and harmless.

Correct answer: Elevated temperature, inflammation, erythema and streaking

Cellulitis is inflammation and subsequent infection (as indicated by a fever) of the connective tissue between adjacent tissues and organs, and it commonly results from bacterial infection. Signs and symptoms of cellulitis include fevers/elevated temperature, pain, erythema with streaking, inflammation, tenderness, one bulla or a few bullae, no crusting, no lesions elsewhere, and unilateral infection. Infection can be located in the toes, dorsum and plantar surface of the feet, and lower leg skin. The initial insult is often trauma. Risk factors include wounds and immunodeficiency syndrome. 

Venous dermatitis is a common but distressing inflammation of the epidermis and dermis on the lower extremity of patients with LEVD. Often, it is the earliest cutaneous sequela of chronic venous disease (CVD). Manifestations include scaling, crusting, weeping, erythema, erosion, and intense itching. Symptoms can be acute or chronic and affect one or both lower legs. 

Correct answer: Tertiary intention 

Tertiary intention, otherwise known as delayed primary-intention wound healing, is a dirty wound that is left open to allow cleansing and then closed by the surgeon at a later time. This approach is sometimes required for abdominal incisions complicated by significant infection. Closure and/or approximation of the wound is delayed until the risk of infection is resolved, and the wound is free of debris. 

Correct answer: To enhance clinical decision-making based on reliable evidence

The primary purpose of integrating research studies into wound care protocol recommendations is to enhance clinical decision-making based on reliable evidence. By utilizing research findings, healthcare providers can make informed decisions about treatment strategies supported by scientific evidence, leading to better patient outcomes.

The primary purpose of integrating research studies into wound care protocol recommendations is not to increase healthcare costs. While new technologies may be incorporated based on research findings, the ultimate goal is to improve patient outcomes and optimize care, not to inflate costs. Integration of research studies into wound care protocol recommendations does not aim to limit treatment options. Instead, it seeks to provide healthcare providers with a broader understanding of effective treatments backed by evidence, thereby expanding their toolkit for addressing patient needs. It is meant to update and improve practices, not reinforce outdated ones, and to ensure that protocols are based on the most current evidence available rather than perpetuating practices that may no longer be optimal.

Correct answer: Poor circulation 

When assessing for PAOD in patients, a nurse should check for the "5 Ps," which are pulselessness, pain/numbness, poikilothermia (coolness), pallor, and paresthesia. Any of these findings should be reported to the physician. 

Poor circulation is part of the pathophysiology of this disease but not one of the signs included in the "5 Ps." 

Correct answer: Reassess the use of enzymatic debridement and consider alternative treatments if pain persists

Patients may experience a transient burning or stinging sensation, especially when the enzyme comes into contact with intact skin. While some discomfort can be expected with enzymatic debridement, excessive pain should not be dismissed as merely indicative of effectiveness. Pain could signify that the patient is having an adverse reaction or that the treatment is too aggressive for the patient's current condition. Continuing without reassessment could exacerbate the patient's discomfort or further damage healthy tissue surrounding the ulcer. Reassessing its use and considering alternatives can ensure that the patient receives the most appropriate and comfortable treatment.

While stopping the agent and cleaning the wound might provide immediate relief from discomfort, this action alone does not address the need for ongoing effective debridement or the management of the patient's pain during treatment. This approach might temporarily alleviate symptoms without considering a sustainable and effective ongoing treatment strategy. Although administering a local anesthetic could help manage pain, this solution might mask symptoms that need to be evaluated to adjust treatment properly. Additionally, frequent use of local anesthetics can have side effects and may not be suitable for all patients, especially if there are underlying conditions that contraindicate their use.

Correct answer: Ensure the tool aligns with both facility protocols and applicable regulatory guidelines

Healthcare facilities often have specific protocols to ensure standardized care practices. At the same time, regulatory guidelines, whether at the federal or state level, govern the proper use of medical devices and wound care tools. Ensuring the tool adheres to both sets of guidelines is essential for maintaining legal compliance and delivering consistent care.

Using a single tool exclusively can be limiting because not all wounds are the same, and some wounds may require different methods of measurement depending on their type, location, and complexity. Applying a one-size-fits-all approach may prevent accurate assessments. State guidelines provide legal frameworks, but healthcare facilities often implement protocols that are even more detailed or specific. Disregarding facility protocols could lead to discrepancies in internal audits or inconsistent care practices. Reporting only inconsistencies would result in incomplete data and documentation. A comprehensive reporting process should involve regular assessments and documentation, providing a clear picture of the tool's effectiveness over time. This ensures better patient monitoring and compliance.

