×

Quiz Session - Attempts With Random Questions

NAWCO WCC Exam Questions

Page 6 of 35

101.

What is the most superficial (i.e., outermost) layer of the epidermis? 

  • Stratum corneum 

  • Stratum lucidum 

  • Stratum granulosum 

  • Stratum spinosum 

Correct answer: Stratum corneum 

Healthy skin is characterized by its resilience, flexibility, elasticity, slight moisture, and good hydration. It comprises two main layers: the outermost layer, known as the epidermis, and the innermost layer, called the dermis. These layers are separated by a structure called the basement membrane. Below the dermis lies a layer of loose connective tissue known as the hypodermis or subcutis.

The epidermis lacks its own blood supply and is predominantly made up of keratinocytes, which account for around 90% of its composition. Keratinocytes are responsible for producing keratin, a fibrous protein. The epidermal keratinocytes are organized into five layers: the outermost layer is the stratum corneum, followed by the stratum lucidum, stratum granulosum, stratum spinosum, and finally, the deepest layer known as the stratum basale or germinativum, which rests upon the basement membrane.

102.

A patient with a neuropathic foot is being fitted for orthotics. To size the foot for the appropriate shoe length, how much space should be in front of the longest toe? 

  • 1/2 to 3/4 of an inch

  • 3/4 to 1 inch

  • 1/4 to 1/2 of an inch

  • 1 to 1.5 inches

Correct answer: 1/2 to 3/4 of an inch

A patient should not depend on the "feel" of a shoe to select the correct size. The shoe must be full width and girth and allow 1/2 to 3/4 of an inch of space beyond the longest toe to prevent distal shoe constraint through the gait cycle. 

103.

Wound temperature is typically assessed by touching the skin with the back of the fingers. The skin should be warm and equal bilaterally. Hypothermia (skin coolness) would not indicate which of the following?

  • Infection 

  • Impaired circulation 

  • Immobilized limb (i.e., in a cast)

  • Hypothyroidism 

Correct answer: Infection 

Coolness of the skin could indicate poor vascularization, hypothyroidism, immobilized limb, or intravenous infusion. 

Hyperthermia should be interpreted as a fever, inflammation or infection, or hyperthyroidism. 

104.

A 65-year-old male patient with a moderately exudative venous leg ulcer presents with signs of periwound maceration and skin irritation. Which of the following products or treatments should be avoided for this patient?

  • Hydrocolloid dressings

  • Foam dressings 

  • Zinc oxide-based barrier creams

  • Calcium alginate dressings

Correct answer: Hydrocolloid dressings

Hydrocolloid dressings are indicated for dry, flat wounds and healthy tissues; they should be avoided for this patient due to their potential to exacerbate periwound maceration. Hydrocolloid dressings may trap moisture against the skin, leading to further irritation and maceration in an already compromised area. 

Foam dressings are better suited for wounds with moderate to heavy exudate and can help manage moisture while protecting the periwound skin. Zinc oxide-based barrier creams can provide a protective barrier against moisture and irritants, aiding in the prevention of further skin breakdown. Calcium alginate dressings are indicated for wounds with moderate to heavy exudate and can help maintain a moist wound environment without contributing to periwound maceration.

105.

Which vitamin is essential for epithelial cell structure and function, protein synthesis, and the inflammatory response?

  • Vitamin A

  • Vitamin C

  • Vitamin E

  • Vitamin K

Correct answer: Vitamin A

Vitamin A is required for the inflammatory response and plays an important role in immune function; it is essential for epithelial cell structure and function and influences the synthesis or activation of many proteins, hormones, and insulin. 

Deficiencies of vitamin A have been associated with delayed reepithelialization, collagen synthesis, and cellular cohesion. Vitamin A is also depleted during malnutrition, infection, and injury. Fortunately, because vitamin A is a fat-soluble vitamin and not excreted from the body, deficiencies are rare. 

106.

A 49-year-old male patient recently started using a new topical antibiotic for a leg ulcer. During a follow-up visit, the patient complains of increased pain and itching at the site of application. What should the wound care nurse do first?

