CWCN PRACTICE QUESTIONS AND ANSWERS
The foot care nurse should describe the distal margin of superficial skin extending over
the base of the toenail as:
a. subungual
b. periungual
c. perionychium
d. eponychium - Answer -d. eponychium
Which of the following is an example of mechanical debridement?
A. Using gauze moistened with 0.25% sodium hypochlorite solution and a cover
dressing
B. Applying saline moistened gauze to the wound bed and removing when dry
C. Cleansing with betadine and applying a thin layer of silver sulfadiazine cream
D. Using saline to clean the wound and applying a thin film dressing - Answer -B.
Applying saline moistened gauze to the wound bed and removing when dry
A 58 year old gentleman presents to the outpatient wound clinic for a new onset of
scattered bullae to the upper arms, shoulder and a few areas on the abdomen and
trunk. The palmar surfaces of his hands are red. You note that the intact skin is dry and
has a "tight" texture. He has been seeing dermatology for the past few years and states
he is taking the tacrolimus (Prograf®) as scheduled for the Graft vs. Host Disease
(GVHD). Your plan of wound care will include:
A. A hydrocolloid dressing
B. A referral to the Registered Dietician, RD
C. A non-adherent, absorptive dressing
D. Transparent film as the secondary dressing - Answer -C. A non-adherent, absorptive
dressing
A patient with a right venous insufficiency leg ulcer returns to the clinic 2 weeks after
initiating weekly compression therapy; the leg edema is markedly reduced, but the
patient continues to have a large amount of exudate. The wound has enlarged, and
there is increased periwound erythema extending 3 cm from the wound edge. What is
the best wound care-management approach at this point?
A. Weekly sharp debridement
B. Apply silver nitrate
C. Increase the compression-dressing change frequency
D. Consider obtaining a wound culture - Answer -D. Consider obtaining a wound
culture
Mr. Jones, 75, lives with his family at home. His BMI is 45. He has two stage IV
pressure ulcers; one on his left trochanter, and one on his sacrum. You are developing
the plan of care. You understand that, under Medicare guidelines, your patient qualifies
for a specialty surface. The best surface for Mr. Jones is:
A. A low air loss mattress replacement
,B. A small-cell mattress overlay
C. An air-fluidized bed
D. A high-density foam mattress - Answer -A. A low air loss mattress replacement
A 73-year-old patient presents with a weeping wound on the right leg gaiter region with
associated long-standing lower leg edema. The patient reports leg pain that worsens
during the day. In discussing treatment recommendations with the patient, the CWCN
provides education that:
A. Solo therapy with absorptive dressing is indicated.
B. Compression therapy assists with increased healing rates, improved symptoms, and
reduction of edema.
C. Limb elevation for extending periods throughout the day is the best method for
edema reduction
D. Pharmacotherapy with diuretics for fluid reduction is the best treatment option for
edema. - Answer -B. Compression therapy assists with increased healing rates,
improved symptoms, and reduction of edema.
You suspect that a patient may have a wound infection. What is the best technique to
obtain a wound culture?
A. Flush the wound with sterile water followed by a 10-point swab covering all the areas
of the wound surface
B. Use a 19-gauge angiocatheter and a 10-cc syringe to aspirate purulent fluid from the
wound bed
C. Flush the wound with normal saline and swab 1 square cm of the viable tissue with
enough force to produce fluid
D. Clean the wound with providone iodine, then use a10-pt swab to cover all the areas
of the wound surface - Answer -C. Flush the wound with normal saline and swab 1
square cm of the viable tissue with enough force to produce fluid
A 73-year-old woman with irritable bowel hesitantly reports occasional bowel leakage.
Which of the following strategies can the Certified Continence Care Nurse (CCCN)
employ to help reduce her reluctance to share with her health care team?
A. Suggest a referral to a psychologist.
B. Offer body-worn absorbent product information.
C. Communicate consistently and avoid blaming language.
D. Provide a handout of pelvic floor exercises. - Answer -C. Offer body-worn absorbent
product information.
Comprehensive exam of a 50-year-old man with inflammatory bowel disease reveals
chronic diarrhea with occasional fecal incontinence. His International Consultation on
Incontinence Questionnaire-Bowel Symptoms (ICIQ-B) indicates a poor quality-of-life
related to fecal incontinence. Further interview provides evidence that the patient's
lifestyle may be contributing to his incontinence. Which of the following information
,provided during the interview would the continence nurse identify as a reversible risk
factor for this patient's fecal incontinence?
