NAWCO WCC Exam Questions

Correct answer: Discuss potential reasons for non-adherence with the patient

Effective wound care management begins with understanding the patient's perspective and challenges. Understanding the patient's reasons for non-adherence is essential to adjusting the treatment effectively. Discussing non-adherence directly with the patient can reveal underlying issues, such as misunderstood instructions, financial constraints, or practical difficulties in following the regimen, leading to more tailored and effective solutions.

Changing the treatment without understanding the reasons for non-adherence might not address the underlying issues. Reporting to a supervisor should follow the initial assessment and discussion with the patient, not precede it. Adjusting the treatment frequency without understanding the causes can lead to insufficient care and may not address the real barriers to adherence.

Correct answer: To promote rapid epithelialization

Collagen dressings are primarily used in wound care to provide a scaffold that mimics the natural collagen in the skin, thus promoting new tissue growth. Collagen is integral to wound healing because it attracts cells such as fibroblasts and keratinocytes to the wound site, accelerating the process of epithelialization, in which new skin cells form and cover the wound. This helps to close the wound more quickly and effectively.

While collagen can assist in hemostasis due to its platelet-binding properties, controlling heavy bleeding is not the primary goal of collagen dressings in wound management. Other, more specialized products are specifically designed for hemostasis in acute and heavy bleeding scenarios. Although maintaining a wound environment that can help manage bioburden is essential, collagen dressings are not specifically aimed at reducing bioburden. They do not possess inherent antimicrobial properties. Collagen dressings do not primarily serve to add moisture to a wound. Moisture management would be more directly addressed by hydrogels or other moisture-retentive dressings designed specifically to maintain or add moisture to the wound environment.

Correct answer: Moisture vapor transmission rate (MVTR)

Foam dressings are produced from polyurethane as soft, open-cell sheets and can be composed of one layer or multiple layers. They can be impregnated with charcoal and with a waterproof, adhesive film backing. They absorb exudate, raise the core temperature of the wound, and maintain a moist environment. A moist environment physiologically favors cellular migration and extracellular matrix formation, which facilitates the healing of wounds, reduces pain and tenderness, reduces fibrosis, decreases wound infection, and produces a better cosmetic outcome. 

Foam dressings that contain an adhesive film keep a wound moist (even when no additional moisture is supplied) by "catching" and retaining moisture vapor that is being lost by the wound on a continual basis. Their ability to maintain tissue hydration can be characterized by a measurement known as the MVTR. 

Adhesive foams leave no residue. 

Correct answer: Negative Pressure Wound Therapy (NPWT)

NPWT is effective for diabetic foot ulcers as it promotes healing by increasing blood flow to the area, reducing edema, and stimulating granulation tissue formation. It is an ideal adjunctive therapy for non-healing wounds that do not respond to conventional treatments.

Topical steroids are generally not used for wound healing as they can impair skin integrity and delay healing. HBOT could be beneficial but is usually considered for severe cases and is less commonly available. Compression therapy is typically used for venous ulcers, not diabetic foot ulcers. 

Correct answer: Wong-Baker FACES Pain rating scale 

The Wong-Baker FACES Pain rating scale consists of six cartoon faces ordered from smiling to crying. The FACES scale has been used extensively with pediatric populations. A version for use with adults and patients who are cognitively impaired or non-English-speaking uses oval-shaped faces, without tears, that are more adult-like in appearance. The FACES pain scale offers easy and quick administration, simplicity, correlation with VAS, and little mental effort required by the patient to respond appropriately. 

Correct answer: Gauze 

Autolysis is a natural, highly selective, painless method of debridement involving the breakdown of necrotic tissue by the body's white blood cells and natural enzymes. They enter the wound site during the normal inflammatory process. Autolysis is a selective method of debridement, meaning only the necrotic tissue is removed. 

As a naturally occurring physiologic process, autolysis is stimulated by a moist, vascular environment with adequate leukocyte function count. This moist environment is facilitated by the application of a moisture-retentive dressing left undisturbed for 24 to 72 hours. Maintaining a moist wound environment allows the cellular structures that are essential for phagocytosis to remain intact and avoid premature destruction through desiccation. 

Any moisture-retentive dressing can achieve autolysis, but it is preferable to use a transparent dressing over a dry wound or dry eschar and hydrocolloids or hydrogels over moist wounds. Gauze is not effective for this type of debridement. 

Correct answer: Ischial tuberosities 

Bony locations are most susceptible to pressure ulcer formation because a person's body weight is concentrated on these areas when resting on an unyielding surface. 

High-pressure areas in the supine position include the occiput, sacrum, and heels. In the sitting position, the ischial tuberosities exert the highest pressure, and the trochanters are most affected in the side-lying position. 

