NAWCO WCC Exam Questions

Correct answer: Alcohol-containing wipes

Alcohol is a drying agent that can severely irritate sensitive skin, especially in individuals with atopic dermatitis. Alcohol-impregnated wipes can strip the skin of its natural oils, exacerbating dryness, leading to increased irritation and inflammation, and potentially worsening the dermatitis. They should be avoided in favor of gentler cleaning and dressing options that do not compromise the skin's barrier function.

Hydrofiber dressings are designed to be highly absorbent and create a moist wound environment, which is beneficial for healing. They do not typically irritate the skin and are suitable for use on patients with atopic dermatitis because they help maintain a balanced moisture level without causing dryness or excessive wetness. Silicone gel sheeting is generally well suited for sensitive skin, including that of individuals with atopic dermatitis. It is non-adhesive and minimizes trauma to the skin during removal, which helps prevent irritation and exacerbation of atopic dermatitis. Petrolatum-impregnated gauze is another gentle option for dressing wounds in patients with sensitive skin or skin conditions like atopic dermatitis. It provides a protective barrier that promotes healing and prevents the dressing from sticking to the wound, reducing irritation upon removal.

Correct answer: Venous anastomosis obstruction or congestion 

The term "free" denotes that the tissue, along with its vascular supply, is completely removed from its original site (the donor site), relocated to a different site (the recipient site), and then connected to the blood vessels at the new site through anastomosis. A free flap can involve various types of tissues, including skin and fat, skin with fascia, muscle, nerve, bone, or a combination thereof. In every instance of a free flap, the blood supply is reestablished using microsurgical techniques to attach the artery and vein.

The primary serious risk associated with free flaps is the loss of the flap, often due to venous congestion. This complication can arise from issues such as a twisted pedicle, overly tight closure, or a thrombosed anastomosis.

Correct answer: To prevent complications 

While numerous wound specialists offer hands-on patient care for intricate wounds, in most environments, their role primarily entails serving as consultants.

In this capacity, specialists are adept at addressing the needs of most patients by organizing a comprehensive skin and wound care regimen overseen by a diverse team of healthcare professionals to mitigate complications. Effective communication, collaboration, and education are essential skills for a consultant to succeed. 

Correct answer: Reevaluate the fit and function of the NPWT system

Reassessing the fit and function of the NPWT system directly targets the patient's complaint. NPWT must be properly fitted and functioning to be effective and minimize discomfort. Misfitting equipment or incorrect operation can cause unnecessary pain or anxiety. By checking these aspects, the clinician can adjust the treatment to improve comfort and ensure the therapy is being delivered effectively.

While managing a patient's anxiety is important, administering anxiolytics does not address the root cause of the discomfort or the anxiety related to the NPWT. Furthermore, medication can have side effects and may not be the most appropriate first step if other modifications can resolve the issue. Discontinuing the therapy is a premature decision that could impede the patient's healing process. NPWT is often prescribed for its benefits in promoting wound healing, and discontinuing it without attempting adjustments or identifying specific issues might result in a setback in the patient's recovery. While some discomfort can be expected with NPWT, telling the patient it is normal without assessing for correctable problems may ignore a solvable issue and can diminish trust in the caregiver. It’s essential to validate the patient’s concerns and investigate potential causes, as ongoing discomfort could indicate a problem with the treatment's application or settings.

Correct answer: Atherosclerosis 

Atherosclerosis (hardening of the arteries) leads to impaired circulation in the legs and is the most common cause of LEAD and arterial ulceration. It is also one of the most important causes of gangrene, leading to amputation. Atherosclerotic disease can occur in any vessel.

Smoking, diabetes, dyslipidemia, and hypertension are risk factors for LEAD. 

Correct answer: Mast cells 

T cells generate cytokines to orchestrate the immune response and release toxic granules to eliminate infected cells. B cells manufacture antibodies to deactivate foreign entities such as bacteria and viruses. NK cells safeguard the host against both tumors and virally infected cells.

Mast cells, while not belonging to the lymphocyte category, play a role in the skin's immune system. They are mainly found in the papillary dermis, commonly located near blood vessels and nerves.

