No products in the cart.
NAWCO WCC Exam Questions
Page 8 of 35
141.
Which of the following is not a proper technique for obtaining a wound culture via the Levine swab method?
-
Swabbing for the specimen in the area with the largest collection of drainage
-
Thoroughly cleansing the wound surface prior to obtaining the specimen
-
Choose an area to swab that is free of nonviable tissue
-
Rolling the end of the swab over the wound surface, pressing gently to elicit fresh exudate
Correct answer: Swabbing for the specimen in the area with the largest collection of drainage
The Levine swab technique is the most commonly performed (and the preferred) technique for obtaining a wound culture specimen. The specimen should be collected before starting antibiotics.
First, cleanse the wound with a solution that contains no antiseptic. The end of a sterile, cotton-tipped applicator stick is rotated in a 1-cm2 area of the open wound for 5 seconds. Do not swab through dressing residue, old exudate, necrotic tissue, or blood. Next, choose an area that is free of nonviable tissue. Pressure is applied to the swab to cause tissue fluid to be absorbed into its cotton tip. Do not bother swabbing dry surfaces. Then, the swab tip is inserted into a sterile tube containing a transport medium and sent to the laboratory.
142.
The International Society of Lymphology (ISL) has created lymphedema classifications. Which of the following is not a characteristic of stage I lymphedema?
-
Thick, leathery skin
-
Pitting on pressure
-
Reduction on elevation
-
No clinical fibrosis
Correct answer: Skin that is thick and leathery
The ISL recognizes four categories (stage 0 through stage III) or classifications for staging. Stage 0 is subclinical lymphedema in which swelling is not evident despite impaired lymphatic function. Stage 0 may exist for months or years before edema occurs.
Stage I is defined as lymph fluid with a high protein content (in contrast to venous ulcer disease edema) that dissipates after limb elevation. Pitting occurs with pressure, swelling is reduced on elevation, and there is no clinical fibrosis yet.
Skin that is thick and leathery is indicative of lymphostatic elephantiasis (grade III).
143.
A wound care clinic implements telehealth services to reach a broader patient base. What is a significant benefit of this approach for patients in rural areas?
-
Increased access to specialists
-
Reduced treatment costs
-
Improved technological infrastructure
-
Expedited healing rates
Correct answer: Increased access to specialists
Telehealth services provide patients in rural areas with access to specialists who may not be available locally. This broader access ensures that these patients receive appropriate care from wound care experts, which can significantly improve outcomes.
While telehealth can reduce costs by eliminating the need for travel, increased access to specialists is a more direct and significant benefit for these patients, addressing a key need. While improved technological infrastructure could benefit rural communities, the immediate and direct benefit of telehealth for rural patients is increased access to wound care specialists. Healing rates depend on the quality of care and adherence to treatment rather than on telehealth alone. Telehealth primarily benefits rural patients by providing access to specialists who can guide their treatment effectively, potentially leading to better outcomes but not necessarily faster healing rates.
144.
A 49-year-old male patient with a chronic venous ulcer to the left lower extremity has a serum prealbumin level of 15 mg/dL. How should this value be interpreted in the context of wound healing?
-
It may indicate a mild nutritional deficiency
-
It is within normal limits and should not contribute to impaired wound healing
-
It is reflective of significant malnutrition
-
It is unrelated to nutritional status
Correct answer: It may indicate a mild nutritional deficiency
Prealbumin, also known as thyroxine-binding prealbumin or transthyretin, is commonly used as a marker of nutritional status in hospitalized patients. It is sensitive to protein intake and nutritional changes and responds more rapidly than other proteins, such as albumin.
A serum level of 15 mg/dL is slightly below normal values (18–45 mg/dL) but not extremely low, suggesting a mild nutritional deficiency that could compromise optimal wound healing. While the level is low, it does not typically signify significant malnutrition unless accompanied by other indicators.
145.
What is the primary purpose of suction in pulsatile lavage with suction?
-
Remove contaminants, necrotic debris, and irrigation solution
-
Prevent wound infection by directly administering antiseptic
-
Allow wound care specialists to collect wound fluid samples
-
Prevent bleeding by applying pressure to the wound edges
Correct answer: Remove contaminants, necrotic debris, and irrigation solution
The suction feature in pulsatile lavage is designed specifically to clear away debris, bacteria, and any remaining irrigation solution that may contain loosened pathogens or necrotic material. By removing these elements, the suction minimizes the risk of infection and facilitates a cleaner wound bed conducive to healing.