Correct answer: Regular offloading of pressure points and use of total contact casting

Offloading the pressure from the affected area is critical in diabetic foot ulcer management. It helps reduce pressure and shear forces, two primary risk factors for ulceration in diabetic patients. Total contact casting is specifically designed to offload pressure from the foot, which accelerates healing by reducing further trauma to the area and improving blood circulation. Research supports offloading as a fundamental and evidence-based approach to treating diabetic foot ulcers. Total contact casting is often considered the gold standard for offloading diabetic foot ulcers.

Wet-to-dry dressings involve applying a wet gauze to the wound and allowing it to dry before removing. This method can be painful and may damage new tissue during the removal process. It is considered outdated and less effective than newer, more advanced wound care technologies that maintain a moist wound environment conducive to healing. While maggot debridement can be effective in cleaning out necrotic tissue from non-healing wounds, it is generally considered when other debridement methods are not suitable or have failed. It is not the primary recommendation for initial wound care management, especially when offloading can address the primary cause of the ulcer. Prophylactic antibiotics are not generally recommended for diabetic foot ulcers unless there is evidence of systemic infection. Overuse of antibiotics can lead to resistance, and in the absence of clinical infection signs, the focus should remain on local wound care and addressing the underlying causes, such as pressure and blood flow to the area.

Correct answer: Specialty cushions help prevent pressure injuries when combined with regular repositioning

Specialty cushions are designed to redistribute pressure to prevent prolonged pressure on specific areas, reducing the risk of pressure injuries. However, they work best when combined with regular repositioning (turning or shifting patients periodically), which is vital to minimize continuous pressure on any part of the body. 

Specialty cushions are not guaranteed to prevent pressure injuries on their own. Without regular repositioning, pressure on specific body areas may still occur, leading to pressure injuries. By reducing and redistributing pressure, specialty cushions can help prevent the occurrence of new injuries while also being used to manage existing pressure injuries. Specialty cushions are not limited to use in patients with severe pressure injuries (Stages 3 or 4). They are also valuable for preventing pressure injuries in high-risk individuals and can be used for any pressure injury stage, depending on the clinical context and the patient's needs.

Correct answer: Prealbumin

Because of the short half-life of prealbumin (2 days), this protein is decreased quickly when nutrition is inadequate and responds quickly when external nutrients are provided. Because of this, it is most commonly monitored for acute changes in nutritional status. 

Normal values of prealbumin are 14 mg/dL or greater. If levels fall below 11 mg/dL, the patient should be evaluated further for malnutrition. 

Correct answer: To determine whether the current treatment is effective

Weekly measurements are an essential part of evaluating the progress of wound healing. By consistently measuring the wound, you can observe changes in size, depth, and other healing indicators over time. This data allows you to assess the efficacy of the current treatment regimen and make evidence-based decisions about whether it should be continued, modified, or replaced. The effectiveness of the treatment is directly reflected in how the wound is healing, which makes this the primary reason for routine measurements.

Checking for compliance with treatment protocols is more related to quality control and procedural adherence. It is not the primary clinical reason for measuring the wound. This aspect is more about ensuring that the prescribed treatment plan is being followed rather than assessing the wound's response to the treatment. Adjustment of the frequency of dressing changes may sometimes be a consequence of the findings from wound measurements, but it is not the primary reason for taking these measurements. Decisions about dressing changes are usually based on wound condition, exudate levels, and other clinical signs, not solely on size measurements. While documenting the size of the wound in medical records is important for historical data and tracking purposes, documentation serves as a secondary function to support the main goal of evaluating treatment efficacy.

Correct answer: Sequential pneumatic compression pumps 

Compression wraps and stockings are an important component of therapy for all patients with lymphedema to prevent the reaccumulation of lymph fluid in the limb. 

Sequential pneumatic compression pumps are usually used when outpatient complete decongestive therapy is not possible due to the patient being confined to home or the patient undergoing treatment for open wounds. Intermittent pneumatic compression pumps decrease the volume of the affected limb and are used to maintain the reduction of lymphedema following phase I and phase II of complete decongestive therapy. They should be worn either daily or twice daily, and the patient should continue with compression (either through a garment or bandaging) for the remainder of the day.  

Diuretics are not beneficial for lymphedema because they may promote volume depletion. Bed rest and offloading are not effective treatment modalities for lymphedema.