A. High fat diet
B. History of back injury
C. Use of body-worn absorbent products
D. Probiotics - Answer -A. High Fat diet (known to increased GI motility & Risk fo for
fecal incontinence)
The APRN is consulted to evaluate a malodorous wound. What would be the most
appropriate treatment?
A. Fluconazole
B. Metronidazole
C. Miconazole
D. Minocycline - Answer -B. Metronidazole ← Effective in controlling odor by reducing
the odor-producing anaerobic pathogens
- Wound odor← Often caused by Anaerobic pathogens in wound
- Odor← common w/ chronic wounds
- Effective in fungating wounds due to Gram negative activity
A newly diagnosed patient with diabetes with an A1C of 10.2 has a wound on the lateral
aspect of the foot with evidence of exposed tendon (Wagner grade 2). What would be
the most appropriate intervention for this patient?
A. Evaluate for hyperbaric oxygen therapy (HBOT)
B. Order a pulse volume recording study
C. Refer to a diabetic educator
D. Start enzymatic debridement - Answer -C. Refer to a diabetic educator
You are concerned about the patient's complaints of itching to the skin around the leg
ulcer. You will contact the licensed independent practitioner (LIP) to apply this
substance to the intact periwound skin before the compression stocking:
A. Lidocaine Gel
B. Topical corticosteroid
C. Neomycin
D. Silver Sulfadiazine - Answer -B. Topical corticosteroid
(mild potency) can be applied to periwound over Short term to decrease inflammation
+itching
Scattered thin lesions of smooth white plaque are noted around a patient's dry bilateral
ankles and feet. You tell the patient that:
A. They are healed full-thickness ulcers, and we need to protect them
B. They are healed full-thickness ulcers, and we need to protect them
C. These skin changes are called atrophie blanche, and we need to protect them
, D. You will need a physical therapy referral for lymphedema management - Answer -C.
These skin changes are called atrophie blanche, and we need to protect them
A patient with darker skin tone has a lower extremity wound. After a saturated dressing
is removed, the periwound skin was assessed as gray in color and wrinkled in
appearance. What is the best treatment for this wound?
A. Zinc-based barrier to peri-wound, nonadhesive foam dressing
B. Liquid acrylate barrier film to peri-wound, adhesive foam dressing
C. Petrolatum ointment to peri-wound, adhesive foam dressing
D. Hydrogel to wound base, transparent adhesive dressing - Answer -B. Liquid acrylate
barrier film to peri-wound, adhesive foam dressing
A man with a chronic lower leg venous insufficiency ulcer has had intermittent
improvement and worsening of the ulcer over 5 years. In the last month, the wound has
developed a pearly white, flat wound bed with raised, firm wound margins. The ulcer
has not improved despite several topical dressing changes geared to disrupt biofilm
production and promote healing. You are considering the use of growth factors in the
wound care plan. What should you do next?
A. Consult a licensed independent practitioner, LIP, and request a wound biopsy
B. Consult a vascular medicine physician and request an arterial blood flow study
C. Consult a physician to request a complete blood count
D. Interview the patient to assess any barriers to wound care dressing adherence -
Answer -A. Consult a licensed independent practitioner, LIP, and request a wound
biopsy
Marjolin ulcers present as flat, indolent, pearly white lesions with indurated, elevated
margins. (Growth factor use is contraindicated in the presence of cancerous lesion)
A 10-year-old boy with sickle cell anemia is being seen for a non-healing ulcer caused
by a bicycle accident near his right lateral malleolus. The child is terrified of his twice-
daily dressing changes due to the pain. What is the best recommendation?
A. Premedicate him for pain 20 minutes prior to the dressing changes
B. Apply a calcium alginate as the primary dressing, a nonadherent foam as the
secondary, and secure with a flexible tube netting. Change every other day
C. Recommend that a contact cast be applied twice weekly
D. Refer for hyperbaric oxygen therapy (HBOT) to improve perfusion - Answer -B.
Apply a calcium alginate as the primary dressing, a nonadherent foam as the
secondary, and secure with a flexible tube netting. Change every other day
You are assessing a patient's neuropathic swollen foot and notice that the 6 mm
indentation of the left dorsal foot does not resolve after 1 minute. The edema is graded
at:
A. 4+
B. Weeping
C. 2+
The foot care nurse should describe the distal margin of superficial skin extending over
the base of the toenail as:
a. subungual
b. periungual
c. perionychium
d. eponychium - Answer -d. eponychium
Which of the following is an example of mechanical debridement?
