CWCA 2023 STUDY GUIDE WITH COMPLETE SOLUTION

CWCA 2023 STUDY GUIDE WITH COMPLETE SOLUTION Corneum – ANSWER The outermost layer of the skin is known as the Stratum right medial malleolus – ANSWER bed confined elderly individual , positioned in left side -lying with the hips and knees slightly flexed , would be most susceptible to skin breakdown over which of the following boney prominences ? peroneal – ANSWER You have been requested to perform a dressing change and light irrigation of a deep wound just posterior to the fibular head . Care should be taken to avoid irritation of which nerve that passes through the area ? Node – ANSWER What is the term for the oval shaped structure that acts as a filter in thelymphatic system ? platelet activation – ANSWER Q : Which of the following occurs first in the wound healing process ? production of collagen – ANSWER Q : Which of the following is a function of the fibroblast ? increased fibrin deposition – ANSWER Q : Which of the following characteristics would be most indicative of a wound chronic stages of repair ?Proliferative - ANSWERQ : Fibroplasia is most associated with which of the following phases of wound healing ? Epidermis - ANSWERQ : What layer of skin is composed of stratified squamous epithelium and keratinocytes ? Fascia - ANSWERQ : A 35 year old female of average weight is seen 1 week post C - section . She is concerned due to redness and drainage on the left side of her dressing . On dressing removal , dehiscence of the left half of the incision is noted . Following irrigation of the wound , it is noted to have a shiny , white , string - like appearance in the wound base . What tissue is this most likely to be ? Epithelialization , neoangiogenesis , and synthesis - ANSWERQ : Which of the following wound healing events are most associated with the proliferative phase of repair ? rolled skin margins in chronic wounds - ANSWERQ : Epibole represents dermis - ANSWERQ : Skin appendages exist in the Myofibroblasts - ANSWERQ : Which of the following cells is noted for its contractile properties that play a role in wound contraction ? Masseter - ANSWERQ : You are treating a patient with this full thickness wound just anterior to the right ear . What muscle lies at the base of the wound ? Peroneal - ANSWERQ : The patient has been wearing the pictured clam - shell orthosis for management of a diabetic plantar ulcer . He has recently begun to experience some weakness and foot drop which appears secondary to nerve pressure . Which nerve is most likely implicated ?controlled moisture - ANSWERQ : Wound healing is facilitated by protection , sensory perception and temperature regulation - ANSWERQ : The primary functions of the skin include full - thickness - ANSWERQ : A wound that extends through the dermis and into the sub dermis is classified as serosanguineous - ANSWERQ : Drainage from a patient's wound consists of clear , thin fluid that is blood tinged . This should be described as Phagocytosis - ANSWERQ : Which of the following is a function of the macrophage ? Collagen - ANSWERQ : Approximately 75 % of the skin's total dry weight is made of which of the following ? Inflammatory - ANSWERQ : Which phase of repair immediately follows the hemostatic phase in wound repair ? Pyoderma gangrenosum - ANSWERQ : The concept of pathergy is most frequently associated with which of the following disease entities ? social history - ANSWERQ : Your supervisor has requested you to obtain some basic information from a patient prior to the physical examination . Information about tobacco use should be recorded under which area of your note sheet ? 0.85 - ANSWERQ : You have just completed an Ankle - Brachial Index assessment andnoted a systolic pressure in the arm of 130 mmHg and a systolic pressure at the ankle of 110 mmHg . How would you report the ankle - brachial index ? the point at which a stimulus begins to be perceived as painful - ANSWERQ : A clinician is trying to ascertain a patient's pain threshold . This relates to plantar surface of the midfoot - ANSWERQ : A patient with a Charcot foot is at greatest risk of developing an ulceration over the Assisted - ANSWERQ : You are called upon to transfer a patient from their bed to a wheelchair for transport to the wound care center . The patient is weak but can stand with assistance and provide 50 % effort . Which of the following standing transfer techniques would be most appropriate ? Plain film radiograph - ANSWERQ : Most imaging evaluations in patients with chronic wounds , begin which type of examination ? Iron - ANSWERQ : Which of the following nutritional substances is most important of the oxygen carrying capacity of hemoglobin ? draw a single line through the entry , initial and date - ANSWERQ : In documenting the treatment of a patient , the practitioner writes something in error . The proper