WOCN Wound Exam Questions With Correct
Answers
Goals |of |wound |assessment |- |CORRECT |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? |- |CORRECT |ANSWER✔✔-Impairs |leukocyte |
function |and |negatively |impacts |collagen |syntehesis, |development |of |tensile |strength, |
epithelial |resurfacing
What |BG |parameters |should |be |maintained |for |wound |healing? |- |CORRECT |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? |- |CORRECT |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? |- |CORRECT |ANSWER✔✔-compromise |
collagen |synthesis/crosslinking
What |amino |acids |are |essential |for |collagen |synthesis? |
,What |is |the |effect |of |stress |on |these |amino |acids? |- |CORRECT |ANSWER✔✔-Glutamine |and |l-
arginine
Not |adequately |produced |during |times |of |physiologic |stress
What |weight |trend |suggests |nutritional |deficiency? |- |CORRECT |ANSWER✔✔-Unplanned |weight
|loss |=>2.5% |of |usual |weight |in |30 |days |or |=>10% |within |180 |days
BMI |<18.5
What |serum |albumin |level |indicates |malnutrition? |- |CORRECT |ANSWER✔✔-<3.5 |g/dl
What |serum |transferrin |level |indicates |malnutrition? |- |CORRECT |ANSWER✔✔-<100mg/dl
What |serum |prealbumin |level |indicates |malnutrition? |- |CORRECT |ANSWER✔✔-<19.5
What |total |lymphocyte |count |level |indicates |malnutrition? |- |CORRECT |ANSWER✔✔-<1500
What |are |s/s |of |nutritional |deficits? |- |CORRECT |ANSWER✔✔-skin |rashes, |cracks |in |mucous |
membranes, |edema, |muscle |and |subQ |tissue |wasting, |nonhealing |wounds, |dry/pluckable |hair, |
dry |flaky |itchy |skin
What |is |the |suggested |caloric |intake? |- |CORRECT |ANSWER✔✔-30-35 |cal/kg |body |weight
What |is |the |suggested |protein |intake? |- |CORRECT |ANSWER✔✔-1.25-1.5 |g/kg |body |weight
What |is |the |suggested |fluid |intake? |- |CORRECT |ANSWER✔✔-30ml |per |kg |(unless |fluid |
restriction |indicated)
,How |do |you |assess |perfusion/oxygenation? |- |CORRECT |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
How |do |you |assess |for |immunosuppression? |- |CORRECT |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? |- |CORRECT |ANSWER✔✔-renal |failure, |liver |
failure, |multisystem |trauma, |smoking, |advanced |age
What |are |the |layers |of |the |skin |- |CORRECT |ANSWER✔✔-Epidermis |
Basement |Membrane |Zone
Dermis |
Subcutaneous |Tissue |
Muscle/Fascia/Bone
What |are |the |layers |of |the |epidermis? |- |CORRECT |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? |- |CORRECT |ANSWER✔✔-Dermal-epidermal |junction
What |are |the |components |of |the |dermis? |- |CORRECT |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? |- |CORRECT |ANSWER✔✔-Epidermis |and |parts |of |
the |dermis
What |structures |of |the |skin |heal |by |scar |formation? |- |CORRECT |ANSWER✔✔-Epidermal |
appendages, |Subcutaneous |tissue/fascia/muscle
How |is |newborn |skin |different? |- |CORRECT |ANSWER✔✔-No |scars |up |to |2nd |trimester
30% |thinner |skin
Faster |epidermal |turnover
How |is |premature |infant |skin |different? |- |CORRECT |ANSWER✔✔-Very |thin, |increased |fluid |
loss, |functional |stratum |corneum |at |30-32 |weeks
What |problems |may |arise |with |infant |skin? |- |CORRECT |ANSWER✔✔-increased |permeability, |
increased |MARSI |risk, |extravasation, |diaper |dermatitis
How |do |you |mitigate |MARSI |risk |in |infants/elderly? |- |CORRECT |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? |- |CORRECT |ANSWER✔✔-Hyaluronidase |
OR |
phentolamine |if |vasoconstrictor
How |do |you |mitigate |diaper |dermatitis? |- |CORRECT |ANSWER✔✔-Higher |pH
Use |petroleum |base |for |mild |erythema |and |zinc |oxide |for |denuded |skin
