CWCN REVIEW BOOK QUESTIONS & ANSWERS
Which of the following is the best approach to management of a fungating breast tumor
with very malodorous exudate and a friable surface that bleeds with dressing removal?
The wound is currently managed with damp gauze dressings.
A. Dakins soaked wtd dressing
B. Dsd + charcoal dressing secured with surgical netting
C. Amorphous gel + damp gauze covered with dry gauze and surgical netting
D. Crushed metronidazole tablets to wound surgcace + adaptic + dsd and surgical
netting - answer -d. Crushed metronidazole tablets to wound surgcace + adaptic + dsd
and surgical netting
The most critical intervention in management of a blistering weeping allergic reaction is:
A. Systemic antihistamines
B. Antibiotics to prevent secondary infection
C. Avoidance of contact with allergen
D. Topical therapy to control edema and itching - answer -c. Avoidance of contact with
allergen.
You are assessing a 56 yo female who is 5 days s/p cholecystectomy and is now
complaining of feeling "really awful, like i have the flu or something" and also reports
intense pain medial to incision. On inspection, you note a petechial rash. Temp 101,
wbc 15,000. These findings are most consistent with:
A. Cellulitis and impending incisional dehiscence
B. Necrotizing fasciitis
C. Toxic epidermal necrolysis syndrome
D. Allergic reaction to tape on incisional dressing. - answer -b. Necrotizing fasciitis
Which of the following is the most significant indicator of nutritional compromise?
A. Weight 90% of ideal body weight
B. Prealbumin 12.8 in patient who has sustained multiorgan trauma
C. Unplanned weight loss over 3 months, (from 160 to 140 lbs).
D. Incisional dehiscence - answer -c. Unplanned weight loss over 3 months (from 160
to 140 lbs)
Which of the following best describes the effects of hyperglycemia on wound healing?
A. Impaired collagen synthesis and impaired epithelialization
B. Increased risk hypertrophic scars with reduced tensile strength
C. No impact on partial thickness repair, major delay in full thickness healing
D. No change in granulation; marked reduction in tensile strength. - answer -a.
Impaired collagen synthesis and impaired epithelialization
A patient presents to outpatient clinic with deep laceration on right thigh sustained 36
hours previously in motorcycle accident. Laceration 6x2x1.8. No s/s infection. Which of
the following best represents management of this wound?
, A. Thorough cleansing (pulsed lavage) followed by surgical closure
B. Cleansing followed by application of sustained release antimicrobial dressing
C. Surgical closure + systemic abx
D. Antimicrobial dressings for 72 hours followed by delayed surgical closure - answer -
b. Cleansing followed by application of sustained release antimicrobial dressing
Jason l present to your outpatient clinic with thermal burns on his hands and arms; the
bases of the wounds are pale white with distinct red islets. Tbsa <10%. No other
injruies. Which represents best management of these burns:
A. Silvadene + wrap gauze, change daily
B. Sustained release silver gel + nonadherent dressings changed q2d
C. Referral to burn center/burn specialist
D. Moisture retentive dssg + systemic abx - answer -c. Referral to burn center/burn
specialist
In managing a patient with tens, you should recommend which of the following:
A. Aggressive bedside debridement; systemic abx
B. Nonadherent dssg; low shear low friction support surface
C. Systemic antiviral agents; hydration; zinc oxide to lesions
D. Hydrocolloid dssg to prevent infection; pain control - answer -b. Nonadherent dssg;
low shear low friction support surface
You are consulted on management of a wound that is 100% soft escar with moderate
amount foul-smelling exudate and erythema and induration extending 2cm from wound
edge. Which of the following is the best approach:
A. C+s; begin abx once results obtained
B. Broad spectrum abx coverage
C. Dakins soaked gauze + pulsed lavage daily
D. Obtain c+s; initiate broad spectrum abx coverage immediately and modify once c+s
results - answer -d. Obtain c+s; initiate broad spectrum abx coverage immediately and
modify once c+s results
Pressure injury in which 80% of the wound bed is covered with slough and 20% of
wound bed is viable muscle should be staged as:
A. Unstageable
B. Stage 3
C. Stage 4
D. Dti - answer -c. Stage 4.
Ms. J is a 44 yo female with aids who is referred to your hha for management of
dehisced incisional wound. On assessment, wound measures 10x5x3. Base clean but
not granulating. Small amt serosanguineous drainage, and faint halo erythema 2cm
from wound edges. Which of the following is most accurate:
A. These are normal findings for wound at end of inflammatory phase.
B. These findings are indicative of wound infection (cellulitis).
C. These findings are consistent with early proliferative phase of repair.
Which of the following is the best approach to management of a fungating breast tumor
with very malodorous exudate and a friable surface that bleeds with dressing removal?