way to correct this entry is to Withhold compression until vascular status can be better evaluated - ANSWERQ : A 62 year old male with a history of diabetes ( HGbA1C - 8.3 ) and hypertension presents to the clinic with a wound on his left posterior calf . The wound edges are unequal but well defined and drainage is moderate . The patient rates his pain as 7 out of 10 and that it is throbbing in nature . The initial assessment reveals a wound bed completely covered in thick yellow slough . Lower extremity ankle - brachial indices ( ABI ) are 1.5 on the left and 0.7 on the right . The left leg is swollen but there are no other signs of deep veinthrombosis . Following wound debridement , what type of compression would be most indicated for the left leg ? give no strong indication of degree of infection - ANSWERQ : Swab cultures of chronic wounds generally unreliable due to non - compressible calcified arteries - ANSWERQ : The ankle - brachial index in a patient with advanced diabetes is Granulation tissue is present - ANSWER: When changing a wound dressing over a full thickness wound , you notice the wound bed to be shiny , moist , and red and to have the cobblestone appearance noted in the photograph . The depth of the wound is unchanged . What terminology would you use to document this observation ? prognosis - ANSWERQ : A determination of expected outcome and time needed to reach that level would best be termed a ( n ) Normal - ANSWERQ : In performing a nutritional assessment , a patient is noted to have a body mass index of 23. This would be reported as Visual analog scale ( VAS ) - ANSWERQ : Which of the following pain scales asks respondents to specify their level of agreement to a statement by indicating a position along a continuous line between two end points ? 4 - ANSWERQ : According to the Wagner scale for diabetic foot ulcers , partial foot gangrene would be recorded as Venous filling time - ANSWERQ : In assessing the arterial system , the examiner first elevates the lower extremity to drain venous blood . The limb is then lowered and hung over the edge of the table while the examiner times how long it takes for the superficialveins on the dorsum of the foot to distend What clinical test is being performed ? At each visit - ANSWERQ : How frequently should pressure ulcer risk assessments be performed on patients receiving home health care ? hemosiderin staining - ANSWERThe brownish discoloration seen on the medial ankle area of this patient with venous insufficiency would most accurately be described as retrograde venous flow in the leg - ANSWERQ : The vascular assessment known as the Trendelenburg test is used to evaluate sensation - ANSWERQ : If you were to perform a Semmes Weinstein monofilament test on a patient , you would be trying to gather information about the status of the patient's Ankle - brachial index - ANSWERQ : Which of the following is a quick , non invasive test that compares blood pressure measured in the ankle and arm ? pain - ANSWERQ : The LEAST well documented component of a patient with a chronic wound is a stage I pressure ulcer - ANSWERQ : A patient presents with an area of non blanching erythema over the sacrum . This should be classified as Loss of hair over the digits - ANSWERQ : Which of the following findings would be most closely associated with a patient with a diagnosis of lower limb ischemia ? 1+ - ANSWERQ : If an examiner can barely palpate a faint pulse , it should be graded asmonitor change in pressure ulcer status over time - ANSWERQ : The PUSH tool was developed primarily to serous - ANSWERQ : Drainage from a patient's wound consists of clear , thin fluid . This should be described as Fourth - ANSWERQ : A patient presents with burns to the arm that have resulted in damage to the biceps muscle . This would most appropriately be classified as what burn degree ? undermining - ANSWER: In evaluating a wound , the examiner is able to slide a cotton - tipped applicator beneath the wound edge from the 1 to 5 o'clock position . This area should be documented as Yellow - Black - ANSWERQ : Utilizing the Red - Yellow - Black system of wound description , which of the following would best describe a wound covered with 50 % slough and 50 % dry , necrotic tissue ? Pain - ANSWERQ : Which of the following signs is termed the 5th vital sign since it should be assessed at each patient visit ? adds a visual confirmation to the written record - ANSWERQ : Utilizing digital photography in assessment of a pressure ulcer is a valuable tool as it During each nursing shift - ANSWERQ : How frequently should a pressure ulcer risk assessment be performed in the intensive care setting ? Lipedema - ANSWERQ : Which of the following clinical scenarios would be less likely to demonstrate pitting edema ?Volumetric assessment with instilled saline - ANSWERQ : Which of the following techniques would provide the most accurate assessment of the extent of a full thickness wound on the buttocks ? If a digital camera is used , the photograph should be deleted after transfer to storage media - ANSWERQ : In photographing a patient's wound , which of the following is an important consideration ? 