Pulsatile lavage primarily involves irrigating the wound with a solution, often normal saline or sterile water. While antiseptics can sometimes be included, the main purpose of the suction is not to directly administer antiseptic but to clear out the contaminants that could cause infection. Although some residual fluid may be collected during the process, the primary purpose of the suction isn't sampling but rather clearing the wound of unwanted materials. Fluid samples are generally collected by swabs or separate techniques. Suction does not apply pressure to wound edges but instead gently vacuums away debris and fluid. It is not designed to stop bleeding directly, as this requires pressure or other methods, like hemostatic agents.
146.
Clinically significant lower extremity arterial disease is noted if pedal pulses are absent and/or the ankle-brachial index (ABI) falls below which value?
-
0.9
-
1.1
-
1.3
-
1.5
Correct answer: 0.9
ABI is a simple bedside test in which perfusion pressures in the lower leg are compared with those in the upper arm using a standard blood pressure cuff and a handheld, battery-operated, continuous-wave, Doppler ultrasound device. Clinically significant arterial disease should be ruled out by establishing that pedal pulses are clearly palpable or that the ABI is >0.9. A "normal" ABI ranges from over 0.9 to 1.3; although an ABI of 0.9 to 0.99 has been considered a normal range, some recent data suggest an increased risk of cardiovascular disease and mortality in these patients. An ABI of ≤0.90 is approximately 95% sensitive for detecting lower extremity arterial disease (LEAD) compared with angiography-proven ischemic disease.
An ABI over 1.3 (abnormally high) typically indicates calcification of the vessel wall in a patient with diabetes.
147.
Which of the following wounds should not be debrided?
-
Arterial and ischemic ulcers
-
Pressure and venous ulcers
-
Diabetic and arterial ulcers
-
Vasculitic and pressure ulcers
Correct answer: Arterial/ischemic ulcers
Debridement is necessary for any type of wound, whether it's acute or chronic, when there is dead tissue (such as slough or eschar) or foreign objects present. It's also necessary if the wound is infected. Once the wound has been cleaned and viable tissue is visible, debridement is not needed (unless there's a biofilm present).
However, debridement is not recommended for arterial/ischemic ulcers. Before performing debridement, it's important to conduct arterial testing (such as ankle-brachial index or vascular studies) to assess the circulation. Additionally, stable eschar (which is firmly attached, not infected, and dry) on a poorly perfused limb or on a pressure ulcer on the heel should not be debrided.
148.
A wound care specialist is teaching a group of nurses about hydrotherapy for wounds and is explaining the benefits and risks of this treatment. What is a significant risk associated with the use of hydrotherapy in wound care?
-
Increased risk of infection
-
Reduced blood flow to the wound area
-
Rapid healing of the wound
-
Decreased sensation in the wound area
Correct answer: Increased risk of infection
The primary risk associated with hydrotherapy in wound care is an increased risk of infection. This can happen if the water or equipment is not properly sanitized or if the water is reused between patients. Contaminated water can introduce new pathogens into the wound or exacerbate existing infections. Moreover, the warm, moist environment created during hydrotherapy can promote bacterial growth if not managed correctly.
Hydrotherapy generally does not reduce blood flow. In fact, warm water and gentle agitation can increase blood circulation, which can aid in the healing process by delivering more oxygen and nutrients to the wound. Hydrotherapy, when correctly administered, can help facilitate the desired outcome of wound healing. Hydrotherapy does not typically cause decreased sensation. If there are preexisting conditions that impair sensation (e.g., neuropathy), hydrotherapy will not directly cause further reduction in feeling. The therapy is intended to aid in wound cleansing and debridement without affecting the nerve function in the wound area.
149.
A third-degree burn is now universally classified as which of the following?
-
Full-thickness burn
-
Superficial-thickness burn
-
Partial-thickness burn
-
Subdermal burn
Correct answer: Full-thickness burn
Burn injuries have historically been classified as first-, second-, third-, or fourth-degree. Today, they are more universally classified as superficial-thickness (first-degree), partial-thickness (second-degree), full-thickness (third-degree), and subdermal (fourth-degree).