The wound is currently managed with damp gauze dressings.
A. Dakins soaked wtd dressing
B. Dsd + charcoal dressing secured with surgical netting
C. Amorphous gel + damp gauze covered with dry gauze and surgical netting
D. Crushed metronidazole tablets to wound surgcace + adaptic + dsd and surgical
netting - answer -d. Crushed metronidazole tablets to wound surgcace + adaptic + dsd
and surgical netting
The most critical intervention in management of a blistering weeping allergic reaction is:
A. Systemic antihistamines
B. Antibiotics to prevent secondary infection
C. Avoidance of contact with allergen
D. Topical therapy to control edema and itching - answer -c. Avoidance of contact with
allergen.
You are assessing a 56 yo female who is 5 days s/p cholecystectomy and is now
complaining of feeling "really awful, like i have the flu or something" and also reports
intense pain medial to incision. On inspection, you note a petechial rash. Temp 101,
wbc 15,000. These findings are most consistent with:
A. Cellulitis and impending incisional dehiscence
B. Necrotizing fasciitis
C. Toxic epidermal necrolysis syndrome
D. Allergic reaction to tape on incisional dressing. - answer -b. Necrotizing fasciitis
Which of the following is the most significant indicator of nutritional compromise?
A. Weight 90% of ideal body weight
B. Prealbumin 12.8 in patient who has sustained multiorgan trauma
C. Unplanned weight loss over 3 months, (from 160 to 140 lbs).
D. Incisional dehiscence - answer -c. Unplanned weight loss over 3 months (from 160
to 140 lbs)
Which of the following best describes the effects of hyperglycemia on wound healing?
A. Impaired collagen synthesis and impaired epithelialization
B. Increased risk hypertrophic scars with reduced tensile strength
C. No impact on partial thickness repair, major delay in full thickness healing
D. No change in granulation; marked reduction in tensile strength. - answer -a.
Impaired collagen synthesis and impaired epithelialization
A patient presents to outpatient clinic with deep laceration on right thigh sustained 36
hours previously in motorcycle accident. Laceration 6x2x1.8. No s/s infection. Which of
the following best represents management of this wound?
, A. Thorough cleansing (pulsed lavage) followed by surgical closure
B. Cleansing followed by application of sustained release antimicrobial dressing
C. Surgical closure + systemic abx
D. Antimicrobial dressings for 72 hours followed by delayed surgical closure - answer -
b. Cleansing followed by application of sustained release antimicrobial dressing
Jason l present to your outpatient clinic with thermal burns on his hands and arms; the
bases of the wounds are pale white with distinct red islets. Tbsa <10%. No other
injruies. Which represents best management of these burns:
A. Silvadene + wrap gauze, change daily
B. Sustained release silver gel + nonadherent dressings changed q2d
C. Referral to burn center/burn specialist
D. Moisture retentive dssg + systemic abx - answer -c. Referral to burn center/burn
specialist
In managing a patient with tens, you should recommend which of the following:
A. Aggressive bedside debridement; systemic abx
B. Nonadherent dssg; low shear low friction support surface
C. Systemic antiviral agents; hydration; zinc oxide to lesions
D. Hydrocolloid dssg to prevent infection; pain control - answer -b. Nonadherent dssg;
low shear low friction support surface
You are consulted on management of a wound that is 100% soft escar with moderate
amount foul-smelling exudate and erythema and induration extending 2cm from wound
edge. Which of the following is the best approach:
A. C+s; begin abx once results obtained
B. Broad spectrum abx coverage
C. Dakins soaked gauze + pulsed lavage daily
D. Obtain c+s; initiate broad spectrum abx coverage immediately and modify once c+s
results - answer -d. Obtain c+s; initiate broad spectrum abx coverage immediately and
modify once c+s results
Pressure injury in which 80% of the wound bed is covered with slough and 20% of
wound bed is viable muscle should be staged as:
A. Unstageable
B. Stage 3
C. Stage 4
D. Dti - answer -c. Stage 4.
Ms. J is a 44 yo female with aids who is referred to your hha for management of
dehisced incisional wound. On assessment, wound measures 10x5x3. Base clean but
not granulating. Small amt serosanguineous drainage, and faint halo erythema 2cm
from wound edges. Which of the following is most accurate:
A. These are normal findings for wound at end of inflammatory phase.
B. These findings are indicative of wound infection (cellulitis).
C. These findings are consistent with early proliferative phase of repair.