10 gram - ANSWERQ : In performing a monofilament test on the plantar foot of a patient with suspected diabetic neuropathy , which monofilament is typically used ? Protein deficiency - ANSWERQ : Which of the following factors would be the main contributor to skin changes , fatigue and weight loss in a patient with a sacral pressure ulcer ? Maceration - ANSWERQ : A patient presents to the wound clinic with a lower extremity ulcer . The clinician removes a wet dressing and then cleanses the wound . White , pale discoloration is noted around the wound edges . This discoloration is most likely due to Wound location , severity and exacerbating factors - ANSWERQ : In performing a history and subjective exam on a patient with a wound , which of the following would provide the most useful information related to causation ? Use the uninvolved arm for measurement - ANSWERQ : Which of the following would be most appropriate when taking the blood pressure of a patient who has recently undergone a unilateral radical mastectomy non - verbal - ANSWERQ : It is most difficult to assess pain in patients who areInform the physician immediately - ANSWERQ : Which of the following is the appropriate action to take if a random glucose reading on a patient is extremely high ? Arterial pressure in the lower leg is divided by arterial pressure in the ipsilateral arm - ANSWERQ : Which of the following computations needs to be made indetermining an ankle brachial index ? Obtain a comprehensive history including appetite , diet , preferences and restrictions - ANSWERQ : Which of the following is the most important step in assessing the nutritional status of a patient ? Radial - ANSWERQ : When obtaining a pulse measurement in adults and children over 3 years of age , which of the following arteries is most commonly used ? Undermining should be documented using the clock system with head at 12:00 - ANSWERQ : Which of the following statements is correct regarding the measurement of wound undermining ? Assessment should include a description of pain , location , and intensity - ANSWERQ : Which of the following statements is most accurate regarding a comprehensive wound pain assessment based upon patient self - report ? Autolytic - ANSWERQ : Which of the following forms of debridement causes the least damage to viable tissue and is most specific Hydrofiber - ANSWERQ : Which of the following types of dressings would be most indicated for a wound exhibiting a large amount of exudation ? Metronidazole - ANSWERQ : Which of the following topical agents has been demonstrated to have good wound deodorization properties ?Pseudomonas aeruginosa - ANSWERQ : The photo below is of a patient who presents to the wound clinic complaining of an unpleasant , sweet odor coming from his wound . Upon dressing removal , a greenish drainage is noted . The wound care associate should readily recognize this as being caused by Lipids - ANSWERQ : The wound care associate reports to the primary care provider that healing has slowed substantially in an elderly wound care patient . Additionally , the skin on the extremity has become dry and scaly in appearance even though the patient appears well hydrated . The primary care provider would likely diagnose a deficiency in Using a narrower bandage - ANSWERQ : You are applying a compression bandage to a patient . If all other factors remain constant , which of the following would result in an increase in sub - bandage tension ? A dehisced abdominal wound in an obese but otherwise healthy individual - ANSWERQ : Which of the following would be most suited for treatment with negative pressure wound therapy ? Total contact walking cast - ANSWERQ : A patient presents with a plantar ulcer as demonstrated in the photograph below Which of the following offloading devices would the wound specialist likely prescribe to offload the ulcerated area ? Determine barriers to adherence and develop plan with patient input . - ANSWERQ : Which of the following is most important in dealing effectively with a nonadherent patient ? Peroneal - ANSWERQ : A wheelchair restricted patient is positioned such that the lateral portion of his leg is pressing against the footrest support . If this is not corrected , what type of motor neuropathy could result ?Autolytic - ANSWERQ : Which of the following types of debridement is associated with the removal of necrotic tissue by means of moisture and endogenous enzymes ? ICD - 10 - ANSWERQ : Which of the following types of codes are used to describe the diagnosis of