  • Document the reaction and notify the physician to reassess the treatment plan 

  • Encourage the patient to continue the treatment, as the symptoms are normal with this antibiotic 

  • Discontinue the antibiotic and clean the area to remove any residues

  • Apply a thicker layer of the antibiotic to offset the symptoms

Correct answer: Document the reaction and notify the physician to reassess the treatment plan 

Documenting the adverse reaction and notifying the physician are critical first steps to reassess the treatment plan and determine whether the antibiotic should be continued or changed. Continuing the treatment or increasing the dosage without reassessment could worsen the symptoms. Discontinuing the antibiotic immediately without consulting a physician may not be appropriate if the antibiotic is essential for preventing or managing infection. 

107.

A patient with a third-degree burn to the hands is being prescribed mafenide acetate cream. What is the purpose of this topical cream? 

  • To inhibit pathogenic organisms from proliferating 

  • To prevent loss of fluid through the injured tissue

  • To stimulate tissue growth

  • To decrease the transmission of pain impulses 

Correct answer: To inhibit pathogenic organisms from proliferating 

Mafenide acetate (Sulfamylon) is a suspension cream with broad-spectrum activity against gram-positive and gram-negative organisms, including P. aeruginosa. It penetrates burn eschar well and is useful when an infection is suspected (inhibits bacterial growth) or the vascular supply is minimal. 

Pain on application is a possible side effect of mafenide. 

108.

Which of the following methods of obtaining a wound culture is the gold standard?

  • Tissue biopsy

  • Needle aspiration

  • Quantitative swab technique 

  • Levine technique 

Correct answer: Tissue biopsy

Tissue biopsy is the removal of a piece of tissue with a scalpel or by punch biopsy. It is considered the gold standard for wound culturing. 

Needle aspiration and the swab technique are other methods of obtaining a wound culture. The Levine technique is recommended as the primary method of swabbing a wound for culture. 

109.

An 88-year-old female patient has been admitted to a long-term care facility with a stage 3 pressure ulcer on her sacrum. The facility's protocol emphasizes a comprehensive, multidisciplinary approach. Which of the following actions should the wound care specialist prioritize in accordance with facility processes?

  • Request a nutritional assessment by a dietitian

  • Apply a hydrocolloid dressing

  • Implement daily saline dressings

  • Refer the patient for surgical debridement of the wound 

Correct answer: Request a nutritional assessment by a dietitian

A nutritional assessment is indicated for the patient who has a wound of any kind. A stage 3 pressure ulcer requires a multidisciplinary approach, as emphasized by the facility’s protocol. A nutritional assessment by a dietitian ensures that the patient’s nutritional/dietary needs are addressed, which is critical for wound healing. While the other options might be relevant, providing nutritional support aligns directly with the comprehensive approach that facility processes require. 

110.

Which of the following is not an appropriate intervention to implement for the patient with contact precautions?

  • Wear a respiratory mask 

  • Wear gloves and gown when performing patient care

  • Provide a cohort room with another patient with the same microorganism 

  • Clean the room thoroughly between patients 

Correct answer: Wear a respiratory mask 

Contact precautions are guidelines to prevent the spread of disease through direct contact with a patient's skin, bodily fluids, or items within the patient's environment. It is a type of transmission-based precaution in which the patient requires a private room. However, if a private room is unavailable, it is acceptable to cohort with another patient with the same microorganism (such as MRSA). Gloves should be worn, and hands should be washed with an antimicrobial agent after glove removal; remove gloves while inside the patient's room. A gown should be worn if there may be patient contact or contact with infectious surfaces. Limit patient movement outside of their room and dedicate noncritical equipment to a single patient or patients with the same microorganism. The room should always be cleaned thoroughly between patients. 

A respiratory mask should be worn when caring for the patient with airborne precautions. 

111.

Screening for neuropathy by testing protective sensation can be done using which of the following tests? 

  • Semmes-Weinstein 5.07 Monofilament Examination (SWME)

  • Catheter-based angiography

  • Doppler ultrasound

  • Ankle-brachial index

Correct answer: Semmes-Weinstein 5.07 Monofilament Examination (SWME)

A swift and dependable method for neuropathy screening involves the SWME test. This test evaluates the loss of protective sensation by applying a 5.07 monofilament at five specific locations on each foot. Typically, the monofilament is affixed to a sturdy paper holder. The standardization ensures that when pressed against a foot area, the monofilament exerts a force of 10 grams.

The other choices are common tests and procedures for confirming peripheral arterial disease (PAD). 

