WOCN Wound Exam / 444 Complete Questions
And Answers Download To Pass!!!
Quiz :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
Quiz :Why does hyperglycemia affect wound healing? - Answer :Impairs
leukocyte function and negatively impacts collagen syntehesis, development of
tensile strength, epithelial resurfacing
Quiz :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
Quiz :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
Quiz :What effect do low zinc levels have on wound healing? -
Answer :compromise collagen synthesis/crosslinking
Quiz :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
Quiz :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
Quiz :What serum albumin level indicates malnutrition? - Answer :<3.5 g/dl
Quiz :What serum transferrin level indicates malnutrition? -
Answer :<100mg/dl
,Quiz :What serum prealbumin level indicates malnutrition? - Answer :<19.5
Quiz :What total lymphocyte count level indicates malnutrition? -
Answer :<1500
Quiz :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
Quiz :What is the suggested caloric intake? - Answer :30-35 cal/kg body
weight
Quiz :What is the suggested protein intake? - Answer :1.25-1.5 g/kg body
weight
Quiz :What is the suggested fluid intake? - Answer :30ml per kg (unless fluid
restriction indicated)
Quiz :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
Quiz :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
Quiz :What comorbidities compromise wound healing? - Answer :renal
failure, liver failure, multisystem trauma, smoking, advanced age
Quiz :What are the layers of the skin - Answer :Epidermis
Basement Membrane Zone
Dermis
Subcutaneous Tissue
Muscle/Fascia/Bone
Quiz :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
Quiz :What is the Basement Membrane Zone? - Answer :Dermal-epidermal
junction
Quiz :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
Quiz :What structures of the skin can regenerate? - Answer :Epidermis and
parts of the dermis
Quiz :What structures of the skin heal by scar formation? - Answer :Epidermal
appendages, Subcutaneous tissue/fascia/muscle
Quiz :How is newborn skin different? - Answer :No scars up to 2nd trimester
30% thinner skin
Faster epidermal turnover
Quiz :How is premature infant skin different? - Answer :Very thin, increased
fluid loss, functional stratum corneum at 30-32 weeks
Quiz :What problems may arise with infant skin? - Answer :increased
permeability, increased MARSI risk, extravasation, diaper dermatitis
Quiz :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)
Quiz :How do you mitigate extravasation in an infant? -
Answer :Hyaluronidase
OR
phentolamine if vasoconstrictor
Quiz :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)
, Quiz :What bathing considerations must you take for premature infants? -
Answer :<30 weeks bathe with water only for 2 weeks
Quiz :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)
Quiz :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
Quiz :What types of products are emollients? - Answer :mineral oil,
petrolatum, lanolin, ceramides
Quiz :What do emollients do? - Answer :penetrates stratum corneum to
increase lipid component and soften
Layer on skin retards water loss to rehydrate
Quiz :What is dimethicone? - Answer :Moisture barrier that retards water loss
Quiz :What products are humectants? - Answer :glycerin, urea, propylene
glycol, lachydrin, alpha hydroxy acids
Quiz :What do humectants do? - Answer :Water attractants - increase
strateum corneum water content
Quiz :Who are humectants for? - Answer :Only for xerosis - not for macerated
and sometimes not for fragile skin
And Answers Download To Pass!!!
Quiz :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
Quiz :Why does hyperglycemia affect wound healing? - Answer :Impairs
leukocyte function and negatively impacts collagen syntehesis, development of
tensile strength, epithelial resurfacing
Quiz :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
Quiz :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
Quiz :What effect do low zinc levels have on wound healing? -
Answer :compromise collagen synthesis/crosslinking
Quiz :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
Quiz :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
Quiz :What serum albumin level indicates malnutrition? - Answer :<3.5 g/dl
Quiz :What serum transferrin level indicates malnutrition? -
Answer :<100mg/dl
,Quiz :What serum prealbumin level indicates malnutrition? - Answer :<19.5
Quiz :What total lymphocyte count level indicates malnutrition? -
Answer :<1500
Quiz :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
Quiz :What is the suggested caloric intake? - Answer :30-35 cal/kg body
weight
Quiz :What is the suggested protein intake? - Answer :1.25-1.5 g/kg body
weight
Quiz :What is the suggested fluid intake? - Answer :30ml per kg (unless fluid
restriction indicated)
Quiz :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
Quiz :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
Quiz :What comorbidities compromise wound healing? - Answer :renal
failure, liver failure, multisystem trauma, smoking, advanced age
Quiz :What are the layers of the skin - Answer :Epidermis
Basement Membrane Zone
Dermis
Subcutaneous Tissue
Muscle/Fascia/Bone
Quiz :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
Quiz :What is the Basement Membrane Zone? - Answer :Dermal-epidermal
junction
Quiz :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
Quiz :What structures of the skin can regenerate? - Answer :Epidermis and
parts of the dermis
Quiz :What structures of the skin heal by scar formation? - Answer :Epidermal
appendages, Subcutaneous tissue/fascia/muscle
Quiz :How is newborn skin different? - Answer :No scars up to 2nd trimester
30% thinner skin
Faster epidermal turnover
Quiz :How is premature infant skin different? - Answer :Very thin, increased
fluid loss, functional stratum corneum at 30-32 weeks
Quiz :What problems may arise with infant skin? - Answer :increased
permeability, increased MARSI risk, extravasation, diaper dermatitis
Quiz :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)
Quiz :How do you mitigate extravasation in an infant? -
Answer :Hyaluronidase
OR
phentolamine if vasoconstrictor
Quiz :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)
, Quiz :What bathing considerations must you take for premature infants? -
Answer :<30 weeks bathe with water only for 2 weeks
Quiz :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)
Quiz :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
Quiz :What types of products are emollients? - Answer :mineral oil,
petrolatum, lanolin, ceramides
Quiz :What do emollients do? - Answer :penetrates stratum corneum to
increase lipid component and soften
Layer on skin retards water loss to rehydrate
Quiz :What is dimethicone? - Answer :Moisture barrier that retards water loss
Quiz :What products are humectants? - Answer :glycerin, urea, propylene
glycol, lachydrin, alpha hydroxy acids
Quiz :What do humectants do? - Answer :Water attractants - increase
strateum corneum water content
Quiz :Who are humectants for? - Answer :Only for xerosis - not for macerated
and sometimes not for fragile skin