A patient can often have burns at multiple depths.
150.
How can a wound care specialist address cultural beliefs legally and ethically during treatment?
-
Integrate the patient's beliefs into the treatment plan
-
Prioritize the treatment's medical necessity
-
Ensure standard of care is prioritized over cultural beliefs
-
Integrate family members' decisions into the treatment plan
Correct answer: Integrate the patient's beliefs into the treatment plan
From the first encounter, the wound care specialist must openly address the patient's individualized cultural beliefs without stereotyping; being respectful and responsive to cultural needs optimizes communication. Integrating the patient's cultural beliefs into the care plan respects both legal and ethical principles. This approach ensures that treatment aligns with the patient's cultural values, honoring their autonomy and allowing for personalized care that is both legally compliant and ethically sound.
Legal and ethical considerations require the treatment plan to reflect both the patient's medical needs and cultural values. Prioritizing standard of care over cultural beliefs disregards the patient's autonomy and can lead to treatment that is legally and ethically questionable. Legally and ethically sound care requires respect for the patient's cultural identity, even if adjustments to standard care are necessary. Although family input may be valuable, integrating family members' decisions into the treatment plan may override the patient's autonomy and personal cultural beliefs. Legal and ethical practice necessitates the integration of the patient's own views into the care plan.
151.
In Spaulding's classification for medical equipment, what level of disinfection or sterilization do semi-critical items that come into contact with mucus membranes or non-intact skin require?
-
High-level disinfection
-
Sterilization
-
Low-level disinfection
-
Intermediate-level disinfection
Correct answer: High-level disinfection
Items categorized as semi-critical, which interact with mucous membranes or broken skin, necessitate high-level disinfection. Items deemed critical, which are introduced into tissue or the vascular system, must be sterilized. Meanwhile, non-critical items that touch only intact skin need low-level disinfection.
152.
What is a commonly reported side effect of Electrical Stimulation (ES) therapy for wound care?
-
Mild discomfort
-
Severe pain
-
Fasciculations
-
Skin necrosis
Correct answer: Mild discomfort
Mild discomfort is a common and expected side effect of ES, reflecting the typical sensation experienced by patients without implying improper therapy or unusual outcomes. Other options, such as severe pain and skin necrosis, suggest incorrect application methods, and fasciculations (muscle twitching) are not directly relevant to wound care scenarios.
153.
Which of the following is an example of chemical (enzymatic) debridement?
-
Hypertonic saline dressings
-
Pulsed lavage
-
Negative-pressure wound therapy
-
Hydrogels and hydrocolloids
Correct answer: Hypertonic saline dressings
Chemical (also called enzymatic) debridement involves applying a concentrated, commercially prepared chemical (enzyme) to the surface of nonviable, necrotic tissue in the expectation that it will digest the devitalized tissue or loosen the bonds between nonviable tissue and tissues. Examples of chemical debridement include:
- enzyme agents or preparations
- hypertonic saline dressings
Pulsed lavage is an example of mechanical debridement. Hydrogels and hydrocolloids are examples of autolytic debridement. Negative-pressure wound therapy is an example of both autolytic and mechanical debridement.
154.
A diabetic foot ulcer that has penetrated the subcutaneous tissue with exposed bone, tendon, ligament, or joint capsule is classified as which Wagner grade?
-
Grade 2
-
Grade 3
-
Grade 4
-
Grade 5
Correct answer: Grade 2
The widely used Wagner foot wound classification system is an assessment tool that divides diabetic foot ulcers into six grades based on the depth of the lesion and the presence of osteomyelitis or gangrene. The grades progress from 0 to 5 in the order of breakdown severity for a diabetic, neuropathic foot.
Grade 2 indicates a deep penetration through the subcutaneous tissue with possible exposure of bone, tendon, ligament, or joint capsule. No abscess or osteomyelitis is noted in this grade.
155.
Which of the following best describes the appearance of granulation tissue within a wound bed?
-
Red, firm, and pebbled
-
Yellow and firm
-
Yellow to gray-green and loose
-
Black and soft and wet or hard and dry
Correct answer: Red, firm, and pebbled
Granulation tissue constitutes a combination of small blood vessels and connective tissue within the wound's base. This base creates a nourishing matrix capable of facilitating the migration of epidermal cells over the wound bed. A well-granulated wound offers an ideal environment for epidermal migration and the application of a skin graft, given that the newly formed capillaries aid in limiting or diffusing exudates through the host bed. A defining characteristic of the proliferative phase is the emergence of granulation tissue, which typically initiates as the inflammatory phase diminishes, typically occurring 3 to 4 days post-injury.