112.

Which of the following patient populations is considered at high risk for developing pressure ulcers, requiring specialized interventions?

  • Patients with spinal cord injury

  • Patients with a history of diabetes

  • Patients with a recent history of orthopedic surgery

  • Patients with seasonal allergies

Correct answer: Patients with spinal cord injury

Spinal cord injury often leads to impaired mobility and sensation, predisposing individuals to pressure ulcers due to prolonged pressure on specific areas of the body. Therefore, these patients require specialized interventions to prevent pressure ulcer development.

While individuals with diabetes may be at higher risk of various complications, including peripheral neuropathy and compromised circulation, they are not specifically identified as high-risk for pressure ulcers. While orthopedic surgery can temporarily limit mobility and increase the risk of complications such as deep vein thrombosis, it is not directly associated with pressure ulcer development. Seasonal allergies do not directly contribute to an increased risk of pressure ulcers.

113.

During sharp instrument debridement of a wound, which signs and/or symptoms indicate that it should be discontinued?

  • Bleeding

  • Eschar removal

  • Purulent drainage

  • Patient complaint of fatigue 

Correct answer: Bleeding

Sharp debridement is the most rapid means of debridement and is selective for nonviable tissue; it is the preferred method for debriding most infected wounds and all necrotic tissue. If a wound has dry eschar, autolytic or enzymatic debridement can be used first to soften necrosis and facilitate the sharp removal of debris. Sharp debridement should be repeated whenever necrotic tissue reappears. One initial sharp debridement episode is not likely to remove all the necrotic tissue that continually accumulates in chronic wounds. 

Blood loss is not expected during sharp debridement (although it is a possibility) and is an indication to discontinue the process. Purulent discharge often occurs with an infected wound and is not a reason to discontinue treatment. Fatigue may be a concern, but explaining the procedure to the patient, positioning them for comfort, and reassuring them can be helpful.

114.

A pressure ulcer is assessed on a patient's coccyx as full-thickness tissue loss with visible subcutaneous fat. The wound has not reached bone, tendon, muscle, or cartilage, and there is undermining in the wound. What stage ulcer is this, based on the NPUAP classification system?

  • Stage III

  • Stage II

  • Stage IV

  • Unstageable/unclassified 

Correct answer: Stage III

This is a stage III pressure ulcer based upon the International NPUAP pressure ulcer staging system. 

  • Stage I: Intact skin with non-blanchable erythema that is not blue or purple located in an area usually over a bony prominence; darkly pigmented skin may not have visible blanching, but the color may differ from the surrounding area
  • Stage II: Partial thickness damage with dermis exposed presenting as a shallow open ulcer with a red-pink wound bed, without slough, granulation, or eschar. The area can manifest as an intact or open/ruptured serous fluid blister or as a shiny or dry shallow ulcer without slough or bruising. This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration, or excoriation. Bruising indicates a suspected deep tissue injury (sDTI).
  • Stage III: Full-thickness loss of skin with adipose tissue visible; granulation or epibole can be present. Depth of wound does not extend to bone, tendon, muscle, or cartilage. The wound can have undermining and/or tunneling. Slough can appear but does not obscure the depth of tissue loss. If slough/eschar is present and obscures the extent of tissue loss, then the wound is termed an "unstageable pressure injury."
  • Stage IV: Full-thickness skin and tissue loss with palpable fascia, muscle, tendon, ligament, cartilage, or bone. Slough or eschar can be present on some parts of the wound bed; if slough/eschar is present and obscures the extent of tissue loss, then the wound is termed an "unstageable pressure injury."
  • Unstageable pressure injury: Full-thickness skin/tissue loss; the extent of tissue damage cannot be confirmed due to obscuring slough/eschar (the base of the ulcer is covered by slough and/or eschar in the wound bed). This injury cannot be staged until the slough and/or eschar is removed to expose the base of the wound and its true depth.

115.

The routine use of topical antibacterials is strongly discouraged because its frequency leads to the development of resistant organisms. This is particularly true of which of the following medications? 

  • Mupirocin 

  • Bacitracin

  • Triple antibiotic ointment

  • Gentamycin 

Correct answer: Mupirocin 

Mupirocin is effective against methicillin-resistant staphylococcus aureus (MRSA) infection. If used inappropriately, it will not be effective when most needed. Because of this, it should be reserved for confirmed MRSA infections only. 