Correct answer: An impending wound infection 

Excessive signs of acute inflammation should be considered a signal of impending wound infection. 

Correct answer: Living will 

A living will is a legally recognized document that outlines a patient's preferences for medical treatment, including palliative care options. It explicitly states what interventions they do or do not want, providing clear guidance to healthcare providers. This document is particularly valuable in palliative wound care as it helps ensure the treatment plan aligns with the patient's wishes, thereby respecting their autonomy.

A treatment plan outlines the medical interventions to be undertaken for a patient's care. While important, it reflects the decisions of healthcare providers, not necessarily the patient's wishes, unless it is developed in direct consultation with the patient. A living will, on the other hand, directly reflects the patient's choices. A power of attorney designates someone to make decisions on behalf of the patient if they are unable to do so themselves. While relevant in some palliative care cases, it primarily functions as a backup measure. A living will takes precedence by clearly articulating the patient's preferences directly. Consent forms give permission for specific treatments or procedures. They are crucial for medical interventions but lack the comprehensive scope of a living will, which provides detailed preferences for various medical situations, including palliative care, thus offering broader legal guidance.

Correct answer: Remove the film dressing and assess the wound for signs of infection

New-onset fever and localized heat around a wound could indicate an infection. Removing the dressing and assessing the wound allows for immediate evaluation and appropriate management, including cleaning the wound, obtaining cultures, or initiating antibiotic therapy.

While warmth and mild redness can be part of the normal inflammatory response, the presence of fever and localized heat suggests a potential infection, not just standard inflammation. Reassuring the patient without further investigation can delay the identification and treatment of an infection, potentially worsening the patient's condition. While applying a cold compress may temporarily relieve discomfort, it does not address the underlying cause of the symptoms. Increasing or starting antibiotics without a proper assessment and confirmation of an infection may lead to inappropriate antibiotic use, which can contribute to antibiotic resistance and cause side effects. It's essential to assess and confirm an infection before modifying antibiotic treatment.

Correct answer: Diffusion 

Diffusion is simply the movement of anything from an area of high concentration to an area of low concentration. 

Permeability is the ease with which substances can cross a cell membrane. 

Osmosis is the diffusion of water across a membrane in response to differences in solute concentration. The pressure that must be applied to a solution to prevent the inward flow of water across a semipermeable membrane is known as osmotic pressure. 

Correct answer: Reposition the cables and tubing regularly and pad the contact areas

Regular repositioning and padding of medical devices, such as tubing and cables, help distribute pressure and reduce the risk of pressure injuries. This is particularly important in patients who are immobile and under continuous monitoring. Applying additional adhesives to secure the tubing could exacerbate skin damage by increasing pressure. Increasing the frequency of vital sign monitoring does not address the cause of the skin impairment. Using larger, heavier cables to distribute pressure more evenly may increase pressure on the skin rather than relieve it.

Correct answer: A patient with a non-healing diabetic foot ulcer

HBOT is particularly beneficial for chronic non-healing wounds, especially diabetic foot ulcers, which are characterized by poor healing due to reduced blood flow and oxygenation. It increases the oxygen concentration in blood and tissues, promoting wound healing and reducing the risk of infection. 

Chronic venous ulcers are primarily treated with compression therapy, wound dressings, and sometimes surgical interventions. While HBOT can be used in refractory cases, it is not the first-line treatment for venous ulcers, making them a less likely candidate for HBOT than a non-healing diabetic foot ulcer. Newly developed pressure ulcers are usually managed with pressure relief, proper wound care, and nutritional support. HBOT is generally reserved for more severe or chronic wounds that do not respond to standard treatments. A newly developed pressure ulcer has high potential for healing with conventional care. Surgical incision site infections are typically managed with appropriate antibiotics, wound care, and sometimes surgical debridement. HBOT might be considered in severe or complicated cases, but it is not a standard treatment for most surgical site infections, especially if they are acute and manageable with standard medical care.

Correct answer: Hydrocolloid dressing 

Hydrocolloid dressings are designed to create and maintain a moist healing environment, which can promote epithelialization and granulation. They also provide protection from external contaminants. For a clean and dry post-surgical wound, a hydrocolloid dressing is suitable for supporting healing by maintaining a balanced environment while protecting the wound.