Answers
Goals |of |wound |assessment |- |CORRECT |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? |- |CORRECT |ANSWER✔✔-Impairs |leukocyte |
function |and |negatively |impacts |collagen |syntehesis, |development |of |tensile |strength, |
epithelial |resurfacing
What |BG |parameters |should |be |maintained |for |wound |healing? |- |CORRECT |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? |- |CORRECT |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? |- |CORRECT |ANSWER✔✔-compromise |
collagen |synthesis/crosslinking
What |amino |acids |are |essential |for |collagen |synthesis? |
,What |is |the |effect |of |stress |on |these |amino |acids? |- |CORRECT |ANSWER✔✔-Glutamine |and |l-
arginine
Not |adequately |produced |during |times |of |physiologic |stress
What |weight |trend |suggests |nutritional |deficiency? |- |CORRECT |ANSWER✔✔-Unplanned |weight
|loss |=>2.5% |of |usual |weight |in |30 |days |or |=>10% |within |180 |days
BMI |<18.5
What |serum |albumin |level |indicates |malnutrition? |- |CORRECT |ANSWER✔✔-<3.5 |g/dl
What |serum |transferrin |level |indicates |malnutrition? |- |CORRECT |ANSWER✔✔-<100mg/dl
What |serum |prealbumin |level |indicates |malnutrition? |- |CORRECT |ANSWER✔✔-<19.5
What |total |lymphocyte |count |level |indicates |malnutrition? |- |CORRECT |ANSWER✔✔-<1500
What |are |s/s |of |nutritional |deficits? |- |CORRECT |ANSWER✔✔-skin |rashes, |cracks |in |mucous |
membranes, |edema, |muscle |and |subQ |tissue |wasting, |nonhealing |wounds, |dry/pluckable |hair, |
dry |flaky |itchy |skin
What |is |the |suggested |caloric |intake? |- |CORRECT |ANSWER✔✔-30-35 |cal/kg |body |weight
What |is |the |suggested |protein |intake? |- |CORRECT |ANSWER✔✔-1.25-1.5 |g/kg |body |weight
What |is |the |suggested |fluid |intake? |- |CORRECT |ANSWER✔✔-30ml |per |kg |(unless |fluid |
restriction |indicated)
,How |do |you |assess |perfusion/oxygenation? |- |CORRECT |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
How |do |you |assess |for |immunosuppression? |- |CORRECT |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? |- |CORRECT |ANSWER✔✔-renal |failure, |liver |
failure, |multisystem |trauma, |smoking, |advanced |age
What |are |the |layers |of |the |skin |- |CORRECT |ANSWER✔✔-Epidermis |
Basement |Membrane |Zone
Dermis |
Subcutaneous |Tissue |
Muscle/Fascia/Bone
What |are |the |layers |of |the |epidermis? |- |CORRECT |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? |- |CORRECT |ANSWER✔✔-Dermal-epidermal |junction
What |are |the |components |of |the |dermis? |- |CORRECT |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? |- |CORRECT |ANSWER✔✔-Epidermis |and |parts |of |
the |dermis
What |structures |of |the |skin |heal |by |scar |formation? |- |CORRECT |ANSWER✔✔-Epidermal |
appendages, |Subcutaneous |tissue/fascia/muscle
How |is |newborn |skin |different? |- |CORRECT |ANSWER✔✔-No |scars |up |to |2nd |trimester
30% |thinner |skin
Faster |epidermal |turnover
How |is |premature |infant |skin |different? |- |CORRECT |ANSWER✔✔-Very |thin, |increased |fluid |
loss, |functional |stratum |corneum |at |30-32 |weeks
What |problems |may |arise |with |infant |skin? |- |CORRECT |ANSWER✔✔-increased |permeability, |
increased |MARSI |risk, |extravasation, |diaper |dermatitis
How |do |you |mitigate |MARSI |risk |in |infants/elderly? |- |CORRECT |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? |- |CORRECT |ANSWER✔✔-Hyaluronidase |
OR |
phentolamine |if |vasoconstrictor
How |do |you |mitigate |diaper |dermatitis? |- |CORRECT |ANSWER✔✔-Higher |pH
Use |petroleum |base |for |mild |erythema |and |zinc |oxide |for |denuded |skin