A. Using gauze moistened with 0.25% sodium hypochlorite solution and a cover
dressing
B. Applying saline moistened gauze to the wound bed and removing when dry
C. Cleansing with betadine and applying a thin layer of silver sulfadiazine cream
D. Using saline to clean the wound and applying a thin film dressing - Answer -B.
Applying saline moistened gauze to the wound bed and removing when dry
A 58 year old gentleman presents to the outpatient wound clinic for a new onset of
scattered bullae to the upper arms, shoulder and a few areas on the abdomen and
trunk. The palmar surfaces of his hands are red. You note that the intact skin is dry and
has a "tight" texture. He has been seeing dermatology for the past few years and states
he is taking the tacrolimus (Prograf®) as scheduled for the Graft vs. Host Disease
(GVHD). Your plan of wound care will include:
A. A hydrocolloid dressing
B. A referral to the Registered Dietician, RD
C. A non-adherent, absorptive dressing
D. Transparent film as the secondary dressing - Answer -C. A non-adherent, absorptive
dressing
A patient with a right venous insufficiency leg ulcer returns to the clinic 2 weeks after
initiating weekly compression therapy; the leg edema is markedly reduced, but the
patient continues to have a large amount of exudate. The wound has enlarged, and
there is increased periwound erythema extending 3 cm from the wound edge. What is
the best wound care-management approach at this point?
A. Weekly sharp debridement
B. Apply silver nitrate
C. Increase the compression-dressing change frequency
D. Consider obtaining a wound culture - Answer -D. Consider obtaining a wound
culture
Mr. Jones, 75, lives with his family at home. His BMI is 45. He has two stage IV
pressure ulcers; one on his left trochanter, and one on his sacrum. You are developing
the plan of care. You understand that, under Medicare guidelines, your patient qualifies
for a specialty surface. The best surface for Mr. Jones is:
A. A low air loss mattress replacement
,B. A small-cell mattress overlay
C. An air-fluidized bed
D. A high-density foam mattress - Answer -A. A low air loss mattress replacement
A 73-year-old patient presents with a weeping wound on the right leg gaiter region with
associated long-standing lower leg edema. The patient reports leg pain that worsens
during the day. In discussing treatment recommendations with the patient, the CWCN
provides education that:
A. Solo therapy with absorptive dressing is indicated.
B. Compression therapy assists with increased healing rates, improved symptoms, and
reduction of edema.
C. Limb elevation for extending periods throughout the day is the best method for
edema reduction
D. Pharmacotherapy with diuretics for fluid reduction is the best treatment option for
edema. - Answer -B. Compression therapy assists with increased healing rates,
improved symptoms, and reduction of edema.
You suspect that a patient may have a wound infection. What is the best technique to
obtain a wound culture?
A. Flush the wound with sterile water followed by a 10-point swab covering all the areas
of the wound surface
B. Use a 19-gauge angiocatheter and a 10-cc syringe to aspirate purulent fluid from the
wound bed
C. Flush the wound with normal saline and swab 1 square cm of the viable tissue with
enough force to produce fluid
D. Clean the wound with providone iodine, then use a10-pt swab to cover all the areas
of the wound surface - Answer -C. Flush the wound with normal saline and swab 1
square cm of the viable tissue with enough force to produce fluid
A 73-year-old woman with irritable bowel hesitantly reports occasional bowel leakage.
Which of the following strategies can the Certified Continence Care Nurse (CCCN)
employ to help reduce her reluctance to share with her health care team?
A. Suggest a referral to a psychologist.
B. Offer body-worn absorbent product information.
C. Communicate consistently and avoid blaming language.
D. Provide a handout of pelvic floor exercises. - Answer -C. Offer body-worn absorbent
product information.
Comprehensive exam of a 50-year-old man with inflammatory bowel disease reveals
chronic diarrhea with occasional fecal incontinence. His International Consultation on
Incontinence Questionnaire-Bowel Symptoms (ICIQ-B) indicates a poor quality-of-life
related to fecal incontinence. Further interview provides evidence that the patient's
lifestyle may be contributing to his incontinence. Which of the following information
,provided during the interview would the continence nurse identify as a reversible risk
factor for this patient's fecal incontinence?
