WOCN Wound Exam Questions With Correct
Answers., Exams of Nursing
What amino acids are essential for collagen synthesis?
What is the effect of stress on these amino acids? - ANSWER-Glutamine and l-arginine
Not adequately produced during times of physiologic stress
What weight trend suggests nutritional deficiency? - ANSWER-Unplanned weight loss
=>2.5% of usual weight in 30 days or =>10% within 180 days
BMI <18.5
What BG parameters should be maintained for wound healing? - ANSWER-BG <180 for
leukocyte function; <140 for healing
A1C <7 for most, <8 if hx of severe hypoglycemia, advanced comorbidities, limited life
expectancy
Why is nutrition relevant to wound healing? - ANSWER-Muscle or SubQ wasting
increases risk of pressure/shear damage
malnourished pt unable to synthesize and cross-link collagen normally
protein deficiency increases risk of infection
What effect do low zinc levels have on wound healing? - ANSWER-compromise
collagen synthesis/crosslinking
Goals of wound assessment - ANSWER-1. Determine etiologic factors
2. Assess systemic factors/comorbidities
3. Assess wound to determine phase of healing
4. Determine goals of topical therapy
Why does hyperglycemia affect wound healing? - ANSWER-Impairs leukocyte function
and negatively impacts collagen syntehesis, development of tensile strength, epithelial
resurfacing
What serum albumin level indicates malnutrition? - ANSWER-<3.5 g/dl
What is the suggested caloric intake? - ANSWER-30-35 cal/kg body weight
What is the suggested protein intake? - ANSWER-1.25-1.5 g/kg body weight
What is the suggested fluid intake? - ANSWER-30ml per kg (unless fluid restriction
indicated)
,How do you assess perfusion/oxygenation? - ANSWER-capillary refill, pulses,
presence/absence of edema, TcpO2 levels (at least 40), color of wound bed (bright
pink/red), ABI for lower extremity ulcers, systolic bp/episodes of hypotension,
vasopressor administration
What serum transferrin level indicates malnutrition? - ANSWER-<100mg/dl
What serum prealbumin level indicates malnutrition? - ANSWER-<19.5
What total lymphocyte count level indicates malnutrition? - ANSWER-<1500
What are s/s of nutritional deficits? - ANSWER-skin rashes, cracks in mucous
membranes, edema, muscle and subQ tissue wasting, nonhealing wounds,
dry/pluckable hair, dry flaky itchy skin
How do you assess for immunosuppression? - ANSWER-Comorbidities/therapies such
as HIV, steroid tehrapy in doses >30mg/day for >30 days, and/or chemo resulting in
neutropenia; high dose NSAIDs
What comorbidities compromise wound healing? - ANSWER-renal failure, liver failure,
multisystem trauma, smoking, advanced age
What are the layers of the skin - ANSWER-Epidermis
Basement Membrane Zone
Dermis
Subcutaneous Tissue
Muscle/Fascia/Bone
What are the layers of the epidermis? - ANSWER-Stratum corneum - keratinocytes
filled with keratin
Stratum lucidum - only in palms/soles, thick areas
Stratum granulosum - odland bodies secrete ceramides, lipophilic
Stratum spinosum - desmosomes (cell to cell junctions)
Stratum germinativum - dermal-epidermal junction
What is the Basement Membrane Zone? - ANSWER-Dermal-epidermal junction
What are the components of the dermis? - ANSWER-Papillary dermis: papillae interlock
with rete ridges, capillary loops, sensitive to point pressure
Reticular dermis: mostly type 1 collagen, vasculars, and lymphatics
What structures of the skin can regenerate? - ANSWER-Epidermis and parts of the
dermis
What structures of the skin heal by scar formation? - ANSWER-Epidermal appendages,
Subcutaneous tissue/fascia/muscle
,How is newborn skin different? - ANSWER-No scars up to 2nd trimester
30% thinner skin
Faster epidermal turnover
How is premature infant skin different? - ANSWER-Very thin, increased fluid loss,
functional stratum corneum at 30-32 weeks
What problems may arise with infant skin? - ANSWER-increased permeability,
increased MARSI risk, extravasation, diaper dermatitis
How do you mitigate MARSI risk in infants/elderly? - ANSWER-avoid tape or use
hydrocolloid base or silicone adhesive, no alcohol removers only mineral oil, petroleum,
silicone (preferred), and citrus)
How do you mitigate extravasation in an infant? - ANSWER-Hyaluronidase
OR
phentolamine if vasoconstrictor
How do you mitigate diaper dermatitis? - ANSWER-Higher pH
Use petroleum base for mild erythema and zinc oxide for denuded skin
sever denudation - carboxymethylcellulose/petrolatum/zinc oxide (Ilex)
What bathing considerations must you take for premature infants? - ANSWER-<30
weeks bathe with water only for 2 weeks
What are common issues with older skin? - ANSWER-Thinner, collagen shrinks and
