NAWCO WCC Exam Questions

Correct answer: For consistent tracking and care coordination

Knowing the precise location of the wound enables the patient's healthcare team to monitor its progression accurately; it is the first step in being able to reproduce measurements at that site. Consistent tracking of wound location allows for exact comparisons over time, which is critical for evaluating the effectiveness of treatment. Accurate location documentation ensures continuity of care among healthcare providers. It helps avoid confusion or oversight when different healthcare professionals treat the patient, ensuring the wound receives appropriate and consistent care. 

The location can influence the appropriate treatment modality, but this alone isn't a sufficient reason for accurate documentation. The primary goal is consistent tracking and care coordination. Accurate documentation can prevent unnecessary treatments by ensuring appropriate care, but the main reason for recording the wound's location is to ensure consistent tracking and coordination. While it can be helpful for the patient to know where the wound is, the primary purpose of documenting the wound location is to ensure consistent care and accurate monitoring by healthcare providers. 

Correct answer: Negative Pressure Wound Therapy (NPWT)

NPWT helps reduce pressure around the wound, assists with exudate removal, and promotes granulation tissue formation, making it ideal for patients who cannot be repositioned frequently. 

Electrical stimulation is primarily used to enhance muscle function and promote wound healing through increased circulation but is not ideal for managing immobility due to pain. Ultrasound therapy focuses on stimulating the wound bed to enhance healing at a cellular level but does not alleviate the need for repositioning in the context of pain management. Low-level laser therapy aids in reducing inflammation and promoting healing but does not address the patient's inability to be repositioned due to pain or provide direct pressure relief.

Correct answer: Moisture, activity, mobility, nutrition, and mental condition

The Norton Scale is one of the older scales used to assess the risk of developing pressure ulcers, and it includes factors such as moisture (incontinence), activity, mobility, nutrition (physical condition), and mental condition. Each factor is scored, and the total score helps to determine the overall risk level of pressure ulcer development in patients.

Although pressure intensity, shear, and skin type are important factors in the development of pressure ulcers, they are not specifically assessed by the Norton Scale. The Norton Scale focuses more broadly on general health indicators that contribute to pressure ulcer risk rather than directly measuring mechanical forces on the skin. Blood flow, skin temperature, and sensory perception relate to physiological assessments that are more commonly part of a comprehensive clinical evaluation rather than being specifically included in the Norton Scale. Age, weight, and medical history are significant risk factors for pressure ulcers, but they are not part of the Norton Scale. 

Correct answer: Systemic corticosteroids 

TEN is a rare severe exfoliating disorder characterized by epidermal sloughing at the dermal-epidermal junction. Most cases (up to 80%) are caused by a reaction to a medication (a milder form is Stevens-Johnson syndrome). This is a potentially deadly skin disease due to infection resulting from a drug reaction (Cox-2 inhibitor Bextra penicillin) and affects over 30% of a patient's total body surface area (TBSA). TEN is characterized by epidermal detachment and lesions (blisters) in the mucosal tissue including the mouth, eyes, respiratory tract, and genitourinary tract, that are painful. Generalized erythema and macules initially appear on the trunk and then spread to the neck, face, and upper arms (the palms and soles can be affected as well). A macular rash develops, and the macules gradually coalesce. These mucosal lesions in conjunction with the macular rash are strongly suspicious of TEN. 

Treatment involves prompt cessation of suspicious medications and supportive care. The standard of care is a transfer to a burn center to best manage the complex and life-threatening complications, such as temperature regulation, electrolyte disturbances, significant nutrition needs, and propensity to wound or skin infections. In general, systemic corticosteroids are not recommended. A sloughed epidermis can be debrided, but a temporary skin substitute (biologic or biosynthetic) or non-adherent antimicrobial dressings should be applied. A low-friction support surface should be provided for the hospitalized patient to prevent further tissue damage. 

Correct answer: Assessment, diagnosis, goals, and intervention 

The wound care process offers a framework for clinicians caring for patients with wounds. The use of clinical judgment with diagnostic reasoning is one of the essential practice tools that nurses, physical therapists, and other healthcare practitioners employ. This process is described in four steps, each with two or three parts:

1. Assessment: a review of the reason for referral, collection of patient history, systems review/physical assessment, and wound assessment
2. Diagnosis: examination strategy, evaluation, and diagnosis
3. Goals: prognosis, the establishment of goals and outcomes, and evaluation of progress
4. Intervention: measures to resolve the diagnosis

Correct answer: The use of clean, nonsterile gloves causes higher infection rates than the use of sterile gloves when performing wound care

The use of clean, nonsterile gloves poses no higher risk of infection than the use of sterile gloves, and they cost less.

