, Question 1
A patient with a Stage 4 pressure injury over the sacrum has a wound bed with
60% slough and 40% granulation tissue. Which debridement method is most
appropriate as the initial intervention?
A. Autolytic debridement with hydrocolloid dressing
B. Sharp/surgical debridement of necrotic tissue
C. Enzymatic debridement with collagenase
D. Mechanical debridement with wet-to-dry dressings
Correct Answer: B - Sharp/surgical debridement of necrotic
tissue
RATIONALE
Sharp/surgical debridement is the fastest and most selective method to
remove significant slough (60%) and promote healing in a Stage 4
pressure injury. Autolytic and enzymatic methods are slower and
better for smaller amounts of nonviable tissue. Wet-to-dry is
nonselective and can damage healthy tissue.
Question 2
A patient with a new ileostomy has liquid output of 1500 mL/day and reports
dizziness. Which intervention should the WOC nurse prioritize?
A. Increase intake of high-fiber foods
B. Administer loperamide as prescribed and encourage oral rehydration
solution
C. Restrict fluids to 1000 mL/day
D. Apply a convex pouching system
Correct Answer: B - Administer loperamide as prescribed and
encourage oral rehydration solution
Page 2
, RATIONALE
High-output ileostomy (>1200 mL/day) can lead to dehydration and
electrolyte imbalance. Antimotility agents like loperamide and oral
rehydration solutions are first-line. Fiber and fluid restriction would
worsen the condition; convexity addresses stoma fit, not output.
Question 3
Which urodynamic finding is most consistent with stress urinary incontinence?
A. Detrusor overactivity during filling
B. Low Valsalva leak point pressure with no detrusor contraction
C. Increased post-void residual volume
D. Reduced bladder capacity with sensory urgency
Correct Answer: B - Low Valsalva leak point pressure with no
detrusor contraction
RATIONALE
Stress urinary incontinence is characterized by involuntary urine loss
with increased intra-abdominal pressure without detrusor contraction.
Low Valsalva leak point pressure confirms urethral hypermobility or
intrinsic sphincter deficiency. Detrusor overactivity and urgency
indicate urge incontinence.
Question 4
A patient with a venous leg ulcer has an ankle-brachial index (ABI) of 0.6.
Which intervention is contraindicated?
A. Application of multilayer compression bandaging
B. Leg elevation above heart level
C. Use of a hydrocolloid dressing
D. Referral for vascular surgery evaluation
Correct Answer: A - Application of multilayer compression
bandaging
Page 3
, RATIONALE
An ABI of 0.6 indicates moderate arterial insufficiency.
High-compression therapy is contraindicated as it can worsen
ischemia. The patient requires vascular evaluation, and modified
compression may be considered only after revascularization.
Question 5
Which statement best describes the mechanism of action of a
silver-impregnated dressing in wound care?
A. Provides a moist wound environment and autolytic debridement
B. Releases silver ions that disrupt bacterial DNA and cell wall synthesis
C. Stimulates angiogenesis and collagen deposition
D. Creates a cytotoxic environment that inhibits all cell proliferation
Correct Answer: B - Releases silver ions that disrupt bacterial
DNA and cell wall synthesis
RATIONALE
Silver dressings release silver ions (Ag+) that bind to bacterial DNA
and enzymes, disrupting replication and cell wall synthesis, providing
broad-spectrum antimicrobial action. They are used for infected or
critically colonized wounds. They do not primarily provide moisture
or stimulate angiogenesis.
Question 6
A patient with a colostomy reports stool leaking under the pouch within 24
hours of application. The stoma is flush with the skin and located in a skin
fold. Which pouching system modification is most appropriate?
A. Use a flat, one-piece pouch with standard barrier
B. Apply a convex pouching system with belt
C. Use a two-piece system with a large skin barrier
D. Apply a pouch without skin barrier to reduce bulk
Page 4
A patient with a Stage 4 pressure injury over the sacrum has a wound bed with
60% slough and 40% granulation tissue. Which debridement method is most
appropriate as the initial intervention?
A. Autolytic debridement with hydrocolloid dressing
B. Sharp/surgical debridement of necrotic tissue
C. Enzymatic debridement with collagenase
D. Mechanical debridement with wet-to-dry dressings
Correct Answer: B - Sharp/surgical debridement of necrotic
tissue
RATIONALE
Sharp/surgical debridement is the fastest and most selective method to
remove significant slough (60%) and promote healing in a Stage 4
pressure injury. Autolytic and enzymatic methods are slower and
better for smaller amounts of nonviable tissue. Wet-to-dry is
nonselective and can damage healthy tissue.
Question 2
A patient with a new ileostomy has liquid output of 1500 mL/day and reports
dizziness. Which intervention should the WOC nurse prioritize?
A. Increase intake of high-fiber foods
B. Administer loperamide as prescribed and encourage oral rehydration
solution
C. Restrict fluids to 1000 mL/day
D. Apply a convex pouching system
Correct Answer: B - Administer loperamide as prescribed and
encourage oral rehydration solution
Page 2
, RATIONALE
High-output ileostomy (>1200 mL/day) can lead to dehydration and
electrolyte imbalance. Antimotility agents like loperamide and oral
rehydration solutions are first-line. Fiber and fluid restriction would
worsen the condition; convexity addresses stoma fit, not output.
Question 3
Which urodynamic finding is most consistent with stress urinary incontinence?
A. Detrusor overactivity during filling
B. Low Valsalva leak point pressure with no detrusor contraction
C. Increased post-void residual volume
D. Reduced bladder capacity with sensory urgency
Correct Answer: B - Low Valsalva leak point pressure with no
detrusor contraction
RATIONALE
Stress urinary incontinence is characterized by involuntary urine loss
with increased intra-abdominal pressure without detrusor contraction.
Low Valsalva leak point pressure confirms urethral hypermobility or
intrinsic sphincter deficiency. Detrusor overactivity and urgency
indicate urge incontinence.
Question 4
A patient with a venous leg ulcer has an ankle-brachial index (ABI) of 0.6.
Which intervention is contraindicated?
A. Application of multilayer compression bandaging
B. Leg elevation above heart level
C. Use of a hydrocolloid dressing
D. Referral for vascular surgery evaluation
Correct Answer: A - Application of multilayer compression
bandaging
Page 3
, RATIONALE
An ABI of 0.6 indicates moderate arterial insufficiency.
High-compression therapy is contraindicated as it can worsen
ischemia. The patient requires vascular evaluation, and modified
compression may be considered only after revascularization.
Question 5
Which statement best describes the mechanism of action of a
silver-impregnated dressing in wound care?
A. Provides a moist wound environment and autolytic debridement
B. Releases silver ions that disrupt bacterial DNA and cell wall synthesis
C. Stimulates angiogenesis and collagen deposition
D. Creates a cytotoxic environment that inhibits all cell proliferation
Correct Answer: B - Releases silver ions that disrupt bacterial
DNA and cell wall synthesis
RATIONALE
Silver dressings release silver ions (Ag+) that bind to bacterial DNA
and enzymes, disrupting replication and cell wall synthesis, providing
broad-spectrum antimicrobial action. They are used for infected or
critically colonized wounds. They do not primarily provide moisture
or stimulate angiogenesis.
Question 6
A patient with a colostomy reports stool leaking under the pouch within 24
hours of application. The stoma is flush with the skin and located in a skin
fold. Which pouching system modification is most appropriate?
A. Use a flat, one-piece pouch with standard barrier
B. Apply a convex pouching system with belt
C. Use a two-piece system with a large skin barrier
D. Apply a pouch without skin barrier to reduce bulk
Page 4