Correct answer: To participate in the biosynthesis of collagen to form the extracellular matrix (ECM) 

Fibroblasts migrate to the wound area along fibrin strands of the wound clot and synthesize ground substance and collagen in order to form the ECM. 

Integrins are cells in wounded tissues that are involved in repair; they serve a critical function in cell adhesion and signaling during wound healing and are vital for reepithelialization and the formation of granulation tissue. 

Growth factors promote cell migration, proliferation, angiogenesis, and synthesis of the ECM components. Macrophages and neutrophils help control infection in an open wound. 

Correct answer: Impaired skin integrity 

This patient has actual skin impairment due to excoriation from scratching, so they are no longer "at risk." Because the skin rash is not deeper than just the epidermis (deeper tissue layers are not affected at this time), the patient does not have impaired tissue integrity. Superficial excoriation is not prone to becoming infected. 

Correct answer: Stage 3

A Stage 3 pressure ulcer is a severe condition characterized by full-thickness skin loss that may expose subcutaneous fat but not yet deeper structures of bone, tendon, or muscle. The ulcer appears as a deep crater, and at this stage, there may be slough and/or necrotic tissue present, which often needs to be removed to assess the depth of the injury properly and to promote healing. The base of the ulcer can be covered by yellow, tan, gray, green, or brown tissue. 

Stage 1 pressure ulcers involve intact skin with non-blanchable redness. Stage 2 pressure ulcers involve partial-thickness loss of dermis presenting as a blister or shallow open ulcer. Stage 4 pressure ulcers involve full-thickness tissue loss with exposed bone, tendon, or muscle.

Correct answer: Handwashing

Handwashing with either soap and water or 70-95% alcohol products is considered the most effective method of preventing the spread of infection.

Other important methods of controlling the spread of infection include proper personal protective equipment, proper disposal of contaminated dressings, proper handling of contaminated equipment, and utilizing aseptic technique (use of dressings and equipment that have been disinfected or sterilized). 

Correct answer: High humidity 

High humidity can exacerbate the risk of skin maceration, in which the skin becomes overly moist and thus more fragile and prone to breakdown. This condition can make the skin more susceptible to damage under pressure, particularly in areas where bones are close to the skin surface, such as the sacrum, heels, and elbows. In humid environments, the persistence of moisture against the skin can increase the likelihood of pressure injuries developing.

While colder environments can affect skin dryness and may contribute to discomfort, they do not inherently make the skin more susceptible to the kind of damage seen with pressure injuries. Indeed, colder temperatures might even decrease sweat and moisture accumulation, which could indirectly help prevent moisture-related skin breakdown. Frequent repositioning is a recommended practice that can help alleviate and redistribute pressure from vulnerable areas, significantly reducing the risk of tissue damage and subsequent pressure injuries. The use of pressure-relieving mattresses is another protective measure against pressure injuries. These mattresses are designed to distribute weight more evenly and reduce the pressure on any single point of the body, thus directly combating one of the primary mechanisms by which pressure injuries develop. 

Correct answer: 92–96°F (33.5–35.5°C)

The optimal temperature for hydrotherapy water is warm but not hot, typically 92–96°F (33.5–35.5°C), to facilitate cleansing and promote comfort without causing thermal injury to the skin. Temperatures that are too hot or too cold can harm the tissues and reduce the therapeutic benefits of hydrotherapy. The treatment should be followed with a warm water rinse, and then compression therapy should be applied. 

Correct answer: Erythema signifies a secondary infection. 

HSV infections of the epidermis are highly contagious and can be spread when a susceptible, noninfected person comes into direct contact (via broken skin or a mucous membrane) with a person shedding the virus. There are two types of HSV: HSV-1 (oral herpes) and HSV-2 (genital herpes). 

HSV infections have two phases: primary infection and secondary phase. During the primary infection, a significant inflammatory response extends from the base of the lesions down into the dermis, which results in the classic presentation of uniform, grouped vesicles on an erythematous base. This clinical presentation is a key indicator of HSV and can be confirmed with a Tzanck smear. 