The other answer choices are accurate statements regarding wound management. Tap water from treated sources (such as filtered or disinfected water) is as effective as other solutions to cleanse a wound. Never put any substance in a wound that should not be put in an eye. Warming lidocaine to body temperature (37 degrees Celsius or 98.6 degrees Fahrenheit) can minimize pain during injection.

Correct answer: Every 1 hour

Changing position helps decrease both the length and strength of pressure applied on areas where bones are close to the skin's surface. Patients prone to developing pressure ulcers should refrain from prolonged sitting in chairs and should change positions every hour. While altering position may not lower the strength of pressure, it does decrease the duration, which is more crucial in preventing pressure ulcer formation.

Repositioning enhances the patient's comfort, preserves their dignity, and maintains their ability to function. Sitting in a chair should be restricted to no more than 2 hours at a time.

Correct answer: Increase epithelial tissue formation

Hydrotherapy, specifically when used for wound care, utilizes the gentle flow of water to help clean the wound bed, which aids in the removal of nonviable tissue, reduces bacterial load, and promotes a moist environment. This moist environment is conducive to the proliferation of epithelial cells, which expedites the wound closure process, making it a primary benefit of hydrotherapy.

While hydrotherapy can have soothing effects that might temporarily reduce pain due to the warmth and gentle motion of the water, this is not considered a primary benefit. Its impact on pain relief is more indirect and less significant than its role in promoting healing and debridement. Dehydration of a wound can hinder the healing process by causing cell death and tissue damage. While it is true that properly administered hydrotherapy should decrease infection rates, this is not the primary benefit of this treatment. 

Correct answer: Purulent 

Purulent drainage is thick, translucent to opaque in consistency and yellow, tan, or green. Purulent drainage signals infection and may have a foul odor. Do not mistake purulent with seropurulent, which is thin and watery in consistency and can be an early indicator of impending wound infection. 

Sanguineous drainage is normal, signaling new blood vessel growth. It is thin and watery in consistency and red. Serosanguineous drainage is also normal during the inflammatory and proliferative phases of healing. It is thin, watery, and light pink to red. 

Correct answer: "I will need to schedule a follow-up appointment to have my staples removed in seven to ten days."

Stapling the skin is faster than suturing and is associated with lower rates of tissue reactivity and wound infection. External skin staples do not dissolve on their own and need to be removed within seven to ten days (for scalp, chest, hand, fingers, and lower extremities) by a healthcare provider. 

The patient should be taught to shower (not to soak in a bath) following wound closure and to gently cleanse the wound with soap and water to prevent infection. The incision should remain uncovered to allow it to heal correctly.

Correct answer: Apply silver nitrate 

When a wound is in a chronic proliferative state, hypergranulation tissue is the result; it is generally caused by excess moisture or friction, and the tissue is predisposed to infection. Silver nitrate is used to chemically cauterize hypergranulation tissue, effectively reducing its size and promoting normal healing. This intervention directly addresses the overgrowth of granulation tissue, making it a highly effective initial management approach.

While topical antibiotics are used to prevent or treat infection, they do not specifically address hypergranulation tissue. Hypergranulation is characterized by an overgrowth of granulation tissue, and antibiotics do not reduce this overgrowth. Debridement is the removal of nonviable or necrotic tissue, which helps prepare the wound bed for healing. However, hypergranulation is a viable tissue overgrowth, and its management requires a different approach, such as cauterization. While covering a wound with a dry gauze dressing might protect it from external contaminants, it does not specifically target hypergranulation tissue. Moreover, it might not allow for proper wound bed moisture balance, which can inhibit healing.

Correct answer: By analyzing staff and patient performance data before and after

Analyzing staff and patient performance data before and after exposure to the educational material provides the most direct measure of its impact. Comparing changes in wound healing rates, adherence to wound care protocols, and reductions in treatment errors after media consumption helps to establish a causal link between the educational intervention and improvements in outcomes. This ensures that the media directly contribute to better wound care practices.

While download and view counts indicate interest or awareness, they don't necessarily reflect whether the audience understood or applied the educational content. Social media metrics (likes, shares, comments) show how users interact with posts but are not a reliable measure of effective knowledge transfer or practice change. Although sponsors may provide useful feedback, their focus on ROI is primarily financial. This perspective doesn't capture the actual educational impact on staff and patient care quality.

Correct answer: Wart

A papule is defined as an elevated, firm, circumscribed area that is under 1 cm in diameter. Examples include warts, elevated moles, and lichen planus. 

A freckle is an example of a macule. Psoriasis is classified as a type of plaque. An insect bite is a wheal. 