causes wrinkles
Rete ridges and dermal papillae flatten - increased risk for tears/stripping
Reduced sebaceous and sweat glands - dry skin
Erratic/decreased melanin production
Decreased sensation - increased trauma risk
Loss of SubQ tissue - increased shear and decreased insulation
Increased malignant lesions - refer to derm
Reduced blood flow, increased epidermal turnover - slow healing
Increased senescense
Maybe increased inflammatory mediators, decreased inhibitors
Increased capillary fragility (bruises)
What strategies keep skin healthy? - ANSWER-pH balanced cleaners - no alkaline
soaps
Superfatted nonalkaline soaps for dry skin
CHG reduces pathogens and sepsis
Individualize bathing schedule
Apply lubricants, oils, creams to clean slightly damp skin
, What types of products are emollients? - ANSWER-mineral oil, petrolatum, lanolin,
ceramides
What do emollients do? - ANSWER-penetrates stratum corneum to increase lipid
component and soften
Layer on skin retards water loss to rehydrate
What is dimethicone? - ANSWER-Moisture barrier that retards water loss
What products are humectants? - ANSWER-glycerin, urea, propylene glycol, lachydrin,
alpha hydroxy acids
What do humectants do? - ANSWER-Water attractants - increase strateum corneum
water content
Who are humectants for? - ANSWER-Only for xerosis - not for macerated and
sometimes not for fragile skin
Which tissue layer is most susceptible to ischemic damage? - ANSWER-Muscle/fascia
layer
What is a macule - ANSWER-Flat spot of color change less than 0.5cm in diameter
What is a papule - ANSWER-Flat spot of color change greater than 0.5cm in diameter
What is a patch? - ANSWER-Raised spot of color change less than 0.5cm in diameter
What is a plaque? - ANSWER-Raised spot of color change greater than 0.5cm in
diameter
What is a blister? - ANSWER-Serous fluid trapped under skin less than 0.5cm in
diameter
What is a bulla? - ANSWER-Serous fluid trapped under skin greater than 0.5cm in
diameter
What is erythema? - ANSWER-Generalized redness
What is denudation? - ANSWER-Loss of superficial skin layer
What is crusting? - ANSWER-Scab of dried exudate of body fluid, blood, or pus
What is granulation? - ANSWER-proliferating tissue made of capillary networks,
collagen, and other connective substances
What is slough? - ANSWER-Loose, stringy, nonviable tissue
Answers., Exams of Nursing
What amino acids are essential for collagen synthesis?
What is the effect of stress on these amino acids? - ANSWER-Glutamine and l-arginine
Not adequately produced during times of physiologic stress
What weight trend suggests nutritional deficiency? - ANSWER-Unplanned weight loss
=>2.5% of usual weight in 30 days or =>10% within 180 days
BMI <18.5
What BG parameters should be maintained for wound healing? - ANSWER-BG <180 for
leukocyte function; <140 for healing
A1C <7 for most, <8 if hx of severe hypoglycemia, advanced comorbidities, limited life
expectancy
Why is nutrition relevant to wound healing? - ANSWER-Muscle or SubQ wasting
increases risk of pressure/shear damage
malnourished pt unable to synthesize and cross-link collagen normally
protein deficiency increases risk of infection
What effect do low zinc levels have on wound healing? - ANSWER-compromise
collagen synthesis/crosslinking
Goals of wound assessment - ANSWER-1. Determine etiologic factors
2. Assess systemic factors/comorbidities
3. Assess wound to determine phase of healing
4. Determine goals of topical therapy
Why does hyperglycemia affect wound healing? - ANSWER-Impairs leukocyte function
and negatively impacts collagen syntehesis, development of tensile strength, epithelial
resurfacing
What serum albumin level indicates malnutrition? - ANSWER-<3.5 g/dl
What is the suggested caloric intake? - ANSWER-30-35 cal/kg body weight
What is the suggested protein intake? - ANSWER-1.25-1.5 g/kg body weight
What is the suggested fluid intake? - ANSWER-30ml per kg (unless fluid restriction
indicated)
,How do you assess perfusion/oxygenation? - ANSWER-capillary refill, pulses,
presence/absence of edema, TcpO2 levels (at least 40), color of wound bed (bright
pink/red), ABI for lower extremity ulcers, systolic bp/episodes of hypotension,
vasopressor administration
What serum transferrin level indicates malnutrition? - ANSWER-<100mg/dl
What serum prealbumin level indicates malnutrition? - ANSWER-<19.5
What total lymphocyte count level indicates malnutrition? - ANSWER-<1500
What are s/s of nutritional deficits? - ANSWER-skin rashes, cracks in mucous
membranes, edema, muscle and subQ tissue wasting, nonhealing wounds,
dry/pluckable hair, dry flaky itchy skin