116.

Viable muscle can be recognized by the 4 Cs. Which of the following is not included in the 4 Cs of healthy muscle tissue? 

  • Compressible

  • Color

  • Consistency 

  • Capacity to bleed

Correct answer: Compressible 

Characteristics of healthy, viable muscle tissue include the following: 

  • red color
  • contraction upon stimulation with forceps or electrocautery
  • strong consistency
  • capacity to bleed

Compressibility is a characteristic of healthy skin (not muscle). 

117.

A compression stocking that provides 25-35 mm Hg of compression is considered to be in what compression class? 

  • Class 3

  • Class 1

  • Class 2

  • Class 4

Correct answer: Class 3

Compression stockings (or hose) provide a graded compression from the ankle to below the knee to mobilize edema fluid. There are four classes of compression stockings based on the amount of compression they provide:

  • Class 1: 14-19 mm Hg
  • Class 2: 19-24 mm Hg
  • Class 3: 25-35 mm Hg
  • Class 4: 40-50 mm Hg
     

There is debate about which is the most effective compression stocking, but the most effective stockings are those that are worn. The literature supports the use of 30 to 40 mm Hg compression because it offers a good compromise between compression, comfort, and ease of use. 

118.

A wound care specialist is teaching a group of nurses about hydrotherapy treatment for wound care. How does hydrotherapy facilitate wound healing?

  • By mechanically debriding the wound

  • By increasing systemic metabolic activity

  • By decreasing pH levels in the wound bed

  • By reducing the mechanical load on the wound

Correct answer: By mechanically debriding the wound

Hydrotherapy assists wound healing primarily by mechanically debriding the wound. The water flow helps to loosen and remove necrotic tissue (nonviable tissue), debris, and contaminants from the wound bed. This mechanical action prepares the wound bed to form new, healthy tissue and reduces the bacterial load, providing a cleaner environment that promotes healing.

While warm water used in hydrotherapy might increase blood flow to the wound area, it does not directly impact the body's metabolic rate. The primary benefit of hydrotherapy lies in its ability to cleanse the wound and promote tissue regeneration, not to affect metabolic activity systemically. Maintaining a moist wound environment is vital to the healing process, and the water used does not typically alter the wound’s pH significantly. Instead, hydrotherapy focuses on mechanical cleaning and debridement. Hydrotherapy does not aim to reduce the mechanical load (pressure or friction) on the wound. Reducing mechanical load is usually accomplished through offloading techniques like repositioning or specialized dressings.

119.

When considering the use of silver dressings in wound care, which condition serves as a primary indication?

  • Wounds with heavy colonization of bacteria

  • Superficial abrasions

  • Dry, non-draining wounds

  • Patients with known silver allergies

Correct answer: Wounds with heavy colonization of bacteria

Silver dressings are often used in wound care for their antimicrobial properties. Wounds with heavy colonization of bacteria are particularly suitable for silver dressings because silver can help reduce bacterial load and prevent infection. The antimicrobial action of silver can aid in promoting a healthy wound environment and facilitating healing in such cases.

Superficial abrasions typically do not require antimicrobial dressings like silver. These wounds are often minor and may heal well with simple cleaning and bandaging. Silver dressings may be unnecessary and could delay healing in such cases. Silver dressings are not typically indicated for dry, non-draining wounds. They are often used in wounds with exudate or signs of infection, as they provide antimicrobial activity and help manage wound exudate. Using silver dressings on dry wounds may lead to unnecessary expense and delay healing. Patients with known silver allergies are not appropriate candidates for silver dressings. Use on individuals with silver allergies can lead to adverse reactions, including contact dermatitis or systemic allergic responses.

120.

Which of the following vitamins has shown evidence of negating the effect of steroids on wound healing? 

  • Vitamin A

  • Vitamin C

  • Vitamin D

  • Vitamin E

Correct answer: Vitamin A

Vitamin A is essential for epithelial cell structure and function and influences the synthesis of various proteins, hormones, and insulin. It is required for the inflammatory response, and vitamin A deficiencies have been associated with retarded epithelialization and decreased collagen synthesis. 

Vitamin A can negate the effect of steroids on wound healing. 

×