a patient to assure proper billing for reimbursement ? for the life of the affected individual - ANSWERQ : Compression therapy for patients with chronic venous insufficiency is indicated interrupting the normal inflammatory process - ANSWERQ : Steroids delay wound healing by poor wound hygiene - ANSWERQ : A family member is commenting about a slight odor from the patient's dressing . If infection has been ruled out , the most likely cause of the odor is Surgical - ANSWERQ : An 85 year old patient with Alzheimer's disease has an ulcer over her greater trochanter . The ulcer measures 6.8x7.6cm and is 100 % eschar covered . The patient is confused , restless , and easily agitated during your examination but otherwise has no significant medical problems . Which method of debridement would be most effective for this patient ? Delayed primary - ANSWERQ : One week following debridement , the surgeon decides to surgically close a post operative wound . This would be termed what type of closure ? Dressing selection - ANSWERQ : Local wound care for a patient with a venous insufficiency ulcer consists of once weekly application of moisturizing lotion to intact skin , an amorphous hydrogel , and gauze covered with a compression wrap . On the next clinic visit , you notice the edges of the wound are macerated causing the wound to increase in size . To what do you attribute this finding ?are associated with implanted electronic devices . - ANSWERQ : Contact kilohertz ultrasound is CONTRAINDICATED in wounds Calciphylaxis - ANSWERQ : A patient with end stage renal disease presents with a necrotic wound on the anterior leg . Several small , hard deposits are noted in the painful wound . Which of the following conditions is likely causing the complications noted ? II - ANSWERQ : What class of stocking is designed to provide pressure between 30 - 40 mmHg ? Hydrofiber - ANSWERQ : Which of the following dressing types would provide the most absorption for a highly exudating wound ? Non - removable padded walking cast - ANSWERQ : Which of the following offloading devices has been found to be equally effective to the total contact cast in healing plantar neuropathic ulcerations ? Surgical incision closed with sutures - ANSWERQ : Which of the following types of wound closures would be considered closure by primary intention ? Normal saline - ANSWERQ : Which of the following cleansing agents would be the LEAST cytotoxic to a healing wound ? center of the wound outward - ANSWERQ : When utilizing a saline filled syringe to irrigate a wound , irrigation should proceed from the odor and pain management - ANSWERQ : The most appropriate goal for a Hospice patient whose demise is imminent isShort stretch bandaging is indicated - ANSWERQ : A patient with venous insufficiency has an ankle - brachial index ( ABI of.85 . How would this affect your decision as to the role compression therapy may play in the patient's management ? Compression , elevation and ambulation - ANSWERQ : Which of the following would be the most effective management for a patient with leg swelling associated with venous insufficiency ? Dry gauze - ANSWERQ : Which of the following dressings is most indicated for treatment of a toe with dry gangrene ? Hydrogel - ANSWERQ : Which of the following dressings would be most helpful in adding moisture to a desiccated wound bed ? odor - ANSWERQ : Charcoal activated dressings are indicated primarily to control Hydrocolloid - ANSWERQ : Which of the following dressings is sometimes associated with a foul odor and the presence of a pus - like material at dressing removal ? allow for bacterial protection and wound inspection - ANSWERQ : Transparent film dressings would be most indicated to Semi - occlusive film - ANSWERQ : Which of the following dressings would provide protection but very little ability to handle wound exudate ? Prone - ANSWERQ : Which of the following positions would provide full pressure relief for a patient with sacral and trochanteric ulcers ?Encourage patient to weight shift several times per hour when seated - ANSWERQ : In developing a care plan for a patient at risk for development of ischial pressure ulcers , which of the following would be appropriate to include ? designed to clean inanimate objects - ANSWERQ : Disinfectants are wound secondary to pyoderma gangrenosum - ANSWERQ : Debridement would be CONTRAINDICATED for which of the following ? Pulsatile lavage with suction - ANSWERQ : Of the following wound management procedures , which would be considered a form of mechanical debridement ? Whirlpool - ANSWERQ : Which of the following would be considered as an inappropriate form of hydrotherapy for the treatment of a chronic venous insufficiency ulceration ? Hydrofiber - ANSWERQ : Which of the following dressings would be of greatest benefit in trying to manage a macerated wound ? Wound will be clinically free of signs and symptoms of infection in 2 weeks - ANSWERQ : Which of the following would be an appropriate goal for a plan of care on a patient with a chronic wound ? denuded - ANSWERQ : A nursing home patient presents to the wound center with a 3.0 x 5.0 cm superficial , red , weepy sacral ulceration . The patient is incontinent of urine . This patient's ulcerated area should be documented as Strike through the error with a single line , write correct information and initial - ANSWERQ : An error was been made during documentation in a patient's record . Whataction needs to be taken ? Elastic bandage - ANSWERQ : Which of the following compression devices applied to the lower extremity would provide a high resting pressure and a high working pressure ? contains a higher tensile strength - ANSWERQ : The white ( polyvinyl alcohol or PVA ) foam used with the original Vacuum Assisted Closure VAC® ) device differs from the black foam in that it The care giver should be alerted to the fact that with initial use of the device , the patient may experience an increased frequency of urination - ANSWERapplication Q : A care giver is being instructed in proper and use of a lower extremity compression wrap on a family member . Which of instructions would be appropriate ? the following Check facility policy before entering room - ANSWERQ : Which of the following should be performed first prior to taking care of a patient identified to be positive for MRSA ? Normal Saline - ANSWERQ : Considering safety and physiologic factor , which of the following would be the most commonly used wound irrigation solution for a small wound with a minimal amount of loosely attached yellow slough ? to remove spore forming pathogens - ANSWERQ : Both the World Health Organization and the Centers for Disease Control recommend washing hands with soap and water develop a baseline inventory system - ANSWERQ : In order to properly manage inventory and assure necessary items are available in the clinic when needed , the wound care associate should any procedure where there is a risk for exposure to body fluids - ANSWERQ : In which of the following situations would it be necessary to wear personal protective equipment (PPE ) ? saturate the dressing with saline if the dressing is adherent - ANSWERQ : In removing a dressing from a patient , the wound care associate should treat the entire patient - ANSWERQ : When treating a patient who has a chronic wound , practitioners most often forget Inspect your skin daily - ANSWERQ : Which of the following would be important to educate a patient about before discharging from the wound care clinic ? place the scissors in an instrument container filled with approved disinfectant - ANSWERQ : You are cleaning up after a wound care procedure and find a pair of bandage scissors on the instrument table . You should a review of the job description and performance expectations - ANSWERQ : Your facility has just hired a front desk receptionist to answer phones and schedule patient appointments . The main focus and top priority during orientation and training should be Alert your supervisor and / or the physician - ANSWERQ : What is the most appropriate step to take when you notice that a lab value is out of range ? Sterile Saline - ANSWERQ : After a biopsy is taken from a wound for tissue culture and sensitivity , in what medium should it be properly transported ? Gently express exudate then rotate swab in a one centimeter area of granulation tissue - ANSWERQ : Which of the following best describes the Levine Method for taking a culture ?achieves more intimate contact with the foot than fiberglass - ANSWERQ : In total contact casting of the lower extremity , plaster layers are applied to the foot and leg because plaster Cast removal should be done with the patient in a supine position - ANSWERQ : Which of the following states is most accurate regarding the removal of a total contact cast ? Patient should be told to wear the footwear for two hours on and two hours off - ANSWERQ : Patient education on offloading / pressure relief should include which of the following ? Cultural and religious practices - ANSWERQ : When performing patient education , which of the following would be appropriate factors to consider ? Answering basic questions about diagnostic tests ordered by the physician - ANSWERQ : Patient education on diagnostic testing should include which of the following ? Consent should be obtained prior to photography of wounds - ANSWERQ : Which of the following statements is correct regarding documentation of patient information ? Avoid any bending or twisting motions while lifting - ANSWERQ : When performing a transfer on a patient , which of the following is a key principle that should be considered ? A new field needs to be created with new sterile instruments - ANSWERQ : You are assisting in preparing a sterile field for a wound procedure . All of the instruments are in place and while placing a sterile cup of saline onto the field , there is a slight spill which soaked through the sterile liner and onto the instrument table . What action should be taken ? Flex hips and knees with uppermost leg slightly forward and lying on a pillow -ANSWERQ : A patient needs to be positioned in sidelying so that a trochanteric ulcer can be treated . Which of the following techniques should be used ? Warm irrigation solution if possible - ANSWERQ : When preparing a patient for debridement , which of the following should be considered ? debridement of the wound with edge approximation only while antibiotics are instituted - ANSWERQ : A 29 year old previously healthy man presents to the emergency department with a 3 hour old irregular laceration on the leg which he suffered in a fall . There is significant contamination . The most appropriate care for this individual would be The presence of granulation and contraction is indicative of a good time to apply skin substitute - ANSWERQ : You are assisting in the application of a skin substitute . Which of the following is a good rule of thumb that the physician might explain prior to performing the procedure ? administration of sedation for patient comfort - ANSWERQ : Proper assistance with excisional debridement of the wound includes all of the following EXCEPT : Engage family members in educational activities to reinforce understanding and adherence - ANSWERQ : During the process of educating patients about a newly prescribed medication , which of the following practices is acceptable ? Developing algorithms for care helps to assure consistency in management - ANSWERQ : Which of the following is important in the standardization of protocols and procedures in a wound care setting ? A sign in sheet with patient's first and last name is provided at the front desk - ANSWERQ : Which of the following would be a violation of the Health Insurance Portability and Accountability Act ( HIPAA ) ?It is of significant importance that the physician be notified when a patient appears depressed - ANSWERQ : Which of the following statements is most accurate regarding ethical treatment of patients by a wound care associate ? Maggot debridement - ANSWERQ : The physician indicates to you that a patient you are seeing had recently been treated with biosurgical debridement . Which of the following would fall under this category ? Charcot fracture - ANSWERQ : A young , athletic male patient who has been followed recently for a diabetic foot ulcer presents to the clinic with a hot , swollen foot after a weekend of playing basketball . He does not recall any injury . The temperature of the involved foot is demonstrably elevated over the uninvolved . The erythema and swelling are localized primarily to the mid - foot area and there are no areas of epidermal breach noted . Pulses are bounding in character , but both feet are insensate . When the leg is elevated , the erythema lessens but returns as soon as the leg is returned to a dependent position . What is the most likely cause of this patient's presentation ? Venous insufficiency - ANSWERQ : A 68 y.o. female presents with a four - month history of a poorly healing ulcer just proximal to the right medial malleolus . The wound measures 4 cm by 2 cm , is shallow and has a good granulation base spotted intermittently with yellow fibrinous tissue . The patient reports that the drainage is moderate and actually soaks through the gauze wrap by the end of the day . Pedal pulses are present bilaterally and Semmes Weinstein monofilament testing is negative . What is the most likely etiology of this ulceration ? Ischemia - ANSWERQ : Just knowing the following information about a patient would lead one to suspect which of the following etiologies Middle aged Male Smoker Ulceration over lateral three toes Pain made worse by elevation of the extremity Faint pedal pulses Negative Stemmer's sign Shear - ANSWERQ : Which of the following causative factors in pressure ulcer development is most likely to result in undermining and tunneling ?Makeup of the interstitial fluid - ANSWERQ : Which of the following factors best differentiates lymphedema from other types of edema ? Fasciotomy for compartment syndrome - ANSWERQ : A patient ended up with the below pictured surgical wound after experiencing trauma to the leg from falling debris . Prior to the surgery , the leg was swollen , extremely painful and pulses were absent in the foot . What is the most likely etiology of the wound ? dehiscence - ANSWERQ : The wound pictured below is from a patient whose closed surgical site spontaneously reopened . This represents Biopsy the wound - ANSWERQ : The below pictured wound is from the forearm of a 68 year