Correct answer: Surgical debridement 

For proper wound bed preparation, removing nonviable tissue and slough is essential. This can be achieved through surgical debridement, which quickly and effectively removes the necrotic tissue, allowing for a clean wound bed that can support healing and new tissue growth. By clearing away nonviable tissue, surgical debridement also reduces the risk of infection and prepares the wound for further management steps.

While antibiotic ointment might help prevent or manage infection, it does not address the fundamental problem of slough and nonviable tissue in the wound bed. The priority should be to remove these barriers to healing through debridement before considering antimicrobial treatments. Hydrocolloid dressings are useful for moisture management and can aid in healing by maintaining a moist wound environment. However, applying this type of dressing without first removing slough and necrotic tissue would be counterproductive. A clean wound bed is necessary for such dressings to work effectively. Offloading can help prevent additional trauma or damage to the affected area, especially in pressure ulcers. However, the immediate need is to remove the slough and nonviable tissue from the wound bed. Offloading alone does not address this need and is therefore not the next best step in wound bed preparation.

Correct answer: Spoon-shaped nails

Concave, spoon-shaped nails are an indication of insufficient iron levels in the body. Other symptoms suggest a zinc deficiency.

Correct answer: HOB at 45 degrees 

The head of the bed (HOB) should be kept at or below an angle of 30 degrees to prevent shear. When the HOB must be temporarily elevated over 30 degrees, such as when eating or drinking or during procedures, the caregiver needs to monitor the patient closely so that the HOB is not left in the elevated position longer than needed. 

The other choices are appropriate interventions when caring for a patient with a stage I pressure ulcer. 

Correct answer: Known hypersensitivity to silver 

The most important contraindication for the use of silver dressings is an allergy to silver. If the patient has a known hypersensitivity, using silver dressings could lead to adverse reactions, making this choice inappropriate despite the benefits of silver in managing bacterial burden in wounds. 

The high cost of silver dressings and the need for daily dressing changes could be considered practical limitations, but they are not absolute medical contraindications. The patient's preference for less frequent dressing changes might align with using silver dressings, which often do not require daily changes.

Correct answer: Encourage questions and have the patient or family repeat key instructions

Encouraging questions and having the patient or their family repeat key instructions helps confirm that the educational content has been understood. This "teach-back" technique allows you to clarify any misconceptions, reinforce important points, and ensure that the patient and family feel confident in the care plan.

A follow-up quiz might seem like a good way to verify understanding, but it can be stressful or intimidating for patients, possibly reducing their willingness to engage. Additionally, quizzes may not accurately reflect the patient's practical understanding of wound care. Assuming that the patient and family have understood everything is risky because it doesn't verify comprehension. Patients often have varying levels of health literacy, and failure to confirm understanding could lead to improper adherence to the care plan. Having the patient sign a form acknowledging receipt of information does not confirm understanding or encourage engagement. It is purely procedural and does not provide an opportunity to clarify instructions or answer questions.

Correct answer: Surgical debridement can lead to excessive bleeding if not done properly

Surgical debridement is the removal of necrotic tissue using sharp instruments, which requires precision. If performed improperly, this technique can lead to excessive bleeding due to the inadvertent cutting of healthy tissue or blood vessels. The procedure should be done by skilled healthcare specialists to minimize the risk.

While the goal of surgical debridement is to be selective, it can cause unintended damage to surrounding healthy tissues, particularly if not performed with caution. It requires careful technique and assessment. Infection is a known risk of surgical debridement due to the creation of a larger wound surface. Proper sterilization, wound care, and monitoring are crucial to minimize this risk. The use of aseptic techniques and appropriate post-procedure wound management is essential. Depending on the extent and location of debridement, patients may need time to recover before resuming normal activities. Healing often requires careful wound care and sometimes additional support (e.g., dressings, limited mobility), meaning a gradual return to activities.

Correct answer: Obesity

Obesity is a systemic (not local) factor that can impact the healing process. Patients who are overweight are at an increased risk of pressure sores because of the compression of tissues and have slower rates of healing, as well as an increased risk of infection.

Impaired tissue oxygenation, repeated trauma, and local infection are all local factors that can impact the healing process.