A transition from healthy red granulation tissue to a darker red or dusky pink hue warrants further assessment and potential intervention. Changes in the color and quantity of wound fluid may also occur. Additionally, heightened pain levels may signify the presence of an infection.
156.
Pathergy is a phenomenon that is often manifested in what clinical condition?
-
Pyoderma gangrenosum (PG)
-
Diabetic foot ulcers
-
Pressure ulcers
-
Factitious disorder
Correct answer: Pyoderma gangrenosum (PG)
A common and notable characteristic of PG is a phenomenon known as pathergy, which is the abnormal and exaggerated inflammatory response to noxious stimuli. Patients often report the lesion developing after minor trauma, such as a bump against a piece of furniture. Minor trauma preceding the development of the ulcer is an important piece of information to obtain during history-taking.
157.
What common foot lesion is caused by an infection with human papillomavirus?
-
Plantar warts
-
Tinea pedis
-
Callus
-
Hard and/or soft corn
Correct answer: Plantar warts
A plantar wart (verruca plantaris) is caused by a contagious viral infection (human papillomavirus) and involves an overproliferation of skin and mucosa growing downward (iceberg effect). It can create a single lesion or clustered lesions that have a yellow, brown, gray, or black appearance. Vesicular inclusion from dried capillary ends leads to a black/red appearance.
158.
Which of the following is the loss of full-thickness tissue that prevents wound-edge approximation?
-
Avulsion
-
Laceration
-
Abrasion
-
Puncture wound
Correct answer: Avulsion
An avulsion is a type of injury in which a portion of the skin and sometimes the underlying tissue is partially or completely torn away. This can occur secondary to accidents, animal bites, or trauma, resulting in skin that is not just cut but forcefully removed from the body. Avulsion wounds involve peeling of the skin from underlying tissue, which compromises the blood supply and can lead to tissue necrosis.
Lacerations are open skin wounds caused by blunt or penetrating trauma. Abrasions are the partial-thickness denudation of a portion of skin, and puncture wounds are caused by an object that punctures the skin.
159.
Which of the following offloading measures is most effective at relieving pressure and healing diabetic foot ulcers?
-
Total-contact cast (TCC)
-
Bedrest
-
Wheelchair
-
Surgical shoes
Correct answer: Total-contact cast (TCC)
Offloading and redistributing pressure are basic principles in the prevention of foot ulcers and lower extremity amputations, as well as the healing of existing diabetic foot ulcers. Of the options for offloading (bedrest, wheelchairs, crutches, surgical shoes, custom sandals, healing shoes, cast shoes, and foam dressings), total-contact casts are highly effective at relieving pressure and healing diabetic foot ulcers.
160.
What is the purpose of the PUSH tool in wound care?
-
To measure the severity of the wound and track healing progress
-
To predict the time it will take for a wound to heal completely
-
To assess the patient’s pain tolerance level before, during, and after treatment
-
To determine the cost-effectiveness of the treatment
Correct answer: To measure the severity of the wound and track healing progress
The PUSH (Pressure Ulcer Scale for Healing) tool is specifically designed to provide a standardized method for assessing the severity of pressure ulcers (wounds) and monitoring changes over time. It does this by evaluating and scoring various wound characteristics, such as the area (size), exudate amount, and tissue type. This standardized approach allows healthcare professionals to track wound healing progress effectively and adjust treatment plans based on quantifiable data. It’s a critical tool for observing how well a wound responds to treatment.
While it helps monitor progress, which might indirectly give clues about healing trajectory, it is not designed to forecast healing times. Wound healing is influenced by various patient-specific factors that the PUSH tool does not predict. The PUSH tool does not assess pain or pain tolerance. Pain assessment involves different scales and observations that are not part of the PUSH tool's functionality. While efficient wound management can indirectly influence cost-effectiveness, the PUSH tool itself does not calculate cost-effectiveness or perform any economic evaluations. Its primary function is clinical in nature, aimed at assessing wound severity and progression, not financial analysis.