WOUND CERTIFICATION EXAM BY WOCNCB NEW
LATEST VERSION WITH ALL 120 QUESTIONS,
CORRECT ANSWERS AND RATIONALE
what are the goals in treating LEAD? - CORRECT ANSWERS-maximizing perfusion, minimizing
risk of infection, using evidence-based wound care, and ongoing assessment and managment of
ischemic pain
What is the gold standard for revascularization of sapenous veins? - CORRECT ANSWERS-
bypass graft
what are the 6 P's in assessing for acute limb ischemia? - CORRECT ANSWERS-pulse, pallor,
polar (cool), pain, paresthesia(burning and tingling sensation), and paralysis
What is the general appearance of LEAD? - CORRECT ANSWERS-thin, shiny epidermis, loss of
hair growth, thickened nails, edema is variable depending on positioning and coexisting disease; pale or
ischemic (purpura and petechiae secondary to blood thinners)
What vacular symptoms or perfusion status will you see in LEAD during assessment? - CORRECT
ANSWERS-diminished ABI and TBI; dimished or absent pulse; delayed capillary refill time; abnormal
turbulence of blood flow (aka bruit), depedent rubor or elevational pallor, cool skin
how does friction play a role in shearing which eventually leads to pressure ulcer? - CORRECT
ANSWERS-friction alone causes only superfical abrasion, but with gravity it plays a synergistic effect
leading to shearing. When gravity pushes down on the body and resistance (friction) between the
patient and surface is exerted, shearing occurs. because skin does not freely move, primary effect of
shearing occurs at the deeper fascial level.
what are the intrisinc factors of pressur ulcers? - CORRECT ANSWERS-nutritional debilitation,
advanced age, low BP, stress, smoking, elevated body temperature
Aging skin undergoes what elements affecting risk for pressure ulcer? - CORRECT ANSWERS-
dermoepidermal junction flattens, less nutrient exchange occurs, less resistance to shearing, changes in
,sensory perception, loss of dermal thickness, increased vascular fragility; ability of soft tisuse to
distribute mechanical load w/out comprosing blood flow is impaired
What does nonblanching erythema indicate in the skin r/t PU? - CORRECT ANSWERS-when
pressure is applied to the erythematic area skin becomes white (blanched), but once relieved, erythema
returns -indicating blood flow; however in nonblanching erythema, skin does not blanche-indicating
impaired blood flow-suggesting tissue destructon
why does sitting in a chair pose more of a risk in skin break down than lying? - CORRECT
ANSWERS-deep tissue injury or PU is likely to occur sooner sitting down because tissue offloading
over boney prominences is higher
Describe what you will see in deep tissue injury? - CORRECT ANSWERS-purple or maroon
localized area of discolored intact skin skinor blood filled blister; may be preceded by painful, firm,
mushy, or boggy; skin may be warmer to cooler in adjacent tissue. In dark skin, thin blister or eschar over
a dark wound bed may bee seen
Describe stage I pressure ulcer? - CORRECT ANSWERS-Intact skin with nonblanchable redness
of localized area. Will not see blanching in dark skin, but changes in skin tissue consistency (firm vs boggy
when palpated), sensation (pain), and warmer or cooler temperature may differ from surrounding area
Describe stage II pressure ulcer? - CORRECT ANSWERS-partial-thickness wound where
epidermis and tip of dermis is lost with red-pink wound bed w/out slough. may also present as intact or
open/ruptured serum -filled blister
Describe stage III pressure ulcer? - CORRECT ANSWERS-full-thickness wound where both
epidermis and dermis is lost and subcutaneous tissue may be visible, but deeper structures such as
muscle, bone, and tendon are not exposed; slough my be present but it doesn't obscure depth and
tunneling and undermining may be present
Describe stage IV pressure ulcer? - CORRECT ANSWERS-full-thickness wound with exposed
bone,tendon, and muscle; slough or eschar may be seen in some parts of the wound bed. you will often
see tunneling and undermining. Osteomyelitis may be dxed at this stage, since bone is palpable
, Describe unstageble ulcers? - CORRECT ANSWERS-full-thickness wound where base of the
ulcer is covered by slough and/or eschar, obscuring depth
When should eschars not be removed? - CORRECT ANSWERS-when it's stable with dry,
adherent, and intact w/out erythema on the heel; this serves as the body's natural cover and should not
be removed.