Correct answer: To decrease the pressure on the wound area

Offloading is an important technique in wound management, especially for patients with pressure ulcers, diabetic foot ulcers, or wounds from burns. The concept revolves around reducing pressure, which can significantly aid the healing process. Offloading helps to redistribute weight away from the wound, minimizing pressure and friction that could impede healing, cause pain, or lead to further tissue damage.

Increasing pressure on a wound is counterproductive to healing. Increased pressure can reduce blood flow to the area, which can exacerbate the wound by depriving it of essential nutrients and oxygen needed for healing. This approach goes against the fundamental principles of wound care. While aesthetic considerations can be part of overall patient care, they are not a primary concern in clinical wound management strategies like offloading. The main focus of offloading is to support the physiological process of healing, not to improve the appearance of the healed wound. Although maintaining a warm and moist environment can be beneficial for certain types of wounds, the primary purpose of offloading is to reduce pressure, not to manage thermal properties of the wound environment.

Correct answer: Necrobiosis lipoidica 

Necrobiosis lipoidica diabeticorum is a dermatologic condition that can appear on the skin (along the tibia) of diabetic patients. This condition manifests as irregular patches of degenerated collagen with reduced fibrocytes. The dry, scaly area has been infiltrated with chronic inflammatory cells. 

The round, firm plaques of reddish-brown to yellow happen three times more often in women than in men. It can be confused with venous stasis disease but does not require or respond to extensive treatment. These ulcerations require only protective dressings. 

Correct answer: Difficulty with self-application 

Compression therapy can be challenging for patients to apply on their own. If the patient struggles to apply the compression correctly or consistently, it can lead to suboptimal therapeutic outcomes and inadequate ulcer healing. This difficulty in self-application can significantly hinder adherence to the prescribed treatment plan.

While cost can be a barrier to treatment adherence in some cases, it is not the primary issue in this scenario. The question suggests the patient's ulcer is not healing as expected due to a barrier specifically affecting adherence. Compression therapy typically involves reusable or long-lasting items, making the immediate cost less likely to be the direct barrier. Although nutrition can impact wound healing, it does not directly affect adherence to compression therapy. Poor hygiene may contribute to infection or complications that impede wound healing, but it does not relate directly to adherence to the prescribed therapy. In this context, difficulty with self-application is a more direct and relevant barrier to treatment adherence.

Correct answer: Partial-thickness wound healing

The five basic wound healing models are:

• Superficial wound healing: a wound involving only the epidermis
• Partial-thickness wound healing: a shallow wound involving epidermal loss and possibly partial loss of the uppermost layers of the dermis
• Full-thickness/secondary-intention wound healing: total loss of skin layers (epidermis and dermis), extending into subcutaneous tissues and deeper structures that heals by secondary intention
• Primary or first-intention wound healing: a process in which the wound is cleaned, then the edges approximated by a surgeon and then held in place with sutures or another method (approximated surgical incisions)
• Delayed primary-intention wound healing: a dirty wound that is left open to allow cleansing and then closed by a surgeon (healing by secondary intention)

Correct answer: Superficial serum-filled blistering with partial-thickness skin loss involving the epidermis and dermis 

Stage II category pressure ulcers are superficial and primarily result from mechanical force or friction on the epidermis. Partial-thickness loss of the epidermis and dermis creates a shallow, open ulcer with a pink-red wound bed and without slough. Stage II ulcers can also lead to an intact or open/ruptured serum-filled blister. 

Stage I involves nonblanchable erythema, a temperature increase or decrease at the wound site, and discoloration of the skin. In addition, skin texture changes in stage I pressure ulcers; the skin may feel hard and indurated, and observation may reveal heightened skin features or an orange-peel appearance. This stage of tissue destruction is reversible, although tissues may take 1 to 3 weeks to return to normal. 

Stage III pressure ulcers involve full-thickness loss of skin with visible adipose tissue (i.e., the wound has not extended to bone, tendon, muscle, or cartilage). Stage III can involve undermining and tunneling. 

Correct answer: Place commercially available emollients in the affected skin fold

ITD is inflammation resulting from moisture trapped in skin folds subjected to friction. Risk factors for the development of ITD include hyperhidrosis, obesity, pendulous breasts, deep skin folds, immobility, and diabetes. Treatment involves separating intertriginous skin folds and applying a skin barrier protectant, wicking garments, and crusting with stoma powder followed by a skin barrier wipe. Routine hygiene is of the utmost importance. 

Emollients could contribute to moisture development (instead of inhibiting it) in the skin folds and thus are not indicated in the prevention or treatment of ITD. 

Correct answer: Pressure ulcers 

There are several staging models used for pressure ulcers, but the National Pressure Ulcer Advisory Panel Pressure Ulcer Staging System (NPUAP) is probably the most widely known wound classification system. Its items consist of stages I, II, III, IV, unstageable, and suspected deep tissue injury (sDTI).