Antimicrobial dressings are useful for managing or preventing infections in wounds at risk of bacterial contamination. However, the scenario describes a clean wound with no signs of infection, making this type of dressing unnecessary. The focus here should be on protecting the wound and maintaining a balanced healing environment. Foam dressings are designed to absorb moderate to heavy exudate and protect wounds. However, in this scenario, the wound is dry, making a foam dressing unnecessary and potentially even detrimental by drying out the wound bed further. The focus should be on maintaining moisture balance, which a hydrocolloid dressing can provide. Composite dressings typically consist of multiple layers designed to manage exudate, protect the wound, and provide a moist healing environment. While they might be useful for more complex wounds, they aren't necessary for this clean, dry wound. A simpler dressing like a hydrocolloid can suffice.

Correct answer: From inflammation to proliferation

The transition from the inflammation phase to the proliferation phase of chronic wound healing involves a decrease in inflammatory signs like swelling and redness and the beginning of new tissue formation, indicating the body's shift toward rebuilding and covering the wound bed.

Hemostasis to inflammation does not describe the transition observed, which is marked by a decrease in inflammation and the start of tissue formation. Proliferation to maturation is incorrect as the scenario describes the initiation of new tissue growth, a hallmark of proliferation, not the later phase of maturation. Maturation to hemostasis is incorrect because maturation is the final phase and hemostasis the first, with no cyclic return in the wound healing process.

Correct answer: The insurance company

The insurance company representative will have specific information regarding the patient's policy, what treatments are covered, and any exceptions or limitations that apply. This information allows the wound care specialist to devise a treatment plan that aligns with the patient's coverage, ensuring it is both effective and affordable. Collaboration with the insurer helps the patient receive appropriate care while minimizing the financial burden.

Although primary care physicians play an important role in a patient's overall healthcare, they may not have a detailed understanding of the patient's insurance coverage and its specific limitations related to wound care. Their input is valuable for overall treatment, but prioritizing collaboration with the insurance company directly addresses coverage concerns. While social workers can help patients access various resources and provide essential support, they may not have the detailed knowledge needed to navigate the complexities of the patient's specific insurance coverage. Their assistance is valuable but secondary to direct collaboration with the insurer. Pharmacists provide essential advice about medications and can assist with selecting wound care supplies, but they are not typically involved in insurance-related challenges.

Correct answer: Papule  

A papule is a superficial, circumscribed dome-shaped or flat-topped palpable lesion elevated above the skin surface and under 10 mm (1 cm) in diameter. It can vary in color. 

A pustule is an elevated lesion that contains pus. A vesicle is an elevated lesion that contains clear fluid and is also under 10 mm in diameter. A nodule is a firm lesion that is thicker or deeper than the average plaque or papule. 

Correct answer: Emollient compounds 

Moisture-associated skin damage (MASD), which can occur from conditions like incontinence, presents with symptoms such as redness, a rash, blistering, discomfort, and/or itching. Healthcare providers face the challenge of preventing both incontinence-associated dermatitis (IAD) and pressure ulcers in patients who experience urinary and/or fecal incontinence, as their skin becomes less tolerant to injury.

When excessive moisture from urine and feces leads to maceration and overhydration of the skin's outer layer, it becomes more susceptible to damage from friction. To mitigate this risk, it's advisable to use moisture barrier ointments containing emollients like lanolin, mineral oil, or petroleum to shield the skin from enzymatic effluent.

Skin cleansers with a pH close to that of the skin can effectively prevent IAD, and moisturizers serve as a crucial follow-up step in perineal skincare routines, often included in commercially available skin cleansers. While these products cleanse and dry the skin surrounding the wound, they do not offer protection against further damage. It's important to avoid the use of powders in these cases.

Correct answer: Enzymatic debridement

The primary focus in managing this wound should be to remove the slough and necrotic tissue, which can impede healing and increase the risk of infection. Enzymatic debridement offers a selective approach to debriding the wound bed by breaking down and removing nonviable tissue without damaging healthy granulation tissue. This promotes healing by clearing the wound bed and allowing granulation tissue to proliferate.

Barrier creams are useful for protecting the surrounding skin from moisture or irritants, which can help reduce maceration. However, they do not address the issue of slough and nonviable tissue in the wound bed, which need to be removed to promote healing. An antimicrobial dressing can help prevent infection but does not address the primary issue. Effective healing requires the removal of nonviable tissue, making debridement a necessary step before considering antimicrobial dressings. Surgical debridement can effectively remove nonviable tissue but may be too aggressive for a wound bed containing both slough and granulation tissue. Enzymatic debridement is a gentler option, selectively breaking down necrotic tissue while preserving viable tissue, making it more appropriate for this wound.

Correct answer: Paraplegia 

Paraplegia (paralysis) and spinal cord injury place a hospitalized patient at high risk of developing a pressure ulcer due to their inability to feel susceptible areas that may be causing skin breakdown. Those with the greatest level of disability and mobility impairment have the highest pressure ulcer risk.