old gentleman who had sustained a 3rd degree burn 5 years ago . The area originally healed but then ulcerated and he has been dealing with varying stages of a chronic wound since then . What would the wound care associate suspect that the physician might do with this patient's wound ? Candidiasis - ANSWERQ : An elderly lady who has been treated with several antibiotics for local wound infections , complains of a discomfort and rash under her breasts as pictured . What is the most likely cause of this finding ? Erysipelas - ANSWERQ : Which of the following is a bacterial infection in the upper layer of the skin that frequently occurs in the legs and face ? Chemical burn - ANSWERQ : A 40 y.o. male presents to a wound care center with red , weeping lesions on both feet that begin at the lower third of the leg and extend to the toes . The patient's work history reveals that he spends long periods standing as he hoses down appliances with a bleach solution . The most likely etiology of his wounds isCalf pump dysfunction - ANSWERQ : Which of the following is believed to be the primary cause of venous ulceration in ambulatory individuals ? Venous Insufficiency - ANSWERQ : A patient presents with a 5 x 2 x 0.4 cm wound on the left lower extremity . The lower limb is edematous and the skin in the malleolar area has a reddish brown discoloration The foot is warm to the touch with palpable pulses . Hair is present on the leg and toes . The patient rates his pain as 6/10 when he is standing or sitting . The wound drains to the point that the inside of the patient's shoe get wet . An ankle - brachial index of 0.8 is noted What is the most likely wound etiology ? Heel - ANSWERQ : Which of the following anatomical sites is of greatest risk for the development of a deep tissue injury due to its relatively thin soft tissue covering and small radius of curvature ? interfering with oxygen diffusion - ANSWERQ : The primary means by which edema interferes with wound healing is by Ischemia - ANSWERQ : A patient presents with the ulcer as noted in the picture . He complains of significant pain at rest and the 4th digit has become gangrenous over the past several weeks . The patient's ankle brachial index is 0.55 and his hemoglobin a1c is 5.9 % . There is also a negative Stemmer's sign . Which of the following is the most likely cause of the ulceration ? shear - ANSWERQ : The condition indicated by the cotton tipped applicators in this photograph is primarily secondary to epibole - ANSWERQ : The rolled edge marked by the arrow in this picture is a wound complication known Escalating pain - ANSWERQ : A patient presents to the emergency department following a crush injury to the leg . In taking the patient's history and performing the physicalexamination , which of the following findings would most likely be acutely present if the patient were beginning to experience a compartment syndrome ? Venous Insufficiency - ANSWERQ : A patient presents with the ulcer pictured . He complains of pain when standing that is relieved somewhat by ambulation . His ankle brachial index is 0.95 and his hemoglobin a1c is 5.8 % . Based on this information alone , what would be the most likely diagnosis ? Melanoma - ANSWERQ : Which of the following is a cancer that originates in the pigment producing cells of the epidermis ? using nicotine - ANSWERQ : Patients with ischemia of the lower extremity will greatly complicate healing by Motor neuropathy - ANSWERQ : Claw toe deformity is most closely related to which of the following ? Phantom sensation - ANSWERQ : A patient is several weeks post - op from a below knee amputation . Which of the following is a common finding associated with this condition ? gastric fistula - ANSWERQ : An abnormal connection between the stomach and the skin surface would most appropriately be termed a ( n ) wound bed desiccation - ANSWERQ : Patients with venous insufficiency ulcers generally experience all of the following EXCEPT Rest pain - ANSWERQ : Which of the following signs or symptoms would be most associated with a patient experiencing worsening ischemia in the leg ?diabetes - ANSWERQ : One of the major causes of lower - extremity amputation is cellulitis - ANSWERQ : While examining a patient's lower extremities , you note that one leg is swollen , erythematous and warm to the touch . The patient is also febrile . The most likely cause of these findings is A large quantity of gel was applied to the wound during the dressing change - ANSWERQ : Which of the following scenarios would be most likely to cause dermatitis denudement and maceration ? The dressing being unable to handle the exudate - ANSWERQ : If a wound is described as having maceration in the periwound area , which of the following is the most likely cause ? atrophy of rete pegs - ANSWERQ : Skin tears in the elderly are due primarily to