Therapeutic function of pressure distribution is accomplised by what 2 factors? - CORRECT
ANSWERS-immersion and envelopement
Define immersion? - CORRECT ANSWERS-depth of penetration or skining into surgace
allowing pressure to be spread out over surrounding area rather than directly over boney prominence
Define envelopement? - CORRECT ANSWERS-is the ability of support surface to conform to
irregularities without causing substantial increase in pressure
what is bottoming out? - CORRECT ANSWERS-this occurs when depth of penetration or
sinking is excessive, allowing increased pressure to concentrate over boney prominences
what factors contribute to bottoming out? - CORRECT ANSWERS-weight, disproportion of
weight and size such as amputation, tendency to keep HOB >30 degrees, inappropriate support surface
settings
When should you consider reactive support surface with features and components such as low air loss,
alternating pressure, viscous or air fluids? - CORRECT ANSWERS-for patients who cannot
effectively position off their wound, have PUs in multiple turning surfaces, or have PUs that fail to
improve despite optimal comprehensive management
When should active support surface be considered? - CORRECT ANSWERS-when effective
positioning is determined by an MD to be medically contraindicated
What is the difference between an active and reactive support surfaces/ - CORRECT
ANSWERS-active support surface is a powered mattress or overlay that changes it's load-
distribution with or without applied load; pressure is redistributed across the body by inflating and
LATEST VERSION WITH ALL 120 QUESTIONS,
CORRECT ANSWERS AND RATIONALE
what are the goals in treating LEAD? - CORRECT ANSWERS-maximizing perfusion, minimizing
risk of infection, using evidence-based wound care, and ongoing assessment and managment of
ischemic pain
What is the gold standard for revascularization of sapenous veins? - CORRECT ANSWERS-
bypass graft
what are the 6 P's in assessing for acute limb ischemia? - CORRECT ANSWERS-pulse, pallor,
polar (cool), pain, paresthesia(burning and tingling sensation), and paralysis
What is the general appearance of LEAD? - CORRECT ANSWERS-thin, shiny epidermis, loss of
hair growth, thickened nails, edema is variable depending on positioning and coexisting disease; pale or
ischemic (purpura and petechiae secondary to blood thinners)
What vacular symptoms or perfusion status will you see in LEAD during assessment? - CORRECT
ANSWERS-diminished ABI and TBI; dimished or absent pulse; delayed capillary refill time; abnormal
turbulence of blood flow (aka bruit), depedent rubor or elevational pallor, cool skin
how does friction play a role in shearing which eventually leads to pressure ulcer? - CORRECT
ANSWERS-friction alone causes only superfical abrasion, but with gravity it plays a synergistic effect
leading to shearing. When gravity pushes down on the body and resistance (friction) between the
patient and surface is exerted, shearing occurs. because skin does not freely move, primary effect of
shearing occurs at the deeper fascial level.
what are the intrisinc factors of pressur ulcers? - CORRECT ANSWERS-nutritional debilitation,
advanced age, low BP, stress, smoking, elevated body temperature
Aging skin undergoes what elements affecting risk for pressure ulcer? - CORRECT ANSWERS-
dermoepidermal junction flattens, less nutrient exchange occurs, less resistance to shearing, changes in
,sensory perception, loss of dermal thickness, increased vascular fragility; ability of soft tisuse to
distribute mechanical load w/out comprosing blood flow is impaired
What does nonblanching erythema indicate in the skin r/t PU? - CORRECT ANSWERS-when
pressure is applied to the erythematic area skin becomes white (blanched), but once relieved, erythema
returns -indicating blood flow; however in nonblanching erythema, skin does not blanche-indicating
impaired blood flow-suggesting tissue destructon
why does sitting in a chair pose more of a risk in skin break down than lying? - CORRECT
ANSWERS-deep tissue injury or PU is likely to occur sooner sitting down because tissue offloading
over boney prominences is higher
Describe what you will see in deep tissue injury? - CORRECT ANSWERS-purple or maroon
localized area of discolored intact skin skinor blood filled blister; may be preceded by painful, firm,
mushy, or boggy; skin may be warmer to cooler in adjacent tissue. In dark skin, thin blister or eschar over
a dark wound bed may bee seen
Describe stage I pressure ulcer? - CORRECT ANSWERS-Intact skin with nonblanchable redness
of localized area. Will not see blanching in dark skin, but changes in skin tissue consistency (firm vs boggy
when palpated), sensation (pain), and warmer or cooler temperature may differ from surrounding area
Describe stage II pressure ulcer? - CORRECT ANSWERS-partial-thickness wound where
epidermis and tip of dermis is lost with red-pink wound bed w/out slough. may also present as intact or
open/ruptured serum -filled blister
Describe stage III pressure ulcer? - CORRECT ANSWERS-full-thickness wound where both
epidermis and dermis is lost and subcutaneous tissue may be visible, but deeper structures such as
muscle, bone, and tendon are not exposed; slough my be present but it doesn't obscure depth and
tunneling and undermining may be present
Describe stage IV pressure ulcer? - CORRECT ANSWERS-full-thickness wound with exposed
bone,tendon, and muscle; slough or eschar may be seen in some parts of the wound bed. you will often
see tunneling and undermining. Osteomyelitis may be dxed at this stage, since bone is palpable
, Describe unstageble ulcers? - CORRECT ANSWERS-full-thickness wound where base of the
ulcer is covered by slough and/or eschar, obscuring depth
When should eschars not be removed? - CORRECT ANSWERS-when it's stable with dry,
adherent, and intact w/out erythema on the heel; this serves as the body's natural cover and should not
be removed.
Therapeutic function of pressure distribution is accomplised by what 2 factors? - CORRECT
ANSWERS-immersion and envelopement
Define immersion? - CORRECT ANSWERS-depth of penetration or skining into surgace
allowing pressure to be spread out over surrounding area rather than directly over boney prominence
Define envelopement? - CORRECT ANSWERS-is the ability of support surface to conform to
irregularities without causing substantial increase in pressure
what is bottoming out? - CORRECT ANSWERS-this occurs when depth of penetration or
sinking is excessive, allowing increased pressure to concentrate over boney prominences
what factors contribute to bottoming out? - CORRECT ANSWERS-weight, disproportion of
weight and size such as amputation, tendency to keep HOB >30 degrees, inappropriate support surface
settings
When should you consider reactive support surface with features and components such as low air loss,
alternating pressure, viscous or air fluids? - CORRECT ANSWERS-for patients who cannot
effectively position off their wound, have PUs in multiple turning surfaces, or have PUs that fail to
improve despite optimal comprehensive management
When should active support surface be considered? - CORRECT ANSWERS-when effective
positioning is determined by an MD to be medically contraindicated
What is the difference between an active and reactive support surfaces/ - CORRECT
ANSWERS-active support surface is a powered mattress or overlay that changes it's load-
distribution with or without applied load; pressure is redistributed across the body by inflating and