How do you assess for immunosuppression? - ANSWER-Comorbidities/therapies such
as HIV, steroid tehrapy in doses >30mg/day for >30 days, and/or chemo resulting in
neutropenia; high dose NSAIDs
What comorbidities compromise wound healing? - ANSWER-renal failure, liver failure,
multisystem trauma, smoking, advanced age
What are the layers of the skin - ANSWER-Epidermis
Basement Membrane Zone
Dermis
Subcutaneous Tissue
Muscle/Fascia/Bone
What are the layers of the epidermis? - ANSWER-Stratum corneum - keratinocytes
filled with keratin
Stratum lucidum - only in palms/soles, thick areas
Stratum granulosum - odland bodies secrete ceramides, lipophilic
Stratum spinosum - desmosomes (cell to cell junctions)
Stratum germinativum - dermal-epidermal junction
What is the Basement Membrane Zone? - ANSWER-Dermal-epidermal junction
What are the components of the dermis? - ANSWER-Papillary dermis: papillae interlock
with rete ridges, capillary loops, sensitive to point pressure
Reticular dermis: mostly type 1 collagen, vasculars, and lymphatics
What structures of the skin can regenerate? - ANSWER-Epidermis and parts of the
dermis
What structures of the skin heal by scar formation? - ANSWER-Epidermal appendages,
Subcutaneous tissue/fascia/muscle
,How is newborn skin different? - ANSWER-No scars up to 2nd trimester
30% thinner skin
Faster epidermal turnover
How is premature infant skin different? - ANSWER-Very thin, increased fluid loss,
functional stratum corneum at 30-32 weeks
What problems may arise with infant skin? - ANSWER-increased permeability,
increased MARSI risk, extravasation, diaper dermatitis
How do you mitigate MARSI risk in infants/elderly? - ANSWER-avoid tape or use
hydrocolloid base or silicone adhesive, no alcohol removers only mineral oil, petroleum,
silicone (preferred), and citrus)
How do you mitigate extravasation in an infant? - ANSWER-Hyaluronidase
OR
phentolamine if vasoconstrictor
How do you mitigate diaper dermatitis? - ANSWER-Higher pH
Use petroleum base for mild erythema and zinc oxide for denuded skin
sever denudation - carboxymethylcellulose/petrolatum/zinc oxide (Ilex)
What bathing considerations must you take for premature infants? - ANSWER-<30
weeks bathe with water only for 2 weeks
What are common issues with older skin? - ANSWER-Thinner, collagen shrinks and
causes wrinkles
Rete ridges and dermal papillae flatten - increased risk for tears/stripping
Reduced sebaceous and sweat glands - dry skin
Erratic/decreased melanin production
Decreased sensation - increased trauma risk
Loss of SubQ tissue - increased shear and decreased insulation
Increased malignant lesions - refer to derm
Reduced blood flow, increased epidermal turnover - slow healing
Increased senescense
Maybe increased inflammatory mediators, decreased inhibitors
Increased capillary fragility (bruises)
What strategies keep skin healthy? - ANSWER-pH balanced cleaners - no alkaline
soaps
Superfatted nonalkaline soaps for dry skin
CHG reduces pathogens and sepsis
Individualize bathing schedule
Apply lubricants, oils, creams to clean slightly damp skin
, What types of products are emollients? - ANSWER-mineral oil, petrolatum, lanolin,
ceramides
What do emollients do? - ANSWER-penetrates stratum corneum to increase lipid
component and soften
Layer on skin retards water loss to rehydrate
What is dimethicone? - ANSWER-Moisture barrier that retards water loss
What products are humectants? - ANSWER-glycerin, urea, propylene glycol, lachydrin,
alpha hydroxy acids
What do humectants do? - ANSWER-Water attractants - increase strateum corneum
water content
Who are humectants for? - ANSWER-Only for xerosis - not for macerated and
sometimes not for fragile skin
Which tissue layer is most susceptible to ischemic damage? - ANSWER-Muscle/fascia
layer
What is a macule - ANSWER-Flat spot of color change less than 0.5cm in diameter
What is a papule - ANSWER-Flat spot of color change greater than 0.5cm in diameter
What is a patch? - ANSWER-Raised spot of color change less than 0.5cm in diameter
What is a plaque? - ANSWER-Raised spot of color change greater than 0.5cm in
diameter
What is a blister? - ANSWER-Serous fluid trapped under skin less than 0.5cm in
diameter
What is a bulla? - ANSWER-Serous fluid trapped under skin greater than 0.5cm in
diameter
What is erythema? - ANSWER-Generalized redness
What is denudation? - ANSWER-Loss of superficial skin layer
What is crusting? - ANSWER-Scab of dried exudate of body fluid, blood, or pus
What is granulation? - ANSWER-proliferating tissue made of capillary networks,
collagen, and other connective substances
What is slough? - ANSWER-Loose, stringy, nonviable tissue