A. High fat diet
B. History of back injury
C. Use of body-worn absorbent products
D. Probiotics - Answer -A. High Fat diet (known to increased GI motility & Risk fo for
fecal incontinence)
The APRN is consulted to evaluate a malodorous wound. What would be the most
appropriate treatment?
A. Fluconazole
B. Metronidazole
C. Miconazole
D. Minocycline - Answer -B. Metronidazole ← Effective in controlling odor by reducing
the odor-producing anaerobic pathogens
- Wound odor← Often caused by Anaerobic pathogens in wound
- Odor← common w/ chronic wounds
- Effective in fungating wounds due to Gram negative activity
A newly diagnosed patient with diabetes with an A1C of 10.2 has a wound on the lateral
aspect of the foot with evidence of exposed tendon (Wagner grade 2). What would be
the most appropriate intervention for this patient?
A. Evaluate for hyperbaric oxygen therapy (HBOT)
B. Order a pulse volume recording study
C. Refer to a diabetic educator
D. Start enzymatic debridement - Answer -C. Refer to a diabetic educator
You are concerned about the patient's complaints of itching to the skin around the leg
ulcer. You will contact the licensed independent practitioner (LIP) to apply this
substance to the intact periwound skin before the compression stocking:
A. Lidocaine Gel
B. Topical corticosteroid
C. Neomycin
D. Silver Sulfadiazine - Answer -B. Topical corticosteroid
(mild potency) can be applied to periwound over Short term to decrease inflammation
+itching
Scattered thin lesions of smooth white plaque are noted around a patient's dry bilateral
ankles and feet. You tell the patient that:
A. They are healed full-thickness ulcers, and we need to protect them
B. They are healed full-thickness ulcers, and we need to protect them
C. These skin changes are called atrophie blanche, and we need to protect them
, D. You will need a physical therapy referral for lymphedema management - Answer -C.
These skin changes are called atrophie blanche, and we need to protect them
A patient with darker skin tone has a lower extremity wound. After a saturated dressing
is removed, the periwound skin was assessed as gray in color and wrinkled in
appearance. What is the best treatment for this wound?
A. Zinc-based barrier to peri-wound, nonadhesive foam dressing
B. Liquid acrylate barrier film to peri-wound, adhesive foam dressing
C. Petrolatum ointment to peri-wound, adhesive foam dressing
D. Hydrogel to wound base, transparent adhesive dressing - Answer -B. Liquid acrylate
barrier film to peri-wound, adhesive foam dressing
A man with a chronic lower leg venous insufficiency ulcer has had intermittent
improvement and worsening of the ulcer over 5 years. In the last month, the wound has
developed a pearly white, flat wound bed with raised, firm wound margins. The ulcer
has not improved despite several topical dressing changes geared to disrupt biofilm
production and promote healing. You are considering the use of growth factors in the
wound care plan. What should you do next?
A. Consult a licensed independent practitioner, LIP, and request a wound biopsy
B. Consult a vascular medicine physician and request an arterial blood flow study
C. Consult a physician to request a complete blood count
D. Interview the patient to assess any barriers to wound care dressing adherence -
Answer -A. Consult a licensed independent practitioner, LIP, and request a wound
biopsy
Marjolin ulcers present as flat, indolent, pearly white lesions with indurated, elevated
margins. (Growth factor use is contraindicated in the presence of cancerous lesion)
A 10-year-old boy with sickle cell anemia is being seen for a non-healing ulcer caused
by a bicycle accident near his right lateral malleolus. The child is terrified of his twice-
daily dressing changes due to the pain. What is the best recommendation?
A. Premedicate him for pain 20 minutes prior to the dressing changes
B. Apply a calcium alginate as the primary dressing, a nonadherent foam as the
secondary, and secure with a flexible tube netting. Change every other day
C. Recommend that a contact cast be applied twice weekly
D. Refer for hyperbaric oxygen therapy (HBOT) to improve perfusion - Answer -B.
Apply a calcium alginate as the primary dressing, a nonadherent foam as the
secondary, and secure with a flexible tube netting. Change every other day
You are assessing a patient's neuropathic swollen foot and notice that the 6 mm
indentation of the left dorsal foot does not resolve after 1 minute. The edema is graded
at:
A. 4+
B. Weeping
C. 2+
